Doctor of philosophy (PhD) / Abstract As one of the most culturally diverse countries in the world, Australia has a high proportion of minority communities. However, its ageing population, particularly within these ethnic minorities, faces a range of barriers or difficulties in gaining access to and using health and aged care services. This study aims to identify the acculturation factors that affect the health status of Iranian-born elderly immigrants to Australia and their utilisation of health and community aged care services. The results of this study will be of value to Iranian elders, their families, and Australian aged health care service providers. The findings could also contribute towards enriched multicultural policy and improved social fairness, access to services, and equity for the aged from different ethnic backgrounds. 302 Iranian migrants aged 65 years who had lived in the Sydney Metropolitan area for at least six months were surveyed via a written questionnaire, face-to-face interviews, and telephone interviews. The results were analysed using SPSS and then compared to the findings from a 1999 survey of NSW elderly. The results indicate that Iranian migrants suffer higher levels of psychological distress and are more limited in their physical functioning than the general population of older Australians. They are in greater need of assistance with activities of daily living, have a lower sense of wellbeing, and are far less likely to utilise aged care services. Iranian migrant who do not speak English at home experience these disadvantages to an even greater extent English language proficiency was the only acculturation factor found to affect whether Iranian elderly utilised health and community aged care services, while ability to engage in activities of daily living (ADL) was the only health variable associated with their utilisation of community supportive aged care services. This variable did not predict the use of community aged care services in the broader sample of NSW respondents. Since limited proficiency in English placed elderly Iranian migrants at greater health risk and impeded their access to necessary assistance, the findings suggest that they would clearly benefit from English classes and from access to health and community care services and information regarding these services in the Farsi language.

Ensamstående mammor upplever en högre grad av psykisk ohälsa i jämförelse medsammanboende mammor. Att vara en ensamstående mamma kan på många sätt varautmanande, därför kan socialt stöd från omgivningen vara extra viktigt för just dem. Syftetmed föreliggande studie var att undersöka upplevt socialt stöd och dess samband med psykiskohälsa bland ensamstående mammor. För att samla in data genomfördes enenkätundersökning med totalt 140 deltagare, vilka delades upp i grupperna: ensamståendemammor (n = 78) och sammanboende mammor (n = 62). För att undersöka studiensvariabler, psykisk ohälsa och upplevt socialt stöd, användes skalorna Kessler PsychologicalDistress Scale och The Multidimensional Scale of Perceived Social Support. Resultatetvisade att det fanns en signifikant skillnad mellan grupperna ensamstående mammor ochsammanboende mammor vad gällde både psykisk ohälsa och upplevt socialt stöd. Gruppenensamstående mammor rapporterade en högre grad av psykisk ohälsa och en lägre grad avupplevt socialt stöd till skillnad från sammanboende mammor. Resultatet visade även att detfanns ett signifikant negativt samband in mellan psykisk ohälsa och upplevt socialt stöd, dettasamband var dock svagare bland ensamstående mammor. Därför är studiens viktigasteslutsats att det kan finnas andra faktorer än socialt stöd som är viktigare och därmed har ettstarkare samband med psykisk ohälsa bland ensamstående mammor.

