Thesis (Ph. D.)--University of Sydney, 2008. / Title from title screen (viewed Jan. 28, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health, Faculty of Medicine. Includes bibliographical references and list of publications. Also available in print form.

Ο αριθμός των ατόμων με χρόνιες ασθένειες αυξάνει καθώς ο πληθυσμός γερνάει όλο και περισσότερο. Οι χρόνιες ασθένειες δεν εμφανίζονται μόνο σε ασθενείς μεγάλης ηλικίας(αν και εκει είναι όμως είναι συχνότερες). Το Εθνικό Σύστημα Υγείας δεν περιλαμβάνει δομές Πρωτοβάθμιας Περίθαλψης, όμως με την βοήθεια της Τηλεϊατρικής μεμονωμένα κέντρα ή νοσοκομεία προσπαθούν να καλύψουν ασθενείς με χρόνιες παθήσεις δίνοντας τους την δυνατότητα να ζήσουν καλύτερα με την ασθένεια, να μειώσουν τις επισκέψεις στο Νοσοκομείο και το κυριότερο να έχουν ενεργό ρόλο στη διαχείριση της ασθένειάς τους. Στο πρόβλημα των χρόνιων ασθενειών η Τηλεϊατρική αποτελεί την βασική λύση, όμως για την ολοκληρωμένη διαχείριση των χρόνιων ασθενών χρειάζονται και επιμέρους υπηρεσίες που θα πρέπει να προέρχονται από το κράτος πρόνοιας. Η παρούσα εργασία αναλύει το πρόβλημα των χρόνιων παθήσεων και των ασθενών στην Ελλάδα, αναφέρει τις επιμέρους προσπάθειες που γίνονται, με όποια προβλήματα και ελλείψεις υπάρχουν καθώς επίσης και τα κέρδη (ποσοτικά και ποιοτικά) από την χρήση τέτοιων δομών. / The number of people with chronic diseases is increasing as the population ages more and more.Chronic diseases do not only occur in older patients but is more frequent. The National Health System does not include structures for Primary Care, but with the help of Telemedicine individual centers or hospitals try to provide patients with chronic diseases by giving them the opportunity to live better with illness, reduce hospital visits and most importantly be actively role in managing the disease problem safeguarded. In the era of chronic diseases that / where Telemedicine is the basic solution, but for the integrated management of chronic patients need and individual services should come from the welfare state. This paper analyzes the problem of chronic diseases and patients in Greece, reports on various efforts made, whatever the problems and deficiencies exist and to report its earnings (quantitatively and qualitatively) the use of such structures.

Orientador: Hamilton Almeida Rollo / Banca: Luciana Patrícia Fernandes Abbade / Banca: Amélia Cristina Seidel / Banca: Regina Moura / Banca: Domingos de Morais Filho / Resumo: A doença venosa crônica (DVC) é uma doença comum com conseqüênciassócio-econômicas importantes. O refluxo é uma das principais causas da OVC. Detectar e quantificar o refluxo são medidas importantes no diagnóstico de insuficiênciavenosa crônica. A avaliação quantitativa da DVC pode ser realizada por meiode métodos invasivos e não invasivos. Os métodos não invasivos, quantitativos, 810: fotopletismografia (FPG), pletismografia a ar e o mapeamento dúplex. O MO, rão-ouro, permite a detecção e quantificação acurada do refluxo em veias individuais, pela medida da duração do refluxo ou tempo de fechamento da válvula, além de proporcionar informações anatõmicas e funcionais relevantes para direcionar o tratamento de veias varicosas. Nos pacientes com varizes primárias dos membros -'inferioresa veia safena magna (VSM) é freqüentemente acometida, especialmente por refluxo na junção safeno-femoral (JSF), por insuficiência da válvula ostial. A avaliaçãoda VSM é importante porque a sua preservação traz vantagens, pois a mesmatem sido utilizada como substituto arterial em doenças degenerativas, como a doença arterial obstrutiva crônica dos membros inferiores, na revascularização miocárdica e nos traumas vasculares de extremidades. Estudos já publicados mostraram que o MO permite avaliar as alterações morfológicas e funcionais da V5M e quantificá-las, porém dúvidas permaneceram em relação... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The chronic venous disease (CVD) is a common disease with socio-economic consequences. Reflux is one of the main causes of CVD. Detecting and quantifying the reflux are important steps in the diagnosis of chronic venous insufficiency. The quantitative evaluation of CVD may be performed by means of invasive and non-invasive methods. Non-invasive quantitative methods are: photoplethysmography (FPG), air plethysmography and duplex scan. The DS, gold standard, allows the detection and quantification accurate measurement of the vein reflux individual, by the measure of length of reflux or time of valve closure, in addition to providing functional and relevant anatomical information to guide the treatment of varicose veins. In patients with primary varicose veins of the lower limbs the great saphenous vein (GSV) is frequently affected, especially by reflux in the saphenofemoral junction (SFJ), because of the failure of the ostial valve. The evaluation of the GSV is important because its preservation brings advantages so that it has been used as a replacing arterial in degenerative diseases such as chronic obstructive arterial disease of the lower limbs, in myocardial revascularization and in vascular trauma of the extremities. Studies already published showed that the DS makes it possible to evaluate the morphological and functional alterations of the GSV and quantifies them, but doubts remained in relation to the value of these parameters... (Complete abstract click electronic access below) / Doutor

