Petri Net Siphon Analysis and Network Centrality Measures for Identifying Combination Therapies in Signaling Pathways

Aberrant behavior of biological signaling pathways has been implicated in diseases such as cancers. Therapies have been developed to target proteins in these networks in the hope of curing the illness or bringing about remission. However, identifying targets for drug inhibition that exhibit good therapeutic index has proven to be challenging since signaling pathways have a large number of components and many interconnections such as feedback, crosstalk, and divergence. Unfortunately, some characteristics of these pathways such as redundancy, feedback, and drug resistance reduce the efficacy of single drug target therapy and necessitate the employment of more than one drug to target multiple nodes in the system. However, choosing multiple targets with high therapeutic index poses more challenges since the combinatorial search space could be huge. To cope with the complexity of these systems, computational tools such as ordinary differential equations have been used to successfully model some of these pathways. Regrettably, for building these models, experimentally-measured initial concentrations of the components and rates of reactions are needed which are difficult to obtain, and in very large networks, they may not be available at the moment. Fortunately, there exist other modeling tools, though not as powerful as ordinary differential equations, which do not need the rates and initial conditions to model signaling pathways. Petri net and graph theory are among these tools. In this thesis, we introduce a methodology based on Petri net siphon analysis and graph network centrality measures for identifying prospective targets for single and multiple drug therapies. In this methodology, first, potential targets are identified in the Petri net model of a signaling pathway using siphon analysis. Then, the graph-theoretic centrality measures are employed to prioritize the candidate targets. Also, an algorithm is developed to check whether the candidate targets are able to disable the intended outputs in the graph model of the system or not. We implement structural and dynamical models of ErbB1-Ras-MAPK pathways and use them to assess and evaluate this methodology. The identified drug-targets, single and multiple, correspond to clinically relevant drugs. Overall, the results suggest that this methodology, using siphons and centrality measures, shows promise in identifying and ranking drugs. Since this methodology only uses the structural information of the signaling pathways and does not need initial conditions and dynamical rates, it can be utilized in larger networks.

Dealing with Shifting Labor Employment Sands

Changes in regulations and tighter interpretations of existing regulations engaged participants in 14th annual Labor and Employment Roundtable, hosted by the Cornell Institute for Hospitality Labor and Employment Relations. They also reviewed changes in union organizing rules. Two Supreme Court decisions dealt with the challenging application of accommodating workers’ health and religious needs, while a new ruling by the National Labor Relations Board calls into question the supposedly arm’s length relationship of employee leasing firms and their clients, as well as franchisors and franchisees. The NLRB also has shortened the campaign time for union elections. In one Supreme Court case, Young v. United Parcel Services, Inc., the Court pointed to a simple principle when employers implement policies for those with illness or medical conditions. Policies must be consistent with regard to how on-job and off-job health issues are treated, and the company’s policy must not be driven by economic considerations. That is, the Court stated that an employer’s denial of a light-duty assignment for an employee could not be based on cost or convenience. The case relating to religious accommodation also involved an economic hinge. In an earlier case, the Court had held that religious accommodations are limited to that which would have no more than a de minimus cost on the employer. In this case, EEOC v. Abercrombie & Fitch Stores Inc., Abercrombie had declined to hire a woman wearing a headscarf on the assumption that she would need a religious accommodation. The Court frowned on the idea that an employer would take religious accommodations into account when deciding whether to hire a person. The franchising industry is attempting to make sense of the NLRB ruling regarding joint employment, in which the board ruled that franchisors that maintain some kind of control over their franchisees’ employees should be considered joint employers of those employees. This is a complicated matter, and the situation is still in flux. Finally, with regard to the telescoped union campaign ruling, these are supposed to benefit the unions. So far, however, there’s no indication that the change has affected the overall outcome of union election campaigns.

Public Attitudes and Perceptions toward the NCRMD Defense

In Canada today, a person who performs an illegal act that is deemed to be the result of a mental illness is eligible for the not criminally responsible on account of mental disorder (NCRMD) defense. This defense can remove the blame and responsibility from an individual for an act that would otherwise be considered criminal. The present study examines possible factors that may influence people’s opinions on the defense and the treatment of mentally ill offenders in general. A sample of 257 participants (190 women, 38 men, 29 gender unknown) with ages ranging from 18-73 (M = 26.59, SD = 12.59) completed an online survey that assessed attitudes, opinions, and knowledge of mental illness, mentally ill offenders, and the NCRMD defense. Results showed that several factors were related to how positive or negative participants considered the defense to be, including experience with mental illness or the justice system and knowledge of schizophrenia or the sentences associated with the NCRMD defense. Findings suggest education is important in attaining more positive views of mentally ill offenders and the NCRMD defense.

Programa Nacional de Vigilância da Gripe: relatório da época 2015/2016

O vírus da gripe é uma das maiores causas de morbilidade e mortalidade em todo o mundo, afetando um elevado número de indivíduos em cada ano. Em Portugal a vigilância epidemiológica da gripe é assegurada pelo Programa Nacional de Vigilância da Gripe (PNVG), através da integração da informação das componentes clínica e virológica, gerando informação detalhada relativamente à atividade gripal. A componente clínica é suportada pela Rede Médicos-Sentinela e tem um papel especialmente relevante por possibilitar o cálculo de taxas de incidência permitindo descrever a intensidade e evolução da epidemia de gripe. A componente virológica tem por base o diagnóstico laboratorial do vírus da gripe e tem como objetivos a deteção e caraterização dos vírus da gripe em circulação. Para o estudo mais completo da etiologia da síndrome gripal foi efectuado o diagnóstico diferencial de outros vírus respiratórios: vírus sincicial respiratório tipo A (RSV A) e B (RSV B), o rhinovírus humano (hRV), o vírus parainfluenza humano tipo 1 (PIV1), 2 (PIV2) e 3 (PIV3), o coronavírus humano (hCoV), o adenovírus (AdV) e o metapneumovirus humano (hMPV). Desde 2009 a vigilância da gripe conta também com a Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe que atualmente é constituída por 15 hospitais onde se realiza o diagnóstico laboratorial da gripe. A informação obtida nesta Rede Laboratorial adiciona ao PNVG dados relativos a casos de doença respiratória mais severa com necessidade de internamento. Em 2011/2012, foi lançado um estudo piloto para vigiar os casos graves de gripe admitidos em Unidades de Cuidados Intensivos (UCI) que deu origem à atual Rede de vigilância da gripe em UCI constituída em 2015/2016 por 31 UCI (324 camas). Esta componente tem como objetivo a monitorização de novos casos de gripe confirmados laboratorialmente e admitidos em UCI, permitindo a avaliação da gravidade da doença associada à infeção pelo vírus da gripe. O Sistema da Vigilância Diária da Mortalidade constitui uma componente do PNVG que permite monitorizar a mortalidade semanal por “todas as causas” durante a época de gripe. É um sistema de vigilância epidemiológica que pretende detetar e estimar de forma rápida os impactos de eventos ambientais ou epidémicos relacionados com excessos de mortalidade. A notificação de casos de Síndrome Gripal (SG) e a colheita de amostras biológicas foi realizada em diferentes redes participantes do PNVG: Rede de Médicos-Sentinela, Rede de Serviços de Urgência/Obstetrícia, médicos do Projeto EuroEVA, Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe e Rede vigilância da gripe em UCI. Na época de vigilância da gripe de 2015/2016 foram notificados 1.273 casos de SG, 87% dos quais acompanhados de um exsudado da nasofaringe para diagnóstico laboratorial. No inverno de 2015/2016 observou-se uma atividade gripal de baixa intensidade. O