Thesis (M.A. (Health Social Science))--Mahidol University, 2007. / LICL has E-Thesis 0024 ; please contact computer services.

Thesis (Ph.D. in Human Medical Genetics) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 104-138). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Abstrakt Hjärtinfarkt är ett av de största hälsoproblemen i Sverige idag. Kvinnor drabbas i stor utsträckning av hjärtinfarkt men de riskeras att missas då den mesta evidensen utgår från ett manligt perspektiv och normer. Syftet med denna integrerade litteraturöversikt var att sammanställa kunskap inom omvårdnadsforskning om kvinnors erfarenheter  efter att ha drabbats av en första hjärtinfarkt. En integrerad litteraturöversikt enligt Whittemore och Knafl metod utfördes och granskades enligt SBU:s riktlinjer. Kvalitativa, kvantitativa och mix studier sammanställdes. Sökningen utfördes i databasen CINAHL. Resultatet visade att kvinnors symtom vid en första hjärtinfarkt särskildes sig från mäns symtom och riskerades att missas av vården på grund av kunskapsbrist. Kvinnor avvaktade att uppsöka vård på grund av ovisshet kring symtomens allvar. Sjuksköterskan behöver uppmärksamma prodromala symtom samt lyfta frågor kring sexuellt samliv. Ny evidens behövs för att få kunskap om kvinnors upplevelser av att drabbas av en första hjärtinfarkt.

Previous research has shown that excessive cardiovascular reactivity may be important in the development of coronary heart disease. The present study examines the role of masculine cognitive appraisal of stress as a mediator of cardiovascular reactivity in men. The reactivity of men who differed on a measure of cognitive appraisal of masculine gender role stress (MGRS) was compared using the cold-pressor test under conditions of high and low masculine performance challenge. Under conditions of minimal challenge, it was predicted that high and low MGRS men would not differ on reactivity. Under high challenge, high MGRS men were expected to show greater reactivity than low MGRS men. Since coping responses are related to appraisal of stressful situations and impact on cardiovascular reactivity, subjects' coping responses were also assessed. Analysis of results for systolic blood pressure confirmed the major predictions. High MGRS men showed greater systolic blood pressure reactivity than low MGRS men under high challenge and equal or less reactivity under low masculine performance challenge. In general, the high and low MGRS groups did not differ in their use of coping strategies as a function of the high and low challenge condition. The implications of MGRS appraisal for men's health are discussed. / Master of Science

<p>Cilj ovog istraživanja je bio da se utvrdi nivo folne kiseline u serumu (fiziolo&scaron;ka vrednost je od 16,31 do 34,88 nmol/l) i proceni težina kliničke slike instrumentima kliničke procene (HAMD 17 i 21, MADRS i CGI skala) u populaciji bolnički lečenih pacijenata, koji boluju od te&scaron;ke depresivne epizode, ili rekurententog depresivnog poremećaja, i njihov odgovor na inicijalnu antidepresivnu terapiju sprovođenu prema smernicama nacionalnog vodiča. Odgovor na antidepresivnu terapiju je određivan nakon četiri i osam nedelja lečenja u odnosu na nivo folne kiseline i prema nadoknadi folne kiseline u dozi od 15 mg dnevno (kod pacijenata koji nisu adekvatno odreagovali na terapiju). Smatrano je da je antidepresivni odgovor adekvatan ukoliko je utvrđena redukcija skora na HAMD (17, 21) i MADRS za 50%. Istraživanje je obuhvatilo 102 pacijenata (69 osoba ženskog pola i 33 osobe mu&scaron;kog pola) starosti između 18 i 70 godina života. Utvrđeno je da je snižen nivo folne kiseline u krvi imalo 41,2% pacijenata.<em> X</em>² testom je ustanovljeno da postoje značajne razlike nivoa folne kiseline u krvi u odnosu na pol. Snižen nivo folne kiseline je zastupljeniji kod osoba mu&scaron;kog pola. Pacijenati sa sniženim nivoom folne kiseline su imali inicijalno značajno vi&scaron;e skorove na skalama kliničke procene i izostanak adekvatnog terapijskog odgovora u četvrtoj nedelji lečenja. U osmoj nedelji lečenja se ta razlika u terapijskom odgovoru izgubila. Utvrđena je statistički značajna razlika u skorovima na HAMD (17) i MADRS u tri merenja u zavisnosti od nivoa folne kiseline i nadoknade uz upotrebu vi&scaron;esmerne me&scaron;ovite analize varijanse (ANOVA). Utvrđeno je da postoji značajan glavni efekat merenja (skorovi se značajno razlikuju od merenja do merenja), i značajan efekat interakcije merenja i nadoknade.