Objective: Chronic physical health problems are on the rise. Psychological interventions can play a role in helping people cope with the challenges that long term physical conditions brings. This thesis systematically reviewed the literature for group psychological interventions. Following this, an Acceptance and Commitment Therapy group intervention for people living with a range of long term physical conditions was designed and evaluated. Methods: Key databases were searched for relevant randomized-controlled studies. Papers that met inclusion criteria were quality assessed, and a meta-analysis was conducted. Participants with chronic physical health conditions were invited to an Acceptance and Commitment Therapy group (n=53). Measures were completed at assessment, pre, post and 3-month follow-up. These assessed anxiety and depression symptoms, health perceptions, values-based living and psychological flexibility. Assessment to pre-intervention served as a within-participant control. Results: 22 relevant studies were retrieved, with 18 rated as acceptable or high quality and 14 included in a meta-analysis. The majority of studies reported interventions as efficacious at reducing mental health problems, though effect sizes were weaker when compared to active controls such as education. In the Acceptance and Commitment therapy group, depression and anxiety symptoms reduced significantly from pre to post, compared to control period. Conclusions: Group psychological interventions may be beneficial for people with physical health problems. In particular, group-based ACT interventions may be effective with this population and can be delivered transdiagnostically for a range of physical conditions.

Carta al editor / Revisión por pares

Vad finns  det  för  strategier  att  ta  till  för  att  hjälpa  elever  med  matematiksvårigheter? Matematiksvårigheter finns det flera varianter av och de är vanligt förekommande hos elever. Det är därför viktigt att det finns olika strategier och verktyg för att hjälpa varje elev utifrån dess egen förmåga. Syftet med denna studie är att få en inblick i forskning om strategier för inlärning anpassade till elever med matematiksvårigheter. Denna studie avser att sammanställa och presentera vetenskapliga artiklar som är interventionsstudier och som handlar om vilka strategier som gynnar elever med matematiksvårigheter och förbättrar deras prestationer inom matematik. Vår kunskapsöversikt bygger på nio artiklar publicerade mellan 2010 och 2017 som vi funnit genom att söka i databaserna PRIMO och Eric ProQuest. Vi genomförde kunskapsöversikten utifrån följande steg: identifiera intresseområde och definiera sökord, bestämma kriterier för vilka studier som ska väljas, utföra sökning i lämpliga databaser, välja relevanta artiklar och läsa sammanfattningar och läsa artiklarna och göra en kvalitetsvärdering. Studierna i kunskapsöversikten visade att det fungerar väl när pedagogen använder sig av tydlig strategisk instruktion med faser i undervisningen. Pedagogen bör också introducera eleverna till att använda visuella och konkreta hjälpmedel, uppmärksamma sammanhang mellan det vardagliga språket och matematikens språk samt använda matematikberättelser för att skapa koppling till elevernas vardag.

Bakgrund: Sjuka spädbarn riskerar att utsättas för ett stort antal smärtsamma provtagningar och procedurer inom sjukvården. Det finns kunskapsluckor och bristande riktlinjer på många arbetsplatser, vilket leder till att sjuksköterskor inte alltid följer den evidensbaserade omvårdnaden som finns vid blodprovstagningar på spädbarn. Syfte: Studiens syfte var att undersöka om en intervention kan påverka sjuksköterskors val av blodprovstagningsmetod på spädbarn. Ytterligare syfte var att undersöka kunskap hos sjuksköterskor avseende smärtlindringsmetoder i samband med blodprovstagning på spädbarn. Metod: Studien genomfördes med en kvasi-experimentell design med kvantitativ ansats. En grupp sjuksköterskor fick besvara en enkät, därefter deltog de i en intervention som bestod av ett utbildningstillfälle, för att efter interventionen besvara ytterligare en enkät. Resultat: En signifikant ökning av deltagarnas kännedom om smärtlindringsmetoder kunde påvisas. Ingen signifikant skillnad avseende val av provtagningsmetod och tillämpning av smärtlindringsmetoder framkom. Sjuksköterskornas upplevda utbildningsbehov av både venös provtagning på spädbarn samt smärtlindringsmetoder minskade efter interventionen. Slutsats: Utbildning var ett lämpligt tillvägagångssätt för att öka deltagarnas kännedom om olika smärtlindringsmetoder. Det skulle kunna hjälpa sjuksköterskor att tillämpa evidensbaserad omvårdnad vid val av provtagnings- och smärtlindringsmetoder i samband med blodprovstagning på spädbarn.

