Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

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Computer-assisted interventions designed to remediate low numeracy and developmental dyscalculia (mathematical learning disability) have been utilised in preschools and kindergartens with some efficacy for over thirty years (Clements, 2002). A recent development in this field is ‘adaptive game’ technology, which adapts task difficulty online as children learn. The Number Race is the first such package for mathematics. Previous efficacy studies suggest its use results in an improvement in core measures of early numeracy, such as speed at enumerating 1-3 objects (subitizing) and comparison of numerals and groups of objects. The present study tested the efficacy of a new version of The Number Race (version 3.0) using New Zealand English and incorporating new instructional factors, in a younger population than most previously tested. Participants were twelve 5-to-7-year-old children and a typically developing control group matched on age and sex (n = 12). Following pre-testing using standardised tests and a computerised battery, children in the intervention group used The Number Race for twenty minutes each school night, for one month. Post-testing results showed that there was a significant improvement in counting and subitizing speed for the intervention group. Participants also became faster and more accurate at comparing numerals. There were no significant changes in standardised mathematics scores. The mental number line task did not show any significant differences before and after intervention but a wide variety of patterns and possible use of strategies were revealed. Overall, this new version of The Number Race seems to have modest effects in this population.

Bakgrund: Sömn är ett mänskligt grundläggande behov och bör därför tillgodoses hos patienter som vårdas på sjukhus. Patienter som vårdas på intensivvårdsavdelningar upplever dock ofta upprepade avbrott på sömnen och sömnbrist vilket kan leda till både fysiska och psykiska negativa konsekvenser. Intensivvårdsmiljön med dess oljud, starka belysning och frekventa vårdrelaterade interaktioner leder ofta till oförmåga hos patienterna att få en adekvat sömn. Syfte: Att belysa olika interventioner sjuksköterskan kan tillämpa för att förbättra sovmiljön och sömnkvaliteten hos patienter som vårdas på en intensivvårdsavdelning. Metod: En litteraturöversikt med grund i analys av kvantitativ forskning. Resultat: I resultatet framkom sju interventioner som delades in i tre olika kategorier: skapa en bättre sovmiljö, avskärmning från ljud och ljus samt förbereda patienten för sömn. De sju interventionerna som identifierades var: tysta/störningsfria perioder, riktlinjer/ramverk innefattande aktiviteter för att kontrollera yttre störande faktorer, utbildning, öronproppar och ögonmask, adderat "white noise", musik samt akupressur. Slutsats: Genom att tillämpa en eller fler av de sju interventionerna kan sovmiljön och sömnkvalitet förbättras för patienter som vårdas på intensivvårdsavdelningar. Dock krävs ytterligare forskning inom området då vissa interventioner ger motstridiga resultat. Klinisk betydelse: Sömn är ett nödvändigt behov och har en stor betydelse för återhämtning från sjukdom och bör därför tillgodoses av sjuksköterskan. Resultatet i denna litteraturöversikt kan ge en ökad förståelse för vilka interventioner sjuksköterskan kan tillämpa i sitt omvårdnadsarbete för att förbättra sovmiljön och sömnkvalitet för patienter som vårdas på intensivvårdsavdelningar. / Background: Sleep is a basic human need and should be addressed in patients being treated in hospital. Patients cared for in intensive care units often experience repeated interruptions of sleep and sleep deprivation, which can lead to both physical and psychological adverse consequences. The intensive care environment with its noise, strong lighting and frequent care-related interaction often leads to the inability of patients to get adequate sleep. Aim: To illustrate the various interventions the nurse can implement to improve the sleep environment and quality of sleep in patients who are cared for in an intensive care unit. Methods: A literature review with its basis in an analysis of quantitative research. Results: The result emerged in seven interventions that were divided into three different categories: creating a better sleep environment, shielding from light and sound, and preparing the patient for sleep. The seven interventions identified were: quiet/non-disturbance periods, guidelines/framework including activities to control disturbing environmental factors, education, ear plugs and eye mask, added "white noise", music and acupressure. Conclusion: By applying one or more of the seven interventions the sleep environment and sleep quality for patients cared for in intensive care units may improve. However, as some interventions produced conflicting results, further research in the area is required. Clinical significance: Sleep is an essential requirement and has great importance in the recovery from illness and should therefore be carefully understood by the nurse. Findings from the literature review can provide a better understanding of which interventions nurses can apply in their work to improve the sleep environment and sleep quality for patients cared for in intensive care units.