</p> / <p>The aim of this paper is to establish the levels of folic acid in serum (physiological values is from 16.31 to 34.88 nmol/l) and the assessment of seriousness of clinical picture by clinical assessment instruments (HAMD 17 and 21, MADRS and CGI scales) in the population of hospitalized patients suffering from severe depressive episodes, or recurrent depressive disorder, and their response to the initial anti-depressant therapy administered according to national guidelines. The response to anti-depressant therapy was determined after four or eight weeks of treatment in relation to the levels of folic acid and according to recuperation of folic acid in the dose of 15 mg daily (in patients who did not react adequately to the therapy). It was believed that the anti-depressive response was satisfying in case of the established score reduction on HAMD (17, 21) and MADRS for 50%. The research encircled 102 patients (69 of whom female patients and 33 males) aged between 18 and 70. A reduced level of folic acid in blood was found in 41.2% of the patients. By<em> X</em>² test determined that there were significant differences in the levels of folic acid in relation to the patient gender. A reduced level was more found in male patients. The patients with reduced levels of folic acid had initially significantly higher scores on clinical assessment scales and the lack of an adequate therapeutic response in the fourth week of the treatment. In the eighth week of the treatment that difference vanished in therapeutic response. A statistically significant difference was determined on HAMD (17) and MADRS during three measurements depending on the levels of folic acid and its recuperation by using a multiway diverse analysis of variance (ANOVA). It was determined that there is a significant central effect of measurements (scores significantly differ from measurement to measurement), as well as an effect of interaction of measurements and the recuperation.</p>

<p>UVOD: Moždani udar spada u grupu masovnih nezaraznih bolesti, koje se smatraju najče&scaron;ćim oboljenjima savremenog čoveka. On predstavlja jedan od najče&scaron;ćih uzroka mortaliteta i invaliditeta u savremenom svetu. Među brojnim pratećim komplikacijama moždanog udara, navode se psihički poremećaji: depresija, anksioznost i psihotični poremećaji. Utvrđivanje povezanosti moždanog udara sa psihičkim poremećajima, kao i mehanizma njihovog nastanka predstavlja značajan doprinos boljem razumevanju ovog veoma čestog oboljenja, a njihov rani tretman omogućio bi brži i potpuniji oporavak nakon moždanog udara. CILJ: Utvrditi karakteristike psihičkog funkcionisanja osoba nakon ishemičnog moždanog udara, utvrditi uticaj lokalizacije lezije na nastanak određenih psihičkih poremećaja nakon moždanog udara, utvrditi uticaj vaskularnog statusa na nastanak psihičkih poremećaja, te utvrditi korelaciju između psihičkih komplikacija moždanog udara i brzine i stepena oporavka op&scaron;te životne aktivnosti. MATERIJAL I METODE: Istraživanje je izvedeno kao prospektivna studija, obuhvatilo je 101 pacijenta oba pola obolelih od moždanog udara, koji su hospitalno lečeni na Klinici za neurologiju u Novom Sadu. Svim pacijentima je uzeta anamneza o toku bolesti, faktorima rizika za moždani udar, kao i laboratorijska dijagnostika. Svim pacijentima načinjena je kompjuterizovana tomografija (CT) mozga (ili magnetna rezonanca - MRI mozga), ultrazvučni pregled karotidnih arterija, vertebrobazilarnih i krvnih sudova Willisovog poligona. Stepen neurolo&scaron;kog deficita i praćenje funkcionalnog oporavka u akutnoj fazi i nakon 3 meseca vr&scaron;eno je primenom Skale Moždanog Udara Nacionalnog Instituta za Zdravlje (NIHSS), Rankinove skale i Bartelovog indeksa. Svim pacijentima je načinjena eksploracija psihičkog statusa u akutnoj fazi bolesti primenom Bekove Skale Depresije 2 (BDI-2), Skale procene anksioznosti kao stanja i odlike (STAI), Skale pozitivnih i negativnih sindroma (PANSS) i Kornelovog regrutnog indeksa (CSI). Kontrolno testiranje gore navedenim testovima obavljeno je nakon 3 meseca. Od statističkih metoda kori&scaron;ćena je deskriptivna statistika: tabelarni prikazi učestalosti i procentualna izraženost kod neparametrijski (nominalno ili ordinarno) organizovanih varijabli. Za ukr&scaron;ten prikaz dve varijable kori&scaron;ćene su tabele kontingencije. Takođe su kori&scaron;ćene mere centralne