Background: Latinas experience a greater number of symptoms and are at an elevated risk for depression and anxiety following a diagnosis of breast cancer compared to Non-Hispanic Whites and African Americans. Cancer-related symptom clusters are frequently reported in women with breast cancer and research suggests these women follow distinct trajectories for depression and anxiety. However, little is known about the trajectories of anxiety and depression or cancer-related symptom clusters in Latinas with breast cancer. Methods: 296 Latinas previously recruited and diagnosed with breast cancer comprised this sample. Questionnaires for depression (the Center for Epidemiological Studies-Depression) and Anxiety (Speilberger State-Trait Inventory and PROMIS Anxiety) were administered at baseline, 2 and 4 months post enrollment. To identify classes of Latina breast cancer survivors based on patterns of symptom occurrence, symptoms latent class analysis was used to describe symptom clusters. Group-based growth mixture modeling was utilized to identify classes of women who followed distinct trajectories of depression and anxiety. Results: On average women reported 4.2±3 symptoms with an overall symptom distress score of 6.4±2.5 (out of a scale of 10). Three symptom classes were identified: Weary and Sleepy (class 1), Weary (class 2) and Weary, Sleepy and Hurting (class 3). Women were most likely to cluster in class 1, followed by class 2 and 3 with fatigue (labeled weary) being the most prevalent symptom for all three classes. Three trajectories emerged for both depression and anxiety. For depression, the majority of women (79.6%) fell in the high then reducing trajectory for depression followed by the low and remaining low (17%) and the high and increasing (worsening) trajectories of depression (3%). For anxiety the majority (78% of women) followed the moderate to increasing (worsening) trajectory of anxiety followed by 14% in the moderate to declining (improving) and 8% in the low to slightly increasing (worsening) trajectories for anxiety. Conclusion: This study suggests Latina breast cancer survivors experience burdensome cancer-related symptom clusters and distinct trajectories for depression and anxiety. Further research is needed in minority women with breast cancer to adequately understand and treat cancer-related symptom clusters as well as depression and anxiety.

Background: Despite the increased awareness and education to the public, concussions in children continue to ensue without proper concussion education and management in school systems. Whether the child suffers a concussion in school or at home, it is essential for school nurses to have proper concussion education and evidence based management strategies to further monitor post-concussive symptoms in the school setting. Concussion symptoms can affect the student up to 7-10 days following the injury. Concussions can range from mild to severe, with symptoms lasting hours, days, months or longer. Children who experience a concussion can experience academic challenges that will affect them in the classroom. Without proper concussion education for school nurses, concussed youth may experience post-concussive symptoms. School nurses have a significant role, collaborating with the parents, providers, and the student in providing accommodations and support while transitioning back into the classroom. Purpose: To assess the knowledge of Utah school nurses regarding concussion education and management of the concussed student. In addition evaluating the educational intervention, which changed the knowledge base of the participants. Methods: A one group pre-test and post-test design was used. Study materials were emailed via the Utah School Nurse Association listserv to all Utah school nurses. A concussion educational power point was provided to these nurses before having them complete the post-test. Results: The results of the paired sample t-test revealed that there was a significant difference (p= .000) in comparison of the pre-test and post-test results after viewing the concussion educational power point. Conclusion: The results of this study showed that there was a significant difference between pre-test and post-test results after viewing the concussion educational power point. Therefore it can be concluded that providing education and awareness regarding concussion and its management will increase the knowledge and ultimately may change practice which in turn may improve patient outcomes.

