Introduction: Psychological disturbances after combat and major civil accident has long been recognised, but it has become clear that more "everyday" trauma such as road traffic accidents can lead to similar problems. Post-traumatic Stress Disorder (PTSD) is the extreme of a spectrum of Post-traumatic Psychopathology (PTP), is known to influence the Metabolic Response to Trauma (MRT), and may affect physical recovery after injury. This thesis details the results of a large study of accident victims, following their physical, physiological and psychological recovery. Methods: Cohort study of 200 patients aged 16-60 y with musculoskeltal injuries. The patients completed questionnaires that examined their psychological health (GHQ), and their physical and pyschosocial health (SIP, SF-36, MFA), and trauma scores were calculated. Assessments were made on admission (<i>vice</i> health before the accident), and were repeated at two and six months. A subgroup of 82 patients also gave blood samples at each of the follow up points, and these were analysed for pro-inflammatory markers of the MRT (CRP, IL-6, soluble IL-6 receptor, and TNF-a). Results: Follow up was 79% and 75% at two and six months for the main group, and 82% and 59% respectively for the Metabolic Markers subgroup. PTP was found in 11% of patients at initial assessment, 46% at two months and 22% at six months. It was strongly related to impaired physical and psychosocial functioning There were also associations between PTP and sIL-6r and TNF-a at six months. Injury Severity Score was predictive of PTP at two and six months. Discussion: There are strong associations between psychological and physical health after musculosketal trauma. Injury Severity Score is predictive of this psychological disturbance, which is also associated with disturbance of pro-inflammatory markers. Truly holistic care of patients who have suffered musculoskeletal trauma must include management of the psychological injury as well as the more obvious physical injuries.

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Bariatric surgery is a life-altering procedure that leads to substantial weight loss for most patients with obesity. Psychiatric conditions that may interfere with eating behavior and other behavioral prescriptions after surgery are common. Disordered eating is an established risk factor for inferior weight loss but the effects of negative mood and impulsivity are largely unknown. This thesis aims to investigate the prevalence of and associations between these potential risk factors and eating behavior in bariatric surgery patients. Study I assessed the prevalence of adult Attention Deficits/Hyperactivity Disorder (ADHD) symptoms in bariatric surgery patients. Symptoms of adult ADHD were elevated compared to the normal population and associated with symptoms of disordered eating, anxiety, and depression. Study II investigated whether treatment with Behavioral Activation (BA) could ameliorate binge eating and other symptoms of disordered eating in patients with obesity and Binge Eating Disorder. The results showed that BA was effective in increasing activity levels and improving mood but not in ameliorating binge eating in these patients. Study III was a prospective study on disordered eating, symptoms of depression and anxiety, symptoms of adult ADHD, and alcohol risk consumption before surgery and at follow-up after 12 months. After controlling for age, no variable measured before surgery could predict weight loss after surgery. Disordered eating after surgery was associated with inferior weight loss in men and a subgroup of older female participants. The present thesis concludes that symptoms of adult ADHD are common among bariatric surgery patients and associated with disordered eating. There is no indication that symptoms of adult ADHD are associated with short-term inferior weight loss after surgery. However, adult ADHD may be a risk factor for postsurgical alcohol abuse. The treatment study showed no direct association among activity, mood, and binge eating. BA, while effective in improving mood, was found not to be an effective treatment for BED, at least in the short group format investigated.

The emergence of technology in its many forms has intercepted the connection that the natural body once had with spatial experiences. These tangible interactions between the body and space have been replaced with technology causing the body to become de-valued and disconnected from itself and the surrounding environment. This disconnect between the body and space is felt by many people, however, the effect is compounded in women suffering from eating disorders because of a pre-existing disconnect with the body. Eating disorders are becoming much more prevalent in society. According to Health Canada,1-2% of women between the ages of 15 and 25 have anorexia, 3-5 % have bulimia, with 10-20% eventually dying of complications despite interventions (Health Canada). While many of these women will enter the recovery phase from the disorder, relapse will occur with approximately 1/3 of the women (Zerbe, 17). There are many centres that focus on the treatment of eating disorders while few focus on the aftercare that is crucial to prevent relapse. This design project will attempt to create a wellness centre focused on awareness, education and prevention of eating disorders through a strengthened connection with nature. The exploration of biophilic concepts, which are interactions with nature will foster the connection between the body and space re-developing and sustaining a body awareness that has become obsolete to the technical body in this modern world.

