Adaptation as a part of system resilience. insights from fish producers organizations in Portugal

Complex problems of globalized society challenge its adaptive capacity. However, it is precisely the nature of these human induced problems that provide enough evidence to show that adaptability may not be on a resilient path. This thesis explores the ambiguity of the idea of adaptation (and its practice) and illustrates the ways in which adaptability contributes to resilience of social ecological systems. The thesis combines a case study and grounded theory approach and develops an analytical framework to study adaptability in resource users’ organizations: from what it depends on and what the key challenges are for resource management and system resilience. It does so for the specific case of fish producers’ organizations (POs) in Portugal. The findings suggest that while ecological and market context, including the type of crisis, may influence the character of fishers’ adaptation within POs (i.e. anticipatory, maladaptive and reactively adaptive), it does not determine it. Instead, it makes agency even more crucial (i.e. leadership, trust and agent’s perceptions in terms of their impact on fishers’ motivation to learn from each other). In sum, it was found that internal adaptation can improve POs’ contribution to fishery management and resilience, but it is not a panacea and may, in some cases, increase system vulnerability to change. Continuous maladaptation of some Portuguese POs points at a basic institutional problem (fish market regime), which clearly reduces fisheries resilience as it promotes overfishing. However, structural change may not be sufficient to address other barriers to Portuguese fishers’ (PO members) adaptability, such as history (collective memory) and associated problematic self-perceptions. The agency (people involved in structures and practices) also needs to change. What and how institutional change and agency change build on one another (e.g. comparison of fisheries governance in Portugal and other EU countries) is a topic to be explored in further research.

