Amalgam has been used as a dental restorative material for centuries, but its potential health effects and biopersistance has lead to a decreased use especially in the Nordic countries. New materials have been introduced, partly to replace the mercury containing amalgam and partly because of esthetical reasons. The possible health effects of amalgam have been studied extensively and the material has been replaced with other less well-examined materials during the last few decades. The prevalence of side effects of dental materials is considered to be low in relation to the vast number of dental treatments undertaken. With the introduction of new and more complex materials, side effects related to dental treatment may increase. Epidemiological data suggest that the side effects of dental resins that have almost completely replaced amalgam fillings in Scandinavia, possess a risk for adverse reactions; however, the causal relation has not been fully established. Therefore, the type and extent of side effects caused by resin-based materials are of great interest. The aims of the study were: - to describe the change in health over time for patients with problems related to their dental materials. The hypothesis was that the patients could be divided into subgroups based on their symptoms and that the ability to recover differs between these groups [Paper I]. Furthermore, to determine whether factors such as the replacement of dental restorative materials and follow-up time had any impact on the perceived health. - to assess the long-term development of symptoms and their social consequences among patients referred for diagnosis and treatment of symptoms related to dental materials [Paper II] - to investigate the possible risks with dental restorative materials other than amalgam [Paper III]. - to describe side effects assessed to be caused by resin-based materials that occurred in a group of patients as well as treatment and long-term consequences of the reactions [Paper IV]. A questionnaire was sent to 614 patients [Paper I and II] that had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental materials. The questionnaire contained questions on, among others; civil status, present health, medical and dental treatment and other measures and precautions taken because of psychosocial problems related to current employment situation, feelings, self-image and coping behavior. Moreover, information was collected [Paper III] from the Swedish Dental Materials Register 2003 (DentMr), a compilation of MSDS for 487 materials, and information from the user guide of the materials. The Material Safety Data Sheets (MSDS) included in the DentMR were examined regarding the given composition of the products, the occurrence of CAS-numbers and the risk- and safety phrases of the substances. Information was collected [Paper IV] on 36 patients with reactions to resin-based restorative materials from the Swedish National Register of Side-Effects of Dental Materials. Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with local symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. However, the reason for this improvement was unclear. Replacement of dental restorative materials had no significant impact on the ability to recover completely. Our results also indicate a relationship between patients’ self-related health and social consequences in daily life. Those with remaining complex symptoms had more often stopped working or had decreased their work hours because of their symptoms The information about hazards with dental materials seems insufficiently described in MSDS and there might be materials with side effects unknown to both patients and dental professionals. A literature search indicated that some of the listed substances had possible hazards, e.g. substances with embryotoxic and neurotoxic potential. The patients were very heterogeneous; a few with only local symptom free reactions while other had more complex symptoms. The latter group would gain from a multidisciplinary approach, i.e. dental, medical, as well as social and psychological factors have to be considered when developing care management programs for this group of patients. Furthermore, there is a need for stronger regulations of dental materials, such as those applied to pharmaceutical drugs. Finally, it was found that the majority of symptoms suspected to be caused by resin-based materials were local or a combination of local and extra-oral symptoms that appeared within the first 24 hours after treatment. The most frequent adverse effect reported was skin problems/dermatitis. It appears as though immediate reactions to resin based materials are not uncommon and more prevalent than allergic reactions. Still, we have had, difficulties in verifying associations between the dental restorative materials and adverse reactions and also to identify the offending component.

