The main aim of this project was to encircle the subtype of temporomandibular disorders (TMD) present in patients with chronic whiplash-associated disorders (WAD) and study the debut of TMD symptoms, the provoking factors and the outcome of conservative TMD treatments. The results could add to the aetiological discussion about TMD mainly as being part of chronic WAD pain or not. The subjects were referred patients with chronic WAD at a specialized rehabilitation centre where they were diagnosed using a standardized classification of WAD diagnosing that resulted in approximately 20% WAD grade 2 and 80% WAD grade 3. In Studies I and II, a total 136 individuals with chronic WAD were found to have a significantly higher prevalence of pain associated with TMD compared to a control group of 66 general dental patients. The symptoms debuted approximately six months after the whiplash injury and were most often provoked by stress. In Study III, the effect of a therapeutic jaw exercise (TJE) program on TMD was studied over six months in patients with chronic WAD and TMD, randomized to TJE (25 subjects) or not (30 subjects). TJE had no effect on TMD. In Study IV, patients with chronic WAD and TMD were found to have a mainly myogenous origin of TMD pain. Five months of stabilisation appliance therapy (SAT) equally resulted in an almost complete perceived reduction of jaw pain and frontal headache in patients with chronic WAD and TMD (n=14) and TMD patients without WAD (n=10). In the long-term, TMD was significantly lower in patients with chronic WAD who were treated compared to patients with chronic WAD and TMD who were not treated (n=9). TMD in patients with chronic WAD grades 2 or 3 may be the same kind of musculoskeletal disorder as in TMD patients without WAD, and not primarily part of the WAD pain. A functional TMD examination as well as assessment of perceived stress can be recommended as part of the standardized screening procedure for patients with chronic WAD grades 2 and 3. Patients with symptoms and signs of TMD could be recommended SAT. Patients with symptoms of frontal headache alone should also be considered as candidates for SAT.

Introduction Approximately 1-2% of the adult population in developed countries suffer from heart failure (HF), with the prevalence rising to more than 10% among patients 80 years of age or older. The HF syndrome is associated with elevated mortality and morbidity, and decreased quality of life. Cognitive dysfunction has been reported in patients suffering from a variety of cardiovascular disorders. However, few studies have systematically assessed cognitive performance in HF patients, its prevalence and other factors influencing cognition in HF patients. Further, it is of great interest to understand the relationship between self-care in HF and cognition. It may be important to screen for cognitive dysfunction as it may influence HF patients’ ability to perform self-care, e.g. make lifestyle changes, adhere to medical treatment and monitor, evaluate and treat symptoms of deterioration. Aim The overall aim of this thesis was to explore cognitive function in elderly patients with chronic heart failure with focus on prevalence, risk factors, sleep and self-care. Design and method This thesis is based on four quantitative studies. The data from study I and II were collected in a prospective longitudinal design, including Swedish same-sex twin pairs born in 1913 or earlier in Sweden. The study was conducted 1991-2002 and a total of 702 individuals aged 80 and older were included. Study III and IV had a cross- sectional design and included stable HF patients, median 72 years of age, living in the community in the south of Sweden. Data were collected between 2009 and 2012. Study III included a total of 137 patients and Study IV included 142 patients. Results Study I found that  octogenarians with HF had significantly poorer spatial performance and episodic memory, and that the episodic memory declined more over time compared to a non-HF population of the same ages. Study II showed that octogenarians with HF had a significantly higher prevalence of vascular dementia, 16% vs. 6%, and all types of dementia, 40% vs. 30%, than those not diagnosed with HF. Factors related to dementia in individuals with HF were depression, hypertension and increased levels of homocysteine. Diabetes was associated with an increased risk for vascular dementia. In study III we found that  HF patients with sleep disordered breathing (SDB) (apnoea-hypopnoea index >15) had significantly higher saturation time < 90%, more difficulties maintaining sleep and lower levels of daytime sleepiness compared to those in the non-SDB group. Cognitive function did not differ between the SDB and the non-SDB-group. Only insomnia was associated with a decreased global cognititive function measured with the Mini Mental State Examination instrument. Finally, in study IV, the relationship between self-care and different dimensions of cognitive function was explored. Psycho- and visuomotor function (speed and attention) was the only dimension of cognitive function associated with self-care. Conclusion Octogenarians suffering from HF have a decreased performance in spatial and episodic memory and they also have a higher risk for developing dementia. Cognitive dysfunction as well as higher prevalence of dementia can contribute to decreased adherence to prescribed therapy and self-care management, and lead to other socio-behavioural problems.   Self-care was found to be associated with psychomotor speed. This may influence sustained attention negatively and the ability to carry out more than one task at the same time. This may lead to decreased attention for receiving and understanding information on self-care. / Thesis

