Personer som drabbats av depression återfaller/återinsjuknar ofta en eller flera gånger i livet. Forskning har visat att b la demografiska faktorer, residualsymtom och insomni är prediktorer för återfall. Syftet med studien var därför att undersöka betydelsen av demografiska faktorer, residualsymtom och insomni för nivån av depression 6-12 månader efter avslutad behandling på en psykiatrisk specialistmottagning. Urvalet var alla patienter som diagnosticerats med depression eller recidiverande depression och genomgått KBT-terapi under perioden 2008 – september 2013, och som hade uppföljningsdata vid sex eller tolv-månader, vilket sammanlagt var 111 patienter. Beroendevariabel var resultat på formuläret Patient Health Questionnaire (PHQ-9). Resultaten visade att patienter med residualsymtom inte försämrades signifikant mellan eftermätningen och uppföjningsmätningen, ett fynd som inte överensstämmer med forskning på området. Regressionsanalyser visade ingen signifikant påverkan av kön, ålder och utbildningsnivå på senare nivå av depression vid uppföljningsmätning. Däremot visade regressionsanalyser att sömnbesvär, mätt med formuläret Insomnia Severity Index (ISI), vid framför allt eftermätning hade ett samband med senare nivå av depression vid uppföljningsmätningen. Resultaten indikerade att kvarstående sömnbesvär då behandlingen avslutades predicerade senare nivå av depression. Slutsatsen är att ett tillägg av en sömnintervention för de patienter som har insomni då behandlingen avslutas kan minska sannolikheten för återfall i depression. Då många patienter saknade uppföljningsdata kunde inga säkra slutsatser dras.

Empirical studies focusing on the subjective experience of health among patients in contact with the mental health services are rare and most questionnaires are based on a medical model that emphasizes objectively observed disease-oriented health indicators. In studies I and II perceptions of the concept of health among patients and nurses in mental health services were explored and described using a phenomenographic approach. The perceptions and description categories that emerged from these studies were transformed into a number of items forming a questionnaire intended to measure subjectively experienced health among patients in mental health services. In study III, a randomly selected sample was used to test the psychometric properties of the new Health Questionnaire. A factor analysis revealed three factors labelled Autonomy, Social Involvement and Comprehensibility. The purpose of study IV was to examine the construct validity of the Health Questionnaire. The hypothesis was that subjectively experienced health would be positively associated to self-esteem, empowerment and quality of life, and negatively associated to psychiatric symptoms, perceived stigmatization experiences and perceived attitudes of devaluation and discrimination. This hypothesis was mainly confirmed insofar that overall health was positively correlated to self-esteem, empowerment and quality of life and negatively correlated to symptoms, attitudes of devaluation and discrimination and rejection experiences. The results of this thesis show that health is more than just an absence of disease and support a focus on health promotion interventions in mental health care. / <p>Medicine doktorsexamen</p>

Text in Afrikaans / The purpose of this study was to determine the nature, origin and negative consequences of perfectionism and to set guidelines for the therapeutic handling of perfectionism. Two literature studies were done to investigate the phenomenon and therapeutic techniques with regards to perfectionsim. A questionnaire was developed as aid to the therapist to identify negative perfectionism and associated problem areas. An empirical study was done to investigate the effectivity of the questionnaire and to compose a program and guidelines for the therapist and perfectionist. Results of the study indicated that negative perfectionism resulted in affective, cognitive, interpersonal and behavioural consequences for the client. It further showed that it is necessary to find the origin of the client's perfectionism and to give them insight in their problem to enable the therapist to succesfully apply cognitive behavioral therapy. / Educational Studies / M. Ed. (Voorligting)

Note from the Library: The fulltext electronic version of this thesis has been removed due to restricted content. Please contact the Unisa Library for more details. / Industrial and Organisational Psychology / M.A. (Industrial Psychology)

