Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2009.

Background: Continuity of care and post-discharge follow-up visits can improve the quality of care and reduce the likelihood of relapse and re-hospitalization in patients with psychotic disorders. Purpose: This study aimed to analyze post-discharge follow-up interventions in patients with psychotic disorders, and to identify measurement instruments for intervention outcomes. Method: The literature review described here used a specific framework, where the follow-up interventions and the measurement instruments were analyzed systematically, to investigate fifteen studies identified through electronic databases such as Pubmed, Psychinfo, ProQuest, Cinahl, Medline, and Scopus. Results: The studies used interventions including psychoeducation, cognitive-behavioral therapy, cognitive behaviorally oriented service, optimal clinical management, relapse prevention plan, software suggested intervention, ambulatory outpatient care, community re-entry module, integrated treatment, and hospital-based community psychiatric service. Additionally these studies used thirty-eight measurement instruments to assess change in psychiatric patients or their relatives, based on psychological, social, and occupational factors as well as specific symptoms and symptom severity. The instruments also measured quality of life, insight, self-esteem, and cognitive function. Further, the studies examined therapeutic alliances and the experience of family members. The most commonly used instruments were the Global Assessment of Functioning and the Positive and Negative Syndrome Scale. Conclusion: The interventions reviewed here emphasize an individualized approach that targets education, illness management, coping strategies, social skills training and relapse prevention, and seeks to alter any harmful understanding of the illness. Although researchers can choose among numerous interventions, psychoeducation was the most appealing follow-up intervention for patients suffering from psychotic disorders. Importantly, evaluation instruments must be relevant to psychological symptoms, treatment, time and resources available, and what questions were being sought to answer. Approximately eleven of the thirty-eight instruments reviewed here showed weak or unclear reliability and validity. The most practical instrument for evaluating the outcome of an intervention for patients suffering from psychotic disorders wasthe Positive and Negative Syndrome Scale. / <p>ISBN 978-91-86739-70-6</p>

Bakgrunn: Forekomsten av overvekt og fedme er økende i de nordiske landene og iverden forøvrig. Utviklingen er bekymringsfull fordi den bringer med seg uhelse og alvorlig sykdom. Ulike virkemidler er tatt i bruk for å løse problemene forårsaket av overvekt og inaktivitet. Samtidig prøver man å påvirke til endret helseatferd. Det er behov for å utvide kunnskapen om hva som i denne sammenheng er effektive strategier. Hensikt: Studiens hensikt er med kvalitativ metodikk å studere hvordan personer som har lykkes med å endre livsstilsvaner, opplevde og håndterte endringsprosessen. Metode: 14 personer, derav åtte menn, i alderen 23 til 68 år er intervjuet individuelt. Modifisert versjon av Grounded Therory er brukt som metode i innsamling av data og i analyseprosessen. Resultat: Studien viser at deltakernes vellykkede livsstilsendring har forløpt gjennom en rekke sosiale prosesser som kan beskrives ut fra tre hovedkonsepter som her er samlet i følgende kategorier; Motiverer til endring, danner nye vaner og håndterer seg selv. Det som kjennetegner endringsprosessen i sin helhet er hvordan hovedpersonene har utviklet større grad av kontroll og håndterbarhet i egne liv. Konklusjon: Vellykket livsstilsendring er en psykologisk empowermentprosess med vekt på prosesser omkring selvregulering, motivering, psykisk uhelse og det å danne nye vane / The incidence of overweight and obesity is steadily increasing in the Nordic countries and the entire world. This trend is a cause for concern because obesity links directly to many several illnesses, some life-threatening. Various methods have been developed in an effort to manage problems associated with obesity and inactivity. These methods also try to initiate positive lifestyle changes. However, it is necessary to broaden the knowledge base regarding the effectiveness of these strategies. Aim: This study aimed to use qualitative methodology to assess people who have succeeded in making positive lifestyle changes, documenting their experiences and learning how they adapted during the change process. Methodology: A group of 14 people consisting of eight men and six women, all between the ages of 23 and 68 years, were individually interviewed using a modified version of Grounded Theory to collect and analyze the data. Results: The study shows that the participants' positive lifestyle changes have gone through a variety of social processes. These processes comprised three main categories: motivation to change, development of new habits, and self-management. A defining factor in the change process of each candidate was how well that individual developed a greater degree of self-control and management of their own lives. Conclusion: Successful lifestyle change is a psychological empowerment process that emphasizes self-regulation, motivation, mental disorders, and the development of new habits. / <p>ISBN 978-91-86739-44-7</p>

This qualitative study of six Indigenous youth HIV prevention peer educators is presented to help understand how Indigenous youth perceive HIV/AIDS education. The research used a semi-structured questionnaire as a guide to conducting in depth individual interviews. The research followed decolonizing methodologies to explore the views of peer educators about the HIV/AIDS education they delivered, and the issues around perceptions of infection and risk. It examines the youth’s views on peer education, the importance of cultural revitalization in relation to health education and how peer education can be most effective. This study has included examples of programs with marginalized communities in several parts of the world and compared them with Indigenous experiences in Canada, in order to develop an understanding and recommendations of the most effective approaches in Indigenous youth health interventions. There have been very few research studies on Indigenous youth involvement in STD interventions. Indigenous youth have only been marginally included in the design of most of the social programming they receive, even though they have the unique knowledge, skills, language and cultural perspective necessary to reach their peers. HIV infection is on the rise with Indigenous youth because of historical and ongoing socio-economic and political inequities. Therefore, it is crucial that young Indigenous people be welcomed as integral participants in the strategies for improving Indigenous health.

The purpose of the research project was to examine the effects of exercise and social support for postnatal women who reported experiencing Postnatal Depression (PND). PND is a serious condition that affects up to 10%-15% of women (O'Hara & Swain, 1996). Many previous studies have reported an improvement of depressive symptomatology following a pram walking intervention. However, no published research exists which assesses postnatal women who report experiencing PND. A randomised controlled trial was used, where pre-test data were compared to post-test effects. Two studies were conducted. In study 1 (n= 20) a multi-intervention group (exercise and social support) was compared to a control group who received no intervention. Study 2 (n= 19) was conducted 20 months later on a different group of women and involved a pram walking intervention group and a comparison social support group. Structured questionnaires assessing depressive symptomatology, general health and levels of social support were administered at pre-test phase, week 6 and 12. A sub-maximal fitness test was conducted the week before the program started and at week 12. The chief investigator was present at all sessions to guide the participants. Study 1 (S1): The multi-intervention group attended 3 pram walking sessions per week. After the exercise session the group met for refreshments in a local hall. The control group was only required to perform the fitness tests and answer the questionnaires. A 6-week alternative program of exercise and social support was offered to all the women at the completion of the intervention period. Study 2 (S2): The pram walking group met for 2 exercise sessions and were required to make up the third session independently. The comparison social support group met once per week for morning tea with the children. The samples for both studies were drawn from the Gold Coast region in Australia. Women of childbearing age who were experiencing depressive symptoms were recruited. For S1 their child had to be less than or equal to 12 months and for S2 the age cut off was increased to less than or equal to 18 months. The participants were screened to ensure that they did not have a medical condition that would prevent regular aerobic exercise and they were also excluded if they had a previous history of mental illness or could not speak English. Demographic data were obtained from each participant and details such as height, weight and age were collected for use in analysing fitness levels. The data for each study were collected across three time points (pre, week 6 and week 12) using widely tested instruments. Some additional questions relating to the participants experiences were collected at the completion of the study from the women allocated to the intervention groups. Data were also collected on fitness levels (pre and week 12) and the instrument was tested for its reliability. Both pram walking intervention groups were required to complete a weekly exercise diary. For each study, to test for the effect of the intervention over time, a two-way analysis of variance was conducted on the major outcome variables. Group (intervention versus control) was the between subject factor and time (pre-test, week 6, week 12) was the within subject factor or repeated measures factor. Due to the small sample size, further tests were conducted to check the assumptions of the statistical test to be used. The results showed that using Mauchly's Test, the Sphericity assumptions of repeated measures for ANOVA were met. Further, tests of homogeneity of variance assumptions also confirmed that this assumption was met. Data analysis was conducted using the software package SPSS for Windows Release 10.0. (Norusis, 2000). Overall, the findings from both S1 and S2 showed that the groups who received the pram walking intervention improved their depressive symptomatology and fitness levels when compared to those of the control (S1) and social support group (S2). Social support levels did not alter for either group from both studies. These results are encouraging and suggest that a pram walking program is an effective form of intervention for postnatal women experiencing depressive symptomatology.

