Decreased amyloid-ß42 (Aß42), increased total tau (t-tau) and phosphorylated tau (p-tau) in cerebrospinal fluid (CSF) reflect histopathological core changes in the most common dementia disorder, Alzheimer’s disease (AD). They discriminate AD from healthy controls and predict conversion to AD with a relatively high accuracy. Memantine, an uncompetitive NMDA-receptor antagonist, is indicated for symptomatic treatment of AD. The first aim of this thesis was to investigate effects of memantine on CSF concentrations of Aβ42, tau and p-tau. Secondly, the aim was to explore the relation between these CSF biomarkers and retention of the amyloid biomarker Pittsburgh compound B using positron emission tomography (PIB PET), regional glucose metabolism measured with 18Fluoro-2-deoxy-d-glucose (FDG) PET and neuropsychological test performance. The third aim was to investigate their possible utility as predictors of future rate of AD dementia deterioration. All patients in the studies were recruited from the Memory Clinic, Uppsala University Hospital. In study I CSF p-tau concentrations in 11 AD patients were reduced after twelve months treatment with memantine, indicating that this compound may affect a key pathological process in AD. Results from study II showed that the concentrations of CSF Aß42 are lower in PIB+ patients than in PIB- patients, and that the PIB retention was stable during 12 months. In study III 10 patients with the diagnoses AD (6 PIB+/4 PIB-) and 8 subjects (1 PIB+/7 PIB-) with frontotemporal dementia were included. PIB+ patients had lower psychomotor speed measured by performance on the Trail Making Test A and impaired visual episodic memory compared to the PIB- patients. The initial clinical diagnoses were changed in 33% of the patients (6/18) during follow-up. Study IV is the first-ever report of an association between high CSF tau and dying in severe dementia. These 196 AD patients were followed up to nine years after baseline lumbar puncture. Moreover, CSF t-tau concentrations above median was associated with an increased risk of rapid cognitive decline (OR 3.31 (95% CI 1.53-7.16), independently of baseline functional stage. Thus, a clear association between high levels of CSF t-tau and p-tau and a more aggressive course of the disease was shown.

This master thesis is about an investigation of anti-moisture methods for a nonhermeticelectronics enclosure containing a number of printed circuit boards(PCB) and placed in a severe climatic environment. The relevant theoretical background was provided first. It included the impact of moisture on electronics, some useful psychrometrics concepts, heat transfer fundamentals, introduction of environmental test, temperature and humiditysensing techniques, computational fluid dynamics (CFD) modelling, antimoisture methods and commercial heaters in the current marketing. Then a CFD modelling methodology was developed and validated based on experiment data. An extra heater was added to the enclosure to prevent water adsorption on printed circuit assemblies (PCA) surfaces. The heat dissipation and switch-on period strategies were parametrically studied in order to maintain the internal relative humidity below 60% in the vicinity of PCA surfaces, according to the relative humidity control method. In the end, results obtained from the environmental tests and the CFD simulations were presented and analyzed. Conclusions and future work were also discussed.

The aim of this thesis work is to design and manufacture a Dissimilar Channel Angular Pressing (DCAP) system for severe plastic deformation of aluminum alloy sheets in order to obtain ultra-fine grained structure. First, a DCAP system was designed by Finite Element Analysis and constructed after various optimization trials. Next, 6061-T0 aluminum alloy plates were severely deformed by various DCAP passes through the system. The samples were characterized by metallography, X-ray diffraction, tension and hardness tests. It has been observed that the yield strength was improved about 100 % after 2 DCAP passes, and 45 nm sub-grain size was obtained.

