Caught in the eye of the storm: a qualitative study of views and experiences of planned drug holidays from methylphenidate in child and adolescent ADHD treatment

Background: Attention deficit hyperactivity disorder (ADHD) can be treated with stimulant medication such as methylphenidate. Although effective, methylphenidate can cause serious side-effects, including suppressed appetite, growth retardation and sleep problems. A drug holiday is a deliberate interruption of pharmacotherapy for a defined period of time and for a specific clinical purpose, for example for appeasing side-effects. Whilst some international guidelines recommend introducing drug holidays in ADHD treatment, this is not practised routinely. Our aim was to examine the views and experiences of planned drug holidays from methylphenidate with adults who have responsibility for treatment decisions in children and adolescents with ADHD. Method: In-depth interviews were carried out. Child and Adolescent Mental Health Services (CAMHS) practitioners (n=8), General Practitioners (n=8), teachers (n=5), and mothers of children with ADHD (n=4) were interviewed in a UK setting. Interview transcripts were analysed using grounded theory. Results: Methylphenidate eases the experience of the child amid problems at home and at school and once started is mostly continued long-term. Some families do practise short-term drug holidays at weekends and longer-term ones during school holidays. The decision to introduce drug holidays is influenced by the child’s academic progress, the parents’ ability to cope with the child, as well as medication beliefs. Trialling a drug holiday is thought to allow older children to self-assess their ability to manage without medication when they show signs of wanting to discontinue treatment prematurely. Conclusions: Planned drug holidays could address premature treatment cessation by enabling adolescents to assess repercussions under medical supervision.

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.

Explaining sleep duration in adolescents: The impact of socio-demographic and lifestyle factors and working status

Previous studies found students who both work and attend school undergo a partial sleep deprivation that accumulates across the week. The aim of the present study was to obtain information using a questionnaire on a number of variables (e.g., socio-demographics, lifestyle, work timing, and sleep-wake habits) considered to impact on sleep duration of working (n = 51) and non-working (n = 41) high-school students aged 14-21 yrs old attending evening classes (19:00-22:30h) at a public school in the city of Sao Paulo, Brazil. Data were collected for working days and days off. Multiple linear regression analyses were performed to assess the factors associated with sleep duration on weekdays and weekends. Work, sex, age, smoking, consumption of alcohol and caffeine, and physical activity were considered control variables. Significant predictors of sleep duration were: work (p < 0.01), daily work duration (8-10h/day; p < 0.01), sex (p = 0.04), age 18-21 yrs (0.01), smoking (p = 0.02) and drinking habits (p = 0.03), irregular physical exercise (p < 0.01), ease of falling asleep (p = 0.04), and the sleep-wake cycle variables of napping (p < 0.01), nocturnal awakenings (p < 0.01), and mid-sleep regularity (p < 0.01). The results confirm the hypotheses that young students who work and attend school showed a reduction in night-time sleep duration. Sleep deprivation across the week, particularly in students working 8-10h/day, is manifested through a sleep rebound (i.e., extended sleep duration) on Saturdays. However, the different roles played by socio-demographic and lifestyle variables have proven to be factors that intervene with nocturnal sleep duration. The variables related to the sleep-wake cyclenaps and night awakeningsproved to be associated with a slight reduction in night-time sleep, while regularity in sleep and wake-up schedules was shown to be associated with more extended sleep duration, with a distinct expression along the week and the weekend. Having to attend school and work, coupled with other socio-demographic and lifestyle factors, creates an unfavorable scenario for satisfactory sleep duration.

Work and Excessive Sleepiness among Brazilian Evening High School Students Effects on Days Off

Previous studies have revealed that students who work and study build up sleep deficits during the workweek, which can trigger a sleep rebound during days off. The objective of this study was to investigate the impact of working/non-working on sleepiness during days off among high school students. The study population, aged 14-21 years, attended evening classes in Sao Paulo, Brazil. For the study, the students completed questionnaires on living conditions, health, and work; wore actigraphs; and completed the Karolinska Sleepiness Scale (KSS). To predict sleepiness, a logistic regression analysis was performed. Excessive sleepiness was observed on the first day off among working students. Results suggest that working is a significant predictor for sleepiness and that two shifts of daily systematic activities, study and work, might lead to excessive daytime sleepiness on the first day off. Further, this observed excessive sleepiness may reflect the sleep debt accumulated during the workweek.