Auf der Grundlage einer epidemiologischen Untersuchung an 3021 Probanden im Alter von 14-24 Jahren (Ausschöpfung 71%) werden Prävalenz von Gebrauch, Miβbrauch und Abhängigkeit von Ecstasy, verwandten Amphetaminen und Halluzinogenen bestimmt sowie Gebrauchsmuster und Korrelate des Gebrauchs untersucht. Als diagnostisches Interview wurde das computerisierte und standardisierte M-CIDI verwendet. Ergebnisse: (1) 14-24jährige gebrauchen Ecstasy häufig (4% aller Manner und 2,3% aller Frauen), XTC-verwandte Amphetamine werden mit 3,6% (Manner) bzw. 1,6% (Frauen) etwas seltener konsumiert. Die LSD-Gebrauchs-Prävalenz liegt bei 2,8% (Manner) bzw. 1,4% (Frauen); verwandte Halluzinogene werden von insgesamt 1,5% der Befragten angegeben. (2) Vergleiche mit Erhebungen aus dem Jahr 1990 lassen eine erhebliche Steigerung (Verdoppelung bzw. Verdreifachung) des Konsums sowohl von Ecstasy und verwandten Präparaten wie auch von Halluzinogenen erkennen. (3) Die Prävalenz klinisch manifester Miβbrauchs– und Abhängigkeitsdiagnosen nach DSM-IV liegen in der Altersgruppe 14-24jähriger bezüglich Ecstasy bei fast 1%, bei Halluzinogenen etwas darunter. Das Verhältnis Gebrauchs-Prävalenz zu diagnostischer Prävalenz von zirka 6:1 läβt auf ein signifikantes «Sucht»potential dieser Substanzen schlieβen. (4) Altersrisikoanalysen lassen erkennen, daβ sich das Einstiegsalter für beide Substanzen in jüngere Altersgruppen verschiebt. Nur für Ecstasy läβt sich über alle Altersstufen hinweg ein stetiger Anstieg von Erstgebrauchsraten nachweisen, demgegenüber bleibt die Rate von Erstkonsumenten bei Halluzinogenen nach dem 18. Lebensjahr stabil. (5) Bezüglich Einstiegs-und Ausstiegsmotivationen ergaben sich für beide Stoffgruppen recht unterschiedliche Muster, die als Hinweis für die Notwendigkeit substanz-spezifischer Präventionskonzepte interpretiert werden. Folgerungen: Die Verbreitung von Ecstasy und Halluzinogenen bei Jugendlichen und jungen Erwachsenen nimmt offensichtlich weiter in beschleunigter Form zu. Im Zusammenhang mit einem bislang häufig unterschätzten «Sucht»potential wird ein rapid wachsender Präventions– und Therapiebedarf absehbar, der für die Verhaltenstherapie eine besondere Herausforderung darstellt.

This study explores the accuracy of prevalence estimations for suicide attempts. Data came from the Early Developmental Stages of Psychopathology (EDSP) Study, a prospective community study (mean follow-up period was 42 months) of 3,021 respondents aged 14 to 24 years at the outset of the study. Suicide attempters are at least 1.6 times more likely to drop out than subjects with no suicide attempts and suicidal ideas. A total of 8% of all suicide attempters answered in the negative the depression-related gate questions of all surveys. One-third of all baseline suicide attempters did not report their suicide attempt again at the four years later assessment. In particular, 80% of all nonreporters were female, and almost 60% were aged 14–17 at baseline.

