Enhancing recovery rates: lessons from year one of IAPT

BACKGROUND: The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. METHOD: Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). RESULTS: Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. CONCLUSIONS: Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer

Background Depression and anxiety are common after diagnosis of breast cancer. We examined to what extent these are recurrences of previous disorder and, controlling for this, whether shame, self-blame and low social support after diagnosis predicted onset of depression and anxiety subsequently. Method Women with primary breast cancer who had been treated surgically self-reported shame, self-blame, social support and emotional distress post-operatively. Psychiatric interview 12 months later identified those with adult lifetime episodes of major depression (MD) or generalized anxiety disorder (GAD) before diagnosis and onset over the subsequent year. Statistical analysis examined predictors of each disorder in that year. Results Of the patients, two-thirds with episodes of MD and 40% with episodes of GAD during the year after diagnosis were experiencing recurrence of previous disorder. Although low social support, self-blame and shame were each associated with both MD and GAD after diagnosis, they did not mediate the relationship of disorder after diagnosis with previous disorder. Low social support, but not shame or self-blame, predicted recurrence after controlling for previous disorder. Conclusions Anxiety and depression during the first year after diagnosis of breast cancer are often the recurrence of previous disorder. In predicting disorder following diagnosis, self-blame and shame are merely markers of previous disorder. Low social support is an independent predictor and therefore may have a causal role.

Motivational trajectories for early language learning across the primary-secondary school transition

The transition from primary to secondary school is an area of concern across a range of curriculum subjects, and this is no less so for foreign language learning. Indeed problems with transition have been identified in England as an important barrier to the introduction of language learning to the primary school curriculum, with implications for learners’ longer-term motivation for the subject. This longitudinal study investigated, through a questionnaire, the development of 233 learners’ motivation for learning French in England, during the transition from primary to secondary schooling. It also explored whether levels and patterns of motivation differed according to the type of language teaching experienced, comparing a largely oracy-focused approach with one with greater emphasis on literacy activities. Learners showed high and increasing levels of motivation across transition, placing particular value on learning French for travel. Being taught through an oracy or a literacy-focused approach had less impact on learners’ motivation than broader classroom experiences, with the development of a sense of progress and feeling that instruction met their learning needs being especially important. A growing disjuncture emerged between valuing the learning of French for travel/communication and learners’ low levels of self-efficacy for communication with native speakers, together with a desire for more communication-based activities. By the end of the first year of secondary school less positive attitudes towards learning French and less optimism about the possibility of future progress were beginning to emerge. The paper concludes by outlining the implications of the study for classroom practice in language learning.

Long-term positive effects of repeating a year in school: Six-year longitudinal study of self-beliefs, anxiety, social relations, school grades, and test scores

Consistently with a priori predictions, school retention (repeating a year in school) had largely positive effects for a diverse range of 10 outcomes (e.g., math self-concept, self-efficacy, anxiety, relations with teachers, parents and peers, school grades, and standardized achievement test scores). The design, based on a large, representative sample of German students (N = 1,325, M age = 11.75 years) measured each year during the first five years of secondary school, was particularly strong. It featured four independent retention groups (different groups of students, each repeating one of the four first years of secondary school, total N = 103), with multiple post-test waves to evaluate short- and long-term effects, controlling for covariates (gender, age, SES, primary school grades, IQ) and one or more sets of 10 outcomes realised prior to retention. Tests of developmental invariance demonstrated that the effects of retention (controlling for covariates and pre-retention outcomes) were highly consistent across this potentially volatile early-to-middle adolescent period; largely positive effects in the first year following retention were maintained in subsequent school years following retention. Particularly considering that these results are contrary to at least some of the accepted wisdom about school retention, the findings have important implications for educational researchers, policymakers and parents.

What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs. CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

