Background: Whilst the experience of chronic physical conditions is well documented and has been recognised as relevant for health policy and practice little is known about notions of recovery and prognosis from the point of view of those with long-term physical health conditions. The extent to which people consider the future outcomes of their conditions is relevant to health policy which seeks to engage people in shared decision making, care plans, and self-management. This gap in knowledge about lay perceptions of recovery and prognosis becomes more pronounced when compared with literature from the mental health field in which recovery is one of the dominant foci, is comparatively well researched and in recent years has fed into policy and management approaches.Aims: The aim of the thesis is to explore perceptions of recovery and prognosis with people with long-term physical health conditions and to compare these with perspectives on recovery and prognosis apparent in the mental health field.Methodology: Using qualitative methods, a two phased approach to data collection and analysis was undertaken. Phase 1 used secondary data analysis with two existing datasets to examine whether notions of recovery and prognosis were implicit in narratives about the experience of illness. Phase 2 built on the findings from phase 1 and utilised longitudinal, primary data collection in the form of narrative interviews undertaken at two time points (baseline and 12 month follow-up). The analysis in both phases involved a cross case thematic analysis to look for commonalities and differences across individuals. Data from phase 2 were also subject to a narrative emplotment of individual stories which were used to capture the longitudinal changes in patient perspectives over time.Results: There were similarities with findings from the mental health field (recovery as a complex, nonlinear journey, the input from friends and family, notions of burden and the impact of condition on sense of self). However, there were nuanced differences in relation to physical health conditions which related to expectations about mortality, the experience of time, the extent to which narratives were future oriented and the experience of stigma. The dual focus on mental and physical health recovery proved useful for understanding those experiences of multiple morbidities. The results were used to develop a model of recovery narratives based on two dimensions (expectations and responsibility) which gave rise to four typologies of narratives. The aim of this model was to further highlight and summarise the themes arising from the data analysis.Discussion: The results of this study highlight the importance of understanding notions of recovery and prognosis in order to better understand the experience of illness and self-management. The thesis challenges the blanket use of health promotion strategies for those with and without chronic health conditions and supports a shift in policy focus from improved choice and autonomy to what Mol (2009) refers to as ‘enhanced care’.

Submitted by Valquíria Barbieri (kikibarbi@hotmail.com) on 2017-09-06T15:09:54Z No. of bitstreams: 1 DISS_2014_Lidiane Mara de Ávila e Silva.pdf: 1327393 bytes, checksum: 8b3241d9cd78ed1d599055ddb5bc5fe3 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-12T13:22:55Z (GMT) No. of bitstreams: 1 DISS_2014_Lidiane Mara de Ávila e Silva.pdf: 1327393 bytes, checksum: 8b3241d9cd78ed1d599055ddb5bc5fe3 (MD5) / Made available in DSpace on 2017-09-12T13:22:55Z (GMT). No. of bitstreams: 1 DISS_2014_Lidiane Mara de Ávila e Silva.pdf: 1327393 bytes, checksum: 8b3241d9cd78ed1d599055ddb5bc5fe3 (MD5) Previous issue date: 2014-06-10 / CAPES / A hanseníase se constitui atualmente como um problema de Saúde Pública e apesar de significativa redução, o Brasil ocupa o segundo lugar no mundo em número de casos da doença. Neste cenário destaca-se o estado de Mato Grosso, cuja magnitude sinaliza o quanto ela ainda é um desafio a ser enfrentado pelo campo da Saúde Pública. Embora a detecção e o tratamento sejam previstos no