An estimated 14 million people in the United States currently have chronic obstructive pulmonary disease (COPD). This nonreversible illness causes progressively decreasing airflow and is manifested by frequent episodes of acute and chronic dyspnea. The purposes of this study were: 1) to examine the relationships between mastery (MS), negative affectivity trait (NA), perceptions of patient dyspnea severity (DSI), and perceptions of which dyspnea interventions are effective (DE) among family caregiver-COPD patient dyads and 2) to examine the degree of agreement between the dyad members regarding dyspnea assessment and management. The study subjects were elderly (patients = 71.6 years, caregivers = 63.4 years), mostly women (patients = 60%, caregivers = 63.3%), Caucasian (96.7%), and patients had severe/very severe COPD (80%). No significant differences were found between family caregivers' and patients' ratings of MS, NA, DSI, or DE. The most effective dyspnea management strategies identified by both dyad members included changing activity, relaxation, inhaled medication use, and altering breathing pattern. The study conceptual model was tested to identify the interrelationships between the study variables. Significant effects in the patient model were between DSI and NA (p = 0.04), DE and gender (p = 0.04), DE and education (p = 0.015), and between DE and disease severity (p = -0.026). The caregiver model demonstrated no significant effects between the study variables. Significant effects in the dyad model were between DSI and the length of time caregiving had been provided (LOT, mean = 25.2 years) (p = 0.013), DE and DSI (p = 0.004), and between DE and LOT (p = 0.03). Gender, education, disease severity, LOT, and DSI influenced DE. Negative affectivity and LOT (mean = 25.2 years) influenced DSI. The findings of this study indicate that when the family caregiver of a patient with COPD is present, he or she is able to provide valid and reliable assessments of the patient's dyspnea severity. During acute exacerbations of dyspnea, persons with COPD are often unable to speak for themselves and these experienced family caregivers may be valuable partners with nurses and other healthcare providers to represent the patient's responses and needs.

The hospice care population with cancer are often older adults who report many cancer-related symptoms experienced often in clusters. Most prevalent of these symptoms is fatigue and often it co-occurs with depressive symptoms and poor physical functioning. This dissertation examined fatigue, symptom clusters, depression, physical activity, and functional status in older adults with cancer. The aims of the literature review were to understand the relationship among physical functioning, cancer fatigue, fatigue-related symptom clusters, and their relationship with functional status In older adults. The literature related to these associations is insufficient and inconclusive. The methods section aimed to investigate the reliability and validity of the Center for Epidemiology Studies-Depression scale, Boston Short Form (CESD-10). Using Structural Equation Modeling (SEM) for confirmatory factor analysis, the factor structure of responses in a cross-sectional sample (N = 200) of adults with different types and stages of cancer was examined. Internal consistency reliability estimate Cronbach’s alpha =0.737. The CESD-10 four-factor model (positive affect, depressive affect, somatic complaints, and interpersonal challenges) fits the data well. The CESD-10 was a valid and reliable measure for assessing depressive symptoms in this study. The final section examined fatigue related symptom clusters and their relationships with functional status in older adult hospice patients with cancer (N=519). The fatigue-related symptom cluster (lack of energy, feeling drowsy and lack of appetite), significantly predicted poor functional status. Experiencing physical and psychological symptoms has a significant impact on functional dependence. Hospice healthcare professionals should be alert to older adults’ symptom cluster experience during assessment and management.

[pt] Esta dissertação investiga o alcance da abordagem psicanalítica aos novos sintomas, que não obedecem à lógica do recalque, mas são marcados por manifestações de impulsividade entre as quais se destacam as passagens ao ato. Nossa investigação parte da construção freudiana que resultou na noção de Agieren, em inglês acting out. Utilizamos também as contribuições teóricas de Lacan, que perfilhou na psicanálise o termo passagem ao ato que é originário da psiquiatria, para demarcar uma nuance no campo do acting out, e assim redefinir ambos os conceitos. Pretendemos situar o diferencial que o saber psicanalítico traz para compreensão da passagem ao ato, situada como uma característica do novo mal estar na cultura. / [en] This dissertation investigates the scope of the psychoanalytic approach to the new symptoms which does not obey the logic of repression, but are marked by manifestations of impulsivity among which stand out the passages to the act. Our investigation started from the Freudian s construction that resulted in the notion of Agieren in English acting out. We also used the theoretical contributions of Lacan, who affiliated in psychoanalysis the term passage to the act that originated in psychiatry, to demarcate a nuance in the field of acting out, and so, to reset the two concepts. We intend to place the differential that brings the psychoanalytic knowledge to understand the passage to the act, situated as a feature of the new discontent in culture.

