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Stadler, Sophia. "Child disruptive behaviour problems, problem perception and help-seeking behaviour." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/26942.
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Disruptive behaviour problems in early childhood are found to be associated with many negative long-term outcomes, such as antisocial behaviour, adolescent delinquency, and substance abuse (Kellam, Werthamer-Larsson & Dolan (1991), as cited in Butler, 2005:1). Even after adolescence this arises, for, as Vogel (2008:16) states the 'frequency of behavioural problems or challenging behaviour among the youth of today often predicts the size of our future prison population'. These findings clearly highlight the importance of early identification of behavioural problems, adequate preventative intervention (Butler, 2005:1) and the necessity for early intervention to prevent their continuity, since behaviour problems are found to worsen without treatment (Loeber, 1982, cited in Butler, 2005:1). The goal of this study is to gain an understanding of disruptive behaviour in primary school learners. To achieve this goal, the objectives of this are to explore the nature of child disruptive behaviour problems; to explore parents and teachers' problem perception of child disruptive behaviour; to explore the problem threshold of parents and teachers toward child disruptive behaviour; and to explore their help-seeking behaviour. The study's aim, therefore, is to better understand and gain more insight in child disruptive behaviour problems before a threshold is reached by parents and teachers and help is sought from social service professionals. The study uses an exploratory qualitative research design to gain insight into child disruptive behaviour problems, problem perceptions and help-seeking behaviour in the Southern Cape Karoo District in the Western Cape. Child disruptive behaviour patterns were analysed along a three-point continuum (from less severe - 'preventative'; to moderate - 'early intervention'; and most severe - 'statutory') based, on problem perceptions of parents, teachers and social service professionals. In addition, the present study examines parents and teachers' problem thresholds to identify help-seeking behaviour and sources. A purposive sampling technique was used to select the participants according to appropriation and availability. Parents and teachers were contacted to participate voluntarily in the research from schools in the area - Acacia Primary School, Baartmansfontein Primary School, Buffelsriver Private Primary School and Matjiesfontein Primary School. The social service professionals who participated consisted of social workers, social auxiliary workers and police officials from the Department of Social Development, Child Welfare SA and the South African Police Service. The study consisted of a broad range of child ages and parental ages. Parent participants also included biological and foster parents. Data was gathered by means of a semi-structured interview schedule administered during 24 individual interviews. The schedule is based on information obtained from the literature review relevant to the models and theories selected. Previous research done by Jessica Hankinson in 2009 in America on child psychopathology, parental problem perception, and help-seeking behaviours was used as a reference for creating the data collection tool, since she also focused on child behavioural problems and used similar models in the theories. This tool was created in such a way as to be relevant to the South African context. The findings confirmed the serious nature of child disruptive behaviour amongst primary school learners, including abusive behaviour, assault, bullying, fighting, swearing, theft, criminal involvement, substance abuse, truancy and school dropouts. The participants were found to be able to perceive their child's problem behaviour and to perceive themselves to be competent parents in dealing with disruptive behaviour. Child disruptive behaviour was found to have a significant effect on classroom learning. Despite legislation banning this, the participants still resort to punitive corrective measures. Stigma related to professional services and the privacy of the family are found to be very relevant in help-seeking efforts. This lead to the conclusion that child disruptive behaviour may become a normal and acceptable phenomenon, and thus leads to late reporting - and social services being contacted only as a last resort. The most important recommendation resulting from the study indicates that there is a need for prevention and early intervention services for child disruptive behaviour. This should address the escalation of the behaviour that later results in the need for statutory services. The study further indicates that various sectors (social workers, teachers, community structures and the departments) need to collaborate and form partnerships in order to enhance the early reporting of children in need and the accessibility and availability of services rendered in rural areas. This could enhance the early identification, reporting and service delivery in order to find problem resolutions.
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Warburg, Richard. "Assessment of memory problems by clinical neuropsychologists." Thesis, Bangor University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390999.
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Farina, Dmytro. "Forward and inverse problems of electrocardiography clinical investigation." Karlsruhe : Univ.-Verl. Karlsruhe, 2008. http://d-nb.info/988009609/34.
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Fradet, Christiane. "Coping strategies in young men with and without drinking problems." Thesis, University of Ottawa (Canada), 1993. http://hdl.handle.net/10393/6845.
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Social learning theory (Abrams & Niaura, 1987) assumes that individuals who lack effective coping strategies are more likely to drink in response to stressful situations. A review of the literature suggests that coping strategies have not typically been studied in the context of a specific theory of alcohol abuse. Consequently, little progress has been made in the understanding of possible links between alcohol abuse and the use of coping strategies. The primary objective of the present study was to assess whether drinking problems are associated with specific coping strategies. Coping strategies were defined according to the coping models of Lazarus and Folkman (1984), Tobin, Holroyd, Reynolds and Wigal (1989) and Rosenbaum (1980). It was hypothesized that students with drinking problems, in comparison to students with no drinking problems, would report engaging less in self-control and problem-focused strategies and more in avoidant coping strategies. A secondary objective was to determine whether these coping characteristics are associated with a family history of drinking problems, a risk factor for drinking problems. One hundred and eighty-nine male university students completed screening questionnaires about their alcohol and drug consumption and about the drinking behaviors of their family members. Students accepted for this study met the criteria for one of the following groups: (a) no family history of drinking problems (FH$-$) and no drinking problems, (b) FH$-$ and drinking problems, (c) family history of drinking problems (FH+) and no drinking problems, or (d) FH+ and drinking problems. Students completed self-report questionnaires on the reactions they experience in stressful situations. Self-control strategies were assessed by the Self-Control Schedule (Rosenbaum, 1980), and task-oriented and avoidant strategies by the Coping Inventory for Stressful Situations (Endler & Parker, 1990a). The last questionnaire was repeated for three different situations: (a) negative emotion, (b) interpersonal conflict, and (c) pressure to drink. Multivariate analyses of variance showed that students with drinking problems, in comparison to students without drinking problems, reported engaging less in self-control and task-oriented coping strategies. However, students with drinking problems did not report engaging more in avoidant strategies. This finding was contrasted with the results of other studies in which avoidant strategies were found to be related to alcohol abuse. Finally, there were no significant differences in coping between FH+ students and FH$-$ students. The potential relevance of coping to a model of alcohol abuse was discussed as well as its practical implications. For example, students with drinking problems might benefit from being taught task-oriented strategies and self-control skills, in addition to specific skills to reduce drinking.
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Watkins, Simon. "Disclosure of voice hearing and mental health problems : experiences and effects." Thesis, University of Hull, 2018. http://hydra.hull.ac.uk/resources/hull:16483.
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Research suggests that people who experience mental health problems and people who hear voices are likely to experience stigmatising attitudes and discrimination. This portfolio considers the experiences and impact of disclosing these stigmatised experiences, both to immediate family, friends, and partners, and to people in wider society. The portfolio has three parts. Part one is a systematic literature review which considers the impact/effect of disclosing mental health problems by reviewing the literature base. Twelve articles which aimed to answer the research question were quality assessed, then compared and contrasted in order to provide conclusions and offer recommendations for future research and clinical practice. Part two is an empirical study which enquires into the personal experiences of people who hear voices using Interpretative Phenomenological Analysis (IPA). Six participants were interviewed about their experiences of talking about hearing voices with family, friends, and other people they considered close to them. Themes were developed from the interviews and conclusions were drawn about future research and clinical implications. Part three of this portfolio contains the appendices, consisting of supporting documents from the literature review and empirical study, along with both epistemological and reflective statements.
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Morrow, James. "The clinical, social and psychological problems of patients with epilepsy." Thesis, Queen's University Belfast, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.333780.
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Brackenbury, Tim, Marc Fey, Gregory Lof, Benjamin Munson, and A. Lynn Williams. "Practice in Child Phonological Disorders: Tackling some Common Clinical Problems." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/2071.
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Ries, Adrienne Sandra. "Psycho-social problems identified by adult bone marrow transplant survivors." Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/23344.
