Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.

A psicomotridade em saúde mental de adultos no Fórum Sócio-Ocupacional de Lisboa, ARIA

O presente relatório de estágio descreve de forma detalhada as atividades desenvolvidas no âmbito do Fórum Sócio-Ocupacional de Lisboa (FsoLis) na instituição ARIA (Associação de Reabilitação Integração e Ajuda), que foram desenvolvidas no âmbito do Mestrado de Reabilitação Psicomotora, da Faculdade de Motricidade Humana da Universidade de Lisboa. Em primeiro lugar haverá um enquadramento teórico que suporta a Psicomotricidade em Saúde Mental de adultos, mais especificamente ao nível da esquizofrenia e da perturbação bipolar. Em segundo lugar serão apresentados os dois estudos de caso que dizem respeito à intervenção neste contexto. O primeiro estudo-caso diz respeito a um jovem adulto com perturbação bipolar em que as dificuldades centravam-se ao nível do corpo, da sua autodeterminação e autonomia desta forma as intervenções tiveram por base sessões individuais. O segundo estudo-caso foi com um grupo fechado de três elementos que apresentavam dificuldades de compreensão e retenção de informação e assim houve a necessidade de se trabalhar em grupo a fim de criar estratégias e facilitadores para o seu contexto. Para cada caso encontra-se descrito o processo de observação, avaliação, plano terapêutico e programa de intervenção, bem como uma análise global. No final é realizada uma análise e reflexão de todo este processo em que se conclui que o trabalho psicomotor é muitas vezes fundamental para se trabalhar ao nível da saúde mental.

The incorporation of violence by women video artists

This paper examines the way in which women video artists embodied violence in their video pieces as a strategy of critique of the patriarchal regime. Since the 1960s several generations of women artists used different strategies of self-harm or explored the physical and mental limits of their bodies to express the anguish of those who are excluded from the patriarchal society on sexist and/or racist grounds. Considering the guiding line that covers three fields – art, gender, and feminist social movements – as well as their key thinkers and scholars in Sociology, Fine Arts and the Humanities, we have built the object of study of this essay, namely, the relationship between women's video art focused on the body, violence and gender along with feminist social movements in the period ranging from 1967 to 2007, in a Western context. The methodology used had as its primary goal to create a link between the micro-sociological level of expressions, body gestures and behaviours in the videos and the macro-sociological level of broader, institutionalized social forces that are at the origin of inequalities, such as dimensions of gender and «race». This study concluded that at least since the 1960s there is the denunciation by women video artists of the general circumstances women live under, while enduring violence of various kinds, such as socio-cultural, psychological and sexual violence against women.

Validación de la escala de las necesidades psicológicas básicas en el contexto laboral

El presente proyecto se desarrolló bajo el marco de la Teoría de la Autodeterminación (TAD) (Self-Determination Theory [SDT]; Deci y Ryan, 1985, 2002) la cual, aborda factores personales y situacionales que provocan la energización de la motivación humana en diferentes ámbitos. Sugiere que los individuos que desarrollan una motivación que los acerca y mantiene en una actividad, se basan en qué tan buena es su participación dentro esa actividad para satisfacer las necesidades de competencia, relaciones y autonomía. Debido a la importancia que tiene la satisfacción de estas tres necesidades psicológicas básicas para el desarrollo de la motivación autónoma, sus implicaciones en el contexto laboral quedan de manifiesto, ya que las personas que desarrollan una motivación de mayor calidad incrementarán su confianza lo que facilitará el desarrollo del disfrute, esfuerzo, persistencia, bienestar y satisfacción con su trabajo, incrementando su compromiso y productividad. El objetivo principal de este trabajo es validar la escala de Necesidades Psicológicas Básicas en el Trabajo en una muestra de trabajadores mexicanos. El estudio se llevó a cabo en una empresa cuya planta se encuentra dentro del estado de Nuevo León. La muestra consta de 480 trabajadores (62.7% hombres y 37.3% mujeres). Se examinó la fiabilidad de la escala global y las diferentes sub-escalas mediante el alfa de Cronbach con el software estadístico SPSS versión 21. La estructura factorial de los dos modelos se pondrán a prueba mediante el análisis factorial confirmatorio (AFC) utilizando el programa estadístico LISREL 8.80. La adecuación de los modelos se analizó a través de diferentes índices de ajuste que incluye la chi-cuadrada dividida por los grados de libertad (χ2/gl), el índice de ajuste no normativo (NNFI), el índice de ajuste comparativo (CFI) y la raíz de promedio del error de aproximación.

Entre discursos e práticas : as relações entre estados (pluri) nacionais e povos indígenas no Brasil e na Bolívia a partir do direito de consulta

Tese (doutorado)—Universidade de Brasília, Instituto de Ciências Sociais, Centro de Pesquisa e Pós-Graduação sobre as Américas, Programa de Pós-Graduação em Estudos Comparados sobre as Américas, 2015.

Le processus d’élaboration des politiques publiques comme espace d’autodétermination : les cas de l’Accord de Kelowna et de la Loi sur le contrôle par les Premières Nations de leur système d’éducation

L’objectif du présent mémoire est double. D’une part, il cherche à identifier les facteurs qui permettent au gouvernement canadien et aux peuples autochtones de s’entendre sur des politiques publiques, malgré la persistance d’une logique coloniale. Nous verrons que l’atteinte d’une entente est conditionnelle à la légitimité du processus d’élaboration de la politique publique d’un point de vue autochtone. D’autre part, ce travail invite à penser le processus d’élaboration des politiques publiques comme espace potentiel d’autodétermination. Étant donné la malléabilité des règles qui encadrent l’élaboration des politiques publiques en contexte canadien, le gouvernement – s’il en a la volonté - peut modeler le processus d’élaboration de façon à le rendre plus égalitaire et donc plus légitime d’un point de vue autochtone. Il sera démontré que, dans une optique de changements progressifs, un tel processus d’élaboration peut permettre aux peuples autochtones de regagner une certaine autonomie décisionnelle et ainsi atténuer les rapports de pouvoir inégalitaires. Notre cadre théorique a été construit à l’aide de différents courants analytiques, issus notamment des littératures sur le colonialisme, sur les politiques publiques et sur la légitimité. La comparaison de deux études de cas, soit les processus d’élaboration de l’Accord de Kelowna et du projet de loi C-33, Loi sur le contrôle par les Premières Nations de leur système d’éducation, permettra d’illustrer nos arguments et d’en démontrer l’applicabilité pratique. En somme, nous verrons comment la première étude de cas permet de concevoir l’élaboration des politiques publiques comme espace potentiel d’autodétermination, et comment la deuxième, au contraire, démontre que cette sphère peut encore en être une d’oppression.

Le processus d’élaboration des politiques publiques comme espace d’autodétermination : les cas de l’Accord de Kelowna et de la Loi sur le contrôle par les Premières Nations de leur système d’éducation

L’objectif du présent mémoire est double. D’une part, il cherche à identifier les facteurs qui permettent au gouvernement canadien et aux peuples autochtones de s’entendre sur des politiques publiques, malgré la persistance d’une logique coloniale. Nous verrons que l’atteinte d’une entente est conditionnelle à la légitimité du processus d’élaboration de la politique publique d’un point de vue autochtone. D’autre part, ce travail invite à penser le processus d’élaboration des politiques publiques comme espace potentiel d’autodétermination. Étant donné la malléabilité des règles qui encadrent l’élaboration des politiques publiques en contexte canadien, le gouvernement – s’il en a la volonté - peut modeler le processus d’élaboration de façon à le rendre plus égalitaire et donc plus légitime d’un point de vue autochtone. Il sera démontré que, dans une optique de changements progressifs, un tel processus d’élaboration peut permettre aux peuples autochtones de regagner une certaine autonomie décisionnelle et ainsi atténuer les rapports de pouvoir inégalitaires. Notre cadre théorique a été construit à l’aide de différents courants analytiques, issus notamment des littératures sur le colonialisme, sur les politiques publiques et sur la légitimité. La comparaison de deux études de cas, soit les processus d’élaboration de l’Accord de Kelowna et du projet de loi C-33, Loi sur le contrôle par les Premières Nations de leur système d’éducation, permettra d’illustrer nos arguments et d’en démontrer l’applicabilité pratique. En somme, nous verrons comment la première étude de cas permet de concevoir l’élaboration des politiques publiques comme espace potentiel d’autodétermination, et comment la deuxième, au contraire, démontre que cette sphère peut encore en être une d’oppression.

A motivação para o trabalho e os comportamentos desviantes

Dissertação de Mestrado apresentada no ISPA - Instituto Universitário

DIGITAL HISTORY: DESIGNING VIRTUAL ENVIRONMENTS THAT SUPPORT CRITICAL THINKING AND IDEA EXCHANGE, MOTIVATE AND ENGAGE USERS

Thesis (Master, Education) -- Queen's University, 2016-08-29 15:56:53.748

TOWARD A POLITICAL CONCEPTION OF MINORITY RIGHTS: RECONCILING SOVEREIGNTY, HUMAN RIGHTS AND MINORITY CLAIMS

The question that I will explore in this research dissertation is whether one can defend the rights of homeland minorities as a progressive extension of the existing norms of human rights. This question calls for several deeper inquiries about the nature, the function and the underlying justifications for both human rights and minority rights. In particular, this research project will examine the following issues: on what normative grounds the available norms of human rights and minority rights are justified; if there is any methodic way to use the normative logic of human rights to support substantial forms of minority claims, such as the right to self-determination; whether human rights can take the form of group rights; and finally, whether there is any non-sectarian basis for justifying the minority norms, which can be acceptable from both liberal and non-liberal perspectives. This research project has some implications for both theories of minority rights and human rights. On the one hand, the research employs the topic of minority rights to shed light on deficiencies of the existing political theories of human rights. On the other hand, it uses the political theory to shed light on how existing theories of minority rights could be improved and amended. The inquiry will ultimately clarify how to judge the merit of the claim that minority rights are or should be a part of human rights norms.

The Proceedings of the South Carolina Historical Association

Annually, the association publishes a journal, The Proceedings, which consists of papers presented at the annual meeting. The United States and Austria, 1918-1919: The Problem of National Self-Determination by Duane Myers The German Economy during World War II: Petroleum by Peter W. Becker Tillman’s Lieutenant: John Laurens Manning Irby by Jerry Slaunwhite Tillman’s Lieutenant: John Lowndes McLaurin by Rodger Stroup

Adesão ao regime medicamentoso dos adolescentes submetidos a transplante hepático: fatores motivacionais.

Introduction: In liver transplantation the immunosuppression is essential for the survival of the graft and of the receiver. Although characteristics of adolescent development may influence medication non-adherence, the literature on the subject is scarce. The high prevalence and consequences of non-adherence makes it essential to identify the non-adherent adolescent with the intention of promoting medication adherence. Methods: The aim of this descriptive cross-sectional study is to characterize adolescents undergoing liver transplantation, and to determine the degree of medication non-adherence, using the Measure Treatment Adherence (MAT) scale and immunosuppression blood values. Moreover, the study seeks to explore the relationship between adherence and motivation - using the Treatment Self-Regulation Questionnaire (TSRQ), and adherence and competency - using Perceived Competence Scale (PCS). Results: The sample consisted of 32 adolescents (Age M=14,44 (SD=2,66); 56,3% (n=18) male) who underwent liver transplantation at a Portuguese pediatric hospital. Adolescents self-reported medication adherence scores in the MAT were significantly higher (100%) than what was expected based on the mean value of the three blood values of tacrolimus obtained within one year prior to completing the questionnaire (66,7%). As a subjective self-reported measure, the MAT is prone to bias and inflated self assessed adherence is commonly found in the literature. On the other hand, the mean value of the three blood levels of tacrolimus obtained widely and considered objective adherences measure, they may individually vary in terms of pharmacokinetic response and absorption. Adolescents showed a predominantly autonomous motivation to fulfill the medication prescription, being that motivation high (TSRQ autonomous motivation subscale presents an average value of 6.5, in a range of 1 to 7). They showed themselves confident and believing in their capacity to follow the medication regimen, due to the high perceived competence (PCS presents an average value of 6.65, in a range of 1 to 7). Opposed to what was postulated by the Self-determination Theory and other investigation's results, motivation and perceived competence are not related to adherence to the medication regimen in this study (rs=,119 p=,523; rs=,283 p=,123, respectively). Thus, perceived competence seems to have a positive influence on the autonomous motivation of these adolescents (rs=,482 p=,006). Conclusion: This study shows that medication adherence when evaluated subjectively scores higher compared to the blood values of immunosuppression. Also, Motivation and Perceived Competence do not seem to influence the adherence to the medication regimen. More multi-centre studies are needed, based on solid theory to examine adherence behaviour more.

Determination of the rheological parameters of self-compacting concrete matrix using slump flow test

The classification of a concrete mixture as self-compacting (SCC) is performed by a series of empirical characterization tests that have been designed to assess not only the flowability of the mixture but also its segregation resistance and filling ability. The objective of the present work is to correlate the rheological parameters of SCC matrix, yield stress and plastic viscosity, to slump flow measurements. The focus of the slump flow test investigation was centered on the fully yielded flow regime and an empirical model relating the yield stress to material and flow parameters is proposed. Our experimental data revealed that the time for a spread of 500 mm which is used in engineering practice as reference for measurement parameters, is an arbitrary choice. Our findings indicate that the non-dimensional final spread is linearly related to the non-dimensional yield-stress. Finally, there are strong indications that the non-dimensional viscosity of the mixture is associated with the non-dimensional final spread as well as the stopping time of the slump flow; this experimental data set suggests an exponential decay of the final spread and stopping time with viscosity. © Appl. Rheol.

Electron ground state energy level determination of ZnSe self-organized quantum dots embedded in ZnS

Optical and electrical characterization of the ZnS self-organized quantum dots (QDs) embedded in ZnS by molecular beam epitaxy have been investigated using photoluminescence (PL), capacitance-voltage (C-V), and deep level transient Fourier spectroscopy (DLTFS) techniques. The temperature dependence of the free exciton emission was employed to clarify the mechanism of the PL thermal quenching processes in the ZnSe QDs. The PL experimental data are well explained by a two-step quenching process. The C-V and DLTFS techniques were used to obtain the quantitative information on the electron thermal emission from the ZnSe QDs. The correlation between the measured electron emission from the ZnSe QDs in the DLTFS and the observed electron accumulation in the C-V measurements was clearly demonstrated. The emission energy for the ground state of the ZnSe QDs was determined to be at about 120 meV below the conduction band edge of the ZnS barrier, which is in good agreement with the thermal activation energy, 130 meV, obtained by fitting the thermal quenching process of the free exciton PL peak. (C) 2003 American Institute of Physics.