<p>Syftet med detta arbete var att studera vad som utmärker de så kallade bokstavsbarnen och vad som tros vara orsaken till deras problem. Genom arbetet ville jag få en bild av hur handikappet upplevs av föräldrar och barn och jag ville få en uppfattning om hur man som lärare klarar av barnen i klassrummet. </p><p>I flera år har det pågått en debatt i samhället om diagnoserna är till godo eller till ondo för barnen som har drabbats. Efter att ha läst både sidornas argument har jag kommit till den slutsatsen att utredning och diagnos är nödvändigt för att Damp- och Adhdbarnen ska få den hjälp de behöver för att klara skolan. </p><p>Metoderna som används i arbetet är litteraturstudier och fem intervjuer av föräldrar till Damp- diagnostiserade barn.</p>

<p>Mitt syfte med detta arbete är att reda ut begreppen ordblindhet, dyslexi och läs- och skrivsvårigheter. Jag har sedan valt att använda definition läs- och skrivsvårigheter. I arbetet har jag undersökt hur pass väl teori stämmer överens med praktik, med tyngdpunkt på dessa orsaker, symptom, diagnos och åtgärder. Det är idag ganska oklart om vilka faktorer som är bidragande orsaker till läs- och skrivsvårigheter. Forskarna är osäkra på om läs- och skrivsvårigheter kan vara ärftligt betingat. Dock vet man säkert att miljön är en starkt påverkande faktor. Mina studier, såväl i teorin som i praktiken visar däremot på att symptomen för läs- och skrivsvårigheter är tydliga. Dessutom är åtgärder i form av hjälp från speciallärare en viktig del för att individen med läs- och skrivsvårigheter skall få det stöd som han/hon behöver för att lyckas i sitt fortsatta skolarbete.</p>

<p><b>Objectives</b>. To study medication utilization and adherence to prescribed therapy in a female population in central Sweden. To study usage of hormone replacement therapy (HRT) in this population and to assess how HRT users compare to non-users regarding symptom reporting, general health and other variables. To evaluate symptom prevalence adjusted for potential symptom affecting variables. </p><p><b>Material and methods</b>. A cross-sectional postal questionnaire study was performed in 1995 in seven counties in central Sweden. A questionnaire was sent to a random sample of 4,200 women aged 35-64, of whom 2,991 responded (71.2%). The questionnaire contained questions on psycho-socio-economic background, quality of life, self-reported health, height and weight, climacteric symptom prevalence, and menopausal status and symptoms. It also comprised questions on medication prescribed during the past year. </p><p><b>Results</b>. 40% used prescribed medication and 12% took four drugs or more. Age, educational level, self-rated health, and BMI remained significantly correlated to drug use in multivariate analysis. Adherence ranged from 15%-98% depending on age, a scheduled check-up, perceived importance of medication, concern about medication, taking cardiovascular and respiratory disease drugs. The highest adherence was found for hormonal medication the lowest for musculoskeletal medication. </p><p>HRT was used by 15% of the women. 13 % used other symptom relieving therapy. HRT users reported higher score of vasomotor symptoms, except for sweating during the daytime. </p><p>Prevalence of general symptoms did not necessarily increase with age. Especially symptoms related to stress-tension-depression decreased with age. Four different symptom prevalence patterns were found. </p><p><b>Conclusions</b>. Age, health status, educational level and body mass index (BMI) appear to affect drug use. Adherence to therapy is highest among elderly women who regard their medication as important and have a scheduled check-up. HRT relieves some vasomotor symptoms but does not affect other symptoms or self-rated health. Prevalence of symptoms related to Stress-tension-depression appears to decrease with age.</p>

