This study examined the early course of depression by testing a conceptual model for the development and remission of depressive symptoms. In this model, prodromal symptoms emanate from the core pathological processes underlying the disorder and comprise the core syndrome as the earliest symptoms to appear, with episodes of depression representing the more pronounced peaks of symptomatology; the core symptoms would also be the last to remit. Several general hypotheses generated from this model were tested. Additionally, the hopelessness and endogenous subtypes of depression were conceptualized within this model and examined. Cognitive risk for depression and the cognitive personality modes of sociotropy and autonomy were also examined as predictors of specific prodromal and residual symptoms. Correlation and survival analyses were conducted to test the various hypotheses. Results supported the existence of a depressive prodrome as well as the general model being tested. The earliest symptoms to appear in an episode of depression were generally consistent throughout the episode and remained as the last to remit. The order of symptom onset was related to the reverse of the order of symptom remission. The durations for the prodromal and remission phases were significantly correlated. When applied to the hopelessness subtype of depression, and depressions experienced by highly sociotropic individuals, the model held. In the endogenous subtype of depression, and among cognitively high-risk and highly autonomous individuals, the model was not strongly supported. / Psychology

<p> Diabetes is a chronic disease that affects more than 2 million Canadians. In order to reduce the risk of complications, people with diabetes must monitor their symptoms and actively manage diet, exercise, and medication. Patient priority is defined as the patient's implicit or explicit ordering of importance, ease and frequency of preventative or treatment activities for managing diabetes. In this study, we report on the findings of a questionnaire of diabetes patient priorities. The primary purpose of this study was to identify patient priorities and their relationships for managing diabetes from a patient's perspective. Multivariate analysis techniques were applied to find the patterns within the ratings of importance, ease and frequency for seventeen diabetes care activities. Multivariate analysis is used when more than one measurement is taken on a given experimental unit and all the measurements need to be considered together so that one can understand how they are related and what the essential structure is. In our study, the multivariate techniques used were MANCOVA, multivariate regression, and factor analysis. Due to the missing values, simple and multiple imputations were necessary. This study acts as a pilot study for a future, larger study about patient priorities.</p> / Thesis / Master of Science (MSc)

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23061号 / 医博第4688号 / 新制||医||1048(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙橋 良輔, 教授 高橋 淳, 教授 伊佐 正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases with a substantial burden in terms of morbidity, mortality and costs. Smoking is the single most important risk factor for COPD, and is associated with incident asthma. It is important to know if the prevalence of asthma and COPD is increasing or decreasing in the population in order to effectively allocate health care resources. The definitions of these diseases have varied over time which makes it difficult to measure changes in prevalence. The preferred method is to estimate the prevalence with the same procedures and definitions based on cross-sectional population samples with identical age distributions in the same geographical area at different time points. Measurements of lung function (spirometry) are required to diagnose COPD, and spirometry is used to evaluate disease severity and progress of both asthma and COPD, where observed values are compared to reference values. The most commonly used reference values in Sweden are published during the mid 1980s, and there are few evaluations of how appropriate they are today based on Swedish population samples. The aim of the thesis was to estimate trends in the prevalence of asthma and COPD in relation to smoking habits, and to evaluate and estimate reference values for spirometry. Methods The project was based on population-based samples of adults from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Postal questionnaires were sent to large cohorts, recruited in 1992 (n=4851, 20-69 years), 1996 (n=7420, 20-74 years) and 2006 (n=6165, 20-69 years), respectively. The questionnaire included questions on respiratory symptoms and diseases, their comorbidities and several possible risk factors including smoking habits. Structured interviews and spirometry were performed in random samples of the responders to the 1992 and 2006 surveys, of which n=660 (in 1994) and n=623 (in 2009) were within identical age-spans (23-72 years). The trend in asthma prevalence was estimated by comparing the postal questionnaire surveys in 1996 and 2006, and the trend in COPD prevalence was estimated by comparing the samples participating in dynamic spirometry in 1994 and 2009, respectively. The prevalence of COPD was estimated based on two different definitions of COPD. Commonly used reference values for spirometry were evaluated based on randomly sampled healthy non-smokers defined in clinical examinations of participants in the 2006 postal questionnaire (n=501). The main focus of the evaluation was the global lung function initiative (GLI) reference values published in 2012, for which Z-scores and percent of predicted values were analysed. New sex-specific reference values for spirometry were estimated by linear regression, with age and height as predictors. These new OLIN reference values were also evaluated on a sample of healthy non-smokers identified in the population-based West Sweden Asthma Study. Results Although the prevalence of smoking decreased from 27.4% to 19.1%, p&lt;0.001, between 1996 and 2006, the prevalence of physician-diagnosed asthma increased from 9.4% to 11.6%, p&lt;0.001. The prevalence of symptoms common in asthma such as recurrent wheeze did not change significantly between the surveys or tended to decrease, while bronchitis symptoms such as cough and sputum production decreased significantly. The evaluation of the GLI reference values showed that the predicted values were significantly lower compared to the observed values in Norrbotten, which makes the percent of predicted too high. This was especially true for FVC percent predicted with a mean of 106%. In general, the deviations were more pronounced among women. New OLIN reference values valid for the Norrbotten sample were modelled and showed a high external validity when applied on the sample from western Sweden. The prevalence of moderate to severe COPD decreased substantially over the 15-year period between 1994 and 2009, regardless of definition. Conclusions In parallel with substantially decreased smoking habits in the population between 1996 and 2006, the prevalence of several airway symptoms decreased while the prevalence of physician-diagnosed asthma increased. These results suggest increased diagnostic activity for asthma, but may also suggest that the asthma prevalence has continued to increase. In contrast to asthma, the prevalence of COPD tended to decrease and moderate to severe COPD decreased substantially. The continuous decrease in smoking in Sweden during several decades prior to the study period is most likely contributing to these results. The evaluation of reference values showed that the GLI reference values were lower than the observed spirometric values in the population, especially for women, why the new up-to date reference values may be of importance for disease evaluation in epidemiology and in the health care as well.

