Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 116-130).

Thesis (Ph. D.)--Ohio State University, 2007. / Full text release at OhioLINK's ETD Center delayed at author's request

Caregiving for a close family member with Alzheimer’s disease is a stressful situation to be in, that often leads to high levels of caregiver burden and subsequent stress and depressive symptoms, and while there are numerous community and government resources available to caregivers, there are aspects of Hispanic cultures that may lead Hispanic caregivers to have higher levels of caregiver burden and depressive symptoms than White caregivers. 80 Hispanic caregivers and 80 White caregivers, with 40 males and 40 females within each group, will be recruited to participate in this study. Scales will be administered to both Hispanic and White caregivers in order to assess levels of caregiver burden, depressive symptoms, familism values, gender role beliefs, acculturation levels, and knowledge, comfort, and use of community resources. Hispanic caregivers will have higher levels of caregiver burden and depressive symptom scores than White caregivers, while women will have higher scores overall than men overall. Hispanic caregivers will have less knowledge, comfort, and use of community resources than White caregivers, while gender role views, familism values, and acculturation levels will be mediating factors of these relationships. Cultural differences in caregiver burden need to be assessed further, so that clinical and practical implications for community and government resources can be discussed.

Made available in DSpace on 2014-06-11T19:23:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-23Bitstream added on 2014-06-13T20:30:24Z : No. of bitstreams: 1 facina_vb_me_arafcf.pdf: 1022448 bytes, checksum: fccac3737fb0a4e1993b48dc9b30ee8f (MD5) / Universidade Estadual Paulista (UNESP) / O câncer é um importante problema de saúde pública mundial e, também, em países em desenvolvimento, como o Brasil. Dentre os tipos mais frequentes entre as mulheres brasileiras, têm-se os cânceres de mama, de colo de útero e de ovário. Nesta pesquisa foram estudados aspectos relativos à alimentação e nutrição de mulheres acometidas por estes cânceres ginecológicos, com o objetivo de avaliar o efeito da quimioterapia na evolução do estado nutricional destas mulheres considerando os sintomas gastrintestinais, o consumo alimentar e as alterações nos exames bioquímicos. Participaram do estudo 29 mulheres, sendo 22 acometidas pelo câncer de mama, 4 pelo câncer de ovário e 3 pelo o de colo de útero. Para tanto, no 1º, 3º e 5º ciclos de quimioterapia foram realizadas entrevistas nas quais as pacientes eram inquiridas sobre intolerâncias alimentares, sintomas gastrintestinais e aplicada a Avaliação Subjetiva Global Produzida Pelo Paciente (ASG-PPP).O consumo alimentar foi avaliado pelo recordatório do consumo de 24 horas, no dia que precedeu a quimioterapia e no dia do procedimento. No dia da quimioterapia foi realizada ainda a avaliação antropométrica. Os dados de exames bioquímicos e de protocolos de quimioterapia foram coletados dos prontuários. Como resultado se obteve que durante a quimioterapia, os sintomas mais frequentes foram: náusea, disgeusia, obstipação, anorexia, diarreia e mucosite. O consumo alimentar sofreu redução em relação à quantidade de energia e nutrientes ingeridos no período em que a paciente realizava a sessão quimioterápica em relação ao período que antecedia a esta. Houve pequena, mas significativa redução na média geral do peso corporal do primeiro para o terceiro ciclo de quimioterapia. No entanto, a maioria das mulheres com câncer de mama ganhou peso... / Cancer is an important public health problem worldwide, and also in developing countries like Brazil. Among the most frequent type affecting Brazilian women, there are cancers of breast, cervical and ovarian. This research studies the aspects related to feeding and nutrition of women affected by these gynecological cancers, with the goal to assess the effect of chemotherapy on the evolution of the nutritional status of these women considering gastrointestinal symptoms, food consumption and changes in biochemical tests. The study included 29 women, 22 affected by breast cancer, 4 by ovarian cancer, and 3 had cervical cancer. Interviews were conducted, on first, third and fifth chemotherapy protocols, in which patients were asked about food intolerance, gastrointestinal symptoms and applied Subjective Global Assessment Produced by the Patient. Dietary intake was assessed by recall of consumption of 24 hours on the day prior to chemotherapy and the day of the procedure. On the day of chemotherapy was also evaluation anthropometric. The data from biochemical and chemotherapy protocols were collected from medical records. As a result it was found that during chemotherapy, being the most common symptoms were: nausea, dysgeusia, constipation, anorexia, diarrhea and mucositis. Food consumption reduced in relation to the amount of energy and nutrients consumed in the period in which the patient was a chemotherapy session in relation to the period preceding this. There was a small but significant reduction in overall mean body weight from first to third cycle of chemotherapy. However, most women with breast cancer gained weight during the procedure. There was no association between frequency of symptoms with the anthropometric indicators, but rather with the consumption of macronutrients and erythrocytes. The ASG-PPP showed... (Complete abstract click electronic access below)