primeiro nível de atenção, um percentual de adoecidos pode desenvolver reações hansênicas que se constituem como um agravo à hanseníase, produzindo marcas corporais como manchas, descamações e ulcerações na pele, nódulos subcutâneos, entre outras alterações que remetem ao plano dos significados e afetam a identidade destas pessoas, dando visibilidade a uma condição que pode levá-las a serem estigmatizadas socialmente. Este estudo analisa a experiência de mulheres com reações hansênicas, interpretada pelo conhecimento prático do senso comum na perspectiva das entrevistadas. Trata-se de pesquisa qualitativa, a qual se vale dos estudos da experiência de uma doença tropical negligenciada com potencial estigmatizante, baseado em pressupostos da fenomenologia. Os resultados foram analisados em categorias que abrangem: o processo de descoberta da doença, em que destaca-se o diagnóstico tardio e o despreparo dos profissionais e equipes de unidades básicas de saúde; as noções de causalidade, sendo a hanseníase atribuída a lugares sujos e a microorganismos que invadem o corpo; o conceito de hanseníase e de reações hansênicas, relacionados a uma doença que afeta os nervos e suas sequelas, respectivamente; os impactos e enfrentamentos cotidianos, destacando-se a dor, que assume um aspecto central nesta experiência; o apoio social recebido especialmente dos filhos, instituições religiosas e profissionais de saúde; a relação com o tratamento e as expectativas futuras, centradas em retomar à vida normal. Estas categorias elucidam a complexidade dos aspectos que incidem na experiência de adoecimento por reações hansênicas, mostrando que as marcas afetam diretamente a vida social das adoecidas, fazendo com que elas se isolem socialmente. Ressaltamos que a proposição de intervenções mais sensíveis às especificidades socioculturais pode tornar a atenção aos adoecidos mais humanizada e integral. / Leprosy is currently constitutes as a public health problem and despite significant reduction, Brazil ranks second in the world in number of cases. This scenario highlights the state of Mato Grosso, whose magnitude indicates how much it is still a challenge to be faced by the field of Public Health. Although the detection and treatment are provided in primary care, a percentage of diseased may develop leprosy reactions that constitute as a grievance to leprosy producing body marks such as spots, desquamation and ulceration of the skin, subcutaneous nodules, among other changes refer to the sphere of meanings and affect the identity of these people by giving visibility to a condition that can lead them to be socially stigmatized. This study examines the experience of women with leprosy reactions, interpreted by practical common sense knowledge from the perspective of the interviewees. It is a qualitative research, which draws on the studies of the experience of a neglected tropical disease with potentially stigmatizing, based on assumptions of phenomenology. The results were analyzed in categories covering: the process of discovery of the disease, in which we highlight the late diagnosis and the lack of preparation of professionals and staff at the primary health care; notions of causality, leprosy is attributed to dirty places and the microorganisms that invade the body; the concept of leprosy and leprosy reactions, related to a disease that affects the nerves and their sequelae, respectively; impacts and daily confrontations, especially pain, which assumes a central aspect in this experiment; social support received especially the children, religious institutions and health professionals; the relationship to treatment and future expectations, focusing on getting back to normal life. These categories elucidate the complexity of aspects that influence the illness experience by leprosy reactions, showing that brands directly affect the social life of fallen ill, causing them to isolate themselves socially. We emphasize that the proposition more sensitive to sociocultural specific interventions can make attention to more humane and comprehensive sickened.