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Bone marrow transplantation (BMT) offers many patients who are diagnosed with leukaemia, lymphoma, myeloma and aplastic anaemia the opportunity of increased survival. Chemotherapy is one of the most common forms of treatment for cancer patients en-route to BMT, which is often a concomitant stressor in the patient's life. Due to the side effects of chemotherapy, patients are often required to remain in a protective isolation unit for several weeks at a time. In most cases, BMT constitutes the final phase of the treatment process. This procedure is not without its risks and may create significant psychosocial stress for patients. Social work intervention in the Department of Haematology at Groote Schuur Hospital has focused primarily on newly diagnosed patients and those patients undergoing transplantation. However, with the increased success of BMT, it is important to address the needs of cancer survivors. An ongoing support group with BMT survivors, provided the opportunity for the researcher to conduct a qualitative exploratory study of how survivors conceptualise and describe their current lives. To this end, fifteen group sessions were tape recorded and the self-identified issues raised by the members were organised into themes. It was ascertained that adjustment post BMT was stressful for most of the survivors. In general, survivors experienced numerous losses in terms of intimate and social relationships, memory and sexual functioning. Anxiety was pervasive and was heightened by an underlying fear of relapse. However, survivors also acknowledged the positive benefits of having been diagnosed with cancer and undergoing a BMT, such as improved family relationships, renewed interest in religion and the changing of attitudes and values. Members utilised numerous coping skills including denial, avoidance, rationalisation, confrontation and problem solving in an attempt to master their situation. The group experience was viewed favourably by members who formed a strong bond as a result of their shared experiences. Some of the survivors were able to use the group to express fears that they felt uncomfortable to express elsewhere. BMT survivors enter a distinct phase of adjustment with the re-entry into their premorbid lifestyles. Preparation is essential if this phase is to mastered. Further research across race and cultural groupings is required in order to ensure that social work intervention is appropriate to all in South Africa.
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Quetsch, Lauren Borduin. "Emotion Regulation in Families of Children with Behavior Problems versus Nonclinical Comparisons." Thesis, West Virginia University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1588121.
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<p>The following study explored the relationship between emotion regulation in children with and without externalizing behavior problems and their caregivers. The study examined emotion regulation in both clinical and comparison samples. The main research question for the study was determining if there was a link between parent and child emotion regulation in both clinical and comparison samples. Sixty families were collected from two rural populations in the United States. Families referred for parent training with children ages 2 through 8 were recruited for a clinical sample (n = 34) along with a nonclinical comparison group (n = 26). A blocking design was used. The sample was largely Caucasian (73.3%), boys (71.7%), aged 4.62 years. Parents completed measures related to child behaviors, parenting stress, and child and parent emotion regulation at a single time point. Family behaviors were also coded during structured behavioral observations. Analyses indicated higher rates of problem behaviors in the clinical group, higher rates of parenting stress, higher levels of parental emotion dysregulation, and higher levels of child emotion dysregulation. Parents of children in the clinical sample also used more negative verbalizations with their children. Parent emotion regulation was found to be correlated with child emotion regulation, parenting stress, child behavior problems, and parental use of negative speech toward their child during play situations. Findings from this research indicate a need to target and measure outcomes for emotion regulation in both parents and their children when working with families who are referred for treatment of child behavior problems.
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Roper, Mona. "Supportive psychotherapy : an exploratory study of expressed views, feelings, practices and problems." Master's thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/13499.
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Includes bibliographical references.<br>Supportive psychotherapy is documented as the psychological treatment of choice for patients with severe psychopathology. It follows that this psychotherapy is particularly relevant to psychiatric hospitals which predominantly treat this category of patient. This study takes place at such a hospital. Problems which have implications for the practice and development of supportive psychotherapy, both at the hospital concerned and in general, have been reported. With a view to addressing these problems at the hospital, this dissertation explores some of the views, feelings, practices and problems regarding supportive psychotherapy reported by a number of clinicians at the hospital. An essentially qualitative research approach, involving interviews with 26 clinicians from various professional disciplines, is employed. A number of potential problems pertaining to terminology, definition, theoretical framework, referral, training and clinician attitudes are raised and discussed. Recommendations are made which are applicable to the hospital concerned, to teaching institutions, and to interested psychotherapists.
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Neal, Dan J. Carey Kate B. "The relationship between alcohol consumption and alcohol-related problems an event-level analysis /." Related electronic resource: Current Research at SU : database of SU dissertations, recent titles available full text, 2004. http://wwwlib.umi.com/cr/syr/main.
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Farina, Dmytro [Verfasser]. "Forward and inverse problems of electrocardiography : clinical investigation / von Dmytro Farina." Karlsruhe : Univ.-Verl. Karlsruhe, 2008. http://d-nb.info/988009609/34.
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Solomon, P. J. "Some problems in the statistical analysis of large scale clinical trials." Thesis, Imperial College London, 1985. http://hdl.handle.net/10044/1/37860.
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MacQueen, Ian James. "Progressive resistance exercise and its application to health and clinical problems." Thesis, Imperial College London, 2006. http://hdl.handle.net/10044/1/40049.
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The term "Progressive Resistance Exercise" means exercise performed against Resistance which is increased periodically as the exerciser gains strength. The American College of Sports Medicine defines it as - "the problems by which muscle forces or torques are increased to overcome the internal or external resistances imposed upon skeletal muscles". Progressive Resistance Exercise is based on the overload principle and usually refers to weight lifting exercise. To achieve gains in muscle strength and Itypertroplty, progressive resistance is essential to compensate for gains as the training progresses. Without this, the body's adaptation to the stimulus is limited. This thesis will be presented in four consecutive parts. The first will be an introduction outlining the history of Progressive Resistance Exercise (PRE) and its use in developing physical health and strength and how in the last half century exercise programmes have been experimented and designed for use in the treatment of different clinical conditions. Mention will also be made of the contribution of the lay sports community in designing and improving Progressive Resistance Exercise protocols for physical developmait and better performance in sports. This interest and technology has penetrated deeply into mary Olympic events. The second part of the thesis is a detailed description of animal experimmts with rats done by the auftor under British Medical Association and Nuffield Research Scholarships. The experiments involve testing the effect of different Progressive Resistance Exercise programmes on skeletal muscle. Comparative graphs of the performance results have bean made and also clear photomicrographs of the results of the Progressive Resistance Exercise on the gastrocnemius and quadriceps muscles. Similar experiments were done on partially dmervated muscles and impressive adaptations found in the process of axon sprouting and reinnervation of these animal muscles. As these experiments were done a long time ago, it recommended that the literature on Progressive Resistance Exercise be reviewed and this has been done back to 1950 but particular attention paid to tiie literature during the last ten years. Thirty-two selected papersfi-omthis decade will be analysed in detail and their programmes and results discussed and criticized in the light of tiie most modem concepts on Progressive Resistance Exercise training. These modern exercise techniques will be described and suggestions made for modifications to bring the medical use of Progressive Resistance Exercise more up to date.
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Hudson, Kelsey Elizabeth. "Risk profiles for adolescent internalizing problems." ScholarWorks @ UVM, 2019. https://scholarworks.uvm.edu/graddis/1165.
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Objective: Internalizing problems are commonly diagnosed during adolescence, and are associated with distress, impairment, and negative mental health outcomes in adulthood. Thus, there is a critical need to characterize adolescents who are at the highest risk for escalating to clinical levels of internalizing problems while extending current literature and incorporating both biological and environmental predictors. This study aimed to characterized risk profiles for fourteen-year-old adolescents who developed clinical levels of internalizing (High Internalizing [HI]) problems by age nineteen, using brain, genetic, personality, cognitive, life history, psychopathology, and demographic measures. The study also examined whether there were functional and structural brain differences in three groups of adolescents on select regions of interest (ROIs) on the Faces Task, Stop Signal Task, and Modified Incentive Delay Task.
Method: Participants were 91 adolescents who met clinical criteria for at least one Anxiety and/or Depressive Disorder by age 19 and 1,244 controls who varied in symptom level but did not reach clinically-diagnostic criteria. Ten-fold cross-validated logistic regression using elastic net regularization was used to identify risk profiles associated with high levels of internalizing symptomatology. To examine group differences in regions of interest on three fMRI tasks and in gray matter volume, ANCOVAs were conducted. The three groups were: 1) adolescents who never met HI criteria (Controls), 2) those who met HI criteria in middle adolescence (Middle Onset), and 3) those who met HI criteria in late adolescence (Late Onset).
Results: Logistic regression identified 13 variables from personality, psychopathology, life events, and functional brain variables to predict High Internalizing symptoms (mean AUC 0.78, p<.0001). ANCOVAs showed there were several ROIs that demonstrated main effects of Time, and one main effect of Group during response inhibition in the left inferior frontal gyrus, triangular part (pars triangularis), with participants in the Middle Onset group showing increased activation levels compared with the Control group. There were no other significant main effects of Group or Time x Group interactions.
