The overall aim of this thesis is to increase our knowledge of relevant exposure parameters when discussing possible health implication from exposure to radiofrequency electromagnetic fields (RF), especially effects that might occur at non-thermal levels. In this thesis an effort is made to broaden the exposure assessment and to take the exposure time into account and combine it with the Specific Absorption Rate (SAR) and the field parameters (electric and magnetic field strength) to approach a dose concept. In the first part of the thesis self-reported subjective symptoms among mobile phone users were studied. As a basis for this an epidemiological study among mobile phone users was completed with the main hypothesis that users of the digital transmission system GSM experience more symptoms than users of the older analogue NMT transmission system. The hypothesis was falsified, but an interesting side finding was that people with longer calling time per day experienced more symptoms than people with shorter calling time per day. The time-aspect (long duration phone call etc.) was also found to be relevant for the occurrence of symptoms in association with mobile phone use as well as duration of symptoms. The new suggested dosimetric quantity Specific Absorption per Day (SAD), in which both calling time per day as well as the measured SAR1g are included showed a stronger association to the prevalence of some of the symptoms, such as dizziness, discomfort and warmth behind the ear compared to both CT and SAR1g alone. In the second part whole body exposure conditions were considered. Methods to measure the induced current were examined in an experimental study, where different techniques were compared in different grounding conditions. The results were used in a study of operators of RF plastic sealers (RF operators) where the health status as well as the exposure were studied. The results showed that RF operators are a highly exposed group, which was confirmed by the fact that 16 out of 46 measured work places exceeded the ICNIRP guidelines. Headaches were found to be associated with the mean value of the time integrated E-field during a weld (E-weld) and the warmth sensations in the hands (warm hands) with the time integrated E-field exposure during one day (E-day). The general findings in this thesis indicated that time should be included in the exposure assessment when studying non-thermal effects such as subjective symptoms in connection with RF exposure. The thesis proposes two different methods for doing this, namely timeintegrated exposure [V/m x t and A/m x t] and dose [J/kg].

This study was designed to increase our understanding of remitted major depressive disorder among parents and how it relates to child externalizing problems. Specifically, various facets that may differentiate one remitted clinical depressive presentation from another were investigated: past depression severity, past depression chronicity, and residual or current levels of depressive symptoms. Relations of these characteristics of parent depression with youth externalizing symptomatology, as well as the mediating role of negative parenting, were studied among 118 parent-child dyads across two sites. Specifically, three hypotheses were tested: (1) all three indicators of parental depression would have a significant relationship with adolescent externalizing problems when examined individually; (2) when examined simultaneously, past depression chronicity and current depressive symptoms, but not past depression severity, would each have a unique association with young adolescent externalizing outcomes; and (3) negative parenting would partially mediate the relationship of each of the three indicators (i.e., current parental symptoms, past depression chronicity, past depression severity) with child externalizing behavior. Results revealed that residual parent depressive symptoms were most salient in their association with youth externalizing behavior. Further, negative parenting mediated this relationship for parent, but not child, report of child problem behavior. Findings highlight the importance of further research to investigate remitted clinical depression in parent populations, and the impact on child behavioral adjustment. As well, implications for preventive and other intervention efforts are considered.