COMMUNICATION AND INFORMATION BARRIERS TO HEALTH ASSISTANCE FOR DEAF PATIENTS

IN BRAZIL, recent regulations require changes in private and public health systems to make special services available to deaf patients. in the present article, the researchers analyze the perceptions of 25 sign language using patients regarding this assistance. The researchers found communication difficulties between these patients and health services staff, as well as a culture clash and a harmful inability among the service providers to distinguish among the roles of companions, caretakers, and professional translator/interpreters. Thus, it became common for the patients to experience prejudice in the course of treatment and information exchange, damage to their autonomy, limits on their access to services, and reduced efficacy of therapy. The researchers conclude that many issues must be dealt with if such barriers to health access are to be overcome, in particular the worrying degree of exclusion of deaf patients from health care systems.

The Nurse Professional Competence (NPC) scale : self-reported competence among nursing students on the point of graduation

BACKGROUND: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. OBJECTIVES: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. METHODS AND PARTICIPANTS: The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1 [20-56]years, 87.3% women) from 11 universities/university colleges participated. RESULTS: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (93.2% vs 87.5% of NSPGs). SUMMARY AND CONCLUSION: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.

Possible Migration Routes Through Maine by Vernal Migrants

In this study we evaluate the possibility of two routes of migration into the state of Maine. The first possible route would be for migrants to continue along the coast, north of the Maine/New Hampshire border, and later swinging inland across the interior. The second path is for migrants who come up the east coast and straight into Maine, spreading across the state as they move north. In order to evaluate these possible routes we utilize a citizen-science project that measures the spring arrival dates of migrants according to the biophysical regions of Maine (Wilson 2007). Independent t-Tests and maps indicate that there is a trend of birds continuing along the coast before moving inland; six of the nine species show this pattern. Of the nine birds studied, only the eastern phoebe showed a significant trend of moving directly inland and moving across the state. Two birds show non-significant patterns of migration which could indicate insufficient data, or random migration patterns. The results are not conclusive because several of the biophysical regions have less reporting, and so the relationships among regions regarding arrival dates are skewed. Continued data collection and analysis is recommended.

Corridors for Wolf Reintroduction to Maine

Maine has been identified as holding potential for the reintroduction of wolves. Due to the long ranges of wolves, it is beneficial to map potential corridors of movement. This project analyzes the best routes for movement from suitable habitats in New York to suitable habitats in Maine. It shows the paths likely to be taken by wolves, based on their affinity for mixed and coniferous forest and their avoidance of areas of high road density. These corridors are identified using least cost path analysis and take into account topography as well as forest and road densities.

Estimated Number and Location of Future Moose-Vehicle Collisions (MVC) in Maine

Moose (Alces alces) are a keystone herbivore in Maine. Because of the large number of rural roads in Maine, there is a high rate of moose-vehicle collisions (MVCs), which is increasing. On-road encounters with animals resulted in 231 fatalities in the United States in 1999. Because of the fatality of MVCs, it is important to know where they are most likely to occur. I used GIS analysis to estimate where future MVCs would occur, factoring in the variables of land cover suitability for moose, distance from water bodies, locations of past MVCs, and speed limits on the roads. I ran four different analyses, each one weighting the variables equally. I also ran a regression to determine if increasing road speed was associated with the increase in the number of MVCs per length of road. There was not a strong positive relationship between the number of MVCs per length of road and the speed limit, but it was interesting to note that there were more MVCs per length of road on 35mph and 40mph roads than on 45, 50, 55 or 65mph roads. Future research on MVCs would benefit from the inclusion of include moose population density and road traffic data.

Three essays on education from the perspective of the economics of public setor

This work consists of three essays organized into chapters that seek to answer questions at first sight unrelated, but with one common denominator, which is the scarcity of public resources devoted to education, overall, especially in lower education. . The first chapter deals with the scarcity of resources devoted to education in a context of population aging. Two hypotheses were tested for Brazilian municipalities on the relationship between the aging of the population and educational expenditure. The first, already proven in the literature, is that there is an intergenerational conflict for resources and the increase of the share of elderly in the population reduces the educational expenditure. The second, proposed here for the first time, is that there should be reduction of competition for resources if there is a relationship of co-residence between young and old. The results indicated that an increase in the share of elderly reduces the educational expenditure per youth. But the results also illustrate that an increase in the share of elderly co-residing with youth (family arrangement more common in Latin American countries) raises the educational expenditure, which reflects a reduction of competition for resources between generations. The second chapter assesses the allocative efficiency of investments in Higher Education. Using the difference between first-year and last-year students’ scores from Enade aggregated by HEI as a product in the Stochastic Production Function, is possible to contribute with a new element in the literature aimed at estimating the production function of education. The results show that characteristics of institutions are the variables that best explain the performance of students, and that public institutions are more inefficient than the private ones. Finally, the third chapter presents evidence that the allocation of public resources in early childhood education is important for a better future school performance. In this chapter was calculated the effects of early childhood education on literacy scores of children attending the 2nd grade of elementary school. The results using OLS and propensity score matching show that students who started school at the ages to 5, 4, and 3 years had literacy scores between 12.22 and 19.54 points higher than the scores of those who began school at the ages 6 years or late. The results also suggest that the returns in terms of literacy scores diminish in relation to the number of years of early childhood education.

Drug battles and school achievement: evidence from Rio de Janeiro's favelas

This paper examines the effects of armed conflicts between drug gangs in Rio de Janeiro's favelas on student achievement. We explore variation in violence that occurs across time and space when gangs battle over territories. Within-school estimates indicate that students from schools exposed to violence score less in math exams. The effect of violence increases with conflict intensity, duration, and proximity to exam dates; and decreases with the distance between the school and the conflict location. Finally, we find that school supply is an important mechanism driving the achievement results; armed conflicts are significantly associated with higher teacher absenteeism, principal turnover, and temporary school closings.

Effects on school enrollment and performance of a conditional transfers program in Mexico

We study the effects of a conditional transfers program on school enrollment and performance in Mexico. We provide a theoretical framework for analyzing the dynamic educational decision and process inc1uding the endogeneity and uncertainty of performance (passing grades) and the effect of a conditional cash transfer program for children enrolled at school. Careful identification of the program impact on this model is studied. This framework is used to study the Mexican social program Progresa in which a randomized experiment has been implemented and allows us to identify the effect of the conditional cash transfer program on enrollment and performance at school. Using the mIes of the conditional program, we can explain the different incentive effects provided. We also derive the formal identifying assumptions needed to provide consistent estimates of the average treatment effects on enrollment and performance at school. We estimate empirically these effects and find that Progresa had always a positive impact on school continuation whereas for performance it had a positive impact at primary school but a negative one at secondary school, a possible consequence of disincentives due to the program termination after the third year of secondary school.

Does money in schools matter? evaluating the effects of FUNDEF on wages and test scores in Brazil

In this paper we investigate the effects of the 1998 reform in the funding of fundamental education in Brazil (FUNDEF) on the relative wages of public school teachers and on the relative proficiency of public school pupils. The evidence suggests that, on average, FUNDEF raised the public school teachers’ relative wages and improved the relative proficiency of the public school students. Some indirect evidence was presented that showed that the effect of FUNDEF on proficiency seems to be related to its effect on wages and on school characteristics. The effect on proficiency seems to be concentrated in the municipal schools in the Northeast of the country.

