An examination of the role of the sports and exercise medicine specialist in Ireland- from epidemiology to treatment

The expansion of the specialty of sports and exercise medicine (SEM) is a relatively recent development in the medical community and the role of the SEM specialist continues to evolve and develop. The SEM specialist is ideally placed to care for all aspects of physical activity not only in athletes but also in the general population. As an advocate for physical activity the SEM specialist plays a broad role in advising safe effective sports and recreation participation; screening for disease related to sports participation; examining and contributing to the evidence behind treatment strategies and evaluating any potential negative impact of sports injury prevention measures. In this thesis I will demonstrate the breadth of the role the Sports and Exercise Medicine Specialist from epidemiology to in-depth examination of treatment strategies. In Chapter 2, I examined the epidemiology of sports and recreation related injury (SRI) in Ireland, an area that has previously been poorly studied. We report on 3,172 SRI (14% of total presentations) presentations to the ED over 6 months. Paediatric patients (4-16 yrs) were over represented comprising 39.9% of all SRI presentation compared to 16% of total ED presentations and 18% of the general population. These injuries were serious (32% fractures) and though 49% of injuries occurred during organised competition/practice, 41.5% occurred during recreation-most often at home. In Chapter 3, I examined risk factors associated with hand injury in hurling. The previous chapter highlighted the importance of a firm evidence base underpinning treatment strategies. When measures to improve welfare are introduced not only must potential benefits be measured, so too must potential unwanted adverse outcomes. In this study I examined a cohort of adult hurlers who had presented to the ED with a hurling related injury in order to highlight the variables associated with hand injury in this population. I found the athletes who wore a helmet were far more likely (OR 3.15 95% CI (1.51-6.56) p= 0.002) to suffer a hand injury than athletes who did not. Very few of those interviewed (4.9%) used hand protection compared to 65% who used helmet and faceguard. The introduction of the helmet and faceguard in hurling has undeniably decreased the incidence of head and face injury in hurling. However in tandem with this intervention several observational studies have demonstrated an increase in the occurrence of hurling related hand injuries. This study highlights the importance of being cognisant of unanticipated or unintended consequences when implementing a new treatment or intervention. In Chapter 4, I examined the role of population screening as applied to sport and exercise. This is a controversial area –cardiac screening in the exercising population has been the subject of much debate. Specifically I define the prevalence of exercise induced bronchoconstriction (EIB) using a specifically designed sports specific field-testing protocol. In this study I found almost a third (29%) of a full international professional rugby squad had confirmed asthma or EIB, as compared with 12-15% of the general population. Despite regular medical screening, 5 ‘new’ untreated cases (12%) were elicited by the challenge test and in the group already on treatment for asthma/EIB; over 50% still displayed EIB. In Chapter 5, I examined the evidence supporting current treatment options for iliotibial band friction syndrome (ITBFS). The practice of sports medicine has traditionally been ‘eminence based’ rather than ‘evidence based’. This may be problematic as some of these practices are based upon flawed principles- for example the treatment of iliotibial band friction syndrome (ITBFS). In this chapter, using cadaveric and biomechanical studies I expand upon the growing base of evidence clarifying the anatomy and biomechanics of the area-thereby re-examining the principles on which current treatments are based. The role of the SEM specialist is broad; we chose to examine specific examples of some of the roles that they execute. An understanding of the epidemiology of SRI presenting to the ED has implications for individual patients, sports governing bodies and health resource utilisation. Population screening is an important tool in health promotion and disease prevention in the general population. Screening in SEM may have similar less well-recognised benefits. The SEM specialist needs to be conversant in screening for medical conditions concerning physical activity. A comprehensive understanding of the pathophysiology of a disease is required for its diagnosis and treatment. Due to the ongoing evolution of SEM many treatments are eminence-based rather than evidence‐based practice. Continued re-examination of the fundamentals of current practice is essential. An awareness of potential unwanted side effects is essential prior to the introduction of any new treatment or intervention. The SEM specialist is ideally placed to advise sports governing bodies on these issues prior to and during their implementation.