período epidémico ocorreu entre a semana 53/2015 e a semana 8/2016 e o valor mais elevado da taxa de incidência semanal de SG (72,0/100000) foi observado na semana 53/2015. De acordo com os casos notificados à Rede Médicos-Sentinela, o grupo etário dos 15 aos 64 anos foi o que apresentou uma incidência cumulativa mais elevada. O vírus da gripe foi detetado em 41,0% dos exsudados da nasofaringe recebidos tendo sido detetados outros vírus respiratórios em 24% destes. O vírus da gripe A(H1)pdm09 foi o predominantemente detetado em 90,4% dos casos de gripe. Foram também detetados outros vírus da gripe, o vírus B - linhagem Victoria (8%), o vírus A(H3) (1,3%) e o vírus B- linhagem Yamagata (0,5%). A análise antigénica dos vírus da gripe A(H1)pdm09 mostrou a sua semelhança com a estirpe vacinal 2015/2016 (A/California/7/2009), a maioria dos vírus pertencem ao novo grupo genético 6B.1, que foi o predominantemente detetado em circulação na Europa. Os vírus do tipo B apesar de detetados em número bastante mais reduzido comparativamente com o subtipo A(H1)pdm09, foram na sua maioria da linhagem Victoria que antigenicamente se distinguem da estirpe vacinal de 2015/2016 (B/Phuket/3073/2013). Esta situação foi igualmente verificada nos restantes países da Europa, Estados Unidos da América e Canadá. Os vírus do subtipo A(H3) assemelham-se antigenicamente à estirpe selecionada para a vacina de 2016/2017 (A/Hong Kong/4801/2014). Geneticamente a maioria dos vírus caraterizados pertencem ao grupo 3C.2a, e são semelhantes à estirpe vacinal para a época de 2016/2017. A avaliação da resistência aos antivirais inibidores da neuraminidase, não revelou a circulação de estirpes com diminuição da suscetibilidade aos inibidores da neuraminidase (oseltamivir e zanamivir). A situação verificada em Portugal é semelhante à observada a nível europeu. A percentagem mais elevada de casos de gripe foi verificada nos indivíduos com idade inferior a 45 anos. A febre, as cefaleias, o mal-estar geral, as mialgias, a tosse e os calafrios mostraram apresentar uma forte associação à confirmação laboratorial de um caso de gripe. Foi nos doentes com imunodeficiência congénita ou adquirida que a proporção de casos de gripe foi mais elevada, seguidos dos doentes com diabetes e obesidade. A percentagem total de casos de gripe em mulheres grávidas foi semelhante à observada nas mulheres em idade fértil não grávidas. No entanto, o vírus da gripe do tipo A(H1)pdm09 foi detetado em maior proporção nas mulheres grávidas quando comparado as mulheres não grávidas. A vacina como a principal forma de prevenção da gripe é especialmente recomendada em indivíduos com idade igual ou superior a 65 anos, doentes crónicos e imunodeprimidos, grávidas e profissionais de saúde. A vacinação antigripal foi referida em 13% dos casos notificados. A deteção do vírus da gripe ocorreu em 25% dos casos vacinados e sujeitos a diagnóstico laboratorial estando essencialmente associados ao vírus da gripe A(H1)pdm09, o predominante na época de 2015/2016. Esta situação foi mais frequentemente verificada em indivíduos com idade compreendida entre os 15 e 45 anos. A confirmação de gripe em indivíduos vacinados poderá estar relacionada com uma moderada efetividade da vacina antigripal na população em geral. A informação relativa à terapêutica antiviral foi indicada em 67% casos de SG notificados, proporção superior ao verificado em anos anteriores. Os antivirais foram prescritos a um número reduzido de doentes (9,0%) dos quais 45.0% referiam pelo menos a presença de uma doença crónica ou gravidez. O antiviral mais prescrito foi o oseltamivir. A pesquisa de outros vírus respiratórios nos casos de SG negativos para o vírus da gripe, veio revelar a circulação e o envolvimento de outros agentes virais respiratórios em casos de SG. Os vírus respiratórios foram detetados durante todo o período de vigilância da gripe, entre a semana 40/2015 e a semana 20/2016. O hRV, o hCoV e o RSV foram os agentes mais frequentemente detetados, para além do vírus da gripe, estando o RSV essencialmente associado a crianças com idade inferior a 4 anos