Chronic Kidney Disease (CKD) is common and is associated with increased risk of progression to end stage renal disease, cardiovascular disease and death. CKD is a heterogeneous condition and accurately predicting an individual’s risk for adverse outcomes remains a challenge. Over the past decade there has been a focus on the identification of novel biomarkers that may help improve risk stratification and the prediction of clinical endpoints in this population. The overall aim of this research project was to investigate a series of novel biomarkers in patients from the Chronic Renal Insufficiency Standards Implementation Study (CRISIS), a prospective observational study of outcome in all cause non-dialysis dependent CKD 3-5. The biomarkers selected for this project were Anti-Apolipoprotein A-1 (Anti-apoA-1 IgG), fetuin-A, fibroblast growth factor-23 (FGF23), high sensitivity cardiac troponin T (HS-cTnT), kidney injury molecule-1 (KIM-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), neutrophil gelatinase associated lipocalin (NGAL) and osteoprotegerin (OPG). These biomarkers were chosen to address the three clinical endpoints of progression, cardiovascular disease and death with biomarkers considered both individually and as groups of related markers. The first aim of this project was to examine associations between the novel biomarkers and the clinical characteristics of the CRISIS population. The second aim was to investigate the associations between novel biomarkers and the study endpoints. In the case of FGF23 longitudinal measurements were analysed and in all other cases associations between baseline levels of the markers and clinical outcomes were considered. The third aim was to consider whether the biomarkers investigated in this project actually improve parameters of risk stratification and model discrimination, thereby demonstrating a potential to improve the prediction of outcome events in the CKD population. Many of the biomarkers were independently associated with one or all of the clinical outcomes considered. Despite these associations, it was more difficult to demonstrate clear improvement in risk classification or the prediction of clinical endpoints. Baseline models of standard biochemical and clinical parameters performed very well so even biomarkers that were strongly associated with clinical outcomes resulted in only small incremental improvements in the prediction of outcome events. It is now important to focus on defining how biomarkers may fit into clinical decision pathways.

In the past decade, numerous studies have examined the correlation between repetitive head trauma in athletes who participated in contact sports and the development of various personality, behavioral, and cognitive changes. Autopsy data from these athletes have uncovered unique patterns of neuropathology that are believed to be associated with the observed clinical symptoms, and together characterize a condition known as chronic traumatic encephalopathy (CTE). Historically, the condition was known as “dementia pugilistica” commonly found in boxers; however, recent studies have identified cases of CTE in retired football players, hockey players, soccer players, war veterans, and other non-athletes. CTE is a progressive disease and clinical signs often appear many years after the trauma. These symptoms frequently include depression, aggression, suicidality, short-term memory loss, and executive functioning impairments. Postmortem examinations of individuals with CTE reveal distinct gross and microscopic pathology, including atrophy of the frontal and temporal cortices, sulcal accumulation of hyperphosphorylated tau, -amyloid deposition, and TAR DNA-binding protein 43 abnormalities. Although current hypotheses suggest that repetitive head trauma causes the development of CTE, the lack of prospective studies hinders our ability to definitively determine its etiology. Likewise, the inability to diagnose CTE in vivo has constrained our attempts to systematically examine the disease’s progressive nature. The goal of this paper is to review the past and current literature on CTE in boxers and football players. We also discuss current hypotheses concerning CTE’s clinical presentation and neuropathology, and situate CTE within the context of other neurodegenerative diseases. Finally, we address the current limitations of CTE research and propose key objectives for future studies.