Conclusions: These findings give insight into personality, psychopathological, and brain-related factors that are associated with high levels of internalizing symptoms, highlighting the importance of including biological variables in conjunction with psychosocial variables when examining risk factors for internalizing problems. Results also suggest an association between activation in frontal cortex and parietal lobe regions during response inhibition and higher internalizing symptoms in late adolescence. Between-group activation and volumetric ROI comparisons generally yielded main effects of time, confirming prior evidence that activation levels and GMV continue to change over the course of adolescence.
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Mendez, Marcos. "An examination of the relationship between various mental health problems and the three sub factors of the Rutgers Alcohol Problem Index." Thesis, Manhattan, Kan. : Kansas State University, 2009. http://hdl.handle.net/2097/1406.
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Katz, Jonathan E. "Psychological stability, change and mental well-being in stress-related problems : the exploration of clinical and non-clinical populations." Thesis, Cranfield University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.284919.
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Mauldin, Jo A. Seaman John Weldon. "Bayesian approaches to problems in drug safety and adaptive clinical trial designs." Waco, Tex. : Baylor University, 2008. http://hdl.handle.net/2104/5177.
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Richardson, Kim. "The youth of Atlantis : can found youth be lost? : problems, needs and psychodynamics : an exploratory analysis." Master's thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/13495.
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Bibliography: leaves 60-71.<br>Objective: There is an urgent need to conduct community based research into the issue of youth development in a post-apartheid South Africa. The aim of this study is to explore the problems, needs I and experiences of youth in Atlantis using an action research approach. Method: A purposive convenience sample of 15 youth between the ages of 12 and 21 were interviewed using semi-structured in-depth interviews (average length 70 minutes). In addition, two focus groups were held. The data were analysed using descriptive analysis and open coding. The descriptive results were fed back at a workshop open to all youth in Atlantis. Results: The problems cited most frequently included the lack of recreational facilities, unemployment and family disintegration. These problems were validated at the workshop and a process designed to address the problems was set in motion. Needs identified included the need for a teen-centre and various inter-relational needs. Conclusions: Some features of this sample of youth are considered and recommendations for the implementation of results and further research are offered.
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Jordan, Caroline. "Maternal self-efficacy in mothers of children with and without clinical feeding problems." Thesis, Loughborough University, 2016. https://dspace.lboro.ac.uk/2134/25515.
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The understanding of maternal factors associated with child feeding problems is limited due to a lack of research which has examined a comprehensive range of maternal factors and the existing literature focussing on a narrow range of ideas about the wider familial context in which feeding problems occur. The broad aim of this thesis is to investigate maternal parenting of children with and without clinical feeding problems to provide insights into the wider context in which feeding problems occur. In study 1, thematic analysis of interviews with 10 mothers of children with, and 10 mothers of children without, clinical feeding problems revealed that mothers of children with clinical feeding problems appeared to have less maternal self-efficacy for managing parenting challenges than mothers in the non-clinical group. A template analysis found that these perceptions seemed to be informed by four theoretical sources of self-efficacy: mastery experiences, verbal persuasion, vicarious experience and physiological state. In study 2, 278 mothers of children with and without clinical feeding problems completed existing self-report measures of maternal self-efficacy. It was found that lower levels of maternal self-efficacy for establishing structure and routine around instrumental child care tasks and for implementing discipline and setting limits for the child was predictive of problematic child feeding behaviour and maladaptive maternal responses to child feeding problems. In study 3, 215 mothers of children with and without feeding problems completed self-report measures of the theoretical components of self-efficacy (mastery experiences, verbal persuasion, vicarious experience, physiological state). Physiological state was found to be the strongest predictor of maternal self-efficacy for establishing structure and routines as well as for providing discipline and setting limits for the child. Maternal self-efficacy mediated the relationship between physiological state and problematic child feeding behaviour and the relationship between parenting stress and maladaptive maternal responses. The final study was a pilot study using autophotography. This study explored parenting dimensions and tasks which contributed towards perceptions of maternal self-efficacy in 13 mothers of children without clinical feeding problems. Findings suggested that child feeding was an especially difficult and complex task for mothers to manage, with many mothers reporting perceptions of low efficacy for managing mealtimes. This appeared to be due to the large number of health related concerns and the worry mothers felt when children did not eat a healthful diet. Overall, results of this thesis suggest that mothers who lack confidence in their ability to manage child behaviour report more problematic child feeding behaviours and use more maladaptive strategies for managing feeding problems. Findings of the studies in this thesis suggest that mothers of children with feeding problems, and who are experiencing high levels of stress, may be especially vulnerable to lower levels of maternal self-efficacy which may exacerbate difficulties. Increasing maternal self-efficacy for providing structure, routines and discipline in mothers experiencing feeding problems in their children may improve outcomes for those affected.
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Feder, Caryn Ann. "Impact of perceived responsibility for problems and their solutions on perceptions of clients." Diss., The University of Arizona, 1992. http://hdl.handle.net/10150/185912.
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This study investigated the effects of being perceived as responsible or not for a psychological problem, being responsible or not for solving that problem, as well as type of disorder (substance abuse or depression), on perceptions of clients. It was predicted that clients perceived as more responsible for causing their problem and/or solving it would elicit greater negative reactions than clients perceived as not responsible for their problem and/or its solution. It was also predicted that substance abusers would be derogated more than depressed clients. These hypotheses were tested by having college students (N = 336) read therapists' case descriptions in which the key independent variables were manipulated and then subjects responded to questions measuring perceived client responsibility for the problem and its solution, treatment effectiveness, client competency, feelings toward the client, and social acceptance of the client. A series of hierarchial regressions was performed to create a path analysis. Clients presented as responsible for their problem were perceived to be more responsible and were viewed as less competent, elicited more negative feelings, and were less socially accepted than clients perceived as not responsible for their problems. Although clients presented as responsible or not responsible for the solution to their problems were perceived as such, those perceptions had no impact on other perceptions of clients. Instead, clients presented as responsible for their own treatment were perceived as receiving a less effective treatment than those presented as not responsible for the solution. Perceptions of low treatment effectiveness, in turn, lead to lower ratings of client competency, more negative feelings, and less social acceptance of the client. In addition, substance abusing clients were seen as more responsible for their problem and its solution, were viewed as less competent, elicited more negative feelings, and were less socially accepted than depressed clients. This research has many clinical implications and may help alleviate the discomfort caused when certain attributions are made in regard to clients in treatment for psychological problems.
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Sullivan, Daniel P. "Psychological Mechanisms, Interventions, and Clinical Outcomes in Sleep-Related Headaches." Thesis, Griffith University, 2022. http://hdl.handle.net/10072/417223.
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Sleep problems are one of the most frequent triggers of primary headaches such as migraine and tension-type headache, second only to stress. Whilst the relationship between various sleep disorders, and poor sleep in general has been well established, to date there has been a paucity of research examining psychological mechanisms of sleep-related headaches. This thesis sought to examine the following research questions about sleep-related headaches, in the context of the discipline of Clinical Psychology: Study One (Chapter Two) – What is causing the problem? What are the psychological mechanisms underpinning sleep-related headaches? Study Two (Chapter Three) – What are the consequences of the problem? Do insomnia, headaches and co-morbid insomnia and headaches predict poor therapeutic response to psychotherapy? Study Three (Chapter Four) – What can we do about the problem? Do psychological sleep interventions help both sleep and headaches? Chapter Five – What does the future hold? Exploring the next directions in sleep and headache research. Study One demonstrated that both maladaptive sleep beliefs and sleep safety behaviours are associated with greater headache frequency, mediated by sleep quality. This study also provided preliminary empirical support for sleep-related triggers in the Trigger Avoidance Model of Headaches. It was found that greater efforts to avoid both inadequate and excessive sleep, and fatigue and tiredness were associated with greater headache frequency, mediated by increased trigger sensitivity. Study Two demonstrated that in adults attending the Griffith University Psychology Clinic, the presence of frequent insomnia or headache symptoms at the initial session was highly predictive of an inadequate response to psychotherapy (remaining clinically symptomatic at the final session of therapy). This effect was found to be even more pronounced in those with both insomnia and headaches. Study Three was a systematic review and meta-analysis, which assessed the literature on the use of psychological sleep interventions for headaches. The review found only four studies which met criteria for inclusion. In pooling the three studies which were suitable for meta-analysis, a random-effects model demonstrated that psychological sleep interventions (such as Cognitive Behaviour Therapy for Insomnia) reduced the frequency, but overall, not the intensity of primary headaches. Given the small number of studies and overall patients included, this should not be considered a conclusive finding. Taken together, the findings of this thesis demonstrate both cognitive and behavioural factors are at play in sleep-related headaches, and that insomnia and headaches may blunt the therapeutic response to psychotherapy. Reassuringly, however, psychological sleep interventions are known to improve sleep, and this thesis found they also reduce headache frequency. This may mitigate some of the negative effects of sleep and headache problems on psychotherapeutic response. Future research directions (discussed in Chapters Five and Six) should examine the role of sleep behaviours in clinical samples of chronic migraine patients, and assess neurophysiologic markers of sleep-related headaches and subsequent response to therapy (such as EEG power spectrum and sleep architecture), and the pursuit of integrative and modular headache treatments tailored to co-occurring conditions/problems. The original contributions to knowledge from this thesis are the implication of maladaptive sleep beliefs in the sleep-headache relationship, that insomnia and headaches impair psychotherapeutic response – an effect which is additive when both occur, and the first systematic review and meta-analysis of psychological sleep interventions for headaches.<br>Thesis (Professional Doctorate)<br>Doctor of Philosophy in Clinical Psychology (PhD ClinPsych)<br>School of Applied Psychology<br>Griffith Health<br>Full Text
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Mason, Erin. "The role of world view changes in longitudinal associations between depression and PTSD symptoms and later sexual problems." Thesis, Wayne State University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1543711.