tendencije (aritmetička sredina) i mere disperzije (standardna devijacija) kod parametrijski korektno uređenih varijabli. Pored toga, kori&scaron;ćen je Hi-kvadrat test za utvrđivanje razlika između grupa za varijable nominalnog nivoa merenja, Kramerovo V za utvrđivanje povezanosti između nominalnog nivoa merenja, Pirsonov koeficijent korelacije r, za utvrđivanje povezanosti između varijabli intervalnog nivoa merenja, te analiza varijanse (ANOVA) za utvrđivanje značajnosti razlika između aritmetičkih sredina vi&scaron;e grupa. REZULTATI: U ispitivanje je uključen 101 pacijent, 65.3% mu&scaron;kog pola, 34.7% ženskog pola. Prosečna starost bila je 60.69 godina (medijana=62.00, standardna devijacija =10.828, statistička gre&scaron;ka=1.077). 38.6% je imalo lokalizaciju u desnoj hemisferi velikog mozga, 34.7% u levoj hemisferi, 4% u cerebelumu, 11.9% u moždanom stablu, dok je 10.9% imalo vi&scaron;estruku lokalizaciju infarkta. 39.6% je imalo teritorijalni infarkt, a 59.4% lakunarni infarkt. Distribucija faktora rizika za moždani udar bila je uobičajena za podneblje na kojem je vr&scaron;eno istraživanje. 26.7% je imalo uredan nalaz na karotidnim krvnim sudovima, 26.7% je imalo difuznu ateromatozu, 27.7% je imalo stenozu ACI &lt;70% , dok je 18.8% pacijenata imalo stenozu ACI&gt;70%. U odnosu na nalaz u VB slivu, 52.5% je imalo uredan nalaz, a 47.5% patolo&scaron;ki nalaz (stenozu i difuznu ateromatozu). 54.5% pacijenata je imalo uredan nalaz na arterijama Willisovog poligona, a 45.5% je imalo patolo&scaron;ki nalaz (stenozu i difuznu ateromatozu). 5.9% je imalo depresivni poremećaj, 29.7% anksiozni poremećaj, 9.9% neurotski poremećaj i 2% psihotični poremećaj. U odnosu na pol, depresivni poremećaj javlja kod 3% mu&scaron;karaca i 11.4% žena, anksiozni kod 25.8% mu&scaron;karaca i 37.1% žena, neurotski kod 7.6% mu&scaron;karaca i 14.3% žena i psihotični kod 3% mu&scaron;karaca, dok kod žena nije zabeležen. U odnosu na životno doba, kod mlađih od 45 godina depresija nije bila prisutna, anksioznih je bilo 30%, 10% psihotičnih, dok neurotičnih nije bilo. U grupi 46-65 godina depresivnih je bilo 6.9%, anksioznih 22.4%, neurotičnih 12.1%, a psihotičnih 1.7%. U grupi starijih od 65 godina, depresivnih je bilo 6.1%, anksioznih 42.4%, neurotičnih 9.1%, dok psihotičnih nije bilo. Distribucija odgfovora dobijenih na BDI-2 skali ukazivala je na veću učestalost depresivnog poremećaja kod lezija u levoj hemisferi velikog mozga. Distribucija odgovora dobijenih primenom STAI ukazivala je na veću učestalost anksioznog poremećaja kod lezija desne hemisfere. Distribucija odgovora dobijenih primenom CSI ukazivala je na veću učestalost neurotskog poremećaja kod vi&scaron;estrukih lezija. Distribucija odgovora dobijenih primenom PANSS ukazivala je na veću učestalost psihotičnog poremećaja kod lezija desne hemisfere. Upoređivanje lezije na karotidama i psihičkih poremećaja pokazalo je na progresivni porast učestalosti psihičkih poremećaja sa težinom lezije na karotidnim krvnim sudovima, kao i na potpuno odsustvo psihičkih poremećaja kod osoba koje su imale uredan nalaz na karotidama. Praćenje uticaja psihičkih poremećaja (sumarno i pojedinačno) na funkcionalni oporavak pacijenata nakon moždanog udara, nije pokazalo statistički značajan uticaj. Zabeleženo je statistički značajno udruženo pojavljivanje depresivnog i anksioznog, depresivnog i neurotskog i anksioznog i neurotskog poremećaja, bez značajne interakcije navedenih poremećaja sa psihotičnim poremećajem. ZAKLJUČAK: Kod pacijenata sa ishemičnim moždanim udarom najveća je učestalost anksioznog poremećaja, zatim depresivnog poremećaja, a najređe se javlja psihotični poremećaj. Depresivni i anksiozni poremećaj značajno su če&scaron;ći kod žena, dok se psihotični poremećaji isključivo javljaju kod mu&scaron;karaca. Depresivni poremećaj značajno se če&scaron;će javlja u srednjem i starijem životnom dobu, anksiozni poremećaj se če&scaron;će javlja u mlađem i srednjem životnom dobu, dok se psihotične manifestacije javljaju najče&scaron;će u srednjem životom dobu. Depresivni i anksiozni poremećaj jednako se često javljaju kod pacijenata sa teritorijalnim i lakunarnim infarktom, dok se psihotične manifestacije isključivo javljaju kod pacijenata sa teritorijalnim infarktom. Ne postoji značajna korelacija između prisustva faktora rizika za moždani udar i pojave psihičkih poremećaja, iako je upadljivo odsustvo psihičkih poremećaja kod pacijenata bez faktora rizika za