Bakgrund: Hjärtinfarkt bedöms vara den ledande dödsorsaken världen över. Trots att fler män än kvinnor insjuknar i hjärtinfarkt är dödligheten bland kvinnor högre. Bilden av hjärt- kärlsjukdom har länge präglats av ett manligt perspektiv vilket är en livshotande inställning som leder till att kvinnors symtom inte tas på allvar. Syfte: Syftet med studien var att beskriva kvinnors upplevelser av symtomen vid hjärtinfarkt. Metod: En litteraturöversikt där elva  artiklar från databaserna CINAHL Complete och PubMed granskats och analyserats. Resultat: De vanligaste symtomen hos kvinnor med hjärtinfarkt var smärta, fatique, andningspåverkan, gastrointestinala besvär och kroppstemperaturförändringar. Många kvinnor hade svårt att förstå och relatera sina symtom och blev inte tagna på allvar i vården. Det fanns en tydlig frustration då symtomen i många fall inte överensstämde med de symtomförväntningar som fanns. Slutsats: Litteraturöversikten lyfter fram kvinnors symtom vid hjärtinfarkt och bidrar till att skapa en förståelse för kvinnans tankemönster vid vårdsökandet. Hjärtinfarkt ska inte baseras på kön utan på kliniska fynd. Genom att vidga en större förståelse för hur kvinnor tolkar sina symtom kan vårdpersonal förbättra utgången för kvinnor med hjärtinfarkt. / Background: Myocardial infarction is considered to be the leading cause of death worldwide. Although the number of cases is higher in men, the mortality rate is higher amongst women. The image of cardiovascular disease has long been characterized by a male perspective, which is a life-threatening attitude that leads to women's symptoms not being taken seriously. Aim: The aim of this study was to describe women’s experiences of myocardial infarction symptoms. Method: A literature study where eleven articles from the databases CINAHL Complete and PubMed were reviewed and analyzed. Results: The most common symptoms in women with myocardial infarction were pain, fatigue, respiratory distress, indigestion and body temperature changes. Many women had a hard time understanding and relating their symptoms to cause and were hence not taken seriously in care. There was a clear frustration as the symptoms in many cases did not match the expectations that existed. Conclusion: This literature review highlights women’s symptoms of myocardial infarction and helps to create an understanding of the woman's thought patterns when seeking care. Assessment of myocardial infarction should not be based on gender but on clinical findings. By broadening a greater understanding of how women interpret their symptoms, healthcare professionals can improve the outcome for women with myocardial infarction.

Dissertation submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2009. / Introduction Provings form a fundamental part of the philosophy and practice of homoeopathy and the foundation on which homoeopathic prescribing rests. The substance chosen for this study is Yam ha-Melach (Dead Sea water). This substance has been known for its healing properties since ancient times and thus seemed an apt addition to the homoeopathic Materia Medica. Purpose The primary purpose of this investigation was to investigate and determine the complete symptom picture of Yam ha-Melach , homeopathically prepared to the thirtieth centesimal potency, on the healthy individuals and record the mental, emotional and physical signs and symptoms produced, so that it may be prescribed to those suffering from similar signs and symptoms, according to the Laws of Similars, as required by homoeopathy. A further purpose of this investigation was to compare the symptom picture gained to the existing indications of clinical therapeutic use of this substance. This study was done in conjunction with Natasha Wallace, who compared the symptom picture gained from the proving of Yam ha-Melach 30CH to the symptom picture of its constituent minerals. Methodology To prepare the remedy, Yam ha-Melach was triturated at a ratio of 1:99 with Saccharum lactis powder to the 3rd centesimal potency. Liquid potencies were then manufactured from Yam ha-Melach 3CH to a potency of 30CH. The remedy was dispensed in the form of Saccharum lactis granules that have been triple impregnated at 1% volume/volume (according to Method 10 of the GHP) with Yam ha-Melach 30CH in 90% ethanol. The remedy was dispensed in the form of 6 single enveloped powders. 10 lactose granules impregnated with potentised Yam ha-Melach 30CH was added to each envelope. This was administered to the provers in the experimental group. The placebo was dispensed in the form of 6 single enveloped powders. 10 neutral lactose granules were added to each envelope. This was dispensed to the placebo group. The placebo and the active remedy were identical in appearance thus ensuring the double blind nature of the experiment with neither the provers nor the researchers able to differentiate the active remedy from the placebo. The research methodology of Jeremy Sherr is thorough and well researched as well as very user friendly thus for the purpose of this study the methodologies suggested by Sherr in his Dynamics and methodology of Homoeopathic Provings were used (1994). Twenty healthy individuals took part in this study. Participants were fully informed about the research (Appendix D) and had to meet all the inclusion criteria (Appendix B) before commencing the proving. 