Indiana University-Purdue University Indianapolis (IUPUI) / Latina adolescents are more likely to suffer from depressive symptoms and less likely to receive mental health services for depression than their White peers, and this mental health disparity is poorly understood. The purpose of this dissertation study is to describe how Latina adolescents experience and seek mental health services for their depressive symptoms. The dissertation includes three components. The first is an integrative literature review to determine which cultural stressors are associated with depressive symptoms among Latino/a youth. The results indicate that discrimination, family culture conflict, acculturative and bicultural stress, intragroup rejection, immigration stress, and context of reception are associated with depressive symptoms in this population. The second and third components were based on interviews with 25 Latinas (ages 13-20) who experienced depressive symptoms during adolescence. In the second component, a content analysis was conducted to determine cultural stressors experienced by contemporary Latinas living in a tumultuous sociopolitical climate in the United States. The stressors included (a) pressure to succeed, (b) parental oversight, (c) being treated differently, and (d) fears of deportation. In the third component, grounded theory methods were used to develop a theoretical framework to describe the process by which Latina adolescents self-managed and sought treatment for depressive symptoms. In this framework, participants shared a psychosocial problem labeled Being Overburdened and Becoming Depressed. They responded to this problem through the psychosocial process labeled Getting a Grip on My Depression, which consisted of five phases: 1) hiding my depression, 2) keeping my depression under control, 3) having my depression revealed, 4) skirting treatment for my depression, and 5) deciding to move on from depression. The Latino family, peer groups, and mainstream authorities influenced the participants’ experiences. The process of experiencing, self-managing, and seeking treatment for depressive symptoms for Latina adolescents is both similar to and unique from the processes by which other groups of adolescents experience depressive symptoms. These results will contribute to the development of culturally-sensitive strategies to prevent, identify, and treat depressive symptoms in Latina adolescents.

Os gliomas compreendem mais de 70% de todos os tumores cerebrais primários. Mesmo com tratamento agressivo, a média de sobrevivência relatada para estes tumores é geralmente menor do que 1 ano após o diagnóstico. A quimioterapia baseada em agentes alquilantes, como a temozolomida (TMZ), tem mostrado, em média, uma modesta resposta e pequeno aumento da sobrevida. As principais lesões causadas pela TMZ são os aductos N7-metil-G e N3-metil-A, que são processados pelo reparo por excisão de base (BER), compreendendo mais de 80% das lesões induzidas no DNA pela TMZ. Há evidência de que a resistência a este quimioterápico pode ser causada em parte por um eficiente processo de reparo via BER, mas poucos estudos têm focalizado essa abordagem. Metoxiamina (MX) é um inibidor do reparo via BER que tem sido atualmente investigado como um possível aliado no combate a vários tipos de tumores, aumentando os efeitos citotóxicos de drogas, tais como a TMZ. No presente trabalho, foram avaliadas as respostas celulares de células de glioblastoma (GBM) ao tratamento com a TMZ, associada ou não à MX. Foram analisados parâmetros como citotoxicidade (24 h, Kit XTT), sobrevivência celular (120 h, Kit XTT) e clonogênica (10 dias após o tratamento), danos no DNA pelo Ensaio Cometa (2, 6, 12 e 24 h), a indução de apoptose (24, 48 e 72 h) e alterações na expressão gênica e transcricional (24, 48 e 72h) de genes envolvidos na via de reparo por BER. Sob tratamento das linhagens de GBM (U87, U343, U251, U138 e T98G) a diferentes concentrações de TMZ (100 a 1000 M), o efeito citotóxico foi observado em células analisadas após 120 h, sendo que a linhagem T98G foi a mais resistente ao tratamento com TMZ e foi a única a apresentar diferenças significativas entre o tratamento sozinho e combinado (p 0,05). Assim, foi selecionada a linhagem T98G para os demais experimentos e estudar as possíveis vias implicadas na resistência a essa droga. A sobrevivência clonogênica das células T98G foi reduzida, sob tratamento com a TMZ (100 a 800 M), com diferença significativas para as concentrações superiores a 400 M. Observou-se que o efeito da TMZ foi acentuado quando associada ao inibidor, com diferenças significativas para todas as concentrações testadas. A droga induziu uma maior porcentagem de danos no DNA (Ensaio Cometa) para ambos os tratamentos (400 e 600 M) e nos tempos de 2 e 6 h, com diferenças significativas entre os tratamentos (TMZ e TMZ+MX), somente na concentração de 600 M/2 h. Entretanto esses danos se equipararam nos tempos seguintes. A indução de apoptose analisada nas células T98G mostrou a freqüência máxima de 24,2% no tempo de 72h, na concentração de 600 M de TMZ, enquanto que uma maior indução de apoptose (47,7%) foi observada para a mesma concentração no tratamento combinado (TMZ + MX), resultando em diferenças