moždani udar. Nakon 3 meseca od moždanog udara nije primećena značajnija regresija simptoma psihičkih poremećaja. Anksiozni poremećaj i psihotične manifestacije se statistički značajno če&scaron;će javljaju kod infarkta u desnoj hemisferi, dok za depresivni poremećaj nije potvrđeno statistički značajno če&scaron;će pojavljivanje kod infarkta u levoj hemisferi. Psihički poremećaji kod pacijenata sa moždanim udarom če&scaron;će se javljaju kod pacijenata sa lezijama u karotidnom slivu, &scaron;to se povećava sa težinom lezije i veličinom stenoze. Ne postoji statistički značajna korelacija između lezija krvnih sudova u vertebrobazilarnom slivu i Willisovom poligonu sa pojavom psihičkih poremećaja. Nije dokazan značajan uticaj psihičkih poremećaja na oporavak bolesnika nakon moždanog udara. Dokazan je visok stepen udruženog javljanja depresivnog i anksioznog poremećaja.</p> / <p>INTRODUCTION: Stroke belongs to noninfectious diseases, which are considered the most common diseases of modern man. It is one of the most common causes of mortality and disability in the modern world. The many associated complications of stroke include mental disorders: depression, anxiety and psychotic disorders. Determining the relationship between stroke and mental disorders, as well as enlightening their underlying mechanism, represents a significant contribution to a better understanding of this very frequent disease, and an early treatment of these associated disorders should allow a faster and more complete recovery from stroke. OBJECTIVE: To determine characteristics of mental functioning after ischemic stroke, to determine the impact of lesion localization on development of certain mental disorders after stroke, to determine the impact of vascular status on development of mental disorders, and to determine the correlation between the associated mental disorders and the speed and degree of recovery of general life activities. MATERIALS AND METHODS: The research was conducted as a prospective study that included 101 ischemic stroke patients of both sexes, hospitalized at the Clinic of Neurology in Novi Sad. Data about the course of disease and stroke risk factors was collected and laboratory diagnostics was performed in all patients. All patients underwent brain computed tomography (CT) (or magnetic resonance imaging - MRI), and ultrasound examination of carotid and vertebrobasilar arteries and the circle of Willis. The degree of neurological deficit and functional recovery in the acute phase and at 3-month follow-up were assessed using the National Institute of Health Stroke Severity (NIHSS) scale, the Rankin scale, and the Barthel Index. All patients underwent psychological exploration of the mental status in the acute phase of stroke by using the Beck Depression Inventory 2 (BDI - 2), the State-Trait Anxiety Inventory (STAI), the Positive and Negative Syndrome Scale (PANSS), and the Cornell Services Index (CSI). Follow-up testing with the same tests was performed after 3 months. Statistical analysis included methods of descriptive statistics: tabular presentation of the frequency and percentages in case of nonparametric (nominal or ordinal) variables. Contingency tables were used to present relationships between two variables. In addition, measures of central tendency (arithmetic mean) and measures of dispersion (standard deviation) were used for parametric variables. The chisquared test was used to determine differences between groups for nominal measurement variables, Cramer&rsquo;s V was used to examine association between nominal levels of measurement. Association between interval measurement variables was measured by the Pearson correlation coefficient (r), and significance of differences between arithmetic means of more groups was determined by the analysis of variance (ANOVA). RESULTS: The study included 101 patients, 65.3% male and 34.7% female. The average age of patients was 60.69 years (median=62.00, standard deviation=10.828, statistical error=1.077). Stroke localizations were as follows: the right cerebral hemisphere in 38.6%, the left hemisphere in 34.7%, the cerebellum in 4%, the brainstem in 11.9%, and 10.9% of patients had multiple localizations. In 39.6% of patients, stroke was territorial, and in 59.4% lacunar. The distribution of risk factors for stroke was typical for the study area. Normal carotid arteries were found in 26.7%, 26.7% had diffuse atheromatosis, 27.7% had &lt;70% ACI