A study was carried out on the selection of processing condition that would yield Mg-Ti with most favourable hydrogenation properties. Processing routes under consideration were / mechanical milling under inert atmosphere, reactive milling i.e. milling under hydrogen atmosphere, ECAP (equal channel angular pressing) and thermal plasma synthesis. Structure resulting from each of these processing routes was characterized with respect to size reduction, coherently diffracting volume and the distribution of Ti catalyst. Mechanical milling yielded a particulate structure made up of large Mg agglomerates with embedded Ti fragments with a uniform distribution. Mg agglomerates have sizes larger than 100 &micro / m which arises as a result of a balance between cold welding process and ductile fracture. Repeated folding of Mg particles entraps Ti fragments inside the Mg agglomerates resulting in a very uniform distribution. Coherently diffracting volumes measured by X-ray Rietveld analysis have small sizes ca. 26 nm which implies that the agglomerates typically comprise 1011 crystallites. Mechanical milling under hydrogen, i.e. reactive milling, led to drastic reduction in particle size. Mg and Ti convert to MgH2 and TiH2 which are milled efficiently due to their brittleness resulting in particle sizes of sub-micron range. Hydrogenation experiments carried out on Mg-10 vol % Ti milled under argon yields enthalpy and entropy values of -76.74 kJ/mol-H2 and -138.64 J/K.mol-H2 for absorption and 66.54 kJ/mol H2 and 120.12 J/K.mol H2 for desorption, respectively. For 1 bar of hydrogen pressure, this corresponds to a hydrogen release temperature of 280 &deg / C. This value is not far off the lowest desorption temperature reported for powder processed Mg based alloys. ECAP processing is a bulk process where the powders, consolidated in the first pass, have limited contact with atmosphere. This process which can be repeated many times lead to structural evolution similar to that of milling, but for efficient mixing of phases it was necessary to employ multi-pass deformation. An advantage of ECAP deformation is strain hardening of the consolidated powders which has improved milling ability. Based on this, a new route was proposed for the processing of ductile hydrogen storage alloys. This involves several passes of ECAP deformation carried out in open atmosphere and a final milling operation of short duration under inert atmosphere. The plasma processing yields Mg particles of extremely small size. Evaporation of Mg-Ti powder mixture and the subsequent condensation process yield Mg particles which are less than 100 nm. Ti particles, under the current experimental condition used, have irregular size distribution but some could be quite small, i.e. in the order of a few tens of nanometers. Of the four processing routes, it was concluded that both reactive milling and thermal plasma processing are well suited for the production of hydrogen storage alloys. Reactive milling yield particles in submicron range and plasma processing seems to be capable of yielding nanosize Mg particles which, potentially, could be decorated with even smaller Ti particles.

<p><p>This master thesis is about an investigation of anti-moisture methods for a nonhermeticelectronics enclosure containing a number of printed circuit boards(PCB) and placed in a severe climatic environment.</p><p>The relevant theoretical background was provided first. It included the impact of moisture on electronics, some useful psychrometrics concepts, heat transfer fundamentals, introduction of environmental test, temperature and humiditysensing techniques, computational fluid dynamics (CFD) modelling, antimoisture methods and commercial heaters in the current marketing.</p><p>Then a CFD modelling methodology was developed and validated based on experiment data. An extra heater was added to the enclosure to prevent water adsorption on printed circuit assemblies (PCA) surfaces. The heat dissipation and switch-on period strategies were parametrically studied in order to maintain the internal relative humidity below 60% in the vicinity of PCA surfaces, according to the relative humidity control method.</p><p>In the end, results obtained from the environmental tests and the CFD simulations were presented and analyzed. Conclusions and future work were also discussed.</p></p>

Considering the late in-vessel phase of an unlikely core melt down scenario in a light water reactor (LWR) with the formation of a corium pool in the lower head of the re-actor pressure vessel (RPV) the possible failure modes of the RPV and the time to failure have to be investigated to assess the possible loadings on the containment. In this work, an integral model was developed to describe the processes in the lower plenum of the RPV. Two principal model domains have to be distinguished: The temperature field within the melt and RPV is calculated with a thermodynamic model, while a mechanical model is used for the structural analysis of the vessel wall. In the introducing chapters a description is given of the considered accident scenario and the relevant analytical, experimental, and numerical investigations are discussed which were performed worldwide