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Life expectancy in countries of Central and Eastern Europe (CCEE) is substantially shorter than in Western Europe, and similar divide exists in self-rated health. The project described in this thesis was set up to study the effects of socio-economic factors (such as material deprivation, education and inequalities) and psychosocial factors (perceived control, psychosocial work environment) on self-rated health (a predictor of mortality in prospective studies). Cross-sectional surveys were conducted in seven CCEE: Russia, Lithuania, Latvia, Estonia, Poland, Czech Republic and Hungary. Data were collected by interviews in randomly selected national samples in all seven countries (total 7,599 subjects), and by questionnaires in random community samples in 4 countries (total 6,642 subjects). The data included socio-economic and psychosocial factors, self-rated health (SRH) and behavioural risk factors. Overall, 17% of men and 23% of women rated their health as worse than average. In the national samples, perceived control, material deprivation and education were strongly related to poor SRH. In the pooled data, adjusted odds ratio (OR) of poor health for 1 standard deviation (SD) increase in perceived control was 0.59 (95% Cl 0.54-0.63). The OR for 1 SD increase in the material deprivation score was 1.35 (95% Cl 1.26-1.46). The ORs for vocational, secondary and university education, compared with primary education, were 0.75,0.58 and 0.53, respectively. We also examined the ecological effects of income inequality; the OR for the most versus the least unequal populations (using the Gini coefficient of income inequality) was 1.88 (95% Cl 1.55-2.28). In multivariate analyses, however, the effect of inequality was eliminated by adjustment for material deprivation and perceived control. In the community samples, the results were similar. Among psychosocial factors at work, the effort-reward imbalance appeared to be the strongest predictor of self-rated health; work variety was also a predictor of self-rated health. Job strain was not associated with SRH. Our results suggest that (a) the prevalence of poor SRH in CCEE is high, and (b) socioeconomic and psychosocial factors are strongly related to self-rated health in these populations. The gradients were present in all populations, and were of the same direction and similar magnitude as in the West. Prospective studies are needed to address the problems of temporality and reporting bias, which are the major problems of these results.

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Quality of life (QoL) questionnaires have been suggested as the most appropriate way to measure the effectiveness of low vision rehabilitation. However, several research studies have not been able to detect differences in effectiveness between rehabilitation strategies. The hypothesis of this study is that there are other factors, unrelated to vision, influencing the scores obtained in these questionnaires and masking the changes achieved by rehabilitation. The suggestion is that patients' realistic acceptance of, and successful adaptation to, their visual loss is influenced by psychosocial factors such as; personality, religious beliefs, social support, general health (i.e. mental and physical), understanding of their eye condition, level of education, and financial status. Concurrently, a parallel study was conducted with children. As with the adult arm, the aim of the study was to understand whether quality of life, and social behaviour and relationships in children with a visual impairment were related to the vision loss, vision rehabilitation, or non-visual factors. Patients attending the Manchester Royal Eye Hospital low vision clinic between May 2009 and August 2010, were recruited: 448 patients between 18 and 96 years old, with best-corrected binocular visual acuity smaller or equal to6/18, and 62 children between 5 and 16 years old. Telephone delivery of previously validated questionnaires was used with adult patients and parents of child patients; face-to-face interviews were completed by children. Both studies showed how psychosocial factors were stronger determinants of quality of life in people with low vision, than traditional low vision rehabilitation using optical aids. In the case of adults, physical and mental health appeared to be major predictors of quality of life, adaptation to the vision loss and participation restriction. In the case of children, visual acuity at distance and near, contrast sensitivity (CS), age, and parents' coping strategies appeared to determine quality of life and children behaviours. The final element of this work was a pilot study to attempt to address issues causing poor quality of life. Seventy-one participants who scored low in the Low Vision Quality of Life Questionnaire (LVQOL-25) (i.e. below 62.5) were given the opportunity to enrol for the Expert Patient Programme, which is a self-management programme aimed at adults with chronic health problems or disabilities. Only 2 participants expressed an interest in the programme, and none of them actually took part.

