Moçambique é um pais que vem passando por profundas mudanças políticas e sociais nos últimos 50 anos. Dentro deste contexto, em 1996, uma Unidade de Dor foi criada no Hospital Central de Maputo. O objetivo do presente estudo foi descrever e analisar os aspectos epidemiológicos, clínicos e emocionais de pacientes com dor crónica atendidos na Unidade de Dor. Um total de 118 pacientes foram entrevistados por um período de 2 meses. Destes, 79 (66,9%) eram mulheres e 39 (33,1%) eram homens. A média de idade foi de 52,4 anos, com um desvio padrão de 13,7. Cento e sete (90,7%) eram negros. Quarenta pacientes (33,9%) tiveram o diagnóstico da dor neuropática, 40 (33,9%) apresentaram dor osteomuscular, 8 (6,8%) tiveram dor relacionada com a SIDA, 17 (14,4%) tiveram dor oncológica. A média da escala numérica de dor foi 8,37 e a media de duração da dor crónica foi 41,75 meses. Entre os medicamentos abortivos para a dor, o paracetamol foi o mais utilizado e amitriptilina profilático foi o mais amplamente utilizado. Independentemente do seu tratamento na unidade de dor, cinquenta e oito pacientes (49,2%) também receberam algum tratamento de curandeiros locais. Quanto aos aspectos emocionais, foram encontrados 39 (33,1%) pacientes que preenchiam os critérios do DSM-IV de transtorno depressivo maior. Estes resultados são discutidos com base nos aspectos culturais envolvidos / Mozambique is a country that has been experiencing profound political and social changes over the last 50 years. Within this context, in 1996 a Pain Unit was set up in the Central Hospital of Maputo. The objective of the present study was to describe and analyze the epidemiological, clinical and emotional aspects of patients with chronic pain attended at the Pain Unit. A total of 118 patients were interviewed over a period of 2 months. Of these, 79 (66.9%) were women and 39 (33.1%) were men. Mean patient age was 52.4 years, with a standard deviation of 13.7. Hundred seven (90.7%) were black. Forty patients (33.9%) had a diagnosis of neuropathic pain, 40 (33,9%) had ostheomuscular pain, 8 (6.8%) had pain related to AIDS, 17 (14.4%) had oncologic pain. Mean of visual analogic scale for pain was 8,37 and chronic pain duration was 41.75 months . Between the abortive medications for pain, paracetamol was the most used and prophylactic amitriptyline was the most widely used. Regardless of their treatment at the Pain Unit, fifty eight patients (49.2%) also received some treatment from local healers. When emotional aspects were considered, 39 (33.1%) patients were found to have depressive symptoms that fulfilled DSM IV criteria of depressive disorder. These results are discussed based on the cultural aspects involved

O objetivo geral deste estudo foi monitorar a atividade da doença periodontal e sugerir potenciais biomarcadores salivares relacionados a esta atividade em pacientes com periodontite crônica associada ou não Diabetes mellitus tipo 2, a partir da avaliação do perfil da expressão gênica de sítios periodontais progressivos e de proteínas inflamatórias salivares. Foram incluídos 56 pacientes, sendo 21 com periodontite crônica (DP), 20 com periodontite crônica associada ao Diabetes mellitus tipo 2 (DP+DM) e 15 periodontal e sistemicamente saudáveis (controle). Foi realizado exame radiográfico antes e dois meses após a terapia periodontal básica, e posteriormente foi feita a subtração radiográfica a partir dos pares das radiografias. As medidas das áreas com perda de densidade foram registradas. Coleta de saliva não estimulada, verificação da hemoglobina glicada (HbA1c) e exame clínico periodontal profundidade de sondagem (PS), nível clínico de inserção relativo (NCIR), sangramento à sondagem (SS) e índice de placa (IP) também foram realizados antes e dois meses após a terapia periodontal básica. Os sítios periodontais com perda de inserção progressiva 1 mm na reavaliação foram considerados ativos de acordo com uma adaptação do método de tolerância. Biópsias de tecido gengival de sítios ativos e inativos com parâmetros clínicos semelhantes foram analisadas com real time PCR Array para análise do perfil de expressão gênica da resposta imune-inflamatória. As amostras de saliva foram submetidas ao imunoensaio Multiplex Cytokine Profiling para análise de expressão de proteínas. No grupo DP, 9% dos sítios foram classificados como ativos e no grupo DP+DM, 12% (p > 0,05). A média de perda de inserção clínica foi maior no grupo DP+DM (1,34 mm) em relação ao grupo DP (1,21 mm) (p < 0,05). Houve correlação entre a perda de inserção clínica e a área da perda de densidade radiográfica tanto nos sítios ativos do grupo DP (R = 0,79; p = 0,001), quanto do grupo DP+DM (R = 0,86; p < 0,001). Ambos os grupos DP e DP+DM apresentaram um perfil down-regulated em relação aos pacientes saudáveis (grupo controle). Quando comparado o grupo DP+DM ao grupo DP, pacientes diabéticos apresentaram um perfil up-regulated. Sítios ativos do grupo DP mostraram nove genes (ABCF1, CD40LG, IL10, IL5, CCR2, CCR4, CCR7, CCL18 e CXCL1) diferencialmente expressos (p < 0,05) com um perfil up-regulated. Sítios ativos do grupo DP+DM mostraram seis genes (LTA, CXCR1, CCL19, CCL8, CCL17 e CXCL12) diferencialmente expressos (p < 0,05) com um perfil up-regulated. Após a terapia periodontal básica, houve uma significante redução de algumas proteínas salivares (IL1b, IL1ra, IL10, IL17, TGFb, IL8, eotaxin e MCP-3) nos grupos DP e DP+DM, mas sem diferença estatisticamente significante (p > 0,05). Concluindo, este estudo foi capaz de monitorar a atividade da doença periodontal em pacientes com e sem diabetes após a terapia periodontal básica; foi possível identificar genes diferencialmente expressos em sítios ativos de ambos os grupos, que podem ser úteis na indicação de potenciais biomarcadores para diagnóstico da doença periodontal na fase ativa; as proteínas salivares analisadas mostram uma tendência em diferenciar o padrão de saúde e de doença, podendo ser futuramente utilizadas como potenciais biomarcadores de periodontite associada ou não ao diabetes. / The overall aim of this study was to monitor the periodontal disease activity and suggest potential salivary biomarkers related to this activity in chronic periodontitis patients with or without type 2 Diabetes mellitus (DM), based on the evaluation of gene expression profile of progressive periodontal sites and salivary inflammatory proteins. Fifty-six patients were enrolled, 21 with chronic periodontitis (PD group), 20 with chronic periodontitis and DM (PD+DM group) and 15 periodontal- and systemically healthy (control). Radiographs were taken before and two months after non-surgical periodontal therapy, and radiographic subtraction was performed from pairs of these radiographs. Measurements of the areas with density loss were recorded. Unstimulated saliva collection, glycated hemoglobin (HbA1c) measurement and periodontal examination probing pocket depth (PPD), relative clinical attachment level (rCAL), bleeding on probing (BOP) and plaque index (PI) were also conducted before and two months after non-surgical periodontal therapy. The periodontal sites with progressive attachment loss 1 mm at the recall visit were considered active sites according to the adapted method of tolerance. Gingival biopsies of active and non-active sites with similar clinical parameters were harvested for gene expression analysis of the immune-inflammatory response with Real Time PCR Array. Saliva samples were analyzed by Multiplex Cytokine Profiling Immunoassay for analysis of protein expression profile. In PD group, 9% of the sites were classified as active and in PD+DM group, 12% (p > 0.05). The clinical attachment loss mean was higher in the PD+DM group (1.34±0.23 mm) compared to the PD group (1.21±0.16 mm) (p < 0.05). There was a correlation between clinical attachment loss and darkened radiographic areas in active sites of the PD group (R = 0.79, p = 0.001) and PD+DM group (R = 0.86, p < 0.001). Both PD and PD+DM groups showed a down-regulated profile compared to healthy subjects (control group). When compared PD group to PD+DM, patients with diabetes had an upregulated profile. Active sites of the PD group showed nine genes (ABCF1, CD40LG, IL10, IL5, CCR2, CCR4, CCR7, CCL18 and CXCL1) differentially expressed (p < 0.05) with an up-regulated profile. Active sites of the PD+DM group showed six genes (LTA, CXCR1, CCL19, CCL8, CCL17 and CXCL12) differentially expressed (p < 0.05) with an up-regulated profile. After non-surgical periodontal therapy, there was a significant reduction of clinical parameters and HbA1c levels (p < 0.05), accompanied by a reduction of some salivary proteins (IL1b, IL1ra, IL10, IL17, TGFb, IL8, eotaxin and MCP-3) in groups PD and PD+DM, but without statistically significant difference (p > 0.05). In conclusion, this study was able to monitor the periodontal disease activity in periodontal patients with or without diabetes after the non-surgical periodontal therapy; it was possible to identify genes differentially expressed in active sites from both groups, which may be considered useful in indicating potential biomarkers for the diagnosis of active periodontal disease; salivary proteins show a trend in distinguishing the standard of health and disease and may be used in the future as potential biomarkers of periodontitis with or without diabetes.