Background For patients in need for psychiatric care who refuse treatment, coercive care might be necessary due to The Law of Psychiatric Compulsory Care, LPT. The purpose of this law is to make sure the patient later on will be able to increase autonomy. The most frequent patients in coercive care suffer from psychosis, heavy depression or having high risk of committing suicide. One of the most important tasks in the nurse profession is to increase patients’ autonomy. Therefore having ethical judgment is necessary to know when to use paternalism. To take note of patients’ experiences may increase awareness, making care more patient-centered. Aim To describe patients’ experiences of coercive care and coercive interventions in psychiatric care. Method A literature review has been conducted in order to compile what is currently known about the topic at hand. The result is based on ten scientific articles with findings responding to the aim of this study. The articles have been analyzed by identifying similarities and differences that have synthesized to a new whole.   Result The literature review yielded a profound view of patients’ experiences when being in coercive care. Three main themes were found to cover the phenomenon. Those were Coercive Care - limits and possibilities, The care relationship is fundamental and From abuse to life saving. Discussion The result has been discussed using the theory about Care Suffering, as described by Katie Eriksson. This theory is applicable on the context of interest. The findings has also been discussed using earlier studies concerning coercive care, as well as studies emphasizing the perspective of the nurse’s using coercive restraint. Key words Coercive care, coercive interventions, psychiatric care, patients’ experiences.

Past research has shown us that males have higher self-efficacy and motivation in the subjects of mathematics/science, and females have higher self-efficacy and motivation in the subject of English (reading/writing). This paper explores the constructs of self-efficacy, domain-specific self-efficacy, differences in gender related to academic self-efficacy, and research that has been done on interventions related to academic self-efficacy in the past. The aim of this paper is to develop intervention designs that help improve academic self-efficacy and motivation for females in the field of mathematics/ science, and improve academic self-efficacy and motivation for males in the field of English (reading/writing).

Program Description CHOICES: A Brief Alcohol Abuse Prevention and Harm Reduction Program, is a research-based intervention program that can assist college students in making safer choices as it relates to alcohol consumption. Students in CHOICES are informed of the risks associated with alcohol use and are provided with the tools and strategies necessary for reducing these risks. Students who complete CHOICES leave with the knowledge and strategies that are required to modify risky drinking behavior and reduce negative consequences related alcohol consumption. Evaluation Questions The purpose of the evaluation was to determine how effective is the CHOICES program. Program effectiveness was measured through the assessment of student’s change in background knowledge, knowledge of health related risks associated with alcohol consumption, and attitudes towards excesive drinking. Student’s perceived effectiveness of the program and their likelihood to modify their behavior was also assessed. Below are the five evaluation questions: Do students display an increase in background knowledge of alcohol consumption? Do students display an increased knowledge of health-related risks associated with alcohol consumption? Do students display a change in attitudes towards excessive drinking? Do students consider the CHOICES Program an effective alcohol abuse prevention program? Are students likely to modify their behavior as a result of the CHOICES Program? Methods There were 88 students mandated to participate in and complete Georgia State University’s CHOICES Program from May 2013 to December 2013. Of those 88 students, 83 of them completed pre- and post-tests, and 84 completed the de-identified evaluation. The data was entered directly into IBM’s SPSS Statistics Desktop Version 21. Reliability analyses were conducted to evaluate the internal consistency and reliability of the scales created to answer the evaluation questions. Frequencies were run on the responses from the pre-tests, post-tests and evaluations. A paired-samples t-test was used to compare mean scores of students before and after completing the CHOICES Program. An independent-samples t-test was used to compare the difference in mean scores between men and women. Key Findings Statistically significant findings suggests that CHOICES is an effective alcohol abuse prevention program. There was a statistically significant increase in background knowledge scores from the pre-test to the post-test. These results indicate that students who complete CHOICES display an increase in background knowledge of alcohol use. There was also a statistically significant increase in health knowledge scores from the pre-test to the post-test. This indicates that students who complete CHOICES display an increase in knowledge of health-related risk associated with alcohol consumption. Statistical significance was also found in the increase of student’s attitude scores from the pre-test to the post-test, indicating that students who complete CHOICES display a positive change in attitude towards excessive drinking. Over half of students gave CHOICES an overall rating of “excellent” and 38.6% gave it a rating of “good”. Also, 60.6% of students scored above a 28 on the Program Effectiveness Scale. These results indicate that students consider CHOICES an effective alcohol abuse prevention program. 60.7% of students reported that they would “definitely” change some aspect of their alcohol-related behavior as a result of the CHOICES Program. 29% reported “maybe”. These results indicate that the majority of students are likely to modify their behavior as a result of CHOICES. Students who participate in CHOICES leave the program with increased knowledge, a change in attitude towards excessive drinking and are motivated to make safer choices related to drinking.

The importance of health and quality health care in people’s daily lives is widely recognised. Physicians play a key role in delivering quality health care and improved patient outcomes. However, the evidence regarding physicians’ decision making and their perception of quality of health care delivery and its influencers is inconclusive. The overall aim of this thesis is to increase the understanding of quality in health care delivery and the factors that influence it from a physician’s perspective. This aim is fulfilled by conducting three interlinked research projects. The first research project comprises a systematic review of the literature that identifies the factors, contexts and theoretical underpinnings influencing physician decision making. The synthesis of 160 studies reveals two main categories of influencing factors. The first is ‘Contexts’, which refers to the set of circumstances or facts surrounding a particular event or situation. The second category is ‘Interventions’, which are the techniques, processes or actions introduced to create changes in how physicians make decisions while performing their clinical duties. Although extant literature provides ample evidence on factors influencing physician decision making the link to quality in health care is under researched. In the second research project, the author explores how physicians construct quality of health care delivery by means of investigating 162 clinical cases with 27 repertory gird interviews that yield eleven key constructs representing a classification of physicians’ conception of quality. The third research project examines physicians’ perceptions of enablers and barriers to quality in health care delivery, employing semi-structured interviews. Findings indicate that physician’s effort in delivering quality health care is largely influenced by factors affecting behavioural control (freedom to act). This research makes five contributions to knowledge. First, a novel classification of factors influencing physician decision making when prescribing is developed, providing new understanding of the link between these factors and quality of health care. Second, the systematic review shows an innovative application of factor analysis to structure the findings of a complex phenomenon. Third, the study presents a new conceptualisation of physicians’ construction of quality in health care. Fourth, the research provides a categorization of physicians’ perceived enablers and barriers to quality health care and the mechanisms by which they operate. Finally, this research develops a theoretically-grounded and empirically-informed conceptual model that incorporates three hitherto separate domains: agency, planned behaviour, and decision theories. This model provides a new integrated lens to better understand the complexities influencing quality in health care delivery. This study also makes two significant contributions to practice. First, the findings have helped initiate a transformation in the pharmaceutical industry’s business model, evolving from business-to-person to business-to-business. Second, the findings serve as a catalyst to drive organizational changes at Norway’s largest emergency hospital. As a result, a national debate was initiated, involving the Prime Minister and Minister of Health, on how hospital emergency care can best be provided at a national level.