Introduction: Dyspnea on exertion (DOE) is a common symptom experienced by 40% of healthy obese women. Dyspnea has at least two dimensions: a sensory (intensity) and an affective dimension. The affective dimension was measured in this study by unpleasantness and negative emotions (i.e., depression, anxiety, frustration, anger, and fear) related to DOE, measured as rating of perceived breathlessness (RPB). Purpose: To examine whether RPB during exercise was associated with unpleasantness and negative emotions and the relative exercise intensity and to examine whether 12-week exercise training can reduce unpleasantness and negative emotions related to breathlessness in healthy obese women. Methods: A secondary analysis was conducted from data collected from an interventional study. Volunteers underwent body measurements, underwater weighing, pulmonary function testing, and a constant-load cycle test (60 watts). RPB, unpleasantness, and negative emotions related to DOE were obtained. Results: There was a positive relationship (n = 74) between RPB and unpleasantness (r = .61) and RPB and anxiety (r = .50). There was a relationship (n = 52) between unpleasantness and %VO₂max, r = .28 as well as %HRmax r = .38; anxiety and %HRmax, r = .28 (p < .05). Unpleasantness and anxiety were different between groups (n=55). Unpleasantness was higher in the +DOE group (M = 3.91, SD = 2.29) than the–DOE group (M = 1.37, SD = 2.01), t(53) = 4.27, p = < .0001; Anxiety was higher in the +DOE group (M = 2.76, SD = 2.99) than in–DOE group (M = 0.72, SD = 1.23), t(41.95) = 3.45, p = < .001. Within group analysis (n = 13) showed that participants in +DOE experienced a decrease in unpleasantness after 12-week exercise training (p = .013; paired t test). There was a main effect of exercise on unpleasantness (p = .0307) and a group x training interaction (p = .0285) indicating that persons with DOE prior to the exercise intervention experienced less unpleasantness after the intervention. Conclusion: Unpleasantness and anxiety have been identified as the most common symptoms associated with RPB. Healthy obese women who engage in physical activity may experience higher rates of unpleasantness and anxiety based on their relative intensity of exercise. In addition, women with DOE who experience unpleasantness as an associated symptom could possibly decrease the level of unpleasantness if they engage in an exercise-training program.

published_or_final_version / Community Medicine / Master / Master of Public Health

The purpose of this study was to gain understanding of the early symptom experience of ischemic stroke in women. This is the only study of which the researcher is aware in which narrative inquiry was used to examine the period of time from symptom onset until emergency department arrival in women. Data collection was achieved by in-depth interviews during which participants’ stories of stroke were elicited. Individual narrative accounts were created and analyzed using within and across case techniques. The participants were nine women ranging in age from 24-86 years (average age 53). Four participants were Caucasian, three were Hispanic, one was African American and one woman was of mixed race. The participants experienced the onset of stroke as the inability to carry out accustomed activities in usual ways. There was a tendency to objectify the body. Only two participants considered stroke as a possible cause for their symptoms, and the other women attributed symptoms everyday bodily experiences and/or other health conditions. Most participants did not perceive themselves at risk for stroke although all but one woman had risk factors. The participants displayed a variety of responses to symptoms, including trying to continue with usual activities and seeking help as well as deciding not to tell anyone about their symptoms. Symptom response was related to women’s evaluation of and emotional response to symptoms. The actions taken by the participants in response to symptoms were informed by the meaning of the symptoms, and meaning was formed within the context of each woman’s life situation. Few women made the decision to seek medical care on their own, and in every case family members or co-workers were reported to take an active role in getting the participant to the hospital. Some family members were reported to consult with one another before making the decision to call EMS or transporting the participant to the emergency department. Consistent with what was expected from extant research the majority of the participants did not arrive at the hospital in time to be offered treatment with t-PA. Recommendations for future research, stroke education and practice were discussed. / text