Smoking rates among senior students have been related to smoking initiation in younger students. Opportunities to select smoking friends may be one explanation, however our understanding of this process has been limited by cross-sectional designs. <br ><br /> The purpose of this longitudinal study was to determine whether senior student smoking rates a) predict smoking initiation in younger elementary school students, controlling for individual exposure to family and friends who smoke and b) are related to the selection of smoking friends, increasing risk of smoking initiation as a result. <br ><br /> This study involved secondary data analysis of 2798 students from 84 Ontario elementary schools involved with the Third Waterloo Smoking Prevention Project (WSPP3). Grade 8 students completed a questionnaire at baseline to obtain the percentage of senior students who smoke in each school. Students in grade 6 completed a similar questionnaire at baseline, and were surveyed again in grades 7 and 8. Multilevel regression analyses were used to examine school and individual characteristics simultaneously. <br ><br /> Each 5% increase in the senior student smoking rate at a school increased the risk that a non-smoking grade 6 student would try smoking more than once by grade 8 (OR 1. 05) and that a non-smoking grade 6 student with no smoking friends would gain a smoking friend by grade 7 (OR 1. 10). Students who remained non-smokers in grade 7 but gained a smoking friend were more likely to try smoking more than once by grade 8 (OR 4. 31). <br ><br /> In schools where a high proportion of senior students smoked, younger students were more likely to initiate smoking, and gain a smoking friend. Anti-smoking policies and interventions may be more urgently required in these schools to lower senior student smoking rates and reduce initiation among younger students. Tailoring the intensity and content of programs to match the needs of schools is one way to potentially maximize effectiveness.

Relevance assessing is an important part of information retrieval (IR) evaluation in addition to being something that all users of IR systems must do as part of their search for relevant documents. In this thesis, we present a user study conducted to understand the relevance judging behaviour of assessors when the prevalence of relevant documents in a set of documents to be judged is varied. In our user study, we collected judgements of participants on document sets of three different prevalence levels. The prevalence levels that we used were low (0.1), balanced (0.5) and high (0.9). We found that participants who judged documents at the 0.9 level made the most mistakes, and participants who judged documents at the 0.5 level made the least mistakes. We did not find a statistically significant difference in judging quality between 0.1 and 0.5 prevalence levels.

Syftet med denna litteraturstudie var att beskriva förekomst och belysa vilka riskfaktorer som bidrar till att män utvecklar ätstörningar samt att beskriva hur dessa kan se ut. Kvalitativa och kvantitativa vetenskapliga artiklar användes för att genomföra denna litteraturstudie. Resultatet visar att det är svårt att veta hur många män som lider av ätstörningsproblematik eftersom området fortfarande är sparsamt utforskat och att prevalensen visar sig vara väldigt olika i olika studier. Ångest och depression och andra affektiva störningar är ofta sammankopplat med ätstörningar men om det är en riskfaktor eller ett symtom är svårt att veta. Grupptryck och massmediala faktorer kan bidra till utvecklandet av ätstörningar hos män, men press från vänner har visat sig vara en större riskfaktor än press från media. Övervikt och högt BMI har visat sig vara en stor riskfaktor för utvecklandet av ätstörningar, men även män som har låg vikt har visat sig vilja bli större och använder sig då av kompulsiv träning och använder anabola steroider i vissa fall. De ätstörningsbeteenden som ofta syns hos män är hetsätning och tvångsmässig träning. Även kräkning och läkemedelsanvändning är vanligt förekommande. Mer forskning kring detta område behövs. Nyckelord: ätstörningar, män, förekomst, symtom, beteenden. / The aim of this literature review was to describe the prevalence and shed light on what risk factors contribute to the development of eating disorders in males and to describe how these disease can express themselves. Qualitative and quantitative scientific papers where used to conduct this literature review. Results show that it is hard to know how many men are suffering from eating disorders is still sparsely researched and the prevalence is very different in different studies. Anxiety, depression and other types of affective disorders are often connected to eating disorders, but whether it is a risk factor or a symptom is hard to know. Peer pressure and pressure from mass medial factors can contribute to the development of eating disorders in males, but the pressure from friends has shown to be a greater risk factor than the mass medial pressure. Obesity and a high BMI has shown to be a big risk factor for the development of eating disorders, but even males who has a low weight has shown interest in getting bigger and uses compulsive exercise and in some cases steroids. The eating disorder behaviors often shown in men are compulsive eating and compulsive exercise. Self-inflicted vomiting and the use of laxatives is also regularly used. More research in this subject is needed. Key words: eating disorders, male, prevalence, symptom, behaviors.

