<p> Hypertension is a modifiable risk factor for cardiovascular disease. The current treatment options are drug therapy and lifestyle modifications. A promising lifestyle modification therapy for the management of hypertension is isometric exercise, as several studies have demonstrated that isometric handgrip (IHG) training reduces resting arterial blood pressure (ABP) (Peters et al., 2006; Taylor et al., 2003; Wiley et al., 1992). The purpose of the present investigation was two-fold: 1) to examine the effectiveness of IHG training in reducing resting ABP in newly diagnosed hypertensive patients, in comparison to matched controls receiving advice from a physician about lifestyle modifications; and 2) to examine markers of autonomic function, specifically, heart rate variability (HRV) to determine if changes in the autonomic nervous system (ANS) existed between the two groups of hypertensive adults.</p> <p> Resting blood pressure and heart rate were assessed with an automated acquisition system before, during and after the 6-week intervention period. Also, power spectral analysis of HRV was used to assess changes in modulation of the ANS. Participants in both groups (n=14) were given lifestyle modification recommendations regarding diet, exercise and stress reduction, while participants in the training group (n=8) also completed a bilateral IHG training protocol 3 times/week at 30% maximum voluntary contraction (MVC).</p> <p> Our results demonstrate that contrary to our hypothesis, isometric exercise in combination with lifestyle modification recommendations did not result in a reduction of resting ABP or change indices of HRV. Possible explanations for these results are that unlike previous IHG training, the present study was the first to use home-based training and the small sample size of this investigation would limit our ability to identify alterations in resting ABP or HRV.</p> / Thesis / Master of Science (MSc)

<p>Bakgrund: I dagens samhälle flödar information från många olika håll. Kunskap förmedlas till patienter och anhöriga av olika professioner utan samordning, vilket kan leda till missförstånd. För patienter med diabetes typ 2 är det viktigt att få information som kan förstås och som är relevant för deras sjukdom. Genom patientutbildning kan patienten sedan bedriva egenvård och ta kontroll över sjukdomen. Syfte: Syftet med studien var att se hur patienter med nydiagnostiserad typ 2 diabetes förstår egenvård efter besök hos diabetessköterskan. Metod: En empirisk, kvalitativ intervjustudie genomfördes och innehållet analyserades med kvalitativ innehållsanalys inspirerad av Graneheim och Lundman. Resultat: Det framkom under intervjuerna att ungefär hälften av deltagarna förväntade sig att drabbas av diabetes, då det fanns i släkten. Diabetes var naturligt att få vid en viss ålder, med eller utan egenvård. De flesta hade gjort förändring av kostvanor och rökning under de första månaderna efter diagnosen och fått bekräftat att egenvården gjort nytta. Många kände oro inför att inte orka fortsätta med de förändringar, men var ändå inte oroliga för framtiden. Andra hade fortsatt stor tillförsikt och visste att resultatet berodde på dem själv. Slutsats: Med eller utan tidig egenvård hade sjukdomen kommit ändå. Den första tiden efter diagnosen genomfördes förändringar och egenvården kändes viktig. När sedan känslan av att ”må bra” återkom, dalade motivationen. Med täta besök hos diabetessköterskan motiverades patienterna att fortsätta.</p> / <p>Background: In today's society, information flowing from many different directions. Knowledge communicated to patients and families of different professions, without coordination, which can lead to misunderstandings. For patients with diabetes type 2, it is important to get information that is understandable and relevant to their illness. Through patient education, the patient may then engage in self-care and take control of the disease. Aim: The purpose of this study was to see how patients with newly diagnosed type 2 diabetes understand self-care after visiting the nurse. Method: An empirical, qualitative interviews were carried out and contents were analyzed using qualitative content analysis inspired by Granheim and Lundman. Results: It emerged during the interviews that about half of the participants expected to suffer from diabetes, when there was a family history. Diabetes was natural to get at a certain age, with or without self-care. Most patients had made changes in diet and smoking during the first months after being diagnosed and confirmed that self-care was useful. Many felt concerned about not being able to continue with the changes, but was not worried about the future. Others had continued very confident and knew that the outcome depended on themselfs. Conclusion: With or without early self-care the disease would had come anyway. The first time after beeing diagnosed, change and self-care feelt important. When the sense of "feel good" reappeared, the motivation faded. With frequent visits to the nurse, the patients were motivated to continue.</p>