(DSM-IV-TR/) nor in withdrawal scales. However, a related term, "impatience" is listed in some nicotine withdrawal scales. (Hughes J. R., Measurements of the Effects of Abstinence from Tobacco: A Qualitative Review, 2007). Although impatience is not a synonym of impulsivity, both share the synonym "impetuous". Therefore, impatience can be considered a measure of impulsivity. Although some reviews of the effect of smoking cessation on impatience have occurred, we know of no quantitative review of prospective studies of whether smoking cessation increases impatience. Purpose: To evaluate the effect of smoking cessation on impatience as measured by the Minnesota Nicotine Withdrawal Scale-Revised (MNWS). Methods: A literature search of MEDLINE (PubMED), EMBASE, and PsychInfo was conducted. Articles containing relevant keywords were reviewed by two evaluators independently. To be considered for inclusion in the meta-analysis, studies had to be prospective studies, had to have pre-cessation impatience measurements, to include at least overnight abstinence, had to have smoking abstinence biochemically verified, and had to include effect size as an outcome measure. Results: All pooled analyses were based on random-effects models. Seven trials met the selection criteria. The total number of subjects was 426. There was a significant level of heterogeneity among studies (X2(6), pI2= 89%). The summary mean effect for impatience after tobacco cessation was an increase of .44 on a 0-3 scale (95% confidence interval [CI], 0.21-0.67) and a p-value Conclusion: The meta-analysis shows that impulsivity increases post smoking cessation. These findings imply that smoking cessation may have an effect on decision making. Additionally higher rates of impulsivity have been associated with smoking relapse. (Doran, Spring, McChargue, Peradia, & Richmond, 2004). In order to better assist in the development of individual treatments, a better understanding is needed of how increased impulsivity influences cognitive behavior and relapse rates. These findings support the inclusion of impulsivity as a criterion for nicotine withdrawal.

Empirically based methods of detecting retrospective malingering (i.e., the false assertion or exaggeration of physical or psychological symptoms reportedly experienced during a prior time period) are needed given that retrospective evaluations are commonplace in forensic assessments. This study's main objective was to develop and validate a focused, standardized measure of retrospective malingering. This objective was addressed by revising the Structured Interview of Reported Symptoms (SIRS), an established measure of current feigning. The SIRS' strategies were retained and its items modified to produce two new SIRS versions: The Retrospective Structured Interview of Reported Symptoms (R-SIRS) and The Concurrent-Time Structured Interview of Reported Symptoms (CT-SIRS). Forensic inpatients were used to test the R-SIRS (n = 25) and CT-SIRS (n = 26) which both showed good internal consistency and interrater reliability. The overall effectiveness of the R-SIRS and the CT-SIRS in the classification of malingerers and genuine patients was established in this initial validation study. Moreover, their classification rates were similar to those obtained by the SIRS. Pending additional validation, these measures are expected to increase the quality of forensic evaluations by providing the first standardized methods of assessing retrospective malingering.

Abstract HEART FAILURE SYMPTOM CLUSTERS AND FUNCTIONAL STATUS Janet Kay Herr Ph.D A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University 2012 Major Director: Dr. Jeanne Salyer, Ph.D., R.N., F.N.A.P Associate Professor, Adult Health & Nursing Systems Clinical assessment of heart failure includes symptom identification and the evaluation of the relationship of symptoms to functional status. Symptom clusters are groups of at least 2 or 3 co-occurring symptoms that are related but are independent of other groups of symptoms. The objectives of this study are to: (1) examine relationships among symptoms commonly experienced by individuals with heart failure, (2) identify symptoms that form clusters, and (3) evaluate the impact of heart failure symptom clusters on attributes of functional status: limitations and mobility The Theory of Unpleasant Symptoms guided the conduct of this study. Heart failure symptoms and the outcome variables functional limitations and mobility were evaluated in a convenience sample of individuals (n = 117) with a confirmed diagnosis of heart failure recruited viii from an academic medical center. Principle components analysis was used to extract symptom clusters and regression analysis was used to evaluate the relationship between the symptom clusters, their interaction terms, the demographic variables, age and co-morbidity, and functional status. Three symptom clusters, sickness behavior, discomforts of illness, and GI distress were extracted. Predictors of functional limitations (F = 35.96, p = 0.0005, R2 = 0.578) included sickness behavior (β = -.681, p 0.0005), discomforts of illness (β = - .765, p = 0.0005) and the interaction term between these two symptom clusters (β = .649, p = 0.014). This model predicted 59% of the variance in functional limitations. Predictors of limited mobility (F 20.68, p = 0.0005, R2 = 0.275) included sickness behavior (β = -0.441, p 0.0005) and co-morbidity (β = -.200, p = 0.019). This model predicted 28% of the variance in mobility. Relationship between clusters of heart failure symptoms and functional limitations or mobility was observed. The interaction between discomforts of illness and sickness behaviors implies that not only do functional limitations increase as discomforts of illness increase, but increases at a faster rate when sickness behaviors are increased. Changes in sickness behaviors has the potential to improve mobility from being bed or chair bound everyday or most days to being bed or chair bound only some days.

