Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2007.

With increasing rates of obesity, research has begun to focus of co-morbidities of obesity such as osteoarthritis. The majority of existing research has focused on older adults as the group most likely to suffer from osteoarthritis. The purpose of this study was to determine if overweight and obese young adults exhibit biomechanical risk factors for knee osteoarthritis, and to determine if young adults with biomechanical risk factors of osteoarthritis can modify these with instruction. This purpose was divided into two separate studies. Study 1: Thirty adults between 18-35 years old were recruited into three groups according to body mass index: normal, overweight, and obese. Participants walked through the lab while we collected 3-d kinematic and kinetic data. Overweight and obese young adults walked with similar gait compared to normal weight young adults. Study 2: Nine young adults between 18-35 years were recruited who walked with stiff-knee gait. Baseline measures of gait were collected in the form of 3-d kinematics and kinetics as participants walked through the laboratory. They then completed the gait instruction program which consisted of four blocks of training. Each block included ten single steps where the participant was provided feedback, followed by 100 practice steps around the laboratory. Participants were successful in increasing sagittal plane kinematics and kinetics of interest in the study. Conclusion: Identifying individuals who had biomechanical risk factors of osteoarthritis according to body mass index was not possible. According to the results of our study, obese and overweight young adults are not at increased risk of osteoarthritis compared to normal weight young adults. Individuals who may be at increased risk due to stiff-knee gait were able to improve their gait following instruction.

De flesta människor som är självdestruktiva i vårt samhälle får en diagnos ställd som understryker att de på ett eller annat vis är psykiskt sjuka, den vanligaste diagnosen är Borderline Personlighetsstörning. I denna studie ifrågasätts detta psykopatologiska perspektiv och istället ämnar jag undersöka om det går att bredda begreppet självdestruktivitet genom att använda ett existentiellt perspektiv. I grunden för studien återfinns teorier från Kierkegaard, May och Fromm vilka berör begrepp som ångest och frihet, två nyckelbegrepp i denna studie. Materialet är insamlat via intervjuer. Genom att använda hermeneutik som analysmetod har uppsatsförfattaren haft möjlighet att använda sin förförståelse i ämnet och via den hermeneutiska cirkeln tolkas materialet. Resultatet speglar de självdestruktivas inre upplevelser av kampen mot ångesten. De söker en identitet men låg självkänsla och tron att de behöver de destruktiva handlingarna för att överleva slår ständigt undan benen för dem. Att ha utgångspunkten i existentialism bidrar till att människan och hennes existentiella frågor får stå i fokus. Genom att ha tilltro till människors egen förmåga att ta sig ur sin problematik skapas en alternativ behandling. Istället för att, som i det psykopatologiska perspektivet, ställa en determinerande diagnos på människan kan man i det existentiella perspektivet lägga mer ansvar på människan och utveckla henne genom att våga se det friska och sunda.

Denna uppsats undersöker förhållandet mellan etnisk identitet och egoidentitet hos vuxna individer. Då Sverige är mångkulturellt är detta förhållande ett viktigt forskningsområde att belysa. En kvalitativ undersökning genomfördes med nio intervjupersoner. Dessa lever i den svenska kulturen samt i en utomeuropeisk kultur. Resultatet visade att kulturen upplevdes vara en mycket viktig del av personligheten på så sätt att den etniska identiteten är en sammansvetsad del av intervjupersonernas egoidentitet. Intervjudeltagarna upplevde sig vara en blandning av de erfarna kulturerna. Majoriteten intervjudeltagare hade en fullbordad identitet, men perioder av förvirring och dilemman förekom som ett resultat av deras bikulturella livssituation. Anpassningsproblem och olika begränsningar var bidragande orsaker till dessa perioder. Studien bidrar till fördjupad kunskap om dubbeletniska vuxnas identitets- och personlighetsutveckling. / This essay examines the relationship between ethnic identity and ego identity among adults. Sweden is a multi cultural country and therefore this relationship is important to examine. A qualitative interview study was conducted with nine interviewees, who live in Sweden and originate from a culture outside Europe. The culture was shown to be an important part of the personality, which indicates that that ethnic identity is a part of ego identity. The interviewees experienced themself to be a mix of two cultures. A majority of the interviewees had an achieved identity, but periods of diffusion occured as a result of adaption problems and limitations. The study contributes with advanced knowledge about identity and personality development of adults.