de idade e o hRV e o hCoV aos adultos e população mais idosa (≥ 65 anos). A Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe, efetuou o diagnóstico da gripe em 7443 casos de infeção respiratória sendo o vírus da gripe detetado em 1458 destes casos. Em 71% dos casos de gripe foi detetado o vírus da gripe A(H1)pdm09. Os vírus da gripe do tipo A(H3) foram detetados esporadicamente e em número muito reduzido (2%), e em 11% o vírus da gripe A (não subtipado). O vírus da gripe do tipo B foi detetado em 16% dos casos. A frequência de cada tipo e subtipo do vírus da gripe identificados na Rede Hospitalar assemelha-se ao observado nos cuidados de saúde primários (Rede Médicos-Sentinela e Serviços de Urgência). Foi nos indivíduos adultos, entre os 45-64 anos, que o vírus A(H1)pdm09 representou uma maior proporção dos casos de gripe incluindo igualmente a maior proporção de doentes que necessitaram de internamento hospitalar em unidades de cuidados intensivos. O vírus da gripe do tipo B esteve associado a casos de gripe confirmados nas crianças entre os 5 e 14 anos. Outros vírus respiratórios foram igualmente detetados sendo o RSV e os picornavírus (hRV, hEV e picornavírus) os mais frequentes e em co circulação com o vírus da gripe. Durante a época de vigilância da gripe, 2015/2016, não se observaram excessos de mortalidade semanais. Nas UCI verificou-se uma franca dominância do vírus da gripe A(H1)pdm09 (90%) e a circulação simultânea do vírus da gripe B (3%). A taxa de admissão em UCI oscilou entre 5,8% e 4,7% entre as semanas 53 e 12 tendo o valor máximo sido registado na semana 8 de 2016 (8,1%). Cerca de metade dos doentes tinha entre 45 e 64 anos. Os mais idosos (65+ anos) foram apenas 20% dos casos, o que não será de estranhar, considerando que o vírus da gripe A(H1)pdm09 circulou como vírus dominante. Aproximadamente 70% dos doentes tinham doença crónica subjacente, tendo a obesidade sido a mais frequente (37%). Comparativamente com a pandemia, em que circulou também o A(H1)pdm09, a obesidade, em 2015/2016, foi cerca de 4 vezes mais frequente (9,8%). Apenas 8% dos doentes tinha feito a vacina contra a gripe sazonal, apesar de mais de 70% ter doença crónica subjacente e de haver recomendações da DGS nesse sentido. A taxa de letalidade foi estimada em 29,3%, mais elevada do que na época anterior (23,7%). Cerca de 80% dos óbitos ocorreram em indivíduos com doença crónica subjacente que poderá ter agravado o quadro e contribuído para o óbito. Salienta-se a ausência de dados históricos publicados sobre letalidade em UCI, para comparação. Note-se que esta estimativa se refere a óbitos ocorridos apenas durante a hospitalização na UCI e que poderão ter ocorrido mais óbitos após a alta da UCI para outros serviços/enfermarias. Este sistema de vigilância da gripe sazonal em UCI poderá ser aperfeiçoado nas próximas épocas reduzindo a subnotificação e melhorando o preenchimento dos campos necessários ao estudo da doença. A época de vigilância da gripe 2015/2016 foi em muitas caraterísticas comparável ao descrito na maioria dos países europeus. A situação em Portugal destacou-se pela baixa intensidade da atividade gripal, pelo predomínio do vírus da gripe do subtipo A(H1)pdm09 acompanhada pela deteção de vírus do tipo B (linhagem Victoria) essencialmente no final da época gripal. A mortalidade por todas as causas durante a epidemia da gripe manteve-se dentro do esperado, não tendo sido observados excessos de mortalidade. Os vírus da gripe do subtipo predominante na época 2015/2016, A(H1)pdm09, revelaram-se antigénicamente semelhantes à estirpe vacinal. Os vírus da gripe do tipo B detetados distinguem-se da estirpe vacinal de 2015/2016. Este facto conduziu à atualização da composição da vacina antigripal para a época 2016/2017. A monitorização contínua da epidemia da gripe a nível nacional e mundial permite a cada inverno avaliar o impacto da gripe na saúde da população, monitorizar a evolução dos vírus da gripe e atuar de forma a prevenir e implementar medidas eficazes de tratamento da doença, especialmente quando esta se apresenta acompanhada de complicações graves.

Speeding stroke recovery? A systematic review of amphetamine after stroke

Introduction: The use of drugs to enhance recovery (“rehabilitation pharmacology”) has been assessed. Amphetamine can improve outcome in experimental models of stroke, and several small clinical trials have assessed its use in stroke. Methods: Electronic searches were performed to identify randomised controlled trials of amphetamine in stroke (ischaemic or haemorrhagic). Outcomes included functional outcome (assessed as combined death or disability/dependency), safety (death) and haemodynamic measures. Data were analysed as dichotomous or continuous outcomes, using odds ratios (OR), weighted or standardised mean difference, (WMD or SMD) using random-effects models with 95% confidence intervals (95% CI); statistical heterogeneity was assessed. Results: Eleven completed trials (n=329) were identified. Treatment with amphetamine was associated with non-significant trends to increased death (OR 2.78 (95% CI, 0.75– 10.23), n=329, 11 trials) and improved motor scores (WMD 3.28 (95% CI −0.48–7.04) n=257, 9 trials) but had no effect on the combined outcome of death and dependency (OR 1.15 (95% CI 0.65–2.06, n=206, 5 trials). Amphetamine increased systolic blood pressure (WMD 9.3 mmHg, 95% CI 3.3–15.3, n=106, 3 trials) and heart rate (WMD 7.6 beats per minute (bpm), 95% CI 1.8–13.4, n=106, 3 trials). Despite variations in treatment regimes, outcomes and follow-up duration there was no evidence of significant heterogeneity or publication bias. Conclusion: No evidence exists at present to support the use of amphetamine after stroke. Despite a trend to improved motor function, doubts remain over

Anthropometric characteristics and the burden of altered nutritional status among neuropsychiatric patients at Zomba Mental Hospital in Zomba, Malawi

Objective To determine the prevalence of overnutrition and undernutrition among neuropsychiatric inpatients and outpatients at Zomba Mental Hospital in Zomba, Malawi. Methods In this analytical cross-sectional study (n = 239), data were collected from psychiatric patients who were either inpatients (n = 181) or outpatients (n = 58) at Zomba Mental Hospital, which is the largest mental health facility in Malawi. Information was collected about patient demographics, anthropometric data, dietary information, and tobacco and alcohol use, among other variables. Data were entered and analysed in SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Means were generated and compared between male and female patients, and between inpatients and outpatients. Results The study recruited 158 male and 81 female patients, with mean ages of 31.24 ± 11.85 years and 33.08 ± 15.18 years (p = 0.328), respectively. Male patients were significantly taller (165.27 ± 7.25 cm) than female patients (155.30 ± 6.56 cm) (p < 0.001); were significantly heavier than females (60.02 ± 10.56 kg versus 55.64 ± 10.53 kg); and had a significantly lower mean body mass index (BMI) than females (21.87 ± 3.21 vs. 23.01 ± 3.78) (p = 0.016). Overweight and obese patients comprised 17.6% of the participants, and 8.8% were underweight. There were no significant differences in the prevalence of overweight, obesity, and underweight between male and female participants, or between inpatients and outpatients. Conclusion Our study—the first one of its kind in Malawi—characterised the anthropometry of neuropsychiatric patients at a major metal health facility in Malawi, and has shown a high proportion of overweight patients and a notable presence of underweight patients among them. Being overweight or obese is a risk factor for metabolic disorders. Being underweight may aggravate mental illness or disturb the effect of medication. There is need, therefore, to include nutrition screening and therapeutic or supplementary feeding as part of a comprehensive care and treatment plan for neuropsychiatric patients.

