Thesis (doctoral)--Nijmegen, 1982.

Light and noise in the neonatal intensive care unit (NICU) may be stressful to infants who are born preterm. The goals of this research were twofold: a) to evaluate the physiological stability (heart rate, heart rate variability, and oxygen saturation) of 28 to 32 gestational age preterm infants while wearing eye goggles and earmuffs for a 4-hour period, and b) to evaluate their pain response (heart rate and heart rate variability) during a painful procedure (heel lance) following the 4-hour period that they had worn the eye goggles and earmuffs. Preterm infants were recruited from four university-affiliated teaching hospitals in the Montreal region that have a level III NICU. A cross-over trial allowed the evaluation of physiological stability in a sample of 54 infants, and a randomized controlled trial with 44 infants was used to evaluate pain response. For the crossover trial, preterm infants were randomized in one of the following sequences: intervention - control or control - intervention. In the RCT, the first randomized study period (A or 8) of the cross-over trial determined whether preterm infants were or were not wearing eye goggles and earmuffs prior to a heel lance procedure. Data were collected using the Somte™ device allowing the continuous recording of outcome measures and infants were videotaped during the study periods for evaluation of potentially confounding variables. Results of the RM~ ANOVA revealed that infants were more physiologically unstable while wearing the eye goggles and earmuffs. This was shown by signs of stress, such as a significantly higher maximum heart rate and a significantly lower high frequency power (heart rate variability), during the intervention period compared with the control period. [...] / La lumière et le bruit dans l’unité néonatale peuvent être particulièrement stressants pour les prématurés. Les buts de cette étude étaient d’évaluer chez des prématurés de 28 à 32 semaines d’âge gestationnel: a) leur stabilité physiologique (rythme cardiaque, variabilité du rythme cardiaque et saturation d’oxygène) lorsqu’ils portent des lunettes et des couvre-oreilles pendant une période de 4 heures, et b) leur réponse à la douleur lors d’une prise de sang au talon (rythme cardiaque et variabilité du rythme cardiaque) après la période de 4 heures où ils ont porté les lunettes et les couvre-oreilles. Les prématurés ont été recrutés dans quatre centres hospitaliers de la région de Montréal qui possèdent une unité néonatale de soins intensifs. La stabilité physiologique a été évaluée à l’aide d’un plan croisé avec un échantillon de 54 prématurés alors que la réponse à la douleur a été évaluée à l’aide d’un essai clinique randomisé avec un nombre de 44. Pour le plan croisé, les prématurés ont été randomisés dans l’une des séquences suivantes : intervention - contrôle ou contrôle - intervention et pour l’essai clinique randomisé, la première période de la randomisation réalisée pour le plan croisé (A ou B) a déterminé si les prématurés portaient ou non les lunettes et les couvre-oreilles avant la prise de sang au talon. Les données ont été collectées à l’aide d’un appareiilage (Somté™) qui permettait un monitorage continu des variables dépendantes et des enregistrements vidéo des prématurés ont été réalisés pour l’évaluation de variables potentiellement confondantes.

Thesis (Ph. D.)--University of Washington, 1989. / Vita. Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [139]-155).

Thesis (M.S.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "December 2008" Includes bibliographical references.

No description available.

Dissertation (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2008. / Vita. Bibliography: p. 96-110.