Background: Understanding of child development is predominantly based on maternal influences on children’s emotional, behavioural and cognitive outcomes. Although there has been an increase in research focus on fathers in recent years suggesting that fathers are important in the development of their child, there is still a shortage of research on fathers in the literature. Research has shown fathers negatively impact on their children’s emotional, behavioural and cognitive development, but there is a lack of understanding regarding the specific mechanisms through which paternal depression influences their children. The aim of the current PhD is to address this gap in the literature and this is done by: a) investigating the prevalence of depressive symptoms among fathers of children (aged 9 months – 7 years) and their associated risk factors; b) investigating the association between paternal depressive symptoms and different aspects of parenting such as warmth, conflict and involvement; c) testing whether fathers’ parenting mediated any association between paternal depressive symptoms and children’s emotional, behavioural and cognitive outcomes; and d) investigating the association between paternal depression/depressive symptoms and insecure father-child attachment. Methods: There are two methods employed for this PhD. One is secondary data analysis of the large and representative Millennium Cohort Study (MCS) (investigating a, b and c) and the other is primary data analysis of the Fathers-in-Focus (FIF) study using interview and observational methods to investigate (d). Results: Paternal depressive symptoms peak during the first year of children’s lives and then gradually decline between the first year and 7 years old (a). These depressive symptoms across the first 7 years of fatherhood were consistently associated with maternal depressive symptoms, relationship conflict and unemployment (a). Moreover, depressive symptoms in the first year were associated with father-child conflict, but not father-child warmth or involvement in parenting activities (b). Father-child conflict mediated the association between paternal depressive symptoms and children’s emotional and behavioural outcomes (c). Finally, father’s depressive symptoms were not associated with father-child attachment or children’s cognitive development (c and d). Conclusion: The key finding of this PhD is that father-child conflict is an important factor that may be associated with the risk transmission of paternal depressive symptoms and children’s emotional and behavioural outcomes. Therefore, it may be beneficial for service providers and clinicians to target interventions with depressed fathers’ and at-risk families.

Introduction: Health professionals performing their social health service (SHS) in rural communities could be at risk of developing depression. Moreover, those who migrate from farther places to perform their SHS could have an increased risk. The objective of this study was to evaluate the association between place of origin and the presence of depressive symptoms, in health professionals performing rural social health service (SHS) in Ancash, Peru. Methods: This was a cross-sectional study. During April 2015, a survey was applied to health professionals performing SHS in the Peruvian Ministry of Health (MINSA) facilities in Ancash. The main outcome was the presence of depressive symptoms, defined as a score =2 points in the Patient Health Questionnaire-2. The main exposure was the place of origin, defined as the place where the subjects completed their undergraduate professional studies (Ancash, Lima city or others). Poisson regressions with robust variance were performed to calculate crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence interval (95%CI). Results: From 573 health professionals performing their SHS in MINSA in Ancash, 347 were included in the study. The mean age was 27.2±4.5 years, 78.7% were women, and 14.7% scored positive for depressive symptoms. Those who had completed their undergraduate professional studies in Lima city had a higher prevalence of presence of depressive symptoms compared to those who did in Ancash (aPR=2.59, 95%CI=1.23-5.45). Conclusions: Those who completed their undergraduate professional studies in Lima had a higher prevalence of depressive symptoms than those who did in Ancash. Possible explanations include the difficulty in visiting family and friends, acculturation, and lack of Quechua language proficiency. / Revisión por pares

Cerebrovascular disease is one of the leading causes of death among persons aged 50 and above and when a stroke does not result in death, it can cause residual cognitive, motor and behavioural disabilities. Emotional effects of brain injury range from reduced quality of life to various neuropsychiatric disturbances and are of great interest in the South African context and throughout the world as they pose a major obstacle to the rehabilitation process. This study explored the relationship between emotion processing, neuropsychiatric symptoms and quality of life specifically, how they operate following a cerebrovascular accident. In order to achieve this, an adult population of high functioning stroke survivors completed the emotion processing scale (EPS), Minnesota Multiphasic Personality Inventory (MMPI-2) and comprehensive quality of life inventory (ComQOL-A5) and a factor analysis provided statistical evidence suggestive of intercorrelations among the variables. The results lent support to this theoretical relationship and determined the structure of this relationship as follows: The satisfaction with quality of life after a stroke that relates to traditional masculine or feminine roles, when not fulfilled, related to neuropsychiatric symptoms of general maladjustment i.e. schizophrenia and psychopathic deviate. The second factor encompassed symptoms of general anxiety both internally and externally directed: Internally directed anxiety included symptoms of hypochondriasis and hysterical conversion, while externally directed anxiety included neuropsychiatric symptoms of paranoia. The third factor was associated with mood modulation in that elevated mood connected to neuropsychiatric symptoms of hypomania and depressed mood connected to symptoms of depression and social introversion. Finally, emotion processing and psychasthenia made up the last principal component, namely emotion modulation. This meant that avoidance of emotional iv content, suppression of emotion, unprocessed emotion etc. related to neuropsychiatric symptoms of obsessions or compulsions. High functioning stroke survivors’ behaviours were thus characterised by general maladjustment, anxiety, and symptoms related to mood and emotion modulation. This study underlies the importance of diagnosing, treating and monitoring stroke survivors’ emotional alterations and suggests the usefulness of its application in clinical settings to evaluate the effectiveness of treatments or more general interventions to improve the neuropsychiatric sequelae and quality of life of stroke survivors. Improved understanding of these constructs from the stroke survivor’s perspective has obvious impact for the therapeutic interventions inherent in stroke rehabilitation and as such, contributes towards the fields of neuropsychology, neuropsychotherapy and the social sciences.