Reflexões e contribuições para o ensino de gravitação clássica no nível médio

The subject of Classic Gravitation is part of the actual curriculum for High School in Brazil, and it is taught in the first year of that education level. This master thesis presents a research regarding the subject Classic Gravitation in High School. This research was based in two complementary guidelines of research and action. The first guideline was the analysis of 21 didactic books of physics which are the more frequently used in High School, in the city of Natal/RN. The second guideline, worked after being verified the most common deficiencies presents in the didactic books, was the elaboration, followed by a practical application, of a course suggesting how to approach that subject in the classroom. The Parâmetros Curriculares Nacionais para o Ensino Médio (National Curricular Parameters for High School PCNEM) defend that Classic Gravitation is very important in the student s formation and that its study helps the comprehension of many nature s phenomena. Because of this vision of that subject by the PCNEM, the 21 analyzed books were separated in two groups: the first one, containing 10 books, was edited before the spreading of PCNEM, and the second, with 11 books, after that spreading. Whatever the group to which the didactic books belonged, the great majority of them let that subject in a second plan; two of them even suggesting, in the teacher s orientations, that the subject Gravitation can be suppressed in case of insufficient time . These analyses points that the PCNEM had produced no changes in the conception of the authors that wrote books regarding that subject. To analyze the didactic books, we elaborated a script which was used as an analysis tool, in which we put in evidence the relative importance of the historic and philosophic contextualization of the subject, the quotidian experience of the students and the interdisciplinary approach, among other aspects. It became evident that the didactic books give very little emphasis to historic aspects of the knowledge construction, to the relations with the day-by-day questions and to the interdisciplinary character of the subject Gravitation. It calls attention the non concordance among the authors opinions regarding the necessary previous knowledge or prerequisites the students should fulfill in order to begin to study Gravitation. The course we elaborated was given to a group of teachers as well as to students. In those courses we treated theoretical and practical aspects and emphasized historical questions and the ones which are related to people s daily life. The course for teachers was realized as an extra-mural activity of the UFRN and was given by the author of this thesis at the Escola Estadual Francisco Ivo Cavalcanti (a state public school in Natal/RN). There were 23 teachers present, from several public schools and several fields of knowledge. The thesis supervisor and the master degree s colleagues of the author acted as collaborators , reporting the participants opinions and speeches. The course to the students, on the other hand, had the participation of 300 regular students who belonged to 6 different 1st year classes of the High School Escola Marista de Natal (RN), in which the author acts as a physics teacher. The student s course was realized as part of the regular curriculum activities, in which three classes stood under the responsibility of the author and other three classes in charge of another Marista s teacher, who participated as a collaborator . The teacher s course as well as the students one were given in two stages, with five hours each. The first stage was divided in two moments, the first one focused on the survey of the spontaneous conceptions about gravitation, in which we worked basically with experiments of free throwing and pendulum, and the second one focused in theoretical presentations and quarrels about universe s models. In the second stage of the course we improved the study of Kepler s laws and the Newton s Universal Gravitation law, and we used as motivating tools some practices involving the construction of the solar system in scale. As instruments for evaluating both courses we used questionnaires and reported the speeches with participants opinions, beyond usual written evaluations in the course for the students. The teachers who participated in the course showed very good wills in realizing interdisciplinary practices; nevertheless, according their own speeches, they frequently came across the difficulty of how to do . From the experience we had in both courses, we conclude that the approach we propose hear to the teaching of the subject Classic Gravitation , supported on the tripod theory, practice and historical and philosophical aspects, is viable and effective. One hopes that this research may contribute in the formation of a opinion, among the teachers, concerning how to approach the subject of Classic Gravitation, and may offer suggestions in order those who want to apply that approach may develop classroom practices aiming to improve the teaching of that subject, which has a singular importance in the formation of High School students

Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Dornase alfa improves the health-related quality of life among Brazilian patients with cystic fibrosis - A one-year prospective study

Background: Health-related quality of life (HRQOL) measurements provide valuable information about the psychological and social impact of treatment on patients with cystic fibrosis (CF). This study evaluated the HRQOL of Brazilian patients with CF and assessed the changes in HRQOL domains over 1 year after dornase alfa (Pulmozyme) introduction. Patients and Methods: One hundred fifty-six stable patients with CF and 89 caregivers answered the Portuguese-validated version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (T 0), and at 3 (T 1), 6 (T 2), 9 (T 3), and 12 (T 4) months of follow-up. Eighteen patientswere excluded because they did not fulfill the inclusion criteria. The patients were analyzed in two groups: those aged 6-11 years and those aged 14 years and older. ANOVA for observed repeated results and the last observation carried forward (LOCF) method for missing data were used for the statistical analysis. Results: After 1 year of follow-up, there was significant improvement in respiratory symptoms (T 4-T 0=8.1; 95% confidence interval (95% CI)=[2.1;14.0]; effect size (ES)=0.35; P<0.001), Emotional Functioning (T 4-T 0=5.6; 95% CI=[1.1;10.1]; ES=0.31; P<0.05), Social Functioning (T 4-T 0=6.0; 95% CI=[1.3;11.7]; ES=0.31; P<0.05), Body Image (T 4-T 0=11.9; 95% CI=[4.1;19.7]; ES=0.42; P<0.05), and Treatment Burden (T 4-T 0=5.3; 95% CI=[0.3;10.3]; ES=0.24; P<0.05) domains in the younger group. A significant improvement in Role Functioning (T 4-T 0=6.1; 95% CI=[1.1;11.1]; ES=0.40; P<0.05), Body Image (T 4-T 0=12.6; 95% CI=[3.5;21.7]; ES=0.46; P<0.05), and Weight (T 4-T 0=11.7; 95% CI=[1.8;21.6]; ES=0.40; P<0.05) was obtained in the older group. The caregivers' CFQ-R showed improvements in the Digestive Symptoms (T 4-T 0=5.5; 95% CI=[1.5;9.4]; ES=0.30; P<0.05), Respiratory Symptoms (T 4-T 0=7.6; 95% CI=[3.9;11.4]; ES=0.48; P<0.05), and Weight (T 4-T 0=10.1; 95% CI=[1.6;18.6]; ES=0.26; P<0.05) domains. Conclusion: The introduction of dornase alfa improved the HRQL of the patients with CF during the first year of treatment. © 2010 Wiley-Liss, Inc.

Práxis intervencionista na escola: experiências de ressignificação, deslocamento e insurgência

Pós-graduação em Artes - IA

Análise e implementação da nova proposta pedagógica estadual para o ensino de língua inglesa no ensino fundamental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A fonoaudiologia e os acidentes humanos: aspectos curriculares e opiniões de docentes e discentes

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estudo das dificuldades de leitura e interpretação de textos matemáticos em enunciados de problemas por alunos do ensino médio

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O uso de objetos educacionais no ensino de Física e suas relações com o processo de inclusão

Pós-graduação em Educação - FCT

A construção do gênero nas propostas curriculares para o último ano da educação infantil e primeiro ano do ensino fundamental elaboradas pelo município de Marília/SP

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Gênero nas aulas de educação física: diálogos possíveis com os conteúdos do currículo do Estado de São Paulo e o Facebook

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC