<p> <p>&nbsp / </p> <p align="left">&nbsp / </p> </p> <p align="left">In addition to football and basketball, volleyball has become a very popular sport globally over the last 30 years. The International Federation of Volleyball represents about 150 million players in approximately 170 countries. While a large body of research has been conducted regarding the nature and prevalence of volleyball injuries internationally, very little has been done locally or on the African continent to assess the status of injuries incurred at professional or amateur levels. The aim of this study is to determine the prevalence of injuries sustained by professional volleyball players of a club in the WPVU in one season. An exploratory, descriptive, nonexperimental approach was used for this study on 42 volleyball players at the University of the Western Cape Volleyball Club. A self&ndash / administered questionnaire that was based on a questionnaire used in a Dutch national volleyball study was used in the present study. A response rate of 89.4% was obtained. The collected data were captured and analysed by means of the Statistical Package for Social Science version 14.0 (SPSS). The associations between variables were evaluated by means of the chi-square test and a 5% level of significance was used. The results were displayed using tables, bar chart, and pie chart. Most of the volleyball players sustained one or more injuries in the season, giving a prevalence rate of 88.1%. The incidence rate was 1.2 injuries per player. Injuries prevalence was higher among male players 54.1% than female players 45.9%. Among the injured players, ankle and knee injuries showed the highest injury prevalence with 25.5% for each followed by 19.6% for shoulder injuries. The study revealed 69.2% injury prevalence with a higher significance (p=0.04) that players who are injured in the ankle were in contact. Half of the injuries (50%), which occurred gradually, were prevalent in the shoulder, followed by the knee (28.6%), then the ankle and fingers (14.3%). Players in the left and right front row were significantly (p=0.008) more prone to be injured during spiking. Awareness programmes highlighting prevention strategies and physiotherapy intervention are required for coaches and players at the University of the Western Cape Volleyball Club to assist in the prevention of volleyball injuries.</p>

A descriptive quantitative cross-sectional survey using convenience sampling was used to gather data with a self-administered questionnaire on a sample of 226 nurses. The study population included all registered nurses of Kabgayi District Hospital and Nyanza District Hospitals and their respective health centers. To be included, the nurses had to have suffered from WRLBP during the previous 6 months before data collection. The Nordic Back Pain Questionnaire, the Oswestry Disability Index and an open-ended questionnaire regarding perceived risk factors have been used. Descriptive statistics to summarize data and inferential statistics such as chi- square test to test the relationship between different variables of the study have been studied at 5% levels. Correlation coefficients in terms of cross-tabulation were also studied at 1% level of significance.

Eating disorders (ED) constitute a significant source of psychiatric morbidity and are an important public health concern in Western societies. Knowledge about risk factors for ED is crucial for early detection and implementation of preventive interventions. The aim of the present thesis was to examine the prevalence, incidence, correlates, and the risk factors for ED among 1,157 young adult women in the general population. The studies in the thesis used a prospective design with the potential of addressing methodological limitations in earlier research. In Study I, conducted in 1997, the lifetime and point prevalence of DSM-IV-based diagnoses of ED was, respectively, 7.85% and 2.59%. Participants with ED reported higher body dissatisfaction, lower perceived social support from the family, and lower self-esteem compared to participants with no ED. In Study II, it was shown that highest relative use of escape-avoidance coping was reported among participants with ED, followed by dieting participants with no ED, and least among those neither dieting nor with ED. In Study III, (i.e., the follow-up in 1999), the point prevalence of ED was 3.15% and the cumulative 2-year first time incidence was .0105 (n=8). The total incidence group (n=34), as compared to the participants with no ED (controls, n=643), reported significantly lower premorbid self-esteem, and perceived social support from the family and higher body dissatisfaction, higher relative use of escape-avoidance coping, and dieting. Furthermore, the incidence group reported a significant increase in body dissatisfaction and relative use of escape-avoidance coping, and a significant decrease in self-esteem as compared to controls from 1997 to 1999. In Study IV, it was shown that the Survey for Eating Disorders is a reliable and valid self-report questionnaire for the screening of ED and case ascertainment. In conclusion, it is suggested that premorbid low self-esteem, perceived low social support, high body dissatisfaction, high relative use of escape-avoidance coping, and dieting be regarded as risk factors for a later development of ED among young adult women. It is also proposed that more attention be devoted to these factors both in designing prevention interventions and in refining current treatments.