Submitted by Valquíria Barbieri (kikibarbi@hotmail.com) on 2017-08-30T21:44:32Z No. of bitstreams: 1 DISS_2014_Beluci Bianca Nunes de Siqueira.pdf: 720939 bytes, checksum: f785c41d77a555cc4b6a978ad9366ed8 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-01T14:03:51Z (GMT) No. of bitstreams: 1 DISS_2014_Beluci Bianca Nunes de Siqueira.pdf: 720939 bytes, checksum: f785c41d77a555cc4b6a978ad9366ed8 (MD5) / Made available in DSpace on 2017-09-01T14:03:51Z (GMT). No. of bitstreams: 1 DISS_2014_Beluci Bianca Nunes de Siqueira.pdf: 720939 bytes, checksum: f785c41d77a555cc4b6a978ad9366ed8 (MD5) Previous issue date: 2014-07-11 / CAPES / Esta pesquisa tem como proposta compreender a experiência de adoecimento de adultos jovens por uma condição crônica: a Leucemia Mielóide Aguda. Ressaltamos nesse estudo a dimensão social, pois essa nova condição é tratada com prognóstico ruim, mutilante, fatal; sendo comparada/associada a desordens físicas, mentais e sociais, além disso, a sociedade deprecia as pessoas adoecidas pelo câncerestigmatizando- as. Trata-se de uma pesquisa qualitativa baseado em pressupostos da fenomenologia de Alfred Schutz. As informações foram obtidas mediante entrevistas semiestruturadas realizada com quatro jovens, na faixa etária de 20 a 28 anos, em fase de manutenção no tratamento em uma unidade de referência oncológica no período de novembro de 2013 até janeiro de 2014, no estado de Mato Groso. Após as entrevistas foi realizada a descrição dos sujeitos entrevistados, e em seguida o agrupamento dos temas principais nas experiências dos adoecidos. Os resultados abrangem: o processo de descoberta do adoecimento por leucemia, em que destacase o diagnóstico realizado com rapidez sendo esse o diferencial entre a vida e a morte; o conceito, sendo a leucemia atribuída a uma doença fatal, contagiosa, silenciosa e invisível; noções causais relacionado a uma doença com causas pluralísticas de acordo com o seu contexto, como hereditariedade, agentes externos e momento marcante negativamente em sua vida; os impactos e as estratégias cotidianas de enfrentamento relatados com maior importância estavam ligados com a aparência corporal, morte vivenciada de amigos e prenúncios da própria morte e o apoio social recebidos tanto pelo apoio informal quanto formal para a realização do tratamento;e as motivações dos sujeitos para as suas ações. A pesquisa demonstrou a complexidade do adoecimento crônico, como o adoecimento marca a vida cotidiana dos sujeitos e como são realizadas as estratégias de enfrentamento na tentativa de integrar a condição crônica ao novo ritmo da vida, resignificando sua experiência com a leucemia. Além disso, possibilita a refletir sobre as práticas de atenção e de gestão oncológica. / This research aims at understanding the experience of illness in young adults with a chronic condition: the Acute Myeloid Leukemia. This study emphasize the social dimension, because this new condition is treated bad, mutilating, fatal prognosis; being compared / associated with physical, mental, and social disorders, moreover, detracts society people with cancer have fallen ill-branding them. This is a qualitative research based on assumptions of phenomenology of Alfred Schutz. Data were obtained through semi-structured interviews conducted with four youths, aged 20-28 years in the maintenance phase of treatment in an oncology referral from November 2013 until January 2014, the state of Mato Groso. After the interviews were performed description of the interviewees, and then grouping the main themes in the experiences of the diseased. The results include: the process of discovery of illness from leukemia, where the highlight is the diagnosis made quickly that being the difference between life and death; the concept, and the leukemia attributed to a fatal, contagious, silent and invisible disease; causal notions related to a disease with pluralistic causes according to its context, such as heredity, external agents and negatively striking moment in your life; impacts and everyday coping strategies reported most importance were linked with body appearance, experienced death of friends and harbingers of death itself and the social support received by both the informal and formal support for the completion of the treatment, and the motivations of the subjects for their actions. Research has demonstrated the complexity of chronic illness, such as illness marks the daily lives of the subjects and how the coping strategies in an attempt to integrate the new chronic condition pace of life are held, redefining his experience with leukemia. Furthermore, it allows to reflect on care practices and oncological management.