Key-elements of family interventions for psychosis : a qualitative research

RESUMO:As perturbações psicóticas são doenças mentais complexas sendo influenciadas na sua etiologia e prognóstico por factores biológicos e psicossociais. A interferência do ambiente familiar na evolução da doença espelha bem esta realidade. Quando em 1962 George Brown e colaboradores descobriram que ambientes familiares com elevada Emoção Expressa (EE) contribuíam para um aumento significativo do número de recaídas de pessoas com esquizofrenia (Brown et al., 1962), estava aberto o caminho para o desenvolvimento de novas intervenções familiares. A EE inclui cinco componentes: três componentes negativos, i.e. criticismo, hostilidade e envolvimento emocional excessivo; e dois componentes positivos, i.e. afectividade e apreço (Amaresha & Venkatasubramanian, 2012; Kuipers et al., 2002). No final dos anos 1970 surgiram os primeiros trabalhos na área das intervenções familiares nas psicoses (IFP). Dois grupos em países diferentes, no Reino Unido e nos Estados Unidos da América, desenvolveram quase em simultâneo duas abordagens distintas. Em Londres, a equipa liderada por Julian Leff desenhava uma intervenção combinando sessões unifamiliares em casa, incluindo o paciente, e sessões em grupo, apenas para os familiares (Leff et al., 1982). Por seu turno, em Pittsburgh, Gerard Hogarty e colaboradores desenvolviam uma abordagem que compreendia a dinamização de sessões educativas em grupo (Anderson e tal., 1980). Para designar este trabalho, Hogarty e colaboradores propuseram o termo “psicoeducação”. As IFP começaram a ser conhecidas por esta designação que se generalizou até aos dias de hoje. Neste contexto a educação era vista como a partilha de informação acerca da doença, dos profissionais para os familiares. Nas sessões os profissionais eram informados acerca das manifestações, etiologia, tratamento e evolução das psicoses, bem como de formas para lidar com as situações difíceis geradas pela doença, e.g. risco de recaída. Os trabalhos pioneiros das IFP foram rapidamente sucedidos pelo desenvolvimento de novos modelos e a proliferação de estudos de eficácia. Para além dos modelos de Leff e Hogarty, os modelos IFP que ficaram mais conhecidos foram: (1) a Terapia Familiar-Comportamental, desenvolvida por Ian Falloon e colaboradores (Falloon et al., 1984); e (2) a Terapia Multifamiliar em Grupo, desenvolvida por William McFarlane e colaboradores (McFarlane, 1991). O incremento de estudos de eficácia contribuiu rapidamente para as primeiras meta-análises. Estas, por sua vez, resultaram na inclusão das IFP nas normas de orientação clínica mais relevantes para o tratamento das psicoses, nomeadamente da esquizofrenia (e.g. PORT Recomendations e NICE Guidelines). No geral os estudos apontavam para uma diminuição do risco de recaída na esquizofrenia na ordem dos 20 a 50% em dois anos (Pitschel-Walz et al., 2001). No final dos anos 1990 as IFP atingiam assim o apogeu. Contudo, a sua aplicação prática tem ficado aquém do esperado e as barreiras à implementação das IFP passaram a ser o foco das atenções (Gonçalves-Pereira et al., 2006; Leff, 2000). Simultaneamente, alguns autores começaram a levantar a questão da incerteza sobre quais os elementos-chave da intervenção. O conhecimento sobre o processo das IFP era reduzido e começaram a surgir as primeiras publicações sobre o assunto (Lam, 1991). Em 1997 foi dinamizada uma reunião de consenso entre os três investigadores mais relevantes do momento, Falloon, Leff e McFarlane. Deste encontro promovido pela World Schizophrenia Fellowship for Schizophrenia and Allied Disorders surgiu um documento estabelecendo dois objectivos e quinze princípios para as IFP (WFSAD, 1997). Não obstante os contributos que foram feitos, continua a existir uma grande falta de evidência empírica acerca do processo das IFP e dos seus elementos-chave (Cohen et al., 2008; Dixon et al., 2001; Lam, 1991; Leff, 2000; McFarlane et al., 2003). Também em Portugal, apesar da reflexão teórica nesta área e do registo de ensaios de efectividade de grupos para familiares – estudo FAPS (Gonçalves-Pereira, 2010), os componentes fundamentais das IFP nunca foram analisados directamente. Assim, o projecto de investigação descrito nesta tese teve como objectivo identificar os elementos-chave das IFP com base em investigação qualitativa. Para tal, conduzimos três estudos que nos permitiriam alcançar dados empíricos sobre o tema. O primeiro estudo (descrito no Capítulo 2) consistiu na realização de uma revisão sistemática da literatura científica acerca das variáveis relacionadas com o processo das IFP. A nossa pesquisa esteve focada essencialmente em estudos qualitativos. Contudo, decidimos não restringir demasiado os critérios de inclusão tendo em conta as dificuldades em pesquisar sobre investigação qualitativa nas bases de dados electrónicas e também devido ao facto de ser possível obter informação sobre as variáveis relacionadas com o processo a partir de estudos quantitativos. O método para este estudo foi baseado no PRISMA Statement para revisões sistemáticas da literatura. Depois de definirmos os critérios de inclusão e exclusão, iniciámos várias pesquisas nas bases de dados electrónicas utilizando termos booleanos, truncações e marcadores de campo. Pesquisámos na PubMed/MEDLINE, Web of Science e nas bases de dados incluídas na EBSCO Host (Academic Search Complete; Education Research Complete; Education Source; ERIC; and PsycINFO). As pesquisas geraram 733 resultados. Depois de serem removidos os duplicados, 663 registos foram analisados e foram seleccionados 38 artigos em texto integral. No final, 22 artigos foram incluídos na síntese qualitativa tendo sido agrupados em quatro categorias: (1) estudos examinando de forma abrangente o processo; (2) estudos acerca da opinião dos participantes sobre a intervenção que receberam; (3) estudos comparativos que individualizaram variáveis sobre o processo; e (4) estudos acerca de variáveis mediadoras. Os resultados evidenciaram um considerável hiato na investigação em torno do processo das IFP. Identificámos apenas um estudo que abordava de forma abrangente o processo das IFP (Bloch, et al., 1995). Este artigo descrevia uma análise qualitativa de um estudo experimental de uma IFP. Contudo, as suas conclusões gerais revelaramse pobres e apenas se podia extrair com certeza de que as IFP devem ser baseadas nas necessidades dos participantes e que os terapeutas devem assumir diferentes papéis ao longo da intervenção. Da revisão foi possível perceber que os factores terapêuticos comuns como a aliança terapêutica, empatia, apreço e a “aceitação incondicional”, podiam ser eles próprios um elemento isolado para a eficácia das IFP. Outros estudos enfatizaram a educação como elemento chave da intervenção (e.g. Levy-Frank et al., 2011), ao passo que outros ainda colocavam a ênfase no treino de estratégias para lidar com a doença i.e. coping (e.g. Tarrier et al., 1988). Com base nesta diversidade de resultados e tendo em conta algumas propostas prévias de peritos (McFarlane, 1991; Liberman & Liberman, 2003), desenvolvemos a hipótese de concebermos as IFP como um processo por etapas, de acordo com as necessidades dos familiares. No primeiro nível estariam as estratégias relacionadas com os factores terapêuticos comuns e o suporte emocional,no segundo nível a educação acerca da doença, e num nível mais avançado, o foco