Magister Educationis (Adult Learning and Global Change) - MEd(AL) / Adult learners’ perception of factors that are internal to their perceived control of their lives can be challenging to overcome when making a decision to participate in learning. There are complex relationships between psychological, and social barriers to participation in adult learning. Psychosocial barriers can deter adults’ participation in learning programmes. Understanding the nature of such barriers can enable policymakers, educators and adult learners create strategies to reduce such barriers in order to increase adults’ participation in adult learning. This study investigated the research question: What are adult learners’ perceptions of psycho-social factors that undermine participation in adult education and learning? The psycho-social interaction model adopted as a conceptual framework allowed the study to contextualise and analyse the effects of socio-economic status on the adult learner’s decision and readiness to participate. The model provided the broad segments of the adult learners’ pre-adulthood and adulthood learning years and through a thematic analysis attempted to analyse psychosocial factors that emerged as barriers to participatory behaviour in learning. An interview guide was used during a semi-structured interview. The study investigated a group of adult learners attending a non-formal learning programme in Central Johannesburg, South Africa. The selection of participants included 6 males and 4 females between 21 years to 49 years of age. The study findings showed that the adult learners’ perceptions of family support as well as the learning environment support are key enabling factors, which assist the adult learner to develop learning capabilities. Negative experiences with prior schooling was also described as a psychosocial barrier to participation. Age was a socio-economic variable that influenced the type of stimuli participants identified as a psycho-social factor which influenced their decision to take up further learning. Adult learners felt confident to successfully complete their current and future studies however perceived their learning press as a motivating factor that impacted their decision to participate. Findings also suggested that experiences of adult learners are unique to their specific context and educational planning can integrate ways to address enhancement of learning experiences for a diverse learner audience in non-formal learning programmes. The study concluded that while adult learners acquire social competencies through accessing nonformal programmes, further learning support is necessary to overcome the social and psychological complexities needed to develop basic academic learning capabilities.

The present study examined a psychosocial-cognitive model that integrates recent findings on the independent effects of early maladaptive cognitive schemas (EMSs; Young, 1994) and psychosocial factors/stressors; viz., social support, expressed emotion, stressful life events and daily hassles, on level of depressive symptoms in young adults. Consistent with Beck's theory of depression, the expectation was that individuals with the EMSs would be more likely to respond to psychosocial stressors with higher levels of depression. Questionnaires measuring the selected psychosocial factors and EMSs were administered to 244 (82 male and 162 female) undergraduate students, mean age 19. Previous findings on the direct relationships between stressful life events, social support and EMSs, and level of depression were replicated. Except for daily hassles, the moderator role of the EMSs was largely disconfirmed when a conservative statistical test (Bonferroni correction) was applied to moderator analyses. With regard to perceived social support received from family and friends, present results were promising for the moderator effect of the EMSs of self sacrifice, functional dependency/incompetence and abandonment. The prediction equation to the criterion of depression indicated independent contributions of stressful life events, and the EMSs of abandonment, functional dependency/incompetence, and insufficient self control, accounting for half of the variance in depression. Taken together, the present data provided little support for the moderator effect of the EMSs rather supported Young's theory (1990) that maladaptive cognitions in themselves can produce increased levels of depression regardless of the presence of triggering stressors. / Master of Science

Syfte: Denna studie har som syfte att beskriva och jämföra den psykosociala arbetsmiljön hos två olika yrkeskategorier, sjuksköterska på vårdavdelning och personer anställda inom kundsupport och samband med upplevd hälsa. Bakgrund: Sjuksköterskor och personer anställda inom kundsupport arbetar i verksamheter där kraven ofta är höga. Stor arbetsbelastning i kombination med  tidspress kan leda leda till att personalen drabbas av ohälsa. Metod: En jämförande tvärsnittsstudie genomfördes våren 2013. Frågeformulär användes för insamlande av data.  Deltagarna bestod av 50 sjuksköterskor från 4 olika vårdavdelningar samt 48 personer anställda inom kundsupport från 2 företag. Data analyserades med statistikprogrammet SPSS version 20.0. Analyser som gjordes var frekvensberäkning, independent T-test (för medelvärden, standardavvikelser och p-värden) samt Pearsons korrelation för sambandsanalys. Resultat: Studien visade skillnader i upplevelse av psykosociala arbetmiljöområden  mellan de båda yrkeskategorierna. Samband mellan psykosocial arbetsmiljö och hälsa fanns i områdena Kontroll i arbetet, Skicklighet i arbetet, Social interaktion, Ledarskap, Organisationskultur-och klimat samt Grupparbete. Sambanden var tydligare för personer anställda inom kundsupport. Slutsats: Det kan finnas samband mellan hälsa och den  psykosocial arbetsmiljö.