Submitted by Valquíria Barbieri (kikibarbi@hotmail.com) on 2017-09-11T21:13:17Z No. of bitstreams: 1 DISS_2014_Patrícia de Lima Lemos.pdf: 1529357 bytes, checksum: fe6572198631f5dddc614302d710b521 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-12T13:28:45Z (GMT) No. of bitstreams: 1 DISS_2014_Patrícia de Lima Lemos.pdf: 1529357 bytes, checksum: fe6572198631f5dddc614302d710b521 (MD5) / Made available in DSpace on 2017-09-12T13:28:45Z (GMT). No. of bitstreams: 1 DISS_2014_Patrícia de Lima Lemos.pdf: 1529357 bytes, checksum: fe6572198631f5dddc614302d710b521 (MD5) Previous issue date: 2014-11-25 / CAPES / Estudo socioantropológico de abordagem qualitativa que analisou a experiência de homens e mulheres adultos com insuficiência renal crônica – IRC – e em terapia renal substitutiva. Esta doença é clinicamente definida como a deterioração progressiva e irreversível das funções renais, doença com nível de ascensão alarmante, requerendo o tratamento contínuo com hemodiálise e diálise peritoneal, ou definitivo, pelo transplante renal. A abordagem da experiência de adoecimento centra-se na pessoa, no processo subjetivo de vivência da enfermidade. Os dados foram coletados baseando-se nos itens do Modelo Explicativo da Enfermidade e a partir de entrevistas gravadas, norteadas pelo relato oral e com o uso de roteiro semiestruturado, junto a quatro mulheres e cinco homens em hemodiálise e um homem em diálise peritoneal. A técnica da representação por desenhos realizados pelos participantes foi usada de forma a complementar às entrevistas para conhecer as noções da fisiopatologia e impactos corporais da IRC. Além das observações durante os momentos das entrevistas, registradas em diário de campo, soma-se a caracterização dos sujeitos. O conjunto dos dados foi tratado conforme a análise temática. Baseando-se na estrutura do Modelo Explicativo, os resultados e discussões foram organizados a partir dos temas: processo de descoberta, conceito e gênese da IRC; noções corporais da IRC; impactos materiais e imateriais, enfrentamentos cotidianos e expectativas futuras. Quanto ao conceito foi comum o uso de metáforas para expressá-la, como “cruz que tenho que carregar”. O início do adoecimento é relatado com o aparecimento de sinais objetivos e subjetivos incomuns. O diagnóstico tardio da IRC se mostrou recorrente entre os casos, somado aos tratamentos equivocados que potencializaram o sofrimento dessas pessoas, constituindo-se em uma ruptura biográfica. Na gênese do adoecimento foram comuns às múltiplas explicações causais que se entrelaçam numa história como a hereditariedade, outras morbidades crônicas, consumo alimentar e hídrico inadequado, em meio às condições de vida precárias e trabalho braçal no passado. Os impactos revelaram aspectos emocionais e físicos, como dor e fraqueza constantes, além do estigma pela presença da fístula-arteriovenosa. A dependência da diálise gera uma situação ambígua com sentimentos de raiva, ocasionada pela dependência, e também gratidão, pelo tratamento que mantém e salva suas vidas. Os desenhos mostraram dores generalizadas, marcas ocasionadas pela fístula e cateter, bem como a ausência e/ou alterações de órgãos. A impossibilidade de viajar e de trabalhar formalmente foram mais ressaltados pelos homens, sendo que as mulheres percebem maiores transformações no âmbito doméstico. As estratégias cotidianas de enfrentamento do adoecimento englobam o apoio social informal advindo dos familiares, dos demais adoecidos e formalmente do serviço de saúde. Expectativas futuras refletem a possibilidade do transplante renal bem sucedido, a fé e esperança em Deus, na possibilidade da cura ou apenas os projetos mais imediatistas do viver o dia a dia. A experiência de adoecimento renal, ainda que a IRC acometa qualquer pessoa, é moldada e influenciada pelas desigualdades sociais. Diante da abordagem de homens e mulheres adoecidos foi possível verificar experiências singulares, idiossincrasias e variações de gênero, mas também convergências nas experiências. Enfim, é pertinente a atenção à saúde socioculturalmente mais sensível, mais confluente e equânime as reais necessidades das pessoas. / This is a socioanthropological study of qualitative approach that examined the experience of adult men and women with chronic renal failure (CRF), and