Syfte och frågeställningar Min avsikt med studien var att undersöka yngre elevers (8-10 år) attityder och upplevelser av fysisk aktivitet, samt vilken roll barnen tilldelar fysisk förmåga och upplevd fysisk självkänsla vid spel och lekar tillsammans med andra barn. Metod Urvalet bestod av 12 elever, 8-10 år med vilka en semistrukturerad intervju genomfördes. Vid intervjun användes bilder som föreställde barn i olika situationer. Utöver Intervjun genomfördes en föräldraenkät för att få en bakgrundsinformation om föräldrarnas syn på barnens fysiska aktivitet och deras egna motionsvanor. Intervjusvaren bearbetades utifrån frågeställningarna, analyserades och tolkades med utgångspunkt från ett interaktionistiskt perspektiv. Resultat Eleverna beskriver den egna fysiska självkänslan i termer av god idrottslig motorisk kompetens. Då respondenterna resonerar kring andras goda kompetenser beskrivs dessa i termer av fysisk styrka och kondition. De fysiskt aktiva (föreningsbundna) eleverna tenderar att vara tydligare i sina motiveringar till varför de är duktiga på idrott eller är sportiga. Majoriteten av respondenterna väljer umgänge och gemensam aktivitet baserat på rörelsekompetens och sportighet. Samtliga respondenter beskriver en positiv upplevelse av ämnet idrott och hälsa. Det förekommer dock i intervjusvaren berättelser om kamrater som beskrivs som fysiskt inaktiva och ej roade av ämnet. De fysiskt aktiva (föreningsbundna) respondenterna har lättare att beskriva vad som är roligt i ämnet och de har en något tydligare bild av ämnets investeringsvärde. Dock legitimeras ämnet enligt ett investeringsvärde snarare än av ett egenvärde av samtliga respondenter. Slutsats Samtliga respondenter äger en hög grad av fysisk självkänsla, som beskrivs i termer av god idrottslig motorisk kompetens. Ur ett interaktionistiskt perspektiv verkar fysisk aktivitet, att vara sportig, ha en viss betydelse för yngre elever då det gäller val av umgänge och fria aktiviteter på exempelvis raster. Detta framträder som mer betydelsefullt för de fysiskt aktiva (föreningsbundna) eleverna och för de äldre eleverna. Dock verkar sportighet ej ha någon betydelse för social positionering eller företräda ett hierarkiskt värde för yngre elever. / Aim My aim was to exploreexperiences and attitudes towards physical activity among juniors (children aged 8 to 10 years), in particular the influence of physical activity and physical self-esteem when playing and interacting with others. Method Interviews with 12 randomly selected juniors from grades 2 to 4, i.e. aged 8 to 10 was carried out. Pictures presenting children in different situations were used during the interviews. The interviews were also supplemented with a questionnaire where the parents views on physical activity andexpectations on their children were displayed. The answers were categorized, compared and analyzed from an interactionist perspective. Results The respondents own physical self-esteem is described in terms of high athletic motor competence. When the respondents argue about others high competence, they use terms of physical power and cardiovascular health. Juniors with memberships in sport clubs tend to be more explicit when giving reasons why they are good at sports. The majority of the respondents choose company and activities based on physical competence and sports performance.  All respondents express favourable experiences from physical education (PE). Yet, the interviews include stories about friends who are physically inactive, and who does not seem to experience a pleasure in, or enjoy participating in PE. Membership in sports clubs is associated with a higher ability to describe what is stimulating in the subject and also associated with having a slightly more distinct picture of the investment value of the subject. However, the subject is justified by an investment value, rather than an intrinsic value by all respondents. Conclusion All of the respondents have a high level of physical self-esteem, which is described in terms of high athletic motor competence. From an interactionist perspective, physical activity, being sporty, seems to have certain significance to juniors concerning choice of company and free activities, e.g. in school breaks. This is even more obvious for pupils with membership in sport clubs, and also for the older pupils. However, being sporty does not seem to have any value of hierarchy, nor does social position seem to depend on being sporty.