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<p> Childhood sexual abuse (CSA) is a risk factor for the development of depression and posttraumatic stress disorder (PTSD) symptoms, as well as sexual problems. Additionally, previous research supports a relationship between symptoms of depression and PTSD and sexual problems in both sexually abused and non-abused samples. There has been little attempt, however, to explain the mechanisms responsible for this relationship. The current study proposed that abuse-related changes in world views might be one such mechanism and examined whether world view changes mediate longitudinal associations between depression and PTSD symptoms and sexual problems (sexual concerns, dysfunctional sexual behavior, and risky sexual behavior). This study is unique in that it considered the effects of both positive and negative world view changes on this relationship. Over half of youth in the study reported at least one world view change, with the preponderance of changes being negative. Thus, youth appear to be cognizant of ways in which their experiences of CSA have affected their beliefs. No straightforward relationship between early abuse reactions and world views emerged, as neither depression nor PTSD predicted world view changes. Although higher levels of symptomatology and stronger world view changes were related to sexual concerns, they were unrelated to dysfunctional or risky sexual behaviors. The reasons for this differentiation could include the nature of constructs or the measures focus on hyper-sexuality. This study contributes to the extant literature by highlighting the implications of CSA experiences for emerging world views and their associations with emerging sexuality.</p>
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Wycherley, Darren. "The application of capillary electrophoresis and mass spectrometry to clinical and environmental problems." Thesis, Open University, 1996. http://oro.open.ac.uk/19806/.
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Using capillary electrophoresis (CE) as a separation technique has allowed analytes, previously difficult to separate by standard methods because they did not conform to requirements for GC or HPLC, to be separated with speed and great efficiency. The only requirements for CE analysis are that the sample is soluble in a liquid matrix and that analytes are present as positive or negative ions whilst in this matrix. This technique has been used here to analyse both clinical and environmental samples, some as cations and others boron-containing complexes as anions. Samples were analysed using a combination of CE alone, mass spectrometry alone and also coupled capillary electrophoresis/electrospray mass spectrometry (CE/ES). Clinically orientated analytes, dipeptides in urine and acylcamitines from blood spots were examined and peaks detected directly via uv absorbance. The environmental samples analysed included those which contained chromophoric or non-chromophoric herbicides as well as those containing diisocyanates. Analytes were either detected in their native form as with the dipeptides and chromophoric herbicides, or more typically after derivatisation to improve their absorbance characteristics. The exception was the non-chromophoric herbicides which were detected via indirect uv. CE was an experimental technique for the analysis of all these compounds, except for the dipeptides, all the others having originally been analysed using HPLC or GC methods. In each case an evaluation of the CE method was performed to determine the suitability of the method. By analysing standards in each case, it was possible to confirm that the technique was suitable for qualitative and quantitative analysis of each class of compound. CE proved to be a viable technique for the separation of all classes of compound dealt with in this thesis. However the method could not be relied upon to confirm the identity of these analytes by their migration time alone. To identify the analytes, experiments were carried out to couple CE with a mass spectrometer. Two techniques of mass spectrometry were used within this thesis, fast atom bombardment and electrospray but only electrospray ionisation mass spectrometry was used to couple to capillary electrophoresis and was the only mass spectrometric technique used to analyse clinical and environmental samples. CE instruments were successfully coupled to an electrospray mass spectrometer which then became the detector. Mass/charge ratio measurements were obtained for each analyte used and these allowed the unambiguous identification of each analyte. Other work involved using CE, ES and FAI3 mass spectrometry, to develop a new technique to detect diol containing compounds. This involved complexing the diol with a boron-containing acid to produce an anion which could then be detected using ES and FAB mass spectrometric methods. This work was viewed as a possible technique for the detection of diol containing lipids found within some body fluids.
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Davison, Elizabeth. "The wounded healer : clinical and counselling psychologists with experience of mental health problems." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12535/.
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This study aimed to explore how the experience of previous mental-health problems affects clinical and counselling psychologists’ approach to practice. Semi-structured interviews were conducted with six clinical and four counselling psychologists who had experienced mental-health difficulties. Data was analysed using Interpretative Phenomenological Analysis. Analysis of the interviews highlighted five master themes: Use of the personal-self of psychologist; Ambivalence; Identity as a psychologist; Psychologists as agent of change; and Finding meaning in suffering. The results of this research showed that psychologists with a history of mental-health problems actively draw upon their experience. In managing their dual identity of service-user and professional, they reported a degree of ambivalence which influenced the way that they viewed themselves and their practice. Their personal experiences seemed to be closely tied up with their professional-identity, which either conflicted with their sense of self or complemented it through highlighting how fortunate they were compared to others. The interviews frequently highlighted how psychologists’ experiences can provide an impetus to speak out for patients’ rights to ensure that they are treated with respect and dignity. A number of psychologists with an experience of mental-health difficulties felt that they might not have pursued their career had they not had previous mental-health difficulties. There appeared to be mixed findings concerning whether the participants felt that their mental-health difficulties had helped or hindered their practice.
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Al-Taani, Ghaith Mohammed Yousef. "Challenges in the provision of clinical pharmacy services to overcome medication-related problems." Thesis, Queen's University Belfast, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.669539.
Full textAbstract:
Pharmaceutical care and medicines management are terms which are often used interchangeably to describe the patient-centred services provided by pharmacists. The programme of research presented within this thesis evaluated a range of topics within this area of endeavour. The extent of pharmaceutical care provision within the community pharmacy setting was examined in a cross-sectional survey in N. Ireland and across 15 European countries. The findings indicated that community pharmacists' provision of comprehensive pharmaceutical care can be deemed as limited in Northern Ireland (mean score 41.4% of the total achievable score) and across Europe (scores ranged from 56.6% in England to 29.4% in Moldova). To inform the development of a definitive RCT for novel post-discharge medicines management clinic (MMC), a feasibility study was carried out, and identified a number of methodological challenges, in particular, challenges around patient recruitment, attrition rates and clinic scheduling. A series of risk assessment models was developed to help with the targeting of patients to be recruited for the RCT referred to above. These models were designed to forecast the likelihood of patient early readmission to hospital (within 30 and 8 to 30 days) and high-cost readmissions. Important risk factors for readmission identified included the Charlson age-adjusted co-morbidity score, respiratory- and genitourinary-related primary diagnoses and number of medications prescribed on discharge, and new patient targeting criteria for the RCT to explore the impact of the MMC was developed. A systematic content analysis revealed that the print media coverage of medicine-related adverse effects requires significant improvement in order to properly inform the public on this matter. Specifically, the reporting of adverse effects, in terms of medicines implicated and organ systems affected, did not correspond with those commonly cited in scientific journal articles. Findings from the present research help contextualise and provide evidence based advice on a number of issues which need to be addressed in pharmaceutical care / medicines management practice and research.
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Foote, Barbaradee. "Predictors of Gambling-Related Problems in Adult Internet Gamblers." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10841287.