on renal replacement therapy. Such disease is clinically defined as the progressive and irreversible deterioration of the kidney function. It is a disease of alarming rise level, and requires continuous treatment with hemodialysis and peritoneal dialysis, or permanent treatment by renal transplantation. The approach of the illness experience focuses on the person, in the subjective process of experiencing the illness. Data were collected based on the items of the Explanatory Model of Illness and on recorded interviews guided by the oral report and a semi-structured script, with four women and five men on hemodialysis, and a man in peritoneal dialysis. The technique of representation by drawings made by participants was used to complement the interviews, in order to understand the concepts of pathophysiology and the physical impacts of the CRF. As well as observations during the interviews, recorded in a field diary, in addition, there was the characterization of the subjects. The group of data was treated as thematic analysis. Based on the structure of the Explanatory Model, the results and discussions were organized from the themes, namely: process of discovery, concept and genesis of the CRF; body notions of the CRF; material and immaterial impacts, daily confrontations and future expectations. Regarding the concept, the use of metaphors for expression was common, such as „the cross I have to bear‟. The onset of illness is reported with the emergence of subjective and objective uncommon signs. The late diagnosis of CRF was recurrent among the cases, added to the wrong treatments, which have worsened the suffering of these people, becoming a biographical disruption. In the genesis of the disease, it was common to find multiple causal explanations intertwining in a story such as heredity, other chronic morbidities, inadequate dietary and water intake, amid poor living conditions and physical work in the past. The impacts revealed emotional and physical aspects, such as constant pain and weakness, as well as the stigma by the presence of arteriovenous fistula. The dependence on dialysis creates an ambiguous situation, with feelings of anger caused by the dependence, and gratitude for the treatment that keeps and saves their lives. The drawings showed generalized pain, marks caused by fistula and catheter, as well as the absence and/or changes in organs. The impossibility of travelling and working formally were the most emphasized by men, and women perceive the greatest transformations in the domestic sphere. Everyday strategies to confront the illness include the informal social support from family members, from other sick people and the formal support from health services. Future expectations reflect the possibility of a successful kidney transplant, the faith and hope in God, in the possibility of healing, or just immediatist projects of living day to day. The experience of renal illness, although the CRF can affect any person, is shaped and influenced by social inequalities. In face of sick men and women, it was possible to find singular experiences, idiosyncrasies and variations of gender, but also the convergence of experiences. Finally, it is pertinent that the health care is socioculturally more sensitive, more confluent and equitable to the real needs of people.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2018-05-30T14:21:40Z No. of bitstreams: 1 DISS_2013_ Carinna Maria Mercedes Vieira Pires.pdf: 1747282 bytes, checksum: 400cd6546a86e46165bd4d25e3451362 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2018-06-15T14:45:02Z (GMT) No. of bitstreams: 1 DISS_2013_ Carinna Maria Mercedes Vieira Pires.pdf: 1747282 bytes, checksum: 400cd6546a86e46165bd4d25e3451362 (MD5) / Made available in DSpace on 2018-06-15T14:45:02Z (GMT). No. of bitstreams: 1 DISS_2013_ Carinna Maria Mercedes Vieira Pires.pdf: 1747282 bytes, checksum: 400cd6546a86e46165bd4d25e3451362 (MD5) Previous issue date: 2013-05-21 / CNPq / O estudo analisou a experiência de adultos com Anemia Falciforme (Anemia Falciforme) abordada em primeira pessoa e como adoecimento crônico. Essa doença genética é comum no Brasil e no mundo, sendo mais frequente na população afrodescendente. Abordar a experiência de adoecimento crônico significa olhar para o sujeito que (con)vive com