A literature study was undertaken to investigate the experience of loss and grief in the different developmental stages, as well as to identify characteristics of loss and grief in the young child. Guidelines have been compiled on how to handle loss and grief in young children. The empirical study comprised of workshop presentations. Through these presentations it was also determined as to whether parents and children would benefit from such workshops, as well as if the information regarding loss and grief addressed the parents’ needs. The empirical study found that parents are ignorant about loss and grief in the young child. However, all the parents had questions about loss and grief. After the workshops parents indicated that they became aware of positive changes in their own behaviour towards their children, and also in that of their children. One of the biggest problems in handling loss and grief in the young child seemed to be open and honest communication. / Educational Studies / M.Ed. (Guidance and Counseling)

L'objectif de la présente étude vise à déterminer si la présence de constipation dyssynergique durant la grossesse est un facteur de risque des déchirures du troisième et du quatrième degré lors d'un premier accouchement vaginal. Un dispositif de recherche cas-témoin rétrospectif a été utilisé. La population était constituée de femmes primipares recrutées à l'aide du registre de la salle des naissances selon leur degré de déchirure périnéale. Les participantes ont ensuite été classées en deux groupes. Le premier groupe, les cas, était constitué de femmes ayant eu une déchirure du troisième ou du quatrième degré. Le deuxième groupe, les témoins, était composé de femmes présentant un périnée intact ou une déchirure du premier ou du deuxième degré. La variable dépendante, soit le degré de déchirure périnéale, a été identifiée à l'aide du dossier obstétrical. La variable indépendante principale, soit la présence de constipation dyssynergique, a été documentée à l'aide du questionnaire Knowles-Eccersley-Scott-Symptom (KESS) envoyé par la poste aux femmes primipares. Les autres facteurs de risque des déchirures périnéales ont été documentés à l'aide du dossier obstétrical et d'un questionnaire maison postal. Un modèle de régression logistique, avec le rapport de cote comme mesure d'association et un intervalle de confiance de 95%, a été utilisé afin de déterminer les facteurs influençant les déchirures du troisième et du quatrième degré. Au total, 549 femmes primipares ont participé à l'étude ; 140 étaient dans le groupe des cas et 409 dans le groupe témoin. Dix-sept pourcent des femmes du groupe des cas et 7,6% des femmes du groupe témoin souffraient de constipation dyssynergique (p=0,001). Une régression logistique multiple a démontré que la présence de constipation dyssynergique est associée à 2,94 fois (95%Cl : 1,47 - 5,88) plus de risque de déchirure du troisième et du quatrième degré. En conclusion, cette étude a démontré que la présence de constipation dyssynergique durant la grossesse augmente le risque de subir une déchirure du troisième et du quatrième degré. Une étude prospective devra cependant être conduite afin d'établir la relation de cause à effet entre la présence de l'incoordination des muscles du plancher pelvien rencontrée dans la constipation dyssynergique et les déchirures du troisième et du quatrième degré."--Résumé abrégé par UMI.

