This thesis presents hormonal, emotional, physical and visual status changes in female fibromyalgia (FMS) patients after treatment with the Creative Art therapy; dance/movement therapy, compared to controls. FMS is a syndrome of chronic pain involving musculoskeletal aches, stiffness and pain where perturbations in the stress-axis and high scores on somatic anxiety and muscular tension also have been found. The study comprises thirty-six female FMS patients divided in treatment- and control group. Serum concentrations of the hormones prolactin, dehydroepiandrosterone sulphate (DHEA-S), cortisol and neuropeptide Y (NPY) in plasma and cortisol in saliva were analysed. Different verbal self-rating scales concerning well-being, pain, personality and life events among other things have been used. Assessments of the condition of the FMS patients affected by video-viewing were evaluated together with interviews about the self-perception phenomenon of video viewing (a phenomenological hermeneutic method). The results of the study show that six months of dance/movement therapy appears sufficient to improve both psychological and physical function, as indicated by the visual analyses. The video interpretation technique (VIT) and self-figure drawings captured treatment effects that were not evident from verbal scales or reflected in hormone levels. The biological markers probably need a longer treatment period to activate the HPA axis and its inter-related hormones and peptides. The use of different assessment techniques most likely has affected the treatment outcome. Difficulties perceiving information through verbal/cognitive modalities as well as alexithymia are factors discussed. The VIT may be useful for early identification of maladaptive movement patterns and as a mirror of facial and bodily expressions of emotions. In conclusion, this study indicates that both the dance/movement therapy and the VIT have had great influence on the FMS patient’s well-being, self-perception and perception of pain.

During the last decade, there has been a renewed interest in physicians´ working conditions at a time when health care is undergoing major structural and financial changes. Physicians report decreasing work satisfaction and at the same time increasingly contemplate on leaving their profession. Despite an increasing proportion of female physicians, they are underrepresented in management positions. Very often, female physicians also report worse personal health and less organisational influence than their male colleagues. Management programs have been viewed as an important vehicle to improve working conditions and career development for female physicians. The aim of the present thesis was to evaluate the effects on individual health, professional development, perception of organisational structure and career development. Fifty-two female physicians participated in structured 1-year management programs. The control group consisted of 52 physicians not participating in any formal management education during the study period. The female physicians were compared with 157 male physicians in order to evaluate possible gender and manager-reported differences on individual and organisational well-being. The study also assessed occupational predictors of individual well-being, health and professional development for managers. Participants in management programs reported a clearer organisational structure and improved professional development and influence. However, there were no significant effects with regard to health, sickness absenteeism, nor career development. Male and female physicians differed in several areas when assessed as a group, but stratifying for management level, most of the gender-related differences disappeared. When managers rated clearer organisational structure, this was associated with higher ratings on individual well-being and professional development. Management programs for female physicians might have some beneficial effects but these programs need to be better defined and targeted to the most important issues at hand to recruit future managers. Furthermore, these programs must be better integrated with other processes to create efficient and able managers.

Thesis (Ph.D.) -- University of Adelaide, Dept. of History, 2001. / Includes bibliographical references (leaves 280-305).

Luo, Weixiang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 90-105). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

<p>This thesis reports on the effects of stress management on long-term pain patients and on a healthy sample from IT and media companies; two groups that are commonly exposed to high stress levels. Even if there are important differences between these two groups, there are similarities such as the necessity for effective stress management. Stress-related and musculoskeletal disorders are major public health issues in most industrialized countries and are expected to become increasingly common during the coming decades. The pathogenic plastic changes in the CNS and immune system caused by long-term stress pose severe burdens to individuals, organizations as well as society in general. Thus, stress management may be essential to maintain and improve long-term health and wellbeing and to proactively counteract stress-related ill-health.</p><p>This thesis is based on four papers: Paper I assessed the effects of massage as compared to relaxation tapes in long-term pain patients. Paper II validated some of the Visual Analogue Scale questions that were to be used in paper III and IV. Paper III assessed the effects on mental and physical wellbeing and biological stress markers from a web-based stress management and health promotion tool. Paper IV aimed at mapping out predictors for trends (improvement vs. worsening) in self-rated health (SRH) over a period of one year.</p><p>The overall results indicate that individually focused stress management interventions in long-term pain patients as well as on a healthy, working population may have short-term beneficial effects on psychological and physiological stress, health and wellbeing. On a long-term basis the beneficial changes seem to revert. In paper four, it is indicated that the stress management intervention is not a significant predictor of long-term changes in SRH. Rather, other factors such as health perception, sleep quality and sense of coherence predicted improvement in SRH over time.</p>