uma condição que o acompanha em todos os lugares. Os dados foram coletados segundo a técnica do relato oral por meio de entrevistas orientadas por roteiro semi estruturado junto a 4 homens e 4 mulheres adoecidos além de 4 familiares (respectivas mães) presentes por ocasião das entrevistas. A essas informações juntaram-se dados objetivos de caracterização dos sujeitos e seu contexto, bem como observações de dados não verbais e conversas informais registrada em diário de campo e que foram tratados conforme a análise temática. Os resultados mais significativos são apresentados em 2 manuscritos compondo a dissertação. O primeiro aborda as explicações sobre o conceito, causalidade, sintomas e enfrentamentos cotidianos expressos pelos adoecidos e o último é um estudo de caso mostrando a complexidade da experiência na sua singularidade. Entre as complicações da anemia falciforme algumas se mostraram comuns, como o uso de metáforas para conceituá-la; a dor e as feridas são crônicas e requerem manejo cotidiano e demandando a procura dos serviços de saúde; bem como a icterícia com potencial estigmatizante. Não obstante, cada caso apresenta peculiaridades pelas singularidades biográficas, idiossincrasias. O diagnóstico tardio foi unânime podendo ser compreendido, em parte, pela inexistência do Teste do Pezinho para detecção precoce da anemia falciforme no estado, porém há outros exames específicos que mediante suspeita clínica podem ser solicitados, contudo remete ao preparo dos profissionais de saúde. Ainda que acometa qualquer pessoa, reconhece-se que os mais atingidos parecem estar em segmentos histórica e socialmente excluídos, com isso não se pode ignorar que a experiência de adoecimento pode ser ainda mais dolorosa diante das desigualdades sociais (entre elas a racial) presentes na sociedade brasileira. Portanto, considera-se pertinente a elaboração de políticas focalizadoras quando se trata de contextos historicamente desiguais, para que seja possível garantir o acesso de todo cidadão aos benefícios das políticas universais de saúde. / The study examined the experience of adults with sickle cell disease (SCD) addressed in the first person and how chronic illness. This genetic disease is common in Brazil and in the world, being more frequent in people of African descent. Address the experience of chronic mean look at the guy (con) lives with a condition that accompanies it everywhere. Data were collected using the technique of oral accounts through interviews guided by a semi structured along the four men and four women sickened beyond 4 family (their mothers) present during the interviews. The information gathered these objective data to characterize the subjects and their context, as well as non-verbal data observations and informal conversations recorded in a field diary and were treated according to thematic analysis. The most significant results are presented in two manuscripts composing the dissertation. The first deals with the explanation of the concept, causation, symptoms and daily confrontations expressed by the diseased and the latter is a case study showing the complexity of the experience in their uniqueness. Among the complications of sickle cell anemia have shown some common, such as the use of metaphors to conceptualize it, the pain and the wounds are chronic and require daily management and demanding the demand for health services, as well as jaundice potentially stigmatizing. Nevertheless, each case presents peculiarities by singularities biographical idiosyncrasies. Late diagnosis was unanimous and can be understood, in part, by the absence of neonatal screening for early detection of sickle cell anemia in the state, but there are other specific tests that upon clinical suspicion may be requested, however refers to the preparation of health professionals. Although it affects anyone, it is recognized that the most affected segments appear to be historically and socially excluded, it can not be ignored that the illness experience can be even more painful in the face of social inequality (including the race) in the Brazilian society. Therefore, it is pertinent to preparation of focusing policies when it comes to historically unequal contexts, so that you can ensure access of all citizens to the benefits of universal health policies.