Abstract According to previous findings girls tend to excel in school to hide and compensate for difficulties due to their ADHD diagnosis. Girls show a higher level of inattentive/introverted symptoms, whereas boys show higher levels of hyperactive symptoms. Based on prevailing research, this essay seeked to find a better understanding toward the symptoms and psychosocial effects among girls with ADHD, with a feminist approach. To investigate the objective a literature study has been conducted, where nine peer reviewed documents have been selected as primary documents for data and analyses. The present study found there to be a lack of knowledge among professionals about girls with ADHD regarding to symptoms, psychosocial effects and treatment. Furthermore, the study suggested a gender bias in the school environment, where teachers had a negative impact on whether girls with ADHD symptoms were referred for further assessment and treatment. Based on the literature review, it was concluded that girls are subordinate to boys in terms of receiving help and support, which may have consequences for the way girls’ symptoms and psychosocial effects are dealt with. The conclusion was made that society’s view of girls with ADHD is, from a feminist approach, not related to an ill will, but lies in deeper social structures. Keywords: ADHD, girls, effects, symptoms, gender

Submitted in fulfillment of the requirements for the degree of Master of Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2015. / Introduction The purpose of this investigation was to determine the effects of Malus domestica 30CH on a group of healthy provers and to compare these signs and symptoms to remedies of repertorial similarity. Malus domestica (common domestic apple) is an indigenous South African fruit which grows on the Drakensberg Mountains in Northern KwaZulu-Natal and is a regular part of the diet for those living there. This study hypothesized that Malus domestica 30CH would prove observable signs and symptoms in healthy individuals. Further it was hypothesized that the comparison of Malus domestica to remedies of reportorial similarity would highlight similarities and differences between existing homoeopathic remedies and Malus domestica 30CH thereby clarifying the therapeutic action of this new remedy and its relative location in the materia medica. The study was conducted by two researchers who each managed 15 provers and shared all primary data. The second researcher hypothesized that there would be a similarity between the proving symptoms of the remedy and the Doctrine of Signatures of the original substance (Ramnarayan 2014). Methodology A double blind placebo controlled proving of Malus domestica 30CH was conducted on 30 healthy volunteers who met specific inclusion criteria, with 6 receiving placebo and 24 receiving verum. A case history and thorough physical examination was performed on every prover before commencement of the proving. Recording of the data collected was in the form of a journal. Once the proving was completed information from each prover was collated and assessed by the two researchers. The symptoms elicited were then translated into materia medica and repertory language and a complete homoeopathic picture of the remedy appeared. Information from case histories and physical examinations were also considered. A repertorisation of 10 rubrics chosen to represent the essence of Malus domestica was conducted using Radar Opus software. Exclusion repertorization then followed in order to identify those remedies producing the highest numerical value and total number of rubrics within the animal, mineral and plant kingdoms in particular. Results Vast arrays of symptoms were experienced by the provers. Polarities in the symptoms were often displayed. On the emotional plane, there were symptoms of depression, sadness and cheerfulness. Some provers experienced tranquility and others felt anger, frustration and irritation. On the mental plane there were symptoms of clarity, focused concentration and confusion. The presence of delusions was marked. The most prominent delusion which infiltrated the mental and physical plane was of disconnection and separation. The main symptoms were sensations as if the extremities were separated from other areas. There was cramping and itching of the extremities as well. Pulsating headaches with perspiration of the scalp and eye pain were experienced. Various gastrointestinal symptoms were experienced ranging from distention, eructations, cramping, and diarrhea to hemorrhage after stool. Constriction of the chest and a loose, dry cough was also experienced. Cervical and lumbar back pain was reported. Sleep was described as unrefreshing with sleeplessness. The themes that emerged from the dreams were of danger (including danger to family), banquets, parties and helping others. The provers had a craving for tea. The similar remedies that emerged from the repertorial analysis were; Natrum muriaticum, Rhus toxicodendron, Lyssin, Cinchona officinalis and Pulsatilla pratensis. Conclusion The proving of Malus domestica 30CH did produce well defined symptoms that were clearly observed in healthy provers as proposed by the hypothesis. As hypothesized the comparison of Malus domestica to remedies of repertorial similarity did highlight similarities and differences between existing homoeopathic remedies and Malus domestica 30CH thereby clarifying the therapeutic range of this new remedy and its relative location in the materia medica. / M

Introduction: This thesis had two primary aims. The first aim was to systematically review the literature investigating trauma symptoms in children and adolescents aged five to eighteen years who had been exposed to domestic abuse. The second aim was to complete an empirical study investigating predictors of trauma symptoms and the relational nature of trauma in women and children aged five to eighteen years who had been exposed to domestic abuse. Method: For the first aim, a systematic literature search identified eligible studies that met predefined inclusion criteria. Following data extraction, the studies were rated against methodological quality criteria. For the second aim, using a quantitative, cross-sectional design, 84 women self-reported on experiences of domestic abuse, symptoms of depression, anxiety, stress and trauma and their child’s trauma symptoms. Analyses investigated the relationship between exposure to domestic abuse and trauma symptoms, predictors of trauma symptoms and whether maternal trauma symptoms moderated the relationship between exposure to domestic abuse and child trauma symptoms. Results: The systematic review identified 14 studies that were eligible for inclusion. Two studies were rated as high quality, ten as acceptable quality and two as low quality. A consistent relationship between exposure to DA and trauma symptoms in children and adolescents was reported, regardless of study quality. The empirical study found a significant relationship between exposure to physical and psychological abuse and trauma symptoms in children aged five to eighteen years. Maternal trauma symptoms were both significantly correlated with and a significant predictor of child trauma symptoms supporting the relational nature of trauma in this population. The interaction was not significant, indicating that maternal trauma symptoms was not a moderator, and the relationship between domestic abuse and child trauma symptoms was present at low, medium and high levels of maternal trauma symptom severity. Conclusion: Across included studies the systematic review found a consistent but variable prevalence of PTSD and trauma symptoms in children and adolescents exposed to domestic abuse, highlighting the importance of assessment and evidence based intervention in this population. Results should be interpreted whilst taking into account the strengths and limitations of individual studies and the overall review. The majority of children in the research study were experiencing trauma symptom severity within the range of clinical concern. The relational nature of trauma was supported in mothers and children exposed to domestic abuse highlighting that treatment should be family based and delivered concurrently to mothers and their children. Results are discussed and should be interpreted whilst considering the limitations discussed.

Chronic obstructive pulmonary disease (COPD) patients are generally more sedentary and less physically active than healthy adults; putting them at increased risk of hospitalisation and death. For patients with mild-moderate COPD, physical activity appears to be reduced compared with apparently healthy adults but differences in time spent sedentary are less well established. Additionally, there is a need for a greater understanding of the correlates of behaviour in mild-moderate patients with much of the existing literature focusing on more severe or mixed stage patient samples and with many studies lacking objective behavioural monitoring, not adjusting for confounders and a paucity of data on correlates of sedentary time. Despite having mild-moderate airflow obstruction, these patients also report a range of symptom burdens with some individuals reporting severe symptoms. Subsequently, these patients represent a sub-set of individuals who may require lifestyle interventions. Therefore, factors associated with patients reporting more severe symptoms need to be identified to help understand how this phenomenon may manifest and be intervened upon. For patients with more advanced COPD who are admitted to hospital for an acute exacerbation behavioural intervention focussing on less intense movement may be a more suitable approach for reducing the risk of readmissions than more intense physical activity or exercise. To date no studies have specifically targeted reductions in sedentary behaviour in COPD. In addition, wearable self-monitoring technology may facilitate the provision of such interventions, removing important participation barriers such as travel and cost, but this has not been sufficiently examined in COPD. This thesis investigated: (i) objectively measured physical activity and sedentary time and the correlates of these behaviours for mild-moderate COPD patients and apparently healthy adults (Study One); (ii) factors associated with self-reported symptom severity and exacerbation history in mild-moderate COPD patients (Study Two) and (iii) the feasibility and acceptability of a home-based sedentary behaviour intervention using wearable self-monitoring technology for COPD patients following an acute exacerbation (Study Three). Methods: Study One: COPD patients were recruited from general practitioners and apparently healthy adults from community advertisements. Objectively measured moderate-to-vigorous physical activity (MVPA), light activity and sedentary time for 109 mild-moderate COPD patients and 135 apparently healthy adults were obtained by wrist-worn accelerometry. Patients with at least four valid days (≥10 waking hours) out of a possible seven were included in analysis. A range of demographic, social, symptom-based, general health and physical factors were examined in relation to physical activity and sedentary time using correlations and linear regressions controlling for confounders (age, gender, smoking status, employment status and accelerometer waking wear time). Study Two: In 107 patients recruited from general practitioners, symptoms were assessed using the COPD Assessment Test (CAT) and Modified Medical Research Council (mMRC) questionnaires. Twelve-month exacerbation history was self-reported. Exercise capacity was assessed via incremental shuttle walk test (ISWT) and self-reported usual walking speed. Physical activity and sedentary time were obtained from a wrist-worn accelerometer. Study Three: Patients were randomised in-hospital into a usual care (Control), Education or Education + Feedback group with the intervention lasting 14 days following discharge. The intervention groups received information about reducing prolonged sitting. The Education + Feedback group also received real-time feedback on their sitting time, number of stand-ups and step count at home through an inclinometer linked to a smart device app. The inclinometer also provided vibration prompts to encourage movement when the wearer had been sedentary for too long. Feasibility of recruitment (e.g. uptake and retention) and intervention delivery (e.g. fidelity) were assessed. Acceptability of the intervention technology (e.g. wear compliance, app usage and response to vibration prompts) was also examined. Results: Study One: COPD patients were more sedentary (592±90 versus 514±93 minutes per day, p < 0.05) and accrued less MVPA (12±18 versus 33±32 minutes per day, p < 0.05) than apparently healthy adults. For COPD patients, self-reported dyspnea and percentage body fat were independent correlates of sedentary time and light activity with exercise capacity (incremental shuttle walk test) an independent correlate of MVPA. For apparently healthy adults, percentage body fat and exercise capacity were independent correlates of sedentary time and light activity. Percentage body fat was an independent correlate of MVPA. Study Two: ISWT (B=-0.016±0.005, partial R2=0.117, p=0.004) and years living with COPD (B=0.319±0.122, R2=0.071, p=0.011) were independently associated with CAT score. ISWT (B=-0.002±0.001, R2=0.123, p < 0.001) and vector magnitude counts per minute (VMCPM) (B=0.0001±0.0000, R2=0.050, p=0.011) were independently associated with mMRC grade. MVPA was independently associated with previous exacerbations (B=-0.034±0.012, R2=0.081, p=0.005). Patients reporting a CAT score of > 20 or an mMRC score of ≥2 had lower VMCPM, were more sedentary and took part in less light activity than patients reporting a CAT score of 0-10 or mMRC of 0, respectively. Patients reporting ≥2 exacerbations took part in less MVPA than patients reporting zero exacerbations. Study Three: Study uptake was 31.5% providing a final sample of 33 COPD patients. Retention of patients at two-week follow-up was 51.5% (n=17). Reasons for drop-out were mostly related to being unable to cope with their COPD. Patients wore the inclinometer for 11.8±2.3 days (and charged it 8.4±3.9 times) with at least one vibration prompt occurring on 9.0±3.4 days over the 14 day study period. Overall, 325 vibration prompts occurred with patients responding 106 times (32.6%). 40.6% of responses occurred within 5 minutes of the prompt with patients spending 1.4±0.8 minutes standing and 0.4±0.3 minutes walking, taking 21.2±11.0 steps. Discussion: Study One: COPD patients were less active and more sedentary than apparently healthy adults; however, factors predicting behaviour were similar between groups. Correlates differed between sedentary time, light activity and MVPA for both groups. Interventions to boost physical activity levels and reduce sedentary time should be offered to patients with mild-moderate COPD, particularly those reporting more severe breathlessness. Study Two: Worse exercise capacity, low levels of physical activity and more time spent sedentary are some of the factors associated with patients of the same severity of airflow limitation reporting differing symptom severities. These patients may benefit from both lifestyle and exercise interventions. Study Three: Recruitment and retention rates suggest a trial targeting sedentary behaviour in hospitalised COPD patients is feasible. A revised intervention, building on the successful components of the present feasibility study is justified. Conclusion: The findings from this thesis have contributed a greater understanding of physical activity and sedentary behaviour in COPD and can inform the development of tailored physical activity and sedentary behaviour interventions for patients across the grades of COPD severity.

