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Background: Liver cirrhosis is a global health problem and a national health problem in Egypt. There is a lack of literature on Health-Related Quality of Life (HRQOL) and symptoms experience of liver disease and cirrhotic patients in Middle East, particularly in Egypt. Aims: This PhD had three major aims: First aim: To describe HRQOL of Egyptian liver cirrhotic patients and to identify and evaluate the factors associated with (HRQOL) physical and mental health domains. Second aim: To explore and describe experienced symptoms (prevalence, severity and hindrance) in Egyptian cirrhotic patients and to identify and evaluate factors associated with symptoms severity and symptoms hindrance (distress). Third aim: To explore and describe how cirrhotic patients in Egypt perceive social support from spouse, family and friends and to identify and evaluate factors associated with general perceived social support. Method: A cross-sectional study with a convenience sample of 401 patients from three hospitals in Cairo, Egypt, was conducted between June and August 2011. Patients were interviewed to complete a background data sheet, Short Form-36v2 (SF-36), the Liver Disease Symptom Index (LDSI)-2.0 and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Findings for first aim: The findings showed that all domains and component summary scores [Physical component summary score (PCS) and mental component summary score (MCS)] of the generic SF-36 were below the norm (cut-off score 50), suggesting that patients with liver cirrhosis in Egypt have poor HRQOL. About 87.2% of the patients rated their general health as poor or fair, which means the majority of these patients have low perceived general health. Many socio-demographic and medial factors were shown to be significantly associated with perceived HRQOL. Women, illiterate and unemployed people, and patients with frequent hospitalisation had poor PCS and MCS, while patients with advanced disease stage, increasing number of comorbidities and complications and those admitted to inpatients had significantly poorer PCS only. Perceived social support from a spouse had a statistically significant positive association with PCS and MCS, while perceived social support from family and friends had a statistically significant positive association with MCS only. Also, severity and hindrance of symptoms significantly correlated with PCS and MCS. Using stepwise multiple linear regression analysis, two models were developed to identify factors associated with PCS (Model 1) and MCS (Model 2) health. Model 1 could significantly explain 19% of the variation in PCS (R2 = 0.190, R2adj = 0.180, p = 0.0005), and four factors (symptoms severity, disease stage, comorbidities and employment status) were significantly (p ≤ 0.02) associated with PCS. Model 2 could significantly explain 31.7% of the variation in MCS (R2 = 0.317, R2adj = 0.308, p = 0.0005), and four factors (symptoms severity, employment status, perceived spouse support and perceived family support) were associated (p ≤ 0.04) with MCS. The key findings of this study were that severity of symptoms and social support from spouse and family were associated with HRQOL. Where patients with high symptoms severity were likely to report poor PCS and MCS; and patients with low perceived social support were likely to report poor MCS. Symptoms severity contributed significantly in explaining 28.7% of the variation in PCS and 43.6% of the variation in MCS. Findings for second aim: This study found that the majority of patients had one or more of a wide range of symptoms and social problems. Two-thirds of patients reported joint pain (78.3%), decreased appetite (75.6%) and memory problems (77.3%). Joint pain and depression were reported to have the biggest impact on daily life. Symptoms severity and distress were significantly higher among patients who were: female, illiterate, unemployed, and who had advanced cirrhosis with more complications and comorbidities (p ≤ 0.006). Symptoms severity (r=-0.206) and symptoms distress (r=-0.205) were negatively associated with perceived social support (p=0.005). Stepwise regression analysis showed that the regression model could significantly explain 19.6% of the variation in symptoms severity (R2 = 0.196, R2adj = 0.180, p = 0.0005), and 14% of the variation in hindrance of symptoms (R2 = 0.140, R2adj = 0.132, p = 0.0005). Being female, having an increasing number of liver disease complications, and having low perceived support from spouse were significantly associated with high-perceived symptoms severity and hindrance (p≤0.01). Findings for third aim: This study found that social support score was relatively high among patients with cirrhosis in Egypt (total score mean of MSPSS was 2.02± standard deviation (0.537), while perceived support from spouse was the highest source of support. 