Plusieurs études ont montré que la prévalence des troubles du sommeil dans la population âgée de 65 ans et plus se situait entre 25 et 50%. Les benzodiazépines sont les médicaments les plus souvent prescrits pour traiter les problèmes de sommeil. La prévalence de la consommation de benzodiazépines chez les personnes âgées se situe à près de 25%. Le Collège des Médecins du Québec préconise une utilisation de benzodiazépines pour une durée maximale de trois mois.Plusieurs études rapportent toutefois que la durée moyenne de consommation de benzodiazépines est bien supérieure à la période recommandée et on possède peu d'information sur l'efficacité populationnelle à long terme de ces médicaments pour réduire les troubles du sommeil. Le but de ce mémoire était d'étudier le lien entre la consommation de benzodiazépines et la qualité de sommeil chez les personnes âgées de plus de 65 ans vivant à domicile au Québec. Pour atteindre cet objectif, deux études ont été réalisées et les résultats sont présentés sous forme d'articles. La première étude visait à documenter le lien entre la consommation de benzodiazépines et la qualité globale du sommeil ainsi que ses différentes composantes. La deuxième avait pour but d'étudier le lien entre la consommation de benzodiazépines et l'évolution de la qualité du sommeil sur une période de 12 mois. Pour répondre à ces objectifs, les données utilisées provenaient de l'Enquête sur la Santé des Aînés (ESA). L'ESA utilise un devis longitudinal avec entrevue à deux temps de mesures à un an d'intervalle auprès de 2798 sujets. Dans le cadre de la première étude, nous avons utilisé le premier temps de mesure de l'ESA et la consommation médicamenteuse était auto-rapportée par l'ensemble des participants. Pour la deuxième étude, nous avons étudié un sous-échantillon de 892 personnes participant aux deux temps de mesure de l'ESA et pour lesquelles les données sur la délivrance de benzodiazépines étaient disponibles via le registre sur la consommation médicamenteuse de la régie de l'assurance maladie du Québec. La qualité du sommeil était auto-rapportée à l'aide du questionnaire Pittsburgh Sleep Quality Index (PSQI). Des analyses de modélisation d'équations structurales ont été effectuées à l'aide du logiciel Lisrel 8,8. Le premier article montre que les facteurs les plus fortement associés à une mauvaise qualité de sommeil chez les personnes âgées sont la consommation de benzodiazépines et le sexe féminin. D'autre part, la consommation de benzodiazépines était associée de façon similaire à chacune des six composantes de la qualité du sommeil mesurées à l'aide du PSQI exception faite de la composante liée aux dysfonctionnements diurnes. Le deuxième article montre que la fréquence de consommation de benzodiazépines durant les 12 mois suivant le temps 1 de l'enquête ESA est associée à une diminution de la qualité de sommeil chez les gens qui ne souffraient pas de troubles du sommeil initialement. Chez les personnes âgées qui souf fraient d'une mauvaise qualité de sommeil au départ, le sommeil est de meilleure qualité après un an. Cette amélioration de la qualité du sommeil est toutefois moins importante chez les consommateurs de benzodiazépines que chez les personnes âgées ne consommant pas ces médicaments. Cette étude suggère donc un effet néfast de la consommation de benzodiazépines sur la qualité de sommeil des personnes âgées. Nous proposons que d'autres études soient réalisées auprès de sujets nouvellement exposés aux benzodiazépines (cas incidents) afin de vérifier la relation délétère suggérée par nos travaux entre la consommation de benzodiazépines à long terme et la qualité de sommeil chez les personnes âgées.

John Gerstner (1914-1996) was a key figure in the renewal of Reformed evangelicalism in America in the second half of the twentieth century. Gerstner’s work as a church historian sought to shape evangelicalism, but also northern mainline Presbyterianism. In order to promote evangelical thought he wrote, taught, lectured, debated and preached widely. In order to achieve his aims he promoted the work of the great colonial theologian Jonathan Edwards. He also defended and endorsed biblical inerrancy and the Old Princeton theology. Gerstner was a critic of theological modernism and had reservations about the theology of Karl Barth—the great Swiss Reformed theologian. Part of Gerstner’s fame was his active participation in mainline Presbyterianism and in so many of the smaller Presbyterian denominations and in the wider evangelical movement. His renewal efforts within the United Presbyterian Church U.S.A. (later PCUSA) were largely a failure, but they did contribute to the surprising resurgence of Reformed evangelicalism. Evangelical marginalization in the mainline led Gerstner and other evangelicals to redirect their energy into new evangelical institutions, groups and denominations. Gerstner’s evangelical United Presbyterian Church of North America (UPCNA) background influenced the young scholar and the legacy of the UPCNA’s heritage can be detected in the popular forms of the Reformed evangelical movement that exist today. It is a central theme of this dissertation that Gerstner’s significance, at least partially, can be observed in the number of Reformed evangelical scholars and leaders who studied with him and play leading roles in the movement today.