This thesis consists of a quantitative and a qualitative study. The quantitative study (articles I-III) aimed to examine how self-reported health in adolescence is associated with behavioral, parental, and school factors. Through a survey directed at all adolescents in grades 7-9, data were collected in 2005 in a region in northern Sweden (n=5060). Statistical methods were used to analyze the survey data: chi2tests, multivariate logistic regressions and multilevel logistic regressions. Results showed that even though most adolescents reported good health, there were also rather large proportions of adolescents who reported headaches, stomach aches and feelings of stress. Girls reported poor health to a higher extent than boys, a difference that was larger in grade 9 than in grade 7. The results also showed that being norm compliant was associated with good self-reported health. Furthermore, perceiving relations and communication with parents as poor was associated with poor self-reported health; however, this relationship could not explain gender differences in self-reported health. Continuing on, analyses showed that there exist greater variations in self-reported health between students (within a school) than between different schools. On an individual level, poor relations to teachers, bullying and truancy were associated with poor general health. The qualitative study  (article IV) sought to examine barriers to and facilitators of utilization of local school survey results within a school setting. In 2011, 21 school district managers and principals within a Swedish municipality were interviewed. Analyses were performed using a qualitative content analysis. The results from the qualitative study showed that the dissemination and utilization of school survey results appeared as two interrelated phases in one process. Barriers and facilitators differed qualitatively depending on the phase, dissemination or utilization. In conclusion, professionals as well as researchers need to consider the complexity of adolescent health and its social determinants. Adolescent health is a concern for multiple sectors in society, which highlights the need for further development of collaborations between professionals in relevant fields, such as health care, school and social services. / Den här avhandlingen består av en kvantitativ och en kvalitativ studie. Syftet med den kvantitativa studien (artikel I-III) var att undersöka sambandet mellan ungdomars självrapporterade hälsa och deras normrelaterade beteende samt föräldra- och skolfaktorer. Data samlades in under 2005, genom en enkät som riktade sig till alla ungdomar i årskurs 7-9 i en region i norra Sverige (n=5060). De statistiska metoder som användes i den kvantitativa studien var bland annat chi2- test, logistisk regression samt flernivåanalys. Resultaten visade att även om de flesta ungdomar rapporterade en god allmän hälsa, så var det också en relativt stor andel som rapporterade huvudvärk, magont samt upplevelser av stress. Flickor rapporterade sämre hälsa än pojkar, en skillnad som var större i åk 9 jämfört med åk 7. Resultaten visade också att normföljsamhet hade ett signifikant samband med god självrapporterad hälsa. De ungdomar som upplevde relationen och kommunikationen med sina föräldrar som dålig, rapporterade också dålig hälsa i högre utsträckning än övriga. Sambandet mellan självrapporterad hälsa och föräldrarelationer kunde inte förklara skillnaderna i ohälsa mellan pojkar och flickor. Vidare, analyser visade att det fanns större variationer i självrapporterad hälsa mellan ungdomar (inom en skola) än mellan olika skolor. Dåliga relationer med lärare, skolk, samt att bli utsatt för mobbning hade ett signifikant samband med dålig självrapporterad hälsa, på en individuell nivå. Syftet med den kvalitativa studien (artikel IV) var att undersöka vilka faktorer inom skolan som möjliggör och som utgör barriärer för användningen av enkätresultaten från en lokal skolenkät. 2011 genomfördes 21 intervjuer med skolområdeschefer och rektorer inom en kommun i Sverige. Analyser av intervjumaterialet genomfördes med hjälp av kvalitativ innehållsanalys. Resultaten från denna studie visade att spridningen och användningen av resultaten från skolenkäten kan beskrivas som två relaterade faser i en process. De faktorer som underlättade samt utgjorde barriärer för spridningen och användningen av enkätresultaten var kvalitativt olika varandra beroende på vilken fas i processen respondenterna hänvisade till. Dessa resultat illustrerar den mångfacetterade komplexitet som inryms i ungdomars hälsa och dess sociala determinanter, en komplexitet som både forskare och professionella behöver ta hänsyn till. Ungdomars hälsa angår ett flertal samhällssektorer, vilket visar på betydelsen av en fortsatt utveckling av samverkan mellan professionella inom exempelvis hälso- och sjukvården, skolan och socialtjänsten.