Strontium isotopes and sedimentology of a marine Triassic succession (upper Ladinian) of the westernmost Tethys, Spain

Chemical Stratigraphy, or the study of the variation of chemical elements within sedimentary sequences, has gradually become an experienced tool in the research and correlation of global geologic events. In this paper 87Sr/ 86Sr ratios of the Triassic marine carbonates (Muschelkalk facies) of southeast Iberian Ranges, Iberian Peninsula, are presented and the representative Sr-isotopic curve constructed for the upper Ladinian interval. The studied stratigraphic succession is 102 meters thick, continuous, and well preserved. Previous paleontological data from macro and micro, ammonites, bivalves, foraminifera, conodonts and palynological assemblages, suggest a Fassanian-Longobardian age (Late Ladinian). Although diagenetic minerals are present in small amounts, the elemental data content of bulk carbonate samples, especially Sr contents, show a major variation that probably reflects palaeoenvironmental changes. The 87Sr/86Sr ratios curve shows a rise from 0.707649 near the base of the section to 0.707741 and then declines rapidly to 0.707624, with a final values rise up to 0.70787 in the upper part. The data up to meter 80 in the studied succession is broadly concurrent with 87Sr/86Sr ratios of sequences of similar age and complements these data. Moreover, the sequence stratigraphic framework and its key surfaces, which are difficult to be recognised just based in the facies analysis, are characterised by combining variations of the Ca, Mg, Mn, Sr and CaCO3 contents

Identification of Microturbine Model for Long-term Dynamic Analysis of Distribution Networks

As one of the most successfully commercialized distributed energy resources, the long-term effects of microturbines (MTs) on the distribution network has not been fully investigated due to the complex thermo-fluid-mechanical energy conversion processes. This is further complicated by the fact that the parameter and internal data of MTs are not always available to the electric utility, due to different ownerships and confidentiality concerns. To address this issue, a general modeling approach for MTs is proposed in this paper, which allows for the long-term simulation of the distribution network with multiple MTs. First, the feasibility of deriving a simplified MT model for long-term dynamic analysis of the distribution network is discussed, based on the physical understanding of dynamic processes that occurred within MTs. Then a three-stage identification method is developed in order to obtain a piecewise MT model and predict electro-mechanical system behaviors with saturation. Next, assisted with the electric power flow calculation tool, a fast simulation methodology is proposed to evaluate the long-term impact of multiple MTs on the distribution network. Finally, the model is verified by using Capstone C30 microturbine experiments, and further applied to the dynamic simulation of a modified IEEE 37-node test feeder with promising results.

Loggerhead nesting trend in three beaches of Boavista, Cape Verde archipelago

[EN] Nesting beach surveys are the most widely implemented monitoring tool in use by the global sea turtle community and are an important component of a comprehensive program to assess and monitor the status of sea turtle populations. These assessments are necessary to evaluate the effects of recovery and conservation activities that are being implemented at all life history stages. Monitoring techniques employed on nesting beaches range from highly structured standardized sampling to “snapshots” of nesting activity within a nesting season. Very long-term nest counts data (more than twenty years) were analyzed for some turtle populations.

Loggerhead nesting trend in three beaches of Boavista, Cape Verde archipelago

[EN] Nesting beach surveys are the most widely implemented monitoring tool in use by the global sea turtle community and are an important component of a comprehensive program to assess and monitor the status of sea turtle populations. These assessments are necessary to evaluate the effects of recovery and conservation activities that are being implemented at all life history stages. Monitoring techniques employed on nesting beaches range from highly structured standardized sampling to “snapshots” of nesting activity within a nesting season. Very long-term nest counts data (more than twenty years) were analyzed for some turtle populations.