Introduction : la période de l’adolescence constitue la tranche d’âge pour laquelle les consommations de cannabis sont les plus élevées en France. L’usage problématique de cannabis à l’adolescence représente un facteur de stress important pour les parents. Cette recherche a pour premier objectif d’identifier une dynamique familiale spécifique ainsi que les stratégies de coping (individuelles et dyadiques) mobilisées par les parents dont l’adolescent est consommateur de cannabis. Le second objectif vise à investiguer les facteurs associés à la détresse psychologique en termes de dynamique familiale et de stratégies de coping (individuelles et dyadiques). Méthode : au cours de cette étude quantitative et qualitative, 50 parents consultant pour l’usage problématique de leur adolescent et 67 parents témoins ont répondu à un questionnaire sociodémographique, au Family Adaptability and Cohesion Scale (FACES IV) et au Family Relationship Index (FRI) pour évaluer la dynamique familiale, à la Brief Cope pour estimer les stratégies de coping situationnelles et au Dyadic Coping Inventory (DCI) pour relever les stratégies de coping dyadique mobilisées par les parents de l’échantillon en couple. Résultats : les parents d’adolescents consommateurs de cannabis présentaient une détresse psychologique élevée et ont obtenu des scores significativement différents aux dimensions de la dynamique familiale en comparaison des parents du groupe contrôle. Ainsi, le fonctionnement familial des parents d’adolescents consommateurs de cannabis était défini par une cohésion et des capacités de communication plus basses mais aussi une intensité de conflit élevée par rapport aux parents du groupe contrôle. Une dimension de la dynamique familiale (conflits) et quatre stratégies de coping situationnelles (expression des sentiments, blâme, utilisation de substances, désengagement comportemental) étaient positivement liées à la détresse psychologique. Les stratégies de coping dyadique (communication autour du stress, stratégies négatives, ect) étaient positivement liées à la détresse psychologique ressentie par les parents en couple. Conclusion : ces résultats montrent l’intérêt de mieux comprendre le vécu des parents confrontés à l’usage problématique de cannabis de l’adolescent et suggèrent des pistes de futures prises en charge. / Introduction: the period of adolescence is the age group for which cannabis use is highest in France. Cannabis use in adolescence is an important stressor for parents. The first aim of the present study was to better identify specific family dynamics and coping strategies (individual and dyadic) mobilized by parents of adolescent cannabis users. Second, was to investigate the factors associated with psychological distress (family dynamics, coping strategies). Method: during this quantitative and qualitative study, 50 parents consult for a problematic adolescent cannabis use and 67 control parents answered at a sociodemographic questionnaire, the Family Adaptability and Cohesion Scale (FACES IV) and the Family Relationship Index (FRI) to assess family dynamics, the Brief Cope to estimate situational coping strategies and dyadic coping Inventory (DCI) to address the dyadic coping strategies mobilized by the sample's parents couple. Results: parents of adolescent cannabis users had a high psychological distress and have obtained significantly different scores on the dimensions of family dynamics, compare at parental control group. Thus, family functioning of parents of adolescent cannabis users was defined as cohesion and lower communication capabilities but also high intensity conflict from parents in the control group. A dimension of family dynamics (conflicts) and four situational coping strategies (expressing feelings, blame, substance use, behavioral disengagement) were positively related to psychological distress. Dyadic coping strategies (communication about the stress, negative strategies, ect) were positively related to psychological distress experienced by parents couple. Conclusion: these results show the interest of better understanding the experiences of parents facing the adolescent problem cannabis use and suggest directions for future supported.

Sixty percent of youth indicate exposure to violence. Such exposure is a noted risk factor for youths' well-being, including cognitive, emotional, and behavioral development. However, there is a gap in the literature regarding whether exposure to violence predicts impaired academic performance. The purpose of this quantitative study was to test a model with cognitive, behavioral, and emotional sequelae of exposure as mediators of the relationship between exposure to violence and academic performance among adolescents who are at risk for exposure and attend inner-city high schools. Ninety-nine students, primarily female and African-American, in Grades 10 to 12 at two public schools in a major mid-Atlantic metropolitan district completed self-report measures for exposure to violence, aggressive behavior, aggressive cognitions, psychoemotional distress, and academic performance. A series of linear regressions was used for mediational analysis. Path coefficients were interpreted to test the proposed causal model. Consistent with previous research, a weak, but statistically significant bivariate relationship was found between exposure and grade point average (GPA). However, the relationship was indirect, mediated by students' aggressive cognitions: Higher levels of aggressive cognitions provided the best predictors of negative relationships exposure to violence with GPA. These findings have important social change implications. In particular, findings suggest that educators, parents, and mental health professionals can strengthen academic performance among adolescents with higher academic potential who are exposed to violence by offering support for positive coping styles and alternatives to attitudes that normalize aggression.

SAMMANFATTNING  Bakgrund  Kateterisering av urinblåsan är en vanligt förekommande behandlingsåtgärd inom hälso- och sjukvården som kan vara indicerad vid exempelvis urinretention och residualurin efter miktion. Kateterisering kan orsaka komplikationer, såsom urinvägsinfektioner och urinläckage, vilket kan medföra lidande. Sjuksköterskan har som uppgift att lindra lidande genom bland annat personcentrerad och säker vård. Att förstå hur kateterisering kan påverka den individ som är i behov av den är därför viktigt för sjuksköterskans yrkesutövande.  Syfte  Syftet var att beskriva patienters upplevelser relaterade till kateterisering och att leva med urinkateter.  Metod  En icke systematisk litteraturöversikt genomfördes och baserades på 16 vetenskapliga artiklar av kvalitativ och kvantitativ design. Inkluderade artiklar söktes fram i databaserna PubMed och CINAHL med hjälp av lämpliga sökord. Med Sophiahemmet högskolas bedömningsunderlag kvalitetsgranskades inkluderade artiklar och sedan analyserades innehållet för att sammanställas i tre övergripande kategorier; ‘En vardag med urinkateter’, ‘livskvalitet’ och ‘patientens relation till hälso- och sjukvården’.  Resultat  De övergripande kategorierna är indelade i sju underkategorier där patienters upplevelser relaterat till kateterisering av urinvägarna beskrivs. Komplikationer som urinvägsinfektion, urinläckage och trycksår; bristande bemötande och förhållningssätt hos sjuksköterskan; svårigheter i vardagen; informationsbrist samt påverkan på sexuell aktivitet är aspekter som kan påverka upplevelsen enligt patienter.  Slutsats  Föreliggande litteraturöversikt beskriver hur olika faktorer påverkar upplevelsen av kateterisering och att leva med urinkateter samt vad de olika metoderna för kateterisering har för betydelse i upplevelsen. Faktorer såsom komplikationer med smärta, urinläckage och urinvägsinfektioner; förändrad självbild och påverkad sexuell aktivitet; bristande information och bemötande från vårdgivare samt skattad livskvalitet hade betydelse för patientens upplevelse och eventuella lidande. Utifrån dessa upplevelser kan hälso- och sjukvård identifiera bristfälligt handhavande med personer och medicintekniska vårdmoment samt initiera förbättringsarbete i syfte att stärka patienters upplevda livskvalitet relaterat till urinkateterisering. / ABSTRACT  Background  Urinary catheterization is a common treatment in health care and there are several reasons why catheter is indicated. It is often due to urinary retention and residual urine volume after urination. Urinary catheterization can cause complications, such as urinary tract infections and leakage, which can cause suffering. The nurse's task is to relieve suffering through, among other things, person-centered and safe care. Understanding how catheterization can affect the individuals who are in need of it, and it is therefore important for the nurses’ professional practice.  Aim  The aim of this study was to describe patients experiences related to urinary catheterization and living with urinary catheter.  Method  A non-systematic literature review was conducted and based on 16 scientific articles, with both qualitative and quantitative design. Included articles were searched in the databases PubMed and CINAHL using appropriate keywords. With the Sophiahemmet university's quality framework the articles were quality examined and then the content was analyzed to be grouped into three general categories; 'A daily life with a urinary catheter', 'quality of life' and 'the patient's relationship to health care'.  Results  The general categories are divided into seven subcategories where patients' experiences related to catheterization of the urinary tract are described. Complications such as urinary tract infection, urinary leakage and pressure ulcers; the deficient conduct and approach of nurses; difficulties in everyday life; Lack of information and influence on sexual activity are aspects that can affect the experience according to patients.  Conclusions  This literature review describes how various factors affect the experience of catheterization and living with urinary catheters, and what the different methods of catheterization have for the impact on the experience. Factors such as complications with pain, urinary leakage and urinary tract infections; altered self-image and affected sexual activity; lack of information and response from caregivers as well as estimated quality of life had significance for the patient’s experience and possible suffering. With these experiences, health care can identify inadequate handling with persons and medical devices, and initiate improvement work with the aim of strengthening the patients’ perceived quality of life related to urinary catheterization.

Bakgrund: Ungdomar och unga vuxna i åldrarna 15 till 39 år är en särskilt sårbar ålder där flertalet stora förändringar sker i livet. Att samtidigt genomgå en cancerbehandling innebär en stor påfrestning som kan ge stora följder för både den fysiska och psykiska hälsan. Ungdomar och unga vuxna som insjuknar i cancer är en växande population och som efter avslutad behandling har livet framför sig där både den fysiska och psykiska hälsan kan påverkas. Syfte: Syftet var att beskriva ungdomar och unga vuxnas psykiska hälsa efter avslutad cancerbehandling.  Metod: Metoden som valdes för denna studie var en litteraturöversikt. Totalt analyserades och sammanställdes 15 vetenskapliga artiklar. Databaserna som användes för sökningarna av vetenskapliga artiklar var Public Medline [PubMed] och Cumulate Index to Nursing and Allied Health Literature [CINAHL]. Data analyserades med hjälp av integrerad analys. Resultat: Resultatet visade att ungdomar och unga vuxna upplevde olika grader av psykisk hälsa efter avslutad cancerbehandling och att den psykiska hälsan påverkades av olika faktorer. Personlig utveckling och nya värderingar av livet var de vanligaste beskrivningarna av psykisk hälsa medan depression, ångest, posttraumatiskt stressyndrom, rädsla för återfall och komplikationer samt osäkerhet inför framtiden var vanliga tillstånd av nedsatt psykisk hälsa. Otillräcklig uppföljning, information och rehabilitering innebar en risk för nedsatt psykisk hälsa hos ungdomar och unga vuxna efter avslutad cancerbehandling.  Slutsats: Ungdomar och unga vuxna som avslutat sin cancerbehandling visade sig ha hög risk för nedsatt psykisk hälsa. Främst var det rädslan för återfall och framtida hälsoproblem som bidrog till depression och nedsatt psykisk hälsa. Ytterligare forskning krävs för att utforma rehabilitering och uppföljning som tillgodoser ungdomar och unga vuxnas specifika behov efter avslutad cancerbehandling. / Background: Adolescents and young adults, ages 15 to 39 years, is a particularly vulnerable age where multiple big changes in life happens. To undergo a cancer treatment at the same time indicates a big challenge for their health and can have big consequences on both their physical and mental health. Adolescent and young adults with a cancer diagnosis are a growing population with their life ahead of them after completion of cancer treatment but may still experience varied outcomes in physical and mental health. Aim: The aim was to describe adolescents’ and young adults’ mental health after completion of cancer treatment. Method: The design chosen for this study was a literature review. A total of 15 scientific articles were analysed and compiled. The databases used for the searches of scientific articles were Public Medline [PubMed] and Cumulate Index to Nursing and Allied Health Literature [CINAHL]. The data was analysed using an integrated analysis. Results: The result showed that adolescents and young adults experienced mental health to varying degrees and that the mental health was affected by different factors. Personal development and new values of lives was the most common descriptions of mental health while depression, anxiety, posttraumatic stress syndrome, fear of cancer recurrence and complications and uncertainty about the future was common conditions of impaired mental health. Insufficient follow-up care, information and rehabilitation implicated a risk for impaired mental health amongst adolescents and young adults after completion of cancer treatment. Conclusions: Adolescents and young adults that have completed their cancer treatment showed high risk for impaired mental health. Especially the fear of cancer recurrence and future health problems contributed to depression and psychological distress. Further research is required to design a program for aftercare and follow-up care to meet the specific needs of adolescents and young adults after completion of cancer treatment.