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Children with developmental speech disorder of no known aetiology constitute a heterogeneous group, both in their presenting difficulties, which can include additional language and speech perception difficulties, and in the developmental course of the disorder. This thesis examines this heterogeneity from a developmental and psycholinguistic perspective. Using a longitudinal design, speech processing and language skills are explored over three years in a group of children with speech difficulties (n=47) and an age- and nonverbal IQ-matched longitudinal control group (n=47), mean age 4;06 - 6;07. Other measures were of developmental history, family history, psychosocial status and therapy input. Key areas of investigation were: the proportion of children whose speech later resolves; uncovering the 'resolving' and 'persisting' profile; the role of input processing in speech development, in particular, the role of accent variability; and the occurrence of dissociable speech processing patterns on matched word/nonword repetition and on speech input tasks. Group characteristics were examined through an analysis of patterns of dissociation on tasks across the group and an examination of patterns of association on speech and language measures (in comparison to the control group) in order to establish the developmental relationships between different aspects of speech processing. Thus concurrent and longitudinal relationships were examined using descriptive statistics, prospective and retrospective subgroup analyses and multiple regression analyses. A 'persisting' speech profile was identified as a pervasive speech processing and language difficulty and/or more severe speech output problems. A 'resolved' profile was confined to early, moderate, specific speech difficulties. Apart from nonword repetition, there was no evidence that speech outcome was related to different rates of speech or language development. Using evidence from normal and atypical development, an interactive view of speech development is outlined. Despite the need to understand development as interactive, speech output performance is argued to be the main factor mediating and constraining change between the ages of 4-6 in children with speech difficulties. An emerging discrepancy between word and nonword repetition, with nonword repetition not improving at similar rates to word repetition in some children with persisting speech difficulties, is cited as additional evidence that speech output, in particular, motor programming deficit, is the core characteristic of a persisting speech disorder.

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No description available.

Objectives: 1) to determine if children and adolescents with autism spectrum disorder (ASD) encounter difficulties accessing dental, 2) to identify barriers that diminish access to dental care for this population. Methods: This descriptive study is based on a web-survey conducted at the Geneva Centre for Autism in Toronto between November 2008 and March 2009. Forty-nine multiple choice questions including open-ended fields were developed. Parents of children with ASD (ages 5–18) completed the survey. Results: The majority of participants visited a dentist regularly (71%) and had private dental insurance (64%). Parents/caregivers were more likely to have difficulties finding a dentist as unmarried parents (OR=3.7, P=0.075) or when their level of education was high school/less (OR=10.4, P=0.043). Conclusions: The majority of children/adolescents with ASD had access to dental care. Difficulties accessing dental care were related to family structure, parents’ education and their perception of dentists’ knowledge of ASD.

Objectives: 1) to determine if children and adolescents with autism spectrum disorder (ASD) encounter difficulties accessing dental, 2) to identify barriers that diminish access to dental care for this population. Methods: This descriptive study is based on a web-survey conducted at the Geneva Centre for Autism in Toronto between November 2008 and March 2009. Forty-nine multiple choice questions including open-ended fields were developed. Parents of children with ASD (ages 5–18) completed the survey. Results: The majority of participants visited a dentist regularly (71%) and had private dental insurance (64%). Parents/caregivers were more likely to have difficulties finding a dentist as unmarried parents (OR=3.7, P=0.075) or when their level of education was high school/less (OR=10.4, P=0.043). Conclusions: The majority of children/adolescents with ASD had access to dental care. Difficulties accessing dental care were related to family structure, parents’ education and their perception of dentists’ knowledge of ASD.