While child and adolescent depressive disorders have been historically studied as a downward extension of adult depression, recent research has supported the existence of child and adolescent depression as a distinct disorder and has indicated important developmental differences in symptomatology (Birmaher, Ryan, Williamson, Brent, & Kaufman, 1996; Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993), as well as greater intensity and endurance of depressive disorders in childhood and adolescence than in adults (Jensen, Ryan, & Prien, 1992). Continued research with adolescence is particularly necessary because such symptomatology can manifest in self destructive or even life threatening behaviors. Symptoms such as depressed mood, irritability, and diminished interest in activities can lead to cognitive, familial, and social problems (Hammen & Rudolph, 1996). There is a particular need to investigate ways to identify individuals at risk for depression, and highlighting interactions between risk factors could make this possible. Childhood and adolescent investigations have under-examined the self-schema and its possible ability to moderate the effect of negative life events on depression. The current study investigated the role of life events as an element that, when combined with distorted and negative cognitions relating to the self, would increase the existence of depressive symptomatology in adolescents. Self-schemas, life events, and interactions of both variables were examined as predictors of the severity of depressive symptomatology in 9- to 14-year old girls in two public school districts in Central Texas. Participants completed a self-report measure of depression, a projective measure of the self-schema, a self-report measure of life events, and a diagnostic interview. As expected, a negative self-schema significantly predicted level of depressive symptomatology. However, the experience of adverse life events did not predict level of depressive symptomatology. Additionally, while analyses demonstrated that adverse life events and negative self-schema together predicted the severity of depressive symptoms to a statistically significant degree, the interaction of the two independent variables did not predict severity of depressive symptoms. Implications of the results, limitations, and recommendations for future research are provided. / text

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

An accumulating evidence-base indicates that internalizing mental health disorders in adulthood are causally associated with cardiovascular diseases (CVD) and type-2 diabetes (T2DM). It is plausible, however, that the relationship between mental and cardiometabolic ill-health becomes established long before adulthood, and that externalizing problems (the other central domain of common psychopathology) are also involved. These questions, as well as questions on the mechanisms that underlie the relationships, have been insufficiently investigated. The overarching goal of this dissertation was to expand current knowledge on how common mental health problems increase cardiometabolic risk over the life course. First, the prospective association between childhood internalizing (emotional problems) and externalizing problems (hyperactivity and conduct problems) with CVD and T2DM risk in adolescence was assessed in data from the Avon Longitudinal Study of Parents and Children (ALSPAC, N=7,730). Results showed that hyperactivity problems were associated with insulin resistance (high HOMA-IR); that hyperactivity and conduct problems were each associated with high triglyceride levels; and that emotional problems were inversely associated with high triglyceride levels. These results suggest that childhood externalizing problems are an early life risk factor for CVD and T2DM and that childhood internalizing problems are not a risk factor or, that risk in these children does not become apparent until after adolescence. Second, the mechanisms underlying the prospective association of childhood hyperactivity and conduct problems with high levels of triglycerides in adolescence were investigated using causal mediation methods. Results showed that despite being associated with hyperactivity and with conduct problems, body mass index and lifestyle health behaviors including sleep, diet, physical activity, alcohol, and smoking, together these variables, as measured, mediated only 19.6 % and 19.3% of the associations of hyperactivity and conduct problems with triglycerides, respectively. These results would suggest that mechanisms other than body adiposity and unhealthy behaviors are also involved and that those mechanisms have a larger role in mediating these relationships. Alternatively, It is possible that the observed small role of health behaviors is due to error in measurement and therefore improving measurements for health behaviors should be a central focus of future work. Third and last, a systematic review of the literature on the relationship between childhood externalizing problems with CVD and T2DM risk was conducted. Studies were graded for propensity to bias. Evidence was summarized and assessed for consistency. Results strongly supported positive associations of externalizing problems with insulin resistance, T2DM, and with increased blood lipids among children and adolescents. Evidence suggested that associations are at least partly independent of body adiposity. Evidence provided mix support for the associations with T2DM and blood lipids in adults and with other outcomes in children or adults. Studies in children tended to be cross-sectional and to use valid and reliable assessment methods, whereas studies of adults tended to be prospective and to rely on less-valid, less reliable assessment methods. These results warrant more research, specifically prospective studies that track children into young adulthood, that employ well-validated measures of externalizing behaviors, that rely on repeated assessments of T2DM and CVD risk throughout follow-up, and that investigate mechanisms other than body adiposity and health behaviors. Overall, this dissertation has found that childhood externalizing problems are prospectively associated with elevated CVD and T2DM risk, specifically with elevated risk of increased levels of blood lipids and insulin resistance. Unlike studies in adults, this dissertation does not support a role of internalizing problems as risk factors. Among children with externalizing problems, risk becomes evident before adolescence and appears to be largely driven by pathways independent of unhealthy behaviors and body adiposity. Implications of this research’s findings for health practice were proposed. This dissertation identified several gaps and methodological shortcoming in the extant literature. Recommendations were made for future research, including fundamental next questions to investigate, and study designs and methodologies that are best suited to tackle those questions.