67.5% of the patients felt their spouse is around when they need him/her and 71.7% of them share their joys and sorrows with their spouse. Likewise, 64.9% of married people feel their spouse cares about their feelings. In relation to the perception of adequacy of family support, it was observed that 52.6% felt that their families do not really try to help them. At the same time, 52.1% reported that they got the emotional help and support that they needed from their families. Regarding perceived support from friends, more than half of the patients reported that their friends do not really try to help them (57.9%), they cannot count on their friends when things go wrong (65.6%) and they cannot talk about their problems with their friends (56.4%). There was a significantly positive association between the perception of social support and general health perception (GHP), suggesting that when social support decreases GHP also decreases or and vice versa (r= 0.208, p = 0.0005). Stepwise regression analysis showed that the regression model could significantly explain 10.9% of the variation in perceived social support (R2 = 0.109, R2adj = 0.100, p = 0.0005). Marital status, gender, age and employment status were significantly associated with general perceived social support (p ≤ 0.01), while unmarried, females, unemployed and elderly cirrhotic patients were vulnerable groups that were likely to perceive low social support. Overall discussion and conclusion: This is the first study to investigate HRQOL, symptoms experience and perceived social support in patients with liver cirrhosis in Egypt. All aspects of HRQOL of Egyptian cirrhotic patients were poor, and they were experiencing various symptoms that can affect their daily life. However, social support was found to be related to perceived symptoms severity and perceived poor mental health. Hence, social support may alleviate suffering for certain cirrhotic patients. Nurses have a responsibility to assess and treat symptoms that cirrhotic patients experience, particularly such treatable symptoms as depression, pain and decreased appetite. Also, nurses should involve the patient’s family in any plan of care. Future intervention studies that aim to develop programs to relieve treatable symptoms and enhance social support are also recommended.

This study explored the relationship between self-development as evidenced in the domain of narcissism and the process of vocational development as evidenced in career values, planning, and decisiveness/self-efficacy. It was suggested that this relationship would be impacted by family birth order and gender. Heinz Kohut's theory of self-psychology was utilized to understand narcissism from both an adaptive and maladaptive, developmental perspective. A review of narcissism and self-development theories was included to provide a comparative and comprehensive approach. Literature indicated that the development of narcissism was influenced by birth order and gender. Additionally, a review of the literature suggested a connection between Kohut's theory of the self and narcissism and aspects of the career development process, such as planning, decision-making, and occupational values. The sample consisted of 346 undergraduate students. Structural Equation Modeling was performed to test causal hypotheses. The major findings of the current study were that superiority (a measure of grandiosity) predicts altruistic career values and career decisiveness. Superiority is a slightly better predictor of altruistic career values than decisiveness. Additionally, goal instability (idealizing) predicts altruistic career values and career decisiveness. Goal instability had a predictive value that was nearly three times stronger for decisiveness. The results indicated that birth order and gender were not moderator variables in examining the relationship between goal instability and superiority. This study provided insight into the relationship between narcissism and the vocational/career development processes. These relationships may be important for career counselors and other related professionals. These findings may encourage counselors to assess and understand a client's narcissistic tendencies and individual representations when assisting in the career development process. A client's values regarding career options, along with his/her associated self-efficacy and ability to make important decisions, appear to be factors to consider when counseling an individual through vocational/career development. Limitations of the study were addressed and directions for further research discussed.