during the last three decades. Following, the occur-ring physical phenomena are analysed and the scaling differences are evaluated between the FOREVER-experiments and a prototypical scenario. The thermodynamic and the mechanical model can be coupled recursively to take into account the mutual influence. This approach not only allows to consider the tem-perature dependence of the material parameters and the thermally induced stress in the mechanical model, it also takes into account the response of the temperature field itself upon the changing vessel geometry. New approaches are applied in this work for the simulation of creep and damage. Using a creep data base, the application of single creep laws could be avoided which is especially advantageous if large temperature, stress, and strain ranges have to be covered. Based on experimental investigations, the creep data base has been de-veloped for an RPV-steel and has been validated against creep tests with different scalings and geometries. It can be stated, that the coupled model is able to exactly describe and predict the vessel deformation in the scaled integral FOREVER-tests. There are uncertainties concerning the time to failure which are related to inexactly known material parame-ters and boundary conditions. The main results of this work can be summarised as follows: Due to the thermody-namic behaviour of the large melt pool with internal heat sources, the upper third of the lower RPV head is exposed to the highest thermo-mechanical loads. This region is called hot focus. Contrary to that, the pole part of the lower head has a higher strength and therefore relocates almost vertically downwards under the combined thermal, weight and internal pressure load of the RPV. On the one hand, it will be possible by external flooding to retain the corium within the RPV even at increased pressures and even in reactors with high power (as e.g. KONVOI). On the other hand, there is no chance for melt retention in the considered scenario if neither internal nor external flooding of the RPV can be achieved. Two patents have been derived from the gained insights. Both are related to pas-sively working devices for accident mitigation: The first one is a support of the RPV lower head pole part. It reduces the maximum mechanical load in the highly stressed area of the hot focus. In this way, it can prevent failure or at least extend the time to failure of the vessel. The second device implements a passive accident mitigation measure by making use of the downward movement of the lower head. Through this, a valve or a flap can be opened to flood the reactor pit with water from a storage res-ervoir located at a higher position in the reactor building. With regard to future plant designs it can be stated - differing from former presump-tions - that an In-Vessel-Retention (IVR) of a molten core is possible within the reac-tor pressure vessel even for reactors with higher power.

Exclusionary discipline policies (Casella, 2003; Christle, Jolivette & Nelson, 2005; Tuzzolo & Hewitt, 2007), academic failure and school dropout are some of the most salient factors in the school to prison pipeline (Christle, Jolivette & Nelson, 2005). While previous research has explored the variability in existing exclusionary discipline policies and identified numerous factors associated with expulsion or criminal justice outcomes among youth, there has been little effort to bring these individual and school level factors together into a single predictive model that is informed by existing criminological theories. In this context, the proposed study will use multiple waves of data from the National Longitudinal Study of Adolescent Health to consider how school discipline policies, demographics, and competing criminological explanations affect the risk of expulsion and then future contact with the criminal justice system. Findings reveal that school-level factors such as severe disciplinary policies, school size, and school type are weak predictors of expulsion and adult arrest. Conversely, measures of social bonding, low self-control, learning, and strain theories show promise in predicting expulsion and arrest outcomes. A history of school disciplinary actions and self-reported delinquency present themselves as the strongest predictors of expulsion and subsequent arrest. Theoretical and policy implications are considered.

The purpose of this study was to determine if there was a functional relation between a peer-delivered modified system of least prompts procedure (SLP) and an increase in level and trend of performance on finding the area of polygons or finding the volume of cylinders, spheres, and cones, and could the peer tutor reliably implement the modified SLP procedure with middle school students with mild to severe disabilities. A multiple probe days across participants design was used. Results from this study show that there was a functional relation across students in which students were able to make progress on academic math skills when taught by a peer tutor using the modified SLP procedure. The peer tutor was able to reliably implement the procedure to multiple students. Limitations and implications for practice are discussed.