This thesis reports on the effects of stress management on long-term pain patients and on a healthy sample from IT and media companies; two groups that are commonly exposed to high stress levels. Even if there are important differences between these two groups, there are similarities such as the necessity for effective stress management. Stress-related and musculoskeletal disorders are major public health issues in most industrialized countries and are expected to become increasingly common during the coming decades. The pathogenic plastic changes in the CNS and immune system caused by long-term stress pose severe burdens to individuals, organizations as well as society in general. Thus, stress management may be essential to maintain and improve long-term health and wellbeing and to proactively counteract stress-related ill-health. This thesis is based on four papers: Paper I assessed the effects of massage as compared to relaxation tapes in long-term pain patients. Paper II validated some of the Visual Analogue Scale questions that were to be used in paper III and IV. Paper III assessed the effects on mental and physical wellbeing and biological stress markers from a web-based stress management and health promotion tool. Paper IV aimed at mapping out predictors for trends (improvement vs. worsening) in self-rated health (SRH) over a period of one year. The overall results indicate that individually focused stress management interventions in long-term pain patients as well as on a healthy, working population may have short-term beneficial effects on psychological and physiological stress, health and wellbeing. On a long-term basis the beneficial changes seem to revert. In paper four, it is indicated that the stress management intervention is not a significant predictor of long-term changes in SRH. Rather, other factors such as health perception, sleep quality and sense of coherence predicted improvement in SRH over time.

Health education is critical to the success of a community health program. Yet the majority of research on health education is conducted from the point of view of programme designers or evaluators. Where health educators themselves are the focus, data is often generated through surveys, questionnaires, field notes, or quantitative measures. Narrative accounts by health educators describing their activities and their perceptions of programme efficacy are thus a neglected line of inquiry. My thesis examines one group of health educators who trained and worked with Sidney and Emily Kark at the Institute of Family and Community Health in Durban during the 1940s and 1950s. The importance of health educators in the Institute's project has often been acknowledged by key figures like the Kark, but few scholars have highlighted the contributions of these paraprofessionals. As catalysts of change and disseminators of knowledge, their role was encapsulated by health educator Neela Govender: "So many things people can do to [become] aware of health problems, and how much they themselves could be responsible for their own health ... that's not something they can forget. They will pass it on to another generation, or influence each other. We sow the seed, and it must grow, and spread". In focusing on the health educators' role, I seek to integrate perspectives of "history from below" to enhance previous analyses that concentrated on doctors and government administrators as the main architects of the Institute of Family and Community Health. To this end, I have collected testimony of health educators as a valuable source of historical evidence, which not only uncovers a foot soldier's view of what the Karks called a "practice of social medicine" but also illuminates various social, political, and economic contexts underpinning health education in South Africa. This study used oral history techniques to explore how retired health educators perceived their experiences at the Institute. It thematically analysed their narratives to gain a sense of their training, goals, methods and working conditions in segregationist and apartheid-era South Africa. My interview subjects were predominantly women whose work reflected the centrality of maternal, child, and family health to the Institute. As intermediaries between the clinic and the community, they were integral to the Institute of Family and Community Health's investigation of the links between health and culture. The themes of race, gender and culture were as pertinent in the mid-twentieth century as they are today in the delivery of health services; health educators' narratives might provide insights into how such conceptual factors influence the operation of community health programs in contemporary South Africa. The ways in which the Institute's health educators became active agents in the face of oppressive circumstances also contain potential lessons for their counterparts currently struggling to address an HIV/AIDS epidemic with inadequate resources and governmental support. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2004.

