Factors associated with adherence to antiretroviral therapy in HIV/AIDS patients: a cross-sectional study in Southern Brazil

A cross-sectional study was conducted on HIV-infected adults being treated with antiretroviral drugs at a reference service in Southern Brazil. Participants answered a sociodemographic questionnaire and were tested by scales assessing sociocognitive variables. Adherence to treatment was assessed by a self-report inventory developed for the study. Clinical information was obtained from the patients' records. Significance tests were conducted using univariate logistic regressions followed by multivariate logistic regression analysis. A total of 195 patients participated in the study and 56.9% of them reported > or = 95% adherence on the previous two days. In univariate analysis, the odds of adherence increased with self-efficacy (a person's conviction that he/she can successfully execute the behavior required to produce a certain desired outcome) in taking medications as prescribed (OR = 3.50, 95% CI 1.90-6.55), and decreased with perception of negative affect and physical concerns (OR = 0.71, 95% CI 0.53-0.95). The odds were lower for taking antiretroviral medications >4 times a day (OR = 0.44, 95% CI 0.20-0.94) and higher for patients with 8 years of schooling (OR = 2.28, 95% CI 1.12-4.66). In the multivariate analysis, self-efficacy (OR = 3.33, 95% CI 1.69-6.56) and taking medication >4 times a day (OR = 0.34, 95% CI 0.14-0.80) were independently associated with adherence. Self-efficacy was the most important predictor of adherence, followed by number of times antiretroviral medication was taken per day. Among sociodemographic and clinical variables, only the number of years of schooling was associated with adherence. Motivational interventions based on self-efficacy may be useful for increasing treatment adherence.

The relationship between self-serving cognitive distortions and bullying behaviours among elementary school children /

The purpose ofthe study was to examine the relationshq) between self-serving cognitive distortions and involvement in bullying behaviours. While relationships were e}q)k)red for both bullies and victims, the bully represented the main focus ofthis research. The participants ofthis study were 206 elementary school children in grades 5, 6, 7, and 8 from a school board in South Western Ontario. Participants conq>leted a 2- part self-report questionnaire within a 1-week time period. Part I aimed to measure self-serving cognitive distortions, while Part II was designed to assess selfreports of bullying behaviours. Analyses revealed that a significant direct relationship existed between children's self-serving cognitive distortions and bullying others. More specifically, children's self-serving cognitive distortions were moderately correlated with bullying others (r = .50, p< 0.01). This finding was consistent for both male and female participants. In addition, significant moderate correlations also existed between each ofthe 9 subscales ofself-serving cognitive distortions and bullying others. In regard to the relationship between children's self-serving cognitive distortions and victimization, a low significant direct relationshq) was found (r = .22 p<0.01). This finding was consistent for both male and female participants. The results ofthis study are discussed in terms oftheir theoretical, as well as applied implications.

Research in the clinical setting : a qualitative study of the value of play research in the continuing education of occupational therapists.

