Diss. (sammanfattning) Umeå : Umeå universitet, 2008. / Härtill 6 uppsatser.

La démence entraine des conséquences non seulement pour le patient, mais également pour sa famille et pour la société elle-même et représente une priorité de santé publique. La connaissance et la compréhension des tendances temporelles de cette maladie est un sujet de recherche majeur, essentiel pour le futur. Cette thèse avait pour but d’analyser les tendances séculaires de l’incidence de la démence, ainsi que de certains de ses composants et conséquences et d’en comprendre les déterminants. Dans la première partie de ce travail, nous avons apporté un argument supplémentaire de la tendance à la baisse de l’incidence de la démence, retrouvé chez les femmes entre les années 90 et les années 2000. Ensuite, nous avons rapporté une amélioration globale des performances cognitives pour les générations plus récentes de personnes âgées, qui semble être due à une amélioration acquise relativement précocement au cours de la vie plutôt qu'à un déclin moins important des performances au cours du vieillissement. Enfin, nous avons mis en évidence une diminution de la mortalité sans démence et de la mortalité des femmes démentes, ainsi qu’une augmentation de l’espérance de vie en bonne santé et de la durée de vie en démence. Ces résultats sont en accord avec une amélioration de l’état de santé des personnes âgées au cours des deux dernières décennies, ce qui est prometteur pour le futur. D’autres travaux afin de mieux comprendre ces tendances et leurs déterminants sont cependant nécessaires ; ils permettront de mieux préciser les stratégies de prévention devant être mis en place pour diminuer ou retarder la démence. / Consequences of dementia are impacting not only patients, but also their family and even society; it has thus been highlighted as an important public health priority. Understanding temporal trends of this disease thus became a major research topic, critical for the future. This thesis aimed at investigating secular trends of dementia incidence as well as some of its components and consequences, trying tounderstand their determinants. In the first part of this work, we have brought further evidence toward a decreasing trend of dementia incidence, only found for women between the 90’s and the 2000’s in our study. Then, we have reported a global improvement of cognitive performance for younger elderly generations, potentially due to improvement early in life rather than to a slower decline across aging. Finally, we have evidenced a decrease in mortality without dementia and for demented women, as well as an increase of healthy life expectancy and survival with dementia. These results are in line with an improvement of health of older people during the last two decades, which is promising for the future.Further research to better understand these secular trends are yet needed ; it will help precise prevention strategies needed to reduce or delay dementia.

