The prevalence of psychiatric symptoms in next-of-kin (NOK) of intensive care unit (ICU) patients has been reported at higher than 70% when screening is performed using the Hospital Anxiety and Depression Scale (HADS). The primary purpose of this study was to assess the ability of the HADS to predict psychiatric illness, diagnosed with the aide of a validated tool, the Structured Clinical Interview for DSM-IV (SCID). In addition, we asked NOK to rate aspects of the ICU experience to determine possible associations with psychiatric diagnosis. Thirty-four NOK were enrolled in this study from July 2006 to November 2006. Subjects were interviewed to gather demographic information, their perception of the ICU experience, and to administer the SCID and the HADS. At least 6 months later, subjects were contacted by telephone to determine presence of psychiatric morbidity after the ICU experience. Fifty-six percent of all NOK experienced symptoms of either anxiety or depression during the ICU admission and 24% had psychiatric illness. The HADS had 100% sensitivity and 58% specificity when used as a screening tool for psychiatric diagnosis. Those with any SCID diagnosis were more likely to be a spouse (50% vs. 9%, p = 0.013) or a primary caregiver (60% vs. 8%, p = 0.003). Most NOK identified the healthcare team as supportive, though a subgroup of NOK who slept in the ICU reported that they found the healthcare team less supportive. This small study suggests the HADS is able to predict psychiatric illness in NOK of ICU patients. The ability to implement this tool as part of clinical practice to better meet the needs of families in the ICU warrants further investigation.

INTRODUÇÃO: Correlações significativas entre asma e ansiedade e entre ansiedade e distúrbios do equilíbrio têm sido consistentemente descritas. Estas observações sugerem que as anormalidades de equilíbrio também podem estar presentes em pacientes asmáticos, embora ainda não existam estudos envolvendo asma, ansiedade e desequilíbrio postural. Esta questão é clinicamente importante porque déficits posturais não tratados potencialmente podem piorar o prognóstico da asma, desencadeando a ansiedade e, conseqüentemente, sintomas respiratórios. Este estudo exploratório tem como objetivo avaliar a eficiência do controle postural em pacientes com asma e sua possível correlação com sintomas de ansiedade. MÉTODOS: 41 indivíduos com asma controlada persistente e 41 controles, pareados por idade e sexo, foram comparados. Sintomas de ansiedade foram avaliados pelo Inventário de Estado-Traço de Ansiedade de Spielberger (IDATE). O controle do equilíbrio foi avaliado pela posturografia dinâmica, que avalia o deslocamento do centro de pressão (CoP) do corpo sobre uma plataforma de pressão, gerando escores de equilíbrio e suas variáveis cinéticas, como área e velocidade de deslocamento do CoP em sentidos látero-lateral e ântero-posterior. RESULTADOS: O grupo asma apresentou escores significativamente maiores no IDATE-Estado (46,8 ± 11,38 vs 38,2 ± 13,16; t = 2,89, p = 0,005) e no IDATE-Traço (50,1 ± 13,60 versus 37,9 ± 12,67; t = 4,22, p <0,001). Na posturografia dinâmica, o teste t de Student evidenciou pior desempenho dos asmáticos nos escores de equilíbrio e na área de deslocamento do CoP, porém o teste de correlação de Pearson não evidenciou associação entre maiores escores de ansiedade com menores escores de equilíbrio (r < 0,3 em todas as condições avaliadas). CONCLUSÃO: As anormalidades de equilíbrio parecem frequentes em pacientes com asma, porém de forma independente da presença de sintomas de ansiedade. No entanto, a presença de disfunção vestibular, ainda que subclínica, pode ter um grande impacto no prognóstico desses pacientes. Estes achados sugerem que queixas relacionadas com o desequilíbrio devem ser investigadas em asmáticos, principalmente naqueles que representem níveis mais elevados de ansiedade / INTRODUCTION: Significant correlations between asthma and anxiety and between anxiety and balance disorders have been consistently described. These observations suggest that equilibrium abnormalities can also be present in asthmatic patients. This issue is clinically important because untreated postural deficits can potentially worse the prognosis of asthma by triggering anxiety and, consequently, respiratory symptoms. This exploratory study aims to evaluate the efficiency of postural control in asthma patients and its possible correlation with anxiety symptoms. METHODS: 41 subjects with persistent controlled asthma and 41 controls, matched for age and sex, were compared. Anxiety symptoms were evaluated by the Spielbergers Inventory of State-Trait Anxiety (STAI). The balance control was assessed by dynamic posturography, which assesses the displacement of center of pressure (CoP) of the body on a platform of