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No. of bitstreams: 1 TeseLFK.pdf: 2440883 bytes, checksum: 190080cc3b0b456d415674f0ed8c8a2c (MD5) Previous issue date: 2017-04-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The present thesis is described in research papers format, whose development is justified by literature review, phase of intervention tests to improve the plans of data collection and data collection itself. PROPOSAL 1 (Literature review) composes paper 1 and along with paper 2 present the synthesis of the analyzed variables, evaluation and intervention forms and the main results of cognitive-behavioral intervention studies on people with chronic pain, whose results helped in the conduction of the following studies. PROPOSAL 2 (Pilot study) presents a study aimed at women with fibromyalgia (FM) and poor sleep quality, whose research design allowed to evaluate: the effects of a brief behavioral intervention for pain and sleep combined with a relaxation training, and the isolated effect of relaxation training, both compared to the control group without intervention (paper 3) and the effect and order of application of the two components (pain and sleep management) of this intervention (paper 4). And, PROPOSAL 3 (Data collection) corresponds to the study conducted to women with FM and insomnia, from Multiple Baseline Design with withdrawal of the intervention and pre and post test evaluations, which was split in two articles: one of them evaluated the effect of two components of a behavioral intervention for pain management (1 - management of the physical environment conditions and 2 - interpersonal relationship management), on pain and sleep indicators (paper 5), and the other evaluated the effect of this intervention on other health indicators, besides clinical significance and reliable change (paper 6). Direct self-report and self-registration measures for pain and/or sleep assessment were considered in all intervention studies. Data showed that the brief analytical-behavioral intervention (pilot study) for pain and sleep had an impact on reducing the intensity and incapacity of pain and anxiety, and the intervention for pain (data collection itself) had an impact both on pain and sleep, anxiety, depression, stress and social skills self-reported indicators. Considering the direct measures, both studies (pilot and data collection) showed a change in the sleep pattern (mainly sleep latency) evaluated by actigraphy, but there was no change in the Cortisol Awakening Response (CAR). The present study results are in line with the literature, and methodological aspects were discussed. / A presente tese é descrita no formato de artigos, cujo desenvolvimento se justifica por levantamento da literatura, fase teste de intervenção para aprimoramento dos planos da coleta e coleta propriamente dita. A PROPOSTA 1 (Revisão de literatura) compõe o artigo 1 que, juntamente com o artigo 2, apresentam a síntese das variáveis analisadas, formas de avaliação e intervenção e principais resultados de estudos de intervenção cognitivo-comportamental para pessoas com dor crônica, cujos resultados auxiliaram na condução dos estudos seguintes. A PROPOSTA 2 (Estudo piloto) apresenta um estudo dirigido a mulheres com Fibromialgia (FM) e má qualidade do sono, cujo delineamento permitiu avaliar: o efeito de uma breve intervenção comportamental para dor e sono em conjunto com o treino de relaxamento, e o efeito isolado do treino de relaxamento, ambos comparados ao grupo controle sem intervenção (artigo 3) e o efeito e a ordem de aplicação dos dois componentes (manejo da dor e manejo do sono) desta intervenção (artigo 4). E a PROPOSTA 3 (Coleta propriamente dita) corresponde ao estudo conduzido à mulheres com FM e insônia, a partit do delineamento de Linha de Base Múltipla com retirada da intervenção e avaliações pré e pós teste, que foi desmembrado em dois artigos: um deles avaliou o efeito de dois componentes de uma intervenção comportamental para manejo da dor (1 – manejo de condições do ambiente físico e 2 - manejo do relacionamento interpessoal), sobre indicadores de dor e sono (artigo 5), e o outro avaliou o efeito desta intervenção sobre outros indicadores de saúde, além da significância clinica e mudança confiável (artigo 6). Medidas diretas, de autorrelato e de autorregistro, para avaliação da dor e/ou sono, foram consideradas em todos os estudos de intervenção. Os dados apontaram que a intervenção analítico-comportamental breve (estudo piloto) para dor e sono teve impacto na redução da intensidade e incapacidade decorrente da dor e ansiedade, e a intervenção para dor (Coleta propriamente dita) impactou tanto nos indicadores de dor, quanto nos indicadores do sono, ansiedade, depressão, estresse e habilidades sociais, avaliados por autorrelato. Considerando as medidas diretas, ambos os estudos (piloto e coleta propriamente dita) apresentaram alteração no padrão do sono (principalmente latência para iniciar o sono) avaliado pela actigrafia, mas não houve alteração na resposta do cortisol ao acordar (Cortisol Awakening Response - CAR). Os resultados apresentaram consonância com a literatura, e aspectos metodológicos foram discutidos.