BlueFriends: measuring, analyzing and preventing social exclusion between elementary school students

Social exclusion is a relatively recent term, whose creation is attributed to René Lenoir(Lenoir, 1974). Its concept covers a remarkably wide range of social and economic problems, and can be triggered for various reasons: mentally and physically handicapped, abused children, delinquents, multi-problem households, asocial people, and other social “misfits” (Silver, 1995, pp. 63; Foucault, 1992). With an increasingly multi-cultural population, cultural and social inequalities rapidly ascend, bringing with them the need for educational restructuring. We are living in an evermore diverse world, and children need to be educated to be receptive to the different types of people around them, especially considering social and cultural aspects. It is with these goals that inclusive education has seen an increased trend in today’s academic environment, reminding us that even though children may be taught under the same roof, discriminatory practices might still happen. There are, however, a number of developed tools to assess the various dimensions of social networks. These are mostly based on questionnaires and interviews, which tend to be fastidious and don’t allow for longitudinal, large scale measurement. This thesis introduces BlueFriends, a Bluetooth-based measurement tool for social inclusion/exclusion on elementary school classes. The main goals behind the development of this tool were a) understanding how exclusion manifests in students’ behaviors, and b) motivating pro-social behaviors on children through the use of a persuasive technology. BlueFriends is a distributed application, comprised by an application running on several smartphones, a web-hosted database and a computer providing a visual representation of the data collected on a TV screen, attempting to influence children behaviors. The application makes use of the Bluetooth device present on each phone to continuously sample the RSSI (Received Signal Strength Indication) from other phones, storing the data locally on each phone. All of the stored data is collected, processed and then inserted into the database at the end of each day. At the beginning of each recess, children are reminded of how their behaviors affect others with the help of a visual display, which consists of interactions between dogs. This display illustrates every child’s best friends, as well as which colleagues they don’t interact with as much. Several tips encouraging social interaction and inclusiveness are displayed, inspiring children to change their behaviors towards the colleagues they spend less time with. This thesis documents the process of designing, deploying and analyzing the results of two field studies. On the first study, we assess how the current developed tools are inferior to our measuring tool by deploying a measurement only study, aimed at perceiving how much information can be obtained by the BlueFriends application and attempting to understand how exclusion manifests itself in the school environment. On the second study, we pile on the previous to try and motivate pro-social behaviors on students, with the use of visual cues and recommendations. Ultimately, we confirm that our measurement tool’s results were satisfying towards measuring and changing children’s behaviors, and conclude with our thoughts on possible future work, suggesting a number of possible extensions and improvements.

The use of software Mapavox for teaching graphics and games to blind and low vision students: a development through practices

Current policies on education to visually impaired point for a growing trend of including students with special educational needs in regular schools. However, most often this inclusion is not accompanied by an appropriate professional trained or infrastructure, which has been presented as a big problem for regular school teachers who have students with visual impairments in their classroom. Based on this situation, the Group of Extension in Tactile Cartography from UNESP - University of the State of São Paulo - Campus de Rio Claro - SP - Brazil has been developing educational material of geography and cartography to blind students at a special school. Among the materials developed in this study highlight the development of graphics and board games provided with sound capabilities through MAPAVOX, software developed in partnership with UFRJ - Federal University from Rio de Janeiro - RJ - Brazil. Through this software, sound capabilities can be inserted into built materials, giving them a multi-sensory character. In most cases the necessary conditions for building specific materials to students with visual impairments is expensive and beyond the reach of features from a regular school, so the survey sought to use easy access and low cost materials like Cork, leaf aluminum, material for fixing and others. The development of these materials was supported by preparation in laboratory and its subsequent test through practices involving blind students. The methodology used on the survey is based on qualitative research and non comparative analysis of the results. In other words, the material is built based on the special students perception and reality construction, not being mere adaptations of visual materials, but a construction focused on the reality of the visually impaired. The results proved were quite successful as the materials prepared were effective on mediating the learning process of students with disabilities. Geographical and cartographic concepts were seized by the students through the technology used, associated with the use of materials that took into account in its building process the perception of the students.