In der Veterinärmedizin verursachen Rotaviren als Jungtiererkrankung vor allem in der Nutztierpraxis hohe ökonomische Verluste. Über die Prävalenz von Rotavirusinfektionen bei Hunden und Katzen ist sehr wenig bekannt, obwohl von den in der Literatur als wechselseitig zwischen Mensch und Tier übertragbaren Viren ein nicht zu unterschätzendes Risiko ausgehen kann. Zunächst wurden retrospektiv Prävalenzdaten über den Nachweis von Rotaviren bei Hunden und Katzen mit Durchfall im Vergleich zu Coronaviren und Parvoviren erhoben. Dazu wurden Kotproben von 2055 Hunden und 1481 Katzen quantitativ auf das Vorhandensein von Rota-, Corona- und Parvovirus untersucht. Desweiteren wurden Aspekte der geographischen Verteilung, der Altersverteilung, mögliche Rasseprädispositionen und das Auftreten saisonaler Erkrankungsgipfel untersucht und ausgewertet. Für Rotavirusinfektionen beträgt die statistische Prävalenz 7% bei Hunden und 8% bei Katzen. Bei Hunden und Katzen konnten signifikant häufiger Dreifachinfektionen nachgewiesen werden. Bei einer Infektion mit Rota- und Coronavirus liegt beim Hund zu 100% auch eine Infektion mit Parvovirus vor. Zweifachinfektionen kamen weniger häufig vor als Monoinfektionen. Alle drei Virusinfektionen kamen bei Hunden statistisch signifikant häufiger in der Altersgruppe ≤ 1 Jahr vor. Ein statistisch signifikant häufiger Rotavirusnachweis konnte bei der Katzenrasse Siam nachgewiesen werden, während keine Hunderasse besonders hervortrat. Im Postleitzahlengebiet 3 konnten im Beobachtungszeitraum von 2000 bis 2006 statistisch signifikant häufiger Rotavirusinfektionen bei Hunden nachvollzogen werden. Es konnte sowohl für Hunde, als auch für Katzen der Trend belegt werden, dass bei steigenden Lufttemperaturen, die Anzahl der Rotavirusinfektionen sinkt. Es kann somit von einer bedingten Saisonalität ausgegangen werden. Im zweiten Teil der Arbeit wurde die Empfänglichkeit von Rotaviren gegenüber kommerziell erhältlichem Typ I Interferon (rFeIFN-ω) in vitro getestet. Zunächst wurde zum Nachweis der Aktivität der Typ I Interferone (rFeIFN-ω, rBoIFN-α, rHuIFN-α) die Expression des Mx Proteins auf Zelllinien felinen, caninen, bovinen und humanen Ursprungs, sowie auf Affenzelllinien untersucht. Es konnte gezeigt werden, dass rBoIFN-α ausschließlich auf Zellen bovinen Ursprungs eine konzentrationsabhängige Expression des Mx Proteins induziert. Das rFeIFN-ω induziert auf Zellen felinen und bei höheren Konzentrationen auch auf Zellen caninen Ursprungs die Expression des Mx Proteins. Das rHuIFN-α zeigt eine konzentrationsabhängige Induktion des Mx Proteins in Zellen humanen, caninen, felinen und bovinen Ursprunges, sowie in Affenzelllinien. Somit konnte in vitro eine Kreuz-Speziesspezifität für rekombinantes humanes Interferon nachgewiesen werden. Zum Nachweis einer immunmodulatorischen Wirkung wurde die Expression der MHC I Oberflächenrezeptoren nach Behandlung mit rFeIFN-ω und rHuIFN-α untersucht. Die Behandlung mit rFeIFN-ω führte ausschließlich in felinen Zellen zu einer konzentrationsabhängigen signifikanten Erhöhung der Rezeptordichte. Die Behandlung mit rHuIFN-α führte zu einer konzentrationsabhängigen signifikanten Erhöhung der Rezeptordichte auf felinen Zellen und in der Affenzelllinie MA104. Die Empfänglichkeit von Rotaviren gegenüber rFeIFN-ω wurde auf der embryonalen felinen Fibroblastenzelllinie (KE-R) und auf der embryonalen felinen Gehirnzelllinine (KG-R) unter steigender Interferonkonzentration (101-104 Einheiten/ml) untersucht. Beide Zelllinien zeigten eine deutliche Reduktion der infizierten Zellen bei steigender Interferonkonzentration. Die antivirale Wirkung war in KE-R Zellen deutlicher ausgeprägt. Dort konnten bereits bei einer Interferonkonzentration von 103 Einheiten/ml keine sichtbar infizierten Zellen mehr nachgewiesen werden, während KG-R Zellen erst bei einer Konzentration von 104 Einheiten/ml keine sichtbar infizierten Zellen mehr nachzuweisen waren. Abschließend wird deutlich, dass Infektionen mit Rotaviren ein vielmals vernachlässigtes Problem in der Veterinärmedizin darstellt, vor allem, wenn man von einer Vergesellschaftung mit den für Hund und Katze pathogenen Viren Corona- und Parvovirus ausgeht. Mit dem rFeIFN-ω steht in vitro eine wirksame antivirale Substanz gegen Rotavirusinfektionen zur Verfügung.