Em uma amostra de 12 por cento da população urbana de Botucatu, São Paulo, constituída de 7.075 pessoas, foram identificados 525 indivíduos com sintomas sugestivos de doença respiratória crônica inespecífica (DRCI). Utilizando o questionário de sintomas respiratórios \"ATS-DLD-78\", aplicado por entrevistadores leigos, a autora determinou a prevalência de alguns sintomas e de associações sugestivas de asma brônquica, bronquite crônica e doença pulmonar obstrutiva crônica (DPOC). Os sintomas mais frequentes no sexo masculino, foram: tosse, expectoração e chiado, cuja prevalência foi de 6,2 por cento , 5,4 por cento e 5,3 por cento , respectivamente. No sexo feminino os sintomas mais frequentes foram: tosse, chiado, dispnéia e rinite alérgica cujas taxas de prevalência foram: 4,7 por cento , 4,7 por cento , 4,2 por cento e 4,0 por cento , respectivamente. Houve maior prevalência de sintomas respiratórios nos maiores de 50 anos de idade e nos menores de 15 anos. A prevalência média de sintomas sugestivos de asma brônquica foi de 5, 0 por cento , e de 1,9 por cento para bronquite crônica e de 0,1 por cento para DPOC. A influência do hábito de fumar, presente entre os sintomáticos respiratórios em 33,7 por cento dos homens e 23,4 por cento das mulheres, foi estudada em relação aos sintomas de tosse e expectoração pela manhã e aos sintomas sugestivos de bronquite crônica. Em vista dos resultados, a autora analisa e comenta a metodologia utilizada e a aplicabilidade do questionário \"ATS-DLD-78\" em nosso meio. Frente a escassez de dados relativos às DRCI, no Brasil, conclui sobre a necessidade de novos inquéritos epidemiológicos em regiões diferentes, realizados com metodologia adequada que possibilite a comparação dos resultados, complementados, quando possível, por estudos clínicos, tendo em vista o planejamento de medidas e programas de intervenção. / In a sample of 12 per cent of the urban population of Botucatu, São Paulo (7075 persons) submitted to a general health and life conditions survey, 525 people with symptoms of inespecific chronic respiratory diseases (ICRD) were detected. The \"ATS-DLD-78\" questionnaire for respiratory symptoms was applyed to these 525 people by non-medical interviewers, and from the collected data the prevalence of some symptoms and association of symptoms suggesting asthma, chronic bronchitis and chronic obstructive pulmonar disease (COPD) was determined. The most frequent symptoms in males were cough (6,2 per cent ), expectoration (5.4 per cent ) and wheezing (5.3 per cent ) and in females, cough (4.7 per cent ), wheezing (4.7 per cent ), dyspnea (4.2 per cent ) and allergic rhinitis (4.01). The prevalence os respiratory symptoms was greater before 15 after 50 years of age. The mean prevalence of symptoms suggesting asthma was 5.0 per cent , suggesting chronic bronchitis, 1.9 per cent and COPD 0,1 per cent . Tobacco smoking was presente in 33.7 per cent of symptomatic men and 23.4 per cent of the symptomatic women. There was a relation between smoking and the presence of morning cough and phlegm and symptoms of chronic bronchitis. The used metodology and the applicability of the \"ATS-DLD-78\" questionnaire to our population is analysed and commented. Taking into account the scarcity of data about ICRD in Brazil, the author concludes emphazising the need of another epidemiological surveys in different parts of the country, using tested and standardized methods that make possible a comparison of data, with the aim of planning intervention measures and programmes.