O impacto da dimensão matutinidade/vespertinidade pode interferir no comportamento social e na saúde do indivíduo. Nos últimos anos, esta dimensão tem sido amplamente estudada dentro do âmbito da cronobiologia. Este estudo transversal teve como objetivo determinar o cronotipo de estudantes universitários do 6º semestre dos cursos de turno integral da Universidade de Passo Fundo - Rio Grande do Sul e observar a associação desses cronotipos com parâmetros sociodemográficos, comportamentais e também com a qualidade do sono, a sonolência diurna e distúrbios psiquiátricos menores. Os instrumentos utilizados na pesquisa foram: Pittsburg (PSQI), para avaliar a prevalência da qualidade do sono; Horne Ostberg (MEQ), para determinar o cronotipo; o SRQ20, para os distúrbios psiquiátricos menores; o Epwort (ESS), para sonolência diurna; o AUDIT, para o uso de álcool, e um questionário para variáveis sociodemográficas e comportamentais. Participaram do estudo 372 estudantes, 66,7% do sexo feminino e 33,3% masculino, com idade média de 21,6 anos DP±3,08 (IC min18 max 50); 92,2% não faziam uso de tabaco; 58,9% praticam atividade física e 58,6 % apresentaram consumo de risco para o álcool; referiram trabalhar no terceiro turno 19,7%. Quanto à prevalência para os cronotipos, foram encontrados cronotipos indiferentes 55,9%, seguidos de 39,5% para vespertinos e 4,6% matutinos. Cronotipos vespertinos foram associados ao sexo masculino odds ratio OR=1,72; pobre qualidade do sono OR=1,89; distúrbios psiquiátricos menores OR=1,92 e uso de tabaco OR=3,65. Estes resultados apontam a necessidade de ações educativas e preventivas para esta população vulnerável, no intuito de minimizar possíveis danos à sua saúde física e mental. / The impact of morningness-eveningness dimension can affect social behavior and individual health. The aim of the present study was to determine the chronotype of full time university students in the 6th semester of the Universidade de Passo Fundo - Rio Grande do Sul, Brazil - and evaluate its influence in behavioral parameters. The instruments used in the study were: a demographic questionnaire; PSQI to evaluate sleep quality; MEQ to determine chronotypes; SRQ-20 to minor psychiatric disorders; ESS to daytime sleepiness; AUDIT to alcohol use. 372 students participated in the study: 66.7% were female and 33.3% were male; aged 21.6 years + 3.08 (mean +SD). 92,2% did not use tobacco, 58.9% practiced physical activity and 58,6 showed risks of alcohol abuse; 19.7% reported working in third shift. Regarding the prevalence of chronotypes, it was found 55,9% of indifferent chronotypes, 39,5% of evening, and 4,6% of morning type. Evening chronotypes was associated that male gender odds ratio OR =1,72; poor sleep quality OR=1,89; minor psyquiatric disorders OR= 1,92 and tobacco use OR=3,65. So this study concluded that evening chronotype was related with gender, poor sleep quality, minor psychiatric disorders and tobacco use in the studied population and points to preventive actions and education for this vulnerable population.

O presente estudo trata da organização dos horários de trabalho em turnos fixos, analisando seu impacto na qualidade do sono, na utilização do tempo livre pelo trabalhador e de aspectos relacionados à sua percepção quanto à saúde. A pesquisa foi realizada com auxiliares do setor de impressão e acabamento de uma gráfica e editora localizada na cidade industrial, em Curitiba no estado do Paraná. Para avaliar a qualidade do sono, das relações sociais e da saúde, utilizou-se a versão traduzida do Standard Shiftwork Index (SSI) (JAFFE; SMOLENSKI; WUN, 1996). Para a identificação do cronotipo (vespertinidade/matutinidade) foi utilizado o questionário de Horne e Ostberg (1976). Os resultados demonstraram não haver diferenças significativas entre os três turnos quando comparados os valores médios dos escores de cada constructo, com exceção para as atividades sociais e familiares. Quando analisadas separadamente, cada questão do SSI referente ao sono, algumas tendências indicaram que quando o cronotipo é relacionado com o turno de trabalho, existem percepções diferentes quanto à qualidade do sono. Foi constatado também nos três turnos um anseio dos trabalhadores por um dia a mais de folga na semana, pois o descanso semanal não é suficiente para reparar a fadiga ocasionada pelo trabalho, principalmente para os trabalhadores do terceiro turno. / The present study analyses the organization of work shifts and their impact on sleep quality, on free time allowed by the work shift for social and family activities, and on specific health aspects perceived by the worker. The subjects of the study were workmen at a printing and publishing company in Curitiba´s Industrial District. In order to evaluate the quality of sleep, social relations, and health, the translated version of the Standard Shiftwork Index (SSI) (JAFFE; SMOLENSKI; WUN, 1996) was employed. The chronotype (evening / morning) was evaluated by use of the Horne and Ostberg (1976) questionary. Results showed no meaningful differences between the three shifts, when comparing average values of the scores for each construct, except for social and family activities. When each SSI sleep related question was analysed separately, there were trends which indicated that when the chronotype is related to work shift, there are different perceptions of sleep quality. A common wish of the workpeople in all three shifts is one extra day off during the week, since it is felt that the weekly rest is not enough to repair work related fatigue, especially for those in the third shift.

Introducción y objetivos Los trastornos del sueño son una de las comorbilidades más comunes en pacientes en hemodiálisis. Los objetivos del estudio fueron determinar la prevalencia de mala calidad de sueño y establecer potenciales factores asociados a la mala calidad de sueño. Materiales y métodos Estudio transversal analítico enrolando pacientes con enfermedad renal crónica en hemodiálisis. La variable resultado fue calidad de sueño evaluado mediante la Escala de Pittsburgh, mientras que las variables de exposición fueron el tiempo en hemodiálisis, la historia de diabetes mellitus tipo 2 y de hipertensión arterial, la presencia de sintomatología depresiva, la presencia de anemia y el compromiso urémico. Se usó el modelo de regresión de Poisson para verificar las asociaciones de interés reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC95%). Resultados Fueron enrolados un total de 450 pacientes, de los cuales, 259 (57.5%) fueron varones, y con una edad entre 18 y 97 años. La prevalencia de mala calidad de sueño fue de 79.3% (IC95%: 75.6%–83.1%). Se encontró asociación significativa entre mala calidad de sueño y sintomatología depresiva (RP=1.28; IC95%: 1.17-1.39), anemia (RP=1.18; IC95%: 1.04-1.34) y compromiso urémico (RP=1.26; IC95%: 1.17-1.36) después de controlar por potenciales confusores. Conclusiones La presencia de sintomatología depresiva, anemia y el compromiso urémico estuvieron positivamente asociados a mala calidad de sueño en pacientes con enfermedad renal crónica en hemodiálisis. Un gran porcentaje de esta población sufre de mala calidad de sueño. Se sugiere desarrollar estrategias para mejorar la calidad de sueño en estos pacientes. / Introduction and objectives Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality. Materials and Methods A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). Results A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%– 83.1%). Poor sleep quality was associated with depressive symptoms (PR=1.28; 95%CI: 1.17-1.39), anemia (PR=1.18; 95%CI: 1.04-1.34) and uremia (PR=1.26; 95%CI: 1.17-1.36) after controlling for potential confounders. Conclusions The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients.

Perceived job insecurity (JI) among employees is a common problem in our globalized economy that is characterized by competition and demands flexibility from both employees and employers. The existing literature presents a lot of evidence for the impact of JI on general physical health and psychological well-being outcomes, but asks for more longitudinal research on the impact of JI on specific outcomes, controlled for their baseline levels. The current study addresses this gap in existing research and investigates the associations between JI and diagnosed major depression, diagnosed acute stress, sleep quality, and the health-related behaviors of smoking and snussing in two Swedish samples from Stockholm and Norrland, over long time spans (up to 17 years for the Stockholm sub-sample). Data was obtained from the WOLF study. Results are mixed. For the Stockholm sub-sample, job insecurity correlates with most outcome measures except diagnosed stress, and predicts small shares of variance of sleep quality, the number of cigarettes participants smoke, and if participants use snus. The Norrland sub-sample replicates the impact of JI on general health and hints at a relationship between JI and sleep quality, but no other correlations with health-related behaviors or diagnoses were significant. Reasons for the differences among the sub-samples and limitations of the study are discussed.