Inledning: Funktionella anfall, anfall som inte är epilepsi utan tros ha en psykologisk orsak, kan mötas av oförståelse också inom sjukvården. För att förstå detta tillstånd behöver man en processinriktad biopsykosocial sjukdomsmodell där patientens egen sjukdomsförståelse är en viktig del. Frågeställningar: Hur upplever patienter med funktionella anfall sin sjukdom?Hur förstår patienter med funktionella anfall sin sjukdom? Metod: Fem fenomenologiska halvstrukturerade intervjuer har genomförts och med hjälp av tematisk analys kondenserats till fyra teman. Resultat: De fyra temana är upplevelsen av anfallen, egen förståelse av anfallen, konsekvenser av anfallen och vad hjälper mot anfallen. Stora skillnader framkommer i intervjupersonernas upplevelse och förståelse av sina anfall. Anfallen upplevs som en känsla av förändrad kontakt eller ingen kontakt mellan kropp och hjärna och de beskrivs både begränsa och berika livet. Sjukdomsförståelsen uttrycks i fysiologiska termer, i mer vaga psykologiska termer eller att det inte går att förstå. Det framkommer tveksamhet till om psykologisk behandling hjälper. Diskussion: Det diskuteras att de funktionella anfallen faktiskt går att förstå, ibland medvetet och ibland omedvetet som en försvarsmekanism enligt psykodynamisk modell. Korttids psykodynamisk terapi såsom ISTDP kan därför vara ett behandlingsalternativ när psykoedukation och KBT inte har varit tillräckligt. / Introduction: Functional seizures, seizures that are believed to have a psychological cause, may face misunderstanding also in health care. To understand this condition, one needs a process-oriented biopsychosocial model in which the patient's own experience of illness is an important part. Questions: How do patients with functional seizures experience their illness?How do patients with functional seizures understand their illness? Method: Five phenomenological semi-structured interviews have been conducted and condensed into four themes using thematic analysis. Results: The four themes are experience of the seizures, understanding of the seizures, consequences of the seizures and what helps against the seizures. Large differences emerge in the interviewees' experience and understanding of their seizures. The seizures are experienced as a feeling of altered contact or no contact between body and brain and they are described to both limit and enrich life. Understanding of illness is expressed in physiological terms, in more vague psychological terms or cannot be understood. There is some doubt as to whether psychological treatment will help. Discussion: It is discussed that the functional seizures can actually be understood, sometimes consciously and sometimes unconsciously as a defense mechanism according to the psychodynamic model. Therefore, short-term psychodynamic therapy such as ISTDP may be a treatment alternative when psychoeducation and CBT have not been sufficient.

Background: Inflammatory Bowel Disease (IBD) is a chronic, relapsing, autoimmune disease, affecting one in every 150 Canadians. Failure to induce remission of IBD with pharmacotherapy can necessitate surgical interventions, such as the creation of an ostomy. Ostomy surgery can help manage severe IBD and thus improve quality of life; however, individuals living with IBD report the possibility of ostomy surgery as a top concern, which can lead them to refuse or delay this decision until the disease becomes life threatening. Research Objective: The aim of this study is to understand what factors influence the decision to have ostomy surgery in young women with IBD, how the perception of the surgery compares to the reality of living with an ostomy, and the role healthcare professionals play in this decision. Methods: Nine participants who (1) identify as female, (2) are between the ages of 19 and 30, and (3) are currently living with an ostomy to treat IBD were recruited for this study. Additionally, seven healthcare professionals who work with IBD patients were recruited. Participants were invited for an individual, semi-structured interview. Findings: Young adult women living with an ostomy to treat their IBD reflected on their initial fears and concerns about undergoing surgery. Due to the severity of their illness, the majority of participants had requested surgery after having some time to adjust to the idea. This request, however, was often met with resistance or obstacles in the healthcare system. Healthcare professionals share mixed perceptions of ostomy surgery, with some viewing it as a last resort and others perceiving it as a treatment option. Once surgery had been performed, young adult women describe some challenges adjusting to life with an ostomy; but the majority report experiencing an overall improvement in quality of life. Conclusion: Understanding the perceptions that influence how young women perceive ostomies prior to versus after surgery will help identify the factors that influence the decision-making process for ostomy surgery, such as gender, age and stigma. Challenging current beliefs and assumptions may allow more supportive conversations between healthcare professionals and patients and provide insight on the actual lived experience of young women living with an ostomy. / Graduate / 2023-01-13