Work stress has a substantial impact on employees, organisations and economies; especially in the fragile economic environment since the ‘Great Recession’ of 2008; which has seen employment levels drop and employees willing to endure more stress at work to avoid retrenchment. These impacts include serious health and financial consequences. Attempts should therefore be made to effectively manage and address work stress to lessen these dire consequences. Many models have been developed and theorised to assist in explaining work stress, the pinnacle of these being the job demands-resources (JD-R) model. In JD-R theory, the dual process explains that work-related well-being follows the following processes: An energetic, also called the health impairment process, in which job demands leads to ill health outcomes through burnout; and then a motivational process which presents that job resources leads to positive organisational outcomes, e.g. organisational commitment, through engagement. The main objectives of this research were 1) to investigate a JD-R model in a large South African sample with a categorical estimator; 2) to investigate the reversed causal hypotheses of burnout and engagement in job demands-resources theory over time; 3) to investigate the likelihood of reporting treatment for health conditions based on burnout and engagement, and 4) to investigate the link between burnout and objective financial outcomes, i.e. by medical aid provider expenditure. To achieve the first objective a cross-sectional design was used (n = 15 633) covering numerous sectors in South Africa. A dual process model was specified with job demands (work overload) leading to ill health through burnout, and job resources (colleague and supervisor support, communication, growth opportunities and role clarity) leading to organisational commitment through engagement. Results of structural equation modelling indicated that the proposed JD-R model was a good fit to the sample. Furthermore, burnout was found to mediate the relationship between job demands and ill health with a medium effect. Engagement was found to mediate the relationship between job resources and organisational commitment with a large effect. The second objective, concerning reversed causality, was achieved with a longitudinal design (n = 593). The hypothesized model included burnout and engagement at time one, and at time two work overload as indicator of job demands, and colleague and supervisor support, communication, growth opportunities and role clarity as indicators of job resources. Results indicated that burnout had a significant negative reversed causal effect to supervisor support and colleague support. Engagement showed only one significant result, i.e. a small negative reversed causal relationship with supervisor support. To achieve the third objective, a cross-sectional design was used (n = 7 895). Results for logistic regression analyses showed that an increase in burnout was associated with a significant increase in the estimated odds for reporting an affirmative answer for receiving treatment for any of the health conditions, i.e. cardiovascular conditions, cholesterol, depression, diabetes, hypertension and irritable bowel syndrome. In contrast, an increase in engagement was associated with a decrease in affirmative reporting for cardiovascular conditions, cholesterol and depression; but not for diabetes, hypertension or irritable bowel syndrome. Addressing the link between burnout and financial outcomes was the fourth objective; and met with a cross-sectional design (n = 3 182). Participants were divided into a high and low burnout group based on the comorbidity of exhaustion and cynicism Analysis of covariance (ANCOVA) was implemented, controlling for age and gender, to investigate the difference in medical aid provider expenditure of the two groups. Results revealed that expenditure in the high burnout group was consistently more in all cases, compared to the low burnout group. By way of conclusion, the implications of the research were discussed and recommendations for managers and for future research were made. / Thesis (PhD (Industrial Psychology))--North-West University, Potchefstroom Campus, 2013

Work stress has a substantial impact on employees, organisations and economies; especially in the fragile economic environment since the ‘Great Recession’ of 2008; which has seen employment levels drop and employees willing to endure more stress at work to avoid retrenchment. These impacts include serious health and financial consequences. Attempts should therefore be made to effectively manage and address work stress to lessen these dire consequences. Many models have been developed and theorised to assist in explaining work stress, the pinnacle of these being the job demands-resources (JD-R) model. In JD-R theory, the dual process explains that work-related well-being follows the following processes: An energetic, also called the health impairment process, in which job demands leads to ill health outcomes through burnout; and then a motivational process which presents that job resources leads to positive organisational outcomes, e.g. organisational commitment, through engagement. The main objectives of this research were 1) to investigate a JD-R model in a large South African sample with a categorical estimator; 2) to investigate the reversed causal hypotheses of burnout and engagement in job demands-resources theory over time; 3) to investigate the likelihood of reporting