Distonia é o terceiro distúrbio do movimento mais comum. Caracteriza-se por contrações musculares sustentadas ou intermitentes que podem gerar posturas anormais. Nos últimos anos, muitos estudos tentaram relacionar a presença de sintomas não motores como parte da manifestação clínica dessa patologia; no entanto, os resultados ainda são controversos. Objetivo: Avaliar a prevalência de sintomas não motores em pacientes com distonia focal ou segmentar idiopática e seu impacto na qualidade de vida. Métodos: Foram avaliados 80 pacientes e 80 controles sem patologias neurológicas pareados para sexo, idade e anos de estudo. Os pacientes foram questionados quanto ao tempo e gravidade de doença. Dados demográficos, comorbidades e medicações em uso foram coletados de ambos os grupos. Os sintomas não motores foram avaliados por meio de escalas validadas para a população brasileira. Foram avaliados sintomas de depressão, ansiedade, fobia social, apatia, sonolência diurna, qualidade do sono, cognição e dor, assim como qualidade de vida. Resultados: 80 pacientes foram avaliados: 28 com diagnóstico de blefaroespasmo ou distonia de Meige, 28 com distonia cervical ou orocervical e 24 com distonia de membro, em sua maioria, distonia tarefa-específica da escrita (cãibra do escrivão). Os pacientes apresentaram mais sintomas de depressão, ansiedade e apatia do que os controles, assim como uma pior qualidade do sono e mais queixas de dor. Ao avaliarmos pelo tipo de distonia, os pacientes com blefaroespasmo foram os mais sintomáticos com relação a esses sintomas. Qualidade de vida foi pior nos pacientes que nos controles. Conclusões: Pacientes com distonia, principalmente com blefaroespasmo, apresentaram maior prevalência de sintomas de depressão, de ansiedade, de apatia, pior qualidade do sono e dor. Esses sintomas causaram impacto negativo na qualidade de vida desses pacientes / Dystonia is the third most common movement disorder. It´s characterized by sustained or intermittent muscle contractions causing abnormal postures. In recent years many studies have sought to relate the presence of non-motor symptoms as part of clinical manifestation of this disease, however, results are still controversial. Objective: To assess prevalence of non-motor symptoms in patients with idiopathic focal or segmental dystonia and its impact in life quality. Methods: We evaluated 80 patients and 80 healthy controls matched for sex, age and years of schooling. Questions about the time at onset and severity of illness were asked to patients. Clinical and demographic data were noted in both groups. Non-motor symptoms were assessed using validated scales for Brazilian population. We assessed symptoms of depression, anxiety, social phobia, apathy, daytime sleepiness, sleep quality, cognition and pain, as well as quality of life. Results: We evaluated 80 patients: 28 with blepharospasm or Meige syndrome, 28 with cervical or orocervical dystonia and 24 with limb dystonia, mostly with specific writing task dystonia (writer´s cramp). Patients had more symptoms of depression, anxiety and apathy than controls, as well as worse quality of sleep and more pain complaints. Analysing by type of dystonia, patients with blepharospasm were the most symptomatic group in relation to these symptoms. Quality of life was worse in dystonic patients. Conclusions: Patients with dystonia, mainly those with blepharospasm, had a higher prevalence of symptoms of depression, anxiety, apathy, worse quality of sleep and pain. These symptoms had a negative impact on these patients\' quality of life

