Syfte: Syftet med studien var att kartlägga förekomst och undersöka samband mellan stress och depression hos patienter som genomgått en hjärtinfarkt. Syftet var även att undersöka eventuella skillnader mellan män och kvinnors upplevelser av stress och depression vid hjärtinfarkt. Metod: Patienter som vårdats på en hjärtavdelning för hjärtinfarkt i Mellansverige och är svensktalande inkluderades i studien. Enkäterna Vardagslivets Stress och MADRS-S användes som mätinstrument. Resultat: Antalet inkluderade deltagare i studien var 20 stycken. Förekomsten av självskattad depression uppgick till 5 % efter en hjärtinfarkt. Förekomst av självskattad stress sågs hos totalt 20 % av deltagarna, av dessa var det 5 % som hamnade i den högsta kategorin av stress. Inget samband konstaterades mellan depression och stress (r=0,15), signifikans (p=0,52). Skillnader mellan män och kvinnors upplevelser av stress och depression vid hjärtinfarkt kunde ej bestämmas i denna studie. Slutsats: Denna studie är relativt liten och omfattar endast 20 deltagare. För att kunna dra giltiga slutsatser, krävs en mer omfattande studie som inkluderar fler deltagare och har en jämnare könsfördelning. / Purpose: The purpose of this study was to evaluate the prevalence and to examine the correlation between stress and depression among patients that have had a myocardial infarction. The purpose was also to examine differences between men and women and their experiences of stress and depression due to myocardial infarction. Methods: Patients who received treatment at a cardiac department in the central parts of Sweden and spoke the Swedish language were included in the study. The questionnaires Everyday Life Stress and MADRS-S were used as measurements. Results: 20 participants were included in the study. The prevalence of self-rated depression was 5 %. Self-rated stress was found among 20 % of the participants, and of these 5 % fell into the highest category of stress. No correlation could be found between depression and stress (r=0.15), significance (p=0,52). Differences in experiences between men and women regarding stress and depression due to myocardial infaction could not be determined. Conclusion: This study is relatively small and covers only 20 participants. In order to reach valid conclusions, a more comprehensive study should be made that includes more participants and with better gender balance.

This study raises the issue of the trafficking of children in favor of voluntourism and orphanage tourism. The phenomenon of tourists who engage in volunteer work during a holiday has increased into a considerable form of tourism and turned in to a profitable business.  This thesis is questioning what factors triggers children to be trafficked and sexual exploited within the phenomenon of orphanage tourism and voluntourism. To conclusion of this thesis will question how the phenomenon affects the children.  This study is an abductive, qualitative desk-study with a thematic text analysis. The analysis is based on Braun and Clarke’s (2006) six step model where themes are constructed from the findings. The elements that the children within this phenomenon are affected by were categorized into these themes. The themes were afterwards analyzed individually in order to create a holistic picture of how they impact children.  The empirical data are all from secondary and tertiary sources out of both academia and media. The findings have been analyzed with the theoretical framework of Johan Galtung and his definition of presence of violence. Galtung’s concept of structural violence has been applied to analyze what drives children to be trafficked- and sexually exploited in connection to orphanage tourism, as well as how this effected the children.  The thesis suggests that the main factor, which fuels children to be trafficked in this context, is the demand for accessible children. Orphanage tourism has become a profitable business and a loophole for the corrupt to gain money on socially vulnerable families. This by presenting them to tourist who pay money in good faith and dedicate time from their vacation in belief that they are doing good.  The thesis addresses how structural violence is present and how it contributes to the phenomenon of orphanage tourism to keep operating by trafficking children in favor of it. It is also shown that psychological stress within various dimensions, which the children are exposed to, lower their actual realization from the potential. The exploitation they live under leaves the children in a disempowered position, without control of their social condition, which is argued to make a significant difference between their potential life expectancy and actual life expectancy.

Syfte: Syftet med studien var att undersöka hur vanligt det är med stress och depression efter genomgången hjärtinfarkt. Vidare planeras att undersöka samband mellan stress och depression samt också eventuella skillnader mellan könen för hur stress och depression upplevs efter genomgången hjärtinfarkt. Metod: Patienter som varit inlagda för hjärtinfarkt vid Akademiska sjukhuset i Uppsala inkluderas i studien. Patienterna skall ha genomgått hjärtinfarkt och/eller PCI och/eller CABG. De tre enkäterna Vardagslivets stress, Känsloläge samt MADRS användes. Frekvenser och korrelationer beräknades med IBM SPSS Statistics version 19. Tillstånd för studien söktes hos klinikchef. Resultat: Antalet patienter i studien är 18. Förekomsten av självskattad depression efter hjärtinfarkt uppmättes till 6%. Självskattad stress varierade mellan patienterna, dock skattade 33%, höga nivåer av stress. Skillnader i hur kvinnor och män upplever stress och depression efter genomgången hjärtinfarkt kunde inte bestämmas i denna studie. Ett signifikant svagt samband mellan stress och depression visades dock (r = 0,52, p= 0,029). Slutsats: Patienter med nyligen genomgången hjärtinfarkt kan uppleva depression i efterförloppet. Att behandla depressionen kan ge ökad livskvalitet. / Objective: The aim of this study was to investigate the frequency of depression and stress after a myocardial infarction. Other aims were to study the relationship between stress and depression and also differences between the sexes in their experience of stress and depression after a myocardial infarction. Method: Patients being hospitalized at Akademiska sjukhuset in Uppsala, Sweden were included in the study. Patients with a myocardial infarction and/or coronary angioplasty and/or coronary bypass surgery were included. Three questionnaires The Everyday Life Stress Scale, The Depressive Mood Scale and MADRS where used. Frequencies and correlations were calculated using IBM SPSS Statistics version 19. Permission for the study was sought from the clinic manager. Result: 18 participants were included in the study. The frequency of self estimated depression after a myocardial infarction was 6%. The frequency of self estimated stress varied throughout the population but 33% estimated their stress as high. Differences in stress and depression between women and men could not be determined in this study. A weak significant correlation between stress and depression was however shown (r = 0,52, p= 0,029). Conclusion: Patients who have gone through a myocardial infarction can experience depression afterwards. Treating depression can improve quality of life.

Few studies have compared cortisol responses to psychological and physical stress tasks with or without social evaluation. Flow-mediated dilation (FMD) with reactive hyperemia is impaired following acute stress though less is known regarding the impact of stress and cortisol on FMD with exercise induced increases in shear stress (EX-FMD). The purpose of this study was 1) to compare cortisol responses between the Trier Social Stress Test (TSST) and 5min cold pressor test with and without social evaluation (CPT, CPT+SE) and 2) to examine the impact of these stressors and cortisol elevation on EX-FMD. 59 healthy male subjects were randomly assigned to one of three conditions: TSST, CPT, or CPT+SE. Brachial artery EX-FMD was assessed before, 15 and 35min post-stress with Echo and Doppler ultrasound. Results are mean ± SD. Baseline parameters did not differ between conditions (p>.05) and stress responses were similar between the three conditions for peak cortisol: TSST 11.34±5.53nmol/L; CPT 10.08±4.48nmol/L; CPT+SE 8.51±3.60nmol/L; condition effect p=.292; cortisol responders only (increase >2nmol/L) TSST 12.48±5.24nmol/L; CPT 12.13±5.31nmol/L; CPT+SE 10.70±2.86nmol/L; condition effect p=.560; peak MAP: 131.99 ±18.56mmHg, condition effect p=.664; peak TPR: 25.84 ± 9.78mmHg/L/min, condition effect p=0.841; peak stress rating out of 10: 5.11 ± 2.12, condition effect p= 0.292; with the exception of HR (TSST: 95.06 ± 15.29bpm; CPT: 79.00 ± 11.85bpm; CPT+SE: 77.98 ± 7.66bpm; condition effect p= 0.003) and pain ratings out of 10 (TSST: 1.21 ± 1.72; CPT: 6.66 ± 1.42; CPT+SE: 6.38 ± 1.73; condition effect p<.001). Shear stress was lower in the 15min post-stress vs. pre stress and 35min post-stress trials (72.34 ± 4.46; 15min post-stress: 70.79 ± 5.39; 35min post-stress: 70.60 ± 6.10; condition effect p= 0.592; trial effect: p= 0.018). EX-FMD increased from pre- stress to 15min post-stress in all conditions (pre-stress 6.22 ± 2.75%; 15min-post stress: 7.91 ± 3.24%; 35min post-stress: 6.60 ± 2.93%; trial effect p<.001). No correlation between change in EX-FMD and change in cortisol was detected (r2= 0.0125; p=.404). In conclusion, the TSST, CPT and CPT+SE elicited similar stress responses and stress transiently enhanced EX-FMD. Cortisol responses did not explain the enhanced EX-FMD post stress. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2012-09-14 15:41:33.325