Occupational therapists have always recognized playas an important part of a child's life. However, until recently play has been viewed as a medium for reaching treatment goals, rather than as an activity that is valuable in and of itself. If occupational therapists think of playas the primary activity or occupation of childhood, then play should be a very important area of focus for paediatric clinicians. In order to assist children to become as independent as possible with play and to have fulfilling play experiences the occupational therapist needs to have a clear understanding of how to assess, set goals which lead towards competence in play, and promote play. Recent play literature has placed importance on play behaviours and looking at the relationship between the child and both the human and nonhuman environment. Believing that play and playfulness can and should be promoted, for children with physical disabilities, requires that therapists learn new assessment and intervention strategies. A new assessment tool, The Test of Playfulness, was developed by Bundy in 1994. It addressed play behaviours and environmental influences. The author, a co-investigator and eight occupational therapists were involved in a playfulness study using this test to compare the playfulness of children with physical disabilities with their able-bodied peers. After the study was completed the author questioned whether or not involvement in the playfulness study was enough of a change agent to bring about transformative learning in order to further the eight occupational therapists' education about play.This study investigated changes in either the therapists' thinking about play or their behaviour in their clinical practice. The study also examined the participants' retention of knowledge about the Test of Playfulness. The eight therapists who had been involved in the playfulness study (participants) were matched with eight therapists who had not been involved (nonparticipants). The therapists were interviewed 9 to 12 months after completion of the playfulness study. They were asked to describe various scenarios of play and open ended prompts were used to elicit the therapists' perceptions of play, good play, the role or value of play, environmental and gender influences on play, play assessment and intervention, and play research, for children with and without disabilities. The participants were also prompted to discuss their experience with the playfulness study. A self-report questionnaire was also completed at the end of the interview. The results of the study demonstrated that: (a) the play research project was a good format for continuing the participants' education about play; (b) their thinking had changed about play; (c) according to self report, they had used this new knowledge in their clinical practice; and (d) the participants remembered the items on the Test of Playfulness and could use them in describing various aspects of play. This study found that participating in a play research project had been an effective method of professional development. It also highlighted the need for increased awareness of the recent literature on play and the developing role of the occupational therapist in the assessment and intervention of play.

Psychopathy and self-monitoring : additive and interactive effects on self-presentation tactics /

The purpose of this study was to determine the relative contributions of psychopathy and self-monitoring to the prediction of self-presentation tactics (behaviours that individuals use to manipulate their self-image). Psychopathy is composed of two main factors: Factor 1, which includes manipulativeness and shallow affect, and Factor 2, which includes irresponsibility and anti-social behaviours. Self-monitoring is a personality trait that distinguishes between those who adapt their behaviour to fit different social situations (high self-monitors) and those who behave as they feel regardless of social expectations (low selfmonitors). It was hypothesized that self-monitoring would moderate the relationship between psychopathy and self-presentation tactics. One hundred and forty-nine university students completed the Self-Monitoring Scale (Snyder, 1974), the Self-Report Psychopathy Scale - Version III (Paulhus et aI., in press), the Self-Presentation Tactics scale (Lee, S., et aI., 1999), the HEXACO-PI (a measure ofthe six major factors of personality; Lee, K., & Ashton, 2004), and six scenarios that were created as a supplementary measure of the selfpresentation tactics. Results of the hierarchical multiple regression analyses showed that self-monitoring did moderate the relationship between psychopathy and three of the selfpresentation tactics: apologies, disclaimers, and exemplification. Further, significant interactions were observed between Factor 1 and self-monitoring on apologies and the defensive tactics subscale, between Factor 2 and self-monitoring on self-handicapping, and between Factor 1 and Factor 2 on exemplification. Contrary to expectations, the main effect of self-monitoring was significant for the prediction of nine tactics, while psychopathy was significant for the prediction of seven tactics. This indicates that the role of these two personality traits in the explanation of self-presentation tactics tends to be additive in nature rather than interactive. In addition. Factor 2 alone did not account for a significant amount of variance in any of the tactics, while Factor 1 significantly predicted nine tactics. Results are discussed with regard to implications and possible directions for future research.

Aerobic exercise in adolescence : self-efficacy and stage of change

The purpose of this cross-sectional exploratory study was to examine the relationships among self-efficacy, stage of change, and exercise behaviour in a sample of younger (Grade 9) and older (Grade 12) adolescents. A secondary objective of this study was to apply the transtheoretical model of Stage of Change, as a measure of intention to change, in order to discover the applicability of the model to an adolescent cohort in relation to exercise behaviour. This five-stage model is a self-report measure of an individual's readiness to adopt a new behaviour (e.g., regular exercise). The transtheoretical model incorporates Bandura's self-efficacy factor, which is purported to be a predictive measure of exercise behaviour and a covariant of stage. Exercise behaviour was measured with the Physical Activity Scale, and the University of Rhode Island Change Assessment Scale (URleA) was used to measure the stage of change and self-efficacy variables. The results of this study indicated significant differences between younger and older adolescents, and between males and females in their exercise behaviour. No significant differences were found for grade and gender on stage of change as measured by either a single-item question or a continuous measure of stage. Although grade and gender subgroups were not significantly different in their self-efficacy, significant interaction was found in the grade*gender variable.