Background Recently, Taiwan has been faced with the migration of numbers of women from Southeast Asian (SEA) countries. It was estimated that the aggregate number of SEA wives in Taiwan was more than 131,000 in 2007 (Ministry of Foreign Affairs, 2006).These women are often colloquially called, “foreign brides” or “alien brides”; most of them are seen as commodities of the marriage trade, whose marriages are arranged by marriage brokers. Some women can be regarded as being sold for profit by their families. These young Vietnamese immigrant women come to Taiwan alone, often with a single suitcase, and are culturally and geographically distinct from Taiwanese peoples; the changes in culture, interpersonal relationships, personal roles, language, value systems and attitudes exert many negative impacts on their health, so greater levels of acculturation stress can be expected. This particular group of immigrant women are highly susceptible and vulnerable to health problems, due to language barriers, cultural conflicts, social and interpersonal isolation, and lack of support systems. The aims of this study were to examine the relationships between acculturation and immigrantspecific distress and health outcomes among Vietnamese transnational married women in Taiwan. This study focuses on Vietnamese intermarriage immigrants, the largest immigrant group in the period from1994 through to 2007. Methodology The quantitative study was divided into two phases: the first was a pilot study and the second the main study. This study was conducted in a communitybased health centre in the south of Taiwan, targeting Taiwanese households with Vietnamese wives, including the Tanam, Kaohsiung, and Pentong areas. This involved convenience sampling with participants drawn from registration records at the Public Health Centre of Kaohsiung and used the snowball technique to recruit 213 participants. The instruments included the following measures: (1) Socio-demographic information (2) Acculturation Scale (3) Acculturative Distress Scale, and (4) HRQOL. Questions related to immigrant women’s acculturation level and health status were modified. Quantitative data was coded and entered into the SPSS and SAS program for statistical analysis. The data analysis process involved descriptive, bivariate, multivariate multiple regression, and classification and regression trees (CART). Results Six hypotheses of this study were validated. Demographic data was presented and it revealed that there are statically significant differences between levels of acculturation and years of residency in Taiwan, number of children, marital status, education, religion of spouse, employment status of spouse and Chinese ethnic background by Pearson correlation and Kendall’s Tau-b or Spearman test. The correlations of daily activity, language usage, social interaction, ethnic identity, and total of acculturation score with DI tend to be negatively significant. In addition, the result of the one-way ANOVA supported the hypothesis that the different types of acculturation had a differential effect on immigrant distress. The marginalized group showed a greater immigrant distresses in comparison with the integrated group. Furthermore, the comparison t-test revealed that the Vietnamese immigrant women showed a lower score than Taiwanese women in HRQOL. The result showed higher acculturative stress associated with lower score of HRQOL on bodily pain, vitality, social functioning, mental health, and mental component summary. The CART procedure to the conclusion that the predictive variables for the physical component of the SF-36 (PCS) were: alienation, occupation, loss, language, and discrimination (predicted 28.8% of the total variance explained). The predictive variables for the mental component of the SF-36 (MCS) were: alienation, occupation, loss, language, and novelty (predicted 28.4% of the total variance explained). Conclusion As these Vietnamese immigrant women become part of Taiwanese communities and society, the need becomes apparent to understand how they acculturate to Taiwan and to the health status they acquire. The findings have implications for nursing practice, research, and will assist the Taiwanese government to formulate appropriate immigrant health policies for these SEA immigrant women. Finally, the application of this research will positively contribute to the health and well being of thousands of immigrant women and their families.

Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Candice A. Shoemaker / The objectives of this study were to determine exercise intensity of common gardening tasks in older adults and to investigate if older gardeners meet the physical activity (PA) recommendations (intensity and time) through their daily gardening. Kinds of gardening tasks, body postures, and bodily pain while gardening of older gardeners were investigated and the possibility of gardening as a predictor for a physically active lifestyle and life satisfaction in older adults was determined. Older participants were randomly recruited from the community of Manhattan, KS. To determine the exercise intensity of gardening, the heart rates of older adults were measured by radiotelemetry during gardening or garden tasks, and then oxygen uptake and energy expenditure were measured via indirect calorimetry using a submaximal graded exercise test. Overall health conditions by the Short Form 36 Health Survey (SF-36), hand functions by hydraulic hand dynamometer and pinch gauge, and bone mineral density (BMD) by dual-energy x-ray absorptiometry were measured. An observational study and weekly logs were conducted to study kinds of gardening, postures, and bodily pain of older gardeners. The Community Healthy Activities Model Program for Senior (CHAMPS) questionnaire was used to measure leisure-time PAs (frequency per week of all PAs and calories expended per week in all PAs). In conclusion, the nine gardening tasks were found to be low to moderate intensity PA in healthy older adults (1.6 ± 3.6 METs). Gardening observed was moderate intensity (3.8 ± 1.4 METs) PA in older adults and the subjects met the PA recommendation, which is at least 30 minutes of moderate intensity PA on most days of the week through their daily gardening (moderate intensity; average 33 hrs/wk in May and 15 hrs/wk in June and July). The older gardeners showed higher values for hand function and some SF-36 domains (physical function, bodily pain, and physical summary) than older non-gardeners. Gripping, stooping, lifting, stretching, walking, standing, kneeling, sitting, and squatting were observed while older adults gardened and lower back pain was the main bodily pain reported. Furthermore, gardening was found to be a predictor for leading a physically active lifestyle and high life satisfaction in older adults.