Thesis (M.A. (Psychology))--University of South Africa,2002

Thesis (DPhil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: It is a general assumption in psychology that past social relationships and experiences influence present social behaviour. With attachment theory and current social-cognitive theory as conceptual basis, the present study focused on the association between past experiences with significant others and the current processing of interpersonal information. By means of a 2x3x4 experimental design the study investigated the influence of chronic accessibility and subliminal priming (of significant other representations) on the accuracy and speed of processing scripted interpersonal information. One hundred and thirty seven university students took part in two sessions no more than two weeks apart. In session one they completed the Attachment Style Questionnaire (ASQ; Feeny, Noller & Hanrahan, 1994), and provided the names of positive and negative significant others. According to a median split of the Confidence Scale of the ASQ, they were assigned to a chronic positive or a chronic negative group, assuming that the information based on predominantly positive or negative experiences with positive or negative significant others will be chronically more accessible. In session two, in an individual computer task, they were subliminally primed (33 ms) with a control word or the name of the positive or negative significant other to increase the accessibility of the appropriate memory structures. They were then asked to read a positive, negative, mixed or ambiguous script of an interpersonal event and complete a memory test of 36 interpersonal statements (nine positive, nine negative, nine ambiguous and nine filler statements). The accuracy and response time for every statement was recorded, and the response times of accurate responses for positive and negative scripts were included in the main analysis. Separate univariate analyses of the differences between positive and negative priming per polarity of chronic group and script supported the priming hypothesis. The average response time of the chronic negative group was fastest when they received a negative prime (p = .039), and the positive group was fastest when they received a positive prime (p = .000). The results of a two-way analysis of variance for chronic group and script showed a highly significant interaction effect between chronic group and script (p = .000). When the primes were congruent to the scripts, the chronic groups were significantly faster in recognising statements from a congruent script. The results supported the conjunctive model of priming. The implications of these findings for the understanding of the cognitive structures and processes involved in processing interpersonal information are discussed, with specific reference to relational schemas and attachment working models. Possible directions for future research as well as the application of the results are also described. / AFRIKAANSE OPSOMMING: Dit is ‘n algemene aanname in die sielkunde dat sosiale verhoudinge en ervarings uit die verlede ‘n invloed het op huidige sosiale gedrag. Vanuit die bindingsteorie en die huidige sosiaal-kognitiewe teorie as konseptuele uitgangspunt, fokus die huidige studie op die assosiasie tussen ervaringe met betekenisvolle persone in die verlede en die huidige prosessering van interpersoonlike inligting. Met behulp van ‘n 2x3x4 eksperimentele ontwerp is ondersoek ingestel na die invloed van chroniese toeganklikheid en subliminale opwekking (van geheuevoorstellings van betekenisvolle ander) op die akkuraatheid en spoed waarmee interpersoonlike tekste verwerk word. Eenhonderd-sewe-en-dertig universiteitstudente het deelgeneem aan twee sessies wat nie meer as twee weke na mekaar plaasgevind het nie. Tydens sessie een het die deelnemers die Attachment Style Questionnaire (ASQ; Feeny, Noller & Hanrahan, 1994) voltooi en die name van positiewe en negatiewe betekenisvolle persone voorsien. Op grond van die mediaan-verdeling van die Selfvertroue Skaal van die ASQ is die deelnemers toegewys aan ’n chronies positiewe of chronies negatiewe groep, met die veronderstelling dat inligting gebaseer op oorwegend positiewe of negatiewe ervarings met positiewe of negatiewe betekenisvolle ander deurlopend meer toegankilk sal wees. Tydens sessie twee, wat ’n individuele rekenaartaak behels het, is ’n subliminale stimulus (33 ms) van ’n kontrole-woord, of die naam van ’n positiewe of negatiewe betekenisvolle ander aan hulle aangebied om die toeganklikheid van die toepaslike geheue-strukture verder te verhoog. Daarna is hulle versoek om ‘n positiewe, negatiewe, gemengde of dubbelsinnige teks van ’n interpersoonlike gebeurtenis te lees en ’n geheuetoets van 36 stellings te voltooi wat bestaan het uit nege positiewe, nege negatiewe, nege dubbelsinnige en nege neutrale stellings. Die akkuraatheid en reaksiespoed van elke stelling is gemeet en die reaksietyd van die akkurate response op stellings uit positiewe en negatiewe tekste is in die primêre ontleding ingesluit. Die resultate van onafhanklike eenveranderlike ontledings van die verskille tussen positiewe en negatiewe opwekking per polariteit van chroniese groep en teks, het die hipotese van opwekking ondersteun. Die gemiddelde responstyd van die chroniese negatiewe groep was die vinnigste wanneer hulle die negatiewe stimulus ontvang het (p = .039) en die van die positiewe groep was die vinnigste wanneer hulle die positiewe stimulus ontvang het (p = .000). Die resultate van ’n tweerigting variansieontleding van chroniese groep en teks het ‘n beduidende interaksie tussen chroniese groep en teks aangedui (p = .000). Wanneer die opwekkingstimuli kongruent met die tekste was, was die chroniese groepe betekenisvol vinniger in die herkenning van stellings van die kongruente teks. Die resultate ondersteun ’n konjunktiewe model van opwekking. Die implikasies van die bevindinge vir die verstaan van die kognitiewe strukture en prosesse betrokke by die verwerking van interpersoonlike inligting word bespreek, met spesifieke verwysing na verhoudingskemas en die gebruiksmodelle in bindingsteorie. Riglyne vir toekomstige navorsing op die gebied word verskaf, en die implikasies vir die praktiese toepassing van die resultate word bespreek.