Mortality statistics are much used although their accuracy is often questioned. Producers of mortality statistics check for errors in death certification but current methods only capture obvious mistakes. This thesis investigates whether non-obvious errors can be found by linking death certificates to hospital discharge data. Data: 69,818 deaths in Sweden 1995. Paper I: Analysing differences between the underlying cause of death from the death certificate (UC) and the main discharge condition from the patient’s last hospitalization (MDC). Paper II: Testing whether differences can be explained by ICD definitions of UC and MDC. Paper III: Surveying methods in 44 current studies on the accuracy of death certificates. Paper IV: Checking death certificates against case summaries for: i) 573 deaths where UC and MDC were the same or the difference could be explained; ii) 562 deaths where the difference could not be explained. Results: In 54% of deaths the MDC differed from the UC. Almost two-thirds of the differences were medically compatible since the MDC might have developed as a complication of the UC. Of 44 recent evaluation studies, only 8 describe the methods in such detail that the study could be replicated. Incompatibility between MDC and UC indicates a four-fold risk that the death certificate is inaccurate. For some diagnostic groups, however, death certificates are often inaccurate even when the UC and MDC are compatible. Conclusion: Producers of official mortality statistics could reduce the number of non-obvious errors in the statistics by collecting additional information on incompatible deaths and on deaths in high-risk diagnostic groups. ICD conventions contribute to the quality problem since they presuppose that all deaths are due to a single underlying cause. However, in an ageing population an increasing number of deaths are due to an accumulation of etiologically unrelated conditions.

The number of persons who are not employed has increased in Sweden since the early 1990s. Unemployment has been found to influence health, especially when unemployment rates are low. The extent to which unemployment affects health when unemployment is high is less clear, and this needs to be further studied. To improve health in the population, the health care system should offer equal access to health care according to need. It is important to study whether the employment status hinders the fulfilment of this goal. This thesis is based on four papers: Paper I and II aimed at analysing self-rated health versus mortality risk in relation to employment status, during one period of low unemployment and one period of high unemployment. Paper III and IV assessed the use of medical health care services and unmet care needs among persons who were unemployed or otherwise not employed. The goal was to analyse what health problems lead people to either seek or abstain from seeking care, and what factors encumber or facilitate this process. The overall results indicate that being unemployed or outside the labour force was associated with an excess risk of poor self-rated health, symptoms of depression, mental and physical exhaustion and mortality. The differences in self-rated health between the unemployed and employed were larger when unemployment levels were high, than when they were low. More groups of the unemployed were also afflicted with poor health when unemployment was high. Thus, poor health among the unemployed seems to be a public health problem during high levels of unemployment. Lack of employment was related to abstaining from seeking care, despite perceiving a need for care, and this was related to psychological symptoms. To deal with the needs of the unemployed and others who are outside the labour force it would be useful to develop and implement interventions within the health care system. These should focus on psychological and psychosocial problems. Future research should analyse how to facilitate health-promoting interventions among persons who are not anchored in the labour market.