treatment for health conditions based on burnout and engagement, and 4) to investigate the link between burnout and objective financial outcomes, i.e. by medical aid provider expenditure. To achieve the first objective a cross-sectional design was used (n = 15 633) covering numerous sectors in South Africa. A dual process model was specified with job demands (work overload) leading to ill health through burnout, and job resources (colleague and supervisor support, communication, growth opportunities and role clarity) leading to organisational commitment through engagement. Results of structural equation modelling indicated that the proposed JD-R model was a good fit to the sample. Furthermore, burnout was found to mediate the relationship between job demands and ill health with a medium effect. Engagement was found to mediate the relationship between job resources and organisational commitment with a large effect. The second objective, concerning reversed causality, was achieved with a longitudinal design (n = 593). The hypothesized model included burnout and engagement at time one, and at time two work overload as indicator of job demands, and colleague and supervisor support, communication, growth opportunities and role clarity as indicators of job resources. Results indicated that burnout had a significant negative reversed causal effect to supervisor support and colleague support. Engagement showed only one significant result, i.e. a small negative reversed causal relationship with supervisor support. To achieve the third objective, a cross-sectional design was used (n = 7 895). Results for logistic regression analyses showed that an increase in burnout was associated with a significant increase in the estimated odds for reporting an affirmative answer for receiving treatment for any of the health conditions, i.e. cardiovascular conditions, cholesterol, depression, diabetes, hypertension and irritable bowel syndrome. In contrast, an increase in engagement was associated with a decrease in affirmative reporting for cardiovascular conditions, cholesterol and depression; but not for diabetes, hypertension or irritable bowel syndrome. Addressing the link between burnout and financial outcomes was the fourth objective; and met with a cross-sectional design (n = 3 182). Participants were divided into a high and low burnout group based on the comorbidity of exhaustion and cynicism Analysis of covariance (ANCOVA) was implemented, controlling for age and gender, to investigate the difference in medical aid provider expenditure of the two groups. Results revealed that expenditure in the high burnout group was consistently more in all cases, compared to the low burnout group. By way of conclusion, the implications of the research were discussed and recommendations for managers and for future research were made. / Thesis (PhD (Industrial Psychology))--North-West University, Potchefstroom Campus, 2013

The purpose of the study was to evaluate the IMB skills model for its relevance to the Ethiopian context. According to the model, adherence-related information and motivation work through adherence-related behavioural skills to affect adherence to ART. Quantitative, analytical, observational, cross-sectional, institution-based study was conducted to evaluate the model by assessing those patients who have and do not have the right information, motivation, and behavioural skills whether they have or do not have good adherence to ART. Data was collected using structured questionnaires where a total of 400 randomly selected participants provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Both descriptive and inferential statistics used in the study. Only 90.75 % of the total sample population reported ART adherence rate of more than or equal to 95% in this study. Free and restricted model tests, through bivariate and multivariate analyses, used to assess the propositions of the IMB model of ART adherence and provided support for the interrelations between the elements proposed by the model. The study has supported the applicability of the IMB model of adherence to the Ethiopian context highlighting its application in adherence-promotion intervention efforts. The findings revealed the need for on-going educational, informational and other interventions to address the knowledge, motivation and adherence behavioural skills of patients in order to improve the current levels of ART adherence behaviour. / Health Studies / D. Litt. et Phil. (Health Studies)