seria o treino de estratégias para lidar com a doença e diminuir a EE. Neste estudo concluímos que nem todas as famílias iriam precisar de IFP complexas e que nesses casos seria possível obter resultados favoráveis com IFP pouco intensas. O Estudo 2 (descrito no Capítulo 3) consistiu numa análise qualitativa dos registos clínicos do primeiro ensaio clínico da IFP de Leff e colaboradores (Leff et al., 1982). Este ensaio clínico culminou numa das evidências mais substanciais alguma vez alcançada com uma IFP (Leff et al., 1982; Leff et al., 1985; Pitschel-Walz et al., 2001). Este estudo teve como objectivo modular a EE recorrendo a um modelo misto com que compreendia sessões familiares em grupo e algumas sessões unifamiliares em casa, incluindo o paciente. Os resultados mostraram uma diminuição das recaídas em nove meses de 50% no grupo de controlo para 8% no grupo experimental. Os registos analisados neste estudo datam do período de 1977 a 1982 e podem ser considerados como material histórico de alto valor, que surpreendentemente nunca tinha sido analisado. Eram compostos por descrições pormenorizadas dos terapeutas, incluindo excertos em discurso directo e estavam descritos segundo uma estrutura, contendo também os comentários dos terapeutas. No total os registos representavam 85 sessões em grupo para familiares durante os cinco anos do ensaio clínico e 25 sessões unifamiliares em casa incluindo o paciente. Para a análise qualitativa decidimos utilizar um método de análise dedutivo, com uma abordagem mecânica de codificação dos registos em categorias previamente definidas. Tomámos esta decisão com base na extensão apreciável dos registos e porque tínhamos disponível informação válida acerca das categorias que iríamos encontrar nos mesmos, nomeadamente a informação contida no manual da intervenção, publicado sob a forma de livro, e nos resultados da 140 nossa revisão sistemática da literatura (Estudo 1). Deste modo, foi construída uma grelha com a estrutura de codificação, que serviu de base para a análise, envolvendo 15 categorias. De modo a cumprir com critérios de validade e fidelidade rigorosos, optámos por executar uma dupla codificação independente. Deste modo dois observadores leram e codificaram independentemente os registos. As discrepâncias na codificação foram revistas até se obter um consenso. No caso de não ser possível chegar a acordo, um terceiro observador, mais experiente nos aspectos técnicos das IFP, tomaria a decisão sobre a codificação. A análise foi executada com recurso ao programa informático NVivo® versão 10 (QSR International). O número de vezes que cada estratégia foi utilizada foi contabilizado, especificando a sessão e o participante. Os dados foram depois exportados para uma base de dados e analisados recorrendo ao programa informático de análise estatística SPSS® versão 20 (IBM Corp.). Foram realizadas explorações estatísticas para descrever os dados e obter informação sobre possíveis relações entre as variáveis. De modo a perceber a significância das observações, recorremos a testes de hipóteses, utilizando as equações de estimação generalizadas. Os resultados da análise revelaram que as estratégias terapêuticas mais utilizadas na intervenção em grupo foram: (1) a criação de momentos para ouvir as necessidades dos participantes e para a partilha de preocupações entre eles – representando 21% de todas as estratégias utilizadas; (2) treino e aconselhamento acerca de formas para lidar com os aspectos mais difíceis da doença – 15%; (3) criar condições para que os participantes recebam suporte emocional – 12%; (4) lidar com o envolvimento emocional excessivo 10%; e (5) o reenquadramento das atribuições dos familiares acerca dos comportamentos dos pacientes – 10%. Nas sessões unifamiliares em casa, as estratégias mais utilizadas foram: (1) lidar com o envolvimento emocional excessivo – representando 33% de todas as estratégias utilizadas nas sessões unifamiliares em casa; (2) treino e aconselhamento acerca de formas para lidar com os aspectos desafiadores da doença – 22%; e (3) o reenquadramento das atribuições dos familiares acerca dos comportamentos dos pacientes, juntamente com o lidar com a zanga, o conflito e a rejeição – ambas com 10%. A análise longitudinal mostrou que a criação de momentos para ouvir as necessidades dos familiares tende a acontecer invariavelmente ao longo do programa. Sempre que isso acontece, são geralmente utilizadas estratégias para ajudar os familiares a lidarem melhor com os aspectos difíceis da doença e estratégias para fomentar o suporte emocional. Por sua vez, foi possível perceber que o trabalho para diminuir o envolvimento emocional excessivo pode acontecer logo nas primeiras sessões. O reenquadramento e o lidar com a zanga/ conflito/ rejeição tendem a acontecer a partir da fase intermédia até às últimas sessões. A análise das diferenças entre os familiares com baixa EE e os de elevada EE, mostrou que os familiares com elevada EE tendem a tornar-se o foco da intervenção grupal. Por sua vez, os familiares com baixa EE recebem mais estratégias relacionadas com aliança terapêutica, comparativamente com os familiares com elevada EE. São de realçar os dados relativamente às estratégias educativas. Foi possível observar que estas tendem a acontecer mais no início dos grupos, não estando associadas a outras estratégias. Contudo é de notar a sua baixa utilização, a rondar apenas os 5%.O Estudo 3 (descrito no Capítulo 4) surgiu como uma forma de completar a análise do Estudo 2, permitindo uma visão mais narrativa do processo e focando, adicionalmente, as mudanças que ocorrem nos participantes. Com base nos mesmos registos utilizados no Estudo 2, codificámos de forma secundária os registos em duas categorias i.e. marcadores de mudança e marcadores emocionais. Os marcadores de mudança foram cotados sempre que um participante exibia comportamentos ou pensamentos diferentes dos anteriores no sentido de uma eventual redução na EE. Os marcadores emocionais correspondiam à expressão intensa de sentimentos por parte dos participantes nas sessões e que estariam relacionados com assuntos-chave para essas pessoas. Os excertos que continham a informação destes marcadores foram posteriormente revistos e articulados com notas e comentários não estruturados que recolhemos durante a codificação do Estudo 2. Com base nesta informação os registos foram revistos e, utilizando um método indutivo, elaborámos uma narrativa acerca da intervenção. Os resultados da narrativa foram discutidos com dados de que dispúnhamos, referentes a reuniões com os terapeutas envolvidos na intervenção em análise (Elizabeth Kuipers, Ruth Berkowitz e Julian Leff; Londres, Novembro de 2011). Reconhecemos que, pela sua natureza não estruturada e indutiva, a avaliação narrativa está mais sujeita ao viés de observador. Não obstante, os resultados deste Estudo 3 parecem revestir uma consistência elevada. O mais relevante foi a evidência de que na intervenção em análise ocorreram mudanças emocionais significativas nos familiares ao longo das sessões em grupo. Numa fase inicial os familiares tenderam a expressar sentimentos de zanga. Seguidamente, os terapeutas iam nterrompendo o discurso de reminiscências, direccionavam o discurso para as suas preocupações actuais e os familiares pareciam ficar mais calmos. Contudo, à medida que os 143 participantes “mergulhavam” nos problemas com que se confrontavam na