The author examined the effect of personality traits and the buffering effect of social support on psychological well-being of primary school teachers in inclusive education in Hong Kong. A sample of 200 Chinese teachers was surveyed. Hierarchical regression analysis showed that neuroticism was highly correlated with and accounted for depression, anxiety, and burnout in our sample. Family support was found to have significant main effect on depression (R² = 48%, ΔR² = 3%), and anxiety (R² = 63%, ΔR² = 2%) when the main effects of neuroticism were partialled out. Significant moderating effect of family support on the relationship between neuroticism and depression was found. To further investigate the effect of marital status on this buffering model, hierarchical regression analysis was conducted with teachers who were married and those who were single, respectively. The analyses revealed significant main effects of neuroticism regardless of teachers’ marital status. Significant main effect of family support and interaction Neuroticism x Family Support were only found for married teachers. These findings have implications that family support was an important factor in mitigating psychological distress particularly for teachers who were married and reported high level of neuroticism. Interventions of enhancing family support and school support were discussed. / published_or_final_version / Educational Psychology / Master / Master of Social Sciences

abstract / Family Medicine and Primary Care / Master / Master of Philosophy

Eine Laryngektomie führt zu teils irreversiblen Einschränkungen von Kommunikation, Sinneswahrnehmungen und Atmung. Unklar ist, bis zu welchem Ausmaß resultierende Symptome als „normal“ und „akzeptabel“ anzusehen sind. Ziel dieser Promotionsarbeit war daher die Festlegung von Cut-off-Werten für die gesundheitsbezogene Lebensqualität von laryngektomierten Karzinompatienten. In einer multizentrischen Querschnittsstudie bestimmten 28 Patienten und 24 Experten für den Lebensqualitätsfragebogen EORTC QLQ-C30 und das entsprechende Modul für Patienten mit Kopf-Hals-Tumoren (EORTC QLQ-H&N35), wo für sie die Grenze einer gerade noch akzeptablen Lebensqualität liegt. Untersucht wurde einerseits die Übereinstimmung zwischen diesen beiden Gruppen und andererseits, inwieweit eine repräsentative Gruppe von 157 Laryngektomierten die von den patienten-definierten Werte erreichte. Die Cut–off-Werte für die Symptomskalen wurden durch die Patienten zwischen 9,1 und 56,5 festgelegt (0 entspräche keinen Symptomen, 100 der höchsten Ausprägung). Die befragten Patienten akzeptierten dabei Einschränkungen der Sinne (56,5) sowie Husten (53,6) und Dyspnoe (44,0) im höchsten Maße, dagegen wurden Obstipation (9,1) sowie Übelkeit und Erbrechen (10,7) am wenigsten toleriert. Auf den Funktionsskalen (100 entspräche keinen Defiziten, 0 stärksten Beeinträchtigungen) wurden die meisten Einschränkungen in Rollenfunktion (63,7) und emotionalem Funktionsniveau (67,6) toleriert, am wenigsten dagegen eine Minderung der kognitiven Funktion (91,1). Die Experten hielten mehr Einschränkungen für akzeptabel als die Patienten, insbesondere in psychosozialen Domänen. Auf den Skalen wurden die patienten-definierten Zielwerte von 34,5% (Sinne) bis 86,5% (Obstipation) der 157 Laryngektomierten erreicht. Zusammenfassend zeigte sich, dass krankheits– oder therapiebedingte Einschränkungen bis zu einem hohen Maß von den Patienten toleriert und eher akzeptiert werden als unspezifische, eventuell auch behandelbare Symptome. Die hier festgelegten spezifischen Zielwerte könnten eine Hilfestellung bei der Interpretation von Lebensqualitätsdaten und auch der Therapie eines individuellen Patienten im klinischen Alltag sein.

Objective: The aim of this study was to examine the impact of social identity, coping style and cognitive impairment, on quality of life and well-being in a group of people with head injury compared to patients with chronic pain. Design: A correlational design using sixty participants recruited from Devon was employed: thirty adults with acquired brain injuries (ABI) were recruited from a charity and thirty adults with chronic pain difficulties from a NHS pain management service. Results: Analysis showed that there was little difference between the two groups on the variables measured. The role of social identity was not associated with better psychosocial outcome or coping style. Maladaptive coping strategies were associated with poorer adjustment in the ABI group and support-seeking strategies were correlated with improved outcomes in the chronic pain group. Objective neuropsychological variables were not associated with coping style, however, a relationship was observed between maladaptive coping styles and self-reported executive functioning. Conclusions: The results add to the literature on social identity, coping and quality of life post-ABI including improved understanding of how cognitive impairment might influence the use of particular coping strategies. The findings are discussed in relation to improved interventions to increase the use of more adaptive coping strategies.