The purpose of this thesis was to investigate overtraining (OT) and burnout (BO) in young athletes. Very little data on the incidence of OT in young athletes is available, hence the purpose of the 1st study was to investigate the prevalence and symptomology of NFOR (non-functional overreaching) and OT in young English athletes practicing different sports and competing across all competitive levels. Data from 376 young athletes (age 15.00 ± 1.97 y) indicated that 29 % had experienced at least one episode of NFOR/OT, and that NFOR/OT was significantly higher at national and international competitive levels (p < 0.01). Presenting symptomology was similar to that reported in adults, with both training and non-training stressors identified as important associates: losses of appetite during periods of hard training, frequent injuries and feelings of a lack of recovery from training, combined with apathy, feeling intimidated by opponents, and being “moody” were the most frequently reported physical and psychological symptoms, respectively. Training load, the commonly believed cause of NFOR/OT, had no significant association with NFOR/OT incidence; however competitive level and gender were significant predictors of NFOR/OT, albeit of a small explained variance (~4%). This study demonstrated that NFOR/OT is evident in young athletes and that the associated factors are multifactorial. The 2nd study monitored prospectively, 4 national-level female swimmers during an 11-month competitive season. Two swimmers (16.00 ± 1.41 y) were diagnosed as OT based on performance decrements (mean decrement of 9 %). One of the OT swimmers (OT2) presented with the classical psychophysiological profile, i.e. high monthly training volumes, low IgA concentration, depressed maximal lactates and high self-reported distress. Conversely the other OT swimmer (OT1) only presented with high Training Distress Scale (TDS) scores. These findings show that both, OT is a complex problem to diagnose and that it’s approach needs to be individualized. The 3rd study investigated the acute psycho-physiological responses to a 6-day training camp in 4 young female swimmers (15.00 ± 1.21 y), of which one was OT and another burnt out (OT1 swimmer from study 2). Both mal-adapted athletes showed performance decrements of ~8 % that lasted for more than 6 months. The OT swimmer, unlike her BO friend, showed a depressed IgA concentration, an unresponsive cortisol, reduced maximal lactate production, and high psychological distress, measured by the TDS. Both swimmers reported slower reaction times on the Stroop test, with the BO swimmer evidencing the worst performance. Finally, the BO swimmer reported very high scores on the Athlete Burnout Questionnaire (ABQ; reduced sense of accomplishment = 4.3; emotional/physical exhaustion = 2.6; sport devaluation = 3.7). This study showed that the psychophysiological profile of an OT swimmer may differ considerably from a BO athlete, with the ABQ being potentially the most efficient tool to diagnose BO. Once more, the individuality of the profiles reinforces the importance of investigating this phenomenon on a case by case basis. The final study used Interpretative Phenomenological Analysis to investigate the psychosocial nature of OT and BO in a 15 year-old female swimmer (OT1 and BO from studies 2 and 3, respectively) and revealed how multiple sources of training and non-training stressors all combined to negatively affect the athlete. The swimmer revealed a past in which she experienced rapid success at an early age and a training mentality of “the more, the better” which was promoted by parents, coaches and herself. Her strong unidimensional identity – centred on swimming – provided few recreational or social opportunities outside the sport. She also reported communication difficulties with her coaches, unwelcome changes in coaching staff, periods of separation from her family, and an over-involved mother. The findings of this thesis suggest that NFOR/OT and BO are issues that many young athletes have to contend with during their sporting careers. The multifactorial nature of these conditions mean that any screening, prevention or recovery interventions must address the problem from a holistic standpoint and as such, Ken Wilber’s (1998) Integral Model is proposed as a suitable framework through which this condition may be investigated in young athletes.

Background: Nowadays people more often are surviving intensive care, which makes it important to increase the knowledge about the experiences. Illusions, nightmares and unreal experiences are common and often linger for quite some time. Aim: The aim of the study was to illuminate patients' experiences after intensive care. Method: A literature-based study of 16 qualitative studies was conducted Results: A lot of the patients have difficulties moving on, and are haunted by their experience. Memories from the hospital stay are often hazy, and evokes a sense of lacking a part of their life story. There is a need to understand in order to move on. Despite of this, some of the patients manage to find happiness. They find a new meaning in life, and learn to look at things from a brighter side. Conclusion: To process the experience, there seems to be a need of further support. Also, patients need to receive more information about what to expect after discharge.