pressure, generating scores of balance and their kinetic variables such as area and speed of displacement of the CoP in lateral and anteroposterior directions. RESULTS: The asthma group had significantly higher scores in STAIState (46.8 ± 11,38 versus 38.2 ± 13,16; t = 2,89; p=0,005) and in STAI-Trait (50.1 ± 13,60 versus 37.9 ± 12,67; t = 4,22; p<0,001). In dynamic posturography, the Student t test showed worst performance of asthmatics in balance scores and in the area of the CoP displacement, but the Pearson correlation test showed no association between higher anxiety scores with lower balance scores (r <0.3 in all conditions evaluated). CONCLUSION: Balance abnormalities seems frequent in asthma patients independently from the presence of anxiety symptoms. However, the presence of vestibular dysfunction, working via anxiety provocation, may have a major impact in the prognosis of these patients. These findings suggest that disequilibrium related complaints must be investigated in asthmatic patients mainly in those presenting higher levels of anxiety

Au Wing-cheong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 73-91). / Abstracts in English and Chinese. / LIST OF ABBREVIATIONS --- p.i / ACKNOWLEDGEMENT --- p.ii / ABSTRACT --- p.iii / LIST OF TABLES --- p.vii / LIST OF FIGURES --- p.viii / LIST OF APPENDICES --- p.ix / Chapter CHAPTER I. --- INTRODUCTION --- p.1 / Chapter CHAPTER II. --- REVIEW OF THE LITERATURE --- p.3 / The construct of community living skills --- p.3 / Assessment tools for community living skills --- p.6 / The St. Louis Inventory of Community Living Skills --- p.9 / Prediction of community level-of-care --- p.12 / Training community living skills in Hong Kong --- p.15 / Chapter CHAPTER III. --- RATIONALE FOR THE STUDY --- p.17 / de-institutionalization movement and community living skills training --- p.17 / Lack of structured community living skills assessment toolsin Hong Kong --- p.20 / The choice of the SLICLS for cross-cultural validation --- p.21 / Chapter CHAPTER IV. --- GENERAL METHODOLOGICAL CONSIDERATIONS --- p.23 / An introduction to the test construction procedures --- p.23 / An outline of the cross-cultural validation process --- p.24 / Issues concerning reliability of rating scales --- p.26 / Issues concerning validity of rating scales --- p.28 / Chapter CHAPTER V. --- METHOD --- p.31 / Translation of the SLICLS --- p.31 / Content validity of the SLICLS-C --- p.32 / Inter-rater reliability of the SLICLS-C --- p.34 / Internal consistency of the SLICLS-C --- p.35 / Construct validity of the SLICLS-C --- p.36 / Concurrent validity of the SLICLS-C --- p.37 / Predictive validity of the SLICLS-C --- p.38 / Ethical considerations --- p.41 / Chapter CHAPTER VI. --- RESULTS --- p.43 / The SLICLS-C --- p.43 / Content validity of the SLICLS-C --- p.44 / Inter-rater reliability of the SLICLS-C --- p.46 / Internal consistency of the SLICLS-C --- p.48 / Construct validity of the SLICLS-C --- p.49 / Concurrent validity of the SLICLS-C --- p.52 / Predictive validity of the SLICLS-C --- p.54 / Chapter CHAPTER VII. --- DISCUSSION --- p.59 / Validity of the SLICLS-C --- p.59 / Reliability of the SLICLS-C --- p.62 / Accuracy of the SLICLS-C in predicting community level of care --- p.63 / Significance of the study --- p.65 / Limitations of the study --- p.67 / Recommendations for further studies --- p.69 / Chapter CHAPTER VIII. --- CONCLUSION --- p.70 / REFERENCES --- p.73 / APPENDICES --- p.92

INTRODUÇÃO: Correlações significativas entre asma e ansiedade e entre ansiedade e distúrbios do equilíbrio têm sido consistentemente descritas. Estas observações sugerem que as anormalidades de equilíbrio também podem estar presentes em pacientes asmáticos, embora ainda não existam estudos envolvendo asma, ansiedade e desequilíbrio postural. Esta questão é clinicamente importante porque déficits posturais não tratados potencialmente podem piorar o prognóstico da asma, desencadeando a ansiedade e, conseqüentemente, sintomas respiratórios. Este estudo exploratório tem como objetivo avaliar a eficiência do controle postural em pacientes com asma e sua possível correlação com sintomas de ansiedade. MÉTODOS: 41 indivíduos com asma controlada persistente e 41 controles, pareados por idade e sexo, foram comparados. Sintomas de ansiedade foram avaliados pelo Inventário de Estado-Traço de Ansiedade de Spielberger (IDATE). O controle do equilíbrio foi avaliado pela posturografia dinâmica, que avalia o deslocamento do centro de pressão (CoP) do corpo sobre uma plataforma de pressão, gerando escores de equilíbrio e suas variáveis cinéticas, como área e velocidade de deslocamento do CoP em sentidos látero-lateral e ântero-posterior. RESULTADOS: O grupo asma apresentou escores significativamente maiores no IDATE-Estado (46,8 ± 11,38 vs 38,2 ± 13,16; t = 2,89, p = 