Όπως φαίνεται από τα ερευνητικά δεδομένα, η παχυσαρκία αποτελεί ένα από τα πιο σημαντικά προβλήματα των συγχρόνων κοινωνιών, καθώς αυτή αποτελεί μια προδιαθεσική κατάσταση και έναν παράγοντα κινδύνου για την εμφάνιση διαφόρων παθήσεων. Η παχυσαρκία αποτελεί ένα σημαντικό παράγοντα κινδύνου για ανάπτυξη καρδιοαγγειακής νόσου, σακχαρώδη διαβήτη, διαφόρων μορφών καρκίνου και άλλων χρόνιων παθήσεων όπως οστεοαρθρίτιδας, νόσων του ήπατος και των νεφρών, υπνικής άπνοιας, ουρικής αρθρίτιδας, γαστροοισοφαγικής παλινδρόμησης και κατάθλιψης. Τα μακροπρόθεσμα αποτελέσματα της δίαιτας, της άσκησης και της φαρμακευτικής αγωγής στην μείωση του σωματικού βάρους παραμένουν σχετικά πτωχά, έως αναποτελεσματικά. Η βαριατρική χειρουργική είναι η πιο αποτελεσματική θεραπεία για την παχυσαρκία και συνιστάται για όλους τους ασθενείς με ΒΜΙ ≥40 kg/m2 (νοσογόνος παχυσαρκία) και για όσους έχουν ΒΜΙ ≥35 kg/m2 οι οποίοι παρουσιάζουν και συμπαρομαρτούσες διαταραχές, οι οποίες αποτελούν συννοσηρότητα της παχυσαρκίας, έπειτα από αποτυχία άλλων θεραπευτικών προσπαθειών, όπως η αλλαγή του τρόπου ζωής με δίαιτα, άσκηση και φαρμακευτική αγωγή, οι οποίες είναι τις περισσότερες φορές αναποτελεσματικές. Η παρούσα μελέτη διενεργήθηκε στην Χειρουργική Κλινική του Ιατρικού Τμήματος του Πανεπιστημίου Πατρών, μεταξύ του Οκτωβρίου του 2008 και του Απριλίου του 2010. Το δείγμα των ασθενών της μελέτης αποτελούσαν 80 διαδοχικοί ασθενείς (50 γυναίκες και 30 άνδρες), οι οποίοι εισήχθησαν στην χειρουργική κλινική για να υποβληθούν σε βαριατρική χειρουργική επέμβαση. Οι ασθενείς ενημερώθηκαν για την μελέτη προτού υποβληθούν στην χειρουργική επέμβαση, και συμφώνησαν να λάβουν μέρος σε αυτή. Ο σκοπός της μελέτης ήταν να εκτιμήσει την ποιότητα ζωής (HRQOL) και την σεξουαλική λειτουργικότητα (SF), πριν και μετά από βαριατρική χειρουργική επέμβαση σε ασθενείς με νοσογόνο παχυσαρκία. Η ποιότητα ζωής είναι μια πολυδιάστατη έννοια η οποία περιλαμβάνει τομείς που σχετίζονται με την φυσική (σωματική), ψυχική, συναισθηματική και κοινωνική λειτουργικότητα του ατόμου. Η ποιότητα ζωής (HRQOL), εκφράζει τον αντίκτυπο που έχει μια νοσηρή κατάσταση ή μια θεραπευτική αγωγή, στην αίσθηση σωματικής και ψυχικής ευεξίας του ατόμου και στην καθημερινή προσωπική και κοινωνική του ζωή. Η σεξουαλικότητα είναι μια εξίσου σημαντική παράμετρος της ανθρώπινης ευεξίας και ευημερίας. Παρουσιάζει αμφιδρομη αλληλεπίδραση με την ψυχική υγεία και με την ποιότητα ζωής. Τα αποτελέσματα των ερευνών δείχνουν ότι η παχυσαρκία επιδρά αρνητικά στην σεξουαλική ζωή του ατόμου. Σχετίζεται με σεξουαλική δυσλειτουργία στις παχύσαρκες γυναίκες και με στυτική δυσλειτουργία και γενικότερη σεξουαλική δυσλειτουργία στους παχύσαρκους άνδρες. Αυτό καθιστά πλέον αναγκαία την εκτίμηση της σεξουαλικής λειτουργικότητας, όταν αξιολογούμε την αποτελεσματικότητα των διαφόρων θεραπειών για την παχυσαρκία. Όλοι οι ασθενείς που αποδέχθηκαν την συμμετοχή τους στην μελέτη συμπλήρωσαν το SF-36 ερωτηματολόγιο για την εκτίμηση της HRQOL. Η σεξουαλική λειτουργικότητα εκτιμήθηκε με το δείκτη γυναικείας σεξουαλικής λειτουργίας (FSFI-Female Sexual Function Index), για τις γυναίκες και με το Διεθνή Δείκτη της στυτικής λειτουργίας ( IIEF -International Index of Erectile Function), για τους άνδρες. Οι ασθενείς συμπλήρωσαν τα ερωτηματολόγια με την συνδρομή ενός ατόμου από την ερευνητική ομάδα, το οποίο καθοδηγούσε τους ασθενείς για να καταλάβουν τις ιδιαιτερότητες των ερωτηματολογίων και να διευκρινίσει τυχόν ασάφειες στις ερωτήσεις που δεν μπορούσαν να διαχειριστούν οι ίδιοι οι ασθενείς, πρόσφερε βοήθεια όπου χρειαζόταν και έλεγχε για τυχόν παραλείψεις στην απάντηση των ερωτήσεων . Οι ασθενείς συμπλήρωσαν τα ερωτηματολόγια πριν το χειρουργείο(Τ1), καθώς και 