significativas. A análise de expressão gênica realizada para os genes APE1, FEN1 e XRCC1, mostraram que houve uma menor indução dos genes APE1 e FEN1 no tratamento combinado. A expressão da proteína APE1 (analisada por Western blot) foi menos intensa em todos os tempos de tratamento combinado (TMZ + MX), possivelmente pelo bloqueio dos sítios AP causado pelo inibidor MX. A proteína FEN1 mostrou-se menos expressa na comparação dos tratamentos, nos tempos de 48 e 72 h, indicando uma inibição de proteínas da via BER downstream à remoção de sítios AP por APE1, possivelmente pela ligação de MX. PCNA teve sua expressão protéica aumentada no tratamento combinado, nos tempos de 24 h, e principalmente em 48 h, sugerindo uma indução devida a um aumento de danos no DNA. Portanto, os resultados dos ensaios realizados com a associação da TMZ à MX demonstraram a influência do tratamento combinado sobre a expressão de proteínas envolvidas no reparo via BER, o que contribuiu para uma redução da capacidade proliferativa das células T98G em decorrência da maior indução de danos por aductos DNA-MX não reparados, resultando também em aumento de morte celular apoptótica. Esses dados mostram que a modulação do reparo via BER pode constituir uma estratégia promissora para aumentar a eficácia do tratamento com a TMZ, o que poderá futuramente embasar a escolha de procedimentos terapêuticos que resultem numa maior eficácia do tratamento de gliomas com agentes alquilantes. / Gliomas represent more than 70% of primary brain tumors. Even following an aggressive therapies, the mean survival rate of patients with these tumors is less than one year after diagnosis. Chemotherapy based on alkyklating agents, such as temozolomide (TMZ) has been reported to increase the survival rate. N7-metyl-G and N3-metyl-A adducts comprise more than 80% of the DNA lesions induced by TMZ and are processed by the base excision repair process (BER). There is evidence in the literature suggesting that the resistance to TMZ could be caused, in part, by an efficient repair by BER pathway, although few studies have focused on this subject. Metoxiamine (MX) is an effective BER inhibitor, which has been investigated as a conceivable treatment for different kinds of tumor, due to its synergistic effect with antitumoral drugs, such as TMZ. In the present study, the cellular responses to TMZ treatment associated or not with MX were evaluated in giloblastoma (GBM) cell lines. Several parameters were analyzed, such as cytotoxicity (24 h), cellular survival (120 h) and clonogenic efficiency (10 days after treatment), DNA damage and repair kinetics (after 2, 6, 12 and 24 h of recovery time), apoptosis induction (24, 48 and 72 h) and alterations in gene expression (24, 48 e 72h) for genes playing role in BER pathway. The treatment with TMZ 100 -1000 M (during 24 h) was cytotoxic for all GBM cell lines tested (U87, U343, U251, U138 and T98G), as analyzed after 120 h, with the T98G cell line being be the most resistant to TMZ; besides, T98G was the only one to present significant differences (p 0,05) in survival rates measured between TMZ treatment and TMZ combined with MX. Thus, T98G cells were selected for the subsequent experiments and for the study of the pathways implicated in TMZ resistance. The clonogenic efficiency of T98G cells was reduced under TMZ treatment (100 - 800 M) with significant differences for treatments above 400 M. In addition, the combined treatment TMZ plus MX significantly increased the cytotoxic effects, even for the lowest concentration. The comet assay showed higher percentage of DNA damage for both treatment modalities (TMZ and TMZ+MX) at 2 and 6 h of recovery, with significant differences between treatments for 2 h. Following 12 and 24 h of recovery, the amount of DNA damage reached the control levels, indicating the repair of DNA breaks. Apoptosis induction in T98G cells showed the highest frequency (24.2%) at 72h for 600 M TMZ, while the highest apoptosis induction (47.7%) was observed for the same concentration combined to MX. Quantitative gene expression analysis performed for three genes, APE1, FEN1 and XRCC1, showed a reduced expression of APE1 and FEN1 for the combined treatment. Western blot analysis demonstrated that APE1 was less expressed for all kind of treatments, probably due to AP-sites blockade caused by the inhibitor MX. In addition, FEN1 showed low levels of expression at 48h and 72h, indicating the inhibition of BER pathway downstream to the AP removal by APE1. On the other hand, PCNA expression was higher for the combined treatment (24h and mainly 48h), suggesting its induction probably due to increased DNA damage. Therefore, the present results demonstrated that the association of TMZ with MX interfered with the expression of proteins involved in BER, thus, reducing the clonogenic efficiency of T98G cells, probably as a consequence of the high production of unrepaired DNA-MX adducts, leading to cell death, including apoptosis. These data show that the modulation of BER is a promising strategy for magnifying the therapeutic impact of TMZ, and in the next future, this strategy may embrace the option to establish novel and efficient therapy protocols for the treatment of gliomas with alkylating agents.