Morbidity of asthma has increased over the world. The reasons for this increase have remained unclear. Studies in children have reported considerable East-West difference in the prevalence of atopy and respiratory allergies. The aim of this thesis was to compare the prevalence and risk factors of respi-ratory symptoms, atopic sensitisation and bronchial hyperresponsiveness (BHR) in young adults in Estonia and Sweden. Following the protocol of the European Community Respiratory Health Survey (ECRHS), two random population samples, 3000 from Tartu, Estonia, and 3600 from Uppsala, Sweden were investigated with postal questionnaires. Random sub samples and subjects with asthma-like complaints were subsequently interviewed, BHR was tested and serum samples analysed for total and specific IgE and eosinophil cationic protein (ECP). In a separate study two methacholine challenge methods, using either Spira Elektro2 or Mefar MB3 as dosimeters, were compared on 28 mild to moderate asthma patients. Symptoms of asthma and hay fever were less common in Esto-nia than in Sweden, while respiratory symptoms in general were more common in Estonia. The prevalence of BHR was high and the prevalence of atopy and the levels of serum ECP were low in Tartu. The differences between the two centres in the prevalence of atopy and allergic rhinitis diminished with age, indicating a probable cohort effect. Current smoking was a dominant risk factor for BHR and for all respiratory symptoms, except attacks of asthma, both in Tartu and Uppsala. There was some difference between risk factors for BHR and atopy between Tartu and Uppsala, mostly of social and environmental origin. The low prevalence of hay fever and asthma in Tartu seemed to be partly explained by a lack of awareness of atopy and allergic diseases in the Estonian society. The estimated cumulative dose causing a 20% fall in FEV1 was smaller and the decline of FEV1 /log(dose) curve steeper, using the Spira, compared to the Mefar protocol.

Urinary incontinence is a prevalent condition; nevertheless few women seek professional help. One aim of this study was to investigate all women aged 18-70 years in a Swedish community regarding (a) the prevalence rate and risk factors of urine leakage and (b) the quality of life for women with and without urine leakage, for women with stress incontinence versus urge incontinence, and for women with urine leakage who had or had not sought help. A second aim was to study all women aged 18-46 years from the same population four years later regarding (a) the quality of life and natural history of urine leakage, (b) why some women with persistent urine leakage seek help and others do not, and (c) how they deal with their urine leakage. Every fourth woman aged 18-70 years was found to have urine leakage. The number of women with urine leakage increased with increasing age, the number of deliveries, the presence of urinary tract infection, and the use of oestrogen substitutions. Women with urine leakage had a lower quality of life in all eight dimensions of the SF-36 as compared with women without urine leakage. Furthermore, in women with urge incontinence the quality of life was lower compared with women with stress incontinence in all dimensions of the SF-36. Women with urine leakage who had sought help had lower quality of life in seven of eight SF-36 dimensions as compared with women with urine leakage who had not sought help. At the four-year follow-up the quality of life had deteriorated in five of eight SF-36 dimensions in women aged 18-46 years with persistent urine leakage as compared with women with persistent continence. The mean annual incidence and remission rates of urine leakage were on the same low level (4%). Most women with slight or moderate long-term urine leakage had not sought professional help, largely because they considered their leakage a minor problem. Pelvic floor exercises was the most commonly used management method for all participants.