altura, os sentimentos de zanga davam lugar a sentimentos de perda e angústia. Nessa altura os terapeutas enfatizavam o suporte emocional e introduziam progressivamente técnicas de reenquadramento para ajudar os participantes a avaliar de forma mais positiva as situações. Este trabalho dava lugar a sentimentos mais positivos, como a aceitação, apreço e a sensação de controlo. O Estudo 3 evidenciou também o que designamos como o “Efeito de Passagem de Testemunho”. Este efeito aconteceu sempre que um membro novo se juntava ao grupo. Os membros antigos, que estavam a ser o alvo das atenções e naturalmente a receber mais intervenção, mudam de papel e passam eles próprios a focar as suas atenções nos membros mais recentes do grupo, contribuindo para a dinâmica do grupo com as mesmas intervenções que os ajudaram previamente. Por exemplo, alguns membros antigos que eram altamente críticos nos grupos em relação aos seus familiares passavam a fazer comentários de reenquadramento dirigidos para os novos membros. Por fim, o Capítulo 5 resume as conclusões gerais deste projecto de investigação. Os estudos apresentados permitiram um incremento no conhecimento acerca do processo das IFP. Anteriormente esta informação era baseada sobretudo na opinião de peritos. Com este projecto aumentámos o nível de evidência ao apresentar estudos com base em dados empíricos. A análise qualitativa do Estudo 2 permitiu pela primeira vez, tanto quanto é do nosso conhecimento, perceber de forma aprofundada o processo subjacente a uma IFP (no contexto de um ensaio clínico que se revelou como um dos mais eficazes de sempre). Identificámos as estratégias mais utilizadas, as relações entre elas e a sua diferente aplicação entre familiares com baixa EE e familiares com alta EE.O Estudo 3 completou a informação incluindo aspectos relacionados com as mudanças individuais durante o programa. No final foi possível perceber que as IFP devem ser um programa por etapas. Nos Estudo 2 e 3, evidenciámos que numa fase inicial, os terapeutas dedicaram especial atenção para que os familiares tivessem espaço para partilharem as suas necessidades, disponibilizando logo de seguida estratégias para promover o suporte emocional e estratégias de coping. Num nível subsequente do programa, o trabalho terapêutico avançou para estratégias mais direccionadas para regular a EE, mantendo sempre as estratégias iniciais ao longo das sessões. Assim apesar de a educação ter sido um componente importante na IFP em análise, houve outras estratégias mais relevantes no processo. A evidência gerada pelos Estudos 2 e 3 baseou-se em registos históricos de elevado valor, sendo que os constructos subjacentes na época, nomeadamente a EE, continuam a ser a base da investigação e prática das IFP a nível mundial em diferentes culturas (Butzlaff & Hooley, 1998). Concluímos que as IFP são um processo complexo com diferentes níveis de intervenção, podendo gerar mudanças emocionais nos participantes durante as sessões. No futuro será importante replicar o nosso trabalho (nomeadamente o Estudo 2) com outras abordagens de IFP, de modo a obter informação acerca do seu processo. Esse conhecimento será fundamental para uma possível evolução do paradigma das IFP. ----------- ABSTRACT: Background: Psychotic-spectrum disorders are complex biopsychosocial conditions and family issues are important determinants of prognosis. The discovery of the influence of expressed emotion on the course of schizophrenia paved the road to the development of family interventions aiming to lower the “emotional temperature” in the family. These treatment approaches became widely recognised. Effectiveness studies showed remarkable and strong results in relapse prevention and these interventions were generalised to other psychotic disorders besides schizophrenia. Family interventions for psychosis (FIP) prospered and were included in the most important treatment guidelines. However, there was little knowledge about the process of FIP. Different FIP approaches all led to similar outcomes. This intriguing fact caught the attention of authors and attempts were made to identify the key-elements of FIP. Notwithstanding, these efforts were mainly based on experts’ opinions and the conclusions were scanty. Therefore, the knowledge about the process of FIP remains unclear. Aims: To find out which are the key-elements of FIP based on empirical data. Methods: Qualitative research. Three studies were conducted to explore the process of FIP and isolate variables that allowed the identification of the key-elements of FIP. Study 1 consisted of a systematic literature review of studies evaluating process-related variables of FIP. Study 2 subjected the intervention records of a formerly conducted effective clinical trial of FIP to a qualitative analysis. Records were analysed into categories and the emerging data were explored using descriptive statistics and generalised estimating equations. Study 3 consisted of a narrative evaluation using an inductive qualitative approach, examining the same data of Study 2. Emotional markers and markers of change were identified in the records and the content of these excerpts was synthesised and discussed. Results: On Study 1, searches revealed 733 results and 22 papers were included in the qualitative synthesis. We found a single study comprehensively exploring the process of FIP. All other studies focused on particular aspects of the process-related variables. The key-elements of FIP seemed to be the so-called “common therapeutic factors”, followed by education about the illness and coping skills training. Other elements were also identified, as the majority of studies evidenced a multiple array of components. Study 2,revealed as the most used strategies in the intervention programme we analysed: the addressing of needs; sharing; coping skills and advice; emotional support; dealing with overinvolvement; and reframing relatives’ views about patients’ behaviours. Patterns of the usefulness of the strategies throughout the intervention programme were identified and differences between high expressed emotion and low expressed emotion relatives were elucidated. Study 3 accumulated evidence that relatives experience different emotions during group sessions, ranging from anger to grief, and later on, to acceptance and positive feelings. Discussion: Study 1 suggested a stepped model of intervention according to the needs of the families. It also revealed a gap in qualitative research of FIP. Study 2 demonstrated that therapists of the trial under analysis often created opportunities for relatives to express and share their concerns throughout the entire treatment programme. The use of this strategy was immediately followed by coping skills enhancement, advice and emotional support. Strategies aiming to deal with overinvolvement may also occur early in the treatment programme. Reframing was the next most used strategy, followed by dealing with anger, conflict and rejection. This middle and later work seems to operate in lowering criticism and hostility, while the former seems to diminish overinvolvement. Single-family sessions may be used to augment the work developed in the relatives groups. Study 3 revealed a missing part of Study 2. It demonstrated that the process of FIP promotes emotional changes in the relatives and therapists must be sensitive to the emotional pathway of each participant in the group.