10% (2 provers) of the prover group received placebo and the remainder (18 provers) of the group received the verum. The homoeopathic proving of Yam ha-Melach 30CH took the form of a double blind placebo controlled study where neither the provers nor the researcher knew to whom the placebo or active remedy was given. The provers had no knowledge of the substance being proved or the potency in which it was administered. The potency utilized for this proving was the 30th centesimal potency or 30CH. Data collection was in the form of a journal kept by each prover. Provers observed themselves before, during and after administration of the remedy and recorded all their mental, emotional and physical signs and symptoms in the journal. On completion of the proving the information elucidated by the provers was correlated and assessed by the two researchers for suitability to be included in the Materia Medica of Yam ha-Melach 30CH. These symptoms were then translated into Materia Medica and repertory language. Information obtained from the case histories, physical examinations (Appendix F) and group discussions were also utilized. The information obtained from the proving of Yam ha-Melach 30CH was compared to the existing indications of clinical therapeutic use. This highlighted important themes in the remedy and explained symptoms. Symptoms and themes that emerged from the proving were related to the ailments, symptoms and signs being treated with Dead Sea water in an attempt to clarify and expand on the understanding of the remedy. Results Provers experienced a wide range of symptoms on the mental, emotional and physical planes. In the mental and emotional spheres, provers experienced intense irritability, anxiety and depression which was characterized by loneliness and hopelessness as well as much crying and thoughts of suicide. Mania was prevalent with spontaneity and rebellion against societal norms and religion, paranoia and discrimination. Physically, provers experienced much joint pain and stiffness as well as a variety of skin symptoms resembling psoriasis and vitiligo. Dehydration was a central theme as was detachment and symptoms involving the female system. Conclusions It was hypothesized that the proving of Yam ha-Melach 30CH would produce clearly observable signs and symptoms in healthy individuals. The results of the proving show no contradiction to this and thus the hypothesis verified. The musculoskeletal symptoms of Yam ha-Melach 30CH were comparable to those of rheumatoid and osteoarthritis and skin symptoms were comparable to those of psoriasis and vitiligo. These are the primary clinical therapeutic indications for Dead Sea products. This verifies the homoeopathic principle of the Law of Similars.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2011. / ‘Cigarette smoking is a modern day epidemic that poses a substantial health burden’, it has been proven that smokers die on average fourteen years earlier than non smokers as a direct result of their smoking. An abundance of evidence indicates that the health risks associated with cigarette smoking can however be reversed with a sufficient period of abstinence. Thus achieving life-long abstinence must be a health priority for both developing and developed countries (Caponnetto &, Polosa, 2008). Over 80% of smokers express a desire to stop smoking and 35% of them try to stop each year. However, less than 5% are successful in un-aided attempts to quit (American Psychiatric Association, 1995). The greatest challenge facing smokers who wish to quit are nicotine withdrawal symptoms; these include dysphoric or depressed mood, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate and increased appetite or weight gain (American Psychiatric Association, 1995). The aim of this double blind placebo controlled quantitative study was to determine the effectiveness of a homoeopathic complex (Caladium seguinum 30 CH, Nux vomica 30 CH and Staphysagria delphinium 30 CH); a tautopathic preparation and the combined effect thereof, in the treatment of nicotine withdrawal syndrome as determined by the Tolerance Dependence Questionnaire, Smoking History and Perceptions of Treatment Questionnaire. Methodology Forty participants recruited by means of convenience sampling were randomly and equally divided into one of four treatment groups, namely tautopathic group, homoeopathic group, combined tautopathic and homoeopathic group and placebo group. The duration of the study was 2 weeks and two consultations with each participant were conducted. The respective interventions were administered in oral spray format; participants were asked to spray their respective preparations directly into their mouth three times daily and to repeat the dose whenever they had a craving for a cigarette. iv Measurements in the form of the Tolerance Dependence Questionnaire (Appendix D), Perceptions of Treatment Questionnaire (Appendix H), and Smoking History (Appendix G) were used to quantify response to treatment. Non-parametric statistical analysis was conducted to analyse the data. Results All four research groups experienced a statistically significant reduction in the amount of cigarettes smoked, favourable perceptions of their response to treatment and improved tolerance. Statistically however when the groups were compared with each other they were similar with respect to their tolerance to nicotine, perception of response to treatment and reduction in amount smoked. Although interventions were statistically similar in terms of effectiveness, the data does suggest that Tautopathy as an intervention warrants exploration. The Tautopathic group achieved the highest reduction in the number of cigarettes smoked when comparing medians (11 less smoked per day), achieved the highest percentage of participants who experienced reduced cravings, and the highest percentage of participants who would continue using the intervention (90% respectively) as well as improvements in 6/9 variables of the Tolerance Dependence Questionnaire. Conclusions The study concludes that each of the four subject groups (including placebo) proved to be successful in aiding the participant to cease smoking. The results showed a significantly positive perception of the participants to the interventions used. The influence of the placebo effect however was very evident in this study; in addition other factors such as the unique method of administration of the medication (oral spray format on demand) the Hawthorn effect and the participants’ desire/commitment to quit smoking may have contributed to the positive results obtained. Notwithstanding the above and although not statistically significant; positive trends within the data do suggest that the Tautopathic approach used in this study should be further investigated in future.