Bakgrunn: Forekomsten av overvekt og fedme er økende i de nordiske landene og iverden forøvrig. Utviklingen er bekymringsfull fordi den bringer med seg uhelse og alvorlig sykdom. Ulike virkemidler er tatt i bruk for å løse problemene forårsaket av overvekt og inaktivitet. Samtidig prøver man å påvirke til endret helseatferd. Det er behov for å utvide kunnskapen om hva som i denne sammenheng er effektive strategier. Hensikt: Studiens hensikt er med kvalitativ metodikk å studere hvordan personer som har lykkes med å endre livsstilsvaner, opplevde og håndterte endringsprosessen. Metode: 14 personer, derav åtte menn, i alderen 23 til 68 år er intervjuet individuelt. Modifisert versjon av Grounded Therory er brukt som metode i innsamling av data og i analyseprosessen. Resultat: Studien viser at deltakernes vellykkede livsstilsendring har forløpt gjennom en rekke sosiale prosesser som kan beskrives ut fra tre hovedkonsepter som her er samlet i følgende kategorier; Motiverer til endring, danner nye vaner og håndterer seg selv. Det som kjennetegner endringsprosessen i sin helhet er hvordan hovedpersonene har utviklet større grad av kontroll og håndterbarhet i egne liv. Konklusjon: Vellykket livsstilsendring er en psykologisk empowermentprosess med vekt på prosesser omkring selvregulering, motivering, psykisk uhelse og det å danne nye vane / The incidence of overweight and obesity is steadily increasing in the Nordic countries and the entire world. This trend is a cause for concern because obesity links directly to many several illnesses, some life-threatening. Various methods have been developed in an effort to manage problems associated with obesity and inactivity. These methods also try to initiate positive lifestyle changes. However, it is necessary to broaden the knowledge base regarding the effectiveness of these strategies. Aim: This study aimed to use qualitative methodology to assess people who have succeeded in making positive lifestyle changes, documenting their experiences and learning how they adapted during the change process. Methodology: A group of 14 people consisting of eight men and six women, all between the ages of 23 and 68 years, were individually interviewed using a modified version of Grounded Theory to collect and analyze the data. Results: The study shows that the participants' positive lifestyle changes have gone through a variety of social processes. These processes comprised three main categories: motivation to change, development of new habits, and self-management. A defining factor in the change process of each candidate was how well that individual developed a greater degree of self-control and management of their own lives. Conclusion: Successful lifestyle change is a psychological empowerment process that emphasizes self-regulation, motivation, mental disorders, and the development of new habits. / <p>ISBN 978-91-86739-44-7</p>

Os gliomas compreendem mais de 70% de todos os tumores cerebrais primários. Mesmo com tratamento agressivo, a média de sobrevivência relatada para estes tumores é geralmente menor do que 1 ano após o diagnóstico. A quimioterapia baseada em agentes alquilantes, como a temozolomida (TMZ), tem mostrado, em média, uma modesta resposta e pequeno aumento da sobrevida. As principais lesões causadas pela TMZ são os aductos N7-metil-G e N3-metil-A, que são processados pelo reparo por excisão de base (BER), compreendendo mais de 80% das lesões induzidas no DNA pela TMZ. Há evidência de que a resistência a este quimioterápico pode ser causada em parte por um eficiente processo de reparo via BER, mas poucos estudos têm focalizado essa abordagem. Metoxiamina (MX) é um inibidor do reparo via BER que tem sido atualmente investigado como um possível aliado no combate a vários tipos de tumores, aumentando os efeitos citotóxicos de drogas, tais como a TMZ. No presente trabalho, foram avaliadas as respostas celulares de células de glioblastoma (GBM) ao tratamento com a TMZ, associada ou não à MX. Foram analisados parâmetros como citotoxicidade (24 h, Kit XTT), sobrevivência celular (120 h, Kit XTT) e clonogênica (10 dias após o tratamento), danos no DNA pelo Ensaio Cometa (2, 6, 12 e 24 h), a indução de apoptose (24, 48 e 72 h) e alterações na expressão gênica e transcricional (24, 48 e 72h) de genes envolvidos na via de reparo por BER. Sob tratamento das linhagens de GBM (U87, U343, U251, U138 e T98G) a diferentes concentrações de TMZ (100 a 1000 M), o efeito citotóxico foi observado em células analisadas após 120 h, sendo que a linhagem T98G foi a mais resistente ao tratamento com TMZ e foi a única a apresentar diferenças significativas entre o tratamento sozinho e combinado (p 0,05). Assim, foi selecionada a linhagem T98G para os demais experimentos e estudar as possíveis vias implicadas na resistência a essa droga. A sobrevivência clonogênica das células T98G foi reduzida, sob tratamento com a TMZ (100 a 800 M), com diferença significativas para as concentrações superiores a 400 M. Observou-se que o efeito da TMZ foi acentuado quando associada ao inibidor, com diferenças significativas para todas as concentrações testadas. A droga induziu uma maior porcentagem de danos no DNA (Ensaio Cometa) para ambos os tratamentos (400 e 600 M) e nos tempos de 2 e 6 h, com diferenças significativas entre os tratamentos (TMZ e TMZ+MX), somente na concentração de 600 M/2 h. Entretanto esses danos se equipararam nos tempos seguintes. A indução de apoptose analisada nas células T98G mostrou