Background: Epidemiologic evidence supports the association between shiftwork and the development of cardiovascular disease. Sleep disturbances are associated with a variety of adverse cardiometabolic outcomes and they may lie on the causal pathway between the exposure to shiftwork and cardiovascular disease. Objectives: 1) To describe sleep quality in a group of shift-working and day-working female hospital employees; 2) To determine the association between shiftwork status and sleep disturbances in this group and to determine the effect of lifetime exposure to shiftwork on current sleep disturbances; and 3) To explore whether sleep disturbances mediate the relationship between shiftwork and cardiometabolic risk. Methods: A cross-sectional study was conducted among female hospital employees: participants were 132 women working only during the day, and 98 women who worked a shift schedule of two 12-hour days, followed by two 12-hour nights and five days off. Sleep quality was assessed with the Pittsburgh Sleep Quality Index questionnaire. The primary outcome of interest was the metabolic syndrome defined in accordance with the 2009 Joint Interim Studies consensus statement. Results: Shiftwork was associated with poor sleep latency (odds ratio (OR)= 2.08 95% CI: 1.11-3.92), poor sleep efficiency (OR=2.35 95% CI: 1.21- 4.54), and poor global sleep quality (OR=1.88 95% CI: 1.02-3.49), while the impact of past shiftwork history was inconclusive. The OR for the association of shiftwork with the metabolic syndrome was 2.00 (95% CI: 0.89-4.51), and there was no evidence of mediation by sleep disturbances in the relationship of shiftwork and the metabolic syndrome. Conclusion: In this study, a rapid forward rotating 2-shift system is associated with self-reported poor sleep quality, while the long-term effects of sleep disturbances on cardiometabolic risk requires further study. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-09-24 21:16:38.768

The purpose of this secondary data analysis was to assess for the relationships among sleep disturbances, depressive symptoms, inflammatory markers, and sexual trauma in female veterans. This may contribute to an understanding of the physical and mental health effects of sexual trauma in female veterans. Correlational analyses were conducted to evaluate the strength of these relationships. A reported history of sexual trauma was significantly correlated with longer sleep latencies, poorer sleep efficiency, shorter sleep durations, more daytime dysfunction, and poorer overall sleep quality in female veterans. A reported history of sexual trauma was also significantly correlated with depressive symptoms including anhedonia and a negative affect in female veterans. No significant correlations were noted between inflammatory markers and a reported history of sexual trauma in female veterans. Female veterans with a reported history of sexual trauma had more trouble falling and staying asleep, had more trouble functioning during daytime hours, and had total poorer sleep quality. These veterans also appeared depressed and they found normally pleasurable activities unenjoyable. Disturbed sleep and depressive symptoms may be risk factors in the development of chronic health diseases. By assessing and treating the sleep disturbances and depressive symptoms experienced by sexually traumatized female veterans, nurses may help to prevent the development of costly and deadly chronic diseases

Adjustment, particularly in adulthood, is a vague concept discussed among researchers. Most often researchers only consider lack of involvement in problem behavior as criteria for positive adjustment. Furthermore, it is unclear what factors influence the likelihood of adjustment and the influence of race on these factors is unknown. The current study proposed a composite of male adult adjustment that considers what the Wellness Model terms the “wholeness” of an individual. In addition, adolescent predictors of adult adjustment and the influence of race on factors influencing adjustment were examined in a longitudinal sample of 481 males. Results revealed 4 profiles of adjustment: 1 profile that included individuals who were overall adjusted, 2 profiles that included individuals who were moderately adjusted, and 1 profile of individuals who were maladjusted. The majority of the sample was identified as adjusted in that they were financially responsible, did not have psychological problems, engaged in little to no acts of delinquency, and acknowledged at least adequate social support. Note, however, that these individuals did engage in some substance use. The smallest profile of individuals was those who were maladjusted in that they engaged in excessive delinquency, used both drugs and drank alcohol heavily, and lacked a positive support system. However these individuals were also absent of psychological problems and were financially responsible. Findings also uncovered predictors of adjustment, such that high levels of depression, physical punishment, and poor relationships with peers were associated with only moderate levels of adjustment regardless of race. Furthermore, racial differences in predictors of adjustment were found. Anxiety and parent/child communication were associated with only moderate adjustment for African American but not Caucasian males. In contrast, mother’s arrest and peer delinquency were associated with only moderate adjustment for Caucasian American but not African American males. Recommendations for prevention and intervention strategies are discussed.