0,005) e no IDATE-Traço (50,1 ± 13,60 versus 37,9 ± 12,67; t = 4,22, p <0,001). Na posturografia dinâmica, o teste t de Student evidenciou pior desempenho dos asmáticos nos escores de equilíbrio e na área de deslocamento do CoP, porém o teste de correlação de Pearson não evidenciou associação entre maiores escores de ansiedade com menores escores de equilíbrio (r < 0,3 em todas as condições avaliadas). CONCLUSÃO: As anormalidades de equilíbrio parecem frequentes em pacientes com asma, porém de forma independente da presença de sintomas de ansiedade. No entanto, a presença de disfunção vestibular, ainda que subclínica, pode ter um grande impacto no prognóstico desses pacientes. Estes achados sugerem que queixas relacionadas com o desequilíbrio devem ser investigadas em asmáticos, principalmente naqueles que representem níveis mais elevados de ansiedade / INTRODUCTION: Significant correlations between asthma and anxiety and between anxiety and balance disorders have been consistently described. These observations suggest that equilibrium abnormalities can also be present in asthmatic patients. This issue is clinically important because untreated postural deficits can potentially worse the prognosis of asthma by triggering anxiety and, consequently, respiratory symptoms. This exploratory study aims to evaluate the efficiency of postural control in asthma patients and its possible correlation with anxiety symptoms. METHODS: 41 subjects with persistent controlled asthma and 41 controls, matched for age and sex, were compared. Anxiety symptoms were evaluated by the Spielbergers Inventory of State-Trait Anxiety (STAI). The balance control was assessed by dynamic posturography, which assesses the displacement of center of pressure (CoP) of the body on a platform of pressure, generating scores of balance and their kinetic variables such as area and speed of displacement of the CoP in lateral and anteroposterior directions. RESULTS: The asthma group had significantly higher scores in STAIState (46.8 ± 11,38 versus 38.2 ± 13,16; t = 2,89; p=0,005) and in STAI-Trait (50.1 ± 13,60 versus 37.9 ± 12,67; t = 4,22; p<0,001). In dynamic posturography, the Student t test showed worst performance of asthmatics in balance scores and in the area of the CoP displacement, but the Pearson correlation test showed no association between higher anxiety scores with lower balance scores (r <0.3 in all conditions evaluated). CONCLUSION: Balance abnormalities seems frequent in asthma patients independently from the presence of anxiety symptoms. However, the presence of vestibular dysfunction, working via anxiety provocation, may have a major impact in the prognosis of these patients. These findings suggest that disequilibrium related complaints must be investigated in asthmatic patients mainly in those presenting higher levels of anxiety

This study explores the relationship between living arrangement and psychological wellbeing in retired elderly individuals living in Yancheng, Jiangsu (PR China). Data on mode of residence, socio-economic background, daily activities, and intergenerational dynamics were collected from 200 subjects, and their potential correlations with depression (assessed via the Geriatric Depression Scale Short Version) were analyzed. Univariate as well as logistic regression confirmed mode of residence as a significant predictor of depression in this group. The following depression odds ratios associated with each mode of residence were derived via logistic regression: 1) nuclear household, i.e. living with a spouse only ¨C 1 [reference category], 2) multigenerational households in which a spouse is not present ¨C 4.341, 3) multigenerational households in which a spouse is present ¨C 0.781, and 4) living alone ¨C 3.018. Based on these ratios, we conclude that the traditional model of intergenerational coresidence is not, in itself, associated with less depression. Rather, it is the presence of a sharing spousal in a household (whether single or multigenerational) that protects against elderly depression. Other predictors of depression identified in backward logistic regression included presence of a chronic illness and self assessed wealth status. Additionally, a number of psychosocial variables were identified as independently correlated with depression, but were subsequently selected out by multivariate analysis. These included: educational background, religious affiliation, membership in an organization, attitude toward aging, and family status. Based on this study, we believe that efforts to promote mental wellbeing among today¡¯s Chinese elders should be directed toward psychosocial factors that are modifiable (education, building supportive social networks etc.) rather than insisting on the traditional ideal of multigenerational living and dependence on filial piety.