Den ökande stressen bland hälso-och sjukvårdspersonal uppmärksammas tid efter annan i olika medier. Omstruktureringar och upplevda neddragningar i vården har lett till högre arbetsbelastning, vilket i sin tur påverkat arbetsförhållandena och det psykiska välbefinnandet hos personalen i negativ riktning. Omvårdnaden skall ges i en anda av respekt och förståelse för den enskildes integritet, och den som är i störst behov av omvårdnad skall prioriteras. Syftet var att beskriva förekomstoch upplevelserav samvetsstress bland sjuksköterskor verksamma på kirurgiska vårdavdelningar på ett sjukhus i Sverige, med hjälp av instrumentet Stress of Conscience Questionnaire (SCQ). Studien,där 60 enkäter analyserades (svarsfrekvens 64,5 %),visadeatt sjuksköterskornaofta upplevdesamvetsstress i relation till sitt arbete. De hanninte ge den vård deras patienterbehövde, och de blev så trötta av sitt arbete att de inte orkademed sina närmasteså som de skulle önska. De yttre, strukturella förhållanden som sjuksköterskor har att förhålla sig till är svåra att påverka på kort sikt. SCQ kan vara ett lätthanterligt hjälpmedel för att beskriva och mäta samvetsstress hos vårdpersonal även om vissa frågor är väl allmänt hållna. Deltagarei studien rapporterade att gemensam reflektion över arbetet hjälpte dem att hantera samvetsstress i relation till arbetet. / The increased stress among health care personnel receives attention from time to time in various media. Restructuring and perceived reductions in health care have led to higher workload, which in turn affects working conditions and the mental well-being of the staff in a negative direction. Care must be given in a spirit of respect and understanding of the individual's integrity, and those most in need of care should be prioritized. The aim was to describe the prevalence and perceptions of conscience among nurses working on surgical wards in a hospital in Sweden, by using the Stress of Conscience Questionnaire (SCQ). The study, where 60 questionnaires were analyzed (response rate 64.5%), indicated that the nurses often experienced stress of conscience in relation to their work. They often lacked the time to pro-vide the care their patients needed, and they got so tired due to the demands from their work that they could not devote themselves to their family as they would like. The external structural conditions that nurses have to relate to are difficult to influence in the short term. SCQ can be a practical instrument to describe and measure stress of conscience in health care personnel, even if some items are expressed in general terms. Study participants reported that joint reflection on ethical issues at the workplace helped them cope with stress of conscience in relation to their work.

Thesis (M.S.)--University of Wisconsin-Madison, 1989. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 78-81).