Made available in DSpace on 2011-05-04T12:36:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / A saúde auto-referida tem sido considerada um indicador útil de condições e desfechos de saúde entre indivíduos idosos, especialmente a mortalidade. Essa medida baseia-se na interpretação de aspectos físicos objetivos, de status mental, de expectativas e referenciais de comparação, representando uma percepção individual, própria de cada sujeito. Apesar da importância dos problemas masculinos de saúde no perfil de morbimortalidade da população brasileira idosa, os homens idosos têm sido pouco contemplados em estudos que analisem suas particularidades. Esta dissertação, composta por dois artigos, objetivou estudar as condições associadas à saúde auto-referida em homens idosos do município de Juiz de Fora, MG. O primeiro artigo é um estudo transversal, que busca contribuir para o entendimento de questões relacionadas às características de saúde dos homens idosos e a forma como estes avaliam sua saúde. Realizou-se a análise descritiva das variáveis do estudo e as relações entre saúde auto-referida e as co-variáveis foram exploradas através de razões de prevalência (RP), sendo a análise multivariada efetuada através da regressão de Poisson. A população de estudo foi constituída por 2876 homens, com idade média de 70,01 anos (DP= 7,21). Saúde razoável/ruim foi referida por quase 40 por cento dos idosos. Na análise bivariada, os homens de 70 anos ou mais (RP= 1,14 IC 95 por cento 1,04-1,25), sem companheira (RP= 1,15 IC 95 por cento 1,03-1,27), com baixa escolaridade (RP= 1,61 IC 95 por cento 1,41-1,83), que não trabalhavam (RP= 1,64 IC 95 por cento 1,43-1,88), eram sedentários (RP= 1,22 IC 95 por cento 1,11-1,34), usuários do SUS (RP= 1,53 IC 95 por cento 1,36-1,71), utilizavam medicação regular (RP=2,44 IC 95 por cento 2,13-2,79), relatavam internação recente (RP= 1,69 IC 95 por cento 1,54-1,86) e uma ou mais condições crônicas de saúde (RP=1,98 IC 95 por cento 1,68-2,33), apresentaram maior probabilidade de referir saúde razoável/ruim. No modelo multivariado, mantiveram-se associadas à saúde auto-referida razoável/ruim as variáveis: número de condições crônicas, uso de medicação regular (RP= 2,22 IC 95 por cento 1,93-2,54), internação recente (RP=1,54 IC 95 por cento 1,38-1,71), não trabalhar (RP= 1,37 IC 95 por cento 1,20-1,56), ter baixa escolaridade (RP= 1,27 IC 95 por cento 1,11-1,45) e ser usuário do sistema público de saúde (RP= 1,40 IC 95 por cento 1,24-1,58). Os resultados desse estudo reforçam a hipótese de que múltiplas questões estão relacionadas à auto-avaliação da saúde em populações idosas. Considerando que este é um bom indicador das condições de saúde nesse grupo etário, é necessário que os serviços de saúde desenvolvam estratégias para captação dos homens idosos com perfil de risco para saúde auto-referida ruim. O segundo artigo, um estudo de seguimento, teve o objetivo de analisar o possível papel da saúde auto-referida como variável preditora de mortalidade nesse grupo populacional. O método de Kaplan-Meier foi utilizado para a análise exploratória dos dados, comparando-se os indivíduos que relataram condição de saúde excelente/boa com aqueles que informaram condição de saúde razoável/ruim, em diferentes estratos de variáveis sóciodemográficas,de estilo de vida e de saúde, através do teste de log-rank, admitindo nível de significância estatística de 5 por cento. A análise multivariada foi efetuada através de modelos de regressão de Cox, com o método Enter, incluindo as variáveis que apresentaram associações estatisticamente significativas naanálise bivariada. A população deste estudo foi constituída por 2875 homens idosos, seguidos até a data do óbito ou do término do período de seguimento de dois anos, sendo então censurados os indivíduos vivos. Durante o seguimento, ocorreram 120 óbitos, sendo as doenças do aparelho circulatório (40 por cento), as neoplasias (22,5 por cento) e as doenças do aparelho respiratório (10 por cento) as principais causas de morte. Em praticamente todos os estratos de variáveis analisadas, os idosos com saúde auto-referida razoável/ruim apresentaram maior risco de morrer do que aqueles com saúde auto-referida excelente/boa. No modelo multivariado final, as variáveis saúde auto-referida razoável/ruim (HR=1,88 IC 95 por cento 1,29-2,72), idade (HR=1,05 IC 95 por cento 1,03-1,08), uso de serviço público de saúde (HR=1,69 IC 95 por cento 1,10-2,60), tabagismo atual (HR=1,94 IC 95 por cento 1,24-3,04) e doença cardiovascular aguda (HR=1,62 IC 95 por cento 1,06-2,47) se mostraram associadas à mortalidade. A saúde auto-referida mostrou-se uma importante variável preditora da mortalidade em homens idosos, em um período de seguimento de dois anos. Diante da importância da saúde auto-referida ruim na predição da mortalidade em homens idosos brasileiros, recomenda-se que os serviços de saúde incorporem esse indicador nas avaliações de saúde do usuário idoso. / Self-reported health has been considered a helpful indicator of health conditions and certain outcomes, especially mortality, in elderly people. This measure is based on the interpretation of objective physical aspects, mental status, expectations and referential systems of comparison, representing an individual perception. Studies have pointed to differences between genders not only in relation to determinants of self-reported health, but also in relation to its capacity to be a predictor of mortality and the magnitude of the associations. Despite the importance of male health problems in the morbimortality profile of the Brazilian elderly population, men have been little contemplated in studies that analyze their particularities. Two studies were carried out to analyze conditions associated to self-reported health in elderly men of Juiz de Fora city, MG. The first was a cross-sectional study, seeking to contribute to the understanding of questions