Diss. Linköping : Univ., 1999.

Thesis (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2006. / Not embargoed. Vita. Bibliography: 100-110.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Introdução: luto complicado é caracterizado pela procura persistente pelo falecido, tristeza e dor emocional intensos em resposta à morte de ente querido. Luto complicado é frequentemente pouco reconhecido e subtratado. O Texas Inventory Revised of Grief (TRIG) é um instrumento de alta confiabilidade e validade na medida de avaliação do luto. Nosso objetivo foi traduzir, adaptar e validar o TRIG para Português do Brasil e verificar se o mesmo, em uma população enlutada, é capaz de distinguir entre os que têm e os que não tem luto complicado assim como identificar quais elementos da escala contribuem para isso. Métodos: o trabalho foi realizado em duas etapas: a) tradução e adaptação transcultural do TRIG para o português do Brasil e b) estudo em corte transversal para análise da confiabilidade e validação desse instrumento. Participantes: 165 pacientes adultos foram recrutados de: a) Ambulatório de Luto do Departamento e Instituto de Psiquiatria - Universidade de São Paulo, b) Ambulatório de convênio e Particulares no mesmo departamento e, c) Colegas de trabalho que perderam um ente querido. Todos os pacientes foram entrevistados com o TRIG e de acordo com critérios clínicos, 69 dos 165 pacientes enlutados foram diagnosticados com luto complicado. Resultados: quanto à tradução e adaptação transcultural, o TRIG foi traduzido para o português, feito a retrotradução para o inglês e adaptado à cultura local. Esse processo foi realizado por dois psiquiatras bilíngues. A confiabilidade e consistência interna do instrumento foram medidos pelo coeficiente de Alpha de Cronbach que alcançou 0,735 para parte I e 0,896 para a parte II do instrumento. A sensibilidade, especificidade e ponto de corte para identificar enlutados com e sem luto complicado foram medidos pela Curva ROC. Viu-se que usando o ponto de corte encontrado de 104 (escore total das partes I, II, III + variáveis psicográficas), é possível classificar corretamente 71,3% dos indivíduos com e sem luto complicado. A validação do instrumento foi realizada pela análise fatorial exploratória e confirmatória. Pela regressão logística demonstrou-se que nível educacional, idade do falecido, idade do enlutado, perda de filho(a) e morte do tipo inesperada são fatores de risco para luto complicado. Nossos resultados também sugerem que religião pode influenciar luto complicado. Conclusões: a versão traduzida e adaptada do TRIG para o português é confiável e válida como medida do luto tanto quanto a versão original. O TRIG foi capaz de distinguir pacientes com e sem luto complicado. Nós sugerimos o uso do TRIG com ponto de corte igual a 104 para identificar enlutados com luto complicado / Background: Complicated grief is characterized by persistent yearning for the deceased, intense sorrow and emotional pain in response to death causing significant distress. Complicated grief is often underrecognized and under treated. The Texas Revised Inventory of Grief (TRIG) is a questionnaire that has been demonstrated to have high validity and reliability in the assessment of complicated grief. Our objective was to translate, adapt, and validate the TRIG to Brazilian Portuguese and to verify whether the TRIG, in a bereaved population, is able to distinguish between those with and those without complicated grief and to identify which elements in the scale contribute to this. Methods: Two stages: a) cross-culture adaptation of a questionnaire, and b) crosssectional study of reliability and validity. Setting and Participants: 165 adult patients were recruited from a) the Grief Outpatient Clinic at the Department and Institute of Psychiatry - University of São Paulo, b) private practice at the same department, and c) co-workers who have lost a loved one. All the patients were interviewed with the TRIG. According to clinical criteria 69 of 165 bereaved patients were presenting complicated grief. Results: Cross-culture adaptation: the TRIG was translated from American English, then back-translated and finally compared with the Brazilian Portuguese version by two bilingual psychiatrists. Reliability: the Cronbach\'s alpha coefficients (internal consistency) of