O enfrentamento do processo do adoecer é mais adequado quando os pacientes possuem esperança. É a esperança na recuperação da saúde que leva o paciente a enfrentar todas as adversidades decorrentes do adoecimento e do tratamento. A avaliação da esperança proporciona a implementação de intervenções que estimulam esperança em pacientes em cuidados paliativos e seus familiares. Diante da inexistência de um instrumento validado no Brasil para medir esse construto, optou-se pela realização da adaptação e validação do Herth Hope Index. Era também nossa intenção comparar o sentimento de esperança entre pessoas sadias, doentes com câncer e de doentes com outra doença crônica com características diferentes, como o diabetes. O estudo teve como objetivos fazer a adaptação cultural e a validação do instrumento Herth Hope Index, comparar os escores de esperança entre pacientes oncológicos, diabéticos e acompanhantes, analisar as relações entre o nível de esperança da amostra com as variáveis sócio-demográficas e analisar as relações entre o nível de esperança nos dois grupos de pacientes com variáveis clínicas de interesse. A adaptação cultural e validação do Hert Hope Index foram realizadas conforme o método preconizado pela literatura. A amostra foi composta por 131 indivíduos, divididos em 3 grupos. Os resultados obtidos demonstram que em relação às propriedades psicométricas, o instrumento apresentou um valor de alpha de Cronbach de 0.834 para a escala total. O teste-reteste conferiu a reprodutibilidade do instrumento. A validade de construto foi confirmada por meio da validade convergente que demonstrou correlação estatisticamente significativa entre a Escala de Esperança de Herth (denominação da versão brasileira) e a Escala de Auto-Estima de Rosenberg, e da validade divergente que também evidenciou correlação significante entre a Escala de Esperança de Herth e o Inventário de Depressão de Beck. A análise fatorial pelo método dos componentes principais não confirmou os três fatores da escala original confirmou apenas que existem três fatores, mas com composição diferente dos itens em relação à escala original. O nível de esperança nos três grupos foi elevado e não houve diferença estatística entre eles. A comparação entre o nível de esperança e as variáveis sócio-demográficas na amostra estudada não apresentou diferença estatisticamente significativa. O nível de esperança não foi relacionado com a dor e tipo de tumor nos pacientes oncológicos e nem com o tratamento ou coexistência de hipertensão arterial nos diabéticos. As propriedades psicométricas do instrumento foram demonstradas e, portanto ele pode ser utilizado para mensurar a esperança na população brasileira. Considera-se importante que a Escala de Esperança de Herth continue a ser testada quanto à sua confiabilidade e validade em diferentes contextos sócio-culturais da realidade brasileira / Facing the process of being sick is more properly done when patients have hope.It\'s the hope of recovering that makes the patient able to face all the difficulties caused by the disease and its treatment. The evaluation of hope makes possible to implement actions which stimulate hope in patients under palliative care and the people who take care of them, specially their relatives. Once in Brazil there is no validated instrument for measure this, the option was to adapt and validate the Herth Hope Index. Our intention was also to compare the feeling of hope of healthy persons, cancer patients and patients with other kinds of chronic disease, with different features, such as diabetes.This study aimed the cultural adaptation and validation of the Herth Hope Index, to compare the hope scores of oncology and diabetic patients and their family, to analyze the relation between their level of hope and social-demographic factors, and to analyze the relation between the level of hope of these two groups of patients and the relevant clinical variables.Cultural adaptation and validation of the Herth Hope Index were done according to the methods already described in literature. There were 131 patients, divided into 3 groups. The result shows that, concerning to psychometric properties, this instrument has presented alpha coefficient of 0.834 for total scale. The test-retest awarded the reliability of the instrument. The construct validity was confirmed by means of the convergent validity that significant correlation between Herth Hope Index (Brazilian version) demonstrated significant correlation with Rosenberg’s Self Steem Scale, and the divergent validity that also significant correlation between Herth Hope Index and the Beck Depression Inventory. The factorial analyses, by the main components method, has not confirmed the three factors of the original scale. It has confirmed only that there are three factors, but there is a different composition among the items of the original scale. The level of hope in these three groups was elevated and there was no statistical difference among them. Comparison between the level of hope and the social-demographical variables hasn\'t shown any statistically significant differences. The level of hope hasn\'t been related to pain and kind of tumor in oncology patients neither to treatment or coexistence of arterial hypertension in diabetic patients either. The psychometrics properties of this tool were demonstrated, it can be used in the evaluation of hope of the Brazilian people. It\'s important that the Herth Hope Index keeps been tested, specially regarding it\'s reliability and validity in different socio-cultural aspects of the Brazilian context

This diploma thesis analyzes trends in life expectancy of long-living people in the Czech Republic. Aim of this study is to compare developments in life expectancies for long-living people in the Czech Republic and Austria between 1960-2014, both in terms of predetermined age groups and between both sexes. This work also includes a projection of mortality rates and life expectancy. Projections are calculated for year 2050, specifically for people of 60 years and older, and it is based on mortality projections from the Czech Statistical Office. Values are given for men and women separately. While calculations and estimates show that life expectancy is extending, it impacts most developed countries with the burden of aging population, manifested by overal decline in mortality rates and increasing amount of elderly people. Historically in most societies an 80 year old, or older person was a rarity, but in recent years their number is increasing to the point of being a new normal. This trend is obviously positive, but it does pose a number of challenges for the respective societies, especially for their pension, social security and medical systems.