1 μήνα(Τ2), 6 μήνες(Τ3) και 1 χρόνο(Τ4) μετά το χειρουργείο. Κοινωνικο-δημογραφικά δεδομένα συλλέχτηκαν που συμπεριλάμβαναν την ηλικία, το φύλο, την χρήση καπνού, το μορφωτικό επίπεδο καθώς και την οικογενειακή κατάσταση. Η παρουσία συμπαρομαρτούντων παθολογικών καταστάσεων διαπιστώθηκε από τα ιστορικά των ασθενών. Οι γυναίκες ερωτήθηκαν και για την γυναικολογική τους κατάσταση (για τον αν είχαν κανονικό ή ακανόνιστο κύκλο ή αν ήταν μετεμμηνοπαυσιακές). Η μελέτη εγκρίθηκε από την αρμόδια Επιτροπή Ηθικής και Δεοντολογίας του Νοσοκομείου και όλοι οι ασθενείς έδωσαν την έγγραφη ενημερωμένη συγκατάθεσή τους πριν την είσοδό τους στην μελέτη. Όλοι οι ασθενείς ήταν κατάλληλοι για βαριατρική χειρουργική επέμβαση σύμφωνα με τις υφιστάμενες ενδείξεις. Η σοβαρότητα της παχυσαρκίας μετρήθηκε με τον Δείκτη Μάζας Σώματος (ΒΜΙ) σε Kg βάρους σώματος διηρημένα με το ύψος του ατόμου σε μέτρα εις το τετράγωνο (kg/m2). Ενήλικες με ΒΜΙ ≥25kg/m2 θεωρούνται υπέρβαροι, με ΒΜΙ ≥30 kg/m2 θεωρούνται παχύσαρκοι και με ΒΜΙ ≥40 kg/m2 ως πάσχοντες από νοσογόνο παχυσαρκία (νοσηρά παχύσαρκοι). Το είδος της χειρουργικής επέμβασης που εφαρμόσθηκε σε κάθε ασθενή βασίστηκε σε ειδικά χειρουργικά κριτήρια σύμφωνα με χειρουργικό πλάνο το οποίο εφαρμόζεται στην χειρουργική κλινική. Σύμφωνα με αυτό, ασθενείς με ΒΜΙ ≥50 kg/m2 υπεβλήθησαν σε χολοπαγκρεατική εκτροπή με Roux-en-Y διαμόρφωση,όπως τροποποιήθηκε στο κέντρο μας (BPD), ενώ ασθενείς με ΒΜΙ<50kg/m2 υποβλήθηκαν σε γαστρικό bypass με μακρές έλικες (RYGBP-LL), ή επιμήκη γαστρεκτομή (SG), ανάλογα με τις συνυπάρχουσες νοσηρότητες και τις διαιτητικές συνήθειες. Αποτελέσματα Η στατιστική ανάλυση έδειξε μια σημαντικού βαθμού μείωση του ΒΜΙ με πάροδο του χρόνου(p<0,001). Όλοι οι τομείς της σεξουαλικής λειτουργίας βελτιώθηκαν μεταξύ του Τ1 και Τ4, με μόνη εξαίρεση την ανδρική οργασμική λειτουργία. Όλοι οι τομείς της HRQOL βελτιώθηκαν και αυτή η βελτίωση έφθασε στο μέγιστο επίπεδο ανάμεσα από το Τ2 και Τ3 χρονικό διάστημα. Το βασικό επίπεδο της HRQOL (Τ1), βρέθηκε να συσχετίζεται σημαντικά με την βελτίωση όλων των τομέων της HRQOL μετεγχειρητικά και η μείωση του ΒΜΙ βρέθηκε να συσχετίζεται μόνον με την βελτίωση στις βαθμολογίες στους τομείς του σωματικού ρόλου, του σωματικού πόνου και της ψυχικής υγείας. Τα βασικά επίπεδα της συνολικής σεξουαλικής ικανοποίησης, αποτελούσαν ανεξάρτητο στατιστικά σημαντικό προγνωστικό παράγοντα για την βελτίωση μετεγχειρητικά της συνολικής σεξουαλικής ικανοποίησης και στα δύο φύλα. Τα αποτελέσματα έδειξαν ότι η σωματική λειτουργία, η ζωτικότητα, ο σωματικός πόνος, και η γενική υγεία, βελτιώθηκαν όλα με την πρόοδο του χρόνου. Ο σωματικός ρόλος βελτιώθηκε με την πρόοδο του χρόνου και τελικά οι πορείες του συναισθηματικού ρόλου, και της ψυχικής υγείας, ακολούθησαν τις ίδιες τάσεις. Τα αποτελέσματα για κάθε ηλικία και φύλο ήταν στατιστικά παρόμοια. Η σεξουαλική ποιότητα ζωής βελτιώθηκε 1 χρόνο μετά την βαριατρική χειρουργική επέμβαση και στους άνδρες και στις γυναίκες. Όλοι οι δείκτες συνηγορούν για το ότι η HRQOL και η σεξουαλική ποιότητα ζωής βελτιώθηκαν μετά το χειρουργείο σε σύγκριση με τα επίπεδα στα οποία βρισκόταν προ του χειρουργείου . Συμπεράσματα Η Βαριατρική χειρουργική συνοδεύεται από σημαντικού βαθμού μείωση του σωματικού βάρους (ΒΜΙ) και βελτίωση στην ποιότητα ζωής (HRQOL) και στην σεξουαλική λειτουργικότητα σε ασθενείς με νοσογόνο παχυσαρκία. Ο μεγαλύτερος βαθμός βελτίωσης παρατηρήθηκε ανάμεσα από τον 1 και 6 μήνες μετεγχειρητικά. Η βελτίωση στην HRQOL και στην σεξουαλική λειτουργικότητα συσχετιζόταν σημαντικά με τα βασικά προεγχειρητικά επίπεδα αυτών, ενώ η μείωση του ΒΜΙ συσχετιζόταν σημαντικά με βελτίωση μόνο σε 3 τομείς της HRQOL. Η τιμή του ΒΜΙ προεγχειρητικά συσχετιζόταν αντίστροφα