One of the main goals of research in clinical psychology is to enhance the understanding and conceptualization of psychopathology. As such, it is essential that the model used to classify mental illness be as valid as possible. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev; DSM-IV-TR, American Psychiatric Association, 2000) provides the current model of psychopathology. However, there has been growing dissatisfaction with the current version of the DSM and there is an increasing view that the DSM taxonomy is scientifically unsound (Brown & Barlow, 2005; Watson & Clark, 2006; Widiger & Samuel, 2005). Quantitative structural models of psychopathology (e.g., Internalizing/Externalizing; Krueger, 1999) have provided an alternative to the DSM model and have greatly advanced the conceptualization of psychopathology. Although these models represent a significant improvement they still have several limitations. First, they exclude many of the "severe" disorders (e.g., psychotic disorders). Second, the placement of some disorders (e.g., OCD and PTSD) in the model has not been consistent. Finally, they are based on categorical diagnoses, which are less valid and reliable than dimensional alternatives (Markon, Chmielewski, & Miller, 2011). Thus, the use of categorical diagnosis as the foundation for empirical models of psychopathology likely results in suboptimal models. Moreover, it has been argued that many diagnoses are excessively heterogeneous, suggesting that analyzing the symptoms that underlie the disorders could result in more fine-grained models that more closely "carves nature at its joints." The current study addresses the limitations of current quantitative models to create an expanded model of psychopathology that likely has increased validity. Structural analyses were conducted at both the syndromal level (to serve as a proxy for dimensional versions of DSM diagnosis) and the symptom level in a large patient sample using both self-report and interview data. A three-factor model, containing Internalizing, Externalizing, and Psychoticism/Oddity dimensions emerged across both sets of analyses The emergence of this model at both the syndromal and symptom level provides strong evidence that a third higher order Psychoticism/Oddity dimension is necessary for a more complete model of psychopathology. The association of these dimensions with normal personality traits and other external correlates also was examined and implications for the conceptualization of psychopathology are discussed.

Although findings from a pilot study indicate that caregivers of persons with dementia (PwD) report feeling stigmatized (Burgener, 2007; Burgener & Buckwalter, 2010), little research has been conducted on the effects of perceived stigma on fostering depressive symptoms among caregivers of PwD. The purpose of this study was to examine the relationship between perceived stigma and depressive symptoms among caregivers of PwD. The Modified Labeling Theory (MLT) developed by Link et. al. (1987; 1989) served as the organizing framework. The design of this study was a mixed methods approach including a descriptive longitudinal design with a qualitative interview. Caregivers of PwD (n=51) were interviewed regarding ethnic background, geographic location (rural and urban), knowledge of dementia, perceived stigma, depressive symptoms, and were asked to rate the extent of PwD's behavioral symptoms, while PwD (n=47) were assessed on their mental ability and disease stage. Caregivers were also asked to share their perceptions of stigma and mood change once their family members were diagnosed. Pearson product-moment correlations and a linear mixed model analysis determined the relationship between variables; for qualitative analysis, a directed approach to content analysis was applied. Findings indicated that caregivers' perceptions of stigma were significantly associated with depressive symptoms, both at baseline (r = 0.357, p = 0.0175) and over 18 months (p = 0.0045). Results also indicated that caregivers of PwD felt more depressed when they perceived additional stigma (p = 0.0019), regardless of caregiver ethnicity/race and caregivers' reactions in response to PwD memory and behavior problems. Moreover, perceived stigma minimally mediated the effect between caregivers' reactions toward the PwD's memory and behavior problems and depressive symptoms (14.4% decrease in the coefficient). Analysis of the qualitative data provided preliminary validation of the MLT and an in-depth understanding of caregivers' mood change since the diagnosis of their family member. Together our findings suggest that depressive symptoms among caregivers of PwD in response to the stresses of perceived stigma underscore the seriousness of this social problem. There is a need for effective interventions to combat caregivers' perceived stigma in order to enhance their psychological well-being.