BACKGROUND: The accumulation of misfolded proteins is a hallmark of many neurodegenerative disorders, including Chronic Traumatic Encephalopathy (CTE). Intracellular protein degradation pathways appear to be insufficient in preventing or halting disease progression. A brain-wide waste clearance pathway mediated by astroglial aquaporin-4 (AQP4) water channels in the perivascular space called the “glymphatic system” has recently been identified. Disruption of this system due to mislocalization of AQP4 away from perivascular astrocytic endfeet (“depolarization”) is linked to reductions in solute clearance and the build up of toxic metabolites in different neurologic conditions associated with aging and traumatic brain injury. Accumulation of aggregated tau protein around blood vessels at the depths of cortical sulci is considered the pathognomonic lesion of CTE, and may reflect impairment of glymphatic pathway function in these perivascular spaces. OBJECTIVES: To investigate whether changes in AQP4 expression or perivascular AQP4 polarization are present in CTE and to assess their relationship with CTE lesions. Additionally, AQP4 expression in CTE will be compared to subjects with a pathological diagnosis of Alzheimer’s disease (AD) and non-pathological controls without a history of head trauma. METHODS: Postmortem frontal cortex samples from neuropatholigcally confirmed cases of CTE, AD, and non-pathological controls were provided by the VA-BU-CLF Brain Bank. Fixed tissue samples were cut at 20 microns from each case and immunofluorescently stained for AQP4, glial fibrillary acidic protein (GFAP), and phosphorylated tau (AT-8). Slides were imaged using a Zeiss 880 Airyscan confocal microscope and analyzed using the HALO image software analysis platform. RESULTS: Increased perivascular AQP4 polarization was significantly associated with lesional vessels compared to non-lesional vessels in CTE (p=0.0187). When assessed between groups, CTE showed less AQP4 polarization surrounding non-lesional vessels compared to controls, and seemingly higher polarization around lesional vessels compared to AD, however these differences were not statistically significant. CONCLUSIONS: Blood brain barrier (BBB) breakdown is a common occurrence following traumatic brain injury (TBI) and has previously been confirmed in postmortem cases of CTE. The findings reported in the current study showing increased, rather than decreased, perivascular AQP4 polarization around lesional vessels compared to non-lesional vessels in CTE may therefore reflect a compensatory mechanism of astrocytes in response to secondary vasogenic edema in the face of chronic inflammation and disrupted BBB integrity, rather than acute cytotoxic edema which is likely the main driver of AQP4 depolarization reported in previous studies.

This participatory action research study evaluated whether, bringing people who have chronic pain together in collaborative learning communities can have an impact upon the way they manage their chronic pain. Participatory action research has been used with other patient groups, but not with people who have chronic pain. People who have chronic pain are often marginalised and restricted from playing a fuller role in society. In this thesis, I consider these processes to be indicators that people with chronic pain may be experiencing a form of social oppression. This justifies the use of participatory action research methods with this group, as these methods are intended to promote wellness and produce liberation from social oppression. A Dionysian inquiry was established in order to promote consciousness-raising among participants in learning communities. Three learning communities were initiated and two were sustained. Nine participants fully immersed in the learning communities. They reported feelings of liberation, identified ways in which their involvement in the learning community had caused them to change their attitudes and acted to improve their situation. This is my original contribution to knowledge, as this demonstrates that the generation of learning communities using PAR, with a Dionysian approach among people who have chronic pain is feasible. This has not been previously published in the literature. Three action cycles have been identified and are discussed in this thesis. These demonstrate the consciousness-raising and individual action that characterised transformation as a result of collaboration. In participatory action research, the production of an action cycle is viewed as the generation of new emergent knowledge, when viewed through the lens of critical theory. Although this knowledge is limited to the learning community and in this study is participant specific. Subsequent findings that emerge from this inquiry, identify that lived experience of chronic pain may be a product of civilised oppression, from which participants might become liberated using consciousness-raising techniques. These findings are significant, as the articulation of chronic pain as an oppressive force and the possible structures by which this is enacted, has seldom occurred in the literature. Without a discussion around oppression and pain and considering ways to raise awareness, people who experience chronic pain are unlikely to overcome these obstructions and attain empowerment.