the TRIG scales were 0,735 (part I) and 0,896 (part II). Sensitivity, specificity as well as cutoff points to identify complicated and non-complicated grief, were measured using the ROC curve Using the total score of 104 (part I + part II + Part III + psychographics variables), we can correctly classify 71.3% of individuals with and without complicated grief. The construct validity was assessed by exploratory factor analysis and confirmatory analysis. Furthermore, by logistic regression, our study demonstrated that a low education level, age of the deceased and age of the bereaved, loss of a son or daughter, and unexpected death were all risk factors for complicated grief. Our results also suggest that religion may influence complicated grief. Conclusions: The TRIG adapted to Brazilian Portuguese is as reliable and valid as the original version. In the evaluation of Brazilian bereaved, it was able to distinguish individuals with and without complicated grief. And, we suggest a cut-off value of 104 for complicated grief

by Iu Wai-yu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 138-146). / Abstracts in English and Chinese. / ACKNOWLEDGMENTS --- p.i-ii / abstract --- p.iii-iv / ABSTRACT (Chinese version) --- p.v-vi / TABLE OF CONTENTS --- p.vii-xii / LIST OF FIGURES --- p.xiii / LIST OF TABLES --- p.xiv-xvi / LIST OF APPENDICES --- p.xvii-xviii / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Research problem --- p.2-6 / Purpose and objectives of the study --- p.7 / Hypothesis --- p.8-9 / Operational definitions --- p.9 / Significance of the study --- p.10-13 / Overview of the thesis --- p.13 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Introduction --- p.14 / Definition of QOL --- p.15-18 / Measurement of QOL --- p.18 / The use of objective and subjective QOL Measurement --- p.19-23 / Generic vs. Specific instruments --- p.23-24 / Studies on QOL on mentally ill clients --- p.25-29 / Factors influencing QOL --- p.29-33 / Conceptual framework of the study --- p.34-37 / Summary --- p.37 / Chapter CHAPTER 3 --- METHODOLOGY / Introduction --- p.38 / Research design --- p.38-39 / Method --- p.39-41 / Sampling --- p.41-44 / Measurements --- p.45-51 / The Brief Psychiatric Rating Scale --- p.45-46 / The WHOQOL-BREF-HK --- p.47-48 / The Lehman QOLI-brief version --- p.48-51 / Demographic data sheet --- p.51 / Pilot study --- p.52 / Data collection --- p.53-54 / Ethical consideration --- p.55-56 / Data analysis --- p.56-58 / Summary --- p.58 / Chapter CHAPTER 4 --- RESULT / Introduction --- p.59 / Sociodemographic characteristics of the participants --- p.59-65 / Clinical characteristics of the participants --- p.66-70 / Results from QOLI --- p.71-79 / Results from WHOQOL --- p.80-81 / Different perception of QOL in different groups --- p.81-94 / Difference in perception of QOL between different gender --- p.82 / Difference in perception of QOL between among different age ranges --- p.83-85 / Relationships between employment status and perception of QOL --- p.86-87 / Relationships between mental status and perception of QOL --- p.88-90 / Relationships between years of onset of mental illness and perception of QOL --- p.91 / Relationships between number of hospitalization and one's QOL --- p.91-92 / Relationships between CPNS and perception of QOL --- p.93 / Relationships between attending DH and perception of QOL --- p.94 / Predictors of QOL --- p.95-98 / Summary --- p.99 / Chapter CHAPTER 5 --- DISCUSSION / Introduction --- p.100 / Sociodemographic and clinical characteristics of the participants --- p.100-104 / Perception of QOL --- p.104-109 / Social relationships --- p.109-111 / Family relationships --- p.111-112 / Sexual relationships --- p.113 / Environment --- p.113-114 / Financial situation --- p.114-115 / Mental status and QOL --- p.115-116 / Service utilization and QOL --- p.117-118 / Predictors of QOL --- p.118-120 / Objective indicators and subjective perception of QOL --- p.121 / Summary --- p.122 / Chapter chapter 6 --- conclusion and implications / Introduction --- p.123 / Summary of the study --- p.123-124 / Implications to health care policy --- p.125-130 / Implications to nursing practice --- p.130-134 / Implications for future research --- p.135-136 / Limitations of the study --- p.137 / references --- p.138-146 / appendices --- p.147-178