Renal replacement therapy, in the form of dialysis or transplantation, is the cornerstone of management for end-stage renal disease. UK renal registry shows nearly half of those needing renal replacement therapy are treated by dialysis – predominantly by haemodialysis. Patients on renal replacement therapy have increased mortality risk compared to age matched general population. Moreover, some specific subgroups of patients on haemodialysis have increased risk of mortality than expected. The survival benefit seen in women in the general population is attenuated resulting in similar survival for men and women on haemodialysis therapy. In addition, obese individuals and those of non-Caucasian origin have better survival outcome. Though the underlying reason for these findings is not clear and is likely to be multi-factorial, it has been hypothesised that this paradox could be due to the current practice of normalising dialysis dose to total body water. A number of metabolic factors – body surface area, resting energy expenditure and total energy expenditure – have been proposed as alternative to total body water for scaling dialysis dose. There were two overarching aims of this work – one was to study the effect of declining renal function on resting and total energy expenditure and to study the influence of various energy expenditure measures on uraemic toxin generation. The second was to study the impact on survival outcome of using these alternate parameters for normalising dialysis dose and to derive dialysis dose adjustments based on these metabolic parameters. In order to study these aims, studies were designed to explore different aspects of energy expenditure measures along with a longitudinal study to examine the impact of these parameters on survival outcome. The relationship between energy metabolism, body composition and uraemic toxin generation was studied with a retrospective analysis of 166 haemodialysis patients in whom urea generation rate was used as surrogate marker of uraemic toxin generation. It was found that total energy expenditure and fat-free mass predicted uraemic toxin generation after adjustment for other relevant variables. This study provided the preliminary data which was useful in designing further studies for this work. The effect of renal function on resting and total energy expenditure was studied in 80 patients with varying stages of chronic kidney disease who were not on renal replacement therapy. Resting and total energy expenditures were measured directly using gold-standard methods. It was found that declining renal function did not have a significant influence on either of these measures. This supports the hypothesis that metabolic rate is the driving force for glomerular filtration rate and not vice-versa. The directly measured energy expenditure measures were also found to have a moderately strong relationship with urea generation rate in these patients not on renal replacement therapy. The impact of physical activity on uraemic toxin generation, and thereby dialysis requirement, was studied in a prospective cross-sectional study of 120 haemodialysis patients in whom the physical activity was measured by an accelerometer device. Results from the study showed physical activity level to be a significant predictor of uraemic toxin generation after adjustment for gender and body size differences. This study results stressed the importance of adjusting dialysis dose based on individual’s physical activity level. To study the impact of using metabolic factors as normalising parameter for scaling dialysis dose on survival outcome, a large-scale longitudinal study was conducted with 1500 maintenance haemodialysis patients recruited for the study. Dialysis dose-related parameters and survival outcomes were collected at baseline and at various time points during the follow-up period of 18 months. Study results were analysed in two parts - the theoretical basis for using these metabolic factors as scaling parameters was explored which showed that current minimum target dialysis dose risks under-dialysis in certain subgroups of patients and using these alternative parameters may provide a more equivalent dialysis dose across individuals of different body sizes and gender. With these results arguing for potential use of the alternative parameters, the impact on survival of using them were examined. It was found that all three parameters performed better than the current parameter (total body water) with regards to predicting mortality. Total energy expenditure was found to be the best parameter with the lowest hazard ratio for risk of death. The study data was also analysed to derive an algorithm for adjustment of minimum target dialysis dose based on body size and physical activity level. This newly derived minimum dose target was also shown to impact on survival with those underdialysed based on this criteria having poorer survival outcomes. To understand the impact of whole body protein turnover on resting energy expenditure and uraemic toxin generation, a cross-sectional study was conducted on 12 patients with advanced CKD – 6 each in pre-dialysis CKD and haemodialysis group. It was found that haemodialysis patients had higher rate of protein turnover compared to pre-dialysis patients. Whole body protein turnover was found to contribute significantly to resting energy expenditure and had a moderately strong relationship with urea generation rate. In the course of these studies, two questionnaire tools have been validated for use for clinical and research purposes – one is a self-report comorbidity questionnaire and the other, the Recent Physical Activity Questionnaire. The comorbidity questionnaire was developed as part of this work and was validated against Charlson Comorbidity Index. The Recent Physical Activity Questionnaire was validated for physical activity data collection and energy expenditure calculation against the gold-standard doubly labelled water method. In conclusion, it has been demonstrated that metabolic factors such as body surface area, resting energy expenditure and total energy expenditure are more closely related to uraemic toxin generation compared to total body water. It has also been demonstrated that physical activity contributes to metabolic waste production and may necessitate changes in dialysis requirement. It has been shown that these metabolic factors, when used as scaling parameter for dialysis dosing, may predict survival better than the current parameter in use. The algorithm for dialysis dose adjustment and the questionnaires validated in this work have provided novel tools for further research studies and clinical practice. The central hypothesis of this work is that some metabolic factors may be better markers of uraemic toxin generation compared to total body water. It is hypothesised that modifications in dialysis practice based on these factors may improve the quality of haemodialysis and favourably impact on survival outcome for patients with end-stage renal disease. The work presented here largely supports this hypothesis.

