Chronic, noncommunicable diseases such as chronic fatigue syndrome (also known as myalgic encephalomyelitis) are rapidly becoming a worldwide epidemic that profoundly affects public health and productivity. Chronic fatigue syndrome (CFS) is characterised by severe and debilitating fatigue and although its etiology is still unknown, recent studies have found considerable evidence that mitochondrial dysfunction and oxidative stress might be responsible for the underlying energy deficit in these patients. Adenine and pyridine nucleotides could be used as potential biomarkers for energy related disorders such as chronic fatigue syndrome because of their various functions in the energy and redox pathways. The first part of this study focussed on developing a liquid chromatography electrosprayionisation tandem mass spectrometry (LC-ESI-MS/MS) method for the quantification of these nucleotides in blood samples. Due to the instability of nucleotides in biological matrices it was also necessary to find a suitable extraction method that would be able to stop enzymatic activity via protein precipitation. Out of the four extraction methods investigated during this study, deproteinisation of whole blood samples with perchloric acid produced the highest nucleotide abundances. Although nucleotide standards were found to be stable in perchloric acid, nucleotide levels in blood samples were not stabilised by addition of perchloric acid. The second part of this study consisted of measuring the nucleotide levels in blood samples of controls and possible CFS patients in order to test the proof of concept of the new LCESI- MS/MS method. Despite changes in the nucleotide levels due to perchloric acid and problems with nucleotide instability, it was still possible to distinguish between the two groups based on the results obtained with the new LC-ESI-MS/MS method. The newly developed LC-ESI-MS/MS method proved to be reliable and adequate for nucleotide quantification in whole blood samples, thus the aim of this study was achieved. / MSc (Biochemistry), North-West University, Potchefstroom Campus, 2014

For people who live with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivity syndrome illness is a hidden construct. The body does not display the chronicity of the internal experience. This thesis removes the barrier between what is experienced and what is visible by creating visual means of communicating the body’s hidden experience. The place of the viewer is part of this discussion. Through visual methods digital photographic techniques and the current interest in sensory anthropology the embodied sensory chronic illness experience is explored. The hidden experiences were made visual creating “MeBoxes” and masks which showed both the external and embodied internal experiences of chronic illness. As the process of working with and walking beside the participants developed, I found that the discourse on imaging within the literature was inadequate to show the real lived experiences of those with chronic illness. My interactions with the people of this thesis and the process of honouring their experiences required a model that would encourage the viewer to new and perhaps unrealised depths of participation to understand the participant’s multi-faceted and multi-layered experiences. Part of the discussion is the ability of images to communicate sensory experience as is the case with Munch’s The Scream and Picasso’s Guernica. Through the use of a hypertextual self-scape I show how participants created access to their experiences through their visual representations and through a collaborative approach became composite hypertextual self-scape metaphors.

For people who live with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivity syndrome illness is a hidden construct. The body does not display the chronicity of the internal experience. This thesis removes the barrier between what is experienced and what is visible by creating visual means of communicating the body’s hidden experience. The place of the viewer is part of this discussion. Through visual methods digital photographic techniques and the current interest in sensory anthropology the embodied sensory chronic illness experience is explored. The hidden experiences were made visual creating “MeBoxes” and masks which showed both the external and embodied internal experiences of chronic illness. As the process of working with and walking beside the participants developed, I found that the discourse on imaging within the literature was inadequate to show the real lived experiences of those with chronic illness. My interactions with the people of this thesis and the process of honouring their experiences required a model that would encourage the viewer to new and perhaps unrealised depths of participation to understand the participant’s multi-faceted and multi-layered experiences. Part of the discussion is the ability of images to communicate sensory experience as is the case with Munch’s The Scream and Picasso’s Guernica. Through the use of a hypertextual self-scape I show how participants created access to their experiences through their visual representations and through a collaborative approach became composite hypertextual self-scape metaphors.