This study examined parenting style variables in predicting college students’ depression symptoms. Participants were 989 college students who participated in the first wave of the Spit for Science project (Dick et al., 2011). This study described the prevalence of depression symptoms, including the percentage of the sample endorsing various depression symptoms, and the frequency depression scores were elevated at multiple time points. A hierarchical multiple regression was conducted to examine whether two dimensions of parenting style, Autonomy Granting and Parental Involvement, would interact in predicting depression symptoms in the Junior year. The present study demonstrates that parenting style predicts a small but significant amount of variance in depression symptoms, after controlling for demographic characteristics, and these variables interact in producing their effect. Overall, findings suggest that depression symptoms are common and parenting style is relevant in understanding such symptoms.

The thesis focuses on the issue of consumption of simple sugar and the psychological and behavioral aspects related to addictive behavior. The aim of the study was to explore and describe whether and how selected behavioral and psychological symptoms are affected by change in the consumption of simple sugar. Data were obtained by semistructured interview and administration of questionnaires. Two questionnaires SCL-90 and the Food frequency questionnaire were used. The research sample was divided into two groups. First - control group are individuals who routinely consume food in which is usually simple sugar. Second - quasiexperimental group are individuals who have at least two years without simple sugar intake. Because of specificity of the selection criteria and in regard to validity of the quasiexperimental group were selected among individuals consuming a macrobiotic diet. Respondents completed an interview and filled out questionnaires within one meeting. Based on data analysis, it was found that individuals who consume sugar showed less psychopathological symptoms according SCL-90, after elimination of sugar also showed more characteristics of addictive behavior in relation to a simple sugar than the control group. Changes after the elimination of simple sugar were most commonly associated...

Starting point: Risk factors associated with suicidality are, for example, severe depressive phase in anamnesis, low self-esteem, feelings of hopelessness, aggressiveness, impulsivity, suicidal thoughts during depressive phase, severe anxiety, personality disorders (border, narcissistic, histrionic personality), nicotine abuse, alcohol or other substance abuse, stress, problems at work, sexual or psychical violence, conflicts with relatives or life partners, absence of the person who the pacient can trust (Látalová, & Praško, 2009). These risk factors can undoubtedly occur in non-alcoholic substance addicts, patients in hospitals or those without treatment. Thaťs why the work has been devoted to the topic of suicide, depression and addiction. In the research part I wanted to verify connection of depressive symptoms and suicidal risks in patients - men in some psychiatric hospitals in The Czech Republic. Aims: The main aim of my work was to map the topic of suicide and depression and connect it with the theme of addiction. The thesis has been compared suicidal risks and depressive symptoms in non-alcohol substance addicts - men in some psychiatric hospitals in The Czech Republic. Methods: We used Beck Depression Inventory and Pöldinger questionnaire for comparison of depressive symptoms and...