Validation of the German version of the Career Adapt-Abilities Scale and its relation to orientations to happiness and work stress

Career adapt-ability has recently gained momentum as a psychosocial construct that not only has much to offer the field of career development, but also contributes to positive coping, adjustment and self-regulation through the four dimensions of concern, control, curiosity and confidence. The positive psychology movement, with concepts such as the orientations to happiness, explores the factors that contribute to human flourishing and optimum functioning. This research has two main contributions; 1) to validate a German version of the Career Adapt-Abilities Scale (CAAS), and 2) to extend the contribution of adapt-abilities to the field of work stress and explore its mediating capacity in the relation between orientations to happiness and work stress. We used a representative sample of the German-speaking Swiss working population including 1204 participants (49.8% women), aged between 26 and 56 (Mage = 42.04). Results indicated that the German version of the CAAS is valid, with overall high levels of model fit suggesting that the conceptual structure of career adapt-ability replicates well in this cultural context. Adapt-abilities showed a negative relationship to work stress, and a positive one with orientations to happiness. The engagement and pleasure scales of orientations to happiness also correlated negatively with work stress. Moreover, career adapt-ability mediates the relationship between orientations to happiness and work stress. In depth analysis of the mediating effect revealed that control is the only significant mediator. Thus control may be acting as a mechanism through which individuals attain their desired life at work subsequently contributing to reduced stress levels.

Controversies about the enhanced vulnerability of the adolescent brain to develop addiction.

Adolescence, defined as a transition phase toward autonomy and independence, is a natural time of learning and adjustment, particularly in the setting of long-term goals and personal aspirations. It also is a period of heightened sensation seeking, including risk taking and reckless behaviors, which is a major cause of morbidity and mortality among teenagers. Recent observations suggest that a relative immaturity in frontal cortical neural systems may underlie the adolescent propensity for uninhibited risk taking and hazardous behaviors. However, converging preclinical and clinical studies do not support a simple model of frontal cortical immaturity, and there is substantial evidence that adolescents engage in dangerous activities, including drug abuse, despite knowing and understanding the risks involved. Therefore, a current consensus considers that much brain development during adolescence occurs in brain regions and systems that are critically involved in the perception and evaluation of risk and reward, leading to important changes in social and affective processing. Hence, rather than naive, immature and vulnerable, the adolescent brain, particularly the prefrontal cortex, should be considered as prewired for expecting novel experiences. In this perspective, thrill seeking may not represent a danger but rather a window of opportunities permitting the development of cognitive control through multiple experiences. However, if the maturation of brain systems implicated in self-regulation is contextually dependent, it is important to understand which experiences matter most. In particular, it is essential to unveil the underpinning mechanisms by which recurrent adverse episodes of stress or unrestricted access to drugs can shape the adolescent brain and potentially trigger life-long maladaptive responses.

