Sickness certification in primary care: a survey on views and practices among Swiss physicians.

QUESTIONS UNDER STUDY: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. METHODS: We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. RESULTS: We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). CONCLUSION: Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.

The role of self-presentation in adolescent health risk behaviours

Self-presentation has been identified as playing a key role in the perfonnance of various potentially hazardous health behaviours such as substance abuse, eating disorders and reckless behaviours (Leary, Tchividjian, & Kraxberger, 1994; Martin & Leary, 2001; Martin, Leary, & O'Brien, 2001). The present study investigated the role of selfpresentation on adolescent health-risk behaviours. Specifically, this study examined the prevalence of adolescent identified health-risk behaviours rooted in self-presentational motives in youths aged 13-18 years. The current study also identified the specific images associated with these behaviours desired by youth, and the targets of these behaviours. Also, the relationship between these behaviours, and several trait measures (social physique anxiety, public-self consciousness, fear of negative evaluations, selfpresentational efficacy) of self-presentation were examined. Finally, the gender differences in health risk behaviours and self-presentational concerns were examined. Participants in the present study were 96 adolescent students, 34 male and 62 female, recruited from various private schools across Southern Ontario. Students ranged in age from 13 to 18 years for both males (M age = 15.81 years, SD = 1.49) and females (M age = 14.89 years, SD = 1.17) and ranged from grades 8 through 13. Results of the current study suggested that Canadian adolescents between the ages of 13 and 18 years participated in health risk behaviours for self-presentational purposes. Drinking alcohol, skipping school, and performing stunts and dares were identified as the most common health risk behaviours performed for self-presentational purposes by both males and females. Appearing fun and cool were the most commonly reported desired images while appearing brave and mature were the least reported. The most desired target group cited was same sex friends, followed by other sex friends. Trait measures of self-presentational concerns identified females as being higher in public self-consciousness, and social physique anxiety than males. Males were found to be higher in self-presentational efficacy than females. The total number of health risk behaviours was predicted by selfpresentational efficacy and social physique anxiety for males, and social physique anxiety for females. Findings of the current study suggest that Canadian adolescents' health risk behaviours are rooted, in part, in self-presentational motives. Thus far, an educational approach to health interventions has been favoured and/or adopted by teachers, health promoters, and educators (Jessor, 1992). Implications of the current study suggest that although educational interventions are beneficial in presenting the associated risks with certain activities and/or behaviours, one reason this type of approach may be ineffective in changing adolescent behaviour over the long run is that it does not address the strong and prominent influences of interpersonal motives on health damaging behaviour. It is evident that social acceptance and public image are of importance to adolescents, and the desire to make the "right" impression and to achieve peer approval and acceptance often override health and safety concerns (Jessor, 1992). Thus, a self-presentational approach focusing on changing the images associated with the behaviours may be more successful at deterring adolescent health risk behaviours.

"Attitude is a little thing that makes a big difference" : further exploration of attitude alignment in the context of close relationship dyads /

One hundred and five primarily Caucasian undergraduate couples were tested to study the phenomenon of attitude alignment, or the way in which individuals change their opinions to achieve greater attitudinal congruence with their romantic partners, and the hypotheses that relationship closeness, affect, attachment, social desirability, and centrality are each related to attitude alignment for individuals in close couples. The couples filled out an attitude questionnaire consisting of 50 issues in which they were asked to give their attitude on a scale from 1 to 9 as well as to rate the centrality, or importance, of that issue on a scale from 1 to 9. Before discussing four of these issues with each other - 2 were more central to the man and less central, or peripheral, to the woman, whereas the other 2 were central to the woman and peripheral to the man - the individuals completed established measures of relationship closeness, affect, attachment, and social desirability. The couples then filled out the identical attitudes questionnaire again, and their answers on the four discussion issues were compared to their prediscussion answers to determine whether attitude alignment had occurred. There were two experimental groups: a social desirability group, where the couples were told it was natural and normal to disagree with their partners, and a control group. Results indicated that attitude alignment did significantly occur across all couples, but most other variables - including centrality, relationship closeness, and affect - did not predict attitude alignment behaviour. As well, the social desirability experimental groups did not significantly differ on attitude alignment behaviours, but higher scores on the social desirability scale, specifically self-deception, significantly predicted higher attitude alignment scores across all couples. Large differences between individuals' frequency.