Chronic liver disease (CLD) is a leading cause of morbidity and mortality in HIV-infected individuals. The purposes of this study were to determine the prevalence and etiologies of CLD in an urban HIV-infected population and to identify CLD risk factors. We conducted a retrospective chart review of 799 HIV-infected patients seen at four New Haven health centers from 2002 to 2003. We applied the New Haven County Liver Study definition to identify patients with CLD. 65% were male, 44% were African American, and 23% were of Hispanic ethnicity. The mean age was 45 years. 30% had a history of alcohol abuse. 35% reported injection drug use as their HIV risk factor. Heterosexual contact and men having sex with men (MSM) were reported in 31% and 16% of cases. 50% of patients had a diagnosis of AIDS. 60% percent of patients had CLD. Over 50% of cases of CLD were attributed to chronic hepatitis C (HCV), either alone or with coexisting alcoholic liver disease. Alcoholic liver disease alone, hepatitis B virus (HBV), HAART-induced liver disease, and non-alcoholic liver disease (NAFLD) accounted for smaller percentages. 84% of patients were on HAART, but only 3.6% of patients with positive HCV or HBV serologies were on treatment for CLD. 75% of patients received pneumococcal and influenza vaccines, but only half of eligible patients received hepatitis A and B vaccines. In multivariate analysis, alcohol abuse and positive HCV status were associated with CLD. CLD is prevalent in our population. Preventive care and treatment for CLD are being overlooked in many. Vaccines, treatment for viral hepatitis, and strategies for reducing drug and alcohol abuse are priorities.

Background: Unintended pregnancy and sexually transmitted infections among young people are priority public health issues in the UK. Social marketing is the preferred Government approach to intervention despite limited evidence on efficacy. There is need to understand its applicability and effectiveness in addressing the specified sexual health issues. Methods: Three studies were carried out, of which the first was a systematic review of 12 studies assessing the effectiveness of social marketing in reducing unintended teenage pregnancies. The second and third were consumer research applications examining factors associated with Long Acting Reversible Contraceptive (LARC) use and Chlamydia screening respectively. The second study involved analysing five ONS Contraception survey datasets while the third involved analysing Havering PCT Chlamydia screening records and qualitative data from 28 participants. Data were analysed using Stata.10 and Framework statistical packages and maps drawn using MapInfo.10.5. Results: The systematic review showed that nine studies achieved significant effects on at least one of the specified outcomes (reduced pregnancy rates and related behaviour changes). The second study showed that the NICE guidelines published in 2005 successfully addressed the disparity in LARC uptake previously experienced by women aged below 20. The third study identified females and non-white participants as more likely to take Chlamydia tests. Motivating factors for testing included convenient access to kits and fear of infertility, while barriers included ignorance and fear of results. Conclusions: Social marketing appears to be effective in reducing unintended teenage pregnancies but evidence is limited to particular outcomes and context. Consumer research provides vital intelligence about target populations necessary for designing effective interventions and addressing inequalities. However to assess its influence on outcomes, studies that feature all social marketing components are required. Overall there is need for more studies that specifically utilize social marketing principles to enable more robust evaluations.