Distonia é o terceiro distúrbio do movimento mais comum. Caracteriza-se por contrações musculares sustentadas ou intermitentes que podem gerar posturas anormais. Nos últimos anos, muitos estudos tentaram relacionar a presença de sintomas não motores como parte da manifestação clínica dessa patologia; no entanto, os resultados ainda são controversos. Objetivo: Avaliar a prevalência de sintomas não motores em pacientes com distonia focal ou segmentar idiopática e seu impacto na qualidade de vida. Métodos: Foram avaliados 80 pacientes e 80 controles sem patologias neurológicas pareados para sexo, idade e anos de estudo. Os pacientes foram questionados quanto ao tempo e gravidade de doença. Dados demográficos, comorbidades e medicações em uso foram coletados de ambos os grupos. Os sintomas não motores foram avaliados por meio de escalas validadas para a população brasileira. Foram avaliados sintomas de depressão, ansiedade, fobia social, apatia, sonolência diurna, qualidade do sono, cognição e dor, assim como qualidade de vida. Resultados: 80 pacientes foram avaliados: 28 com diagnóstico de blefaroespasmo ou distonia de Meige, 28 com distonia cervical ou orocervical e 24 com distonia de membro, em sua maioria, distonia tarefa-específica da escrita (cãibra do escrivão). Os pacientes apresentaram mais sintomas de depressão, ansiedade e apatia do que os controles, assim como uma pior qualidade do sono e mais queixas de dor. Ao avaliarmos pelo tipo de distonia, os pacientes com blefaroespasmo foram os mais sintomáticos com relação a esses sintomas. Qualidade de vida foi pior nos pacientes que nos controles. Conclusões: Pacientes com distonia, principalmente com blefaroespasmo, apresentaram maior prevalência de sintomas de depressão, de ansiedade, de apatia, pior qualidade do sono e dor. Esses sintomas causaram impacto negativo na qualidade de vida desses pacientes / Dystonia is the third most common movement disorder. It´s characterized by sustained or intermittent muscle contractions causing abnormal postures. In recent years many studies have sought to relate the presence of non-motor symptoms as part of clinical manifestation of this disease, however, results are still controversial. Objective: To assess prevalence of non-motor symptoms in patients with idiopathic focal or segmental dystonia and its impact in life quality. Methods: We evaluated 80 patients and 80 healthy controls matched for sex, age and years of schooling. Questions about the time at onset and severity of illness were asked to patients. Clinical and demographic data were noted in both groups. Non-motor symptoms were assessed using validated scales for Brazilian population. We assessed symptoms of depression, anxiety, social phobia, apathy, daytime sleepiness, sleep quality, cognition and pain, as well as quality of life. Results: We evaluated 80 patients: 28 with blepharospasm or Meige syndrome, 28 with cervical or orocervical dystonia and 24 with limb dystonia, mostly with specific writing task dystonia (writer´s cramp). Patients had more symptoms of depression, anxiety and apathy than controls, as well as worse quality of sleep and more pain complaints. Analysing by type of dystonia, patients with blepharospasm were the most symptomatic group in relation to these symptoms. Quality of life was worse in dystonic patients. Conclusions: Patients with dystonia, mainly those with blepharospasm, had a higher prevalence of symptoms of depression, anxiety, apathy, worse quality of sleep and pain. These symptoms had a negative impact on these patients\' quality of life