The aim of the present study was to develop and validate a Swedish questionnaire assessing conditions of actual work flexibility and its determinants. Data was collected by qualitative Think aloud- interviews with three persons, and through discussions with a reference group. The results from the interviews and discussions showed that corrections were needed for some of the concepts, questions, design and number of items. Next, a cross-sectional study was performed by sending the adjusted questionnaire to three companies in Sweden (N = 266), which was answered by 92 employees. The results supported the adjustments and the questionnaires’ content validity and face validity (&gt; 95 % of the employees agreed). Three Principal component analyses showed comprehensible factors for the three main areas of questions: determinants of actual flexibility, technology use, and work-non-work balance, indicating structural validity of the questionnaire. Furthermore, hypothesis testing showed as expected that the most index variables of actual work flexibility could significantly separate the groups with varying extents of regulated work, indicating construct validity. To conclude, this Master thesis has revealed several question domains valid for inclusion in future surveys regarding actual work flexibility and associations with health and wellbeing at work. / Dagens teknik möjliggör för anställda att arbeta mer flexibelt i tid och rum, men forskningen ger ännu en oklar bild över om det har en positiv eller negativ inverkan på de anställdas hälsa och välbefinnande. Den här oklarheten kan ha att göra med att det inom forskningen funnits en brist på tillförlitliga enkätbaserade mätinstrument som kan fånga upp hur flexibelt arbete läggs upp och tillämpas i olika företag. Syftet med den här uppsatsen var att utveckla och validitetstesta ett svenskt frågeformulär som kan fånga upp determinanter för- och förekomsten av faktisk flexibilitet hos tjänstemän med olika grad av reglerat arbete. En enkät utvecklades och dess innehålls- och ytvaliditet prövades genom kvalitativa intervjuer med tre personer, samt i diskussioner med referenspersoner. Enkäten skickades därefter ut till 266 tjänstemän inom tre företag med olika grad av flexibelt arbete och besvarades av totalt 92 anställda. En enkel kvalitativ innehållsanalys av intervjuerna och diskussionerna visade att enkäten behövde korrigeras utifrån de fyra temaområdena, begrepp, frågor, struktur/enkätupplägg och omfattning. Efter korrigeringarna indikerade svaren från de anställda på företagen att frågor och begrepp nu hade god innehållsvaliditet och ytvaliditet (&gt; 95 %), men att frågornas struktur/enkätupplägg kunde tydliggöras (16,3 %). Tre Principalkomponentanalyser på enkätdata visade även att tydliga faktorer kunde dras ut för determinanterna, samt för de två delområdena inom faktisk flexibilitet (teknik och uppkoppling; balans mellan arbete- och privatliv), vilket stödjer strukturell validitet. Vidare visade hypotesprövningen att merparten av frågorna om faktisk flexibilitet gav signifikanta skillnader mellan grupper som har olika grad av reglerat arbete, vilket stödjer begreppsvaliditet. Resultaten bör betraktas som ett första steg i utvecklingen av ett svenskt frågeformulär om flexibelt arbete. Den här uppsatsen har genererat flera valida frågeområden som kan inkluderas vid framtida kartläggningar av flexibilitetens samband med hälsa och välbefinnande i arbetet.