Student Number : 0316118X - MPH research report - School of Public Health - Faculty of Health Sciences / Introduction: On the weekend of 16 – 17 December 1995, the community of Macassar was exposed to elevated levels of sulphur dioxide vapours (SO2) caused by a fire on a nearby stockpile for approximately 21.5 hours. It has been estimated that community members were exposed to levels as high as 200 parts per million (ppm) of this gas as some 15 000 tons of the sulphur stockpile ignited. This resulted in a toxic plume of SO2 being blown over the Macassar area by the prevailing wind. The aim of this study was to assess the environmental and host factors associated with persistent lower respiratory symptoms among residents of this community six years after being acutely exposed to elevated exposures of SO2 vapours. Materials and methods: A case-control study was conducted. The cases and controls were selected from adult residents who reported to the Macassar disaster project clinic for a health assessment in order to lodge a medico-legal claim. Survey instruments included a questionnaire, clinical examination and clinical record review by an expert panel. A case was defined as an adult resident who presented to the clinic for an examination with persistent (at year 1 and 6 after the disaster) lower respiratory symptoms. Controls were chosen from clinic attendees without lower respiratory symptoms at year 1 and 6. Environmental exposure was calculated by using the Industrial Source Complex Short Term Model (ISCST 3) to predict time-averaged concentrations at specified receptor locations. Multiple logistic regression was used to investigate the association between lower persistent respiratory symptoms, host and environmental factors (estimated concentration and duration of exposure to SO2). Results: A total of 76 cases and 180 controls were selected. The cases and controls were comparable with respect to age, gender, height and smoking status. The results indicated that a medical history of pulmonary tuberculosis at least one year prior to the fire (OR: 3.5, CI: 1.5-8.4) was significantly associated with having persistent lower respiratory symptoms. Furthermore, subjects with persistent lower respiratory symptoms were nine times more likely to report symptoms of tight chest (OR: 9.9; CI: 5.2-19.1), and twice as likely to report shortness of breath (OR: 2.0; CI: 1.0-4.1) at the time of the fire. None of the exposure metrics (total hours of exposure, cumulative exposure, peak exposure) were significantly associated with persistent lower respiratory symptoms. However, peak SO2 exposure estimated at hour 15 was significantly associated with persistent lower respiratory symptoms (OR: 1.0; CI: 1.0-1.1). Discussion: The results of this study are consistent with previous studies reporting lower respiratory tract symptoms after chemical exposure irrespective of age or smoking status. Furthermore, as in other studies respiratory health status was a significant factor in determining susceptibility to SO2 exposure. Various reports in the literature suggest that exposure > 20 ppm is associated with chronic respiratory symptoms. This however was not demonstrated in this study, using estimates of exposure calculated using the ISCST model suggesting possible exposure misclassification. “Self-selection” bias was an important limitation in this study, since the entire study population was self-referred and as such the study population was not randomly selected. Another limitation is the possibility that there may be potential recall bias operating since the fire incident happened six years ago; however this was considered unlikely as there was nondifferential reporting between cases and control. Self reported symptoms on the questionnaires might have been over-reported due to fear, anxiety and stress or secondary gain related to compensation issues. The lack of association between exposure variables and persistent asthma may have also been due to lack of power (small sample size), although this was thought to be a minor contributory factor. Conclusion: Host-related factors such as a previous history of pulmonary TB and acute asthma-like symptoms at the time of the fire were important predictors of persistent lower respiratory symptoms reported by residents 6 years after acute exposure to SO2 vapours emanating from a sulphur fire.

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: Herpes Simplex Virus type 2 (HSV-2) is a common cause of genital ulcers worldwide and has emerged as a co-factor in human immunodeficiency virus (HIV) acquisition and transmission. A study was conducted to determine the prevalence of HSV-2, its correlates, the accuracy of reported history of genital ulcer disease (GUD) to predict HSV-2 infection and the extent of symptom recognition in a clinic population in Johannesburg. Methods: 210 women aged 18 years or older were interviewed and socio-demographic, sexual behaviour and clinical information collected. Serological testing for HSV-2 and HIV infections was performed, but only where sera were available for the latter. Factors associations with HSV-2 infection were assessed using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). The sensitivity, specificity, predictive values and likelihood ratios of a history of GUD were calculated. Results: The estimated sero prevalence of HSV-2 was 73% (95% CI 67% - 79%). Few participants, 13/206 (6%) participants had knowledge of genital herpes. Only 9/203 (4%) participants recognised lesions of genital herpes following education and counselling about HSV-2 infection. HSV-2 infection was associated with older age(>25 years of age) OR 2.6 (95% CI 1.4-5.0), spending more than 2 nights away from home, OR 6.0 (95% CI 1.0-62.7), having more than 2 sexual lifetime partners, OR 2.2 (95% CI 1.1-3.9), a history of an STI in the past 3 months ,OR 3.6 (95% CI 1.2-9.5) and HIV infection, OR3.3( 95%CI 1.4-7.9). A history of genital ulceration performed poorly as a predictor of HSV-2 seropositivity; the sensitivity was 7% and specificity was 96%. Conclusion: HSV-2 prevalence was high and few participants were aware of their infection. HVS-2 infection was associated with risky sexual behaviour .A history of genital ulcer disease was not sufficient as a diagnostic tool for HSV-2 infection. Public health interventions should focus on behavioural modification and increasing awareness of genital herpes. HSV-2 management should be incorporated into HIV care and STI protocols.