Parenting practices are known to be associated with childhood behavior difficulties. Past research has focused on the association between parenting practices and externalizing behavior problems in children. The relationship between internalizing behavioral problems and parenting practices has received less empirical attention. The current study explored the connection between internalizing symptomology in children and parenting practices. Sixty-six parents and children between the ages of 8 and 12 were surveyed regarding internalizing symptomology and parenting practices. Results indicated that parents of children with internalizing symptomology displayed statistically significantly poorer parenting behaviors than did parents of children who were free of internalizing symptoms. Two parenting styles were statistically significantly correlated with internalizing symptoms in children: Overreactivity and lax parenting styles. No significant interaction was noted among gender, internalizing symptomology, and parenting practices. Clinical findings may suggest that parent training may be warranted for children with internalizing symptomology.

There has been concern about the impact of cannabis use on the onset, course and relapse of psychosis. Evidence from retrospective and a small number of prospective studies has suggested that cannabis use may precipitate a latent psychosis, exacerbate psychotic symptoms and increase the likelihood of psychotic relapse. The purpose of the current study was to examine the influence of cannabis use on psychotic symptom exacerbation and relapse within the stress vulnerability-coping model of psychosis. Two studies were conducted. The influence of cannabis use on the onset and course of psychosis was retrospectively examined in the first study. The second study prospectively examined the influence of cannabis use on psychotic symptom exacerbation and relapse over a 6-month period. The influence of the severity of psychotic symptoms on a relapse in cannabis use was also explored. Eighty-four participants were assessed at admission, 81 of whom were followed up for a 6-month period. Measures consisted of structured diagnostic interviews and self-report measures of stress, medication compliance, family functioning, premorbid adjustment, quality of life, substance use and psychotic symptoms. The onset of cannabis use clearly preceded the onset of psychosis. Cannabis use was predictive of the severity of psychotic and general psychopathology symptoms at admission. Both the frequency and quantity of cannabis use was predictive of time to psychotic relapse over the 6-month follow up period. Psychotic symptom severity was predictive of a substantial increase in the quantity but not the frequency of cannabis use. Cannabis use was related to the onset, course and relapse of psychosis.

<p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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).</p><p>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]. </p>

A variety of risk factors for bulimia nervosa have been proposed including both environmental factors (e.g., family environment) and personal characteristics (e.g., body dissatisfaction, self-esteem, and perfectionism). The main goal of this study was to further examine the relationship between body satisfaction, self-esteem, and perfectionism in the development of bulimic symptoms. A confirmatory factor analysis on the construct of perfectionism was conducted to determine if it was best explained as a unidimensional or a multidimensional construct. Perfectionism was best explained as a construct consisting of three factors--normal perfectionism, neurotic perfectionism, and orderliness. The relationship between body satisfaction, self-esteem, and perfectionism in the development of bulimic behaviors was also examined using structural equation modeling. We did not find support for a hypothesized three-way interaction among body satisfaction, self-esteem, and neurotic perfectionism in the development of bulimic behavior. We did find support for a pair of two-way interactions predicting bulimic behaviors. Interactions between body satisfaction and self-esteem and body satisfaction and neurotic perfectionism were predicitve of bulimic symptom development.

<p>Akut hjärt-kärlsjukdom orsakar mer än hälften av alla dödsfall i Sverige. Många patienter med akut hjärtinfarkt uppvisar inte de klassiska symtom som vanligtvis förknippas med sjukdomen utan har en mer atypisk symtombild. Syftet med litteraturstudien var att beskriva vikten av god kunskap och kännedom om den varierande symtombild som kan förekomma vid hjärtinfarkt, sett ur ett omvårdnadsperspektiv. I metoden har 23 vetenskapliga artiklar bearbetats. Resultatet visade att förekomst av atypiska symtom var vanligare hos kvinnor, äldre och diabetiker. Män upplevde framförallt bröstsmärta, smärtutstrålning till armar och svettning. Kvinnor uppvisade bröstsmärta i mindre omfattning men upplevde däremot mer andnöd, rygg- och nacksmärta, besvär från mag-tarmkanalen, trötthet och orkeslöshet. Varningssymtom förekom hos ett stort antal patienter och framförallt hos kvinnor. Patienterna uppfattade och uttryckte sina besvär på olika sätt, vilket påverkade deras beslut att söka vård. Sjuksköterskans roll ansågs vara att informera patienter, speciellt de med högre risk att uppvisa atypiska symtom samt allmänheten om den annorlunda symtombild som kan förekomma. Sjuksköterskor måste ha god kunskap och kännedom om olikheter i symtombild hos olika patientgrupper. De bör vara lyhörda och ha en klinisk blick samt förstå vikten av god framförhållning och beredskap för ett adekvat omhändertagande. I framtiden måste kunskapen utökas och spridas bland allmänheten. Vidare forskning i ämnet är önskvärt ur ett sjuksköterskeperspektiv.</p>