related to the health characteristics of elderly men and the way they evaluate their health. A descriptive analysis of the study variables was performed and relations among self-reported health and covariates were explored through the estimation of prevalence ratios (PR). Multivariate analysis was performed through Poisson regression. The study population was formed by 2876 men, with average age of 70.01 years (SD= 7.21). Poor health was referred by almost 40% of the participants. Bivariate analysis showed that, men of 70 years or more (PR= 1.14 95% CI 1.04-1.25), without a companion (PR= 1.15 95% CI 1.03-1.27), with few years of schooling (PR= 1.61 CI 95% 1.41-1.83), who did not work (PR= 1.64 95% CI 1.43-1.88), were sedentary (PR= 1.22 95% CI 1.11-1.34), were users of public health services (PR= 1.53 95% CI 1.36-1.71), used medication regularly (PR=2.44 95% CI 2.13- 2.79), related recent admission to a hospital (PR= 1.69 95% CI 1.54-1.86) and presented at least one chronic health condition (PR=1.98 CI 95% 1.68-2.33), had greater probability to relate poor health. In the multivariate model, the variables: regular use of medications (PR= 2.22 95% CI 1.93-2.54), recent admission to a hospital (PR= 1.54 95% CI 1.38-1.71), not be working (PR= 1.37 95% CI 1.20-1.56), few years of schooling (PR= 1.27 95% CI 1.11-1.45) and to be a user of public health services (PR= 1.40 95% CI 1.24-1.58) remained associated to poor self-reported health. The results of this study strengthen the hypothesis that multiple questions are related to the evaluation of self-reported health in aged populations. Considering that this variable is a strong indicator of health conditions in this age group, it is important that health services develop strategies to attract aged men with a risk profile for poor self-reported health. The second was a follow-up study performed to analyze the possible role of self-reported health as a predictor of mortality in this population group and the study population consisted of 2875 elderly men, followed for two years or until their death, whichever came first. During the follow-up, 120 deaths occurred and cardiovascular diseases (40%), neoplasias (22.5%) and respiratory diseases (10%) were the major causes. Elders with self-reported poor health presented a greater risk of death, compared to those with self-reported good/excellent health in almost all stratus of the analyzed variables. In the final model, the variable poor self-reported health (HR=1.88 95% CI 1.29-2.72), age (HR=1.05 95% CI 1.03-1.08), use of the public health services system (HR=1.69 95% CI 1.10-2.60), current use of cigarette smoking (HR=1.94 95% CI 1.24-3.04) and self-reported ardiovascular disease (HR=1.62 95% CI 1.06-2.47) were independently associated to mortality. As poor self-reported health seems to be a good predictor of mortality for elderly men, it is important that health care services incorporate this indicator in the health evaluation of this population group.

The present paper extends previous research in terms of integrating social learning with morality theories, under the framework of moral educators’ and their conflicting moral influences. Specifically, this study aims to investigate the impact of witnessing moral educators breaking (their) moral teachings on individual’s morality and criminal behavior using a sample of two countries, Sweden and Greece, with similar population but entirely different cultural and social characteristics. We focus on three research questions regarding the correlations and (i) the explanatory influence of witnessing this conflict on moral emotions and values by gender and country, (ii) its impact on traditional crime by gender and country and (iii) the impact that witnessing the conflict and morality mutually have on traditional crime in the two countries. Our findings emerge in three key points. First, we found that witnessing moral educators influenced both moral emotions differentially in each country and gender, but only affected Swedish males’ moral values. Secondly, our results showed that witnessing moral educators can explain a moderate to small variance of traditional crime only for males in the two countries. Lastly, we found that witnessing moral educators together with morality can explain a moderate variance of traditional crime in the two countries, while gender is highly important for both countries. Findings are discussed in relation to theory and previous research. Future research is recommended in order to expand the understanding of the cultural and social learning processes that inhibit (im)moral contexts and subsequently affect morality and offending.