A Sufficiency Rating System for Secondary Roads in Iowa, HR-264, 1985

County engineers in Iowa face the dual problems of rapidly escalating costs and a decreasing rate of growth of revenues. Various priority systems are in use, ranking projects for inclusion in road improvement programs, but they generally have weaknesses when used to compare one project with another in a different location. The sufficiency rating system has proven to be a useful tool in developing a priority list of projects for primary road systems, but there are none currently in use for secondary road systems. Some elements of an existing system used for primary roads could be modified for use with secondary roads, but would require extensive changes. The research reported here, sponsored by the Iowa Department of Transportation, was undertaken to develop a sufficiency rating system which could be used for secondary roads in Iowa and to produce the necessary forms and instructions to aid county engineering personnel in their efforts to complete the ratings for roads within their county. If a usable system were available that would yield reasonable results, county engineers would have an additional tool available to assist them in arriving at a defensible road improvement program.

Essays in International Finance and Macroeconomics

Thesis (Ph.D.)--University of Washington, 2016-08

Conception et caractérisation d'un dosimètre à fibre scintillante pour des applications en imagerie diagnostique et interventionnelle

Cette thèse a pour sujet le développement d’un détecteur à fibre scintillante plastique pour la dosimétrie des faisceaux de photons de basses énergies. L’objectif principal du projet consiste à concevoir et caractériser cet instrument en vue de mesurer la dose de radiation reçue au cours des examens d’imagerie diagnostique et interventionnelle. La première section est consacrée à la conception de six différents systèmes et à l’évaluation de leur performance lorsqu’ils sont exposés à des rayonnements de hautes et basses énergies. Tous les systèmes évalués présentaient un écart type relatif (RSD) de moins de 5 % lorsqu’ils étaient exposés à des débits de dose de plus de 3 mGy/s. Cette approche systématique a permis de déterminer que le tube photomultiplicateur répondait le mieux aux conditions d’exposition propres à la radiologie. Ce dernier présentait une RSD de moins de 1 % lorsque le débit de dose était inférieur à 0.10 mGy/s. L’étude des résultats permis également de suggérer quelques recommandations dans le choix d’un système en fonction de l’application recherchée. La seconde partie concerne l’application de ce détecteur à la radiologie interventionnelle en procédant à des mesures de dose à la surface d’un fantôme anthropomorphique. Ainsi, plusieurs situations cliniques ont été reproduites afin d’observer la précision et la fiabilité du détecteur. Ce dernier conserva une RSD inférieure à 2 % lorsque le débit de dose était supérieur à 3 mGy/min et d’environ 10 % au débit le plus faible (0.25 mGy/min). Les mesures sur fantôme montrèrent une différence de moins de 4 % entre les mesures du détecteur et celles d’une chambre d’ionisation lors du déplacement de la table ou du bras de l’appareil de fluoroscopie. Par ailleurs, cette différence est demeurée sous les 2 % lors des mesures de débit de dose en profondeur. Le dernier sujet de cette thèse porta sur les fondements physiques de la scintillation dans les scintillateurs plastiques. Les différents facteurs influençant l’émission lumineuse ont été analysés afin d’identifier leur contribution respective. Ainsi, la réponse du détecteur augmente de près d’un facteur 4 entre un faisceau de 20 kVp et 250 kVp. De ce signal, la contribution de la fluorescence produite dans la fibre claire était inférieure à 0.5 % lorsque les fibres étaient exposées sur 10 cm par des faisceaux de 20 à 250 kVp. Le phénomène d’extinction de la fluorescence par ionisation a également été étudié. Ainsi, l’atténuation du signal variait en fonction de l’énergie du faisceau et atteignit environ 20 % pour un faisceau de 20 kVp. En conclusion, cette étude suggère que les détecteurs à fibres scintillantes peuvent mesurer avec précision la dose de radiation reçue en imagerie diagnostique et interventionnelle, mais une calibration rigoureuse s’avère essentielle.