Made available in DSpace on 2014-06-11T19:23:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-24Bitstream added on 2014-06-13T20:50:04Z : No. of bitstreams: 1 cantu_so_me_botfm.pdf: 2774821 bytes, checksum: a76a7589e6dc24abf0dc733fa6393398 (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / O processo de adoecer provoca uma crise vital para a pessoa. Na criança traz repercussões mais sérias, pois os conteúdos do inconsciente estão ainda pouco discriminados pelo ego e nesta situação pela percepção da possibilidade de desintegração ou morte, alguns destes conteúdos tornou-se mais intrusos e ameaçadores. Enfermidades graves durante a infância ou na adolescência tais como, as neoplasias, doenças cardíacas, insuficiência renal, diabetes, doenças com má formação genéticas, doenças hematológicas, dentre outras, conduzem o paciente e seus familiares a situações de crise, manifesta por estresse emocional e comportamental, perturbações da auto-imagem e auto-estima, comprometimento da qualidade de vida, dentre outros sintomas psicopatológicos. O objetivo deste trabalho foi o de avaliar a intervenção psicoterápica em modelo analítico em crianças e adolescentes com doenças onco-hematológicas. Foram utilizados dois instrumentos de avaliação: inventários de estresse e depressão infantil (ISI e CDI) aplicados em 4 diferentes momentos após a primeira avaliação: TO, T30, T60 , T90 e T120. Foram acompanhados 7 pacientes do ambulatório de psicologia OEI do Hemocentro de Marília. Trata-se de um ensaio clínico não-randomizado intra-grupos de séries temporais, no qual a intervenção foi realizada com um único grupo e os desfechos foram comparados em cada participante durante diferentes períodos desta intervenção. A análise dos escores CDI ao final do período das intervenções observou-se uma melhora no estado geral dos sintomas de depressão dos participantes (escores finais aos 120 dias inferiores a 17) comprovando a eficácia da intervenção psicoterápica de base analítica na melhora dos sintomas em crianças e adolescentes portadores de neoplasias onco-hematológicos. Os dados... / The process of getting sick causes a vital crisis to the person. It brings more severe repercussions to the children since the unconscious contents are hardly discriminates by the ego and, in this special situation, by the perception of the possibility of disintegration or even death. So some of these contents become more threatening. Serious diseases during childhood or adolescence such as neoplasi, cardio illness, kidney insufficiency, diabetes, genetics and blood problems, among others, lead the patient and his family members to crises with emotional and behavior stress, self-esteem disturbance, even involving the daily life and other psychopathic symptoms. The objective on this paper was to evaluate a psychotherapeutic intervention in an analytical pattern for children and teenagers with onco-hemathology diseases. Two models for evaluation were used: Stress inventory and depression on in children (ISI and CDI) applied in four different times after the first evaluation: TO, T30, T60, T90 and T12. Seven patients of the psychology ambulatory OEI in the Hemocentro in Marilia were watched. It is a clinic essay not at random among groups on specific times in which the intervention was accomplished with a unique group and the results were compared on each participant in different times. In the analyses of the scores CDI in the end of interventions, some improvements in the overall depression symptoms were clearly noticed (final scores in 120 days bellow 17) proving the effectiveness of the psychotherapeutic intervention based on the analysis of the symptoms in kids and teen suffering from neoplasi and oncohematology diseases. The inventory data inn children stress are similar to the depression pointing to the effectives of the psychotherapeutic approach. The variations of the physical reactions (ESI) are related to the... (Complete abstract click electronic access below)