Headache is the most frequently reported pain in children and is associated with missed schooldays, anxiety, depressive symptoms and various physical symptoms. A secular trend of increasing headache prevalence has been suggested. Few studies have focused on tension-type headache among children from the general population. The aims of this thesis were to describe the prevalence, incidence and prognosis of tension-type headache, migraine and overall headache in schoolchildren, to identify medical, psychological and social factors associated with these headache types, and to determine whether the prevalence of headache has increased over the last decades. In 1997, 1850 schoolchildren aged 7-15 years from the city of Uppsala participated in a questionnaire study and 1371 (74.1%) responded. Out of these, a randomly selected, stratified sample of 131 children and their parents were interviewed. Three years later, 122 children from the interview sample replied to an identical headache questionnaire. Compared with a similar study in 1955, a significantly lower proportion of schoolchildren reported no headache. The prevalence of tension-type headache increased with age and was significantly higher in girls than boys after the age of twelve. Similar age and gender differences were obtained for migraine. A higher proportion of girls reported frequent headache than boys. Children with headache, especially those with migraine, as well as their first-degree relatives suffered from other pains and physical symptoms more frequently than headache-free children and their first-degree relatives. Although the likelihood of experiencing the same headache diagnosis and symptoms at follow-up was high, about one fifth of children with migraine developed tension-type headache and vice versa. Female gender was a predictor of migraine and frequent headache a predictor of overall headache at follow-up. The estimated annual incidence for tension-type headache, migraine and overall headache was 81, 65 and 131 per 1000 children, respectively. In conclusion, the results indicate that headache has become increasingly common among schoolchildren over the last decades. Prevention and treatment of headache is particularly important for girls since they have high prevalence of headache, frequent headache episodes and a poor outcome. In children with headache, diagnoses and treatment should be reassessed regularly and other pains should be asked about and treated as well.

The Kappa coefficient is widely used in assessing categorical agreement between two raters or two methods. It can also be extended to more than two raters (methods).  When using Kappa, the shortcomings of this coefficient should be not neglected.  Bias and prevalence effects lead to paradoxes of Kappa. These problems can be avoided by using some other indexes together, but the solutions of the Kappa problems are not satisfactory. This paper gives a critical survey concerning the Kappa coefficient and gives a real life example. A useful alternative statistical approach, the Rank-invariant method is also introduced, and applied to analyze the disagreement between two raters.

Emotional suffering in old age is largely caused by various psychiatric conditions, of which depression is the most common. Depression is associated with a decline in both well-being and daily functioning and reduces both morale and social capacity among the very old, which may produce high health and social costs for society. The overall aim of the thesis was to study the prevalence of depression among the very old, to identify factors associated with depression and to evaluate the prognosis of depression among the very old. In total, 363 people were evaluated for depression, 242 from an urban municipality in the year 2000 and 121 from five rural municipalities in 2002. In 2005, those still alive in the urban municipality were asked to participate again, and were therefore re-evaluated. The prevalence of depression was 27% in the urban municipality, 34% in the rural municipalities and 29% in the total sample. Of those depressed, about 67% were receiving antidepressive treatment, and of those, approximately 50% had responded to treatment. In the rural municipality, the depressed were less often treated with Selective Serotonin Re-uptake Inhibitor medications, receiving instead Tri-Cyclic Antidepressants. In the rural municipalities, only 38% of the depressed had responded to treatment. A higher proportion of women were diagnosed as depressed, 33% vs. 19%, p=0.006, although the response rate was the same for men and women. Depression was twice as common among those with dementia, 44% vs. 23%. There were discrepancies concerning associated factors between the depressed participants with dementia and those without. Experiencing the death of a child during the preceding ten years was associated with depression and independently associated with depression among men and participants with dementia. In all the studies, the depressed were less often able to go outside independently and to visit others. They also received fewer visits from others and often experienced loneliness. The great majority of those who were depressed in 2000 died during the subsequent five years, only 13 out of 65, 22%, were still alive in 2005, compared to 41% of those who were not depressed, p=0.003. Of 13 who survived, only two had recovered. Twenty-four out of 70 non-depressed people, 34%, had developed depression during the five years (2000-2005), and the total prevalence in year 2005 was 42% (35 out of 83 participants). Ten out of the 24 who had developed depression were prescribed antidepressants. Of those ten, four were regarded as responders. In the group with persistent depression, nine out of eleven were receiving antidepressants and 67% were responders. In conclusion, a large proportion of the very old suffer from under-diagnosed and undertreated depression. The response rate to treatment seems to be low, and the quality of treatment and follow-up also seems to be poor. The mortality rate among the depressed was high. The spectrum of factors associated with depression in people with dementia is different from that associated with depression among non-demented. Depression among the very old clearly emerges as a common and serious public health problem, with probably the most serious impact on quality of life. More efforts have to be made to improve the quality of assessments, treatment and research regarding depression among the very old.

Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whiplash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of traumatic and non-traumatic origin and compared the prevalence of, sociodemographic data, self-perceived health, workload and chronic lowback pain in these groups. In a ready-made questionnaire (MONICA study), we added questions about cervical spine and low-back complaints. 6,000 (72%) completed a self-administered questionnaire. 43% reported neck pain: 48% of women and 38% of men. Women of working age had more neck pain than retired women, a phenomenon not seen in men. 19% of the studied population suffered from chronic neck pain and it was more frequent in women. A history of neck trauma was common in those with chronic neck pain. Those with a history of neck trauma perceived their health worse and were more often on sick-leave. About 50% of those with traumatic and non-traumatic chronic neck pain also had chronic low-back pain. We assessed the subjective and objective neuropsychological functioning in 42 patients with chronic neck pain, 21 with a whiplash trauma, and 21 without previous neck trauma. Despite cognitive complaints, the WAD patients had normal neuropsychological functioning, but the WAD group especially had deviant MMPI results—indicating impaired coping ability and somatization.WAD patients had no alterations in cerebral blood-flow pattern, as measured by rCBF-SPECT and SPM analysis, compared to healthy controls. This contrasts with the non-traumatic group with chronic neck pain, which showed marked blood-flow changes. The blood-flow changes in the non-traumatic group were similar to those described earlier in pain patients but— remarkably enough—were different from those in the WAD group. Chronic neck pain of whiplash and non-traumatic origin appears to be unique in some respects. A better understanding of the underlying pathological mechanisms is a prerequisite for prevention of the development of such chronic pain syndromes and for improvement of the treatment of patients with severe symptoms.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of childbearing age and is associated with a number of metabolic disturbances. It has been hypothesised these women carry an increased risk of developing cardiovascular diseases (CVD) with advancing age. The first aim of this thesis was to establish the prevalence of PCOS-related symptoms in Northern Sweden. The Northern part of the WHO MONICA project was used for this purpose. Based on self-reported menstrual disturbances and hirsutism together with biochemical analyses of free androgen index, the estimated prevalence of PCOS in Northern Sweden was 4.8%, which corresponded with previous prevalence studies. Disturbances in the fibrinolytic system are predictors of future cardiovascular events and measurements of plasminogen activator inhibitor 1 (PAI-1) activity and tissue plasminogen activator (tPA) mass concentration may be used to assess fibrinolytic activity in women with PCOS. From the findings, over-weight women with PCOS had impaired fibrinolysis, especially if they displayed objective biochemical markers of hyperandrogenism. Conversely, lean women with PCOS, displayed no signs of disturbed fibrinolysis. The adipose tissue is an active endocrine organ that produces and releases hormones, pro- and anti-inflammatory cytokines, and chemoattractant cytokines. Proinflammatory molecules produced by adipose tissue can be active participants in the development of insulin resistance and the increased risk of cardiovascular disease associated with obesity. The findings suggested being overweight, rather than the PCOS diagnosis per se, was the main explanatory variable for elevated adipose tissue inflammation in PCOS patients. Weight reduction is the primary target for intervention in overweight and obese women with PCOS. When this thesis was planned, no placebo-controlled trials on anti-obesity drugs in women with PCOS had been conducted. Sibutramine in combination with lifestyle intervention resulted in significant weight reduction in overweight women with PCOS. In addition to the weight loss, sibutramine appeared to have a beneficial effect on metabolic and cardiovascular risk factors.