Full textAbstract:
<p> The use of the Internet to gamble has become increasingly prevalent in recent years. Although researchers have suggested that adult Internet gamblers are at high risk for developing a gambling disorder, few studies, overall, have been conducted on the effects of Internet gambling. Furthermore, conflicting research exists regarding what moderates gambling-related problems. The purpose of this quantitative study was to determine if age, gender, and emotions prior to the gambling experience are related predictors of Internet problem gambling severity. A retrospective design was used. The pathways model was used to support the belief that emotions felt before an Internet gambling session are associated with the severity of the gambling problem. Data were obtained from adult Internet gamblers who had Internet gambled in the preceding week. One hundred and fifty participants completed an online survey about the emotions they felt before an Internet-gambling session and self-reported the negative consequences of their gambling. The survey contained demographic questions, questions from the Positive and Negative Affect Schedule (to assess emotions felt before participants’ last Internet gambling session), and questions from the Problem Gambling Severity Index. The results of the multiple linear regression analysis were significant, indicating that, as a group, participants’ age, gender, and emotions felt prior to the gambling experience predicted their problem gambling severity. This study can assist with prevention, early intervention, and treatment of adult Internet gamblers.</p><p>
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Gustafsson, Carina. "Intellectual Disability and Mental Health Problems : Evaluation of Two Clinical Assessment Instruments, Occurrence of Mental Health Problems and Psychiatric Care Utilisation." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3531.
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Betz, Gregory. "When the Heroes Become Less Super: Coping with Problems of Professional Competence." Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1421329013.
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Lukens, Colleen Taylor. "Development and validation of an inventory to assess eating and mealtime behavior problems in children with autism." Connect to resource, 2005. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1127133704.
Full textAbstract:
Thesis (Ph. D.)--Ohio State University, 2005.<br>Title from first page of PDF file. Document formatted into pages; contains vii, 101 p. Includes bibliographical references (p. 72-78). Available online via OhioLINK's ETD Center
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Juster, Robert Paul. "A clinical allostatic load index detects stress-related problems in older adults and workers." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92369.
Full textAbstract:
Allostatic load (AL) refers to biological wear and tear caused by chronic psychosocial stress. The AL model proposes that by measuring the multi-systemic interactions among sub-clinically relevant biomarkers, biomedical advances can be made in the detection of individuals at high risk of developing stress-related diseases. By incorporating an AL index encompassing neuroendocrine, immune, metabolic, and cardiovascular biomarkers, a growing body of literature has demonstrated augmented prediction of numerous deleterious outcomes. As it stands, however, the AL index is a research tool that has not been standardized for use by healthcare providers. Using a new AL index based on clinical reference ranges, we investigated physical and psychological outcomes in two studies. In Study 1, 85 older adults were followed longitudinally over six years, while Study 2 included a separate cross-section of 30 younger workers. We hypothesized that increased AL indices based on 7 and 15 biomarkers respectively would relate to increased levels of psychological distress, dysregulated diurnal and reactive stress hormone levels, subjective memory and physical complaints, objective memory impairments, and finally symptoms of depression and burnout. Our results support our hypotheses at different ages. For older adults, higher AL predicted greater depressive symptoms three years in advance with subsequent cognitive complaints and impairments. For younger workers, higher AL was manifested physiologically and symptomatically as a pre-burnout condition without cognitive and physical complaints. These findings provide preliminary support for the utility of a new clinical AL index sensitive to specific stress-related problems throughout the life span that is easily accessible to healthcare providers.<br>La charge allostatique (CA) est la dégradation biologique causée par le stress chronique. Le modèle de la CA propose qu'en mesurant les interactions multi-systémiques de biomarqueurs qui sont sous-cliniquement significatifs, des avancées biomédicales seront possibles afin de détecter les individus à risque de développer différentes maladies. La littérature démontre qu'en utilisant un indice de CA qui inclut des biomarqueurs neuroendocriniens, immunitaires, métaboliques et cardiovasculaires, il est possible de mieux prédire de nombreuses conséquences négatives. Par contre, à ce jour, l'indice de la CA n'est qu'un outil de recherche et n'a pas encore été validé pour l'utilisation médicale. En utilisant un nouvel indice de la CA basé sur des distributions cliniques, nous avons investigué les conséquences physiques et psychologiques du stress chronique dans le cadre de deux études. Dans l'étude 1, 85 adultes âgés ont été suivis longitudinalement pendant six ans, alors que l'étude 2 a été réalisée à une reprise auprès de 30 travailleurs de divers domaines. Notre hypothèse était que des indices élevés de la CA seraient reliés à des niveaux plus élevés de stress psychologique, des niveaux dérégulés de cortisol basal et réactif, des plaintes subjectives de troubles de mémoire et de fonctionnement physique, des déficits de mémoire, et finalement des symptômes de dépression et d'épuisement professionnel. Nos résultats supportent nos hypothèses, mais diffèrent selon l'âge de l'échantillon étudié. Pour les adultes âgés, une CA plus élevée prédisait des symptômes de dépression trois ans en avance ainsi que des plaintes subjectives de mémoire et des déficits cognitifs. Pour les travailleurs plus jeunes, une CA plus élevée se manifestait physiologiquement et symptomatiquement par une condition ressemblant à l'épuisement professionnel sans trouble cognitif ou physique. Ces résultats sont une évidence p
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Myers, Helen Lucy. "Hand problems and hand function : a clinical epidemiological study in community-dwelling older adults." Thesis, Keele University, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.545751.
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Duguid, Anne E. "Managed clinical and care networks (MCNs) and work : an ethnographic study for non-prioritised clinical conditions in NHS Scotland." Thesis, University of St Andrews, 2012. http://hdl.handle.net/10023/3197.
Full textAbstract:
Managed clinical and care networks (MCNs) have emerged in Scotland as a collaborative form of organising within health and between health and social services. Bringing together disparate disciplines and professions their aim has been to allow work across service and sector boundaries to improve care for patients. Whilst MCN prevalence has increased and policy has moved to centralise this method of organising, many research questions remain. These include: how can we understand the form, function and impact of MCNs, and further, what are the underlying motivations for practitioners and managers to organise in this way? Focussing in on the work of 3 voluntary MCNs operating in Scotland, the centrality of practice emerges. Practice is defined broadly to encompass both the interactions between practitioner-patient and practitioner-population. From this, the MCN becomes conceptualised as a set of activities focussed around ground-level clinical MCN service issues and top-level policy direction. Through considering work the interplay between ethics and scientific evidence emerges. The inherent uncertainty and suffering of daily practice comes to the fore, these concepts are brought together within a framework, morals-in-practice. Further, using the hermeneutic dynamics of alterity, openness and transcendence, MCNs can be understood as providing a space to foster creative responses to the wicked problems created by health and social service design and delivery. The organising opportunities provided by MCNs thus arguably serve several organisational and social functions, providing a forum to: mutually support and respond to the intrinsically challenging nature of practice understood; debate morals-in-practice helping to ensuring collective clinical governance; sharing of organisational knowledge; planning, delivery and audit of services; and creatively respond to wicked problems. By focussing in on the work, the practice particularities of each individual MCN are resultantly emphasised, whilst still maintaining recognition that much of the NHS operational context is more widely shared. Through this these voluntary MCNs, at least, can be viewed as an organising form which has emerged in response to the complexities of modern health and social service, care, design and delivery.
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Wilhoit, Sarah. "Destined for Trouble?: A Prospective Analysis of the Effects of Temperament and Parenting on Conduct Problems." University of Dayton / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=dayton1462489452.
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Cooper, Danielle Marissa. "Clarifying the Longitudinal Relations Between Social Anxiety and Depression: Interpersonal Difficulties as an Explanatory Mediator." Ohio University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1557350417344734.
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Haider, Agha Waqar. "Continuous electrocardiographic recording in the assessment of ischaemic heart disease : technical problems and clinical role." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243945.
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Muharam, Firman Alamsyah. "Overcoming problems with limiting DNA samples in forensics and clinical diagnostics using multiple displacement amplification." Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16207/1/Firman_Muharam_Thesis.pdf.
Full textAbstract:
The availability of DNA samples that are of adequate quality and quantity is essential for any genetic analysis. The fields of forensic biology and clinical diagnostic pathology testing often suffer from limited samples that yield insufficient DNA material to allow extensive analysis. This study examined the utility of a recently introduced whole genome amplification method termed Multiple Displacement Amplification (MDA) for amplifying a variety of limited sample types that are commonly encountered in the fields of forensic biology and clinical diagnostics. The MDA reaction, which employs the highly processive bacteriophage φ29 DNA polymerase, was found to generate high molecular weight template DNA suitable for a variety of downstream applications from low copy number DNA samples down to the single genome level. MDA of single cells yielded sufficient DNA for up to 20,000,000 PCR assays, allowing further confirmatory testing on samples of limited quantities or the archiving of precious DNA material for future work. The amplification of
degraded DNA material using MDA identified a requirement for samples of sufficient quality to allow successful synthesis of product DNA templates. Furthermore, the utility of MDA products in comparative genomic hybridisation
(CGH) assays identified the presence of amplification bias. However, this bias was overcome by introducing a novel modification to the MDA protocol. Future directions for this work include investigations into the utility of MDA products in short tandem repeat (STR) assays for human identifications and application of the modified MDA protocol for testing of single cell samples for genetic abnormalities.