Personnalité et démence: une nouvelle perspective [Personality and dementia: a new perspective]

This article highlights some of the links between pre-morbid personality and clinical features of dementia. Indeed, personality characteristics forge an individual's coping strategies and thus influence the expression of behavioural and psychiatric syndromes of dementia (BPSD) or its precursor stages. Some personality traits such as neuroticism may impact on cognitive decline. BPSD being among the most important determinants of a patient's and their proxies' burden, a better understanding of the links between pre-morbid personality characteristics and BPSD will help define care strategies.

Psychosocial Quality-of-Life, Lifestyle and Adiposity: A Longitudinal Study in Pre-schoolers (Ballabeina Study).

PURPOSE: In obesity prevention, understanding psychosocial influences in early life is pivotal. Reviews reported contradictory results and a lack of longitudinal studies focusing on underlying lifestyle factors. This study tested whether psychosocial Quality-Of-Life (QOL) was associated with pre-schoolers' lifestyle and adiposity changes over one school year and whether lifestyle moderated the latter. It was hypothesised that QOL might not impact adiposity in everybody but that this might depend on preceding lifestyle. METHOD: Longitudinal data from 291 Swiss pre-schoolers (initially 3.9-6.3 years) was available. The following measures were used in longitudinal regressions: psychosocial QOL by PedsQL, adiposity (BMI z-score, waist, fat%), diet (food frequency), sedentary time and accelerometer-based activity. RESULTS: Concerning lifestyle, low psychosocial QOL was only related to unfavourable changes in diet (less fruit β = 0.21 and more fat intake β = -0.28) and lower physical activity (β = 0.21). Longitudinal QOL-adiposity relations appeared only after moderation by lifestyle factors (beta-range 0.13-0.67). Low psychosocial QOL was associated with increased adiposity in children with an unhealthy diet intake or high sedentary time. By contrast, low psychosocial QOL was associated with decreasing adiposity in high fruit consumers or more physically active pre-schoolers. CONCLUSION: Results emphasise the need for testing moderation in the QOL-adiposity relation. An unhealthy diet can be a vulnerability factor and high physical activity a protective factor in QOL-related adiposity. Consequently, QOL and lifestyle should be targeted concurrently in multi-factorial obesity prevention. The environment should be an 'activity encouraging, healthy food zone' that minimises opportunities for stress-induced eating. In addition, appropriate stress coping skills should be acquired.

An investigation into the physical and psychological stress factors that elementary teachers experience : recommendations to boards and personal calming strategies /

The prlmaiy objective of this study was to Identify and describe the physical and psychological stress factors that elementary school teachers experience and how teachers cope with stress. A secondary objective was to offer boards and teachers potential coping strategies counteracting stress and the effects of stress. The sample consisted of 120 elementaiy teachers from southern Ontario. Ten elementaiy schools were randomly chosen. The Teacher Stress Inventory questionnaire (Flmian, 1989) was used. Data were analyzed using a variety of statistics. Test norms and interpretations were performed based on standard results obtained from the author of the questionnaire (Flmian, 1988). Overall, the results indicated that work-related stressors were the main factor for teacher stress. This Included such factors as caseload/class is too big, too much administrative paperwork, and having little time to prepare lessons. Implications for further research and practical suggestions for further reseairch are discussed. Also a variety of recommendations to boards and for individual use are discussed. Some recommendations are having counselling available for teachers, workshops on how to handle stress, and learning how to breathe and using calm visualization.

Physiological reactivity and the perception of emotional stimuli as they relate to social adaptive functioning after traumatic brain injury / y Melonie Jane Hopkins.

Traumatic brain injury (TBI) often affects social adaptive functioning and these changes in social adaptability are usually associated with general damage to the frontal cortex. Recent evidence suggests that certain neurons within the orbitofrontal cortex appear to be specialized for the processing of faces and facial expressions. The orbitofrontal cortex also appears to be involved in self-initiated somatic activation to emotionally-charged stimuli. According to Somatic Marker Theory (Damasio, 1994), the reduced physiological activation fails to provide an individual with appropriate somatic cues to personally-relevant stimuli and this, in turn, may result in maladaptive behaviour. Given the susceptibility of the orbitofrontal cortex in TBI, it was hypothesized that impaired perception and reactivity to socially-relevant information might be responsible for some of the social difficulties encountered after TBL Fifteen persons who sustained a moderate to severe brain injury were compared to age and education matched Control participants. In the first study, both groups were presented with photographs of models displaying the major emotions and either asked to identify the emotions or simply view the faces passively. In a second study, participants were asked to select cards from decks that varied in terms of how much money could be won or lost. Those decks with higher losses were considered to be high-risk decks. Electrodermal activity was measured concurrently in both situations. Relative to Controls, TBI participants were found to have difficulty identifying expressions of surprise, sadness, anger, and fear. TBI persons were also found to be under-reactive, as measured by electrodermal activity, while passively viewing slides of negative expressions. No group difference,in reactivity to high-risk card decks was observed. The ability to identify emotions in the face and electrodermal reactivity to faces and to high-risk decks in the card game were examined in relationship to social monitoring and empathy as described by family members or friends on the Brock Adaptive Functioning Questionnaire (BAFQ). Difficulties identifying negative expressions (i.e., sadness, anger, fear, and disgust) predicted problems in monitoring social situations. As well, a modest relationship was observed between hypo-arousal to negative faces and problems with social monitoring. Finally, hypo-arousal in the anticipation of risk during the card game related to problems in empathy. In summary, these data are consistent with the view that alterations in the ability to perceive emotional expressions in the face and the disruption in arousal to personally-relevant information may be accounting for some of the difficulties in social adaptation often observed in persons who have sustained a TBI. Furthermore, these data provide modest support for Damasio's Somatic Marker Theory in that physiological reactivity to socially-relevant information has some value in predicting social function. Therefore, the assessment of TBI persons, particularly those with adaptive behavioural problems, should be expanded to determine whether alterations in perception and reactivity to socially-relevant stimuli have occurred. When this is the case, rehabilitative strategies aimed more specifically at these difficulties should be considered.