Dissertation submitted in partial compliance with the requirements for the Master‟s Degree in Technology: Homoeopathy, Durban University of Technology, 2011. / Until recently, various attempts have been made to simplify the prescription process in homoeopathic prescribing. The doctrine of signatures, miasmatic theory, the homoeopathic repertory and more recently, kingdom analysis by authors such as Sankaran (1994) and Scholten (1993) are some of the attempts that have been made to understand the materia medica. With the materia medica constantly expanding and considering that plants make up a significant percentage of the materia medica (Kayne, 2006), it is evident that new systems of homoeopathic prescribing are continually needed to help practitioners both study the remedies and prescribe more accurately. Aim The Solanaceae plant family are an important and well utilised plant family in homoeopathy (Vermeulen, 2004). Considering this, it was felt that a study investigating the relationship of the natural history of the family to its general and mental symptoms be conducted in order to apply a previously unexplored research paradigm in order to create a greater understanding of Solanaceae remedies utilised in homoeopathy. The study conducted was a non empirical correlation study of the Solanaceae plant family‟s natural history and general and mental symptoms manifested in Solanaceae remedies utilised in homoeopathy. The aims of the study were to establish if commonalties existed between general and mental symptoms of individual remedies belonging the Solanaceae family and their natural histories, as well as to establish if collective commonalities and correlations existed between the general and mental symptoms and the natural history of the Solanaceae family as a whole. Methodology The homoeopathic remedies obtained from the Solanaceae family of plants for the study were analysed in terms of rubric representation (size) using homoeopathic software packages, Radar 10.4 (Archibel, 2009b) and v Encyclopedia Homoeopathica (Archibel, 2009a) a sample selection was chosen. This selection was analysed in terms of general and mental rubrics. Qualitative thematic analysis was used to establish commonalities in keyword concepts between the respective natural histories of the studied family and their respective general and mental symptoms. Keywords obtained from data tables which included criteria such as habitat and distribution, plant description, active principles (primary alkaloids), uses, physiological action if ingested, historical significance, mythology and toxicology were subjected to thesaurus consultation and tabulated in an attempt to identify synonyms relating to the general and mental symptoms of individual remedies of the sample group in the study. This facilitated in the grouping of similar themes. Once commonalities pertaining to each individual species and remedy was further tabulated and discussed in terms of keywords relating to their natural histories, a collective analysis of common correlations between the plant family as a whole was performed. Results Common themes related to general and mental symptoms and to the natural histories of species in the study included “aggression” found in Atropa belladonna, “depression” found in Solanum dulcamara, “anxiety” found in Datura stramonium, “confusion” found in Hyoscyamus niger, “burns” found in Capsicum annuum, “ convulsions” found in Nicotiana tabacum , “ hallucinations” found in Mandragora officinarum and “delirium” found in Solanum nigrum. Common themes relating to general and mental symptoms and the natural history of the Solanaceae plant family as a whole included convulsions, hallucinations, confusion and anxiety. These themes were further compared to themes exhibited in Solanaceae studies conducted by Mangialavori (2007) and Sankaran (2002).