BACKGROUND: In America, stroke is the fifth leading cause of death taking more than 130,000 people every year. Early recognition is imperative as survival increases with prompt intervention. Unfortunately, many Americans including children do not know the acute signs and symptoms of stroke, especially those in high-risk communities. Due to the significance surrounding the public health burden of stroke, the purpose of this project is to evaluate a time efficient, mobile device supported stroke education program for fifth graders and their parents who live in a multi-ethnic community. DESIGN: This DNP project implemented a prospective descriptive study. SETTING: The study took place at a local public elementary school in Phoenix, Arizona within a multiethnic community with predominately Hispanic children. DATA COLLECTION: The data was collected in the form of pre and post-tests from the fifth-grade students. Surveys were also given to parents and the teacher. RESULTS: Results from 19 students indicated fifth graders can learn about stroke, recognize the early warning signs, and seek help fast. Data from parental surveys indicated students talked to their parents about what they learned and shared the stroke phone app with them. The study also found a positive teacher perception of incorporating technology-supported stroke lesson into fifth-grade curriculum. CONCLUSION: This study found increasing stroke knowledge among fifth graders using a novel mobile technology supported school-based intervention is possible and, in fact, found students shared the information and stroke application with their parents and families at home. Findings also support the need for continual research on educating today’s youth, targeting high-risk populations, and further fine-tuning this sustainable stroke knowledge program for middle schools across Arizona.

No description available.

Communal coping—a process in which romantic partners view a problem or stressor as "ours" rather than "yours" or "mine" and engage in collaborative problem solving to address it —has emerged as an important predictor of health and treatment outcomes. This study investigated communal coping as a theoretically derived and empirically supported intervention target within two couple-focused interventions for health problems: Family Systems Therapy for problematic alcohol use and Family Consultation for health-compromised smoking. With a combined sample of 56 couples (37 alcohol, 21 smoking), this study investigated within-session changes in communal coping—indexed via observable, communal coping behaviors and first-person plural pronoun use (we-talk)—prior to and following therapist implementation of specific solution-focused therapy techniques that aimed to promote communal coping in the couples during a target therapy session. Teams of trained raters observed the target therapy sessions and made independent ratings of couple communal coping behaviors and therapist adherence. Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech during the target therapy sessions. Both patients and spouses showed increases in communal coping behavior and we-talk from a "baseline" problem-focused therapy block to the "active" solution-focused therapy block. In addition, exploratory analyses revealed that several couple and therapist characteristics, as well as specific solution-focused techniques were associated with within-session changes in communal coping. Findings from this study identify communal coping as a client change process and solution-focused therapy techniques as a therapist change process within the two interventions, and demonstrate successful engagement of communal coping as a therapeutic target.