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Muharam, Firman Alamsyah. "Overcoming problems with limiting DNA samples in forensics and clinical diagnostics using multiple displacement amplification." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16207/.
Full textAbstract:
The availability of DNA samples that are of adequate quality and quantity is essential for any genetic analysis. The fields of forensic biology and clinical diagnostic pathology testing often suffer from limited samples that yield insufficient DNA material to allow extensive analysis. This study examined the utility of a recently introduced whole genome amplification method termed Multiple Displacement Amplification (MDA) for amplifying a variety of limited sample types that are commonly encountered in the fields of forensic biology and clinical diagnostics. The MDA reaction, which employs the highly processive bacteriophage φ29 DNA polymerase, was found to generate high molecular weight template DNA suitable for a variety of downstream applications from low copy number DNA samples down to the single genome level. MDA of single cells yielded sufficient DNA for up to 20,000,000 PCR assays, allowing further confirmatory testing on samples of limited quantities or the archiving of precious DNA material for future work. The amplification of degraded DNA material using MDA identified a requirement for samples of sufficient quality to allow successful synthesis of product DNA templates. Furthermore, the utility of MDA products in comparative genomic hybridisation (CGH) assays identified the presence of amplification bias. However, this bias was overcome by introducing a novel modification to the MDA protocol. Future directions for this work include investigations into the utility of MDA products in short tandem repeat (STR) assays for human identifications and application of the modified MDA protocol for testing of single cell samples for genetic abnormalities.
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Leite, Celina Luís Ferreira da Costa. "Comunicação com o doente em farmácia clínica." Master's thesis, [s.n.], 2014. http://hdl.handle.net/10284/4871.
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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas<br>O papel do Farmacêutico evoluiu de modo considerável ao longo das últimas
décadas, passando de uma prática focada no medicamento para a de uma relação com o
doente que abrange, entre outros aspetos, a monitorização da medicação. É sabido que a
maioria dos doentes, particularmente, os crónicos, idosos, deficientes e polimedicados,
apresentam baixos níveis de adesão ou de cumprimento do tratamento. A profissão
farmacêutica aceitou a responsabilidade de proporcionar a informação, a educação, o
aconselhamento e a orientação do doente no contexto da assistência farmacêutica, para
motivar e melhorar a adesão do doente à terapêutica, reduzir os problemas relacionados
com medicamentos e, desse modo, prestar uma melhor qualidade na prestação dos
cuidados de saúde.
Nesta dissertação pretende-se, através de uma revisão bibliográfica, relacionar as
competências da comunicação clínica do Farmacêutico com a intervenção farmacêutica
no seguimento do tratamento farmacológico do doente, através da realização da
entrevista clínica, conducente à melhoria da saúde dos doentes. Neste trabalho
relacionam-se as competências de comunicação com a intervenção farmacêutica, uma
vez que a comunicação é um elemento chave na prestação de cuidados de saúde.
A comunicação com o doente em Farmácia Clínica é uma área a desenvolver e a
expandir na prestação de cuidados farmacêuticos, centrando no doente toda a
intervenção que possa repercutir-se no seu benefício clínico. O desenvolvimento deste
conhecimento no ensino deve ser objeto de implementação na carreira universitária,
considerando a sua repercussão no desempenho profissional do Farmacêutico e na
melhoria dos cuidados de saúde prestados em Portugal. Community pharmacist’s work has evolved greatly over the last decades, moving
from a practice essentially based on preparing and dispensing medicines to patients
towards to a clinically based relationship, which compromises monitoring of patient’s
conditions and concomitant medication use. It is known that most patients, particularly
those with chronic illnesses, elderly and deficient people or with multiple medications
have low levels of adherence to the therapy. The pharmacy profession has accepted the
responsibility for providing patient information, education and counselling in the
context of pharmaceutical care to improve adherence to therapy and minimize drug
related problems.
This dissertation is intended, through a literature review, to relate the skills of
clinical communication of the pharmacist with a pharmaceutical intervention to follow
up the pharmacologic effects by conducting clinical interviews, leading to improved
health-related outcomes of the patients. Communication skills have a relationship with
the pharmaceutical intervention, considering it as a key element in the delivery of health
care.
Patient communication in Pharmacy is a developing area to be considered and
expanding in health care, concentrating on the patient the intervention to maximize the
clinical benefit. The development of this knowledge in the educational institution must
be implemented, considering its impact in the professional performance of the
Pharmacist and in the health care benefits in Portugal.
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Woodruff, James Graham. "Sex-Role Stereotyping in Marital Counseling Sex- Role Style and Type of Problem Effects on Clinical Judgments." Thesis, North Texas State University, 1985. https://digital.library.unt.edu/ark:/67531/metadc332056/.
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The analogue study was designed to extend previous research on clinical sex-role stereotyping of individual clients into the realm of marital counseling. The effects of clinician and couple sex-role style and type of marital problem on clinical judgements of couples was examined through ratings of four audiotaped couples constructed from two scripts depicting either couple financial or sexual problems. Each script produced both a stereotypical and counterstereotypical sex-role styled couple through reversal of spouse verbalizations. A sample of 40 (32 male, 8 female) practicing doctorate-level psychologists rated either two stereotypical or two counterstereotypical couples for level of maladjustment, need for treatment, and prognosis. Individual spouse ratings were also obtained to examine client gender effects.
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Fahey, Jeanette Chandlee Williams J. Michael. "Developmental changes in attention performance and their relationship to behavior and school problems /." Philadelphia, Pa. : Drexel University, 2006. http://dspace.library.drexel.edu/handle/1860/740.
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Lora-Tamayo, Morillo-Velarde Jaime. "Antimicrobial therapy in prosthetic joint infection: an approach to the most relevant and current clinical problems." Doctoral thesis, Universitat de Barcelona, 2014. http://hdl.handle.net/10803/145440.
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Prosthetic joint infections (PJI) are defined as difficult-to-treat, mainly due to the presence of bacterial biofilm and other bacterial adaptive forms. An aggressive treatment including surgery and long antimicrobial therapy must be provided, the economical burden of this complication being very important. Thus, PJI constitute a first-order health care problem, and it is expected that the number of infected devices will increase in the future.
Our knowledge on the efficacy of antimicrobial therapy in the setting of PJI mainly derives from experimental models. Clinical studies are very difficult to perform, due to the specialized nature of this infection, the need for a long follow up and the difficulties for collecting patients. Previous case series usually present with small and quite heterogeneous samples, so the conclusions drawn from these studies are not always very reliable.
The clinical studies presented in this thesis have been performed in the setting of the multidisciplinary Bone and Joint Unit of the Hospital Universitario de Bellvitge, which is integrated in the Spanish Network for the Research in Infectious Diseases (REIPI), thus allowing an appropriate clinical approach to PJI. These studies try to answer clinical questions on PJI regarding the efficacy of the antimicrobial treatment. The specific aims have been classified according to the specific surgical approach with which the patients were managed.
A. Antimicrobial therapy in PJI managed with implant retention
A.1. Infection by staphylococci
Aim 1 – To measure the impact of rifampin in the outcome of a large cohort of PJI by S. aureus
Multicenter observational retrospective study of 345 cases of PJI by S. aureus managed with implant retention, including 81 cases by methicillin-resistant S. aureus (MRSA). Overall failure was 45%. Treatment with rifampin was an independent predictor of a favourable outcome, the specific type of staphylococci having a similar
overall prognosis.
Aim 2 – To assess the efficacy of a short schedule of levofloxacin plus rifampin in staphylococcal PJI
Open, comparative, multicenter clinical trial where patients with acute staphylococcal PJI undergoing debridement plus implant retention were randomized to receive either a short treatment of 8 weeks of levofloxacin plus rifampin, or a standard long treatment of 3 months (hip prosthesis) or 6 months (knee prosthesis). Overall success rate was 93% and 65% in the per-protocol and intention-to-treat analysis, respectively, with no significant differences between the two-arms.