με την επακόλουθη βελτίωση στην σωματική λειτουργικότητα και στο επίπεδο του σωματικού πόνου 1 χρόνο μετεγχειρητικά. / Obesity is considered one of the most relevant problems of modern societies, as it constitutes a predominant risk factor in the development of various diseases. Obesity is a significant risk factor for cardiovascular disease (CVD) and diabetes, for cancer and chronic diseases, including osteoarthritis, liver and kidney disease, sleep apnea and depression. The long term effects of diet, exercise and medical therapy on weight are relatively poor. Bariatric surgery is the most effective treatment for obesity and is considered for all patients with BMI more than 40 kg/m2 and for those with a BMI of more than 35 kg/m2 with concomitant obesity related conditions, after failure of other options as dietary, lifestyle and drug administration, which are often ineffective. The current study was conducted in the Department of Surgery of the University of Patras Medical School, between October 2008 and April 2010. Our sample are 80 (30 men and 50 women) patients who admitted in the Surgery Clinic to undergo a Bariatric Operation.The patients were approached before the operation and invited to take part in the study. The purpose of the study was to measure the Health related quality of life and Sexual functioning, before and after a Bariatric surgery in patients with morbid obesity. Health-related quality of life (HRQOL) is a multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning. HRQOL focuses on the impact of a disease or a medical treatment, on one’s physical and mental wellbeing and on his every day private and social life. Sexuality is an equally important aspect of human well-being and prosperity. Sexual functioning interacts and influences the mental health and the quality of life. The research results show that obesity negatively affects the sexual quality life of the individual, associated with sexual dysfunction in obese women and with erectile dysfunction and general sexual dysfunction in obese men. This makes it necessary to assess sexual functioning when evaluating the effectiveness of several treatments for obesity. All the patients who accepted, were administered the questionnaires accessing Health related quality of life as the sort form 36 questionnaire (SF36). Sexual Functioning was estimated by the Female Sexual function Index (FSFI) for the women, and the International Index of Erectile Function (IIEF) for the men. Patients were administered the questionnaires by a member of our research team who offered assistance when needed and checked the answers for omissions. The patients completed the questionnaires before the operation and 1 month, 6 months and 1 year after the weight loss operation. Sociodemographic data were elicited including age, gender, smoking, educational level and marital status. Comorbidities information was obtained from the hospital charts. The women asked for their gynecological status. If the cycle was regular, irregular or if they were after menopausal. The study protocol was approved by the Institutional Review Board of The University Hospital of Patras, and all participants gave written inform consent before study entry. All the patients were eligible for bariatric operation according the indications for bariatric surgery. The severity of obesity was measured by the B.M.I. (kg/m2). Adults with BMI >25 kg/m2 are overweight, >30 kg/m2 are obese and >40 kg/m2 are considered morbidly obese. The type of procedure performed, was based on specific selection criteria according to an algorithm developed in our center, whereby patients with body mass index (BMI) over 50 kg/m2 undergo