Bakgrund: I dagens samhälle flödar information från många olika håll. Kunskap förmedlas till patienter och anhöriga av olika professioner utan samordning, vilket kan leda till missförstånd. För patienter med diabetes typ 2 är det viktigt att få information som kan förstås och som är relevant för deras sjukdom. Genom patientutbildning kan patienten sedan bedriva egenvård och ta kontroll över sjukdomen. Syfte: Syftet med studien var att se hur patienter med nydiagnostiserad typ 2 diabetes förstår egenvård efter besök hos diabetessköterskan. Metod: En empirisk, kvalitativ intervjustudie genomfördes och innehållet analyserades med kvalitativ innehållsanalys inspirerad av Graneheim och Lundman. Resultat: Det framkom under intervjuerna att ungefär hälften av deltagarna förväntade sig att drabbas av diabetes, då det fanns i släkten. Diabetes var naturligt att få vid en viss ålder, med eller utan egenvård. De flesta hade gjort förändring av kostvanor och rökning under de första månaderna efter diagnosen och fått bekräftat att egenvården gjort nytta. Många kände oro inför att inte orka fortsätta med de förändringar, men var ändå inte oroliga för framtiden. Andra hade fortsatt stor tillförsikt och visste att resultatet berodde på dem själv. Slutsats: Med eller utan tidig egenvård hade sjukdomen kommit ändå. Den första tiden efter diagnosen genomfördes förändringar och egenvården kändes viktig. När sedan känslan av att ”må bra” återkom, dalade motivationen. Med täta besök hos diabetessköterskan motiverades patienterna att fortsätta. / Background: In today's society, information flowing from many different directions. Knowledge communicated to patients and families of different professions, without coordination, which can lead to misunderstandings. For patients with diabetes type 2, it is important to get information that is understandable and relevant to their illness. Through patient education, the patient may then engage in self-care and take control of the disease. Aim: The purpose of this study was to see how patients with newly diagnosed type 2 diabetes understand self-care after visiting the nurse. Method: An empirical, qualitative interviews were carried out and contents were analyzed using qualitative content analysis inspired by Granheim and Lundman. Results: It emerged during the interviews that about half of the participants expected to suffer from diabetes, when there was a family history. Diabetes was natural to get at a certain age, with or without self-care. Most patients had made changes in diet and smoking during the first months after being diagnosed and confirmed that self-care was useful. Many felt concerned about not being able to continue with the changes, but was not worried about the future. Others had continued very confident and knew that the outcome depended on themselfs. Conclusion: With or without early self-care the disease would had come anyway. The first time after beeing diagnosed, change and self-care feelt important. When the sense of "feel good" reappeared, the motivation faded. With frequent visits to the nurse, the patients were motivated to continue.

Bakgrund: Diabetes typ 2 utgör den vanligaste diabetesformen, och cirka 4 % av Sveriges befolkning uppskattades ha diabetes 2010, varav nästan 90 % av dessa utgjordes av diabetes typ 2. Sjuksköterskan har en viktig roll i att stödja och vägleda patienten utifrån dennes upplevelser och behov. Syfte: Att beskriva hur vuxna patienter upplever att diagnostiseras med diabetes typ 2. Metod: Denna studie är en litteraturstudie baserad på tidigare forskning kring diabetes typ 2, och kommer att fokusera på fenomen relaterat till patienters upplevelser av att få en diagnos. Författarna identifierade sex teman: Upplevelser och känslomässiga reaktioner vid diagnos, Information och kunskap, Lära sig leva med diabetes, Att förneka sin sjukdom, Eget ansvar och egenvård samt Syn på framtiden. Teoretisk referensram: Som teoretiskreferensram valdes  Afaf Meleis' Transitionsteori som bygger på tanken om att människor går igenom transitioner i livet av olika art. Resultat: Resultaten visade att deltagarna upplevde att få en diagnos som diabetes typ 2 på olika sätt beroende på hur deras liv sett ut tiden innan diagnos. Det framkom också att kunskapen kring diabetes varierade och att deltagarna hade olika behov av information och stöd vid tillfälle för diagnos. Diskussion: Att få en diagnos som diabetes typ 2 kan upplevas olika och vi har sett att det finns vissa faktorer som kan påverka upplevelsen. Faktorer som vi menar kan ha en inverkan är: den information och det stöd som ges vid diagnos, samt vilket bagage och vilken förförståelse personen i fråga har sedan tidigare. / Background: Type 2 Diabetes is the most common form of diabetes, and approximately 4 % of Sweden's population was estimated to have diabetes in 2010, and almost 90 % of these consisted of type 2 diabetes. The nurse has an important role in supporting and guiding the patient based on his experiences and needs. Aim: To describe how adult patients experience of being diagnosed with diabetes type two. Method: This study is a literature review based on previous research on type 2 diabetes, and the focus will be on the phenomenon related to patient experiences of being diagnosed with type 2 diabetes. The authors identified six themes: Experiences and emotional reactions at diagnosis, Information and knowledge, Learning to live with diabetes, To deny their illness, Personal responsibility and self-care and views of the future. Theoretical framework: The theoretical framework that was chosen for this study was Afaf Meleis' Transition Theory, which is based on the idea that people go through different transitions in life. Results: The results showed that patients experienced diagnosis of type 2 diabetes in different ways, depending on what their life looked like at the time before diagnosis. Findings also demonstrated that knowledge about diabetes varied among participants, and that they had different needs for information and support at the time of diagnosis. Discussion: To receive a diagnosis like type 2 diabetes, can be experienced in different ways, and we have seen that certain factors can have an impact on the experience. These factors that we have identified are: information and support at the time of diagnosis, and the baggage and pre-understanding the person have before diagnosis.