Submitted by CARINA GUIDI PINTO null (carina_guidi@hotmail.com) on 2016-02-26T12:56:51Z No. of bitstreams: 1 Dissertação Carina Guidi Pinto.pdf: 2764188 bytes, checksum: 30bbdd1a9fc0615c8dae9f321f8a83a1 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-02-26T18:59:28Z (GMT) No. of bitstreams: 1 pinto_cg_me_bot.pdf: 2764188 bytes, checksum: 30bbdd1a9fc0615c8dae9f321f8a83a1 (MD5) / Made available in DSpace on 2016-02-26T18:59:28Z (GMT). No. of bitstreams: 1 pinto_cg_me_bot.pdf: 2764188 bytes, checksum: 30bbdd1a9fc0615c8dae9f321f8a83a1 (MD5) Previous issue date: 2016-01-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Pró-Reitoria de Pesquisa (PROPe UNESP) / A ingestão de etanol compromete a estrutura do cérebro, apresentar efeitos bifásicos sobre a atividade motora, agindo como um estimulante ou depressor dependendo da dose ou a duração de utilização. Ele interfere na absorção e metabolismo de vitamina D3, o que se correlaciona com alguns distúrbios neurológicos e neuropsiquiátricos. Há relatos sobre a associação de etanol com alterações ósseas, incluindo baixos níveis de vitamina D3. Com base nisso, o objetivo deste estudo foi avaliar os efeitos em testes de comportamento da administração isolada de vitamina D3 ou a sua administração em associação com etanol, durante alcoolismo crônico. A fim de conseguir isso, foram utilizados dois grupos experimentais: ratos Wistar machos (n = 20) e ratos UChB linhagem machos (n = 20) (bebedores voluntários de etanol). Ambos os grupos foram divididos em dois subgrupos: Vitamina D3 - 12.5μg / kg / dia (500 UI) de colecalciferol (WV, n = 10, e UV, n = 10), e de controle (CC, n = 10, e UC, n = 10), durante um período de 75 dias. O peso corporal análises e testes de comportamento (reflexo de sobressalto acústico e campo aberto) foram realizados em 90 e 165 dias de idade. Além disso, os níveis de plasma de corticosterona foram medidos a 165 dias, sem diferença estatística entre os grupos experimentais. O grupo Wistar apresentou valores mais baixos ASR no momento final (Controle e completada), enquanto as percentagens PPI foram maiores no grupo inicial. No grupo UChB houve nenhuma diferença em percentagens PPI com o pré-estímulos utilizados. Quando as respostas ASR foram comparados entre os grupos (Wistar e UChB), o grupo UChB apresentaram menores amplitudes de ASR quando comparados com os animais do grupo de ratos Wistar. Em relação à PPI percentagens dos três estímulos pré utilizados no grupo UChB, as percentagens foram maiores em comparação com os animais do grupo de ratos Wistar, os valores ASR foi menor no grupo UChB. A presença de fezes e urina foi semelhante tanto nos momentos iniciais e finais, no teste de campo aberto, para todos os grupos experimentais. Considerando-se os outros parâmetros de campo aberto, diminuição da locomoção foi observado no grupo UChB no subgrupo vitamina D3, bem como no grupo de controlo final, em comparação com o controlo inicial. Quando os grupos Wistar e UChB foram comparados, este último apresentado taxas mais elevadas na locomoção. Os resultados obtidos estão em consonância com o efeito sedativo / depressivo de etanol sobre o sistema nervoso central, reduzindo a ASR de amplitude, com um aumento provável ao longo dos circuitos inibitórios que medeiam a PPI, a determinação do aumento na percentagem de inibição no grupo UChB, bem como um aumento na locomoção apresentada pelo grupo UChB no teste de campo aberto, caracterizada por uma diminuição no efeito aversivo ao novo ambiente. Além disso ressaltamos que a dose de vitamina D3 usado não teve efeito sobre o parâmetro de comportamento analisados, diferenças observadas neste grupo parecendo estar relacionada a se acostumar com a sonda gástrica. Este estudo descreve pela primeira vez na literatura as diferenças nas respostas ao teste acústico de sobressalto reflexo entre ratos Wistar e UChB, este último geneticamente predispostos a ingestão de etanol, uma linhagem adequada para ser usada em experiências compreendendo análises de comportamento em face da ingestão de etanol. / Ethanol intake compromises brain structure, presenting biphasic effects over motor activity, acting as a stimulant or depressor depending on the dose or duration of use. It interferes in vitamin D3 absorption and metabolism, what correlates to some neurologic and neuropsychiatric disorders. There are reports on the association of ethanol with bone alterations, including low levels of vitamin D3. Based on that, the objective of this study was