Hintergrund: Schwindel ist ein häufig vorgetragenes Symptom beim Hausarzt. Seine erhöhte Vergesellschaftung mit Ängstlichkeit und Depressivität ist aber bisher zu wenig untersucht worden, ebenso wenig ist dieser Zusammenhang Gegenstand der hausärztlichen Behandlung von Schwindelpatienten. Zielstellung: Kommen unbekannte psychische Hintergründe in Kombination mit Schwindel im hausärztlichen Patientengut häufiger vor als ohne Schwindel? Ergeben sich daraus als Konsequenz unterschiedliche Versorgungsformen durch den Hausarzt? Wie verhält es sich mit deren subjektiven Gesundheitszustand, dem Erfolg der hausärztlichen Behandlung, dem ihnen entgegengebrachten Verständnis und der Häufigkeit der Arztbesuche der Betroffenen? Studiendesign: Prospektive Multicenterstudie in der Allgemeinpraxis Untersuchungsregion: Zehn Hausarztpraxen in Halle a.d. Saale und Nordsachsen/ Leipzig im städtischen und ländlichen Einzugsbereich, welche von Fachärzten für Allgemeinmedizin geführt wurden. Methodik: Die Studie untersuchte insgesamt 590 zufällig am Untersuchungstag eintreffende Patienten in jeweils einer von insgesamt zehn Hausarztpraxen. Die Ausprägung von Schwindelbeschwerden und eventuell vorhandene Merkmale von Ängstlichkeit und Depressivität beim jeweiligen Patienten wurden mit Elementen des Gießener Beschwerdebogens 24 und der Hospital Anxiety and Depression Scale (deutsche Version) untersucht. Ergebnisse: Die Patienten wurden in eine Gruppe mit relevanten (29,7%, n=175) und in eine Gruppe ohne relevante Schwindelbeschwerden (70,3%, n=408) eingeteilt (Cut off >=8 nach GBB 24). Die Gruppe mit relevantem Schwindel wies häufiger Merkmale für Ängstlichkeit (p<0,001) und Depressivität (p<0,001) in allen Altersgruppen auf, zeigte sich unzufriedener mit ihrem Behandlungserfolg (p=0,004), schätzte ihren aktuellen Gesundheitszustand schlechter ein (p<0,001) und konsultierte ihren Hausarzt in den letzten zwölf Monaten häufiger (p=0,020). Sie stellten sich nach ICPC-2 häufiger wegen neurologischer (p<0,001), psychologischer (p=0,026) und unspezifischer Beschwerden (p<0,001) vor. Sie erhielten mehr Diagnosen aus den ICD-10-Kapitel V (Psychische und Verhaltensstörungen) (p=0,030). Diese Patienten waren nach HADS-D auch häufiger psychisch auffällig (p<0,001). Relevanter Schwindel kam bei Frauen aller Altersgruppen häufiger vor als bei Männern (p<0,001). Dennoch ergaben sich keine Behandlungsunterschiede durch die Hausärzte zwischen beiden Gruppen (p=0,101 bis 0,930 je nach ärztlicher Maßnahme). Schlussfolgerung: Schwindelpatienten weisen häufger Ängstlichkeit und Depressivität auf, welche den Schwindel unterhalten. Dieser Zusammenhang sollte in der Sprechstunde bedacht werden. Die psychischen Hintergründe sollten vom Hausarzt aufgedeckt und behandelt werden. Dadurch könnte der Schwindel und damit der subjektive Gesundheitszustand der betroffenen Patienten verbessert und die Inanspruchnahme des Gesundheitswesens verringert werden.

The topic of this thesis is on how text mining could be used on patient-reported symptom descriptions, and how it could be used to aid doctors in their diagnostic process. Healthcare delivery today is struggling to provide care to remote settings, and costs are increasing together with the aging population. The aid provided to doctors from text mining on patient descriptions is unknown.Investigating if text mining can aid doctors by presenting additional information, based on what patients who write similar things to what their current patient is writing about, could be relevant to many settings in healthcare. It has the potential to improve the quality of care to remote settings and increase the number of patients treated on the limited resources available. In this work, patient texts were represented using the Bag-of-Words model and clustered using the k-means algorithm. The final clustering model used 41 clusters, and the ten most important words for the cluster centroids were used as representative words for the cluster. An experiment was then performed to gauge how the doctors were aided in their diagnostic process when patient texts were paired with these additional words. The results were that the words aided doctors in cases where the patient case was difficult and that the clustering algorithm can be used to provide the current patient with specific follow-up questions. / Ämnet för detta examensarbete är hur text mining kan användas på patientrapporterade symptombeskrivningar, och hur det kan användas för att hjälpa läkare att utföra den diagnostiska processen. Sjukvården har idag svårigheter med att leverera vård till avlägsna orter, och vårdkostnader ökar i och med en åldrande population. Idag är det okänt hur text mining skulle kunna hjälpa doktorer i sitt arbete. Att undersöka om läkare blir hjälpta av att presenteras med mer information, baserat på vad patienter som skriver liknande saker som deras nuvarande patient gör, kan vara relevant för flera olika områden av sjukvården. Text mining har potential att förbättra vårdkvaliten för patienter med låg tillgänglighet till vård, till exempel på grund av avstånd. I detta arbete representerades patienttexter med en Bag-of-Words modell, och klustrades med en k-means algoritm. Den slutgiltiga klustringsmodellen använde sig av 41 kluster, och de tio viktigaste orden för klustercentroider användes för att representera respektive kluster. Därefter genomfördes ett experiment för att se om och hur läkare blev behjälpta i sin diagnostiska process, om patienters texter presenterades med de tio orden från de kluster som texterna hörde till. Resultaten från experimentet var att orden hjälpte läkarna i de mer komplicerade patientfallen, och att klustringsalgoritmen skulle kunna användas för att ställa specifika följdfrågor till patienter.