Objective Adolescence is recognised as a risk period for offending and head injury (HI), with higher rates of HI found in the young offender (YO) population compared to the general population. Drug and alcohol use has also been associated with increased risk of offending. This study aims to explore the relationships between HI, Post-concussion symptoms (PCS), reactive and proactive aggression, and offending behaviour in YOs, whilst considering the effects of drug and alcohol use on these relationships. Participants A sample of ninety eight males was recruited from a Young Offender Institute: the age range was 16-18 years of age with an average age of 17. Design A between subjects cross sectional design was employed. Participants were recruited using an opportunistic sampling strategy. Main Measures Self-rated/report measures of: HI, Post-Concussion Symptoms (Adapted Rivermead Post-Concussion Symptom Questionnaire), Aggression (Reactive-Proactive Scale), criminal histories, and drug and alcohol history. Results HI was reported by 73.5% of the overall sample, with 61.1% reporting a “knock out”. Frequency and severity of HI was associated with significantly higher PCS scores. Examination of covariate- drug and alcohol use did not affect these relationships. PCS were a significant predictor of reactive aggression, total number of convictions and number of previous violent convictions. However, dosage of HI (severity and frequency) was not a significant predictor of reactive aggression or criminal profiles. Conclusions There appears to be a dose-response effect of severity and frequency of HI on PCS, with PCS predicting reactive aggression. Such symptoms may compromise functions and lead to increased aggression. This highlights the need for better screening and interventions for HI and on-going symptoms in YOs.

The relationship between alexithymia, PTSD symptoms, attachment, and depression was examined using archival data from a university-based trauma clinic. Participants were 62 women and 20 men, ages ranging from 17 to 59, with childhood histories of physical or sexual abuse. Measures included the Structured Clinical Interview on Childhood Sexual Abuse History (SI-SA), Impact of Events Scale-Revised (IES-R), Attachment Style Questionnaire (ASQ), Beck Depression Inventory-Second Edition (BDI-II), and Toronto Alexithymia Scale-20 (TAS-20). As predicted, alexithymia, PTSD symptoms, and depression were negatively correlated with secure attachment and positively correlated with insecure attachment. Also as predicted, depression and insecure attachment styles containing negative models of the self (need for approval, discomfort with closeness) mediated the relationship between alexithymia and PTSD symptoms while styles involving positive models of the self (confidence, relationships as secondary) did not. Preoccupation with relationships was excluded from mediation analyses because alexithymia was not a significant predictor of this construct. Results suggest that the symptom profile of adult survivors of childhood abuse can be complex and may require interventions that target a broad range of symptoms and difficulties including alexithymia, attachment, and depression.

Patients with heart failure (HF) must monitor and recognize escalating symptoms to manage worsening HF in a timely manner. However, routine symptom monitoring is not commonly performed by this population. Providing a symptom diary along with an education and counseling session may help HF patients promote symptom monitoring and interpretation. The accumulated information about changes in daily symptoms will allow patients to easily compare current symptom status to the past without depending on memory and can rapidly capture worsening HF. To date, few studies have tested the effect of a daily symptom diary. The purpose of this dissertation was to develop and test a symptom diary intervention to improve outcomes in HF patients. Prior to testing the intervention, preliminary work included: (1) determining the impact of symptom clusters on cardiac event-free survival; (2) evaluating the quality of existing symptom measures designed for HF patients; (3) evaluating the effect of physical symptom items that were often included in a depressive symptom instrument on cardiac event-free survival; and (4) evaluating the association between symptom monitoring and self-care management. Based on this information, a randomized, controlled pilot study was conducted to test the effect of a symptom diary with an education and counseling intervention on prognosis, healthrelated quality of life (HRQOL), and self-care maintenance at 3 months follow-up. A total of 44 hospitalized patients with HF were randomly assigned to either usual care or intervention providing a daily symptom diary with education and counseling. There were trends toward fewer HF events and improved self-care maintenance in the intervention group compared to the usual care group. However, there was no difference in HRQOL between the two groups. The results of this dissertation suggest the importance of assessing symptom clusters and further studies to improve the quality of existing HF symptom measures. Results from this dissertation also provided the evidence of the advantages of regular symptom monitoring to facilitate early identification of worsening HF and initiation of timely responses. However, further studies are needed to provide additional evidence of the positive impact of a use of daily symptom diary in patients with HF.