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Ε1. Ποιότητα της ζωής, άγχος και κατάθλιψη σε ασθενείς με κακώσεις νωτιαίου μυελού: Αυτή η μελέτη έχει σκοπό να αξιολογήσει την ποιότητα ζωής, το άγχος και την κατάθλιψη αλλά και τη νευρολογική θέση, σε ένα σύνολο ασθενών που ζουν με κάκωση του νωτιαίου μυελού (SCI). Μία «διατομική» μελέτη χρησιμοποιήθηκε σε 92 ανθρώπους που ζουν με κάκωση νωτιαίου μυελού SCI. Ολοκλήρωσαν το ερωτηματολόγιο της νοσοκομειακής κλίμακας άγχους και κατάθλιψης HADS (ν=42 ), την κλίμακα ποιότητας ζωής SF-36 (ν=42), καθώς επίσης τυποποιήθηκαν οι νευρολογικές (κλίμακα Frankel, Asia motor score), και οι λειτουργικές κλίμακές τους(FIM, MBI). Οι αναλύσεις μελετήθηκαν για ολόκληρο το δείγμα, κατά φύλο, κατά την κλίμακα Frankel, το Asia motor score, την FIM, και το επίπεδο νευρολογικής βλάβης. Αυτή η μελέτη παρουσιάζει τα προκαταρκτικά συμπεράσματα, τα οποία υποστηρίζουν υψηλά αποτελέσματα άγχους και κατάθλιψης (HADS) σε αυτό τον πληθυσμό των ασθενών με SCI, καθώς επίσης και πολύ χαμηλή ποιότητα ζωής. Ε 2. Σεξουαλική λειτουργία σε γυναίκες με κακώσεις νωτιαίου μυελού: Ο στόχος αυτής της μελέτης ήταν να προσδιοριστεί η σεξουαλικότητα των γυναικών με βαριές κακώσεις νωτιαίου μυελού (SCI) χρησιμοποιώντας την κλίμακα γυναικείας σεξουαλικής λειτουργίας. Το ερωτηματολόγιο με 19 ερωτήματα εκφάνσεις της σεξουαλικότητας του FSFI αφορά τη σεξουαλική λειτουργία και την ικανοποίηση στη σεξουαλική ζωή των γυναικών. Σε αυτή τη μελέτη, χρησιμοποίησαμε ένα δείγμα 39 γυναικών ασθενών με σοβαρή κάκωση νωτιαίου μυελού SCI. Συγκρίναμε δε αυτές τις ασθενείς με ένα υγιές δείγμα γυναικών αντίστοιχο σε οικονομικό –εκπαιδευτικό –επίπεδο ηλικίας - και συζυγική θέση- του γενικού πληθυσμού. Η σεξουαλική δραστηριότητα ήταν χαμηλότερη μεταξύ των γυναικών με SCI, αλλά η επιθυμία, η συναισθηματική ποιότητα της ζωής φύλων και η γενική σεξουαλική ικανοποίηση δεν διέφεραν από τις «υγιείς» γυναίκες του γενικού πληθυσμού. Αυτά τα αποτελέσματα καταδεικνύουν ότι η σεξουαλική ζωή σε γυναίκες με κάκωση νωτιαίου μυελού παραμένει σχεδόν απρόσβλητη. E3. Ίλιγγος μετά από κάκωση ΑΜΣΣ δίκην μαστιγίου. Ο ίλιγγος συνοδεύει περιστασιακά μία κάκωση τύπου «whiplash». Η πιστοποίηση του συνδρόμου είναι ιδιαίτερης αξίας, αν αναλογιστούμε τις πολλές προσφυγές στα δικαστήρια και τις υψηλές δαπάνες που προκύπτουν μετά από τέτοιου τύπου κάκωση. Δώδεκα ασθενείς, που αναφέρθηκαν στα εξωτερικά ιατρεία της κλινικής μας, εξαιτίας μακράς διαρκείας υποκειμενικών ενοχλημάτων με κύριο σύμπτωμα τον ίλιγγο μετά από τον αυχενικό τραυματισμό τύπου “whiplash”, υποβλήθηκαν σε κλινικές, εργαστηριακές και ψυχομετρικές εξετάσεις. Κανένας από τους ασθενείς δεν είχε σημαντικά νευρολογικά συμπτώματα,ούτε ιδιαίτερη επίδραση στη ποιότητα ζωής του, και κανένα σημαντικό τραύμα της αυχενικής σπονδυλικής στήλης δεν προσδιορίστηκε με MRI. Τα στοιχεία μας δείχνουν ότι ο ίλιγγος τύπου “whiplash” είναι σημαντικά δυσκολότερο να το χειριστεί και να το αντιμετωπίσει ένας ιατρός συγκριτικά με τον ιδιοπαθή ίλιγγο. Η επαλήθευση του συνδρόμου αυτού απαιτεί ίσως αντικειμενικότερα κλινικά μέσα. Αυτή η έρευνα προτείνει ότι υπάρχει μια οργανική βάση του συνδρόμου αυτού, αλλά δεν δίνει λύση στην πλήρη κατανόηση των παθοφυσιολογικών μηχανισμών που το προκαλούν, δείχνει ότι το σύνδρομο