It is well established that there are many intrinsic and extrinsic risk factors associated with falls in older adults. Less well-known is what risk factors predict falls in more vulnerable populations, such as those with neurological conditions living in long-term care homes or receiving home care services. Furthermore, evidence comparing those with neurological conditions to those without is lacking in the literature. The primary purpose of this thesis was to determine risk factors for falls in long-term care residents and home care clients with no recent history of falls to determine if risk factors differed between individuals with dementia or Parkinson’s disease and those without any neurological conditions. Secondary data analysis was performed on a database of standardized health assessments completed for long-stay home care clients and long-term care residents in Ontario. Within each major diagnostic group, observations were stratified based on ambulatory status (ambulatory vs. non-ambulatory). Bivariate analyses followed by generalized estimating equations were used to determine statistically significant predictors of falls in each group within each care setting. The results of multivariable analyses showed that there is not a distinct set of risk factors associated with falls in home care clients and long-term care residents with dementia or Parkinson’s disease that is systematically different from risk factors associated with falls in clients and residents not diagnosed with any of the neurological conditions in this study. These results suggest that a common set of risk factors may effectively predict falls in all clients and residents with no recent falls history, regardless of certain neurological diagnoses.

With the growing number of older adults in the general population, there is also a concomitant rise in the number of older adults who require mental health services, making the measurement of psychological conditions in later life a priority. However, due to a lack of measures created for older adults, researchers and clinicians must often rely on measures created for younger populations. Three studies were designed to add to the field of evidence-based assessment and determine which anxiety measures possess strong evidence when used with older adults to warrant their use with this specific population. In the first study, I systematically reviewed the literature to identify the anxiety measures most commonly used with older adults. I reviewed each measure to examine its psychometric properties (e.g., internal consistency, test-retest reliability, inter-rater reliability, concurrent and discriminant validity) and the availability of age-appropriate norms in order to evaluate whether the instruments are appropriate for use with older adults. In the second study, I conducted a reliability generalization meta-analysis to estimate the mean reliability of each commonly used anxiety measure identified in the first study. Finally, in the third study, I examined whether the anxiety measures commonly used with an older population can be consistently and accurately categorized as evidence-based. The literature review and the reliability generalization study both revealed that most of the most commonly used measures lacked sufficient evidence to warrant their use with older adults. However, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults. This suggests that based on their overall level of reliability and previous psychometric evidence, both researchers and clinicians assessing anxiety in a geriatric population should consider these measures as likely to be the best currently available.

Background: Anxiety is a barrier to dental care for many people. Preliminary studies suggest that melatonin may possess anxiolytic and sedative properties. Methods: Twelve subjects were selected for this study which compared melatonin, at a dose of 0.14 mg/kg, with placebo, as an oral premedication for anxious dental patients prior to receiving a general anesthetic. A visual analog scale (VAS) was used to measure anxiety. The Richmond Agitation Sedation Scale (RASS) was used to assess sedation, the Trieger Dot Test (TDT) for psychomotor impairment, and Digit Symbol Substitution Test (DSST) for cognitive impairment. A Quality of Recovery Questionnaire (QoR) was completed 24 hours after each appointment. Results: There were no significant differences in VAS scores for melatonin and placebo between baseline and at 30, 60, and 90 minutes. Similar results were found for RASS scores, TDT, DSST, and the QoR. Conclusion: At the doses used in this study, melatonin was not significantly different from placebo in anxiolysis, sedation, cognitive impairment, psychomotor impairment, and quality of recovery from anesthesia, for anxious dental patients.