Adapting prospective structural analysis to strengthen sustainable management and capacity building in community-based natural resource management contexts

Local communities collectively managing common pool resources can play an important role in sustainable management, but they often lack the skills and context-specific tools required for such management. The complex dynamics of social-ecological systems (SES), the need for management capacities, and communities’ limited empowerment and participation skills present challenges for community-based natural resource management (CBNRM) strategies. We analyzed the applicability of prospective structural analysis (PSA), a strategic foresight tool, to support decision making and to foster sustainable management and capacity building in CBNRM contexts and the modifications necessary to use the tool in such contexts. By testing PSA in three SES in Colombia, Mexico, and Argentina, we gathered information regarding the potential of this tool and its adaptation requirements. The results suggest that the tool can be adapted to these contexts and contribute to fostering sustainable management and capacity building. It helped identify the systems’ dynamics, thus increasing the communities’ knowledge about their SES and informing the decision-making process. Additionally, it drove a learning process that both fostered empowerment and built participation skills. The process demanded both time and effort, and required external monitoring and facilitation, but community members could be trained to master it. Thus, we suggest that the PSA technique has the potential to strengthen CBNRM and that other initiatives could use it, but they must be aware of these requirements.

Modélisation du comportement des bétons fibrés à ultra-hautes performances par la micromécanique : Effet de l'orientation des fibres à l'échelle de la structure

Cette thèse s’inscrit dans le contexte d’une optimisation industrielle et économique des éléments de structure en BFUP permettant d’en garantir la ductilité au niveau structural, tout en ajustant la quantité de fibres et en optimisant le mode de fabrication. Le modèle développé décrit explicitement la participation du renfort fibré en traction au niveau local, en enchaînant une phase de comportement écrouissante suivie d’une phase adoucissante. La loi de comportement est fonction de la densité, de l’orientation des fibres vis-à-vis des directions principales de traction, de leur élancement et d’autres paramètres matériaux usuels liés aux fibres, à la matrice cimentaire et à leur interaction. L’orientation des fibres est prise en compte à partir d’une loi de probabilité normale à une ou deux variables permettant de reproduire n’importe quelle orientation obtenue à partir d’un calcul représentatif de la mise en oeuvre du BFUP frais ou renseignée par analyse expérimentale sur prototype. Enfin, le modèle reproduit la fissuration des BFUP sur le principe des modèles de fissures diffuses et tournantes. La loi de comportement est intégrée au sein d’un logiciel de calcul de structure par éléments finis, permettant de l’utiliser comme un outil prédictif de la fiabilité et de la ductilité globale d’éléments en BFUP. Deux campagnes expérimentales ont été effectuées, une à l’Université Laval de Québec et l’autre à l’Ifsttar, Marne-la-Vallée. La première permet de valider la capacité du modèle reproduire le comportement global sous des sollicitations typiques de traction et de flexion dans des éléments structurels simples pour lesquels l’orientation préférentielle des fibres a été renseignée par tomographie. La seconde campagne expérimentale démontre les capacités du modèle dans une démarche d’optimisation, pour la fabrication de plaques nervurées relativement complexes et présentant un intérêt industriel potentiel pour lesquels différentes modalités de fabrication et des BFUP plus ou moins fibrés ont été envisagés. Le contrôle de la répartition et de l’orientation des fibres a été réalisé à partir d’essais mécaniques sur prélèvements. Les prévisions du modèle ont été confrontées au comportement structurel global et à la ductilité mis en évidence expérimentalement. Le modèle a ainsi pu être qualifié vis-à-vis des méthodes analytiques usuelles de l’ingénierie, en prenant en compte la variabilité statistique. Des pistes d’amélioration et de complément de développement ont été identifiées.

Implementing the European quality assurance in vocational education and training (EQAVET) at national level: Some insights from the PEN Leonardo project

EQAVET, the quality assurance tool in vocational and educational training, was developed in response to the need for a supply of a trained workforce for labour market needs. Implementation of EQAVET at national level, however, remains a challenge. The research reported here focused on the implementation of QA processes by VET providers in 4 countries: Malta, Italy, Turkey, and Sweden. Data was collected through a questionnaire with 62 VET providers. Responses showed that there is an overall commitment to quality. There is, however, little knowledge of EQAVET across the countries, with the exception of Malta. None the less, all VET providers have implemented some aspects of EQAVET, even if not always intentionally. The situation is, however, far from EQAVET being fully implemented. Reflections are made on whether the EQAVET model specifically or qualification assurance principles assurances should be promoted across Europe. (DIPF/Orig.)