to evaluate the effects in behavior tests of isolated administration of vitamin D3 or its administration in association with ethanol, during chronic alcoholism. In order to achieve that, two experimental groups were used: male Wistar rats (n=20), and UChB lineage male rats (n=20) (volunteer ethanol drinkers). Both groups were divided in two subgroups: Vitamin D3 – 12.5µg/kg/day (500 UI) of cholecalciferol (WV, n=10, and UV, n=10), and Control (WC, n=10, and UC, n=10), for a period of 75 days. Body weight analyses and behavior tests (acoustic startle reflex and open field) were conducted at 90 and 165 days of age. In addition to that, corticosterone plasma levels were measured at 165 days, with no statistical difference between the experimental groups. The Wistar group presented lower ASR values in the final moment (Control and supplemented), while the PPI percentages were higher in the initial group. In the UChB group there was no difference in PPI percentages with the pre-stimuli used. When the ASR responses were compared between groups (Wistar and UChB), the UChB group presented lower ASR amplitudes as compared to the animals of the Wistar group. In relation to PPI percentages in the three pre stimuli used in the UChB group, the percentages were higher as compared to the animals in the Wistar group, the ASR values been smaller in the UChB group. The presence of feces and urine was similar both in the initial and final moments, in the open field test, for all the experimental groups. Considering the other parameters of open field, decreased locomotion was noted in the UChB group in the vitamin D3 subgroup, as well as in the final control group as compared to the initial control. When the Wistar and UChB groups were compared, the latter presented higher rates in locomotion. The results obtained are consonant to the depressive/sedative effect of ethanol over the CNS, reducing ASR amplitude, with a likely enhancement over the inhibitory circuits which mediate PPI, determining the increase in inhibition percentage in the UChB group, as well as an increase in locomotion presented by the UChB group in the open field test, characterized by a decrease in the aversive effect to the new environment. In addition we emphasize that the dose of vitamin D3 used did not have effect over the behavior parameter analyzed, differences observed in this group seeming to be related to getting used to the gavage. This study describes for the first time in literature the differences in responses to the acoustic startle reflex test between Wistar and UChB rats, the latter genetically predisposed to ethanol intake, a lineage adequate to be used in experiments comprising analyses of behavior in face of ethanol intake. / PROPe/RENOVE: 0252/010/14

Made available in DSpace on 2014-06-11T19:33:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-05Bitstream added on 2014-06-13T20:05:13Z : No. of bitstreams: 1 carvalho_ma_dr_botfm.pdf: 1115571 bytes, checksum: 83b322f65a0c84ce4930adccf88b2d28 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Avaliar as características histopatológicas da mucosa gástrica, duodenal e esofágica de crianças e adolescentes brasileiros infectados por Helicobacter pylori (H. pylori) e submetidas à endoscopia digestiva alta para investigar dispepsia crônica. As correlações entre variáveis clínicas e histopatológicas também foram analisadas. Foi realizado estudo prospectivo de biópsias do trato gastrointestinal superior (mucosa gástrica, duodenal e esofágica) em crianças e adolescentes de 4 a 17 anos de idade. A análise histopatológica foi realizada com coloração por Hematoxilina & Eosina, as lesões gástricas e duodenais foram classificadas de acordo com o Sistema Sydney atualizado e a intensidade da esofagite foi graduada. O estudo incluiu um grupo de crianças infectadas por H. pylori (Hp+), com resultados positivos para dois testes (teste da urease e histologia) e um grupo de não infectadas (Hp-). Utilizou-se teste de Mann-Whitney, Qui-Quadrado, exato de Fisher e correlação de Spearman, sendo p<0,05 considerado significativo. Foram estudadas 185 crianças dispépticas (idade 9.5±2.7 anos), 63,2% (117/185) do sexo feminino, 96 (51,8%) H. pylori positivos (Hp+) e 89 (48,2%) H. pylori negativos (Hp-). O grupo Hp+ foi significativamente mais velho (9.9±2.8 anos) do que o grupo Hp- (9.0±2.6 anos) (p=0,02). Não houve diferença entre a proporção de sintomas entre os grupos Hp+ e Hp-. Não foram encontradas úlcera gástrica ou duodenal durante