For people who live with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivity syndrome illness is a hidden construct. The body does not display the chronicity of the internal experience. This thesis removes the barrier between what is experienced and what is visible by creating visual means of communicating the body’s hidden experience. The place of the viewer is part of this discussion. Through visual methods digital photographic techniques and the current interest in sensory anthropology the embodied sensory chronic illness experience is explored. The hidden experiences were made visual creating “MeBoxes” and masks which showed both the external and embodied internal experiences of chronic illness. As the process of working with and walking beside the participants developed, I found that the discourse on imaging within the literature was inadequate to show the real lived experiences of those with chronic illness. My interactions with the people of this thesis and the process of honouring their experiences required a model that would encourage the viewer to new and perhaps unrealised depths of participation to understand the participant’s multi-faceted and multi-layered experiences. Part of the discussion is the ability of images to communicate sensory experience as is the case with Munch’s The Scream and Picasso’s Guernica. Through the use of a hypertextual self-scape I show how participants created access to their experiences through their visual representations and through a collaborative approach became composite hypertextual self-scape metaphors.

CFS/ME (Chronic Fatigue Syndrome/Myalgic Encephalomyelitis) is a distressing and potentially debilitating condition. It can also be understood as a contested condition, surrounded by controversy about its nature, causes and treatment. Previous research indicates that those affected experience this climate of contestation as a troubling and discrediting assault, not only on the nature of their condition, but also on their identities. However, little attention has been paid to the voices of young people living with CFS/ME. This thesis extends a relatively small literature in new directions, focusing a constructionist, discursive narrative lens on the accounts of ten young people (aged 13-18) living with a diagnosis of CFS/ME. Narratives constructed during repeated interviews over a year, and drawing on multimodal materials collected by participants over that period, were analysed for their content, structure and performance, with reference to the local and broader contexts of their production. This analysis demonstrates that teenagers construct rich, multi-layered narratives with the potential to enhance understanding of their situation and broader features of the social world. As they speak of the onset of illness, attempts to live with enduring, unpredictable symptoms and their psychosocial consequences, and (for some) the possibility of 'moving on' from the worst of illness, this analysis throws new light on how young people's narratives can be understood as simultaneously constructing the condition ('M.E.') and the identities of those involved ('me' and others), in ways that engage with, reflect and resist prevailing discourses. It is argued that the discursive contexts of CFS/ME and adolescence raise particular challenges for young people as they try to construct credible narratives that convey the full extent of their difficulties, while resisting stigmatising identities (eg, as 'complaining', 'lazy' or otherwise 'not normal'). This analysis highlights implications for them, their families and those who work professionally with them; and for the ongoing social construction of CFS/ME in young people.

Syfte: Att beskriva och kartlägga arbetsterapeutiska interventioner för vuxna med ME/CFS och betydelsen för aktivitetsbalans. Metod: För att besvara syftet så utfördes en litteraturöversikt som inkluderar kvalitativa studier, kvantitativa studier och litteraturstudier, totalt åtta studier. Resultat: Arbetsterapeutiska interventioner har många fördelar som visar att arbetsterapi som används i rehabilitering har betydelse för vuxna med ME/CFS i det dagliga livet på olika sätt. Att aktiviteter skulle delas upp i relation till klientens aktivitetsnivåer och energinivåer synliggjordes. Individuell intervention som Pacing strategier och Gruppintervention som Gruppbaserad self-managementprogram kan användas som arbetsterapeutiska verktyg för diagnosgruppen ME/CFS och har betydelse för aktivitetsbalans. Det framkommer att kortsiktiga individuella interventioner kan vara kan vara effektiva och att Gruppbaserad self-managementprogram visar inga långvariga effekter. Slutsats: Uppsatsen visar fördelar att tillämpa Pacing som copingstrategi inom arbetsterapi för klienter med ME/CFS. Pacing strategier kan vara ett betydelsefullt arbetsterapeutiskt verktyg eftersom klienterna behöver strategier till att bespara sina energinivåer för meningsfulla aktiviteter. Pacing strategier visar ge goda effekter och beskrivs vara den säkraste intervention för klienter med ME/CFS. Pacing möjliggör för klienterna att uppnå aktivitetsbalans i vardagen. Arbetsterapeutisk gruppintervention som Gruppbaserad self-managementprogram kan vara en del av den arbetsterapeutiska rehabiliteringen av klienter med ME/CFS. Gruppbaserade self-managementprogram är funktionellt inom primärvården, vilket uppskattades av klienterna eftersom det möjliggör klientträffar med andra med samma diagnos. Genom gruppinterventionen har klienterna lärt sig att använda Copingstrategier och arbeta med sin acceptans. Gruppinterventionen resulterade att klienter lärde sig att undvika överansträngning, lärde sig att förändra levnadsvanor, energibesparing vilket kan stödja klienterna. Resultatet visar att efter genomförd gruppintervention är det betydelsefullt för klienter att hålla kontakten och skapa nätverk mellan klienterna. Arbetsterapi och arbetsterapeuten har betydelse för rehabiliteringen av klienter med ME/CFS och för deras aktivitetsbalans i dagliga livet. Det är viktigt att ta hänsyn till klientens uppfattningar, värderingar och synpunkter i relation till klientens diagnos. Ett dåligt bemötande och omhändertagande i hälso-och sjukvården kan påverka rehabiliteringen negativt. Det är betydelsefullt att arbetsterapeuten respekterar och har kunskapen om diagnosens pendlande symtom i samband med rehabiliteringsinsatser och interventioner. Det finns ett behov och efterfrågan om vidare forskning inom området, eftersom det är ett begränsat område gällande arbetsterapi och arbetsterapeutens betydelse i rehabilitering för klienter med ME/CFS som kan främja aktivitetsbalans.