The dual role of students with behavioural problems: an analysis of their experiences as bullies and victims /

The present study examined the bullying experiences of a group of students, age 10-14 years, identified as having behaviour problems. A total often students participated in a series of mixed methodology activities, including self-report questionnaires, story telling exercises, and interview style joumaling. The main research questions were related to the prevalence of bully/victims and the type of bullying experiences in this population. Questionnaires gathered information about their involvement in bullying, as well as about psychological risk factors including normative beliefs about antisocial acts, impulsivity, problem solving, and coping strategies. Journal questions expanded on these themes and allowed students to explain their personal experiences as bullies and victims as well as provide suggestions for intervention. The overall results indicated that all of the ten students in this sample have participated in bullying as both a bully and a victim. This high prevalence of bully/victim involvement in students from behavioural classrooms is in sharp contrast with the general population where the prevalence is about 33%. In addition, a common thread was found that indicated that these students who participated in this study demonstrate characteristics of emotionally dysregulated reactive bullies. Theoretical implication and educational practices are discussed.

Women over thirty choosing education as a solution to a problem

This study explored motivations of mid-life women over 30 years old who had returned to school. It sought to fmd whether these women returned to solve a problem arising from life events, whether viewing a problem was related to internal or external motivation, whether this perception was related to having greater coping skills, and whether having greater coping was related to seeking support from internal or external sources. This study examined which emotions were most related to viewing a life event as a problem. Finally, it explored the results of previous research of mid-life women in their role as a student. Women (N==83) from three types of institutions volunteered for this study: a university (N==34), a college (N==28), and an adult education centre (N==21). Participants took home a questionnaire package - a I3-page questionnaire and consent form - that were completed and mailed back to the researcher in pre-paid envelopes. Results showed that women over 30 seek education as a solution to a life event problem. External motivation was related to a life event being a problem (p<.005). There was a significant difference in coping scores between institutions. Moods that were related to viewing a life event as problematic were: anger and depressive moods (p<. 001), fatigue and vigor (p<.O 1), and tension/anxiety (p<.05). Mid-life women students' satisfaction in this role was related to being externally motivated. These women sought support from both internal and external sources, rarely had social interactions with peers, and viewed this role as important, yet, temporary in that it will help them change their lives. Implications ofthe results suggest further exploration ofthe roles of anger and depression in motivating women over 30 to learn and finding ways of directing women to use their emotional intelligence to seek out learning.

A journey into narrative inquiry : one teacher's lived experience with eating disorders /

In "A Journey Into Narrative Inquiry: One Teacher's Lived Experience With Eating Disorders," an elementary teacher searches for answers regarding how education can help prevent eating disorders by journeying into her own experience of having had such a disorder. This qualitative study is a personal narrative based on an individual's experience, a method appropriate to the sharing of personal voices and stories told in education research. It is an attempt to address the gap found in the research on this topic by offering a subjective and unique perspective of what it is like to live within the nightmare of an eating disorder and by sharing the wisdom gained from having survived such an experience. This narrative inquiry explains how a teacher found herself at a stage where she was willing and ready to share her experience for the sake of research. The story of having had an eating disorder, consisting of both anorexia and bulimia, for over a decade is shared in a genuine, reflective manner. The researcher then shares the analysis of her own story, unpacking the themes of journeying toward voice, self-esteem, self-acceptance, and self and the completion of an M.Ed. degree. Bridges are made which connect these themes to the personal and professional life of the researcher, to the schools in terms of both curriculum and climate, to research directions, and to the larger culture. Suggestions are made for possible changes in educational settings that may help teachers in providing students with some tools and strategies to prevent turning to eating disorders as coping mechanisms. A literature review of eating disorders is included as well, as a guide for others to use when undertaking such qualitative studies.