Background: Sleep is one of mankind's basic needs and important for the experience of health, as well as essential for the patient's ability to recover. Lack of sleep has a negative effect on the ability to recover from the consequences of illness. Patients states that they have a negative quality of sleep during hospital stay. Aim: The aim of this study was to describe factors that influencing the night sleep of patients during hospital stay. Method: An overview of the literature was performed. Six quantitative, three qualitative and two mixed-method studies were included. Results: Two main categories emerged, which were; Environmental factors and physical- and psychological factors. The result showed that patients experienced environmental factor such as noise and lights, comfort and routines. Physical- and psychological factors experienced by patients was symptoms, anxiety and thoughts and also nurse's bedside manners. Conclusion: Nurses bedside manners have significant importance for patient's ability to experience a quality sleep. The result shows that factors affecting patients sleep are possible to influence and alter in order to enable best possible sleep for patients during hospital stay.

Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. A thorough literature search of over 100 scholarly journal articles, book references, and expert scholarly reports was completed to gain an understanding of this phenomenon in the ICU setting. The Richards-Campbell Sleep Questionnaire (RCSQ) was the data collection tool used to measure improvement in sleep quality. There were 72 participants that are included in the project. The Wilcoxon rank sum and chi square tests were used for the statistical analysis. The findings did not show statistical significance in the improvement in the RCSQ scores after implementation of the intervention. The recommendations include sleep deprivation training for nursing staff and providers, routine use of the RCSQ for data collection, and repeating the study with an increased number of participants and redefined inclusion and exclusion criteria to be more representative of the ICU patient population. The implication for social change is that this project empowers nursing to embrace a leadership role in using evidence-based practice to change clinical guidelines and improve patient outcomes.

abstract: Weight gain and unfavorable body composition are prevalent among midlife and older women; shifts in these characteristics can have detrimental implications on emotional and physical health and longevity. Efforts to attenuate weight-related factors detailing the potential development of obesity are traditionally driven by manipulation of nutrition and/or physical activity; however, sustained results are limited. Novel and integrative approaches are needed to reduce the burden of adverse changes in weight and associated consequences. This dissertation is built around a model of effects of Tai Chi/Qigong in body composition and a pilot test of this intervention and model factors in a group of midlife/older women (N = 36). Three resulting manuscripts include: 1) a proposed biobehavioral model detailing how a Tai Chi/Qigong intervention may improve weight-related outcomes through psychological, behavioral, and physiological pathways, 2) a paper examining pre- to post- intervention differences in the primary outcomes of percent body fat, sleep quality, and emotional eating and the exploratory outcomes of perceived stress, mood state, mindfulness, self-compassion and body awareness; and 3) an exploratory analysis examining correlations between primary (sleep quality, emotional eating), exploratory (perceived stress, mood state, mindfulness, self-compassion and body awareness), and neurophysiological (heart rate variability) outcomes of interest—further, regression models were conducted to explore the predictive value of the independent variables on the dependent variables and associated changes. In manuscript two, dependent t-tests were used to assess pre/post-differences (percent body fat and survey measures); this single group study (8-weeks of Tai Chi/Qigong) did not have a control group. Results of manuscript two demonstrate significant changes in sleep quality (p = .04), perceived stress (p = .05), and body awareness (p = .01). Findings of manuscript three indicate changes in the dependent variable of sleep quality were partially explained by perceived stress (adjusted R2 = 13.4%) and changes in the dependent variable of emotional eating were significantly explained by self-compassion (adjusted R2 = 42.1%). In the context of weight gain and unfavorable body composition in midlife/older women, results of this pilot study, using a standardized Tai Chi/Qigong intervention, indicate that select psycho-emotional factors may be important to explore further. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2019

Self-report retrospective estimates of sleep behaviors are not as accurate as prospective estimates from sleep diaries, but are more practical for epidemiological studies. Therefore, it is important to evaluate the validity of retrospective measures and improve upon them. The current study compared sleep diaries to two self-report retrospective measures of sleep, the commonly used Pittsburgh Sleep Quality Index (PSQI) and a newly developed sleep questionnaire (SQ), which assessed weekday and weekend sleep separately. It was hypothesized that the new measure would be more accurate than the PSQI because it accounts for variability in sleep throughout the week. The relative accuracy of the PSQI and SQ in obtaining estimates of total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) was examined by comparing their mean differences from, and correlations with, estimates obtained by the sleep diaries. Correlations of the PSQI and SQ with the sleep diaries were moderate, with the SQ having significantly stronger correlations on the parameters of TST, SE, and sleep quality ratings. The SQ also had significantly smaller mean differences from sleep diaries on SOL and SE. The overall pattern of results indicated that the SQ performs better than the PSQI when compared to sleep diaries.

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