Orientadores: Carmino Antonio de Souza, Fernando Ferreira Costa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T11:16:23Z (GMT). No. of bitstreams: 1 Mascarenhas_CintiadoCouto_D.pdf: 4558328 bytes, checksum: f219d85bc4e15d72a39a7d3242be9ffb (MD5) Previous issue date: 2013 / Resumo: A elucidação dos mecanismos moleculares envolvidos na fisiopatologia e tratamento das doenças hematológicas, bem como no entendimento do perfil de expressão gênica das linhagens celulares leucêmicas, tem sido objeto de numerosas investigações. Com o uso da técnica SSH (Subtractive Supression Hybridization ou Biblioteca Subtrativa Supressiva) foi possível identificar importantes genes que se encontram diferencialmente expressos em granulócitos de pacientes com Leucemia Mielóide Crônica e indivíduos controle. Foram encontrados 39 genes superexpressos e 173 com expressão diminuída em células de LMC. Ao relacionar esses genes com vias metabólicas que estão reguladas positiva (expressão aumentada) ou negativamente (expressão diminuída) nessa doença, verificou-se que a maioria dos genes estavam relacionados com a regulação de NF-kB, AKT, o Interferon e a IL-4 em células de controle. Entre os genes superexpressos encontrados na LMC, foi observado o SEPT5, RUNX1, MIER1, KPNA6 e FLT3, enquanto PAN3, TOB1 e ITCH estavam com expressão diminuída nessa doença em comparação com indivíduos controle. O TOB1 se mostrou promissor, uma vez que é um gene supressor tumoral, pode estar envolvido na proliferação de células leucêmicas e interage com vários outros genes encontrados neste estudo. Assim, devido à grande heterogeneidade de funções relacionadas com a expressão desse gene, foi investigada a relação entre a expressão de mRNA e as respostas aos ITK's na LMC. A avaliação foi realizada por PCR em tempo real em doentes com CCgR, PCgR, MINCgR e NOCgR após tratamento com TKI's e os resultados foram comparados com a expressão em granulócitos de indivíduos controle, observando que os pacientes NOCgR têm uma expressão de TOB1 significativamente inferior em comparação com doadores saudáveis e pacientes que alcançaram RCgC. Ao comparar pacientes não resistentes e resistentes a diferença foi significativa. Esses resultados sugerem que a expressão diminuída de TOB1 em pacientes NOCgR pode ser indicativo de desregulação da apoptose e de vias de sinalização importantes nessa doença incluindo a via da AKT, conduzindo assim a resistência a ITK's nesses pacientes. Outro objetivo deste trabalho foi caracterizar a função dos genes TOB1 e SEPT5 nos processos celulares e vias de sinalização de apoptose, proliferação, migração e ciclo celular em linhagens celulares leucêmicas. Ao realizar o silenciamento desses genes (utilizando partículas lentivirais) notou-se que o silenciamento de TOB1, como já descrito na literatura em outras doenças, interfere na proliferação celular, clonogenicidade, apoptose, ciclo celular e expressão de proteínas importantes da cascata de sinalização, o que salienta sua importância em células BCR-ABL positivas. Já o gene SEPT5 ao ser silenciado leva a algumas alterações como a apoptose e ciclo celular. Nesse contexto, o silenciamento destes genes chama atenção para as possibilidades de controle da proliferação celular, apoptose, ciclo celular e clonogenicidade em células BCR-ABL positivas. Foi realizada a avaliação da expressão desses genes em células de sangue periférico e medula óssea de pacientes com LMC e indivíduos controles, linhagens celulares de câncer humano e linhagens de murino. Os resultados mostraram um aumento significativo na expressão do gene SEPT5 em todos os tipos celulares analisados em pacientes com LMC. O mesmo padrão foi observado em células de murino que possuem a mutação T315I e em células humanas que possuem a translocação t(9;22) e estão relacionadas com a fase blástica da doença [K562, KU812, NALM]. Quando avaliada a expressão do gene TOB1 nota-se diminuição em todos os tipos celulares analisados em pacientes com LMC e em células BaF3T315I. Também foi observada uma baixa expressão em células com a t(9;22) e estão relacionadas com a fase blástica da doença[K562, KU812, NALM] quando comparadas a expressão em medula óssea controle. Outro resultado interessante foi obtido a partir da análise de adesão celular em granulócitos de pacientes com LMC e controles, evidenciando a diminuição da adesão em granulócitos de pacientes com LMC em relação aos de controles, levando a hipótese de que essa alteração nas propriedades adesivas dos granulócitos em pacientes com LMC pode estar diretamente ligada à liberação de células jovens pela matriz da medula óssea. A criação de estratégias que levam ao melhor entendimento da fisiopatologia da doença e avanço no tratamento da LMC deve ser focada em vários genes alvos e não apenas no BCR-ABL, pois no desenvolvimento da LMC há a ativação e desativação de várias vias de sinalização celular. Os resultados deste estudo podem ajudar na melhor compreensão dessas vias e também para identificar outros genes e vias úteis para a melhora no manejo terapêutico e criação de novas drogas para o tratamento dessa doença / Abstract: The elucidation of the molecular mechanisms involved in the pathophysiology and treatment of blood disorders, as well as the understanding of genes expression profiling of leukemia cell lines has been the focus of numerous investigations. The use of the SSH (Suppression Subtractive Hybridization Library or Suppression Subtractive) technique made available the identification of important genes which are differentially expressed in granulocytes from patients with chronic myeloid leukemia (CML) and healthy controls. 