Main causes of death in Dande, Angola: results from verbal autopsies of deaths occurring during 2009–2012

bACKGROUND - The Dande Health and Demographic Surveillance System (HDSS) located in Bengo province, Angola, covers nearly 65,500 residents living in approximately 19,800 households. This study aims to describe the main causes of deaths (CoD) occurred within the HDSS, from 2009 to 2012, and to explore associations between demographic or socioeconomic factors and broad mortality groups (Group I-Communicable diseases, maternal, perinatal and nutritional conditions; Group II-Non-communicable diseases; Group III-Injuries; IND-Indeterminate). Methods - Verbal Autopsies (VA) were performed after death identification during routine HDSS visits. Associations between broad groups of CoD and sex, age, education, socioeconomic position, place of residence and place of death, were explored using chi-square tests and fitting logistic regression models. Results - From a total of 1488 deaths registered, 1009 verbal autopsies were performed and 798 of these were assigned a CoD based on the 10th revision of the International Classification of Diseases (ICD-10). Mortality was led by CD (61.0%), followed by IND (18.3%), NCD (11.6%) and INJ (9.1%). Intestinal infectious diseases, malnutrition and acute respiratory infections were the main contributors to under-five mortality (44.2%). Malaria was the most common CoD among children under 15 years old (38.6%). Tuberculosis, traffic accidents and malaria led the CoD among adults aged 15–49 (13.5%, 10.5 % and 8.0% respectively). Among adults aged 50 or more, diseases of the circulatory system (23.2%) were the major CoD, followed by tuberculosis (8.2%) and malaria (7.7%). CD were more frequent CoD among less educated people (adjusted odds ratio, 95% confidence interval for none vs. 5 or more years of school: 1.68, 1.04–2.72). Conclusion - Infectious diseases were the leading CoD in this region. Verbal autopsies proved useful to identify the main CoD, being an important tool in settings where vital statistics are scarce and death registration systems have limitations.

The use of motivational interviews by nurses to promote health behaviors in adolescents: A scoping review protocol

Abstract The developmental changes during adolescence may affect subsequent risk for diseases and health-related behaviors. Traditionally, professionals assume that knowledge is sufficient for behavioral changes; however adolescents continue to engage in unhealthy behaviors despite clearly knowing what they should do and how to change. "What is lacking is the motivation to apply that knowledge". Motivational Interview (MI) may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects. Objectives The objective of this scoping is to examine and map the use of MI by nurses in their clinical practice with adolescents to promote health behaviors. The review will focus on knowing what is the current extent of the use of nurse-led MI; which adolescent populations were included; in which contexts nurses use MI; which MI techniques/strategies have been used and what outcomes on health behaviors promotion have been reported. Methodology This scoping review will be informed by JBI methodology. The population of this study is adolescents aged 10 to 19 years participating in nurse-led MI. The concept of MI include MI done by personal or telephone call, with any number of sessions, brief interventions and other motivational interventions grounded but not limited to the principles described by Miller & Rollnick (2008). All geographical and all clinical practice contexts where nurses' undertake MI with adolescents such as hospitals, primary health care, health care centers, community or schools will be contemplated. English, Spanish and Portuguese published studies will be considered for inclusion. Results An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the concepts, synonyms (with truncations), MeSH Terms and Cinhal headings of this study. It was identified 5 synonyms for "Adolescents", 7 for "MI" and 2 for "nurse". A first search using the all 14 identified keywords and index terms was made at Medline (Title/Abstract) and brought up 125 articles. Other 16 databases referenced at the protocol will be searched to identify additional studies. Articles identified from the final search will be assessed for relevance to the review, based on information provided in the title and abstract. The full article will be retrieved for all studies that meet the inclusion criteria of the review. It is expected that findings from this Scoping Review provide needed information to nurses related to the use of MI to promote health behaviors in adolescents. Conclusions There is little knowledge of what works for whom (which adolescent subpopulation) under what circumstances (in which setting, for what problem) in relation to nurse-led MI. There is a need for scoping or mapping the nurse-led MI with adolescents to identify evidence gaps and to inform opportunities for future development in nursing practice. Moreover, information regarding implemented and evaluated interventions, techniques used, contexts of application and adolescents groups is dispersed in the literature which impedes the formulation of questions about the outcomes and effectiveness of those interventions. The practical implication of this mapping will be clarifying all these aspects.