The study explored whether certain factors might be used to distinguish between people with cancer who do or do not want detailed information about their disease progress, do or do not want to be informed if their disease is no longer considered curable, and who do or do not want an estimation of life expectancy if their disease is no longer considered curable. The factors included whether an individual has an internal versus external locus of control, uses an active coping strategy or a planning coping strategy, the level of spirituality, and age. Participants consisted of 51 people with cancer from a cancer center in the state of Washington. Results indicated that 98% wanted detailed information about their disease progress, 94% wanted to be informed if their disease was no longer considered curable, and 78% wanted an estimation of life expectancy if their disease was no longer considered curable. Due to the majority of the participants endorsing the need for prognostic information none of the factors (e.g. coping strategies, locus of control, spirituality) were able to predict the information needs of the patients with cancer. Clinical implications of this study suggest that physicians have an ongoing, open dialogue with their patients about their prognostic information needs. The dialogue might be especially important for patients undergoing active treatment for cancer, since it could affect treatment decisions.

Cardiovascular disease (CVD) risk behaviors, namely tobacco smoking, hazardous alcohol use, poor diet and sedentary behavior, are more prevalent among people living with HIV (PLWH) than the general population. Qualitative evidence shows that PLWH report adopting unhealthy behaviors as a means of coping with the stress of living with HIV, including the adverse physiological symptoms of HIV infection, the psychological stress of being aware of one’s HIV status, and the physiological and psychological impacts of being on HIV treatment. These observations suggest that being HIV-positive may have a causal influence on CVD risk behaviors and that these causal effects likely differ across stages of the HIV continuum. To date, few quantitative studies have been conducted to examine these causal relationships. The goal of this dissertation was to explore the effects of HIV continuum stage on CVD risk behaviors and assess several plausible stress-coping mechanisms, as motivated by established stress-coping theory. This dissertation consisted of three studies. First, a systematic review was conducted to examine the existing quantitative evidence for the causal effects of HIV continuum stage on CVD risk behaviors. Findings from this review revealed that being HIV-positive is associated with excess smoking and drinking, and that while receipt of a positive HIV diagnosis is associated with short-term improvements in some CVD risk behaviors, these improvements are unlikely to be maintained long-term. Overall, however, the existing studies suffer important methodological limitations, notably inadequate characterization of HIV continuum stage. The second study was an empirical analysis of patterns of self-reported CVD risk behaviors across the HIV continuum among a population-based sample of 4,061 adults aged 40 years and over living in rural Agincourt district in South Africa. Results showed no consistent evidence of an association between HIV continuum stage and hazardous alcohol use or sedentary behavior. However, higher prevalence of smoking was observed specifically among males who were HIV-positive and aware of their status but not on treatment, compared to those who were HIV-negative. There was no evidence of mediation by various measures of physiological and/or psychological stress. The third study was an analysis of whether perceived life expectancy (PLE) modifies the effects of HIV continuum stage on CVD risk behaviors. Observed associations were most prominent among individuals with low PLE and null among those with high PLE. Overall, this dissertation contributed to greater understanding of the relationship between CVD risk behaviors among HIV-infected persons across the HIV continuum. Findings did not support a stress-coping hypothesis; however, PLE was found to be a potentially useful indicator of individuals who are most likely to smoke in the presence of HIV. This dissertation also fills evidence gaps among older adults in sub-Saharan Africa, an under-studied population with high and increasing burdens of both HIV and CVD. As HIV-positive population survive longer on antiretroviral therapy and the prevention of age-related conditions becomes increasingly important, these findings may help inform future research and the development of CVD prevention interventions.