αυτό δεν έχει ιδιαίτερη βαρύτητα στον ελληνικό πληθυσμό και προτείνει αυτό το σύνδρομο να εξετάζεται ως τμήμα του χρόνιου συνδρόμου κάκωσης τύπου “whiplash”, του γενικού όρου δηλαδή στην διεθνή βιβλιογραφία : Chronic or Late Whiplash. / Ε1. Quality of life, anxiety and depression in adults with spinal cord injuries: This study aimed to evaluate Life Satisfaction, the Anxiety and Depression and neurologic status, in a community sample of adults living with a spinal cord injury (SCI). A cross-sectional design was used with 92 people living in the community with an SCI. They completed the HADS (42 pts) and SF-36 (42 pts), Life Satisfaction Questionnaire. Analyses were conducted for the whole sample, by gender, Frankel Scale, ASIA motor score, FIM, and level of injury. No correlation findings between motor neurologic scales and quality of life assessment. Additionally this study presents preliminary findings, which support the psychometric integrity of HADS and high HADS scores within an outpatient population with SCI. Items that included potential somatic components revealed a more complex factor loading profile. E2. Sexual function in females with severe spinal cord injuries: The objective of this study was to identify the sexual adjustment of females with severe cervical spinal cord injuries (SCI) using the Female Sexual Function Index (FSFI). The 19-item questionnaire of the FSFI concerns sexual function and satisfaction in sex life. This study, conducted by the Orthopaedic and Psychiatry Departments of Patras University, used a sample of a series of 39 consecutive female patients with severe traumatic SCI. We compared these female patients with an age–economic–educational level- and marital status-matched control group of the general population. Sexual activity was lower among females with SCI, but the desire, the emotional quality of sex life and overall sexual satisfaction did not differ from the controls. These results demonstrate that sexual life in females with SCI remains almost unaffected. E3. Whiplash vertigo: Vertigo or dizziness occasionally accompanies a rear –end, neck injury or is provoked by a neck posture no matter what the orientation of the head is to gravity. Whiplash vertigo is matter of considerable concern because of the high litigation related costs of whiplash injuries. When Whiplash cervical vertigo is diagnosed, the usual symptoms are vertigo, dizziness associated with neck movement. Twelve patients, which were referred to our Outpatient Clinic because of long-lasting subjective vertigo complaints after cervical whiplash spine injury, underwent clinical, laboratorial and psychometric examinations. None of the patients had typical neurological symptoms, and no important lesions of the cervical spine were identified with MRI. Our data indicate that Whiplash Vertigo significantly is more difficult to treat than idiopathic Vertigo. The verification of Whiplash Vertigo Syndrome requires more objective clinical means. This investigation proposes that an organic base of the syndrome might be considered, but does not promote the comprehension of pathophysiologic mechanisms that induces it and of course this syndrome considered as part of the general term Chronic Whiplash Syndrome.