a freqüência máxima de 24,2% no tempo de 72h, na concentração de 600 M de TMZ, enquanto que uma maior indução de apoptose (47,7%) foi observada para a mesma concentração no tratamento combinado (TMZ + MX), resultando em diferenças significativas. A análise de expressão gênica realizada para os genes APE1, FEN1 e XRCC1, mostraram que houve uma menor indução dos genes APE1 e FEN1 no tratamento combinado. A expressão da proteína APE1 (analisada por Western blot) foi menos intensa em todos os tempos de tratamento combinado (TMZ + MX), possivelmente pelo bloqueio dos sítios AP causado pelo inibidor MX. A proteína FEN1 mostrou-se menos expressa na comparação dos tratamentos, nos tempos de 48 e 72 h, indicando uma inibição de proteínas da via BER downstream à remoção de sítios AP por APE1, possivelmente pela ligação de MX. PCNA teve sua expressão protéica aumentada no tratamento combinado, nos tempos de 24 h, e principalmente em 48 h, sugerindo uma indução devida a um aumento de danos no DNA. Portanto, os resultados dos ensaios realizados com a associação da TMZ à MX demonstraram a influência do tratamento combinado sobre a expressão de proteínas envolvidas no reparo via BER, o que contribuiu para uma redução da capacidade proliferativa das células T98G em decorrência da maior indução de danos por aductos DNA-MX não reparados, resultando também em aumento de morte celular apoptótica. Esses dados mostram que a modulação do reparo via BER pode constituir uma estratégia promissora para aumentar a eficácia do tratamento com a TMZ, o que poderá futuramente embasar a escolha de procedimentos terapêuticos que resultem numa maior eficácia do tratamento de gliomas com agentes alquilantes. / Gliomas represent more than 70% of primary brain tumors. Even following an aggressive therapies, the mean survival rate of patients with these tumors is less than one year after diagnosis. Chemotherapy based on alkyklating agents, such as temozolomide (TMZ) has been reported to increase the survival rate. N7-metyl-G and N3-metyl-A adducts comprise more than 80% of the DNA lesions induced by TMZ and are processed by the base excision repair process (BER). There is evidence in the literature suggesting that the resistance to TMZ could be caused, in part, by an efficient repair by BER pathway, although few studies have focused on this subject. Metoxiamine (MX) is an effective BER inhibitor, which has been investigated as a conceivable treatment for different kinds of tumor, due to its synergistic effect with antitumoral drugs, such as TMZ. In the present study, the cellular responses to TMZ treatment associated or not with MX were evaluated in giloblastoma (GBM) cell lines. Several parameters were analyzed, such as cytotoxicity (24 h), cellular survival (120 h) and clonogenic efficiency (10 days after treatment), DNA damage and repair kinetics (after 2, 6, 12 and 24 h of recovery time), apoptosis induction (24, 48 and 72 h) and alterations in gene expression (24, 48 e 72h) for genes playing role in BER pathway. The treatment with TMZ 100 -1000 M (during 24 h) was cytotoxic for all GBM cell lines tested (U87, U343, U251, U138 and T98G), as analyzed after 120 h, with the T98G cell line being be the most resistant to TMZ; besides, T98G was the only one to present significant differences (p 0,05) in survival rates measured between TMZ treatment and TMZ combined with MX. Thus, T98G cells were selected for the subsequent experiments and for the study of the pathways implicated in TMZ resistance. The clonogenic efficiency of T98G cells was reduced under TMZ treatment (100 - 800 M) with significant differences for treatments above 400 M. In addition, the combined treatment TMZ plus MX significantly increased the cytotoxic effects, even for the lowest concentration. The comet assay showed higher percentage of DNA damage for both treatment modalities (TMZ and TMZ+MX) at 2 and 6 h of recovery, with significant differences between treatments for 2 h. Following 12 and 24 h of recovery, the amount of DNA damage reached the control levels, indicating the repair of DNA breaks. Apoptosis induction in T98G cells showed the highest frequency (24.2%) at 72h for 600 M TMZ, while the highest apoptosis induction (47.7%) was observed for the same concentration combined to MX. Quantitative gene expression analysis performed for three genes, APE1, FEN1 and XRCC1, showed a reduced expression of APE1 and FEN1 for the combined treatment. Western blot analysis demonstrated that APE1 was less expressed for all kind of treatments, probably due to AP-sites blockade caused by the inhibitor MX. In addition, FEN1 showed low levels of expression at 48h and 72h, indicating the inhibition of BER pathway downstream to the AP removal by APE1. On the other hand, PCNA expression was higher for the combined treatment (24h and mainly 48h), suggesting its induction probably due to increased DNA damage. Therefore, the present results demonstrated that the association of TMZ with MX interfered with the expression of proteins involved in BER, thus, reducing the clonogenic efficiency of T98G cells, probably as a consequence of the high production of unrepaired DNA-MX adducts, leading to cell death, including apoptosis. These data show that the modulation of BER is a promising strategy for magnifying the therapeutic impact of TMZ, and in the next future, this strategy may embrace the option to establish novel and efficient therapy protocols for the treatment of gliomas with alkylating agents.

Estudo exploratório, de delineamento longitudinal, com 81 pacientes em uso de anticoagulante oral e que foram avaliados durante internação e dois meses após a alta. Os objetivos foram acompanhar a evolução quanto á terapia de anticoagulação oral e adesão ao tratamento; comparar o estado geral de saúde e a presença de sintomas de ansiedade e depressão. Foram utilizados instrumentos específicos para avaliar adesão ao tratamento medicamentoso (Medida de Adesão aos Tratamentos), estado geral de saúde (Escala Visual Analógica) e presença de sintomas de ansiedade (HADS-Ansiedade) e depressão (HADS- Depressão). As análises estatísticas realizadas foram: Teste t de Student pareado para comparar as médias do estado geral de saúde e da HADS; Modelo Linear de Efeitos Mistos para analisar a associação entre estado geral de saúde, ansiedade, depressão e tempo de avaliação no estudo. O nível de significância adotado foi 0,05. Entre os participantes, 54,3% eram mulheres, com idade média de 59,5 anos e nível médio de instrução de 5,1 anos. A principal indicação clínica para uso do medicamento foi formação de trombos (34,6%), sendo a varfarina o anticoagulante oral mais utilizado (97,5%). Dois meses após a alta, todos os pacientes foram classificados como aderentes ao tratamento e 42% mantiveram o INR na faixa terapêutica. As diferenças entre as médias do estado geral de saúde, HADS-Ansiedade e HADS-Depressão durante a internação e dois meses após a alta não foram estatisticamente significantes (p=0,78; p=0,27 e p=0,40, respectivamente). Em relação á presença de ansiedade, quando associamos as duas variáveis de forma categórica, com e sem sintomas, e o tempo de avaliação, 38 (46,9%) pacientes foram classificados como \"sem sintomas\" de ansiedade e 22 (27,1%) \"com sintomas\", sendo esta associação estatisticamente significante (p<0,001). Para depressão, a maioria (55; 67,9%) foi classificada como \"sem sintomas\" e 11 (13,6%) \"com sintomas\", sendo tal associação estatisticamente significante (p<0,001). Ao analisarmos as médias do estado geral de saúde segundo tempo e grupo de sintomas, resultados estatisticamente significantes foram obtidos apenas quando comparamos os valores entre os grupos sem sintomas de depressão (M=80,5; D.P.=23,46) e com sintomas (M=62,5; D.P.=26,07) (p=0,021), dois meses após a alta e quando comparamos as médias do grupo com sintomas de depressão, na internação (M= 75,37; D.P.=25,02) e dois meses após a alta (M=62,5; D.P.=26,07) (p=0,046). Identificar o perfil clínico de pacientes em uso de anticoagulante oral, desde a internação até dois meses de seguimento ambulatorial; conhecer sua percepção sobre estado de saúde, presença de sintomas de ansiedade e de depressão e a adesão ao tratamento são ações importantes a serem consideradas no atendimento desses pacientes. Tais resultados poderão ser utilizados para nortear mudanças na organização do ambulatório de anticoagulação oral e no planejamento da assistência de enfermagem a tais pacientes. / This exploratory and longitudinal research involved 81 patients under oral anticoagulation treatment, who were evaluated during hospitalization and two months after discharge. The objectives were to follow the patients\' clinical evolution, considering the oral anticoagulation therapy and treatment adherence; and to compare the general health condition and the presence of anxiety and depression symptoms. Specific instruments were used to assess adherence to medication treatment (Treatment Adherence Measure), general health condition (visual analogue scale) and the presence of anxiety (HADS-Anxiety) and depression symptoms (HADS-depression). For the sake of statistical analysis, the following were applied: Student\'s paired t-test to compare the mean scores for the general health condition and HADS scores; the Linear Fixed Effects Model to analyze the association between general health condition, anxiety, depression and research moment. Significance was set at 0.05. Among the participants, 54.3% were women, with a mean age of 59.5 years and a mean education time of 5.1 years. The main clinical indication for medication use was the formation of thrombi (34.6%), with warfarin as the most used oral anticoagulant drug (97.5%). AT two months after discharge, all patients were classified as adherent to the treatment and 42% maintained their INR within the therapeutic range. The differences between the mean general health, HADS-Anxiety and HADS-Depression scores during hospitalization and two months after discharge were not statistically significant (p=0.78; p=0.27 and p=0.40, respectively). As regards the presence of anxiety, when the two variables are associated categorically, with and without symptoms, and the research moment, 38 (46.9%) patients were classified as \"without symptoms\" of anxiety and 22 (27.1%) \"with symptoms\", with a statistically significant association (p<0.001). As for depression, the majority (55; 67.9%) was classified as \"without symptoms\" and 11 (13.6%) \"with symptoms\", a statistically significant association (p<0.001). The analysis of the mean general health condition scores according to the research moment and group of symptoms only revealed statistically significant results when comparing the groups without (M=80.5; S.D.=23.46) and with symptoms (M=62.5; S.D.=26.07) (p=0.021) two months after the discharge and when comparing the mean scores for the group with depression symptoms during hospitalization (M= 75.37; S.D.=25.02) and two months after the discharge (M=62.5; S.D.=26.07) (p=0.046). Identifying the clinical profile of patients under oral anticoagulant therapy since hospitalization and after two months of outpatient monitoring and getting to know their perceived health condition, presence of anxiety and depression symptoms and treatment adherence are important actions for consideration in care delivery to these patients. These results can be used to guide changes in the organization of the oral anticoagulation outpatient clinic and in nursing care planning for these patients.

Estudo exploratório, de delineamento longitudinal, com 81 pacientes em uso de anticoagulante oral e que foram avaliados durante internação e dois meses após a alta. Os objetivos foram acompanhar a evolução quanto á terapia de anticoagulação oral e adesão ao tratamento; comparar o estado geral de saúde e a presença de sintomas de ansiedade e depressão. Foram utilizados instrumentos específicos para avaliar adesão ao tratamento medicamentoso (Medida de Adesão aos Tratamentos), estado geral de saúde (Escala Visual Analógica) e presença de sintomas de ansiedade (HADS-Ansiedade) e depressão (HADS- Depressão). As análises estatísticas realizadas foram: Teste t de Student pareado para comparar as médias do estado geral de saúde e da HADS; Modelo Linear de Efeitos Mistos para analisar a associação entre estado geral de saúde, ansiedade, depressão e tempo de avaliação no estudo. O nível de significância adotado foi 0,05. Entre os participantes, 54,3% eram mulheres, com idade média de 59,5 anos e nível médio de instrução de 5,1 anos. A principal indicação clínica para uso do medicamento foi formação de trombos (34,6%), sendo a varfarina o anticoagulante oral mais utilizado (97,5%). Dois meses após a alta, todos os pacientes foram classificados como aderentes ao tratamento e 42% mantiveram o INR na faixa terapêutica. As diferenças entre as médias do estado geral de saúde, HADS-Ansiedade e HADS-Depressão durante a internação e dois meses após a alta não foram estatisticamente significantes (p=0,78; p=0,27 e p=0,40, respectivamente). Em relação á presença de ansiedade, quando associamos as duas variáveis de forma categórica, com e sem sintomas, e o tempo de avaliação, 38 (46,9%) pacientes foram classificados como \"sem sintomas\" de ansiedade e 22 (27,1%) \"com sintomas\", sendo esta associação estatisticamente significante (p<0,001). Para depressão, a maioria (55; 67,9%) foi classificada como \"sem sintomas\" e 11 (13,6%) \"com sintomas\", sendo tal associação estatisticamente significante (p<0,001). Ao analisarmos as médias do estado geral de saúde segundo tempo e grupo de sintomas, resultados estatisticamente significantes foram obtidos apenas quando comparamos os valores entre os grupos sem sintomas de depressão (M=80,5; D.P.=23,46) e com sintomas (M=62,5; D.P.=26,07) (p=0,021), dois meses após a alta e quando comparamos as médias do grupo com sintomas de depressão, na internação (M= 75,37; D.P.=25,02) e dois meses após a alta (M=62,5; D.P.