People with dementia face considerable challenges to preserving identity. It has frequently been observed that group reminiscence work helps sufferers re-establish their past identities as well as position themselves as members of a group in the present. To date, little research has attempted to put these claims directly to empirical test. Drawing on social identity theory (Tajfel & Turner, 1979) this study explores the impact of a group reminiscence intervention in a sample of 58 cognitively impaired older adults living in residential care. Measures of identity, well-being and cognition were taken before and after participants took part in six weekly sessions of either group reminiscence or a group control activity. A Pretest-Posttest Control design was employed to explore the difference in average change between treatment conditions. The main findings showed no difference in average change between the two groups on measures of identity and well-being. However, the reminiscence group showed a greater overall improvement in memory than the control group. The theoretical implications and future directions for working clinically with cognitively impaired populations are considered.

Keloids are a fibroproliferative disorder of unknown etiology developing in the skin after injury or spontaneously. The aim of this thesis is to gain deeper insight into the role of TGF-β and its signaling pathway proteins, SMADs, in the pathogenesis of keloids and describe the gene expression profile in different keloid sites in the search for potential target genes for future treatment. Further aim is to develop an instrument to describe the quality of life of patients with keloids. We find cultured keloid fibroblasts to express an increased level of TGF-β1 mRNA and a decreased level of TGF-β3 mRNA compared to control skin. Keloid derived fibroblasts exhibit significantly decreased mRNA levels of TGF-β receptor type II (TβRII) and the ratio of TβRI/TβRII mRNA expression is increased. This suggests that a certain expression pattern of TGF-β subtypes and receptors may be important in keloid pathogenesis. Analysis of keloid derived fibroblasts reveal decreased SMAD3 mRNA expression and decreased ratio of SMAD2/SMAD3 mRNA implicating a disturbed SMAD signaling. Keloid fibroblasts up-regulate SMAD4 protein after stimulation with TGF-β1 and display diminished levels of the inhibitory proteins SMAD6 and 7. This may contribute to unlimited and deregulated TGF-β signaling leading to increased extracellular matrix production (ECM). The gene expression pattern is described in fibroblasts from different keloid sites using microarrays covering the whole human genome. This study reveals 105 regulated genes (79 genes are up- and 26 down-regulated) resulting in a unique gene expression profile in different sites of keloids, where progression or regression of the keloid process took place. In cells from the central part of keloids with clinical signs of regression, an up-regulation of apoptosis inducing genes as ADAM12 and ECM degrading genes as MMP19 is found. These genes may contribute to regression of keloids and might be possible future target genes for treatment. Overexpression of apoptosis inhibitors as AVEN and down-regulation of angiogenesis inhibiting genes as PTX3 found at the active margin of keloids may be responsible for the invasive character of the keloid margin. We develop a disease specific questionnaire to measure the quality of life of patients with keloids. We find two scales, psychological and physical impairment, describing the dimensions of quality of life in patients with scars. These two scales are independent of each other and show a high test-retest reliability. Single items which clinically characterize the disease show correlations to these scales. The results of this study demonstrate for the first time a severe impairment of quality of life of patients suffering from keloids and hypertrophic scars. In conclusion the described alteration in TGF-β expression and its receptors, the disrupted SMAD signaling pathway and the unique gene expression patterns in different keloid sites provide new knowledge on ECM formation and degradation in keloids. Regulatory genes in ECM homeostasis may be future target genes for keloid prevention, regression and treatment. The disease specific quality of life instrument of patients with keloids and scars is a useful tool to estimate success in future therapeutic efforts over time.

Introduktion: Amyotrofisk lateralscleros (ALS) är en progressiv neuromuskulär sjukdom, som bryter ner det motoriska nervsystemet. Sjukdomen är vanligare hos män än hos kvinnor och i Sverige insjuknar cirka 200 personer varje år. Det är vanligt att drabbas av depression någon gång under sjukdomsförloppet. Sjuksköterskan har i sin profession uppgifter som syftar till att främja hälsa, förebygga sjukdom, återställa/bevara hälsa och minska lidande. Syfte: Var att belysa patientens upplevelse av livskvalité och depression vid ALS. Metod: Metoden som användes var Polit & Beck (2012) niostegsmodell för en litteraturstudie. Databaserna som användes till litteraturstudien var CHINAL och PsycINFO. Artiklarna granskades och elva artiklar inkluderades i litteraturstudien då det svarade på syftet. Resultat: I resultatet framkom två huvudkategorier Emotionell påverkan och stöd. Kategorin emotionell påverkan framkom tre underkategorier möjlighet att bibehålla fysisk funktion, hanterbarhet och acceptans och betydelsen av upplevd kontroll. I kategorin stöd framkom två underkategorier socialt stöd och professionell hjälp. Det framkom att det fanns mycket frustration och rädsla i att förlora kontrollen av sin fysiska funktion. Detta påverkade livskvalitén och ökade risken för depression. De ALS-patienter som upplevde ett bra socialt stöd upplevde även en högre livskvalité. Slutsats: En ökad förståelse för hur patienter med ALS upplever sin livskvalité och hur deras psykiska hälsa påverkas kan vara till stor hjälp för sjuksköterskan i det hälsofrämjande arbetet.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences