Body mass index trajectories and predictors among 3rd to 12th graders using growth curve mixture modeling the Child and Adolescent Trial for Cardiovascular Health (CATCH) study

This dissertation examined body mass index (BMI) growth trajectories and the effects of gender, ethnicity, dietary intake, and physical activity (PA) on BMI growth trajectories among 3rd to 12th graders (9-18 years of age). Growth curve model analysis was performed using data from The Child and Adolescent Trial for Cardiovascular Health (CATCH) study. The study population included 2909 students who were followed up from grades 3-12. The main outcome was BMI at grades 3, 4, 5, 8, and 12. ^ The results revealed that BMI growth differed across two distinct developmental periods of childhood and adolescence. Rate of BMI growth was faster in middle childhood (9-11 years old or 3rd - 5th grades) than in adolescence (11-18 years old or 5th - 12th grades). Students with higher BMI at 3rd grade (baseline) had faster rates of BMI growth. Three groups of students with distinct BMI growth trajectories were identified: high, average, and low. ^ Black and Hispanic children were more likely to be in the groups with higher baseline BMI and faster rates of BMI growth over time. The effects of gender or ethnicity on BMI growth differed across the three groups. The effects of ethnicity on BMI growth were weakened as the children aged. The effects of gender on BMI growth were attenuated in the groups with a large proportion of black and Hispanic children, i.e., “high” or “average” BMI trajectory group. After controlling for gender, ethnicity, and age at baseline, in the “high BMI trajectory”, rate of yearly BMI growth in middle childhood increased 0.102 for every 500 Kcals increase (p=0.049). No significant effects of percentage of energy from total fat and saturated fat on BMI growth were found. Baseline BMI increased 0.041 for every 30 minutes increased in moderate-to-vigorous PA (MVPA) in the “low BMI trajectory”, while Baseline BMI decreased 0.345 for every 30 minutes increased in vigorous PA (VPA) in the “high BMI trajectory”. ^ Childhood overweight and obesity interventions should start at the earliest possible ages, prior to 3rd grade and continue through grade school. Interventions should focus on all children, but specifically black and Hispanic children, who are more likely to be highest at-risk. Promoting VPA earlier in childhood is important for preventing overweight and obesity among children and adolescents. Interventions should target total energy intake, rather than only percentage of energy from total fat or saturated fat. ^

Multicultural education in Clinical Psychology Programs and the needs of racial minority trainees.

With more racial minorities entering the field of clinical psychology, the training needs of racial minority students in doctoral programs must be considered. Few studies address training in multicultural education from the perspective of racial minority students despite their increasing presence in the field. This may be due to assumptions educators make based on their level of competency in the area of multiculturalism. Thus, the goal of this exploratory study is to help determine the multicultural training needs of racial minorities enrolled in clinical psychology programs. This exploratory study was quantitative and used snowball sampling to survey racial minority trainees in doctoral programs in clinical psychology. Sixty one participants completed the survey. Results indicated that multicultural/diversity classes are valued by racial minority students and are relevant to them. However, the majority of students do not feel challenged, suggesting that their needs are not being fully met. It is recommended that their unique needs be included in the curriculum for multicultural education.

Is discrepancy between actual and preferred work activities a factor in work-related stress for mental health occupational therapists and social workers

In the Western developed nations, the changing pattern of mental health care provision has necessitated mental health staff adopting new approaches to service delivery across a diverse and expanding range of service settings. The impact of changed service delivery on Australian mental health professionals is an area that has not been well studied. The aim of the study was to identify the current clinical work activities performed by occupational therapists and social workers and whether there was a discrepancy between the actual and preferred work activities. The study also aimed to identify whether any discrepancy between their actual and preferred clinical work activities was associated with higher levels of stress. A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers in Australian mental health services was conducted. A work activities scale developed specifically for this study and the Mental Health Professionals Stress Scale were used to measure actual and preferred work activities and stress respectively. Both groups experienced a discrepancy between their actual and preferred work activities, with the occupational therapists and the social workers mostly wanting to undertake a diverse range of activities to a significantly greater extent than they currently were. As predicted, stress was associated with the discrepancy between the kind of work that the participants wanted to do and the kind of work that their job actually entailed. Health workers require assistance to adapt to their new work roles and to achieve a balance between generic and discipline-specific competencies. This has implications for education and professional training.

Estrogen replacement, muscle composition, and physical function: The health ABC study

Purpose: Although the beneficial effects of estrogen use on cardiovascular and cognitive function in postmenopausal women have been recently discredited, controversy remains regarding its usefulness for maintaining skeletal muscle mass or strength. Therefore, the purpose of this study was to determine whether estrogen use is associated with enhanced muscle composition and, if so, whether this translates into improved strength and physical function. Methods: Cross-sectional analysis of 840 well-functioning community-dwelling white women (current estrogen replacement therapy (ERT) users = 259, nonusers = 581) aged 70-79 yr participating in the Health, Aging and Body Composition Study. Muscle composition of the midthigh by computed tomography included cross-sectional area (CSA) of the quadriceps, hamstrings, intermuscular fat and subcutaneous fat, and muscle attenuation in Hounsfield units (HU) as a measure of muscle density. Isometric hand grip and isokinetic knee extensor strength were assessed by dynamometry. Physical function was assessed using a summary scale that included usual 6-m walk and narrow walk speed, repeated chair stands, and standing balance. Results: In analyses of covariance adjusted for relevant confounders. quadriceps muscle CSA and HU were greater in Current ERT than non-ERT women (P < 0.05). Grip strength was also greater (P < 0.05) in women taking ERT while knee extensor strength approached significance (P < 0.10). However, differences in muscle composition and strength were modest at <= 3.3%. There was no difference by ERT status for the hamstring, muscles. fat CSA. or for physical function. Conclusion: The associations between ERT and muscle composition and strength were minor and did not translate into improved physical function. Initiation of ERT for preservation of muscle composition and function may not be indicated.

Total quality management in English language teaching:a case study in Turkish higher education

The need to improve the management of language learning organizations in the light of the trend toward mass higher education and of the use of English as a world language was the starting point of this thesis. The thesis aims to assess the relevance, adequacy and the relative success of Total Quality Management (TQM) as a management philosophy. Taking this empirical evidence a TQM-oriented management project in a Turkish Higher Education context, the thesis observes the consequences of a change of organizational culture, with specific reference to teachers' attitudes towards management. Both qualitative and quantitative devices are employed to plot change and the value of these devices for identifying such is considered. The main focus of the thesis is the Soft S's (Shared Values, Style, Staff and Skills) of an organization rather than the Hard S's (System, Structure, Strategy). The thesis is not concerned with the teaching and learning processes, though the PDCA cycle (the Action Research Cycle) did play a part in the project for both teachers and the researcher involved in this study of organizational development. Both before the management project was launched, and at the end of the research period, the external measurement devices (Harrison's Culture Specification Device and Hofstede's VSM) were used to describe the culture of the Centre. During the management project, internal measurement devices were used to record the change including middle-management style change (the researcher in this case). The time period chosen for this study was between September 1991 and June 1994. During this period, each device was administered twice within a specific time period, ranging from a year to 32 months.

Perceptions of learning and teaching quality in Higher Education:developing a culture of co-creation of value

Perceptions about the quality of learning and teaching in Higher Education has for many years focused upon the application of market based principles. This includes the notion of students as “customers” of the Higher Education Institutions (HEI) service. We argue that the application of the customer analogy is unhelpful however, as students this approach is likely to affect student expectations about the service and their judgements about its quality. The purpose of this paper is to propose a study consisting of a series of interventions to develop a culture of value co-creation at a UK based HEI. By introducing CCV principles, it is hoped to steer students away from seeing themselves as “customers”, and passive recipients of in the learning and teaching process, to one where they take responsibility for their own learning experience, to be explored and acted upon in partnership with their lecturers and other stakeholders.

Improving the management of behaviour that challenges associated with dementia in care homes:protocol for pharmacy-health psychology intervention feasibility study

INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

French linguistics research and teaching in UK and Irish HE institutions

Introduction: The research and teaching of French linguistics in UK higher education (HE) institutions have a venerable history; a number of universities have traditionally offered philology or history of the language courses, which complement literary study. A deeper understanding of the way that the phonology, syntax and semantics of the French language have evolved gives students linguistic insights that dovetail with their study of the Roman de Renart, Rabelais, Racine or the nouveau roman. There was, in the past, some coverage of contemporary French phonetics but little on sociolinguistic issues. More recently, new areas of research and teaching have been developed, with a particular focus on contemporary spoken French and on sociolinguistics. Well supported by funding councils, UK researchers are also making an important contribution in other areas: phonetics and phonology, syntax, pragmatics and second-language acquisition. A fair proportion of French linguistics research occurs outside French sections in psychology or applied linguistics departments. In addition, the UK plays a particular role in bringing together European and North American intellectual traditions and methodologies and in promoting the internationalisation of French linguistics research through the strength of its subject associations, and that of the Journal of French Language Studies. The following sections treat each of these areas in turn. History of the French Language There is a long and distinguished tradition in Britain of teaching and research on the history of the French language, particularly, but by no means exclusively, at the universities of Cambridge, Manchester and Oxford.

The clinical competency of practicing and nonpracticing faculty of associate degree schools of nursing

This study assesses and describes the perception of clinical competency and the relationship to clinical practice of full-time nursing faculty in the associate degree nursing programs in the state of Florida. The study was developed around one major hypothesis and four research questions. The Hygiene-Motivators Theory proposed by Herzberg, Mausner, and Snyderman (1959) provided the conceptual framework to explain factors that would motivate a person to expand workload and maintain job satisfaction.^ Data were collected from the 244 faculty members teaching full-time at the 15 associate degree schools of nursing accredited by the National League for Nursing in the state of Florida. A total of 186 faculty (76%) responded and 175 (72%) cases were used for data analysis.^ Two instruments were modified and combined for the investigation. The instruments were the Faculty Perception of Practice Questionnaire (Parascenzo, 1983) and a three-part Attributes Deemed Necessary for Faculty to Proclaim Clinical Competency (Smith, 1991) scale. Computer analyses employing descriptive and inferential statistics were performed.^ The findings revealed that faculty were closely divided as to practice activities with more faculty nonpracticing than practicing. Factors identified as impediments to increased clinical practice were identified as teaching load and personal/family responsibilities that lead to a lack of time and lack of opportunity. Those faculty who practice did so as moonlighters in positions that would not require advanced training. Both the practicing and nonpracticing faculty reported a high level of satisfaction with their activities as a means of maintaining clinical practice. While both groups reported a high level of expertise, those practicing faculty perceived themselves to be more clinically competent on the attributes of knowledge, skills, and on the total attribute scale. It was further revealed that perception of competency declined with the length of time spent out of practice. There was no difference in the two groups on the attributes of values/attitude. ^

Beyond BMI: The “Metabolically healthy obese” phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review

Background A subgroup has emerged within the obese that do not display the typical metabolic disorders associated with obesity and are hypothesized to have lower risk of complications. The purpose of this review was to analyze the literature which has examined the burden of cardiovascular disease (CVD) and all-cause mortality in the metabolically healthy obese (MHO) population. Methods Pubmed, Cochrane Library, and Web of Science were searched from their inception until December 2012. Studies were included which clearly defined the MHO group (using either insulin sensitivity and/or components of metabolic syndrome AND obesity) and its association with either all cause mortality, CVD mortality, incident CVD, and/or subclinical CVD. Results A total of 20 studies were identified; 15 cohort and 5 cross-sectional. Eight studies used the NCEP Adult Treatment Panel III definition of metabolic syndrome to define “metabolically healthy”, while another nine used insulin resistance. Seven studies assessed all-cause mortality, seven assessed CVD mortality, and nine assessed incident CVD. MHO was found to be significantly associated with all-cause mortality in two studies (30%), CVD mortality in one study (14%), and incident CVD in three studies (33%). Of the six studies which examined subclinical disease, four (67%) showed significantly higher mean common carotid artery intima media thickness (CCA-IMT), coronary artery calcium (CAC), or other subclinical CVD markers in the MHO as compared to their MHNW counterparts. Conclusions MHO is an important, emerging phenotype with a CVD risk between healthy, normal weight and unhealthy, obese individuals. Successful work towards a universally accepted definition of MHO would improve (and simplify) future studies and aid inter-study comparisons. Usefulness of a definition inclusive of insulin sensitivity and stricter criteria for metabolic syndrome components as well as the potential addition of markers of fatty liver and inflammation should be explored. Clinicians should be hesitant to reassure patients that the metabolically benign phenotype is safe, as increased risk cardiovascular disease and death have been shown.