39 genes overexpressed were found, and 173 with decreased expression in CML cells. When correlating these genes with metabolic pathways that are regulated positively (increased expression) or negatively (decreased expression) in this disease, it was found that most of the genes were related to the regulation of NF-kB, AKT, Interferon and IL-4 in control cells. The following genes were found overexpressed in CML: SEPT5, RUNX1, MIER1, KPNA6 and FLT3, while PAN3, TOB1 and ITCH were found with decreased expression in this disease compared with controls. The TOB1 gene showed promising since it is a tumor suppressor, may be involved in the proliferation of leukaemic cells and interacts with several others genes found in this study. Thus, due to the great heterogeneity of functions related to this gene, was investigated the relationship between mRNA expression and TKI's responses. The evaluation was performed by real time PCR in patients with CCgR, PCgR, MINCgR and NOCgR after treatment with TKI and healthy controls. Was observed that patients that have NOCgR, the TOB1 expression is significantly lower compared with healthy donors and patients who achieved CCgR. When comparing non-resistant and resistant patients the difference also was significant. These results suggest that reduced expression of TOB1 in NOCgR patients may indicate apoptosis deregulation and changes in important signaling pathways of CML including the Akt pathway, thereby leading to TKI's resistance of these patients. Another aim of this work was to characterize the function of TOB1 and SEPT5 in cellular processes and signaling pathways of apoptosis, proliferation, migration and cell cycle in leukemic cell lines. After the silencing of these genes (using lentiviral particles), was noted that the silencing TOB1 - as described in the literature for other diseases - interferes in cell proliferation, clonogenicity, apoptosis, cell cycle and in expression of important proteins at signaling cascade, which emphasizes its importance in BCR-ABL positive cells. The SEPT5 silencing leads to some changes such as apoptosis and cell cycle. In this context, the silencing of these genes leads to attention of possibilities of control of cell proliferation, apoptosis, cell cycle and cell clonogenicity in BCR-ABL positive cells. Was assessed the expression of these genes in cells from peripheral blood and bone marrow of CML patients and controls, as well in human and murine cell lines. Results showed a significant increase in SEPT5 gene expression in patients with CML in all cell types evaluated. The same profile was observed in murine cells BAF3T315I and in human cells having the translocation t (9; 22) been related to blast crisis [K562, KU812, NALM]. When measuring expression of TOB1, was noted decrease in all cell types studied in CML patients and cells BaF3T315I. Another interesting result was obtained from the analysis of cell adhesion at granulocytes in CML patients and controls which showed decreased adhesion of granulocytes in CML patients compared to controls, leading to the hypothesis that the change in adhesive properties at CML can be directly linked to the release of young cells by bone marrow. The creation of strategies that lead to better understanding of the pathophysiology of the disease and advance in the treatment of CML should be focused on several target genes and not only in BCR-ABL, since in the development of CML there is an activation and deactivation of multiple signaling pathways . The results of this study may help to better understand these pathways and also to identify other genes and pathways useful for improving the management and development of new therapeutic drugs to treat this disease / Doutorado / Clinica Medica / Doutora em Clínica Médica

Previous research with college students had supported that light and heavy smokers differentially imitate smoking models. Light smokers' smoking rates seemed to vary with the rates presented by a model, while heavy smokers' rates tended to remain relatively consistent. This study examined the effects of a smoking and nonsmoking physician model on 54 older, more chronic, in-patient smokers and extended the scope of research in this area by attempting to evaluate whether immediate modeling influences generalize behaviorally and/or attitudinally. A second part of the experiment investigated the effects of the smoking patients' exposure to a nonsmoking physician model who advised quitting, a smoking physician model who advised quitting, and a smoking physician model who did not comment on smoking relative to patient behavior and attitudes.