Akut hjärt-kärlsjukdom orsakar mer än hälften av alla dödsfall i Sverige. Många patienter med akut hjärtinfarkt uppvisar inte de klassiska symtom som vanligtvis förknippas med sjukdomen utan har en mer atypisk symtombild. Syftet med litteraturstudien var att beskriva vikten av god kunskap och kännedom om den varierande symtombild som kan förekomma vid hjärtinfarkt, sett ur ett omvårdnadsperspektiv. I metoden har 23 vetenskapliga artiklar bearbetats. Resultatet visade att förekomst av atypiska symtom var vanligare hos kvinnor, äldre och diabetiker. Män upplevde framförallt bröstsmärta, smärtutstrålning till armar och svettning. Kvinnor uppvisade bröstsmärta i mindre omfattning men upplevde däremot mer andnöd, rygg- och nacksmärta, besvär från mag-tarmkanalen, trötthet och orkeslöshet. Varningssymtom förekom hos ett stort antal patienter och framförallt hos kvinnor. Patienterna uppfattade och uttryckte sina besvär på olika sätt, vilket påverkade deras beslut att söka vård. Sjuksköterskans roll ansågs vara att informera patienter, speciellt de med högre risk att uppvisa atypiska symtom samt allmänheten om den annorlunda symtombild som kan förekomma. Sjuksköterskor måste ha god kunskap och kännedom om olikheter i symtombild hos olika patientgrupper. De bör vara lyhörda och ha en klinisk blick samt förstå vikten av god framförhållning och beredskap för ett adekvat omhändertagande. I framtiden måste kunskapen utökas och spridas bland allmänheten. Vidare forskning i ämnet är önskvärt ur ett sjuksköterskeperspektiv.

Air pollution is a well known public health problem that involves both long-term and acute effects. An outcome associated with traffic-related air pollution is respiratory illness. Many studies have described the relationship between asthmatic symptoms and traffic-related air pollution; however, few have investigated the potential of air pollution to cause asthma itself, especially among adults. The overall aim of this thesis was to study the relationship between vehicle exhaust levels at home and the prevalence of self-reported annoyance and asthmatic symptoms, and the incidence of asthma and rhinitis. These relationships were evaluated using different indicators of exposure with a high spatial resolution. Three different data sets were used for the four papers included in this thesis. The first paper (paper I) is based on a questionnaire that was sent to a random selection of the adult population within three Swedish cities (Gothenburg, Uppsala, and Umeå) as part of the Swedish Environmental Protection Agency’s health-related environmental monitoring. The aim was to study the degree of self-reported annoyance and the prevalence of asthmatic symptoms in relation to the levels of vehicle exhaust outside the home. The level of exposure was described using modeled levels of nitrogen dioxide (NO2) as the exposure indicator. The second paper (paper II) is based on new asthma cases identified within the Obstructive Lung disease In Northern Sweden (OLIN) study, each with a matched referent. The aim of this study was to analyze if new cases of asthma had higher levels of vehicle exhaust outside the home compared to the population controls. Exposure was assessed using both measured levels of NO2 outside each home, and by summarizing the amount of traffic within a 200 metre buffer surrounding each participant’s home. Papers III and IV were based on the Respiratory Health in Northern Europe (RHINE) Cohort, a prospective cohort of adults included in 1990 and followed up with in 1999. The proportion of new cases of asthma (papers III and IV) and rhinitis (paper IV) were identified based on the answers from the initial and follow-up questionnaires. In paper III, exposure was assessed by using meteorological dispersion models to calculate the levels of NO2 outside each home as an indicator of the levels of vehicle exhaust. As an alternative indicator, the distance from each participant’s home to the nearest major road was calculated using geographical information system (GIS) tools. The exposure assessment in paper IV was also based on meteorological dispersion models, but expressed the levels of vehicle exhaust as particle mass concentration. The results show that the levels of vehicle exhaust outside the home are significantly correlated with the degree of self-reported annoyance and the prevalence of asthmatic symptoms, and also with the risk of developing asthma, but not rhinitis, among adults. The odds ratio (OR) for high annoyance to vehicle exhaust and reporting asthmatic symptoms was 1.14 (95% Confidence Interval, CI 1.11-1.18) and 1.04 (95% CI 1.01-1.07) per 1 µg/m3 increase in the NO2 level outside the home, respectively. Paper II showed there was a non-significant tendency for increased risk of developing asthma among those living with high levels of vehicle exhaust outside their home. This finding was then supported by papers III and IV, showing a significant relationship between the onset of asthma and the mean (winter) levels of NO2 outside the home (OR=1.46, 95% CI 1.07-1.99 per 10 µg/m3) and the levels of vehicle exhaust particles outside the home. In paper III, living close to a major road was significantly related to the risk of developing asthma. No significant results were shown between vehicle exhaust and rhinitis. In conclusion, vehicle exhaust outside the home is associated with the prevalence of annoyance and asthmatic symptoms, and with the risk of developing asthma, but not rhinitis, among adults.