Inledning: Myalgisk encefalomyelit/kroniskt trötthetssyndrom (ME/CFS) kännetecknas som en inflammation i hjärna och ryggmärg och karakteriseras framför allt av ihållande utmattning. Sjukdomen är ingen kultursjukdom eller lokal företeelse utan den förekommer i diverse åldrar, länder och sociala grupper. Ansträngningsutlöst försämring (PEM) är ett kardinalsymtom för sjukdomen. PEM kännetecknas av en förvärring av symtom efter rörelse, ortostatisk eller neuromuskulär stress och/eller kognitiv aktivitet. Syfte: Syftet var att beskriva upplevelsen och erfarenheten av ansträngningsutlöst försämring (PEM) hos personer med ME/CFS. Metod: En kvalitativ empirisk studie baserad på bloggar med deduktiv ansats. Livsvärldsteorin användes som en teoretisk referensram. Resultat: Resultatet visade att personer med ME/CFS beskrev PEM som en påfrestande och dramatisk upplevelse och att det krävdes ständiga anpassningar för att undvika försämringen. Situationen förvärrades ytterligare av ett bristfälligt och empatilöst bemötande inom sjukvården. Slutsats: På grund av känslighet för stimuli behöver varje handling gentemot personer med diagnosen ME/CFS reflekteras över huruvida den är till nytta eller till skada. För att förhindra PEM måste vården anpassas utifrån individuella ansträngningströsklar hos varje enskild person. Vidare forskning behövs om vilka förändringar som krävs för att säkerställa högkvalitativ omvårdnad. / Introduction: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized as inflammation of the brain and spinal cord and is characterized above all by persistent fatigue. The disease ME/CFS is not a cultural disease or a local phenomenon and It occurs in various ages, countries and social groups. PEM is characterized by an exacerbation of symptoms after movement, orthostatic or neuromuscular stress and / or cognitive activity. Purpose: The aim of this study was to describe the experiences and the perceptions of post-exertional malaise (PEM) in people with ME/CFS. Method: The study was a qualitative empirical study with a deductive approach based on blogs. Lifeworld was used as a theoretical framework. Result: The results showed that people with ME / CFS described PEM as a stressful and dramatic experience and that constant adjustments were required to avoid this deterioration. The situation was further aggravated by a deficient and unempathetic response in healthcare. Conclusion: Due to abnormal sensitivity to stimuli, each intervention for persons diagnosed with ME / CFS needs to be reflected on whether it is beneficial or harmful. To prevent PEM, healthcare must be adjusted based on the individual effort thresholds of each person. Further research is needed on what improvements are required to ensure high-quality nursing.