AIMS: This study investigated the perception of generic and disease-specific Health-Related Quality of Life (HRQoL) for adults living with hearing impairment (HI) in Aotearoa/New Zealand (NZ). This study aimed to answer three questions: (1) What is the perception of HRQoL amongst adults with hearing impairment in NZ? (2) How do these perceptions compare to adults with HI living in other countries for which we have data? (3) What are the demographic and audiometric variables related to device ownership? METHOD: HRQoL, demographic, and audiometric information was collected from 126 adults in NZ. The following demographic information was collected: age, relationship length, hours worked per week, income, ancestry, sex, level of education, city size, and sexual orientation. The following audiologic information was also collected: ownership of hearing aids (HA), ownership of hearing assistance technology (HAT), better-ear pure-tone average (BEPTA), worse-ear pure-tone average (WEPTA), and signal-to-noise ratio loss (SNR loss). HRQoL information was collected using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36; Ware & Sherbourne, 1992), and the Hearing Handicap Inventory (HHI) for both elderly (HHIE) and adults (HHIA; Ventry & Weinstein, 1982; Newman, Weinstein, Jacobson, & Hug, 1991). Variables discriminating HA and HAT owners from non-owners were also analysed. RESULTS: The relationship between demographic variables and HRQoL scores revealed that only age and income were significant. Audiometric variables had significant relationships with disease-specific HRQoL scores, as well as HA and HAT ownership. Finally, disease-specific HRQoL scores and all audiometric variables differentiated HA owners from non- owners, but demographic variables did not. Generic HRQoL scores and all audiometric variables differentiated HAT owners from non-owners. CONCLUSIONS: These results suggest that the negative impacts of HI on HRQoL as reported overseas are also present in NZ, and that not only do audiometric variables including SNR loss are related to HRQoL, but HRQoL is a significant predictor for HA and HAT ownership. Further QoL research is warranted amongst the HI population in NZ to identify and understand any causal relationships present amongst these variables. Furthermore, HRQoL instruments and a test of speech understanding in noise have been shown to provide additional meaningful information, and therefore clinicians might consider including them during consultation.

The study evaluates the perceived effectiveness of the leadership styles of deans in Ethiopian governmental Technical and Vocational Education and Training (TVET) colleges. The study was contextualised within the domain of relevant leadership theory in chapter 2 (with specific emphasis on the Full Range Leadership model developed by Bass and Avolio), and within the field of Technical and Vocational Education and Training in chapter 3. A mixed method research methodology was employed in the empirical research. The quantitative part received the most emphasis, while a qualitative part was added to attempt to corroborate findings. Quantitative data were collected from teachers (219), student council members (65) and deans (10) in ten TVET colleges using the MLQ 5x short-form questionnaire, which is a standardised questionnaire of high repute. The quantitatively collected data were analysed and presented using both descriptive and inferential statistics. The qualitative part consisted of semi-structured interviews conducted with the ten deans and one TVET Bureau Head. Quantitative findings indicated that the transformational and transactional leadership styles were observed far more frequently than the laissez-faire style. Perceptions regarding the effectiveness of deans, teachers’ job satisfaction and teachers’ willingness to make an extra effort were positively and statistically significantly influenced by the presence of both the transformational and the transactional leadership styles and to a slight extent, influenced negatively by the interaction effect of the two styles. Qualitative findings mostly corroborated the quantitative findings. Recommendations emanating from the research inter alia include: Leadership training opportunities for TVET deans should be scheduled to enhance the appropriate leadership style practice of deans (especially the transformational style); resources (human, financial and materials) should be made available to TVET colleges to develop desired types of leadership in colleges; as part of the selection process when appointing new TVET deans, the leadership style/s that applicants use at that stage should be assessed; a staff-dean-team-approach will be productive if the dean practises a transformational-orientated style of leadership. / Educational Leadership and Management / D. Ed. (Educational Management)