A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre, Malawi

Aim To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables. Methods We conducted a proof-of-concept cross-sectional study, involving 105 healthy blood donors at Malawi Blood Transfusion Service in Blantyre. Eligible participants were HIV-negative males and females, aged 19 to 35 years, who did not have any evidence of acute or chronic illness, or bloodborne infection. We performed the haematological tests at the Malawi-Liverpool Wellcome Trust laboratory in Blantyre, and the screening tests at Malawi Blood Transfusion Service laboratories. Results Out of 170 consenting healthy volunteers, haematological results were available for 105 participants. The proportions of results which were below the lower limit of the manufacturer’s reference ranges were 35.2% (37/105) for haemoglobin, 15.2% (16/105) for neutrophils, 23.8% (25/105) for eosinophils, and 88.6 % (93/105) for basophils. The proportions of results that were above the upper limit of the manufacturer’s reference ranges were 9.5% (10/105) for platelets and 12.4% (13/105) for monocytes. We also observed that the mean leucocyte and basophil counts were significantly higher in males than females (p = 0.042 and p = 0.015, respectively). There were no statistically significant differences in haematological results observed among different ethnic, age, and body mass index groups. Conclusions Over half of otherwise healthy study participants had at least one abnormal haematological result, using previously established foreign standards. More detailed studies are needed to establish locally relevant normal ranges for different age groups and other demographic characteristics of the Malawian population. This will lead to accurate interpretation of laboratory results.

Estrategias de afrontamiento familiar que los padres utilizan ante las pérdidas afectivas de los niños por separación

El siguiente estudio tiene como objetivo principal describir las estrategias de afrontamiento familiar que los padres utilizan ante las pérdidas afectivas de los niños por separación, con fundamento en el modelo estructural de Salvador Minuchín. En esta investigación participaron cinco familias monoparentales. El enfoque de la investigación es cualitativo; se aplicó la escala F-Copes para identificar cómo la familia maneja sus problemas y afronta las demandas que surgen de la separación o divorcio, seguido de una entrevista semiestructurada, la misma que demostró que cuando surge la separación conyugal trae uno o varios cambios en la estructura familiar y, en la relación entre los subsistemas los individuos modifican sus rutinas y se crea una nueva organización. El estudio muestra cómo las potencialidades de estas familias avanzan tejiendo internamente estrategias adaptativas que regulan el equilibrio emocional y relacional del sistema hacia las vicisitudes o desafíos del ciclo vital y de la vida misma; que para afrontar las pérdidas afectivas, uno de los mecanismos de afrontamiento es la alianza entre hermanos, lo que contribuye a una estrategia funcional permitiendo una relación benéfica con vínculos asertivos. Concluyendo que el contexto que rodea al niño es esencial para el desarrollo de estrategias de afrontamiento durante la infancia y las etapas subsiguientes.

The importance of parental involvement in swimming lessons for person with disability

The Ecolological Theory of Human Development proposed by Urie Bronfenbrenner assumes that the activities and people involved in an evironment are essential to stimulate the aquisition of new abilities . Analyze the strategy of parent’s presence with their children in a swimming class for PWD during the teaching process. Also, verify the parent’s views on this experience and the participation of their child during practice. It is a qualitative and action-research. To collect data was utilized observation during to analyse the activities developed in a swimming class for PWD, on the presence of parents with their children. A semi-structured interview was used to analyse the perception parents after the experience of the classroom. Analysis of activities and the interview were based on the assumption of Bronfenbrenner (1996). It was found that 100% of the parents rated the positive experience of being with their children in the pool. We found that only 25% of parents reported that had entered the pool to play with their children. We emphasize that 75% had never entered in the water with their children, whether because of fear, lack of opportunity or not knowing how to swim. The proposal of parents’ participation in the swimming class with the PWD generated a favorable environment for development the activities. Parents identified the improvement, the potential and difficulties of PWD.

Using Needs Assessment to Understand Continuing Disability in Patients with Enduring Mental Illness. Implications for Considerations of Service Development

Particular strengths of the MRC Needs for Care Assessment Schedule have been used to investigate the treatment status of patients with persistent psychiatric disability in ways that other needs assessment tools are unable to. One hundred and seventy-nine such patients from three settings; a private sector psychiatric hospital, two public sector day hospitals situated in the same town, and a high security hospital, were found to have a high level of need. Although there were differences between settings, overall these needs were well met in all three. The high level of persistent disability found amongst these patients could not be attributed to failure on the part of those treating them to use the best available methods, or to failures to comply or engage with treatment on the patient's part. In some two thirds of instances persistent disability was best explained by the fact that even the most suitable available treatments have to be considered only partially effective.