Menopause is the time in a womans life when regular menstrual periods cease, due to a natural change in sex hormones, which may be accompanied by unwelcome symptoms. PURPOSE: To determine whether physical activity is associated with a reduction in menopausal symptoms (hot flashes, insomnia, numbness, fatigue, headaches, psychological symptoms, urogenital symptoms and physical symptoms). Providing that symptom differences among activity levels exist, a secondary purpose was to suggest an adequate level of physical activity for relief of menopausal symptoms. METHODS: Women (n=401) who were not taking hormone replacement therapy completed two questionnaires based on a 7-day recall of an average week: the Leisure-Time Exercise Questionnaire (Godin & Shephard, 1985) and the Menopausal Index (St. Germain, Peterson, Robinson, & Alekel, 2001). Women were divided into quintiles according to their physical activity scores (1=least active, 5=most active) and compared for menopausal symptoms using first a MANCOVA with covariate percent fat, as this was the only covariate that had significant group mean differences. Secondly a MANOVA with the appropriate post-hoc analysis was conducted. RESULTS: The mean (SD) age of the participants was 58.2 (6.3), the mean years postmenopausal was 6.7 (6.0), the mean percent body fat was 37.4 (5.6) %, and 16.5% had a previous hysterectomy. Univariate tests did not identify significant group differences for hysterectomy (p=0.774) or time since menopause (p=0.440); however, there were significant group differences for percent body fat (p=0). The MANCOVA was not significant between physical activity groups with percent fat as a covariate (Wilks Lamda p = 0.126). The MANOVA indicated a significant group main effect of physical activity on menopausal symptoms (Wilks Lamda p = 0.034). Of the 8 symptoms under review there were significant group differences for fatigue (p=0.05), and physical symptoms (p=0.004). The post-hoc analyses identified that two least active groups reported above average fatigue occurrence whereas the three most active groups reported below average fatigue occurrence. Group 2 had significantly more physical symptom complaints than groups 4 & 5. Of the three symptoms comprising physical symptoms, there were significant differences for weight gain (p=0.004) but not for breast tenderness (p=0.742) or aches and pains (p=0.175). Groups 1 & 2 reported significantly higher frequency of weight gain than groups 4 & 5. CONCLUSION: Any indirect effect of physical activity on menopausal symptoms is most likely through the alteration of body composition. Women with lower percent body fat report less weight gain and fatigue. There was no significant relationship between physical activity levels and reporting of hot flashes/night sweats, insomnia, limb numbness, headache, psychological symptoms or urogenital symptoms. A randomized controlled clinical trial would likely determine the relationship between higher activity levels and symptom reduction. For future research it is recommended that groups be matched based on percent body fat prior to randomization and that a greater amount of physical activity be prescribed.