=26,07) (p=0,046). Identificar o perfil clínico de pacientes em uso de anticoagulante oral, desde a internação até dois meses de seguimento ambulatorial; conhecer sua percepção sobre estado de saúde, presença de sintomas de ansiedade e de depressão e a adesão ao tratamento são ações importantes a serem consideradas no atendimento desses pacientes. Tais resultados poderão ser utilizados para nortear mudanças na organização do ambulatório de anticoagulação oral e no planejamento da assistência de enfermagem a tais pacientes. / This exploratory and longitudinal research involved 81 patients under oral anticoagulation treatment, who were evaluated during hospitalization and two months after discharge. The objectives were to follow the patients\' clinical evolution, considering the oral anticoagulation therapy and treatment adherence; and to compare the general health condition and the presence of anxiety and depression symptoms. Specific instruments were used to assess adherence to medication treatment (Treatment Adherence Measure), general health condition (visual analogue scale) and the presence of anxiety (HADS-Anxiety) and depression symptoms (HADS-depression). For the sake of statistical analysis, the following were applied: Student\'s paired t-test to compare the mean scores for the general health condition and HADS scores; the Linear Fixed Effects Model to analyze the association between general health condition, anxiety, depression and research moment. Significance was set at 0.05. Among the participants, 54.3% were women, with a mean age of 59.5 years and a mean education time of 5.1 years. The main clinical indication for medication use was the formation of thrombi (34.6%), with warfarin as the most used oral anticoagulant drug (97.5%). AT two months after discharge, all patients were classified as adherent to the treatment and 42% maintained their INR within the therapeutic range. The differences between the mean general health, HADS-Anxiety and HADS-Depression scores during hospitalization and two months after discharge were not statistically significant (p=0.78; p=0.27 and p=0.40, respectively). As regards the presence of anxiety, when the two variables are associated categorically, with and without symptoms, and the research moment, 38 (46.9%) patients were classified as \"without symptoms\" of anxiety and 22 (27.1%) \"with symptoms\", with a statistically significant association (p<0.001). As for depression, the majority (55; 67.9%) was classified as \"without symptoms\" and 11 (13.6%) \"with symptoms\", a statistically significant association (p<0.001). The analysis of the mean general health condition scores according to the research moment and group of symptoms only revealed statistically significant results when comparing the groups without (M=80.5; S.D.=23.46) and with symptoms (M=62.5; S.D.=26.07) (p=0.021) two months after the discharge and when comparing the mean scores for the group with depression symptoms during hospitalization (M= 75.37; S.D.=25.02) and two months after the discharge (M=62.5; S.D.=26.07) (p=0.046). Identifying the clinical profile of patients under oral anticoagulant therapy since hospitalization and after two months of outpatient monitoring and getting to know their perceived health condition, presence of anxiety and depression symptoms and treatment adherence are important actions for consideration in care delivery to these patients. These results can be used to guide changes in the organization of the oral anticoagulation outpatient clinic and in nursing care planning for these patients.

Recently, an increasing problem in wastewater treatment is the insufficient removal of organic pollutants. These substances can be toxic to the environment already in a small amount, either acutely or chronically. The goal is therefore to develop of technologies that ensure their effective removal. One possibility is to use advanced oxidation processes. Advanced oxidation processes work on the principle of non-selective oxidation mediated by OH radicals. Several methods such as O3/H2O2 (Peroxone), UV/H2O2 or Fenton´s reaction can be used to generate them. The aim of this thesis was to evaluate the effectiveness of the used advanced oxidation processes in wastewater treatment via ekotoxicity tests. Wastewater samples treated with advanced oxidation processes on the pilot unit showed low values of acute toxicity for selected test organisms (D. magna, T. platyurus, S. alba, L. minor). For the sample of waste water that was treated with the UV/H2O2 on AOP laboratory unit, there was an increase in acute toxicity on the testing organism D. magna and L. minor. The similar effect was observer in the tests with the D. magna with the model samples treated with the same method, while the tests on the L. minor showed a reduction in toxicity.