The use of motivational interviews by nurses to promote health behaviors in adolescents: a scoping review protocol

Adolescents - defined as young people between 10 and 19 years of age1 - are, in general, a relatively healthy segment of the population.2 However, the developmental changes that take place during adolescence may affect their subsequent risk for diseases and for a variety of health-related behaviors. In fact, early onset of preventable health problems (e.g. obesity, malnutrition, STDs) and the engagement in health risk behaviors (e.g., sedentary life style, excessive alcohol consumption, unprotected sex) during adolescence, are likely to put them at greater risk for physical and mental health problems at a later stage in life. Moreover, health related problems and health risk behaviors may disrupt adolescents' physical and cognitive development and therefore may affect their ability to think and act in relation to decisions about their health in the future.1 In summary, health-related behaviors in adolescence, apart from their influence on the continuum of "health-disease", they also have the potential to influence future behaviors. In fact, several studies have shown that past behaviors are good predictors of future behaviors .3,4 Thus, promoting healthy practices during adolescence and taking measures to better protect young people from health risks are essential for the prevention of health problems in adulthood.5 According to the World Health Organization, the main problems affecting young people include mental health problems (such as behavioral disorders, eating disorders, suicide, anxiety or depression), the use of substances (illegal substances, alcohol and tobacco), interpersonal violence, nutrition (a proper nutrition consists of healthy eating habits and physical exercise), unintentional injuries (which are a leading cause of death and disability among young people, with road traffic injuries accounting for about 700 deaths per day), sexual and reproductive health (for example, risky sexual behaviors, early pregnancy and childbirth) and HIV (resulting from sexual transmission and drug injection).5,6 On the other hand, the number of children and youth with chronic health conditions has increased dramatically in the past four decades7 as larger numbers of chronically ill children survive beyond the age of 10.8 Despite the lack of data on adolescents' health making it difficult to determine the prevalence of chronic illnesses in this age group9, it is known that one in ten adolescents suffers from a chronic condition worldwide.10 In fact, national population based studies from Western countries show that 20-30% of teenagers have a chronic illness, defined as one that lasts longer than six months.8 The most prevalent chronic illness among adolescents is asthma and the one with the highest incidence is diabetes mellitus, particularly type II.9 Traditionally, healthcare professionals have been mainly investing in health education activities, through the transmission of knowledge with a view to creating habits, customs and behaviors, and promoting healthy lifestyles. However, empowering people does not only consist of giving them the right information11 , i.e. good information is not enough to cause people to make changes.12 The motivation or desire to change unhealthy behaviors and habits depends on many factors, namely intrinsic motivation, control over personal decisions, self-confidence and perception of effectiveness, personal ambivalence, and individualized assistance.12 Many professionals assume that supplying knowledge is sufficient for behavioral changes; however, even very good advice often fails to generate behavioral change. After all, people continue to engage in unhealthy behaviors despite clearly knowing what they should do and how to change. "What is lacking is the motivation to apply that knowledge".13, p.1233 In fact, behavioral change is a complex phenomenon with multiple determinants that also includes motivational variables. It is associated with ambivalent processes expressed in the dilemma between keeping the current status and moving on to new ways of acting. For example, telling adolescents that if they keep on engaging in a certain behavior, they are increasing the risk of developing a long-term condition such as cardiovascular disease, stroke or diabetes is rarely enough to trigger the desired behavioral change; people are more likely to change when they believe that the change is really effective and that they are able to implement it.12 Therefore, it is essential to provide specific training for "healthcare professionals to master motivational techniques, avoid confrontation with the users, and facilitate behavioral changes".14 In this context, motivating patients to make behavioral changes is also an important nursing task where change in lifestyle is a major element of patients' treatment and preventive interventions.15 One of the nurse's goals is to help improve a patient's health or help them to manage existing health conditions. Once nurses are in a position where they have to focus on accomplishing tasks and telling patients what needs to be accomplished16, the role of the nurse is expanding even more into the use of motivational strategies.17 MI is bringing nurses back to therapeutic communication and moving them closer to successful health promotion and disease management, by promoting behavior change and empowering their patients. As the nursing profession evolves, MI is seen as a challenge and the basis of nurse's interactions with individuals, families and communities.16, 17 In the same way, MI