stenosis, and 18.8% had &gt;70% ACI stenosis. As regards VB circulation, 52.5% had normal findings and 47.5% had pathological findings (stenosis and diffuse atheromatosis). As regards the circle of Willis, 54.5% had normal findings and 45.5% had pathological findings (stenosis and diffuse atheromatosis). Regarding mental functioning, 5.9% had depressive disorder, 29.7% had anxiety disorder, 9.9% had neurotic disorder, and 2% had psychotic disorder. In relation to sex, mental disorders were present as follows: depressive disorder in 3% of men and 11.4% of women, anxiety disorder in 25.8% of men and 37.1% of women, neurotic disorder in 7.6% of men and 14.3% of women, and psychotic disorder in 3% of men and none of women. With respect to age, among patients under 45 years of, age none had depressive disorder, 30% had anxiety disorder, 10% had psychotic disorder, and none had neurotic disorder. In the group of patients aged 46-65 years, 6.9% had depressive disorder, 22.4% had anxiety disorder, 12.1% had neurotic disorder, and 1.7% had neurotic disorder. In the group above 65 years of age, 6.1% had depressive disorder, 42.4% had anxiety disorder, 9.1% had neurotic disorder, and none had psychotic disorder. The distribution of responses obtained on the BDI-2 showed a higher prevalence of depressive disorder in patients with lesions in the left cerebral hemisphere. The distribution of responses obtained on the STAI showed a higher prevalence of anxiety disorder in patients who had lesion of the right hemisphere. The distribution of responses obtained on the CSI showed a higher prevalence of neurotic disorder in those who had multiple lesions. The distribution of responses obtained by the PANSS indicated a higher prevalence of psychotic disorder in those with lesion of the right hemisphere. Comparison of carotid artery lesions and mental disorders showed a progressive increase in the prevalence of mental disorders with increasing severity of the lesions, as well as a complete absence of mental disorders in people who had normal findings on carotids. The follow-up results showed that mental disorders (generally and individually) did not have a statistically significant effect on functional recovery of stroke patients. There were statistically significant comorbidities of depressive disorder and anxiety disorder, depressive disorder and neurotic disorder, and anxiety disorder and neurotic disorder, and no significant interactions of any of these disorders with psychotic disorder. CONCLUSION: In patients with ischemic stroke, anxiety disorder has the highest prevalence, followed by depressive disorder, whereas psychosis is the rarest. Depressive and anxiety disorders are significantly more common in women, while psychotic disorder occurs exclusively in men. Depressive disorder is significantly more common in the middle and old ages, anxiety disorder is more frequent in the younger and middle ages, while psychotic manifestations occur most often in the middle age of life. Depressive and anxiety disorders are similarly prevalent in patients with territorial and lacunar strokes, while psychotic manifestations occur exclusively in patients with territorial stroke. There is no significant correlation between the presence of stroke risk factors and mental disorders, although there is an evident absence of mental disorders in patients without stroke risk factors. Three months after stroke, no significant regression of the symptoms of mental disorders was observed. Anxiety disorder and psychotic manifestations are significantly more common in right hemispheric stroke, while as regards depressive disorder, there is no statistically significant association with left-hemispheric stroke. Mental disorders in stroke patients are more common in those with carotid lesions and increase in severity with increasing severity of lesion and degree of stenosis. There are no statistically significant correlations between lesions in the vertebrobasilar circulation or the circle of Willis and development of mental disorders. No significant impact of mental disorders on recovery from stroke was found. A high prevalence of comorbid depressive and anxiety disorders was proven/confirmed.</p>

Thesis (Ph. D.)--University of California, Los Angeles, 1986. / Includes bibliographical references.

published_or_final_version / Community Medicine / Master / Master of Public Health

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.