Background Hay fever is typically poorly managed, particularly in adolescents, in whom it is responsible for considerable morbidity and impairment in educational performance. Evidence-based training of professionals has the potential to improve outcomes, but it can be expensive and so warrants formal evaluation. This trial sought to evaluate the effectiveness of a training intervention for primary care-based health care professionals on adolescent disease-specific quality of life. Methods A cluster randomised controlled trial was conducted in UK general practices. Practices were centrally randomised to a short, intensive training course on the evidence-based management of hay fever (intervention arm) or distribution of guidelines (control arm). The primary outcome measure was the change in the validated Rhinoconjunctivitis Quality of Life Questionnaire with Standardized Activities (RQLQ(S)) score in adolescents with hay fever between baseline and six weeks post-intervention (minimal clinically important difference = 0.5). Secondary outcome measures included health care professionals’ knowledge and confidence in managing hay fever, number of hay fever-related consultations, relevant treatments prescribed and symptom scores. Multi-level modelling using a random effects model was used to take account of between and within cluster variation, adjusting for strata, individual covariates and year of study. Results Thirty-eight general practices were randomised (20 in the intervention arm) and 246/341 patients (50.2% male, mean age 15 years) were included in the primary outcome analysis. Health care professionals’ self-assessed knowledge and confidence improved (prescribing/recommending treatment mean score 95% CI 1.4, 2.8), and the training was perceived to be of value. This did not however result in clinically or statistically significant improvements in RQLQ(S): -0.15, 95% CI -0.52 to +0.21. There were no differences in consultation frequency (95% CI -0.02, +0.63), treatments issued for hay fever (95% CI -0.24, +0.08) or symptom scores (95% CI - 1.03, +0.54). Conclusions Although attendance on this short, intensive hay fever training course was associated with professionals’ increased self-assessed confidence and understanding of the clinical management of hay fever, this did not translate into improvements in disease-specific quality of life or reduction in rhinitis symptoms in adolescents with hay fever.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Dysphagia is commonly known as a swallowing disorder associated with stroke patients. Between 37% - 78% of stroke patients suffer from it initially. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, dehydration, and an increased risk of death. Its early diagnosis and management is an important prerequisite for recovery from stroke during the rehabilitation phase. As healthcare professionals, nurses play an important role in the diagnosis and management of dysphagia in stroke patients. Studies have shown that nurses display a lack of knowledge about dysphagia in stroke patients. The aim of the study was to determine the knowledge of nurses regarding dysphagia in patients with stroke, at an Intermediate Hospital, in Namibia. The objectives of the study were to determine the knowledge of nurses regarding dysphagia, the association between the knowledge and socio demographic factors and to design an intervention program based on the knowledge of the nurses. The study was carried out in a selected hospital in Namibia. All nurses, who were employed at the Intermediate Hospital at the time of the study, were invited to participate. Of the 500 employed nurses, 188 accepted the invitation to participate in the study. The study used a quantitative method consisting of a survey to determine the knowledge of the nurses. Data was collected using a self-administered questionnaire with closed-ended questions which was developed by the researcher. The quantitative data were captured and analysed using SPSS (22.0 version). Descriptive statistics was used to summarize the study findings by using means, standard deviations, frequencies and percentages. To determine the association between the knowledge of dysphagia and the socio-demographic factors, therefore inferential statistics were used to in three levels of analysis. The findings of the study shows that nurses have a moderate knowledge regarding to the signs and symptoms and complications of dysphagia. Poor knowledge was identified in management of dysphagia. Further, the results also indicated that further training and experience in caring for stroke patients was more relevant to knowledge than the position and qualification of a nurse. Training and experience in the care of dysphagia patients is a stronger predictor of knowledge than the initial qualification or years of experience of a nurse. An intervention program was designed based on the information obtained from the findings of the questionnaire and supporting literature. Permission to conduct this study was obtained from the Senate Research Grants and Study Leave Committee at the University of the Western Cape. Written permission was obtained from the Ministry of Health and Social Services, Office of the Permanent Secretary, as well from the Acting Medical Superintendent of the Intermediate Hospital Oshakati. The aim of the study, confidentiality and the participants' freedom to withdraw from the study was explained. In order to maintain anonymity, nurses were asked to place informed consent forms and questionnaires in separate boxes. The outcomes of the study could be used to offer appropriate training programs to increase nurses’ knowledge of dysphagia in stroke patients.

Philosophiae Doctor - PhD / Background: The South African government has taken a stance to prioritise sporting codes within South Africa that report high participation and is inclusive of the population demographic of South Africa. Netball has been highlighted as one of these sixteen named sporting codes. Linked to the high participation of netball players in the sport is a high prevalence of injuries, which is well documented throughout the literature. Injury management within a South African context presents a number of challenges due to the current environment of health care in the country as well as an array of barriers that directly impact the netball players themselves as well as netball as a federation. Injury prevalence results in a need to both manage and prevent sporting injuries. The purpose of this study was to develop an injury prevention programme for netball players in South Africa and to establish the feasibility of such a programme for implementation. Method: The study took place under the auspices of Netball South Africa and the injury prevalence data was collected at a national netball tournament at the University of Pretoria. Sequential mixed methods was used as a framework to guide the study, and included a range of research methods as part of that process. The problem was identified in two phases using a cross sectional self-administered questionnaire and a qualitative aspect using semi-structured interviews. The design of the injury prevention programme that aimed to address the problem was informed by a systematic review of literature. The process that guided the development of the injury prevention programme was intervention mapping. This process led to the development of an injury prevention programme that included a coach’s educational booklet, an injury prevention exercise protocol and an administrative structure of a National Physiotherapy Association. The evaluation for feasibility for the implementation of the injury prevention programme was evaluated via a Delphi study.