Aim 3 – To evaluate daptomycin plus rifampin for fluoroquinolone resistant staphylococcal PJI
Retrospective observational multicenter study of 20 patients with acute staphylococcal PJI undergoing debridement plus implant retention and treated with daptomycin (10 mg/kg/d) plus rifampin for 6 weeks. Two (10%) patients were withdrawn due to toxicity. In the other 18 patients, clinical and microbiological cure were observed in 50% and 73% of cases, respectively. There were no differences as compared with a historical cohort of cases treated with alternative rifampin-based combinations, except for a lesser rate of failure while patients were still under treatment with daptomycin plus rifampin.
A.2. Infection by Gram-negative bacilli
Aim 4 – To assess the impact of fluoroquinolones in the outcome of a large cohort of PJI by Gram-negative bacilli
Observational retrospective multicenter study of 172 cases of PJI by Gram-negative bacilli undergoing debridement plus implant retention. Overall success was 68% after a median follow-up of 25 months. Treatment with ciprofloxacin was an independent predictor of success (79% vs 41%).
A.3. Infection in the elderly
Aim 5 – Comparative evaluation of the antibiotic efficacy in patients carrying total hip prosthesis or hip hemiarthroplasties
Observational retrospective study of 210 patients with hip-PJI, comparing patients carrying either hip-hemiarthroplasties (HHA) or total hip arthroplasties (THA). Patients with HHA were older, had more underlying conditions, and infection by Gram-negative bacilli was more frequent. Overall failure of 123 patients undergoing debridement plus implant retention was 63% after a median follow up of 347 days. While the specific device (HHA or THA) was not associated with a higher likelihood of failure, crude and related mortality were significantly higher in the HHA group.
B. Antimicrobial therapy in PJI managed with implant removal
Aim 6 – To evaluate linezolid in PJI by Gram-positive microorganisms managed with a two-step exchange procedure.
Prospective non-comparative multicenter clinical trial involving 25 patients treated with linezolid for 6 weeks after prosthesis removal. Three (12%) were withdrawn due to toxicity. Among the other 22 (88%) patients, 20 (91%) were considered to be clinically cured. Among them, cultures taken at surgical site at the time of reimplantation were positive in 1 (5%) patient. Thus, clinical and microbiological cure among these 22 patients was 86%.
C. Antimicrobial activity on biofilms of multi-resistant Gram-negative bacilli
Aim 7 – To study the activity of colistin against multi-resistant P. aeruginosa biofilm in an in vitro experimental model.
Based on the CDC Biofilm reactor, the in vitro experiments were conducted during 72 hours, after an initial conditioning phase of 28 hours. Three different strains of P. aeruginosa were used: the referral strain PAO-1 (colistin- and carbapenem-susceptible) and two clinical strains (HUB-1 and HUB-2, both colistin-susceptible and carbapenemresistant).
Two clinically relevant concentrations of colistin were used at constant infusion (1.25 mg/L and 3.50 mg/L), as well as doripenem (as bolus every 8 hours, Cmax 25 mg/L). Monotherapies of colistin produced initial killing followed by regrowth and emergence of colistin-resistance. The combination with doripenem gave place to a more sustained killing and lesser rate of regrowth. Additivity and synergy were observed at different times with the combination therapy. Emergence of colistin resistance was avoided, too. These effects were also observed in the two carbapenem-resistant clinical strains.<br>Las infecciones asociadas a prótesis articulares se han definido como de difícil tratamiento, fundamentalmente por la presencia de biopelículas bacterianas. El abordaje es complejo, pues incluye múltiples cirugías y prolongados tratamientos antibióticos. Por ello y porque se espera un incremento en el número futuro de infecciones, esta patología supone un importante problema para el sistema nacional de salud.
Nuestro conocimiento sobre la eficacia del tratamiento antibiótico en estas infecciones procede fundamentalmente de modelos experimentales. La realización de estudios clínicos es complicada: la mayoría de los realizados incluyen series pequeñas y heterogéneas, y sus resultados son a menudo difíciles de interpretar. Nuestros estudios se han desarrollado en el marco de la multidisciplinar Unidad de Infección Osteoarticular del Hospital Universitario de Bellvitge, integrada en la Red Española para la Investigación en Patología Infecciosa (REIPI), lo cual constituye un marco de aproximación adecuado al problema clínico.
Los estudios incluidos en la presente tesis doctoral intentan responder a distintos problemas clínicos relacionados con la eficacia del tratamiento antibiótico en la infección asociada a prótesis articular. Los objetivos específicos se han dividido de acuerdo con el abordaje quirúrgico empleado.
A. Tratamiento antibiótico en la infección de prótesis articular manejada con retención del implante.
A.1. Infección estafilocócica
Objetivo 1 – Medir el impacto de rifampicina en el pronóstico de una gran cohorte de pacientes con infección protésica por S. aureus, incluyendo MRSA.
Objetivo 2 – Evaluar la eficacia de un tratamiento corto con levofloxacino y rifampicina en la infección estafilocócica de prótesis articular.
Objetivo 3 – Determinar el papel de la combinación de daptomicina más rifampicina para la infección de prótesis articular por estafilococos resistentes a fluoroquinolonas.
A.2. Infección por bacilos Gram-negativos
Objetivo 4 – Medir el impacto de las fluoroquinolonas en el pronóstico de una gran cohorte de pacientes con infección protésica por bacilos Gramnegativos.
A.3. Infección de prótesis articular en ancianos
Objetivo 5 – Análisis comparativo de la eficacia antibiótica en pacientes portadores de hemiartroplastia de cadera frente a pacientes con prótesis total de cadera.
B. Tratamiento antibiótico en la infección de prótesis articular manejada con retirada del implante.
Objetivo 6 – Evaluar el papel de linezolid en la infección de prótesis articular por microorganismos Gram-positivos manejada con un recambio en 2 tiempos.
C. Actividad antimicrobiana en biopelículas de microorganismos Gram negativos multirresistentes.
Objetivo 7 – Evaluación de la actividad de colistina frente a biofilm de P. aeruginosa multirresistente en un modelo experimental in vitro.
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Pathy, Kala. "Bioavailability problems in clinical neuropharmacology with special reference to (1) generic phenytoin and (2) madopar HBS." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1994. http://hub.hku.hk/bib/B31214551.
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Birch, Stephen John. "An exploration with proposed solutions of the problems and issues in conducting clinical research in acupuncture." Thesis, University of Exeter, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.284782.
Full textAbstract:
Many controlled clinical trials of acupuncture have been conducted since the mid 1970s, however, there is almost universal agreement that the quality of these trials has been poor. Previous reviews have exposed many problems in the quality of the clinical trials. While some recent trials have addressed these concerns, these improved methodologies have still not addressed other key problems. This study systematically exposes other problems in published clinical trials of acupuncture, proposes solutions to those problems, and then tests the solutions in a controlled clinical trial of acupuncture for neck pain. Key among the new problems that are exposed are problems with adequacy of knowledge about the nature and practice of acupuncture, consequent problems with the adequacy of the tested acupuncture treatments, problems with the appropriateness of the control needling procedures when so-called "sham" acupuncture is used, and problems with the generalizability of results from these studies. Proposals for improving the ability to control for the non-specific effects of treatment are also developed. Chapters one through three document the nature of the field and problems in common representations about the field, discussing previous studies and their reviews, developing new criteria for conducting clinical trials of acupuncture by documenting problems not systematically described before. Chapter four discusses the importance of assessing the reliability of diagnosis, and presents the design and results of preliminary studies investigating this. Chapter five presents strategies for addressing each methodological criteria developed in Chapters two and three. Chapter six presents the design of a controlled trial of acupuncture for neck pain. Chapter seven presents analysis and results of that trial. Chapter eight discusses those results in light of the goals of the overall study and details plans for improving the methodology for future trials. The trial found results suggesting a treatment effect that appears not to be attributable to non-specific effects alone, and succesfully piloted the methodology developed for clinical trials of acupuncture. This methodology with modifications could be useful for future trials. This study was funded by an intramural grant from the Research Committee of the Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Supplies for the study were donated by the Seirin Needle Company, Tokyo, Japan.
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Thomas, P. H. "Studies on the pharmaceutical and clinical problems associated with the storage and administration of intravenous solutions." Thesis, Cardiff University, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.372586.
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Shawler, Paul. "Does early intervention reduce the risk of future emotional and behavioral problems in children with autism spectrum disorder." Thesis, Oklahoma State University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10190272.