This thesis is focused on the application of advanced methods for evaluating damage to boiler tubes, specifically temperature related damage. The aim of this work is to develop an improved damage evaluation procedure utilizing capabilities of modern approaches. This work describes various types of industrial boiler damage. The main focus is on the most exposed and often the most damaged parts of boilers, which are tube bundles (for example, superheaters). Equipment damage is undesirable and often leads to leakages or even to the boiler shutting down. Therefore, it is necessary to find the problem as soon as possible and make the required changes to prevent further damage. The damage types are divided into five categories based on the damage mechanism. Temperature has one of the biggest influences on damage and it may cause short-term or long-term overheating in the tube bundles. This type of damage occurs when the designated temperature is exceeded and results in reduced creep life. It is necessary to know the real surface temperature history of the tube bundle to estimate temperature related damage, however this is often not available. Therefore, it is necessary to calculate those temperatures based on the available data (i.e. inlet and outlet temperatures and pressures). This is real challenge due to the combination of complex flows of the working substances (mainly flue gasses) and heat transfer. Considering available data, new approach is proposed in order to obtain information required for residual creep life estimation. In the first step, thermal – hydraulic calculation is performed followed by a thermal load estimation of a superheater tube bundle in a natural gas fired boiler, using CFD simulations. In the next step, the surface temperature is evaluated and used to determine the temperature related damage, specifically the creep life estimation. The life expectancy is in some ways influenced by imperfections, and therefore at the end of this thesis the influence of the oxide layer on the inner side of tube and fouling on outer side of tube is described.

Economic growth rate differs largely between different countries. There are many opinions on which factors really affect the rate of growth in different economies and this causes debates. The factors that affect economic growth include political systems, social settings, economic freedom, human capital and institutional organization. These factors affect not only productivity, but also efficiency. This thesis’ purpose is to investigate and explain the factors that affect economic growth in sub-Saharan Africa. Through use of a fixed effects regression model, a panel data investigation will be conducted, and an analysis will be presented in this thesis. By using secondary data for sub-Saharan African countries from reliable sources, the factors that affect economic growth on an annual basis from year 2006 to 2017 are examined. Growth in gross domestic product per individual (GDP per capita growth) is the dependent variable and represents economic growth. The independent variables which are believed to affect this growth are also given, and these include: population growth, foreign direct investment, level of corruption, democracy, life expectancy at birth, expected years of schooling and economic freedom. The findings estimate that some of the chosen variables, for example population growth and life expectancy at birth significantly affect economic growth and development in these countries. The rest of the independent variables have an impact on economic growth but are not statistically significant according to this study.

This thesis investigates the impact of social determinants on life expectancy in 16 transition economies from 1995 to 2012 by a panel data regression analysis. The regression result suggests that, air quality, coverage for tertiary education, spending in health care have statistically positive associations with life expectancy. To be specific, 1 microgram per cubic meter reduction in PM 2.5 air pollution(mean annual exposure) is associated with a gain of 2.16 months of life expectancy at birth. 100 dollars increase in health expenditure per capita is associated with a gain of 2.4 months of life expectancy at birth. 10% points increase in the gross enrolment ratio for tertiary school is associated with a gain of 3.6 months of life expectancy. But the proxy variable of democracy(Unified Democracy Sores), Economic Freedom and out-of-pocket health expenditure are not significant factors of life expectancy.

Zur besseren Beurteilung der Lebensdauer unterschiedlich gegründeter prähistorischer Holzgebäude werden Ausgrabungsbefunde, archäologische Experimente, volks- und völkerkundliche Daten und erstmals Literatur zum historischen Telegraphenbau herangezogen. Es ergibt sich eine übliche Lebenserwartung von 20-30 Jahren für prähistorische Holzgebäude verschiedener Bauweise. Der Pfostenbau, obwohl technisch spätestens seit der Eisenzeit ein Anachronismus, lebte bis ins Mittelalter fort, während nicht-erdfeste Bauweisen die Ausnahme blieben, offenbar weil kurze Lebensspannen von Gebäuden den Erfordernissen der Erbauer genügten und immaterielle Gründe wohl ohnehin häufige Neubauten erforderten. / For a more precise assessment of the life expectancy of different types of prehistoric wooden buildings a short evaluation was made of excavation results, archaeological experiments, ethnological and folklore evidence and – for the first time – of literature on historical telegraph lines. The result was a normal life expectancy of some 20-30 years for prehistoric wooden buildings of different construction types. Post construction, although technically an anachronism by the Iron Age at the latest, persisted into the Middle Ages, while overground construction types remained exceptions, obviously because short life-spans of buildings met the requirements of their builders and immaterial reasons might have demanded frequent rebuilding anyway.