Fibromyalgia is a chronic illness characterized by debilitating symptoms such as unpredictable widespread pain, fatigue and migraines. Social support can be a crucial factor in illness management for individuals living with this medically contested, stigmatized and marginalized illness. For many, social media is a significant aspect of their daily reality and in this social space, new forms of relationships and communities have begun to form. This study explores the ways in which a new form of support community for fibromyalgia develops and maintains itself on the social media platform Instagram. A mixed-method research design incorporating both a content and semiotic analysis of Instagram posts as well as interviews with participants utilizing the app was conducted to shed light on the ways in which the relatively new phenomenon of sharing illness experience and support occur on Instagram. / Graduate

Purpose: The aim of the systematic review was to explore the role that anxiety plays in hospital admissions for those with Chronic Obstructive Pulmonary Disease (COPD). The empirical study aimed to examine whether the frequency of COPD related admissions is related to psychological factors (anxiety, depression, catastrophising, and mindfulness), disease severity, perceived disability and demographic factors. It also sought to examine whether cognitive factors (mindfulness and catastrophising) may explain unique variance in predicting anxiety and COPD-related admissions when other relevant factors are controlled for. Methods: The literature was systematically searched for research related to the predictive power of anxiety in relation to COPD related hospital admissions. A postal cross-sectional survey of 54 people with COPD examined the psychological profile of those who are admitted to hospital for COPD, and if mindfulness and catastrophising can predict anxiety and COPD hospital admissions. Correlations and multiple regressions were utilised to explore these hypotheses. Results: Fourteen studies met inclusion criteria for the systematic review, demonstrating mixed results regarding whether anxiety plays a role in COPD related hospital admissions. Findings from the empirical study suggest that a significant relationship exists between disease severity and number of COPD hospital admissions and catastrophising and overall mindfulness predicted 16.3% of variance in COPD hospital admissions (non-significant). Anxiety scores were significantly correlated with breathlessness, depression, catastrophising and mindfulness with catastrophising and mindfulness predicting 22.3% of variance in anxiety (significant). Conclusions: Further research with robust measures of anxiety and hospital utilization are needed to aid our understanding of the role of anxiety in COPD related admissions. Further research is necessary to determine if mindfulness and catastrophising are useful constructs in predicting anxiety levels and hospital admissions in those with COPD. This will help to inform future psychological interventions with this population.

This thesis follows a paper based format where papers 1 and 2 are stand-alone papers prepared for submission to the Journal of Pediatric Psychology. The relevant submission guidelines are included in the Appendix. Paper One: The purpose of this systematic review was to assess the effects of family-centred interventions for children and adolescents with Type 1 diabetes and review the bias associated with included studies. The review summarises the outcome measures which consisted of HbA1cs, hospital admissions for diabetic ketoacidosis (DKA), adherence, and family relationships including diabetes-related conflict. Research studies that were randomized controlled trials were selected to maximise the quality of information reviewed. Electronic searches of the OVID database using MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from their start dates until May 2012. Nine studies were located and assessed with the Cochrane risk of bias tool. Two studies were excluded from further analysis due to serious concerns about bias of their results. The remaining 7 had their findings summarised in a narrative statement, which indicated that family-centred interventions significantly improved HbA1cs, reduced DKA admission rates, improved adherence, and enhanced family relationships including reduced conflict. Family-centred interventions appear to be effective in enhancing health and psychological outcomes. The interventions however, were mainly in clinical settings and delivered by trained professionals. Given the importance of the family relationships in diabetes control, a need exists for interventions to have a more flexible setting and method of delivery, remain viable and demonstrate sustainability. Paper two: Clinic based interventions in type 1 diabetes have shown improvements in family relationships and metabolic control, but have limited reach. Therefore, a self-directed intervention was evaluated. Recruitment occurred through national advertising with diabetes charities, and the randomized controlled trial was conducted via online data collection. Parents of adolescents (aged 11-17) with diabetes were randomized to usual care (n = 37) or intervention (n = 42) using computerised block randomization, with researchers blinded to block size. The 10 week intervention involved the Self-directed Teen Triple P (Positive Parenting Program) workbook (10x1hour modules) and Chronic Illness tip sheet. Primary outcomes of diabetes-related family conflict and parenting stress were assessed pre and post-intervention. Intention-to-treat analysis was undertaken (n = 79), due to increased attrition from the intervention group. Intervention significantly improved diabetes related conflict, but not parental stress, compared to usual care. Followup analyses will assess maintenance effects and impact on metabolic control. Paper three: This paper was a Critical Evaluation, the purpose of which was to consider the findings from both papers, highlight additional and unexpected outcomes, place the research in the wider context, explore limitations of the thesis, and to discuss implications for future work.