published_or_final_version / Community Medicine / Master / Master of Philosophy

Youth sex offenders are not a homogenous population. They differ in terms of race, social class, victim preferences (both in terms of age and in terms of whether the victim is known to the offender or not), their modus operandi to gain compliance, levels of aggression and physical violence, the types (“hands on” or “hands off”) and levels (level 1, 2, or 3) of offences and lastly their motivations for committing a sex offence. The motivations are linked to the risk factors to which an individual is exposed, for example, a youth that was previously sexually victimised could sexually act out his experiences. A qualitative approach was used in this study. The researcher aimed to gain a holistic comprehension of the risk factors that youth attribute to their sex offending behaviour and thus this was the most appropriate approach to use. A semi-structured interview schedule was used as the data collection method as this allowed the researcher the freedom to change the sequence and forms of the questions in order to follow up on responses. The function of this interview schedule was to direct the researcher to ensure that she covered all the themes needed to obtain the necessary data. The interview schedule was made up of nine categories, namely: biographic characteristics, academic performance, extramural activities, substance use, family substance use problems, family and community violence, emotional status, caring and attachment to family and peers, sexual abuse and knowledge about sex. After the interviews were conducted, the data was transcribed, analysed and interpreted. The researcher made use of interpretative phenomenological analysis (IPA) to determine the emergent themes. The researcher eliminated the emergent themes that were impossible to label, or those deemed to be irrelevant to the study. Thereafter, the researcher clustered the emergent themes into sub-ordinate themes and validated these main and sub-ordinate themes. The researcher then provided a textural description to depict the experience and a structural description to depict the possible explanation of the experience of the respondents. Finally, a composite description provided the structure for the interpretation of the data. The researcher interpreted the main and sub-ordinate themes with relation to the literature review and the theories deemed useful in explaining the risk factors associated with youth sex offending, namely: Sigmund Freud’s psychoanalytic theory, Erik Erikson’s psychosocial theory of personality development, Albert Bandura’s social cognition theory, William Marshall and Howard Barbaree’s integrated theory, and Neil Malamuth’s confluence model of sexual aggression. The analysis and interpretation of the data revealed certain possible risk factors that could contribute to the phenomenon of youth sex offending in South Africa. The researcher provided possible methods of addressing these risk factors. The dearth of knowledge regarding the phenomenon of youth sex offending highlights the need for further research and the researcher made several recommendations regarding future research prospects in order to address this social problem and to give youth sex offenders the best chance of adopting pro-social behaviour. Copyright / Dissertation (MA)--University of Pretoria, 2010. / Social Work and Criminology / unrestricted

Master of Science / Department of Civil Engineering / Sunanda Dissanayake / In the United States, approximately 1,100 people die and 40,000 people are injured annually as a result of motor vehicle crashes in work zones. These numbers may be a result of interruption to regular traffic flow caused by closed traffic lanes, poor traffic management within work zones, general misunderstanding of problems associated with work zones, or improper usage of traffic control devices. In regard to safety of work zones, this study was conducted to identify characteristics and risk factors associated with work zone crashes in Iowa, Kansas, Missouri, Nebraska and Wisconsin, states currently included in the Smart Work Zone Deployment Initiative (SWZDI) region. The study was conducted in two stages. In the first stage, characteristics and contributory causes related to work zone crashes such as environmental conditions, vehicles, crashes, drivers, and roadways were analyzed for the five states for the period 2002-2006. An analysis of percentage-wise distributions was carried out for each variable based on different conditions. Results showed that most of the work zone crashes occurred under clear environmental conditions as during daylight, no adverse weather, etc. Multiple-vehicle crashes were more predominant than single-vehicle crashes in work zone crashes. Primary driver-contributing factors of work zone crashes were inattentive driving, following too close for conditions, failure to yield right of way, driving too fast for conditions, and exceeding posted speed limits within work zones. A test of independency was performed to find the relation between crash severity and other work zone variables for the combined states. In the second stage, a statistical model was developed to identify risk factors associated with work zone crashes. In order to predict injury severity of work zone crashes, an ordered probit model analysis was carried out using the Iowa work zone crash database. According to findings of the severity model, work zone crashes involving trucks, light duty vehicles, vehicles following too close, sideswipe collisions of same-direction vehicles, nondeployment of airbags, and driver age are some of the contributing factors towards more severe crashes.