may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects regarding problems, clarification of doubts, and development of skills.18 In fact, MI may be particularly applicable in work with adolescents because of their specific developmental stage. Adolescents attempt to establish their own autonomy and identity while struggling with social interactions and moral issues, which leads to ambivalence.19 Consistent with the developmental challenges during adolescence, "MI explicitly honors autonomy, people's right and irrevocable ability to decide about their own behavior"20 while allowing the person to explore possibilities for change of risky or maladaptive behaviours.19 MI can be defined as a directive, client-centred counselling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style of interpersonal relationship.21 It is a set of strategies and techniques widely used in clinical practice based on the transtheoretical model of change. The Stages of Change model describes five stages of readiness—precontemplation, contemplation, preparation, action, and maintenance—and provides a framework for understanding behavior change.22 The MI has been widely tested and applied in different areas, such as modification of addictive behaviors, interventions with offenders in the context of justice, eating disorders, promotion of therapeutic adherence among chronic patients, promotion of learning in school settings or intervention with adolescents at risk.18,23 In general, clinical practice has been adopting the perspective of motivation as something relatively immutable, i.e., the adolescent is either motivated for change/treatment and, in these conditions, the professional's role is to help him/her, or the adolescent is not motivated and then change/treatment is not feasible. Alternatively the theoretical model underlying the MI technique postulates that the individual's adherence to change/treatment depends on his/her motivation, which can change throughout the therapeutic intervention. As several studies found positive results for effects of MI24-26 and its use by health professionals is encouraged23,27 nurses may play an important role in patients' process of change. As nurses have a crucial role in clinical contexts, they can facilitate the process of ending risk behaviors and/or adopting positive health behaviors through some motivational techniques, namely with adolescents. A considerable number of systematic reviews about MI already exist pointing to some benefits of its use in the treatment of a broad range of behavioral problems and diseases.13,28,29 Some of the current reviews focus on examining the effectiveness of MI for adolescents with diverse health risks/problems 30-32. However, to date there are no reviews that present and assess the evidence for the use of nurse-led MI in adolescents. Therefore, we have little knowledge of what works for whom (which adolescent subpopulation) under what circumstances (in which setting, for what problem) in relation to motivational interviewing by nurses. There is a clear need for scoping or mapping the use of MI by nurses with adolescents to identify evidence gaps and to inform opportunities for future development in nursing practice. On the other hand, information regarding nurse-led implemented and evaluated interventions, techniques and/or strategies used, contexts of application and adolescents subpopulation groups is dispersed in the literature33-36 which impedes the formulation of precise questions about the effectiveness of those interventions conducted by nurses and therefore the realization of a systematic review. In other words, it is known that different kind of motivational interventions have been implemented in different contexts by nurses, however does not exist a map about all the motivational techniques and/or strategies used. Furthermore the literature does not clarify which is the role of nurses at cross professional motivational intervention implemented programs and finally the outcomes and evaluation of interventions are unclear. Thus, the practical implication of this mapping will be clarifying all these aspects. Without this clarification is not possible to proceed to the realization of a systematic review about the effectiveness of the use of motivational interviews by nurses to promote health behaviors in adolescents, in a particular context and/or health risk behavior; or regarding the effectiveness of certain technique and/or strategy of MI. Consequently, there are important questions about the nature of the evidence in this area that need to be answered before formulating a precise question of effectiveness. This scoping review aims to respond to these questions. An initial search of the JBI Database of Systematic Reviews & Implementation Reports, Cochrane Database of Systematic Reviews, , Database of promoting health effectiveness reviews (DoPHER), The Campbell Library, Medline and CINAHL, has revealed that currently there is no Scoping Review (published or in progress) on the subject. In this context, this scoping review will examine and map the published and unpublished research around the use of MI by nurses implemented and evaluated to promote health behaviors in adolescents; to establish its current extent, range and nature and identify its feasibility, outcomes and gaps in the evidence defining research priorities in this field. This scoping review will be informed by the JBI methodology37 that suggests a five stage methodological framework for conducting scoping reviews which includes: identifying the research question, searching for relevant studies, selecting studies, charting data, collating, summarizing and reporting the results.

