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The psychological well-being of end stage renal disease (ESRD) patients and spouses was investigated from a dyadic perspective. The responses of patients and spouses from five groups of couples--illustrating different points in the progression and treatment of ESRD--were compared both across ESRD groups and between patients and spouses. It was hypothesized that those ESRD groups with the highest levels of illness/treatment intrusiveness, i.e. the two dialysis groups, would exhibit the highest levels of marital role strain and concomitantly the lowest levels of psychological well-being. Despite the fact that the ESRD groups did reflect differences in perceived illness/treatment intrusiveness, no significant differences were found between the ESRD groups, or between patients and spouses, in either marital relations or psychological well-being. However, multiple regression analyses did indicate that marital role strain was a significant predictor of psychological well-being. It explained psychological well-being variance above and beyond demographic, physical health, ESRD group membership and psychological defensiveness considerations. Also, the two dialysis groups evidenced significantly greater correlations between marital role strain and psychological distress than the nondialysis groups. These findings were interpreted as being consistent with a General Systems Theory approach to the conceptualization and treatment of chronic illness.

End-stage renal disease (ESRD) and its treatment are generally considered to be highly stressful and the associated loss of control over important life dimensions is believed to induce widespread depression. This situation was employed as a "living stress laboratory" in which to test the reformulated learned helplessness theory of depression. Results indicated that reduced perceived control over a variety of life dimensions was importantly related to increased depression, although the attributional reformulation of helplessness theory was not supported. Moreover, reanalyses of these data from a social learning theory perspective indicated that perceived self-efficacy contributed uniquely to this negative correlation in addition to expectancies regarding response-outcome contingency (Rotter I-E scores). The hypothesis that the negative correlation between depression and perceived control might also be explained in terms of patients' psychological differentiation and the intrusiveness of ESRD was subsequently examined. Results revealed that perceived intrusiveness contributed uniquely to perceived control and to affect, indicating that perceived control and intrusiveness each contribute independently to mood. Surprisingly, a low prevalence of clinical depression was observed, contradicting the general consensus that helplessness and depression are unavoidable psychological sequelae to ESRD. These findings are equally applicable to several other chronic and life-threatened patient populations (e.g., cancer, cardiac, diabetic) and thus underline the need for a general theory of the emotional impact of illness.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

Neuropsychological deficits have been implicated in Chronic Fatigue Syndrome (CFS) and there is some indication that cerebral efficiency is compromised in these patients. To further investigate the nature of this impairment, 20 patients who had received a medical diagnosis of CFS were neuropsychologically assessed and compared with age-, sex-, and education-matched controls (20 depressed and 20 healthy subjects). The test battery consisted of the Grooved Pegboard Trail Making Test, Symbol Digit Modalities Test, Auditory-Verbal Learning Test, Visual Design Learning Test, Controlled Oral Word Association Test and Paced Auditory Serial Addition Task. Additional measures included a CFS symptom checklist, SCL-90-R and Cognitive Failures Questionnaire (CFQ). Univariate statistical analysis revealed a significant difference between CFS patients and healthy individuals on only one measure; the "S" trial of the COWAT (F[2,59]=3.30, p <.05). This finding suggests the existence of subtle but detectable neuropsychological difficulty in executive or attentional mechanisms in CFS patients. Further analysis revealed that the observed finding could not be attributed to depression or medication side-effects. Although a trend of declining neuropsychological test performance was evident in moving across the spectrum of healthy, depressed, and CFS samples, this reached significance only for the CFS/depressed versus healthy comparison X22 [1] = 9.40, p < .05). The overall similarity of the neuropsychological profiles of CFS and depressed patients was noted, while an additional finding was the discrepancy between reported levels of subjective cognitive failure (CFQ) and objective neuropsychological findings in the CFS patients. The SCL-90-R profiles of the CFS and depressed patients were also found to be similar in terms of reported levels of psychological distress; however group discrimination was evident on two subscales (Somatization and Obsessive-Compulsive). Although the CFS and depressed controls did not differ with respect to levels of depression, there were some indications of a differential impact of depressive symptomatology on neuropsychological functioning. Taken together, the results of this study indicate that while subtle deficits are detectable in the neuropsychological profiles of CPS patients, the magnitude of impairment appears insufficient to significantly interfere with everyday cognitive functioning. / Thesis (Ph.D.)-University of Natal, Pietermaritzburg, 1997.

Diagnosis with a serious chronic illness is a powerful lived experience that touches all aspects of the individual’s life and which necessitates great adaptation across the lifespan. Ambiguity is a lived dimension of illness that is often expressed in illness stories, capturing the new state between health and illness which has also been described as a ‘liminal’ or in-between state of being (Little, Jordens, Paul, Montgomery & Philipson, 1998). Health care providers hold socially prescribed roles in which they are expected to be professionally competent and immune to personal illness. The lived experiences of health care providers who have been diagnosed with serious chronic illness were explored in this study to better attempt to describe the phenomenon. Six health care providers from various professional backgrounds participated in the research. A semi-structured interview guided the conversation between the researcher and the participant. The participants were encouraged to tell the story of what has happened to them and to reflect on the impact to their lives and practice. Participants were also asked to reflect on their perceived level of support and preparedness via their professional training, and to share any recommendations they might have for others going through this experience. The data gathered were found to be rich in both depth and detail. The data were analyzed using van Manen’s interpretive phenomenological method. Significant statements created formulated meanings or categories, which became organized around eight themes. The themes formed several clusters. The theme clusters were then developed into a recognizable pattern of sub-themes which helped to further 7 describe the essence of the experience of health care providers living with serious, chronic illness. The findings of the research were found to be consistent with the literature that describes the lived experience of seriously ill health care providers as liminal in essence. Based on the research findings recommendations for social work practice, administration and policy, educational training reform and future research were outlined.

Introduction: The effects of chronic pain on health-related Quality of Life (HRQoL) among older Canadian adults with disability was not well known. Study Objectives: This study was conducted to examine the relationship between chronic pain and HRQoL among older Canadian adults with disability aged 55+. Methods: This study was a secondary analysis of cross-sectional data from the 2006 Participation and Activity Limitation Survey (PALS). Weighted data was used to examine the relationship between chronic pain and HRQoL using multivariate logistic regression techniques. Results: An estimated 68% of older Canadian adults with disability reported having chronic pain. Multivariate regression analysis confirmed a significant independent effect of chronic pain on self-reported HRQoL. Conclusion: Our results highlight the importance of pain assessment and management for older adults with disabilities in general and in particular among those with limited communication abilities.

The problems and high medical costs associated with chronic wounds necessitate an economical bioactive wound dressing. A new strategy was investigated to inhibit MMP-9 proteases and to release epidermal growth factor (EGF) to enhance healing. Doxycycline (DOX) and EGF were encapsulated on polyacrylic acid modified polyurethane film (PAA-PU) using Layer-by-Layer (LbL) assembly. The number of bilayers tuned the concentration of DOX and EGF released over time with over 94% bioactivity of EGF retained over 4 days. A simple wound model in which MMP-9 proteases were added to cell culture containing fibroblast cells demonstrated that DOX inhibited the proteases providing a protective environment for the released EGF to stimulate cell migration and proliferation at a faster healing rate. In the presence of DOX, only small amounts of the highly bioactive EGF are sufficient to close the wound. Results show that this is new and promising bioactive dressing for effective wound management.