The movement towards the provision of evidence-based services has become increasingly important to psychological practice (CPA Task Force on Evidence-Based Practice of Psychological Treatments, 2012; Levant, 2005). One of the key components of this movement is the summarizing and dissemination of important findings to key stakeholders for interventions using techniques such as meta-analysis. Meta-analyses are typically based on reviews of the published literature on a particular topic, but increasingly researchers are acknowledging the importance of examining and including unpublished, grey literature in their reviews in presenting an accurate picture of a body of literature (Hopewell, McDonald, Clarke, & Egger, 2008; McAuley, Pham, Tugwell, & Moher, 2000). However, the inclusion of grey literature in meta-analyses and reviews remains controversial (Coad, Hardicre, & Devitt, 2006; Martin, Perez, Sacristan, & Alvarez, 2005; Seymour, 2010). A number of reviews of behavioural parenting interventions have been conducted. The body of literature in this area continues to grow quickly, and recent meta-analyses in this area have examined only subsets of the literature, thus necessitating an overall examination of all available literature in this area: published and unpublished. The present meta-analysis synthesized the results of 42 published and 6 unpublished behavioural parenting intervention studies conducted between 1966 and 2011. In the first manuscript, treatment efficacy was examined with respect to three different outcomes (parent behaviour, child behaviour, and parent adjustment). I also examined the differential effects of six moderator variables in two categories: child characteristics (child formal diagnostic status and child age) and methodological characteristics (overall quality, comparison group, experimenter allegiance, and publication status). In the second manuscript, I examined both the advantages and challenges of including grey literature in meta-analyses, and explored the use of an innovative search program. I also explored the influence of the inclusion of grey literature on outcomes, including whether effect sizes, sample homogeneity, and publication bias indices are affected by the inclusion of grey literature. Results of the present study confirm the efficacy of behavioural parenting interventions on parent behaviour, child behaviour, and parent adjustment outcomes. Further, I extend the knowledge base through the inclusion of recent reports, grey literature, searches of basic search engines such as Google and Yahoo, and the examination of previously unexplored moderator variables. My results underline the importance of consistent reporting practices in the field and their impact on the availability of evidence for policy-makers, administrators, researchers, clinicians and consumers. I also discuss the implications of these findings for the provision of evidence-based services for parents, knowledge translation, and grey literature.

Bakgrund: Det sker en ökning i västvärlden av gravida kvinnor som är överviktiga eller lider av fetma. Närmare 40 procent av de gravida i Sverige är överviktiga och drygt 10 procent är feta. Så många som en tredjedel av gravida kvinnor klassas som fysiskt inaktiva. Detta gör området folkhälsovetenskapligt relevant då fysisk inaktivitet och övervikt har samband med flera folksjukdomar. Syfte: Studiens syfte var att beskriva hur fysisk aktivitet främjas hos gravida kvinnor. Metod: Tio vetenskapliga artiklar granskades inom området för att skapa en kunskapsöversikt. Utifrån dessa skapades tre teman, detta gör studien till en litteraturstudie. Resultat: Det finns flera olika faktorer som påverkar den gravida kvinnans fysiska aktivitet. Bland dessa finns symptom som uppstår under en graviditet som exempelvis att kroppen förändras. Omgivning och miljö såsom socialt stöd och förutsättningar till fysisk aktivitet kring bostaden har även visats påverka den fysiska aktiviteten. Effektiva interventioner är rådgivning inom kost och träning samt konkreta mål som är lätta att mäta, t.ex. stegräknare. Slutsats: Slutsatsen av denna studie var att flera faktorer främjar gravida kvinnors fysiska aktivitet. Gravida kvinnor är benägna att följa mödrahälsovårdens råd och därför kan interventioner där mödravården och de främjande faktorerna med fördel integreras. / Background: There is a gradual percentage increase in pregnant women who are overweight or obese in the west hemisphere. In Sweden, nearly 40 percent of those women are overweight and 10 percent are obese. One third of them are physically inactive which makes the research within public health highly relevant. Aim: To promote physical activity amongst pregnant women. Method: Ten research articles on the topic were reviewed to achieve a deeper understanding. By summarizing the most important and relevant points brought up in each article, a conclusion was formed. Those points where then categorized into three themes, which turned the study into a type of literature. Results: There are many factors that impact the pregnant women’s physical activity. These factors can be triggered by the actual pregnancy, such as symptoms causing the body to change. Location and environment is seen as important to help the promotion, such as social support and access to activities close to home. Effective interventions are diet and exercise consultations and measurable goals by using pedometers. Conclusion: The conclusion of this study was that several factors promoting pregnant women’s physical activity. Pregnant women are likely to follow the prenatal cares advice and therefore can interventions designed with the promoting factors integrated to prenatal care to achieve goals of public health.