<p>The overall aim was to study factors that affect behaviour related to CVD (cardiovascular diseases). Study I tested whether gender, education and so-cioeconomic status correlated to knowledge about risk factors, and Study II studied knowledge and risk behaviour from a national perspective (Sweden versus Poland). Furthermore, Study III examined whether obese people dif-fered from people of normal weight regarding knowledge about risk factors, and Study IV examined whether risk behaviour is affected by personal ex-perience of illness and family history of CVD. </p><p>The studies are population-based with cross-sectional design. Data were obtained by questionnaires and by screening results of risk factors related to CVD. The studies were carried out among 50-year old men and women in Västmanland, Sweden (n=1011) and in Wroclaw, Poland (n=1043).</p><p>The results show that women are more knowledgeable than men about the risk factors for CVD, and that low education is associated with insufficient knowledge about CVD (Study I). The discrepancy between knowledge and behaviour was greater among the Poles than it was among the Swedes (Study II). Obese individuals did not differ significantly from individuals with a normal weight regarding knowledge of cardiovascular risk factors when education was controlled for (Study III). Individuals with a personal experience of illness may be more inclined to change smoking behaviour than the average person (Study IV).</p><p>In conclusion, knowledge about risk factors for CVD varies with education, gender and, to a certain degree, nationality. However, knowledge does not only consist of the conditions of behaviour change. The results in the thesis substantiate theories suggesting that change in risk behaviour is a process over time. Predictors of risk behaviours on the individual level as well as national level are of importance, and needs to be considered in the every day practice of health care professionals.</p>

The overall aim was to study factors that affect behaviour related to CVD (cardiovascular diseases). Study I tested whether gender, education and so-cioeconomic status correlated to knowledge about risk factors, and Study II studied knowledge and risk behaviour from a national perspective (Sweden versus Poland). Furthermore, Study III examined whether obese people dif-fered from people of normal weight regarding knowledge about risk factors, and Study IV examined whether risk behaviour is affected by personal ex-perience of illness and family history of CVD. The studies are population-based with cross-sectional design. Data were obtained by questionnaires and by screening results of risk factors related to CVD. The studies were carried out among 50-year old men and women in Västmanland, Sweden (n=1011) and in Wroclaw, Poland (n=1043). The results show that women are more knowledgeable than men about the risk factors for CVD, and that low education is associated with insufficient knowledge about CVD (Study I). The discrepancy between knowledge and behaviour was greater among the Poles than it was among the Swedes (Study II). Obese individuals did not differ significantly from individuals with a normal weight regarding knowledge of cardiovascular risk factors when education was controlled for (Study III). Individuals with a personal experience of illness may be more inclined to change smoking behaviour than the average person (Study IV). In conclusion, knowledge about risk factors for CVD varies with education, gender and, to a certain degree, nationality. However, knowledge does not only consist of the conditions of behaviour change. The results in the thesis substantiate theories suggesting that change in risk behaviour is a process over time. Predictors of risk behaviours on the individual level as well as national level are of importance, and needs to be considered in the every day practice of health care professionals.

To explore attributions about chronically ill peers, 545 older adolescents ages 17-26 read a short vignette describing a brief social encounter with a hypothetical peer suffering from a medical condition, and then responded to a series of questionnaires to assess their perceptions of that peer. Nine measures intended to assess perceptions of ill peers were developed and empirically validated. Test-retest reliability and internal consistency was moderate to good for all measures. Component structure of the Peer Acceptance Questionnaire (PAQ), Peer Acceptance Questionnaire ?? 3rd Person (PAQ-F), and Perceived Similarity Questionnaire (PSQ) were also evaluated. Principal components analysis yielded a 2-factor structure of Openness and Egalitarianism for both the PAQ and PAQ-F. A 6-factor structure of (a) Familial/Spiritual, (b) General Health, (c) Social, (d) Behavioral, (e) Physical, and (f) Educational was suggested for the PSQ. Results indicated an interaction between illness type and behavior on acceptance ratings, such that behavior potentiated the effect of illness type on acceptance. In addition, vignette characters with contagious illnesses were rated less favorably than those with noncontagious illnesses, and vignette characters displaying typical behavior were rated more favorably than either withdrawn or aggressive vignette characters. Illness-specific knowledge, ratings of perceived similarity, and ratings of assigned blame predicted acceptance ratings, whereas illness-specific knowledge and acceptance ratings predicted ratings of assigned blame. Finally, significant differences were observed between first- and third-person ratings of both acceptance and assigned blame.