Thesis (MSocialWork)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The aim of this study was to compile practical guidelines to assist medical practitioners in utilizing social work services in their practices. Exploratory, descriptive and applied research was done to determine and describe medical practitioners' knowledge of psychosocial problems and their present and potential utilization of social work services. Results were generalized in respect of the population as a whole. In the theoretical study social functioning was conceptualized by the description of micro, mezzo and macro levels of functioning. The approach towards rendering of services (in the Medical field) and intervention (in the Social Work field) was described, followed by recommendations for the eclectical utilization of the approaches. The eclectical application of the intervention approaches requires that social workers should have certain knowledge, values and skills to interpret certain roles. This occurs within certain social work areas, with the achievement of the aims and functions of Social Work as goal. The ethical and value basis of Social Work and Medical Science shows certain similarities and disparities. The values of Social Work, as contained in the Behavioural- and Ethical Code for Social Work and the Oath of Hippocrates, in Medical Science, are described in this study. In the empirical study qualitative and quantitative information was gathered, inter alia, about the existence of psychosocial problems of patients in medical practitioners' practices, how medical practitioners handled them, how well equipped they were to do it, their present and potential utilization of Social Work services, the role of third parties in the rendering of services and referral procedures. Thirty nine (39) medical practitioners, selected by random sampling procedure, were involved in the study and completed selfadministered questionnaires. The majority respondents indicated that their undergraduate training was inadequate in enabling them to handle psychosocial problems of patients. The entire spectrum of psychosocial problems existed in all the respondents' practices. The majority of respondents handled such problems themselves, while specialists, psychologists and psychiatrists were at times used as resources. The majority of respondents indicated that they could perhaps utilize Social Work services and that there is a great need for such a resource. Most medical practitioners preferred to send written referrals via patients, with the responsibility being with the patient for making an appointment with the social worker. Minimal use was made of third parties in the patients' frame of reference in the assessment and treatment of patients. Third parties, within the reference framework of patients, were used minimally by medical practitioners in the making of assessments and the rendering of services. Respondents had divergent opinions regarding their competence in the psychosocial field of service rendering. The majority of respondents indicated the need for training programs focusing on the handling of patients' psychosocial problems. Limited time for attending such training programs was however mentioned as the biggest obstacle. These findings of the empirical study, together with the theoretical framework, were used as a guideline for the composition of a practical guideline for the referral of services to social workers in private practice. / AFRIKAANSE OPSOMMING: Die doelstelling van hierdie studie was om praktykriglynne te ontwikkel, waarvolgens geneeshere in privaat praktyk maatskaplike werkers as ondersteuningshulpbron kan benut. Verkennende, beskrywende en toegepaste navorsing is gedoen, ten einde geneeshere se kennis van psigososiale probleme en hul huidige en potensiele benutting van maatskaplikewerkdienste te bepaal en te beskryf. Bevindinge is ten opsigte van die populasie as geheel veralgemeen. In die teoretiese studie is maatskaplike funksionering deur die beskrywing van mikro-, meso- en makrovlakfunksionering, gekonseptualiseer. Die benaderings tot dienslewering (in Geneeskunde) en intervensie (in Maatskaplike Werk) is beskryf. Daarna is 'n aanbeveling vir die eklektiese benutting van die benaderings gedoen. Die eklektiese benutting van die intervensiebenaderings vereis dat maatskaplike werkers oor sekere kennis, waardes en vaardighede moet beskik en sekere rolle moet vertolk. Dit geskied binne sekere maatskaplikewerkvelde en het as mikpunt die verwesenliking van die doelstellings en funksies van Maatskaplike Werk. Die etiese en waardegrondslag van Maatskaplike Werk en Geneeskunde toon sekere ooreenkomste en verskille. Die waardes van Maatskaplike Werk, soos vervat in die Gedrags- en Etiese Kodes vir Maatskaplike Werk, en van Geneeskunde, soos vervat in die Eed van Hippocrates, word in hierdie studie bespreek. In die empiriese studie is kwalitatiewe en kwantitatiewe inligting ingesamel oor, onder andere, die voorkoms van psigososiale probleme by pasiente in geneeshere se praktyke, geneeshere se hantering daarvan, hul bekwaamheid om sodanige probleme te hanteer, hul huidige en potensiele benutting van maatskaplikewerkdienste, die rol van derde partye by dienslewering en verwysingsprosedures. Nege-en-dertig (39) geneeshere, geselekteer deur ewekansige steekproeftrekking, is by die ondersoek betrek en het self die vraelyste ingevul. Die meeste geneeshere het aangedui dat hul voorgraadse opleiding hulle nie voldoende toegerus het om psigososiale probleme by pasiente te hanteer nie. Die hele spektrum van psigososiale probleme het in respondente se praktyke voorgekom. Die meeste respondente het sodanige probleme self hanteer, terwyl spesialiste, sielkundiges en psigiaters soms as hulpbronne benut is. Die meeste respondente het aangetoon dat hulle moontlik van maatskaplike werkers gebruik kan maak en dat daar 'n groot behoefte aan sodanige hulpbron bestaan. Die verwysingsprosedure wat deur die meeste geneeshere verkies is, was die stuur van skriftelike verwysings saam met pasiente. Derde partye, in pasiente se verwysingsraamwerk, is minimaal deur geneeshere by assessering en dienslewering betrek. Geneeshere het uiteenlopende menings gehad oor hul bevoegdhede in die psigososiale veld van dienslewering. Die behoefte aan opleidingsprogramme, wat fokus op die hantering van psigososiale probleme by pasiente, is deur die meeste respondente aangedui. Beperkte tyd is egter as die grootste struikelblok vir die bywoning van sodanige opleidingsessies aangevoer. Hierdie bevindinge van die empiriese studie, saam met die teoretiese raamwerk, is as riglyn benut vir die ontwikkeling van 'n praktykriglyn vir verwysing van dienste na maatskaplike werkers in privaat praktyk.