Background: Anxiety is a barrier to dental care for many people. Preliminary studies suggest that melatonin may possess anxiolytic and sedative properties. Methods: Twelve subjects were selected for this study which compared melatonin, at a dose of 0.14 mg/kg, with placebo, as an oral premedication for anxious dental patients prior to receiving a general anesthetic. A visual analog scale (VAS) was used to measure anxiety. The Richmond Agitation Sedation Scale (RASS) was used to assess sedation, the Trieger Dot Test (TDT) for psychomotor impairment, and Digit Symbol Substitution Test (DSST) for cognitive impairment. A Quality of Recovery Questionnaire (QoR) was completed 24 hours after each appointment. Results: There were no significant differences in VAS scores for melatonin and placebo between baseline and at 30, 60, and 90 minutes. Similar results were found for RASS scores, TDT, DSST, and the QoR. Conclusion: At the doses used in this study, melatonin was not significantly different from placebo in anxiolysis, sedation, cognitive impairment, psychomotor impairment, and quality of recovery from anesthesia, for anxious dental patients.

Overweight and obesity in Canada has significantly increased during the last three decades, paralleled by increased intake of fat and sugar particularly sugary beverages leading to higher level of energy intake, as well as reduction in physical activity. Canadian Community Health Survey, Cycle 2.2, 2004 (CCHS 2.2), provides the opportunity to evaluate beverage intakes of Canadians in relation to overweight and obesity using Body Mass Index (BMI).<p> To examine the association between sugar-sweetened beverages and BMI in Canadian adults, we used data from CCHS 2.2 (n=14,304, aged >18 year and <65 year) in which dietary intake was assessed using 24-h recall. In various steps, data on beverage consumption were identified, coded and classified. Using descriptive statistics, we determined total gram intake and the contribution of each beverage to total energy intake among age/sex groups. To determine the most suitable patterns of beverage consumptions among Canadian adults, a cluster analysis K-means method was applied. Males and females were classified into distinct clusters based on the dominant pattern of beverage intakes. Finally, step-wise logistic regression models were used to determine associations between sugar-sweetened beverages and BMI, controlling for age, marital status, income, education, physical activity, total energy intake, immigration status, smoking habits and ethnicity. To account for complex survey design, all data were weighted and bootstrapped.<p> BMI in women with predominant fruit drink pattern (791.1±32.9 g) was significantly higher than those with no dominant pattern in beverage consumption (28.3±1 vs. 26.8±0.3 respectively, P<0.001). In women, high intake of fruit drinks was a significant predictor of overweight (OR=1.84, 95% C.I:1.06-3.20), obesity (OR=2.55, 95% C.I:1.46-4.47) and overweight/obesity (OR=2.05, 95% C.I:1.29-3.25). In men, mean BMI was not different among beverage consumption clusters and none of the beverages was a predictor for overweight and obesity. For the first time, in a nationally representative data, we report association of sugar-sweetened beverages and overweight and obesity in Canadian women.

Although serious illness is often associated with aging in contemporary society, increasing numbers of young adults are being diagnosed with a variety of serious illnesses. In order to learn more about what it is like to be seriously ill during young adulthood, I completed a qualitative study with ten young women who had recently been affected by a life-threatening or chronic illness. The research was informed by a theoretical approach based on social constructionist and phenomenological principles that recognize that physiological processes such as illness are socially mediated and given meaning within a certain socio-cultural context. Thus,the life course and its corresponding stages are not universal or biologically determined, but rather are social constructions based on socio-cultural factors and the meanings given to certain biological events. This research involved participants between the ages of 20 and 37 from around Saskatchewan who had been affected by a serious illness within the previous three years. The methodological approach that I utilized was interpretive and drew upon phenomenological, feminist, and participatory visual approaches to qualitative research. The young women participated in phenomenological interviews and a photovoice project that explored their lived experiences of serious illness and the specific issues that they faced because of illness. I analyzed the data thematically, incorporating phenomenological concepts of embodiment, temporality, and relationality. Although the interview and photographic data highlighted a range of experiences, the data highlighted several similarities among participants. Foremost, the data revealed that serious illness was highly disruptive for the young women; specifically, participants were required to negotiate disruptions to their sense of embodiment, everyday lives, expectations for the future, and social relationships. Ultimately, serious illness brought about embodied and social experiences that conflicted with how participants had previously envisioned young adulthood and their life course. As such, their experiences of illness had profound implications for their self identity and brought about a complex process of trying to make sense of illness. Based on these findings, I conclude that the young women experienced and made sense of illness within the context of socio-cultural expectations related to age and the life course, as well as gender. I also identify the implications of this research for health care and support services aimed at this population.