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Объект исследования является эмоциональное выгорание. Предметом исследования является эмоциональное выгорание офисных работников и фрилансеров. Магистерская диссертация состоит из введения, двух глав, заключения, списка литературы (67 источников) и приложения, включающего в себя бланки применявшихся методик. Объем магистерской диссертации 92 страницы, на которых размещены 13 рисунков и 8 таблиц. Во введении раскрывается актуальность проблемы исследования, разработанность проблематики, ставятся цель и задачи исследования, определяются объект и предмет исследования, формулируются основная и дополнительные гипотезы, указываются методы и эмпирическая база, а также этапы проведения исследования, научная новизна, теоретическая и практическая значимость работы. Первая глава включает в себя обзор иностранной и отечественной литературы по теме эмоционального выгорания. Представлены разделы, посвященные исследованию показателей синдрома и особенностей эмоционального выгорания. Выводы по первой главе представляют собой итоги по изучению теоретического материала. Вторая глава посвящена эмпирической части исследования. В ней представлено описание организации и методов проведенного исследования и результатов, полученных по всем использованным методикам: диагностика эмоционально выгорания В. Бойко, опросник профессионального выгорания MBI Х.Маслач, в адаптации Водопьяновой и шкала тревожности Спилберга- Ханина.Также в главе представлен сравнительный анализ результатов исследования. Выводы по главе 2 включают в себя основные результаты эмпирического исследования. В заключении в обобщенном виде изложены результаты теоретической и эмпирической частей работы, а также выводы по выдвинутым гипотезам, обоснована практическая значимость исследования и описаны возможные перспективы дальнейшей разработки данной проблематики. / The object of research is burnout. The subject of the research is the emotional burnout of office workers and freelancers. The master's thesis consists of an introduction, two chapters, a conclusion, a list of references (67 sources) and an appendix that includes the forms of the applied methods. The volume of the master's thesis is 92 pages, which contain 13 figures and 8 tables. The introduction reveals the relevance of the research problem, the development of the problematics, the purpose and objectives of the research are set, the object and the subject of research are determined, the basic and additional hypotheses are formulated, the methods and the empirical base are specified, as well as the stages of the research, the scientific novelty, the theoretical and practical significance of the work. The first chapter includes an overview of the domestic and foreign literature on the subject of fifth-graders school adaptation. The first chapter includes a review of foreign and domestic literature on the topic of burnout. The sections devoted to the study of indicators of the syndrome and features of emotional burnout are presented. Conclusions on the first chapter are the results of the study of theoretical material. The second chapter is devoted to the empirical part of the study. It provides a description of the organization and methods of the study and the results obtained using all the methods used: diagnostics of the level of emotional burnout V.Boyko, Maslach's MBI professional burnout questionnaire, adapted by Vodopyanova, Spielberger-Hanin Anxiety Scale. Also, the chapter presents a comparative analysis, of the results of the study. The findings of Chapter 2 are the main results of the empirical study. In conclusion, brief results of the theoretical and empirical parts of the work are presented, as well as conclusions on the hypotheses. The practical significance of the study is substantiated and possible prospects for further development of the problematics are described.

Objectives: To assess the expression of the symptoms of jaw muscle pain and its association with alterations in biochemistry, other symptoms and the carriage of staphylococci. Methods: Three different study populations were assessed. The first was selected and examined by the author and consisted of 43 pain and 41 age and sex matched controls. The second was a study of CFS patients who were blinded to the author and the author subsequently examined the associations between jaw muscle symptom reporting and the standardised biochemistry measures. The third study was also blinded to the author but included an investigation of staphylococci and certain cytokine and biochemistry measures. Results: The three studies clearly establish an association between the carriage of toxicogenic coagulase negative staphylococci and the expression of jaw muscle pain in both males and females. These associations were homogeneous and were found whether the patients were selected on the basis of having jaw muscle pain or selected from within a population of patients selected on the basis of having Chronic Fatigue Syndrome. The studies associated the changes with variations in biochemistry and these were in turn associated with symptom expression within the jaw muscle pain patients. These biochemical alterations included the dysregulation of immune cell counts, cytokines, electrolyte and protein metabolism. These symptoms and biochemical changes were associated with pain severity and illness duration and staphylococcal toxin production. From the data a model was developed which shows the mechanisms involved in the development of chronic pain in the jaw muscles. Conclusions: The carriage of toxicogenic coagulase-negative staphylococci were found to be associated with the expression of jaw muscle pain and the alterations in biochemistry associated with these symptoms.