Text in Afrikaans / The death of a parent is one of the most meaningful experiences in life. When the child in mourning is not given a proper chance to grieve, there could be complications later in life. In this study scrapbooking, as a tool in Gestalt group work, was utilised to assist three pre-adolescents after the death of a parent. The goal of this research was to determine whether scrapbooking could be successfully used with in the grieving stages after the death of a parent. The social caracter of scrapbooking makes this relevant to the pre-adolescent stage as the need to socialize is of great importance. From the results of this study, scrapbooking can be recommended to therapists to be used as a tool in assisting children during the grieving process. / Die dood van cn ouer blyk een van die mees betekenisvolle gebeure in die mens se lewe te wees. Wanneer die kind in ruil nie die geleentheid gegun word om op haar eie tyd en manier te rou nie, kan latere komplikasies na vore tree. In hierdie studie is scrapbooking as hulpmiddel in Gestalt-groepwerk met drie vroee adolessente benut om van hulp te wees na die afsterwe van 'n ouer. Die doel van die navorsing was om te bepaal of scrapbooking wel suksesvol op die wyse in die rou-proses gebruik kan word. Die sosiale komponent van scrapbooking behels die saamwees en saamwerk aan 'n scrapboek met 'n gemeenskaplike tema. Aangesien vroee adolessensie 'n ontwikkelingstadium is waar die sosiale komponent belangrik is, is die navorser van mening dat scrapbooking juis om die rede sal kan werk om verligting te bied na die afsterwe van 'n ouer. Scrapbooking word aanbeveel om tot hulp te wees om die rouproses te vergemaklik. / Social Work / MDIAC (Play Therapy)

Text in Afrikaans / The death of a parent is one of the most meaningful experiences in life. When the child in mourning is not given a proper chance to grieve, there could be complications later in life. In this study scrapbooking, as a tool in Gestalt group work, was utilised to assist three pre-adolescents after the death of a parent. The goal of this research was to determine whether scrapbooking could be successfully used with in the grieving stages after the death of a parent. The social caracter of scrapbooking makes this relevant to the pre-adolescent stage as the need to socialize is of great importance. From the results of this study, scrapbooking can be recommended to therapists to be used as a tool in assisting children during the grieving process. / Die dood van cn ouer blyk een van die mees betekenisvolle gebeure in die mens se lewe te wees. Wanneer die kind in ruil nie die geleentheid gegun word om op haar eie tyd en manier te rou nie, kan latere komplikasies na vore tree. In hierdie studie is scrapbooking as hulpmiddel in Gestalt-groepwerk met drie vroee adolessente benut om van hulp te wees na die afsterwe van 'n ouer. Die doel van die navorsing was om te bepaal of scrapbooking wel suksesvol op die wyse in die rou-proses gebruik kan word. Die sosiale komponent van scrapbooking behels die saamwees en saamwerk aan 'n scrapboek met 'n gemeenskaplike tema. Aangesien vroee adolessensie 'n ontwikkelingstadium is waar die sosiale komponent belangrik is, is die navorser van mening dat scrapbooking juis om die rede sal kan werk om verligting te bied na die afsterwe van 'n ouer. Scrapbooking word aanbeveel om tot hulp te wees om die rouproses te vergemaklik. / Social Work / MDIAC (Play Therapy)

Inledning: Bröstcancer är en vanlig cancerform hos kvinnor och årligen drabbas 1,5 miljoner kvinnor världen över. Screeningprogram och tidig upptäckt är två faktorer som leder till ökad överlevnad. För kvinnor där en ökad cancerrisk föreligger såsom förhöjd ärftlighet och BRCA-mutation rekommenderar socialstyrelsen att mammografiscreening kompletteras med MR. MR kan komplettera bröstdiagnostik till en mer individanpassad behandling. Syftet: Syftet med denna litteraturstudie var att beskriva hur bröstdiagnostik med magnetkamera (MR) inverkar på den kirurgiska behandlingen av bröstcancer. Metod: En litteraturstudie genomfördes, där 11 kvantitativa artiklar användes för att svara på studiens syfte. Resultat: Preoperativ MR detekterade ytterligare maligna lesioner som inte tidigare var kända vilket medförde en förändrad behandling till mer omfattande kirurgi såsom mastektomi och lumpektomi. MR visade generellt en överskattning av tumörstorlek vid bedömning av tumörutbredning. Utöver den redan diagnostiserade bröstcancern detekterades med MR ytterligare lesioner vilka ej var synliga vid mammografi både i det primära och det kontralaterala bröstet. MR i kombination med biopsi konstaterar maligna lesioner. Slutsats: Fakta tyder på att MR har hög sensitivitet men en lägre specificitet vid detektering av förändringar i bröstvävnaden. Resultatet är ej entydigt och behov finns av ytterligare studier inom ämnet. / Introduction: Breast cancer is a common form of cancer in women, annually, 1.5 million women are affected worldwide. Screening programs and early detection lead to increased survival. In women where there is increased cancer risk with increased heredity and in BRCA mutation, the National Board of Health recommends that mammography screening be supplemented with Magnetic resonance imaging (MRI). MRI can supplement breast diagnosis and can lead to a more personalized treatment. Purpose:The purpose of this literature study was to describe how breast diagnosis with MR affects the surgical treatment of breast cancer. Method: A literature study was conducted, where 11 quantitative articles were used to respond to the purpose of the study.Results: Preoperative MRI detected additional malignant lesions not previously known which resulted in a change in treatment for more extensive surgery such as mastectomy and lumpectomy. MRI generally showed an overestimate of tumor size in the assessment of tumor proliferation. In addition to the already diagnosed breast cancer, MR was detected additional lesions which were not visible in mammography in both the primary and the contralateral breast. MRI in combination with biopsy notes malignant lesions. Conclusion: Facts suggest that MRI has high sensitivity but a lower specificity in detecting changes in the breast tissue. The results are not unambiguous and there is a need for further studies on the subject.