Diante das evidências de que o estresse está presente entre os universitários de enfermagem e os malefícios que o estresse crônico pode ocasionar à saúde física e mental, o objetivo deste estudo foi avaliar a influência de fatores pessoais e ambientais relacionados ao estresse recente em universitários de enfermagem, assim como avaliar a ocorrência, os fatores associados e preditores do estresse recente. Foi realizado um estudo epidemiológico, transversal, analítico, com abordagem quantitativa em duas instituições privadas de ensino superior, com 209 universitários de enfermagem do primeiro ao último ano. Foram utilizados como instrumentos de coleta de dados um questionário sociodemográfico, de condições ocupacionais e de saúde, o -Questionário sobre Traumas na infância? (CTQ), a -Escala de Estresse Percebido? (Perceived Stress Scale- PSS), o -Inventário de Sintomas de Stress? para adultos (ISSL), a -Escala de Autoestima de Rosenberg? e a -Escala de Reajustamento Social de Homes-Rahe?. Para a análise dos dados foi realizada a estatística descritiva, medidas de tendência central, teste Qui-quadrado de Person (?²) ou o teste exato de Fisher quando violadas as suposições matemáticas para o teste Qui-quadrado e regressão logística binária, utilizando o software SPSS, versão 21, e o nível de significância adotado em toda a análise foi 5% (alfa=0,05). Observou-se que, entre os universitários de enfermagem, 164 (78,5%) apresentam estresse e a maioria na fase de resistência, 121(57,9%), principalmente com manifestações de sintomas psicológico, 121(57,9%); 77 (36,8%) vivenciaram estresse precoce, com predomínio de abuso emocional, 42(20,5%); e 40(20%) apresentam fortes chances de adoecer. A maioria apresenta autoestima média, 106 (50,7%), ou alta, 95 (45,5%). O estresse recente teve associação com problemas de saúde, uso de medicamentos, autorrelato de estresse, percepção de estresse e exigências de reajustamento social. Além disso, realizar atividade física, tabagismo, alta autoestima, vivências de estresse precoce e ter religião foram apontados como preditores de estresse. Enquanto média e alta percepção de estresse, ser casado, trabalhar, trabalhar na área da saúde, ter atividades de lazer semanal representam menores chances para o estresse nos universitários de enfermagem do estudo. Conclui-se que fatores pessoais como problemas de saúde, uso de medicamentos, autorrelato de estresse, percepção de estresse e o fator ambiental exigências de reajustamento social influenciam no estresse recente em universitários de enfermagem / In light of the evidence that stress is present among university nursing students and the evils that chronic stress can cause to physical and mental health, this study was aimed at assessing the influence of personal and environmental factors related to the recent stress in university nursing students, as well as to assess the occurrence, the associated factors and the predictors of the recent stress. We performed an epidemiological, cross- sectional and analytical study, with a quantitative approach, in two private higher education institutions, with 209 nursing students from the first to the last year. Regarding the data collection tools, we used a sociodemographic questionnaire about occupational and health conditions, the -Childhood Trauma Questionnaire? (CTQ), the Perceived Stress Scale (PSS), the -Inventory of Symptoms of Stress? for adults (ISSL), the -Rosenberg Self-Esteem Scale? and the -Holmes-Rahe Social Readjustment Scale?. In order to analyze the data, we used descriptive statistics, measures of central tendency, Pearson Chi-square test (?²) or Fisher exact test, when the mathematical assumptions for the Chi-square test were violated, and binary logistic regression, using the SPSS software, version 21. The level of significance adopted throughout the analysis was 5% (alpha = 0.05). We have observed that, among university nursing students, 164 (78.5%) presented stress, and most in the resistance stage, 121 (57.9%), especially with manifestations of psychological symptoms, 121 (57.9%); 77 (36.8%) experienced early stress, with a predominance of emotional abuse, 42 (20.5%); and 40 (20%) present strong chances of becoming ill. Most of them have medium or high self-esteem, 106 (50.7%) and 95 (45.5%), respectively. The recent stress was associated with health problems, use of medication, selfreport of stress, perception of stress, and demands for social readjustment. Moreover, performing physical activity, smoking, high self-esteem, experiences of early stress and having religion were signalized as predictors of stress. Conversely, medium and high perceived stress, being married, working, working in the health area and having weekly leisure activities represent lower chances of suffering from stress in the surveyed university nursing students. We have concluded that personal factors such as health problems, use of medication, self-report of stress, perception of stress and the environmental factor demands for social readjustment influence on the recent stress in university nursing students