Purpose The purpose of this enquiry is to explore the symptom experience and the health-related quality of life (HRQL) of children who have survived a brain tumour. Design An emergent, mixed-method study design was used with three phases of inquiry. 1) A systematic review was undertaken of previous research on the HRQL outcomes and symptom experience of children who have survived a brain tumour. 2) A quantitative study of the relationship between symptom experience and HRQL in 50 children who have survived a pediatric brain tumour was completed. This study was followed by a qualitative study of 12 children that used an interpretive descriptive methodology to understand the perceived relationship between symptom experience, coping and quality of life. 3) The results of phases 1 and 2 were translated into an evidence-informed clinical practice framework. Results 1) Pediatric brain tumour survivors had poorer HRQL outcomes than other cancer survivors or healthy peers. Only two previous studies had explored the relationship between symptoms and HRQL. 2) Pediatric brain tumour survivors experience many symptoms following the completion of treatment. The most distressing symptoms were pain, headaches, fatigue and sleep problems. Survivors of pediatric brain tumours described multiple symptoms that affect their life; yet overall they described their quality of life as good. Survivors used a variety of coping strategies to help mitigate the negative effects of these symptoms. 3) The results of the above studies informed the development of a clinical practice framework (the Queen’s-Macartney Multidisciplinary Action Plan for Oncology Survivors - Q-MapS), that requires further testing. It is intended to optimize clinical practice, to encourage education and to stimulate further research. Conclusions Child survivors of brain tumours experience various symptoms that can affect their HRQL. Nurses play a pivotal role in the systematic assessment and management of the multidimensional symptom experience of children following treatment for a brain tumour. Q-MapS can empower patients and their families by increasing their awareness of potential or actual problems related to their symptom experience and HRQL. More research is needed to better understand the relationship between symptoms and HRQL in children surviving brain tumours. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-05-01 21:12:57.809

There is accumulating epidemiological evidence of cross-ethnic differences in relation to schizophrenia’s incidence and prevalence. However, there is a dearth of information about the manifestations of cultural differences in schizophrenia’s symptoms. This thesis aims to bridge the gap in our knowledge about the relationship between cross-cultural differences and schizophrenia. Throughout this thesis, I explore the similarities and dissimilarities of the content of clinical manifestation across cultures. I also examine and further develop epidemiological and clinical issues utilizing the ecological theory model. First, I perform a qualitative systematic review which includes 26 publications. I then discuss findings from a statistical analysis of a mental health population of 860 patients in Brent, North London. Lastly, I report results from a semi-structured mental health questionnaire that was devised and disseminated to 48 mental health professionals in London. Results indicate that ethnic groups which experience a higher incidence of schizophrenia also tend to display more positive or first rank symptoms. These ethnic groups that experience a higher incidence of schizophrenia also belong to cultures that culturally legitimise an externalization of their distress. On the other hand, it was found that cultures that internalize their distress experience lower incidence of schizophrenia. My research further demonstrates that schizophrenia’s interpretations are heavily dependent on the diagnosers’ own cultural background, and on the degree to which the externalization of a symptom is tolerable in that context. Furthermore, evidence of intra-cultural diversity in clinical settings underscores the importance of achieving higher cultural competence.

The overall aim of this thesis is to increase our knowledge of relevant exposure parameters when discussing possible health implication from exposure to radiofrequency electromagnetic fields (RF), especially effects that might occur at non-thermal levels. In this thesis an effort is made to broaden the exposure assessment and to take the exposure time into account and combine it with the Specific Absorption Rate (SAR) and the field parameters (electric and magnetic field strength) to approach a dose concept. In the first part of the thesis self-reported subjective symptoms among mobile phone users were studied. As a basis for this an epidemiological study among mobile phone users was completed with the main hypothesis that users of the digital transmission system GSM experience more symptoms than users of the older analogue NMT transmission system. The hypothesis was falsified, but an interesting side finding was that people with longer calling time per day experienced more symptoms than people with shorter calling time per day. The time-aspect (long duration phone call etc.) was also found to be relevant for the occurrence of symptoms in association with mobile phone use as well as duration of symptoms. The new suggested dosimetric quantity Specific Absorption per Day (SAD), in which both calling time per day as well as the measured SAR1g are included showed a stronger association to the prevalence of some of the symptoms, such as dizziness, discomfort and warmth behind the ear compared to both CT and SAR1g alone. In the second part whole body exposure conditions were considered. Methods to measure the induced current were examined in an experimental study, where different techniques were compared in different grounding conditions. The results were used in a study of operators of RF plastic sealers (RF operators) where the health status as well as the exposure were studied. The results showed that RF operators are a highly exposed group, which was confirmed by the fact that 16 out of 46 measured work places exceeded the ICNIRP guidelines. Headaches were found to be associated with the mean value of the time integrated E-field during a weld (E-weld) and the warmth sensations in the hands (warm hands) with the time integrated E-field exposure during one day (E-day). The general findings in this thesis indicated that time should be included in the exposure assessment when studying non-thermal effects such as subjective symptoms in connection with RF exposure. The thesis proposes two different methods for doing this, namely timeintegrated exposure [V/m x t and A/m x t] and dose [J/kg].