Syftet med detta arbete var att studera vad som utmärker de så kallade bokstavsbarnen och vad som tros vara orsaken till deras problem. Genom arbetet ville jag få en bild av hur handikappet upplevs av föräldrar och barn och jag ville få en uppfattning om hur man som lärare klarar av barnen i klassrummet. I flera år har det pågått en debatt i samhället om diagnoserna är till godo eller till ondo för barnen som har drabbats. Efter att ha läst både sidornas argument har jag kommit till den slutsatsen att utredning och diagnos är nödvändigt för att Damp- och Adhdbarnen ska få den hjälp de behöver för att klara skolan. Metoderna som används i arbetet är litteraturstudier och fem intervjuer av föräldrar till Damp- diagnostiserade barn.

<p>The goal of this research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis.</p>

This thesis deals with methological issues in the study of chemical exposure and sick building syndrome (SBS). SBS is a combination of general, mucosal and skin symptoms that some people experience when staying in specific buildings. The aim was to find chemical patterns associated with SBS, but also to address methological problems in such study. The plan was to conduct a case-control study comparing the two groups’ chemical exposure, where cases were defined as those having at least one general, one mucosal and one skin symptom each week the last three months. For the planning it was necessary to know if cases and controls could be selected from the same building. If everyone in a building have the same chemical exposure it is no use to compare exposure between two persons at the same workplace. In the first paper exposure to more than 100 compounds is compared between 79 participants working in eight buildings. It was found that for the majority of compounds the variation in exposure was larger within buildings than between buildings, which means that cases and controls could be allowed to work in the same building. The second paper is a comparison of three adsorbents usability in finding differences in chemical exposure between SBS cases and controls. This was done by using chemometrical methods but comparisons of sampled amounts, blank values and reproducibility were also done. Tenax TA was found to be the best adsorbent, hence used in the case-control study. In recent years ozone and ozone reaction products with unsaturated volatile organic compounds (VOCs) has been in focus. Nitrogen dioxide is another gas affecting oxidation of reactive VOCs. Formaldehyde is an irritant formed when unsaturated VOCs are oxidised, and in some studies a relation with SBS has been found. In paper three the relation between personal exposure to formaldehyde, nitrogen dioxide, ozone, terpenes and SBS has been investigated among more than 200 office workers in a case control study in Umeå and Vasa. Cases (based on symptoms during the week of measurements) had lower ozone exposure than controls. No further associations were found at present exposure levels. A planed analysis of relations to VOCs could not be done due to analytical problems, and problems due to difficulties with consistent identification of compounds in a very large data set. These problems are further discussed in the thesis. In the case-control, study participants answered questionnaires about symptoms during "the past three months", "right now" (when answering the questionnaire), and during the week of exposure measurements. In the fourth paper the stability of symptoms were compared by answers at different occasions. It was found that the case/control concept was as stable as individual symptoms. More participants with atopic disease and those 41 years old or younger changed class compared with those without atopic disease and older participants. Measurement activities appeared to make participants report more symptoms. Fatigue, dry eyes and dry skin are suggested to be symptoms with strongest, and illness/dizziness to be weakest association with IAQ. / KLUCK-projektet

First use and initiation of regular alcohol use has been frequently found to start in adolescence. However, only few studies have also investigated how many adolescents proceed during ages 14–24 to harmful drinking or even develop alcohol use disorders. This paper – using the EDSP baseline sample of 3,021 community respondents from the Munich area – examines the prevalence of use, abuse and dependence and investigates the dose/disorder relationship. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Men were more likely to report an alcohol disorder than women, prevalence also increased in the older age cohorts. However, even among 14- to 17-year-olds a substantial proportion of respondents report high and regular consumption rates, the occurrence of abuse and dependence criteria and even a full dependence syndrome. There is however only a moderate association between average number of standard drinks consumed with the risk of developing abuse and dependence. In light of the substantial rates among adolescents and young adults the validity of DSM-IV alcohol disorder criteria is discussed.