Objective: Pregnancy requires thorough monitoring and management because not only is it a time where normal physiological and psychological changes put a mother under stress and strain, but maternal sensitivity begins to develop, and the developing foetus needs a well regulated intrauterine environment. Such important processes can be compromised by abnormal or inconsistent physiological and emotional regulation. The study aimed to explore pregnant women’s regulation capacity at rest and their physiological reactivity, and return to physiological baseline, in response to infant related stimuli. Methods: Extended analyses of previously acquired psycho-physiological data at baseline, and pre- and post-presentation of relevant audio-visual stimuli. Results: Baseline physiological activity was significantly different between pregnant participants and controls. There were, however, no other differences in reactivity. Conclusion: Findings were inconsistent with previous research which indicates infant stimuli to become increasingly salient throughout pregnancy.

Abstrakt Bakgrund: Hjärtinfarkt kan vara livshotande och kräver omedelbar sjukhusvård. För att reducera skada på hjärtat är det viktig att patienten kommer till omedelbar reperfusionsbehandling. Om symtom inte känns eller relateras till hjärtat, kan det göra att personen avvaktar med att söka vård och därmed försenas diagnos och behandling vilket kan leda en till ökad risk för att dö. För att öka kunskapen inom detta område vill vi med vår analys undersöka patienters upplevelse av symtom vid en akut hjärtinfarkt. Syfte: Att undersöka patientens upplevelse av symtom vid en akut hjärtinfarkt. Metod: En integrativ litteraturöversikt genomfördes vilken baserades på sökningar i Cinahl och Pubmed. Nio vetenskapliga artiklar med både kvalitativ och kvantitativ ansats valdes ut. Resultat: Studierna visade stor variation av patienternas upplevda symtom och symtomdebutens karaktär. Det fanns även skillnader mellan förväntade och upplevda symtom och resultatet visade att det råder en generell kunskapsbrist om AMI symtom bland allmänheten. Detta sammantaget leder till fördröjning i patienternas beslutsprocess för att uppsöka vård och behandling. Slutsats: Om tiden till behandling kortas, kan det leda till stora förbättringar vad gäller personens hälsa, välmående och livskvalitet. Det borde därmed finnas ett stort intresse att investera i strategier för att öka kunskapen om de olika och varierande symtom vid akut hjärtinfarkt hos allmänheten och även hos yrkesverksamma inom vård- och omsorg.

Lung cancer has developed from a rare condition into the leading cause of cancerrelated death in the United Kingdom. Lung cancer patients face a disease with a high symptom burden, increased psychosocial needs and a high mortality. Supportive care needs are often relevant from diagnosis. Despite this there are no clear follow-up structures for lung cancer patients that address both cancer management and supportive care. The aims of this study were to evaluate supportive care needs, assess predictors of such needs and identify factors which could aid service provision within Stobhill lung cancer services. Methods Supportive care needs were measured using an adapted Palliative Outcome Scale (POS), incorporated within a larger questionnaire. All lung cancer patients attending the clinic could complete this questionnaire. Respiratory symptoms, performance status, service usage, preferences and satisfaction were also assessed. Data were stratified to allow evaluation of three clinical groupings: all patients, newly diagnosed patients and patients in the last three months of life. Analyses were phased: descriptive analyses, univariate tests of association and multivariate regression. Results Three hundred and fifty three lung cancer patients completed questionnaires. The high symptom burden in lung cancer was confirmed. Anxiety, pain and dyspnoea were identified as the key issues. Poor performance status was identified to be an independent predictor of increased POS score, increased anxiety, increased pain and increased dyspnoea. There was no independent relationship between POS and survival. Although the majority of patients were satisfied with the care received, there was uncertainty regarding who was in charge of care and some disparity in preferred structure for follow-up. Conclusions Despite recent advances in lung cancer management, improvements are still required to address unmet supportive care needs of patients. Particular attention should be given to those with poorer performance status to effectively identify and meet such needs.