Effects of computer-mediated communication and face-to-face communication on the quantity and quality of discourse produced by English as a second language students /

The effects oftwo types of small-group communication, synchronous computer-mediated and face-to-face, on the quantity and quality of verbal output were con^ared. Quantity was deiSned as the number of turns taken per minute, the number of Analysis-of-Speech units (AS-units) produced per minute, and the number ofwords produced per minute. Quality was defined as the number of words produced per AS-unit. In addition, the interaction of gender and type of communication was explored for any differences that existed in the output produced. Questionnaires were also given to participants to determine attitudes toward computer-mediated and face-to-face communication. Thirty intermediate-level students fi-om the Intensive English Language Program (lELP) at Brock University participated in the study, including 15 females and 15 males. Nonparametric tests, including the Wilcoxon matched-pairs test, Mann-Whitney U test, and Friedman test were used to test for significance at the p < .05 level. No significant differences were found in the effects of computer-mediated and face-to-face communication on the output produced during follow-up speaking sessions. However, the quantity and quality of interaction was significantly higher during face-to-face sessions than computer-mediated sessions. No significant differences were found in the output produced by males and females in these 2 conditions. While participants felt that the use of computer-mediated communication may aid in the development of certain language skills, they generally preferred face-to-face communication. These results differed fi-om previous studies that found a greater quantity and quality of output in addition to a greater equality of interaction produced during computer-mediated sessions in comparison to face-to-face sessions (Kern, 1995; Warschauer, 1996).

An exploration of the experience of implementing the second step violence prevention curriculum in one primary general learning disabilities class /

Violence has always been a part of the human experience, and therefore, a popular topic for research. It is a controversial issue, mostly because the possible sources of violent behaviour are so varied, encompassing both biological and environmental factors. However, very little disagreement is found regarding the severity of this societal problem. Most researchers agree that the number and intensity of aggressive acts among adults and children is growing. Not surprisingly, many educational policies, programs, and curricula have been developed to address this concern. The research favours programs which address the root causes of violence and seek to prevent rather than provide consequences for the undesirable behaviour. But what makes a violence prevention program effective? How should educators choose among the many curricula on the market? After reviewing the literature surrounding violence prevention programs and their effectiveness, The Second Step Violence Prevention Curriculum surfaced as unique in many ways. It was designed to address the root causes of violence in an active, student-centred way. Empathy training, anger management, interpersonal cognitive problem solving, and behavioural social skills form the basis of this program. Published in 1992, the program has been the topic of limited research, almost entirely carried out using quantitative methodologies.The purpose of this study was to understand what happens when the Second Step Violence Prevention Curriculum is implemented with a group of students and teachers. I was not seeking a statistical correlation between the frequency of violence and program delivery, as in most prior research. Rather, I wished to gain a deeper understanding of the impact ofthe program through the eyes of the participants. The Second Step Program was taught to a small, primary level, general learning disabilities class by a teacher and student teacher. Data were gathered using interviews with the teachers, personal observations, staff reports, and my own journal. Common themes across the four types of data collection emerged during the study, and these themes were isolated and explored for meaning. Findings indicate that the program does not offer a "quick fix" to this serious problem. However, several important discoveries were made. The teachers feU that the program was effective despite a lack of concrete evidence to support this claim. They used the Second Step strategies outside their actual instructional time and felt it made them better educators and disciplinarians. The students did not display a marked change in their behaviour during or after the program implementation, but they were better able to speak about their actions, the source of their aggression, and the alternatives which were available. Although they were not yet transferring their knowledge into positive action,a heightened awareness was evident. Finally, staff reports and my own journal led me to a deeper understanding ofhow perception frames reality. The perception that the program was working led everyone to feel more empowered when a violent incident occurred, and efforts were made to address the cause rather than merely to offer consequences. A general feeling that we were addressing the problem in a productive way was prevalent among the staff and students involved. The findings from this investigation have many implications for research and practice. Further study into the realm of violence prevention is greatly needed, using a balance of quantitative and qualitative methodologies. Such a serious problem can only be effectively addressed with a greater understanding of its complexities. This study also demonstrates the overall positive impact of the Second Step Violence Prevention Curriculum and, therefore, supports its continued use in our schools.