Using a large sample from the NICHD Study of Early Child Care, the current study examined the processes through which children's agentic processes promoted their resilience in the face of mothers' depressive symptoms at first grade. Children's resilience in the presence of mothers' depressive symptoms was demonstrated to be homogeneous across domains of academic performance, social competence, internalizing behavior, and externalizing behavior. Children's effortful control, self-assertion, and mastery motivation predicted their resilience in these domains to a varying degree. The agentic processes mediated the relation of different patterns of individual (i.e., child intelligence, temperament), relational (i.e., attachment security), and environmental (i.e., maternal sensitivity, childcare quality) factors to children's resilience across domains. Interrelations among child individual, relational, and environmental characteristics were also observed. Moreover, findings from two analytic approaches converged in terms of underscoring the importance of the agentic system in promoting child resilience in the face of mothers' depressive symptoms. Children's agentic processes promoted their resilience via additive main effects rather than interactive effects. / text

<p>Today, health problems are likely to have a complex and multifactorial etiology, whereby psychosocial factors interact with behaviour and bodily responses. Women generally report more health problems than men. The present thesis concerns the development of women’s health from a subjective and objective perspective, as related to psychosocial living conditions and physiological stress responses. Both cross-sectional and longitudinal studies were carried out on a representative sample of women. Data analysis was based on a holistic person-oriented approach as well as a variable approach. In Study I, the women’s self-reported symptoms and diseases as well as self-rated general health status were compared to physician-rated health problems and ratings of the general health of the women, based on medical examinations. The findings showed that physicians rated twice as many women as having poor health compared to the ratings of the women themselves. Moreover, the symptom ”a sense of powerlessness” had the highest predictive power for self-rated general health. Study II investigated individual and structural stability in symptom profiles between adolescence and middle-age as related to pubertal timing. There was individual stability in symptom reporting for nearly thirty years, although the effect of pubertal timing on symptom reporting did not extend into middle-age. Study III explored the longitudinal and current influence of socioeconomic and psychosocial factors on women’s self-reported health. Contemporary factors such as job strain, low income, financial worries, and double exposure in terms of high job strain and heavy domestic responsibilities increased the risk for poor self-reported health in middle-aged women. In Study IV, the association between self-reported symptoms and physiological stress responses was investigated. Results revealed that higher levels of medically unexplained symptoms were related to higher levels of cortisol, cholesterol, and heart rate. The empirical findings are discussed in relation to existing models of stress and health, such as the demand-control model, the allostatic load model, the biopsychosocial model, and the multiple role hypothesis. It was concluded that women’s health problems could be reduced if their overall life circumstances were improved. The practical implications of this might include a redesign of the labour market giving women more influence and control over their lives, both at and away from work. </p>

The study was developed after research with older women suffering urinary symptoms showed that many had tolerated social, psychological and hygiene effects on their lives for some time. There is evidence that some symptoms in later life may originate from pregnancy and childbirth. However, whist there is evidence that pelvic floor muscle exercises can be effective in the short term, there is a paucity of research on the reasons why women tolerate symptoms in the postnatal period rather than seek help. It was also unclear what significance the interactions with health professionals had in aiding or suppressing help-seeking. The aim of this qualitative study was to use grounded theory methodology to describe women’s experiences and knowledge of urinary symptoms in the postnatal period and the perceptions of health professionals. Fifteen women were interviewed in the postnatal period, and one woman was interviewed twice. From the interviews and observations of antenatal clinics and postnatal groups three categories emerged; messages women receive, seeking and understanding information and responding to the messages. Views and knowledge of health professionals were obtained through two focus groups of five. From the analysis of the findings the following five categories emerged; clarifying pathways of care, clarifying education, improving communication, understanding actions and serious issues. The core category arising from this; overcoming barriers to facilitate empowerment, revealed barriers that women and health professionals must overcome in order to approach the issue of urinary incontinence collaboratively. This study identified that there can be problems with communication at all levels between women and health professionals, resulting in poor communication regarding urinary symptoms and accessing treatment. Furthermore, superficial education regarding pelvic floor muscle exercises and dysfunction, both in the antenatal and postnatal periods, coupled with difficulties with disclosure on a sensitive subject could be disempowering for women and health professionals. In particular, women found the possibility of an examination so soon after delivery worrying. Normalisation was a negative but powerful influence on women, encouraged by friends and family. It is suggested that, by developing interventions that enable women and health professionals to overcome the barriers of communication and knowledge exchange, women could be empowered in relation to their physical health after childbirth to manage their urinary symptoms. Empowerment for women, therefore, with regard to postnatal urinary symptoms means being able to believe that looking after the pelvic floor is normal rather than accepting urinary symptoms after childbirth as inevitable.