Problem detection is a critical component in nursing, such that superior detection could lead to quicker intervention, even if the nature of the problem is not yet clear. A critical problem intensive care nurses typically engage in is detecting the threat of an impending hospital-acquired infection. The purpose of this study was to investigate the effects of the presence of risk factors, expertise, and time pressure on problem detection. The results suggested that time pressure seemed to have a detrimental effect on problem detection, and nurses benefitted from the presence of more risk factors. When not under time pressure, nurses were more sensitive in their problem detection judgments, and only needed one risk factor to trigger problem detection. Experienced nurses were more sensitive to the type of infection at detection, and were more likely to identify the problem correctly after information had been accumulated. These results suggest that problem detection was differentially affected by risk factors based on the presence or absence of time pressure. In addition, experienced nurses took a different approach to problem detection when compared to novices. Finally, problem detection and problem identification can in some situations occur simultaneously, but are distinct processes.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Objectives: To determine the prevalence and associated risk factors of low back pain (LBP) in an automotive production company, evaluating the relationship between selected risk factors, type of occupational activity and the prevalence of LBP. Methods : This was a descriptive study at a large automotive production company entailing 200 physical production employees and 200 sedentary employees. Using a cross sectional study design, a retrospective analysis investigated the LBP prevalence, by means of a questionnaire. Individuals reported on demographics, injury location, injury aetiology, injury nature, extent of treatment rendered and time lost from work. Additionally, data was obtained regarding smoking, occupational stress and fitness.Results: A significant difference was found between sedentary and manual employees with regards to age, gender, ethnicity, marital status, education and medical aid. Similarly a significant difference between the groups was found for the point prevalence of LBP, current LBP description (sharp, shooting, dull aching, stabbing and catching pain descriptions), past LBP description (catching pain description), sidedness/ location of pain as well as associated features of the current LBP (viz. pins and needles, pain to the knees, numbness, bed rest, absence from work, pain at work and pain on weekends) and associated features of past LBP (viz. pins and needles, pain to the knees, numbness, bed rest, absence from work, pain at work and pain on weekends). There were no noted psychosocial factor that impacted on a difference between the groups, but there was a significant difference between the manual and sedentary employees with regards to absenteeism. Conclusion: A significant rate of LBP was reported amongst both the sedentary (59.6%) and the manual (89%) employees, implying that the costs to the company are relatively high. It is, therefore, suggested that the company looks at a variety of strategies to reduce the burden of LBP in their employees. / National Research Fund

No description available.

Aims The overall aim of this thesis was to extend current knowledge about the prevalence of malnutrition, to identify possible risk factors for development of malnutrition, and to describe the consequences of malnutrition in relation to all-cause and cause-specific mortality among older adults admitted to hospital. Methods The prevalence of malnutrition was estimated in a cohort of 1771 older adults (≥65 years) who were admitted to a Swedish hospital during 2008–2009 (15 months) and screened for malnutrition using the Mini Nutritional Assessment (MNA) instrument. Possible risk factors for malnutrition were recorded during the hospital stay (Study I). Dietary intake 10 years earlier (in 1997) was collected for 725 of these older adults (Study II). All-cause (Study III) and cause-specific (Study IV) mortality were followed up after medians of 3.5 and 5.1 years, respectively, for 1767 of the participants. Results The prevalence of malnutrition was 9.4% while 55.1% were at risk of malnutrition. Risk factors for malnutrition was an overnight fast >11 hours, <4 eating episodes a day, and not cooking independently. In middle-aged and older adults with a body mass index <25 kg/m2 in 1997, the risk of malnutrition increased for each additional percentage point of energy from total, saturated and monounsaturated fat at follow-up after 10 years. Malnourished older adults had almost four times higher risk of death during follow-up, while those at risk of malnutrition had a 56% higher risk, compared to well-nourished. Furthermore, well-nourished older adults had consistently lower risk of death, regardless of the cause of death. Conclusions Only 35.5% of older adults admitted to hospital were well-nourished. The identified risk factors could be used in interventions aimed at preventing malnutrition. Normal-weight and underweight middle-aged and older adults should consider limiting the intake of total fat and/or improve the quality of the fat in the diet in order to decrease the risk of becoming malnourished later in life. Malnutrition and risk of malnutrition were associated with increased overall and cause-specific mortality. These relationships emphasize the need for nutritional screening to identify individuals who may require nutritional support in order to avoid preterm death.