PURPOSE: To compare the characteristics of cancer patients in Taiwan who use complementary and alternative medicine (CAM) to cancer patients who do not use CAM and determine the predictors of quality of life (QoL) among cancer patients who use CAM. PATIENTS AND METHODS: Face-to-face interviews were conducted with and 3 questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire, the Brief Fatigue Inventory, and the Pittsburgh Sleep Quality Index) were administered to 216 cancer patients being treated at the Nuclear Medicine Department in southern Taiwan. Chi-square testing for categorical variables and t-testing for continuous variables were conducted to determine the correlation between sociodemographic and clinical data and CAM use. Analysis of variance was performed to conduct within-group comparison of QoL scales and CAM use. Linear regression models were established to predict QoL score. RESULTS: A total of 216 cancer patients were interviewed. The prevalence of CAM use was found to be 69.4% (150 of 216 subjects). Among the CAM users, 91.6% had used traditional Chinese medicine (TCM), dietary supplementation (vitamin, herbal, mineral, glucosamine, mushroom, and/or fish oil supplementation), or detoxification therapy. A greater percentage (49.5%) of CAM users had breast cancer than any other type of cancer, and a very large percentage (74.7%) did not inform their primary caregiver of their CAM use, whereas 52.7% used CAM after initiation of diagnosis and 26.7% increased the original frequency of their CAM use during the course of their treatment. Overall QoL was not found to be significantly different between CAM users and nonusers. Predictors of poor QoL were female gender, breast or liver cancer patient, younger age, lower education, chemotherapy, increased frequency of CAM use, non-vitamin/TCM use, and having received CAM information from primary caregiver. The factors of CAM use, number of CAM modalities used, frequency of CAM use, duration of cancer diagnosis, mineral/algae supplementation, and detoxification therapy were not found to be significant in this population. CONCLUSION: Cancer patients in Taiwan have a high rate of CAM use but a low rate of disclosure of CAM use to their primary caregivers. Multiple factors appear to have a significant correlation with poor QoL. Clinical physicians should emphasize the QoL of cancer survivors, providing more accurate CAM information and endeavoring to address their unmet needs.

Thesis (D. Min.)--Ashland Theological Seminary, 2002. / Abstract. Includes bibliographical references (leaves 162-165).

Brownfield developments offer cities and developers an opportunity to engage with the public in ways unavailable to greenfield developments as brownfield redevelopments are generally found in established neighborhoods where the site’s history has been deeply intertwined with the history of the neighborhood. However, the levels of public participation vary widely from state to state, city to city, and even project to project; resulting in an array of positive and negative outcomes for all the stakeholders. It is under these varying participatory requirements and engagement strategies this research is grounded. First, the research addresses how varying levels of public participation affect stakeholders’ definitions of success or failure and how it was measured. Secondly, stakeholder’s perceptions of each other are analyzed to determine whether projects that had higher levels of participation also had higher instances of cooperation and collaboration. Thirdly, the research examines how stakeholders perceive the outputs and outcomes of a project and whether varying levels of participation affect stakeholders’ satisfaction with the project. Specific sites for this research were the Summerset at Frick Park, Pittsburgh, Pennsylvania, the Watershed at Hillsdale, Portland, Oregon, the Alta Design District, Dallas, Texas, and Montgomery Plaza, Fort Worth, Texas. / text

Thesis (Ph.D.)--University of Pittsburgh, 2000. / Includes bibliographical references (leaves 160-176).

Thesis (D. Min.)--Ashland Theological Seminary, 2002. / Abstract. This is an electronic reproduction of TREN, #028-0167. Includes bibliographical references (leaves 162-165).