Sexual minority adolescents are at higher risk for a variety of difficulties, including traditional victimization and depression. Also, cybervictimization has been associated with higher rates of depression. However, little attention has been paid to investigating the relations between sexual orientation, cybervictimization, and depressive symptoms, especially within the developmental stage of late adolescence. In fact, very little cybervictimization research has been conducted within this age group due to an assumption that cyberbullying is a problem only seen in middle school and high school. One aim of the current study was to determine whether sexual minority older adolescents are at greater risk for cybervictimization than their heterosexual counterparts. Another aim was to identify the specific sexual orientation and gender categories that were associated with the highest levels of cybervictimization. The study also was intended to examine whether current cybervictimization predicts depressive symptoms above and beyond other predictors, such as current traditional victimization and perceptions of high school cybervictimization. Another goal was to determine whether current cybervictimization interacts with these variables to predict depressive symptoms. The final aim of the study was to investigate whether the relation between cybervictimization and depressive symptoms differed between sexual minority and heterosexual participants. The findings from this study demonstrate that older sexual minority individuals, particularly those who identify as homosexual, are at increased risk for cybervictimization. Also, current traditional victimization and cybervictimization interacted to predict depressive symptoms. The importance of current cybervictimization also was highlighted by the finding that the highest levels of depression were associated with high levels of current cybervictimization, with or without high levels of high school cybervictimization. Finally, the relation between cybervictimization and depressive symptoms did not differ significantly between sexual minority and heterosexual participants. This study examined pressing questions that were previously unanswered in the literature, and the implications for future research, cyberbullying interventions, and societal awareness are vast. This study should be used as a foundation for further investigation on both cyberbullying in late adolescence and cyberbullying among sexual minority individuals. Also, the findings from this study should be applied to the development of cyberbullying interventions for older adolescents with special consideration given to the applicability to the sexual minority population.

This study investigated the etiology of preschoolers’ somatic symptoms and internalizing problems, using a twin sample. A specific focus was placed on the genetic (i.e., DRD4 and 5-HTTLPR) and environmental (i.e., SES, household chaos, family conflict, and maternal emotional stability) factors that were hypothesized to be associated with these problems. This project also explored the possible gene-environmental interactions (GxE) that may exist among these contributors. It was hypothesized that children who are at greatest risk due to their genotype, environment, or a combination of the two would display elevated somatic symptoms and internalizing problems, compared to children who were less at-risk due to these factors. Data from 252 families included in the Southern Illinois Twins/Triplets and Siblings Study (SITSS) at age 5 were examined. Results indicated a significant DRD4 x household chaos interaction predicting preschoolers’ somatic symptoms, demonstrating that children with the DRD4-7r genotype exhibited less somaticizing in highly chaotic homes. Additionally, 5-year-old internalizing problems were significantly predicted by the cumulative environmental risk factor created (i.e., top 15% of scores for each environmental variable in the current sample) and marginally by the additive genotypic risk factor (i.e., a summation of the DRD4 and 5-HTTLPR “risk” scores). These results provide additional insight into the factors that may place children at greater risk for somatic symptoms and internalizing problems.