Gaining a better understanding of how Outward Bound Western Canada course outcomes are achieved : a research study /

This study examined how Outward Bound Western Canada (OBWC) course outcomes are achieved by exploring the relationships among course components, students' characteristics, and course outcomes. OBWC is a wilderness-based adventure education organization that helps students achieve outcomes such as increased self-awareness, self-confidence, motivation, interpersonal skills, concern for others, and concern for the environment. This study explored the ways in which the various components of courses and the characteristics of students contribute to determining the outcomes students experience as a result of their courses. The purpose of the study was to gain a better understanding of how OBWC course outcomes are achieved in order to strengthen adventure education theory, enhance practice at OBWC and other adventure education organizations, and provide a foundation for further research on this topic. As an interpretive case study, this study sought to describe how OBWC course outcomes are achieved and to provide interpretations of the research findings. Data was gathered from OBWC students and instructors using the quantitative and qualitative data collection techniques of questionnaire, interview, and observation. Data collected from 98 participants ensured a considerable breadth to the study, while interviews with a number of participants also enabled the collection of in-depth data. Analysis and triangulation of the data from the various sources allowed discernment of the research findings. A comprehensive and detailed picture of how course outcomes are achieved emerged from the findings. Twenty-nine course components were found to influence course outcomes, including various aspects of course activities, the physical environment, instructors, and the group. The findings indicated that certain course components were most influential in determining increases to students' self-awareness, self-confidence, self-reliance, self-esteem, self-concept, motivation, self-responsibility, interpersonal skills, concern for others, and concern for the environment. A number of course components were found to indirectly contribute to positive course outcomes by helping maximize the effectiveness of other components, by increasing students' motivation while on course, or by facilitating the processing and transference of new information. The findings also suggested that several course components either directly or indirectly affected course outcomes in negative ways. In addition, the gender, age, population, and expectations of students were found to play a role in determining the course outcomes they experienced and in determining which course components caused those outcomes. Interpretation of the findings resulted in the generation of research-based theory. The main theoretical argument derived from the results of the study was that course outcomes are influenced by a combination of course components and characteristics of students. More specifically, the theory generated by the study indicated that five groupings of factors contribute to course outcomes, including course activities, the physical environment, instructors, the group, and students' characteristics. The study was considered in relation to existing adventure education literature and larger theoretical issues. The generated theory and research findings were then used to develop suggestions for improving practice at OBWC and other adventure education organizations, as well as for enhancing future research studies.

Perceived effectiveness of alternative programming : a case study /

The topic of this research was alternative programming in secondary public education. The purpose of this research was to explore the perceived effectiveness of two public secondary programs that are aJternative to mainstream or "regular" education. Two case study sites were used to research diverse ends of the aJtemative programming continuum. The first case study demonstrated a gifted program and the second demonstrated a behavioral program. Student needs were examined in terms of academic needs, emotional needs, career needs, and social needs. Research conducted in these sites examined how the students, teachers, onsite staff, and program administrators perceived that individual needs were met and unmet in these two programs. The study was qualitative and exploratory, using deductive and inductive research techniques. Similar themes of best practice that were identified in the case study sites aided in the development of a teaching and learning model. Four themes were identified as important within the case study sites. These themes included the commitment and motivation of teachers and the support of administration in the gifted program, and the importance of location and the flow of information and communication in the behavior program. Six themes emerged that were similar across the case study sites. These themes included the individual nature of programming, recognition of student achievement, the alternative program as a place of safety and community, importance of interpersonal capacity, priority of basic needs, and, finally, matching student capacity with program expectations. The model incorporates these themes and is designed as a resource for teachers, program administrators, parents, and policy makers of alternative educational programs.

Young children's behavioral responses to the distress of others /

The relationship between child temperament and parenting factors in the development of prosocial behavior during the toddler years was investigated by examining children's helping behaviors and responses to the distress of others as observed and as reported by mothers and teachers. These behaviors were linked to the sociability, emotionality, and attention shifting of toddlers. Children who are relatively high in characteristics such as language skills and sociability appear more likely to exhibit competent prosocial behaviors than children who are relatively low in these skills. Prosocial competence was also linked to maternal comfort, maternal control over children's emotions, and family expressiveness, although the latter two variables related to children's behaviors differently, depending on whether children were low or high in emotional intensity.