biliopancreatic diversion with RYGB (BPD-RYGB) as modified in our center, while patients with BMI under 50 kg/m2 undergo RYGB with long limb (RYGB-LL) or Sleeve Gastrectomy (S.G.), depending on comorbidities and eating habits. RESULTS: Body mass index (BMI) significantly decreased over time (p<0.001). Apart from male orgasm, all sexual functioning components as well as all SF-36 sub-scales improved between T1 and T4. The maximum improvement was observed between T2 and T3. Baseline HRQOL scores correlated with postoperative improvement in all HRQOL components. BMI improvement was correlated with improvement in role physical, bodily pain and mental health scores. Baseline total sexual satisfaction score independently predicted total satisfaction improvement in both genders. The basic levels of total sexual satisfaction (T1-Total Satisfaction score) were independent significant predictor for postoperative improvement in overall sexual satisfaction in both sexes. The results showed that Physical Function,Vitality, the Bodily Pain, and General Health, all improved with the progress of time. The Role Physical improved over time, and finally the improvement in Role Emotional, and Mental Health, followed the same trends. The results for each age and sex were statistically similar. Sexual quality of life improved 1 year after bariatric surgery, in both men and women. All indicators suggest that HRQOL and sexual quality of life improved postoperatively compared to the levels before surgery. CONCLUTIONS The Bariatric surgery accompanied by a significant degree of reduction in body weight (BMI) and improvement in quality of life (HRQOL) and sexual function in patients with morbid obesity. The greatest degree of improvement was observed between the 1 and 6 months postoperatively. The improvement in HRQOL and sexual function correlated significantly with basic preoperative levels of these, while the reduction in BMI was associated with significant improvement in only three aspects of HRQOL. The baseline levels of BMI was reversely significant associated with postoperatively improvement in physical functioning and bodily pain aspects of HRQOL, 1 year postoperatively.

Bakgrund: Genom historien har personer med allvarlig psykisk störning ofta tvingats leva avskilda och utstötta från samhället, en stigmatisering som finns kvar än idag. Syfte: Syftet med litteraturstudien var att belysa hur personer med allvarlig psykisk störning upplever sin sociala situation samt hur dessa personer upplever att sociala relationer påverkar återhämtningen från allvarlig psykisk störning. Metod: Till studien eftersöktes kvalitativa artiklar i relevanta databaser, nio stycken artiklar som passade studiens syfte valdes ut. Artiklarna genomgick manifest innehållsanalys, två huvudkategorier och ett flertal underkategorier kunde urskiljas. Resultat: I litteraturstudien framgick att personer med allvarlig psykisk störning känner sig utstötta från samhället och upplever fördomar riktade mot sig. Svårigheter med sociala kontakter leder till ensamhet. Önskan om meningsfulla aktiviteter fanns för att få en mer meningsfull vardag och lättare kunna knyta kontakter med andra. De sociala relationernas betydelse för återhämtningen från allvarlig psykisk störning framkom tydligt i litteraturstudien. Familj, vänner och vårdare bidrog samtliga till återhämtningsprocessen. Slutsats: Personerna upplevde en stigmatisering som bidrog till att försämra deras sociala situation, vilket bidrar till ökat lidande. Alla inom vården är en viktig del för att minska detta. Sociala relationer som medför att bli sedd och bekräftad som människa är viktigt för återhämtningen från allvarlig psykisk störning.