o procedimento endoscópico. Gastrite crônica ativa moderada/grave esteve presente em 70,5% das biópsias do antro e em 45,2% das biópsias do corpo no grupo Hp+, com intensidade significativamente maior no antro do que no corpo (p<0,05). A pontuação para densidade de H. pylori foi significativamente maior (p=0,005) nas biópsias do antro do que no corpo. Houve uma... / To evaluate the histopathological features of the gastric, duodenal and esophageal mucosa from Brazilian children and adolescents infected with Helicobacter pylori (H. pylori), submitted to upper gastrointestinal endoscopy to investigate chronic dyspepsia. The correlations between clinical and histopathological variables were also analyzed. A prospective study of biopsies from the upper gastrointestinal tract (gastric, duodenal and esophageal mucosa) was performed on children and adolescents 4 to 17 years-old. The histopathological analysis was performed on Hematoxylin-and-Eosin-stained slides, the gastric and duodenal lesions were graded according to the updated Sydney System and the intensity of esophagitis was recorded. The study included one group of H. pylori infected children (Hp+), with positive results for two tests (rapid urease test and histology) and one uninfected group (Hp-). Mann-Whitney, Chi-square, Fisher exact test and Spearman rank correlation were performed and p<0.05 considered significant. We studied 185 dyspeptic children (age 9.5±2.7 years), 63.2% (117/185) female, 96 (51.8 %) H. pylori positive (Hp+) and 89 (48.2%) H. pylori negative (Hp-). H. pylori-positive were significantly older (9.9±2.8 years) than Hp- (9.0±2.6 years) (p=0.02). There was no difference among the proportion of symptoms between Hp+ and Hp- groups. Gastric or duodenal ulcers were not found during the endoscopic procedure. Moderate/severe chronic active gastritis was present in 70,5% of antrum biopsies and in 45,2% of corpus biopsies in the Hp+ group, with significantly higher grading in antrum than in corpus (p<0.05). The scores for H. pylori density were significantly higher (p=0.005) in the antrum biopsies than in the corpus. There was a significant positive association... (Complete abstract click electronic access below)

abstract: Socioeconomic status (SES) is linked with poorer health outcomes across the range of SES. The Reserve Capacity Model (RCM) proposes that low SES fuels repeated and/or chronic exposure to elevated levels of stress, producing deleterious emotional, psychological, social, and physiological changes that result in development of disease over time. The RCM further asserts that a relative lack of social and psychological resources, including efficacy and social support, among low SES individuals accounts for their greater vulnerability to the effects of stress. Although the links between stress, reserve capacity, and health outcomes are framed in the RCM as an ongoing process that produces disease, the majority of investigations testing the model have not examined its utility in explaining 1) coping with daily stressors or 2) symptom flares among individuals managing a chronic illness. This study investigated the effects of SES, reflected in income level, on the: 1) levels of daily financial events and financial worry; 2) relations between daily financial worry and symptoms of pain and fatigue; and 3) extent to which daily coping efficacy and social support mediated the daily financial worry-symptom relation across 21 daily diary reports collected from 220 individuals with fibromyalgia (FM). Simple correlations showed that income was inversely related to frequency of financial events and level of financial worry across 21 days. Results from multilevel models indicated that daily increases in financial worry were unrelated to pain regardless of income level, but were related to increased fatigue among individuals with lower relative to higher income. Daily efficacy and support mediated the relations between financial worry and pain and fatigue, but the extent of mediation did not differ based on high versus low income level. Taken together, the findings suggest that individuals of low versus high income encounter more frequent financial stress and experience greater daily fatigue exacerbation related to that stress, in line with the RCM. Over time, the greater exposure and reactivity to financial strain may account for the inverse relation between income and disability among those with chronic pain. / Dissertation/Thesis / Masters Thesis Psychology 2017