Introdução: o trabalho do policial é complexo e permeado de estresse que, quando associado a hábitos de vida nocivos, aumenta o risco de danos cardiocirculatórios. A crescente onda de violência urbana e o frequente confronto com vândalos expõem os policiais a maior risco de estresse e morte. Objetivo: este estudo tem como objetivo analisar o efeito de uma intervenção educativa de enfermagem (IEE) nos índices da variabilidade da frequência cardíaca em policiais de um Batalhão Militar de Santa Catarina. Método: trata-se de um estudo experimental do tipo antes e depois com um único grupo de abordagem quantitativa com 38 policiais militares do sexo masculino no período de fevereiro a junho de 2016. As variáveis independentes foram compostas por qualidade de vida e estratégias de coping que foram coletadas por meio das escalas de avaliação da qualidade de vida (WHOQOL-Bref) e da escala para avaliar as estratégias de enfrentamento (Coping). Considerou-se variável dependente a variabilidade da frequência cardíaca (VFC). A mensuração da VFC deu-se por meio de método linear, no domínio de tempo e frequência durante quinze minutos. O estresse foi mensurado por meio da variação da concentração de cortisol salivar, com amostras de saliva coletadas individualmente em três horários: ao acordar, 30 minutos após acordar e antes de dormir. Essas medidas foram realizadas no início e ao término das sessões de intervenção educativa. O programa Statistical Package for the Social Sciences foi utilizado para as análises estatísticas descritivas. Os dados foram analisados por meio de medidas de tendência central. A normalidade da distribuição foi analisada pelos testes de Shapiro-Wilk e Kolmogorov-Smirnov. Para comparar as variáveis antes e após a intervenção educativa, usou-se o teste t-Student para amostras pareadas; em caso de assimetria, o teste de Wilcoxon. Para avaliar a associação das variáveis contínuas e ordinais com as variáveis de desfecho após a intervenção, foi aplicado o coeficiente de correlação de Spearman. Foram considerados significativos os dados com valor de p bicaudal menor ou igual a 0,05. Resultados: os policiais militares apresentavam idade média de 30,4 anos (±5,6), trabalhavam há quatro anos na instituição, e 34,2% apresentaram problemas de saúde. Os valores médios de pressão arterial se encontravam dentro da normalidade (123 mmHg x 80,1mmHg), entretanto o Índice de Massa Corporal indica sobrepeso (25,5±2,7 Kg/m²) e o Índice de Adiposidade Cutânea mostra 17,95% de gordura acima da média. Em relação à qualidade de vida, os domínios Físico (p=0,002), Meio Ambiente (p=0,039) e Percepção Global de Qualidade de Vida (PGQV) (p=0,002) do WHOQOL-Bref apresentaram medias superiores após a IEE, enquanto a estratégia de coping reduziu (p=0,042). Houve diferenças nas medianas de cortisol após a IEE. Aumentou ao acordar (p= <0,001), indicando melhora do sono; reduziu antes de dormir (p=0,047), como é esperado; na área abaixo da curva (p=0,007), que representa o cortisol total do período, e na resposta de cortisol ao acordar, indicando a expectativa de que o dia está sob mais controle; aumentou também a inclinação da reta (p<0,001), indicando diminuição dos valores de cortisol ao longo do dia. Na variabilidade da frequência cardíaca, a relação Low Frequency/High Frequency (LF/HF) reduziu (p=0,002), podendo indicar maior atividade parassimpática com balanço simpato-vagal sobre o coração. A concentração do cortisol à noite foi associada positivamente ao domínio Psicológico (0,402) e à Percepção Global de Qualidade de Vida (PGQV) (0,382) da escala WHOQOL-Bref. A área abaixo da curva (AUC) do cortisol teve relação estatística com o domínio Psicológico (0,330). A inclinação da reta de cortisol associou-se positivamente com a PGQV (0,411), enquanto a Resposta de Cortisol ao acordar teve associação positiva com a frequência cardíaca LF/HF (0,361). E ainda se observou melhora das médias na escala de alimentação após a intervenção (p<0,001), demonstrando melhora global nos hábitos alimentares. Conclusão: a intervenção educativa de enfermagem obteve efeito benéfico sobre a saúde dos policiais, com melhora em todos os domínios de qualidade de vida, com menor utilização das estratégias nocivas de enfrentamento Fuga-Esquiva, Afastamento e Confronto, além da melhora dos hábitos alimentares, repercutindo no aumento da variabilidade da frequência cardíaca e na redução da concentração de cortisol salivar. Tais intervenções/medidas podem ser úteis na prevenção de adoecimento por doenças cardiocirculatórias decorrentes de respostas fisiológicas ao estresse. / Introduction: the work of the