Collaborative recovery: An integrative model for working with individuals that experience chronic or recurring mental illness.

Objectives: Recovery is an emerging movement in mental health. Evidence for recovery-based approaches is not well developed and approaches to implement recovery-oriented services are not well articulated. The collaborative recovery model (CRM) is presented as a model that assists clinicians to use evidence-based skills with consumers, in a manner consistent with the recovery movement. A current 5 year multisite Australian study to evaluate the effectiveness of CRM is briefly described. Conclusion: The collaborative recovery model puts into practice several aspects of policy regarding recovery-oriented services, using evidence-based practices to assist individuals who have chronic or recurring mental disorders (CRMD). It is argued that this model provides an integrative framework combining (i) evidence-based practice; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) recognition of the subjective experiences of consumers.

The effectiveness of a short-term group music therapy intervention for parents who have a child with a disability

The relationship between the quality of parent-child interactions and positive child developmental trajectories is well established (Guralnick, 2006; Shonkoff & Meissels, 2000; Zubrick et al., 2008). However, a range of parental, family, and socio-economic factors can pose risks to parents’ capacity to participate in quality interactions with their children. In particular, families with a child with a disability have been found to have higher levels of parenting stress, and are more likely to experience economic disadvantage, as well as social isolation. The importance of early interventions to promote positive parenting and child development for these families is widely recognised (Shonkoff & Meissels, 2000). However, to date, there is a lack of evidence about the effectiveness of early parenting programs for families who have a young child with a disability. This thesis investigates the impact of a music therapy parenting program, Sing & Grow, on 201 parent-child dyads who attended programs specifically targeted to parents who had a young child with a disability. Sing & Grow is an Australian national early parenting intervention funded by the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs and delivered by Playgroup Queensland. It is designed and delivered by Registered Music Therapists for families with children aged from birth to three years. It aims to improve parenting skills and confidence, improve family functioning (positive parent-child interactions), enhance child development, and provide social networking opportunities to socially isolated families. The intervention targets a range of families in circumstances that have the potential to impact negatively on family functioning. This thesis uses data from the National Evaluation Study of Sing & Grow from programs which were targeted at families who had a young child with a disability. Three studies were conducted to address the objectives of this thesis. Study 1 examines the effects of the Sing & Grow intervention on parent reported pre and post parent mental health, parenting confidence, parenting skills, and child development, and other parent reported outcomes including social support, use of intervention resources, satisfaction with the intervention and perceived benefits of and barriers to participation. Significant improvements from pre to post were found for parent mental health and parent reported child communication and social skills, along with evidence that parents were very satisfied with the program and that it brought social benefits to families. Study 2 explored the pre to post effects of the intervention on children’s developmental skills and parent-child interactions using observational ratings made by clinicians. Significant pre to post improvements were found for parenting sensitivity, parental engagement with child and acceptance of child as well as for child responsiveness to parent, interest, and participation in the intervention, and social skills. Study 3 examined the nature of child and family characteristics that predicted better outcomes for families while taking account of the level of participation in the program. An overall outcome index was calculated and served as the dependent variable in a logistic regression analysis. Families who attended six or more sessions and mothers who had not completed high school were more likely to have higher outcome scores at post intervention than those who attended fewer sessions and those with more educated mothers respectively. The findings of this research indicate that the intervention had a positive impact on participants’ mental health, parenting behaviours and child development and that level of attendance was associated with better outcomes. There was also evidence that the program reached its target of high risk families (i.e., families in which mothers had lower educational levels) and that for these families better outcomes were achieved. There were also indications that the program was accessible and highly regarded by families and that it promoted social connections for participants. A theoretical model of how the intervention is currently working for families is proposed to explain the connections between early parenting, child development and maternal wellbeing. However, more research is required to further elucidate the mechanisms by which the intervention creates change for families. This research presents promising evidence that a short term group music therapy program can elicit important therapeutic benefits for families who have a child with a disability.