The use of motivational interviews by nurses to promote health behaviors in adolescents: A scoping review protocol

Abstract The developmental changes during adolescence may affect subsequent risk for diseases and health-related behaviors. Motivational Interview (MI) may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects. At this context, it is important to examine and map the use of MI by nurses in their clinical practice with adolescents to promote health behaviors. Objetives A scoping review has been currently undertaking to find out what is the current extent of the use of nurse-led MI; which adolescent populations were included; in which contexts nurses use MI; which MI techniques/strategies have been used and what outcomes on health behaviors promotion have been reported. The first task was to develop a search strategy to identify relevant studies for this review. It is described here the experience in constructing a search strategy for this review. Methodology This scoping review will be informed by JBI methodology. An initial search of MEDLINE and CINAHL was undertaken. An analysis of the text words contained in the title and abstract, and of the index terms used to describe the searched articles were retrieved and these were then used to construct a search strategy for use in Medline and Cinahl. Results Analysis of the text words and the index terms generated 19 keywords: It was identified 5 synonyms for "Adolescents", 12 for "MI" and 2 for "nurse". A new research formula was designed using the text words identified. Adolescen*[Title/Abstract]) OR Younger*[Title/Abstract]) OR Youth*[Title/Abstract]) OR Teen*[Title/Abstract]) OR Adolescent[MeSH Terms])) AND (((((((((((("Motivational interview"[Title/Abstract]) OR "Motivational intervention"[Title/Abstract]) OR "Motivational interviews"[Title/Abstract]) OR "Motivational interventions"[Title/Abstract]) OR "motivational interviewing"[Title/Abstract]) OR "motivational counseling"[Title/Abstract]) OR "motivational support"[Title/Abstract]) OR "Motivational enhancement"[Title/Abstract]) OR "Brief intervention"[Title/Abstract]) OR "Brief interventions"[Title/Abstract]) OR Motivational Interviewing[MeSH Terms]) OR Directive Counseling[MeSH Terms])) AND ((nurs*[Text Word]) OR Nurses[MeSH Terms]). Limiters - Language: English, Portuguese, Spanish. In MEDLINE this research formula generated 125 results. Other 16 databases referenced at the protocol will be searched to identify additional studies. Articles identified from the final search will be assessed for relevance to the review, based on information provided in the title and abstract. The full article will be retrieved for all studies that meet the inclusion criteria of the review. Conclusions It was presented here the initial results of this search. Next steps of this study will be to develop and refine the search strategy for use in other databases. It is expected that findings from this Scoping Review provide needed information to nurses related to the use of MI to promote health behaviors in adolescents and inform opportunities for future development in nursing practice.