policeman is complex and permeated with stress, which, when associated with harmful living habits, increases the risk of cardiocirculatory damage. The growing tide of urban violence and the frequent confrontation with vandals expose the policemen to a higher risk of stress and death. Objective: this study intends to analyze the effect of an educational nursing intervention (ENI) on the indexes of heart rate variability in policemen of a Military Battalion in Santa Catarina. Method: this is an experimental before-and-after study with a single group, with a quantitative approach, involving 38 male military police officers in the period from February to June 2016. The independent variables were composed of quality of life and coping strategies that were collected through the quality of life assessment scales (WHOQOL-Bref) and the scale for assessing coping strategies. Heart rate variability (HRV) was considered as a dependent variable. The HRV measurement took place by means of the linear method, in the domain of time and frequency for fifteen minutes. Stress was measured by means of the concentration variation of salivary cortisol, with samples of saliva individually collected on three different schedules: when waking up, 30 minutes after waking up and before sleeping. These measures were performed at the beginning and at the end of the educational intervention sessions. The Statistical Package for the Social Sciences program was used for the descriptive statistical analyzes. The data were analyzed by means of measures of central tendency. The distribution normality was analyzed through the Shapiro-Wilk and Kolmogorov-Smirnov tests. In order to compare the variables before and after the educational intervention, the t-Student test was used for paired samples; in case of asymmetry, the Wilcoxon test was used. In order to assess the association of the continuous and ordinal variables with the outcome variables after the intervention, the Spearman correlation coefficient was applied. The data with a two-tailed p value less than or equal to 0.05 were considered significant. Results: military police officers had an average age of 30.4 years (±5.6), worked for four years in the institution, and 34.2% showed health problems. The average blood pressure values were within the normal parameters (123 mmHg x 80,1mmHg), but the Body Mass Index indicates overweight (25.5±2.7 Kg/m²) and the Cutaneous Adiposity Index shows a fat percentage of 17.95% above average. Regarding the quality of life, the WHOQOL-Bref domains Physical (p=0.002), Environment (p=0.039) and Global Perceived Quality of Life (QOL) (p=0.002) showed higher averages after ENI, while the coping strategy decreased (p=0.042). There were differences in the medians of cortisol after ENI. It increased when waking up (p = <0.001), indicating improvement of sleep; decreased before sleeping (p=0.047), as expected; in the area below the curve (p=0.007), which represents the total cortisol of the period, and in the cortisol response when waking up, indicating the expectation that the day is under more control; it also increased the slope of the line (p<0.001), indicating decrease of cortisol values throughout the day. As for the heart rate variability, the Low Frequency/High Frequency (LF/HF) ratio decreased (p=0.002), which may indicate higher parasympathetic activity with a sympathovagal balance on the heart. The cortisol concentration at night was positively associated with the Psychological domain (0.402) and with the Global Perceived Quality of Life (QOL) (0.382) of the WHOQOL-Bref scale. The area below the cortisol curve (AUC) had a statistical relationship with the Psychological domain (0.330). The slope of the cortisol line was positively associated with QOL (0.411), while the Cortisol Response was positively associated with the LF/HF heart rate (0.361). There was also an improvement in the averages in the feeding scale after the intervention (p <0.001), demonstrating a global improvement in the dietary habits. Conclusion: the nursing educational intervention has obtained a beneficial effect on the health of the policemen, with improvements in all domains of quality of life and less use of the harmful coping strategies related to Escape-Avoidance, Distance and Confrontation, besides the improvement of dietary habits, reverberating in the increased heart rate variability and in the decreased salivary cortisol concentration. Such interventions/measures may be useful in preventing illness due to cardiocirculatory diseases arising from physiological responses to stress.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.