Perceived Stress and Self‑rated Health of Haitian and African Americans with and without Type 2 Diabetes

Background: Blacks have a higher incidence of diabetes and its related complications. Self-rated health (SRH) and perceived stress indicators are associated with chronic diseases. The aim of this study was to examine the associations between SRH, perceived stress and diabetes status among two Black ethnicities. Materials and Methods: The cross-sectional study included 258 Haitian Americans and 249 African Americans with (n = 240) and without type 2 diabetes (n = 267) (N = 507). Recruitment was performed by community outreach. Results: Haitian-Americans were less likely to report ‘fair to poor’ health as compared to African Americans [OR=0.58 (95% CI: 0.35, 0.95), P = 0.032]; yet, Haitian Americans had greater perceived stress than African Americans (P = 0.002). Having diabetes was associated with ‘fair to poor’ SRH [OR=3.14 (95% CI: 2.09, 4.72),P < 0.001] but not perceived stress (P = 0.072). Haitian-Americans (P = 0.023), females (P = 0.003) and those participants having ‘poor or fair’ SRH (P < 0.001) were positively associated with perceived stress (Nagelkerke R2=0.151). Conclusion: Perceived stress associated with ‘poor or fair’ SRH suggests that screening for perceived stress should be considered part of routine medical care; albeit, further studies are required to confirm our results. The findings support the need for treatment plans that are patient-centered and culturally relevant and that address psychosocial issues.

A case study of teaching and learning practice in a Chinese adult institution

Résumé: Cette recherche s'est réalisée dans une institution chinoise de formation des adultes. Il existe très peu d'études présentant la pratique de l'enseignement et de l'apprentissage en Chine. Aussi, il semble que cette étude de cas puisse être utile. Elle porte sur le personnel de formation en administration économique dans un centre de formation de Tianjin. Le but premier de cette recherche est de décrire ce qui se fait à cet institut de formation des adultes. Les aspects couverts vont de la sélection du contenu de formation et des modalités d'enseignement jusqu'à la compréhension de l'enseignement et de l'apprentissage. À partir de l'expérience des professeurs de ce centre de Tianjin, cette étude cherche précisément à décrire leurs perceptions et leurs attitudes en regard d'un enseignement centré sur l'apprentissage et développé selon un mode de collaboration. Les fondements théoriques retenus s'inspirent des conceptions andragogiques de Knowles, de celles de Brookfield qui ont trait aux rôles des formateurs et formatrices d'adultes et de Conti qui présente une conception de l'enseignement qui se développe selon un mode de collaboration. Les données sont été retenues à la suite d'interviews et de questionnaires. Ce dernier instrument a été administré à 70 professeurs de formation aux adultes. Les résultats obtenus sont décrits et analysés. Les principaux éléments indiquent que la pratique actuelle de formation des adultes à ce centre de Tianjin ne tient pas compte des principes de l'éducation des adultes présenté selon un mode de collaboration. La formation est centrée sur l'enseignement. Il est à souhaiter que cette recherche contribuera à développer une meilleure compréhension de l'enseignement et de l'apprentissage en Chine tel que perçus par les formateurs et formatrices. Quelques suggestions de recherche complémentaires sont proposées à la fin.||Abstract: The present study grew out of one Chinese adult institute. Relatively few works are available that present a view of what actually happens in Chinese adult teaching and learning practice. Accordingly, it is believed that a case study on Tianjin Institute of Training Economic Management Personnel (TITEMP) which has been working for years in varions forms of adult programs, will be very useful addition to the knowledge of Chinese adult teaching and learning. The primary purpose of the present study is to serve as an introduction to one Chinese adult institute (TITEMP) in terms of characteristics of teaching, including selecting teaching content and teaching pattern, and to expand the understanding of Chinese adult teaching and learning. Based on the experiences of teachers at TITEMP, the study seeks to investigate the issues of teacher's perceptions and attitudes of teaching and learning to obtain implications toward learning-centred and collaborative mode. The theoretical foundations include andragogical conceptions (Knowles), roles of adult teachers (Brookfield), and conceptions of collaborative teaching and learning mode (Conti). The main sources of data are: the interviews and results of the questionnaire. Questionnaire responses from 70 teachers with knowledge of adult teaching and learning are described and interpreted. The general findings of the study are that the existing adult teaching practice at TITEMP does not adequately account for the principles of adult learning in a collaborative mode with adult students. Adult learning is teaching-centred. Some suggestions for further research are offered. It is hoped and believed that this research will contribute to a better understanding of Chinese adult teaching and learning in general, more particularly to the empirical study of the teachers from teaching and learning perspective in a Chinese adult higher learning setting. The research findings will be used as basis for the exploration of Chinese adult teaching.

Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation

Background and Purpose: The morbidity from spontaneous hemorrhage of untreated brain arteriovenous malformations (AVM) is not well described. Methods: The 241 consecutive AVM patients (mean age 3716 years, 52% women) from the prospective Columbia AVM Databank initially presenting with hemorrhage were evaluated using the Rankin Scale (RS) and the National Institute of Health Stroke Scale (NIHSS). From the 241 AVM patients, 29 (12%) had subsequent intracranial hemorrhage during follow-up. For further comparisons, 84 non-AVM patients with intracerebral hemorrhage from the Northern Manhattan Study (NOMAS) served as a control group. Results: In 241 AVM patients presenting with hemorrhage the median RS was 2 and the median NIHSS was 1 (49% RS 0 to 1, 61% NIHSS 2). The median time between hemorrhage and clinical evaluation was 11 days (mean 219 days). Recurrent AVM hemorrhage during follow-up resulted in no significant increase in morbidity (median RS 2, P0.004; median NIHSS 3, P0.322; time between hemorrhage and study evaluation: median 55 days, mean 657 days). Among AVM-hemorrhage subtypes, parenchymatous AVM hemorrhage was associated with higher stroke morbidity (odds ratio, 2.9; 95% CI, 1.5 to 5.8 for NIHSS 2) than nonparenchymatous hemorrhages. Parenchymatous AVM hemorrhage had a significantly better outcome (median NIHSS 1) than non-AVM related hemorrhage (median NIHSS 12; P0.0001). Conclusions: Hemorrhage, either at initial presentation or during follow-up of untreated AVM patients appears to carry

The development and field test of a Mealtime Interaction Clinical Observation Tool: a pilot study and clinical research portfolio

Objective: The purpose of this study was to develop and test psychometric properties of a Mealtime Interaction Clinical Observation Tool (MICOT) that could be used to facilitate assessment and behavioural intervention in childhood feeding difficulties. Methods: Thematic analysis of four focus groups with feeding and behaviour experts identified the content and structure of the MICOT. Following refinement, inter-rater reliability was tested between three healthcare professionals. Results: Six themes were identified for the MICOT, which utilises a traffic-light system to identify areas of strength and areas for intervention. Despite poor inter-rater reliability, for which a number of reasons are postulated, some correlation between psychologists’ ratings was evident. Healthcare professionals liked the tool and reported that it could have good clinical utility. Conclusion: The study provides a promising first version of a clinical observation tool that facilitates assessment and behavioural intervention in childhood feeding difficulties.