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder and the leading female infertility. PCOS is characterized as a clustering of clinical concerns, which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. These characteristics were examined with regard to their impact on women's psychosocial concerns and health related quality of life. Design: Cross-sectional, correlational Setting: Private endocrinology practice in the rural Southeastern U.S. Participants: The study sample consisted of 126 women with PCOS. Methods: Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to conceive had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life.

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder and the leading female infertility. PCOS is characterized as a clustering of clinical concerns, which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. These characteristics were examined with regard to their impact on women's psychosocial concerns and health related quality of life. Design: Cross-sectional, correlational Setting: Private endocrinology practice in the rural Southeastern U.S. Participants: The study sample consisted of 126 women with PCOS. Methods: Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to conceive had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life.

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder characterized by at least two of the following three features: hyperandrogenism, ovulatory dysfunction and/or polycystic ovaries. Prevalence is estimated at 5-10 % of women of reproductive age worldwide and may impact between five and ten million women in the U.S. alone. Rather than a distinct disease entity, PCOS is characterized as a clustering of clinical concerns which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. Our intent was to examine how these three PCOS characteristics impact psychological symptoms (e.g., depression, anxiety, interpersonal sensitivity) and PCOS health related quality of life concerns (weight, hair, infertility, menstrual, emotions). Design: Cross-sectional, correlational Setting: Women were recruited from private endocrinology practices in the rural Southeastern U.S. Patients/Participants: The study sample consisted of 126 women with PCOS. Half of these women were currently attempting to conceive in addition to being treated for their PCOS. The average woman in the study was 30 years of age (M=30.3, range=18-48), White (98 %) and married (79%). On average, participants weighed over 200 pounds (M=213.6 lbs, 116-361 lbs). Methods: During the seven-month enrollment period, women diagnosed with PCOS were invited to participate. Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Insulin level predicted increased levels of symptoms related to somatization, psychoticism, and a global symptom severity index. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to have a baby had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life. Future attention might focus on screening and possible referring to mental health services for women not trying or no longer trying to conceive.

Background: About 3% of new cancer cases affect young adults aged between 15 and 39 years. The young age, the increasing incidence and the relatively good prognosis of this population lead to the growing importance to investigate the psychosocial long-term and late effects. The aims of the AYA-LE long-term effects study are: first, to assess the temporal course and related factors of life satisfaction and psychological distress of adolescent and young adult (AYA) cancer survivors; and second, to examine a specific topic in each of the yearly surveys in a more differentiated way. Methods: This study represents a continuation of the longitudinal AYA-LE study. The existing sample of AYA cancer patients (t1: N = 577; t2: N = 514; aged between 18 and 39 years at diagnosis; all major tumor entities) was extended by four further survey points (t3: 2018, t4: 2019, t5: 2020, t6: 2021). In addition, a comparison sample of young adults without cancer was collected. We measured longitudinal data for outcomes such as quality of life, psychological distress, and fatigue with standardized questionnaires. Furthermore, each survey point included a different cross-sectional topic (e.g., health behavior, occupational situation, and compliance). Discussion: The AYA-LE long-termeffects study will show the long-termconsequences of cancer in young adulthood. We expect at least complete data of 320 participants to be available after the sixth survey, which will be completed in 2021. This will provide a comprehensive and differentiated understanding of the life situation of young adults with cancer in Germany. The findings of our study enable a continuous improvement of the psychosocial care and specific survivorship programs for young cancer patients.