A Study of role conflict, role ambiguity, locus of control, job satisfaction and participation in decision making among front-line vocational service workers for mentally retarded adults

This study was an investigation of individual and organizational factors, as perceived by front-line vocational service workers from Adult Rehabilitation Centres (ARC Industries) for mentally retarded adults. The specific variables which were measured included role conflict/role ambiguity (role factors), internal/external locus of control (individual differences), job satisfaction with work and supervision (job attitudes) and participation in deci~ion making (organizational factor). The exploration of these constructs was conducted by means of self-report questionnaires which were completed by sixty-nine out of a total of ninety front-line employees. The surveys were distributed in booklet form to nine distinct rehabilitation facilities from St. Catharines, West Lincoln, Greater Niagara, Port Colborne, WeIland, Fort Erie, Hamilton, Guelph and Brantford. The survey data was evaluated by the statisti.cal Package for the Social Sciences (SPSS) which used the Pearson Product Moment Correlation procedure and a compar~son of means test. A comparison of correlation coefficients test was also conducted. This statistical procedure was calculated mathematically. The results obtained from the statistical evaluation confirmed the prediction that self-reported measures of participation in decision making and satisfaction (work and supervision) would be negatively correlated with role conflict and role ambiguity. As well, the speculation that perceived satisfaction (work and supervision) would be positively correlated with participation in decision making was empirically supported. Internal and external locus of control did not contribute to a significant difference in r~sponses to role perceptions (conflict and ambiguity) , satisfaction (work and supervision) or the correlational relationship between participation in decision making and satisfaction (work and supervision). Overall, the findings from this study substantiated the importance of examining employee perceptions in the workplace and the interrelationships among individual and organizational variables. This research was considered a contribution to the general area of occupational stress and to the study of individuals in work organizations.

Letting go : a self-study utilizing critical literacy as method in improving my practice /

This is a Self-study about my role as a teacher, driven by the question: "How do I improve my practice?" (Whitehead, 1989)? In this study, I explored the discomfort that I had with the way that I had been teaching. Specifically, I worked to uncover the reasons behind my obsessive (mis)management of my students. I wrote of how I came to give my Self permission for this critique: how I came to know that all knowledge is a construction, and that my practice, too, is a construction. I grounded this journey within my experiences. I constructed these experiences in narrative fomi in order to reach a greater understanding of how I came to be the teacher I initially was. I explored metaphors that impacted my practice, re-constructed them, and saw more clearly the assumptions and influences that have guided my teaching. I centred my inquiry into my teaching within an Action Reflection methodology, bon-owing Jack Whitehead's (1989) term to describe my version of Action Research. I relied upon the embedded cyclical pattern of Action Reflection to understand my teaching Self: beginning from a critical moment, reflecting upon it, and then taking appropriate action, and continuing in this way, working to improve my practice. To understand these critical moments, I developed a personal definition of critical literacy. I then tumed this definition inward. In treating my practice as a textual production, I applied critical literacy as a framework in coming to know and understand the construction that is my teaching. I grounded my thesis journey within my Self, positioning my study within my experiences of being a grade 1 teacher struggling to teach critical literacy. I then repositioned my journey to that of a grade 1 teacher struggling to use critical literacy to improve my practice. This journey, then, is about the transition from critical literacyit as-subject to critical literacy-as-instmctional-method in improving my practice. I joumeyed inwards, using a critical moment to build new understandings, leading me to the next critical moment, and continued in this cyclical way. I worked in this meandering yet deliberate way to reach a new place in my teaching: one that is more inclusive of all the voices in my room. I concluded my journey with a beginning: a beginning of re-visioning my practice. In telling the stories of my journey, of my teaching, of my experiences, I changed into the teacher that I am more comfortable with. I've come to the frightening conclusion that I am the decisive element in the classroom. It's my personal approach that creates the climate. It's my daily mood that makes the weather As a teacher, I possess a tremendous power to make a person's life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humour, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated and a person humanized or de-humanized. (Ginott, as cited in Buscaglia, 2002, p. 22)