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<p> <b>Objective:</b> Early Intensive Behavioral Intervention (EIBI) is the leading recommended treatment for children with Autism Spectrum Disorder (ASD). Children with ASD are at a substantially higher risk for developing symptoms associated with additional psychopathology compared to typically developing children. Currently, little is known about the utility of EIBI on symptoms of additional psychopathology. This study aimed to assess if EIBI would serve as a preventative treatment for the development of symptoms associated with additional psychopathology in a sample of young children with ASD. <b> Method:</b> This study was part of a larger multicenter, 2-year, two-arm randomized clinical trial (RCT) evaluating the effectiveness of Project DATA [Developmentally Appropriate Treatment for Autism] Toddler Model, an inclusive based EIBI for young child with ASD, as compared to Services as Usual (SAU). Fifty-one children between the ages of 20 and 35 months with an Autism Spectrum Disorder were assessed at pretreatment and approximately a year into service. Children’s intellectual ability, level of ASD symptoms, and emotional and behavioral symptoms were assessed at both assessment points. <b>Results: </b> Groups were equivalent on all dependent variables at pretreatment. A one-way multivariate analysis of variance (MANOVA) did not reveal an overall treatment effect when groups were compared simultaneously across level of ASD symptoms, intellectual functioning, and emotional and behavior symptoms. Univariate analyses demonstrated that EIBI resulted in significantly higher child intellectual functioning compared to SAU at post. No significant differences for level of ASD symptoms or emotional or behavioral symptoms indicative of additional psychopathology were revealed between groups at post. <b> Conclusion:</b> EIBI appears to influence child intellectual functioning, but may not have an effect on other important areas of child well-being. The utility of EIBI for children with ASD and additional psychopathology is discussed. More research is needed to identify the impact EIBI has on children with ASD. Particular focus should be given to symptoms of additional psychopathology and emerging treatments for children with ASD.</p>
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Peterman, Jeremy Scott. "The Effects of Cognitive-Behavioral Therapy for Youth Anxiety on Sleep Problems." Diss., Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/401478.
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Psychology<br>Ph.D.<br>Research supports shared neurological, cognitive, and environmental features among youth with sleep-related problems (SRPs) and anxiety. Despite overlap in interventions for SRPs and anxiety, little is known about the secondary benefit on SRPs following anxiety-focused treatment. The present study examined whether SRPs improved following cognitive-behavioral therapy (CBT) for youth with anxiety disorders. It also examined whether variables that may link anxiety and sleep problems (e.g. pre-sleep arousal, family accommodation, sleep hygiene) changed across treatment, and whether said changes predicted SRPs at posttreatment. Youth were diagnosed with anxiety at pretreatment and received weekly CBT that targeted their principal anxiety diagnosis at one of two specialty clinics (N = 69 completers, Mage = 10.86, 45% males). Youth completed a sleep diary between pretreatment and session one and again one week prior to posttreatment. All other measures were administered in the first session and at the posttreatment assessment. Results indicated that parent-reported SRPs improved from pre- to post-treatment and that treatment responders yielded greater improvement than nonresponders. Specific areas of bedtime resistance and sleep anxiety showed significant improvement. Youth reported lower rates of SRPs and no pre- to post-treatment changes. Pre-sleep arousal and parental accommodation decreased over treatment but did not predict lower SRPs at posttreatment. However, higher accommodation positively correlated with greater SRPs. Sleep hygiene evidenced no change and did not mediate accommodation and posttreatment SRPs. Clinical implications for the treatment of anxious youth are discussed and suggestions for future research are offered.<br>Temple University--Theses
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Nardini, C. "STATISTICS IN CLINICAL TRIALS: OUT OF CONDITION. SOME PROBLEMS OF UNCONDITIONAL INFERENCEAT THE CROSSROADS OF METHODOLOGY AND ETHICS." Doctoral thesis, Università degli Studi di Milano, 2013. http://hdl.handle.net/2434/218889.
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Randomized controlled trials are experiments for the evaluation of a new treatment option, currently representing the "gold standard" in health care assessment. Clinical trials fulfill a double role of evidence production and of regulatory oversight in sanctioning new drugs' approval into the drug market.
For this reason trials are large and tightly regulated enterprises that have to comply with ethical requirements while at the same time maintaining high epistemic standards, in a balance that becomes increasingly difficult to strike as research questions become more and more sophisticated.
The statistical framework adopted for designing and analysing trials represents a relevant part of this architecture. Statististical methodology influences such aspects as which inferences are licensed on the basis of data and what is the degree of support granted to an hypothesis. Thus, statistics plays a fundamental role as a gatekeeper both in warranting the ethical permissibility of a trial, and in licensing conclusions about the most effective treatment.
Certain widely-accepted statistical principles have an impact on the way results from medical studies are evaluated.
One such principle is conditioning, i.e. the possibility to incorporate an assessment of strength of evidence in inferential statements of confidence. Currently, conditioning is not part of the statistical method in use, although it is upheld by alternative statistical paradigms such as the Bayesian. In my thesis I analyze the impact of conditioning upon the ethical, epistemic and regulatory facets of trials and I suggest the possibility of incorporating conditioning within the current statistical paradigm of clinical research.
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Gunther, Steven. "Preschools, Pencils, Promise| Cognitive Functioning, Academic Achievement, and Behavior Problems as Correlates of Inhibitory Control Among Head Start Participants." Thesis, Alliant International University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10281603.
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<p> The Pencil-tapping Task is an assessment of key neuropsychological components such as cognitive inhibitory control (Smith-Donald, Raver, Hayes, & Richardson, 2007), attention, and working memory (Xue, Atkins-Burnett, Caronongan, & Moiduddin, 2011). These constructs are parts of executive function, which governs the brain’s ability to analyze and respond to its own processes. Given that executive function has been linked to number knowledge, expressive and receptive vocabulary, and classroom engagement (Fitzpatrick & Pagani, 2012), we may expect tests of executive function and its development to correlate with tests of cognitive functioning, academic achievement, and classroom behavior problems. This study, an analysis of archival data from the Head Start Family and Child Experiences Survey of 2009, seeks to find connections between inhibitory control, cognitive function, academic achievement, and behavior in one of the largest studies ever to feature the relatively new Pencil-tapping Task. </p><p> The central variable in this study, the Pencil-tapping Task, is used as an operationalization of inhibitory control development. Research questions seek to identify relationships between this task, a measure of receptive vocabulary development called the Peabody Picture Vocabulary Test (Dunn & Dunn, 2007), a measure of expressive vocabulary development called the Expressive One-Word Picture Vocabulary Test (Brownell, 2000), measures of language and mathematics skill development contained within the Woodcock-Johnson-III battery (McGrew & Woodcock, 2001), and measures of behavioral control observed by Head Start classroom teachers (West, Tarullo, Aikens, Malone, & Carlson, 2011). </p><p> Multi-level, simple regressions demonstrated that a measure of inhibitory control significantly predicted variance on measures of functioning, achievement, and classroom behavior problems. Large effect sizes were observed for the relationship between inhibitory control and cognitive functioning, as well as the relationship between race/ethnicity and cognitive functioning. These results are similar to those obtained by other researchers of preschool executive function development, and provide support for a general model of executive function predicting both cognitive functioning, academic achievement, and classroom behavior.</p><p>
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Hennessy, Kym. "Pre-clinical development of a podiatry-led complex intervention for foot problems in people with rheumatoid arthritis." Thesis, Glasgow Caledonian University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.636481.
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Foot and ankle involvement in rheumatoid arthritis (RA) is common, and frequently impacts negatively on quality of life. Systemic interventions reduce overall disease activity. However, foot problems may continue even after reaching clinical remission. Therefore, non-pharmacological interventions are commonly utilised concurrently. These interventions have generally been investigated singularly, which does not reflect clinical practice. Thus, a complex intervention study investigating foot and ankle care in RA is needed. Prior to complex intervention study development, theoretical and evidence-based data is required to underpin the design. Therefore, the aim of this research was to provide this data through identifying the current evidence for the clinical effectiveness of foot and ankle care for people with RA, and determining the extent to which this evidence underpins current clinical practice guidelines, stakeholder attitudes and beliefs towards treatment and the interventions used in routine practice. To achieve this aim, three research components were chosen to be used in a mixed methods approach. The individual research components were essential for showing the current evidence base for nonp-harmacological management of the foot and ankle in RA, identifying the minimal clinical standard required in a complex intervention, and determining the views of the major stakeholders regarding foot and ankle care in RA and identifying if these views were reflected in current practice. This in turn showed the complexity of an intervention of this nature and helped to determine the required components and design considerations for a complex intervention study.