The landscape of work engagement in brain injury rehabilitation /

This study examined work engagement among brain injury rehabilitation professionals with specific attention to how they engage with their work (the extent to which they experience vigor, dedication, and absorption while working) and how they engage with people (the degree to which they are welcoming towards others and demonstrate integrity, responsibility, transparency). This study also tested a theoretical model of work engagement that predicted a relationship between engagement and personal, interpersonal, and organizational capacity. Eighty-one staff employed in a hospital-based brain injury program participated in the study. A quantitative self-report survey was used to measure participants' levels of capacity and engagement and a qualitative question was included to identify initiatives that could be introduced to enhance job performance. As predicted by the model, there were statistically significant positive correlations among all three capacity variables and engagement with work and statistically significant positive correlations between ethical engagement and personal and interpersonal capacity. The results of the qualitative data analysis revealed three broad categories of recommendations for improving job performance (more learning opportunities, more resources to support professional development, and the need to build greater team cohesion). These findings provide initial support for a theoretical model that emphasizes the link between capacity and engagement, which could be used to guide theory-driven interventions aimed at improving the work environment.

Effectiveness of life skills training on the total behaviour of six individuals in a job preparation program

In the first week of a Job preparation Program all twelve female members of the class were invited to be part of a study to determine the effect of Life Skills training on their behaviour over the twelve-week period of the program. Six females volunteered and each was interviewed four times during the Job preparation Program and once after the program ended. The interviews focused on three areas of skill deficiency addressed in Life Skills lessons: their knowledge about themselves and attitude towards themselves; their interpersonal relationships; and their problem-solving ability. The participants' comments over the sixteen-week period of the interviews were used to decide if the total behaviour of the participants, (i.e., what they did, thought, and felt) changed so that each became more effective in satisfying her needs. The study suggested that the total behaviour of three of the six women changed so that they became more effective in satisfying their needs. The fourth female's total behaviour changed in only two of the three areas focused on in the interviews, and the total behaviour of the fifth and sixth females showed no change.

Experiential learning instruments : an examination of the concept of the instrumental approach in experiential learning

Experiential Learning Instruments (ELls) are employed to modify the leamer's apprehension and / or comprehension in experiential learning situations, thereby improving the efficiency and effectiveness of those modalities in the learning process. They involve the learner in reciprocally interactive and determining transactions with his/her environment. Experiential Learning Instruments are used to keep experiential learning a process rather than an object. Their use is aimed at the continual refinement of the learner's knowledge and skill. Learning happens as the leamer's awareness, directed by the use of Ells, comes to experience, monitor and then use experiential feedback from living situations in a way that facilitates knmvledge/skill acquisition, self-correction and refinement. The thesis examined the literature relevant to the establishing of a theoretical experiential learning framework within which ELls can be understood. This framework included the concept that some learnings have intrinsic value-knowledge of necessary information-while others have instrumental value-knowledge of how to learn. The Kolb Learning Cycle and Kolb's six characteristics of experiential learning were used in analyzing three ELls from different fields of learning-saxophone tone production, body building and interpersonal communications. The ELls were examined to determine their learning objectives and how they work using experiential learning situations. It was noted that ELls do not transmit information but assist the learner in attending to and comprehending aspects of personal experience. Their function is to telescope the experiential learning process.

Beyond g : putting multiple intelligences theory to the test /

The purpose of this study was to investigate Howard Gardner's (1983) Multiple Intelligences theory, which proposes that there are eight independent intelligences: Linguistic, Spatial, Logical/Mathematical, Interpersonal, Intrapersonal, Naturalistic, Bodily-Kinesthetic, and Musical. To explore Gardner's theory, two measures of each ability area were administered to 200 participants. Each participant also completed a measure of general cognitive ability, a personality inventory, an ability self-rating scale, and an ability self-report questionnaire. Nonverbal measures were included for most intelligence domains, and a wide range of content was sampled in Gardner's domains. Results showed that all tests of purely cognitive abilities were significantly correlated with the measure of general cognitive ability, whereas Musical, Bodily-Kinesthetic, and one of the Intrapersonal measures were not. Contrary to what Multiple Intelligences theory would seem to predict, correlations among the tests revealed a positive manifold and factor analysis indicated a large factor of general intelligence, with a mathematical reasoning test and a classification task from the Naturalistic domain having the highest ^- loadings. There were only minor sex differences in performance on the ability tests. Participants' self-estimates of ability were significantly and positively correlated with actual performance in some, but not all, intelligences. With regard to personality, a hypothesized association between Openness to Experience and crystallized intelligence was supported. The implications of the findings in regards to the nature of mental abilities were discussed, and recommendations for further research were made.