Examining the inclusion experiences of students with intellectual disabilities : a study focusing on the transition from elementary to secondary school

Transitioning from elementary to secondary school is a major event in adolescents' lives and can be associated with academic, social, and emotional challenges (Shaffer, 2005; Sirsch, 2003). Considerably less research has focused on the transitional experiences of students with intellectual disabilities (lD) as they enter secondary school and the role of educational inclusion in this process (Noland, Cason, & Lincoln, 2007). Conceivably, students with ID who leave inclusive elementary schools, where they have been educated alongside their peers without ID, and who enter segregated secondary educational placements may experience unique social and emotional challenges (Farmer, Pearl, & Van Acker, 1996; Fryxell & Kennedy, 1995; Shaffer, 2005). This study examined the transitional experiences of 6 students with ID and the role of educational inclusion, with a focus on elementary to secondary school transitions from inclusive to segregated settings and vice versa. This study included the collection of multiple sources of data. Semi-structured interviews with 6 caregivers and students with ID were conducted. Students' Individual Education Transitional Plans were discussed in caregivers' interviews to determine how they shaped students' educational inclusion experiences (Ontario Ministry of Education & Training, 1999/2000/2004). Parts ofthe following questionnaires were "qualitized" (Tashakkori & Teddlie, 1998) and administered orally: "Youth Self-Report" (YSR; Achenbach, 2001 c) and "Child Behaviour Checklist Caregivers Form" (CBLC/6-18; Achenbach, 200la). The findings of this study contribute to the literature on educational inclusion by highlighting the positive/negative social and emotional impact of congruent and incongruent transitional experiences of students with ID and the role of educational inclusion.

Children's Bullying Experiences and Self-Worth Perceptions in a Private School

This study explored children's bullying experiences (as bully, victim, and bystander) and their self-worth perceptions in a private school in Ontario, Canada. Forty students from 12 different countries participated in a mixed methodology (both quantitative and qualitative) research design using a self-report questionnaire. Students reported involvement in bullying as a bully, victim, and bystander. The overall results reveal a pattern across the three roles where the degree of bullying observed as a bystander is the highest (57%) followed by the experiences as a victim (29%) and that performed as bully (21%). The bystanders reported direct bullying being witnessed, bullies reported indirect bullying interventions as being used, and victims of bullying reported indirect bullying being the most common type of bullying they experienced. Decreased feeling of self-worth is reported in the qualitative research data in regards to bullying. Boarding students reported issues regarding personal safety, need for social relationships, self-worth, and unacceptability of bullying. Implications for practice for the private school are discussed, focusing on the outcome of this study.

Nonsuicidal Self-Injury and Suicidal Behavior: A Latent Class Analysis among Young Adults

Although there is a general consensus among researchers that engagement in nonsuicidal self-injury (NSSI) is associated with increased risk for suicidal behavior, little attention has been given to whether suicidal risk varies among individuals engaging in NSSI. To identify individuals with a history of NSSI who are most at risk for suicidal behavior, we examined individual variability in both NSSI and suicidal behavior among a sample of young adults with a history of NSSI (N = 439, Mage = 19.1). Participants completed self-report measures assessing NSSI, suicidal behavior, and psychosocial adjustment (e.g., depressive symptoms, daily hassles). We conducted a latent class analysis using several characteristics of NSSI and suicidal behaviors as class indicators. Three subgroups of individuals were identified: 1) an infrequent NSSI/not high risk for suicidal behavior group, 2) a frequent NSSI/not high risk for suicidal behavior group, and 3) a frequent NSSI/high risk for suicidal behavior group. Follow-up analyses indicated that individuals in the ‘frequent NSSI/high risk for suicidal behavior’ group met the clinical-cut off score for high suicidal risk and reported significantly greater levels of suicidal ideation, attempts, and risk for future suicidal behavior as compared to the other two classes. Thus, this study is the first to identity variability in suicidal risk among individuals engaging in frequent and multiple methods of NSSI. Class 3 was also differentiated by higher levels of psychosocial impairment relative to the other two classes, as well as a comparison group of non-injuring young adults. Results underscore the importance of assessing individual differences in NSSI characteristics, as well as psychosocial impairment, when assessing risk for suicidal behavior.