Attachment and alcohol : testing a motivational model of problem drinking /

The purpose of this study was to replicate and extend a motivational model of problem drinking (Cooper, Frone, Russel, & Mudar, 1995; Read, Wood, Kahler, Maddock & Tibor, 2003), testing the notion that attachment is a common antecedent for both the affective and social paths to problem drinking. The model was tested with data from three samples, first-year university students (N=679), students about to graduate from university (N=206), and first-time clients at an addiction treatment facility (N=21 1). Participants completed a battery of questionnaires assessing alcohol use, alcohol-related consequences, drinking motives, peer models of alcohol use, positive and negative affect, attachment anxiety and attachment avoidance. Results underscored the importance of the affective path to problem drinking, while putting the social path to problem drinking into question. While drinking to cope was most prominent among the clinical sample, coping motives served as a risk factor for problem drinking for both individuals identified as problem drinkers and university students. Moreover, drinking for enhancement purposes appeared to be the strongest overall predictor of alcohol use. Results of the present study also supported the notion that attachment anxiety and avoidance are antecedents for the affective path to problem drinking, such that those with higher levels of attachment anxiety and avoidance were more vulnerable to experiencing adverse consequences related to their drinking, explained in terms of diminished affect regulation. Evidence that nonsecure attachment is a potent predictor of problem drinking was also demonstrated by the finding that attachment anxiety was directly related to alcohol-related consequences over and above its indirect relationship through affect regulation. However, results failed to show that attachment anxiety or attachment avoidance increased the risk of problem drinking via social influence.

Effects of a preschool parent enrichment programme on children and their parents /

This study evaluated a preschool parent enrichment programme to assess if child and parent involvement in the programme facilitated the children's subsequent school adjustment. Also examined were the programme's effects on parent-child relationships. Participants were 56 Junior-Senior Kindergarten and Grade One students from one elementary school. Parent participants were 12 parents from the preschool parent enrichment programme, 6 parents whose children had attended other preschool programmes, and 6 parents whose children had remained at home prior to school. Five elementary teachers and both nursery school teachers from the parent enrichment programme also participated. Measures used included the Florida Key to assess children's inferred self-concept as learner and four subscales (relating, asserting, coping and investing), and interviews to assess parent and teacher perceptions. Findings indicated that there was little difference between parent and teacher perceptions about children who had attended a preschool programme. Both groups showed improved social, emotional, and behavioural skill development, together with increased self-esteem, and the ability to cope with separation from their parents. This enabled children to make the transition from preschool to primary school more successful. Children from the parent enrichment programme were not readily identifiable in terms of the profile promulgated for disadvantaged children. The Florida Key showed a main effect for the coping subscale, indicating that children from the parent enrichment programme may show more confidence in their abilities, and seek assistance from teachers than children who had no preschool experience. The parent enrichment programme appeared to have the biggest impact on the parents. Parents reported improved relationships with their children, increased confidence and self-esteem, as well as improved parenting and general life skills. The implications for short-term gains for children from this type of programme are better readiness for school, more positive self-esteem, improved social behaviour, and a higher achievement motivation. The long-term gains for children are predicted to be fewer special education placements, less grade retention, and a lower dropout rate from school. The short-term gains for parents are better social support networks," greater self-confidence, better interactions with children, and improved parenting skills. The long-term benefits may be an increased motivation to continue education, gain employment, and less family breakdown and abuse.

Life after hockey : an examination of athletic career transition and the National Hockey League's career transition program

The existent body of athletic career retirement literature is scant in studies of career transition programs. In an effort to attend to this analytical gap, the present study set out to examine the transitions of National Hockey League (NHL; ice hockey) alumni, as well as the effect ~and effectiveness of their respective career transition program, the Life After Hockey program. Interviews with 17 NHL/program alumni revealed that quality of transition (to post-playing life) was affected by: the continuity between pre- and postretirement environments; athletic identity; physical/psychological health (particularly with respect to post-concussion syndrome); selective coping strategies (e.g., preretirement planning (e.g., financial planning, continued education), positive reinterpretation, alcohol/substance abuse); and social support. Also affecting quality of transition, and found to be highly effective (particularly in generating new occupational opportunities, assisting in the acquisition of new skills, and providing a system of continuous support), was the Life After Hockey program.

The Relationship between athlete motivation, strategies used to cope with stress and affective outcomes in Canadian University athletes

Motivation to perform and coping with stress during performance are key factors in determining numerous outcomes of sporting performance. However, less evidence is in place assessing their relationship. The aim of this investigation was to assess the relationship between athlete motivation and the coping strategies used to deal with stress during their sporting performance, as well as the relationship between motivation and affect and coping and affect. One hundred and forty five university athletes completed questionnaires. Regressions revealed that two of the three self determined levels of motivation, identified and integrated regulation, predicted increased task-oriented coping strategies. Two of the three non-self determined levels of motivation, amotivation and external regulation, significantly predicted disengagement-oriented coping. Additionally, intrinsic motivation and task-oriented coping predicted increase positive affect. Increased disengagement-oriented coping predicted decreased positive affect. Disengagement-oriented coping significantly predicted increased negative affect. These findings increase understanding of motivations role in predicting athletes coping.