Investigating a dynamic modular framework for subjective well-being

According to Diener (1984), the three primary components of subjective well-being (SWB) are high life satisfaction (LS), frequent positive affect (P A), and infrequent negative affect (NA). The present dissertation extends previous research and theorizing on SWB by testing an innovative framework developed by Shmotkin (2005) in which SWB is conceptualized as an agentic process that promotes and maintains positive functioning. Two key components ofShmotkin's framework were explored in a longitudinal study of university students. In Part 1, SWB was examined as an integrated system of components organized within individuals. Using cluster analysis, five distinct configurations of LS, P A, and NA were identified at each wave. Individuals' SWB configurations were moderately stable over time, with the highest and lowest stabilities observed among participants characterized by "high SWB" and "low SWB" configurations, respectively. Changes in SWB configurations in the direction of a high SWB pattern, and stability among participants already characterized by high SWB, coincided with better than expected mental, physical, and interpersonal functioning over time. More positive levels of functioning and improvements in functioning over time discriminated among SWB configurations. However, prospective effects of SWB configurations on subsequent functioning were not observed. In Part 2, subjective temporal perspective "trajectories" were examined based on individuals' ratings of their past, present, and anticipated future LS. Upward subjective LS trajectories were normative at each wave. Cross-sectional analyses revealed consistent associations between upward subjective trajectories and lower levels of LS, as well as less positive mental, physical, and interpersonal functioning. Upward subjective LS trajectories were biased both with respect to underestimation of past LS and overestimation of future LS, demonstrating their illusional nature. Further, whereas more negative retrospective bias was associated with greater current distress and dysfunction, more positive prospective bias was associated with less positive functioning in the future. Prospective relations, however, were not consistently observed. Thus, steep upward subjective LS trajectory appeared to be a form of wishful-thinking, rather than an adaptive form of selfenhancement. Major limitations and important directions for future research are considered. Implications for Shmotkin's (2005) framework, and for research on SWB more generally, also are discussed

The expression and development of teachers' capacities within two learning communities : a participant-observer case study

The learning community model has been an integral component of teacher development in Ontarian schools and beyond. This research was conducted to understand how teachers' personal capacity and professional, interpersonal, and organizational competencies are developed and expressed within this context. Nineteen elementary teachers and administrators participated in the study from November through January 2007. A qualitative case study methodology was used to investigate the role ofteachers' capacities and competencies in learning communities. Combined data sources from semistructured interviews, research journals, and document review were used to gather data about teachers' capacities and competencies. The study included 3 phases of analysis. In the final phase the analysis provided 3 qualities of the teachers at Jude and Mountain Schools (pseudonyms): identification as professionals, investment in others, and institutional affiliation that may explain how they differed from other educators. The data revealed these three themes, which provided an understanding of educators at Jude and Mountain Schools as dedicated professionals pushing practices to contribute to school life and address student learning needs, and as teachers who reflected on practices to continue expanding their skills. Teachers were heavily invested in creating a caring culture and in students' and team members' learning. Educators actively participated in solving problems and coplanning throughout the school levels and beyond, assumed collective responsibility for all pupils, and focused on generating school-wide consistent practices. These qualities and action patterns revealed teachers who invested time and effort in their colleagues, who committed to develop as professionals, and who affiliated closely with every aspect of school living.

The role of leaders in building organizational learning capacity

In a world in which social, economic, and environmental circumstances are continuously evolving and increasingly complex, leaders face the challenging prospect of navigating their organizations through unpredictable operating conditions. Finding a way to tap into the learning capacity of the people who comprise their organizations may be the answer to adapt and to survive. This qualitative research study explored the role of leaders in building this organizational learning capacity. The literature identified three domains of personal, interpersonal, and organizational capacity for learning in an organizational setting. Interviews with three senior leaders who had successfully built learning capacity in their respective organizations revealed four elements of leader commitment: (a) to the process of building learning capacity, (b) to organizational objectives and results, (c) to personal actions and behaviours, and (d) to the people of the organization. Each of the four elements of leader commitment spans the three domains of learning capacity that can guide leaders as they build organizational learning capacity.