A Mixed-Method Study of Educator Knowledge and Practice Related to Student Socio-moral Development

The purpose of this study was to explore elementary educators’ knowledge of moral development, how this knowledge relates to their beliefs and sense of efficacy pertaining to character education practices and the socio-moral reasoning of their students. It was hypothesized that educators’ beliefs and practices related to character education would reflect their pedagogy rather than knowledge of moral development theory. It was further hypothesized that there would be differences in student socio-moral reasoning specifically the beliefs and desires that guide actions would differ based on grade and gender. This mixed-method study employing self-report questionnaires, open response vignettes, and semi-structured educator interviews yielded quantitative and qualitative data. Findings indicated socio-moral reasoning of students differed according to grade (age) and gender. Knowledge of moral development theory was found to vary among participants however some practices employed by educators did align with a social cognitive approach to moral development. Significant variables identified consistently among educator and student participants included, autonomy, social competence, sense of school community, and supportiveness. These variables, in conjunction with a sense of fairness, have been identified elsewhere as foundational to moral development (Nucci, 2009), and intrinsic motivation (Ryan & Deci, 2000) and are relevant to educators working to develop student socio-moral reasoning as an aspect of character.

Genetic and Electrophysiological Correlates of Self-Regulation in Adolescence

Self-regulation is considered a powerful predictor of behavioral and mental health outcomes during adolescence and emerging adulthood. In this dissertation I address some electrophysiological and genetic correlates of this important skill set in a series of four studies. Across all studies event-related potentials (ERPs) were recorded as participants responded to tones presented in attended and unattended channels in an auditory selective attention task. In Study 1, examining these ERPs in relation to parental reports on the Behavior Rating Inventory of Executive Function (BRIEF) revealed that an early frontal positivity (EFP) elicited by to-be-ignored/unattended tones was larger in those with poorer self-regulation. As is traditionally found, N1 amplitudes were more negative for the to-be-attended rather than unattended tones. Additionally, N1 latencies to unattended tones correlated with parent-ratings on the BRIEF, where shorter latencies predicted better self-regulation. In Study 2 I tested a model of the associations between selfregulation scores and allelic variations in monoamine neurotransmitter genes, and their concurrent links to ERP markers of attentional control. Allelic variations in dopaminerelated genes predicted both my ERP markers and self-regulatory variables, and played a moderating role in the association between the two. In Study 3 I examined whether training in Integra Mindfulness Martial Arts, an intervention program which trains elements of self-regulation, would lead to improvement in ERP markers of attentional control and parent-report BRIEF scores in a group of adolescents with self-regulatory difficulties. I found that those in the treatment group amplified their processing of attended relative to unattended stimuli over time, and reduced their levels of problematic behaviour whereas those in the waitlist control group showed little to no change on both of these metrics. In Study 4 I examined potential associations between self-regulation and attentional control in a group of emerging adults. Both event-related spectral perturbations (ERSPs) and intertrial coherence (ITC) in the alpha and theta range predicted individual differences in self-regulation. Across the four studies I was able to conclude that real-world self-regulation is indeed associated with the neural markers of attentional control. Targeted interventions focusing on attentional control may improve self-regulation in those experiencing difficulties in this regard.