The purpose of this study was to explore the factors that contributed to the contraction of Tuberculosis (TB) amongst the patients who were newly diagnosed with TB at Katutura TB state hospital Windhoek, Namibia. Quantitative, descriptive research was conducted to explore the factors that contributed to contraction of TB among the newly diagnosed patients. Data was collected using questionnaires from 8th June 2016 to the 8th September 2016. The respondents were the newly diagnosed TB patients (n=40) admitted at Katutura TB state hospital. The findings revealed that there is a change in gender infection rate, men are now on the forefront, comprising 57.5% (n=23) of the sample surveyed. Furthermore, some other factors emerged on the study like TB stigma, poor nutrition, and lack of education. However, some factors are very controversial such as accommodation and sanitation as they need to be explored more to see their influence on TB infection rate / Health Studies / M.A. (Nursing Science)

<p><strong>Purpose</strong></p> <p>Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer death among Canadians. Little is known about the types of supportive care needs (SCNs) that patients with colon cancer experience during the diagnostic phase or whether these needs are met. To inform the development of population specific healthcare services, a needs assessment of patients with newly diagnosed advanced colon cancer was conducted to identify the types, prevalence, severity, and importance of unmet SCNs, as well as to identify any gaps between patient priority needs and their use of supportive care services.</p> <p><strong>Patients and Methods </strong></p> <p>A descriptive cross-sectional survey was conducted. Over one year, all newly diagnosed patients with colon cancer at the Juravinski Cancer Centre were screened for eligibility. Sixty-two of 80 eligible patients completed a self-report written questionnaire prior to starting treatment (response rate = 77.5%). The questionnaire included the Supportive Care Needs Survey-Short Form, Functional Assessment of Cancer Therapy-Colorectal and Health Service Utilization Questionnaire.</p> <p><strong>Results</strong></p> <p>‘Fears about the cancer spreading’ was the most prevalent unmet SCN (n = 52/62 or 84%). Unmet SCNs experienced by 65% or more of participants related to lack of control about treatment outcomes, the uncertain future, and concerns about family member well-being. Patients also rated these needs as being most severe.</p> <p>The two most severe CRC-specific concerns were related to ‘body appearance’ (Mean = 1.77, SD = 1.37) and ‘bowel control’ (Mean = 2.28, SD = 1.37). The most important or priority unmet needs were related to uncertainty about the future (43.5%), fatigue (24.2%), and information (22.6%). Less than 12% of participants had used existing supportive care services in the community.</p> <p><strong>Conclusion </strong></p> <p>Prevalent and priority unmet needs were related to psychosocial support and information. Recommendations for designing colon cancer-specific services are provided along with strategies to improve patient use of existing resources.</p> <p><strong> </strong></p> / Master of Science (MSc)