Over the past several decades the number of youth living with a chronic health condition has drastically increased. A chronic health condition can be defined as an illness that lasts three months or more that can be controlled but not cured (Centers for Disease Control and Prevention [CDC], 2010). Although there is existing literature on youth with chronic health conditions, there are very few studies that examine the levels of health literacy, resiliency and support/advocacy within this population. The current study is a secondary analysis that utilized data collected from the 37-item Youth Health Literacy and Resiliency Scale (HLRS-Y version) in order to determine if there was a relationship between different categories of chronic health conditions and reported levels of health literacy, resiliency and support/advocacy. Ages of participants were also examined to determine if there was an interaction effect. The study consisted of a 143 youth between the ages of 13- 21 years old. All participants completed the Youth Health Literacy and Resiliency Scale (Bradley-Klug, Shaffer-Hudkins, Lynn, DeLoatche, & Montgomery, 2017) and were placed into one of three categories of chronic health condition: 1) Endocrine, nutritional, and metabolic diseases, 2) Diseases of the musculoskeletal system and connective tissue, and 3) Diseases of congenital malformation, deformations, and chromosomal abnormalities. The data were analyzed to determine if there was a difference in the reported constructs of health literacy, resiliency and support/self-advocacy among the three different categories of chronic health illnesses. The results indicated that there was a significant relation between support/self-advocacy and age. As participants increased in age, they reported having lower levels of support/self-advocacy. This finding was significant regardless of the category of chronic health condition that the participants were placed in. There were no other significant findings for the other constructs. This study contributes to the literature because it is one of few to examine health literacy, resiliency and support/self-advocacy levels among youth with chronic health conditions. In addition, it is the first study aside from the pilot, to utilize the HLRS. The findings from this study can be utilized to drive support/self-advocacy interventions for youth with chronic health conditions.

Doctor of Philosophy / School of Family Studies and Human Services / Jared A. Durtschi / Chronic pain is one of the most pervasive healthcare conditions being treated today. The onset of chronic pain can start at any age, and can follow a myriad of trajectories. Health conditions like chronic pain have been shown to be associated with increases in depression, anxiety, and other adverse mental health outcomes. The present study utilized a sample of 10,266 adult individuals with chronic conditions where chronic pain was typically present to identify different profiles of chronic pain sufferers and then examine the associations between general health, chronic pain profile membership, and mental health outcomes. Although previous studies have attempted to identify chronic pain profiles, no study has yet explored how pain frequency and intensity, fatigue, duration of chronic condition, and physical limitations caused by this condition may uniquely identify subgroups within the chronic pain population. Utilizing a latent profile analysis, four distinct profiles of chronic pain were identified, including a Constant Companion profile, an Adjustments Needed profile, an Annoying Companion profile, and a No Limitations profile. Through a path analysis, significant associations were found between both general health and changes in general health, chronic pain profile membership, and frequency of anxious, depressed, and hopeless feelings. Results generally were counterintuitive, with better health linked with higher odds of fitting the more extreme chronic pain profiles compared to the no limitations profile; and those in the more extreme chronic pain profiles had significantly less frequent feelings of depression, anxiety, and hopelessness. Ideas for clinical implications and suggestions for future research are provided.