Development of the Physical Activity Interactive Recall (PAIR) for Aboriginal children

Affiliation: Margaret Cargo : Département de médecine sociale et préventive, Faculté de médecine, Université de Montréal

Evaluación e intervención interdisciplinaria del dolor en Unidades de Cuidado Intensivo

El dolor es un problema importante para los pacientes hospitalizados en las UCI porque genera malestar y distrés. Además, la investigación ha demostrado que en algunos pacientes críticos el dolor agudo puede persistir después de alta y convertirse en crónico. La gestión eficaz del dolor en pacientes críticos requiere un enfoque interdisciplinario, que incorpore la visión y trabajo de expertos que representan una amplia variedad de especialidades clínicas. Así, la utilización de la intervención psicológica en el tratamiento del dolor es una parte integral de un enfoque global. Basado en una revisión de la evidencia científica, se identifican y señalan: (1) los tipos de dolor más comunes; (2) las características del dolor; (3) las patologías más frecuentes asociadas con la presencia de dolor; (4) los procedimientos que generan dolor en la UCI; (5) los métodos de evaluación del dolor; (6) la intervención del mismo y; (7) la contribución del psicólogo en la evaluación y manejo del dolor con el paciente, los familiares y los profesionales de la salud. La revisión realizada indica que los procesos psicológicos influyen tanto en la experiencia del dolor como en los resultados del tratamiento, por lo tanto la integración de los principios psicológicos en el tratamiento del dolor parecen tener potencial mejora de los resultados beneficiando la salud del paciente.

Análisis del gen adra2a receptor alfa 2a adrenergico en pacientes con trastorno de hiperactividad y déficit de atención

El trastorno de hiperactividad y déficit de atención (THDA), es definido clínicamente como una alteración en el comportamiento, caracterizada por inatención, hiperactividad e impulsividad. Estos aspectos son clasificados en tres subtipos, que son: Inatento, hiperactivo impulsivo y mixto. Clínicamente se describe un espectro amplio que incluye desordenes académicos, trastornos de aprendizaje, déficit cognitivo, trastornos de conducta, personalidad antisocial, pobres relaciones interpersonales y aumento de la ansiedad, que pueden continuar hasta la adultez. A nivel global se ha estimado una prevalencia entre el 1% y el 22%, con amplias variaciones, dadas por la edad, procedencia y características sociales. En Colombia, se han realizado estudios en Bogotá y Antioquia, que han permitido establecer una prevalencia del 5% y 15%, respectivamente. La causa específica no ha sido totalmente esclarecida, sin embargo se ha calculado una heredabilidad cercana al 80% en algunas poblaciones, demostrando el papel fundamental de la genética en la etiología de la enfermedad. Los factores genéticos involucrados se relacionan con cambios neuroquímicos de los sistemas dopaminérgicos, serotoninérgicos y noradrenérgicos, particularmente en los sistemas frontales subcorticales, corteza cerebral prefrontal, en las regiones ventral, medial, dorsolateral y la porción anterior del cíngulo. Basados en los datos de estudios previos que sugieren una herencia poligénica multifactorial, se han realizado esfuerzos continuos en la búsqueda de genes candidatos, a través de diferentes estrategias. Particularmente los receptores Alfa 2 adrenérgicos, se encuentran en la corteza cerebral, cumpliendo funciones de asociación, memoria y es el sitio de acción de fármacos utilizados comúnmente en el tratamiento de este trastorno, siendo esta la principal evidencia de la asociación de este receptor con el desarrollo del THDA. Hasta la fecha se han descrito más de 80 polimorfismos en el gen (ADRA2A), algunos de los cuales se han asociado con la entidad. Sin embargo, los resultados son controversiales y varían según la metodología diagnóstica empleada y la población estudiada, antecedentes y comorbilidades. Este trabajo pretende establecer si las variaciones en la secuencia codificante del gen ADRA2A, podrían relacionarse con el fenotipo del Trastorno de Hiperactividad y el Déficit de Atención.