This qualitative descriptive research study was undertaken to describe the experiences of emergency nurses with critical incidents and identify strategies used to manage these situations in the emergency department setting. Critical incidents are events, such as death or serious injury, that cause a strong emotional reaction and may overwhelm a nurse‘s usual coping skills. Nineteen nurses who worked in one of two community-based emergency departments in Central Massachusetts were interviewed and asked to describe a critical incident they had experienced in their nursing career. Qualitative content analysis revealed two major themes: (1) critical incident experiences; and (2) aftermath; and five subthemes: (a) connections; (b) workplace culture; (c) responses; (d) lasting effects; and (e) strategies. Critical incidents were limited to events with children, patient deaths, and interactions with family; this differed from prior research in that no incidents were identified involving multiple casualties, violence, or mutilating injuries. Connections occurred when the patient was known to the nurse or reminded the nurse of self or family. Responses were the reactions of the participants to the critical incident and were physical, psychological, and spiritual in nature. The majority of study participants cried in response to a critical incident. Workplace culture, a subtheme not found in other studies, involved their perceptions of expected behavior in the emergency department and emphasized the influence of workplace culture on newer or inexperienced nurses. The theme of aftermath described the time period following critical incident. Lasting effects occurred in the form of vivid memories that were triggered by different stimuli. The subtheme, strategies, revealed that nurses desired, but lacked formal strategies to manage their reactions following a critical incident. Thus, they described the use of informal strategies such as talking to co-workers and family members. Implications of this study support the need for educational preparation and support of emergency nurses who deal with critical incidents in the workplace. Intervening during the critical incident experience and having follow-up strategies in place to prevent distress and enhance coping in the aftermath are important for well-being, practice, and patient care in the emergency setting.

Crohn’s disease (CD) is an inflammatory disease of the gastrointestinal tract attributed to an aberrant immune response to environmental and microbial triggers. Individuals with CD exhibit an enrichment of pro-inflammatory strains of Adherent-Invasive E. coli (AIEC) and often report a relapse of symptoms following a period of acute psychological stress. Despite a known immunosuppressive role, the mechanism by which stress contributes toward the development and progression of intestinal inflammation remains unknown. Here, we use a well characterized model of restraint stress to investigate the influence of psychological stress on host protection against a CD-associated strain of AIEC. We found that stress results in profound intestinal dysbiosis, allowing for a complete dominance of Enterobacteriaceae. Interestingly, while stress alone drives a state of low-grade inflammation and loss of barrier integrity in the gut, in the presence of a pathobiont strain of AIEC, stress drives a substantially heightened inflammatory response which exacerbated the resultant loss of barrier integrity. Moreover, we have found stress induces an augmented nutritional immune response, providing AIEC a competitive niche against commensal bacteria lacking alternative methods of iron uptake. Further, we see that stress-induced glucocorticoids mediate broad apoptosis of the CD45+CD90+ lymphocytic population in the gut. The loss of this population prevents an appropriate IL-22 mediated response to dysbiosis. Accordingly, blocking glucocorticoid signalling or exogenous administration of IL-22 prevents the stress-induced expansion of AIEC. This work underscores the complex nature of psychological stress such that the combination of iron limitation and glucocorticoid mediated immune attrition are simultaneously required for the stress-induced expansion of AIEC. These findings present novel insight into the mechanistic consequences of glucocorticoid signalling on impaired immune function and the provision of an inflammatory environment, resulting in a distinct impact on CD susceptibility. As such, deeper insight regarding the complex underpinnings of CD will assist in efforts to design representative models and will strengthen the discovery of targeted therapeutics. / Thesis / Master of Science (MSc) / Crohn’s disease (CD) is an inflammatory disease of the gastrointestinal tract resulting from an exaggerated immune response. CD patients often report a relapse of symptoms following a period of psychological stress and are at an increased likelihood of having pro-inflammatory strains of E. coli within their gut. Here, we use a model of restraint stress to investigate how psychological stress modulates the abundance of bacterial species associated with CD. We found stress results in the limitation of essential nutrients, allowing for an outgrowth of E. coli. Further, stress hormones lead to the loss of a protective immune response in which E. coli expansion can be prevented by blocking these hormones or restoring immune signalling. Together, we conclude that stress leads to immune cell death and creates an iron limited environment that favours E. coli expansion. Such work begins to uncover the functional consequence of stress and its’ role in disease progression.

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