目的：基於初診斷乳癌患者的心理沮喪反應存在個別差異性之假設，本研究旨在探討乳癌患者的心理沮喪發展軌跡及其與資源變化、因應風格之間的關係，並採用動態性的壓力調適觀點來說明影響個體間發展差異與個人內變化之因素。三個主要的目的為（1）初診斷乳癌患者是否具有不同的心理沮喪發展軌跡？（2）隨時序變化的資源變化與因應風格可否區辨不同的軌跡組別；以及（3）不同軌跡組別的資源變化與因應風格對其心理沮喪之影響是否不同？ 方法： 本研究採用貫時性的研究設計，共收錄200名初診斷乳癌患者。患者於診斷後的手術前一天進行評估，並於術後一個月、術後四個月、術後七個月及術後一年進行後續的追蹤。每一點的心理沮喪分數採用中文的醫院版焦慮與憂鬱量表（HADS）來測量，追蹤時間點的資源變化與癌症因應風格之分數，分別是以修編的資源改變量表（資源流失與資源獲得）與台灣版癌症心理調適量表（Mini-MAC）進行評估。 結果：潛在類別成長模式的結果顯示，相較於過去的研究，心理沮喪的變化軌跡可區辨出「韌性組」、「復原組」、「晚發組」及「慢性組」。潛在成長曲線模式的分析顯示，相較於其他三組，「韌性組」的壓力因應特性為：診斷之後維持在低資源流失、較低的初始AP，以及較低的CA成長率；相較於「韌性組」，「復原組」還具有下降較慢的FS；「晚發組」與「慢性組」又比前兩組具有更高的初始HH與較高的AP成長率，而「慢性組」比起其他三組在診斷初期具有最高的資源流失、最高的HH以及最低的FS。階層線性模式的分析顯示，四組之中的資源流失與因應風格皆可預測心理沮喪，作用的差異之處主要出現在「慢性組」的資源獲得與CA具有減緩心理沮喪之效果，以及各組之內的預測因子不同。 結論：本研究支持罹癌後的壓力反應具有個別差異性，並且指出乳癌患者的心理沮喪反應具有四種不同的發展型態。本研究也強調於連續變化的向度中考量不同的心理沮喪發展軌跡及其相關的壓力調適因子亦具有時序變化之重要性。有關的理論與實務意涵將於後作進一步地討論。 / Objectives: This study assumed the psychological distress of newly-diagnosed breast cancer (BC) patients existed the entities of the individual difference, so this study examined distinct development trajectories of psychological distress amongst BC patients and their relationship with resource changes and coping styles, and adopted a dynamic stress-coping perspective to shed light on the factors that contribute to the diversity of inter-individual development and intra-individual change. The three major purposes were (1) to determine if there are distinct development trajectories of psychological distress amongst newly-diagnosis BC patients; (2) to test whether time-varying resource changes and coping styles can distinguish the trajectory groups; (3) to explore whether the effect of time-varying resource changes and coping styles on psychological distress differ within each trajectories group. Methods: A longitudinal reasarch study of 200 newly-diagnosed BC patients was recruited and participants were assessed at the day before surgery, and again at the 1-month, 4-month, 7-month and 1-year post-surgery follow-ups. Psychological distress was measured at the five time-points using the Chinese version of Hospital Anxiety and Depression Scale (HADS). Resource changes and cancer-specific coping were assessed at all follow-ups using the revised Resource Change Scale and the the Chinese version of Mini-MAC Scale, respectively. Results: Latent Class Growth Analysis (LCGA) identified four latent classes of BC patients with distinct developmental trajectories of psychological distress - resilience, recovery, late onset and chronic dysfunction. Latent Growth Curve Model (LGM) revealed that the stress-coping properties of the resilience group featured a stabilized lower level of resource loss after diagnosis, a lower level of initial AP-coping and a lower growth rate of CA-coping when compared with the others. The recovery group was more likely to have a lower decrease of FS-coping than the resilience group. Moreover, the late onset group and the chronic dysfunction group were more likely to have a higher level of initial HH-coping and a higher increase in AP-coping, and the chronic dysfunction group was characterized by the highest level of initial resource loss and HH-coping, and the lowest level of initial FS-coping compared with the other groups. The Hierarchical Linear Model (HLM) indicated that resource loss and use of coping styles could significantly predict levels of psychological distress in each trajectory group. The major differences that appeared were in the positive effect of resource gain and use of CA-coping on decreasing distress symptoms amongst people in the chronic dysfunction group, as well as in the different predictors that were found in each trajectory group. Conclusions: The present study shows that there are individual differences in cancer-specific stress responses and outlines four different developmental patterns of psychological distress amongst newly-diagnosed Taiwanese BC patients. This study also stressed the importance of considering time-serial continuity of distinct developmental trajectories with regards to psychological distress as well as the related stress-coping factors which also varies with time. Further theoretical and practical implications are discussed in depth in the content of the study.

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