Children's mental health problems are a significant public health concern. They are costly to society in both human and financial terms. This thesis contributes to the 'science of prevention' by examining issues related to the identification of children at risk of mental health problems. In particular, it was of interest to determine whether 'at-risk' children could be identified before the development of significant behavioural or emotional problems. Three areas were explored: family risk factors that predict the development of children's mental health problems, teachers' ability to identify family risk factors, and parent- and teacher-report screening methods. Data were collected from the parents and teachers of over 1000 children in preschool to Year 3 as part of the Promoting Adjustment in Schools (PROMAS) Project. Parents and teachers each completed two questionnaires at two time points, one year apart. Parents completed the Family Risk Factor Checklist - Parent (FRFCP) and the Child Behaviour Checklist (CBCL) and the equivalent instruments for teachers were, respectively, the Family Risk Factor Checklist - Teacher (FRFC-T) and the Teacher Report Form (TRF). The FRFC-P and FRFC-T were original to the current research and were designed to assess children's exposure to multiple family risk factors across five domains: adverse life events and instability (ALI), family structure and socioeconomic status (SES), parenting practices (PAR), parental verbal conflict and mood problems (VCM), and parental antisocial and psychotic behaviour (APB). Paper 1 investigated the psychometric properties of the FRFC-P and the potential for its use at a population-level to establish community risk factor profiles that subsequently inform intervention planning. The FRFC-P had satisfactory test-retest reliability and construct validity, but modest internal consistency. Risk assessed by the PAR domain was the most important determinant of mental health problem onset, while the PAR, VCM, and APB domains were the strongest predictors of mental health problem persistence. This risk factor profile suggests that, for the studied population, the largest preventive effects may be achieved through addressing parenting practices. Paper 2 examined teachers' knowledge of children's exposure to family risk factors using the FRFC-T. While teachers had accurate knowledge of children's exposure to risk factors within the ALI and SES domains, they had poor knowledge of children's exposure to risk factors within the PAR, VCM, or APB domains - the types of risk factors found in Paper 1 to be the most strongly related to children's mental health problems. Nevertheless, teachers' knowledge of children's exposure to risk factors within the ALI and SES domains predicted children's mental health problems at one year follow-up even after accounting for children's behaviour at the first assessment. Paper 3 investigated the potential of both the FRFC-P and FRFC-T for identifying individual, at-risk children. The accuracy of the FRFC in predicting internalising versus externalising disorders was compared against behavioural and simple nomination screening methods. For both parents and teachers, the behavioural screening methods were superior, however, the simple nomination method also showed promise for teachers. Both parents and teachers were more accurate at identifying children at risk of externalising mental health problems than children at risk of internalising problems. The performance of the FRFC and simple nomination methods in identifying children for selective interventions, before the development of significant behavioural or emotional problems, was also tested. Both the FRFC and simple nomination methods showed only modest predictive accuracy for these children. Combined, the results suggest that while on the one hand, the FRFC is useful for population level screening to inform intervention planning, on the other hand, it falls short of achieving good predictive accuracy for individual children. Future research should investigate ways to optimise predictive accuracy for individual children, particularly those at risk of developing internalising disorders. One option may be to use the FRFC in conjunction with behavioural screening methods. The challenge is to develop accurate screening methods that remain practical to complete at a population level. Finally, this body of research provides insight into the feasibility of offering selective preventive interventions within the school setting. While significant obstacles remain, there were several promising indications that using screening methods such as FRFC-T or simple nomination, teachers may be able to identify children earlier on the developmental pathway, before significant behavioural or emotional symptoms have developed.

Three studies were designed to investigate the effects of exercise-based lifestyle interventions including diet change and exercise training on cardiovascular and autonomic responses to various physical and mental challenges in untrained premenopausal women. In Study 1, the effects of different tasks designed to activate the sympathetic nervous system on autonomic control of cardiovascular functioning such as the Stroop colour-word task (Stroop) and lower body negative pressure (LBNP) in 20 untrained premenopausal women (22.6??0.7 years) were determined. In Study 2, a longitudinal exercise intervention strategy was used with 18 untrained premenopausal women (22.5??0.7 years) in order to investigate the effect of 15 weeks of high intensity intermittent exercise (HIIE) training on cardiac autonomic responses to mental challenge (Stroop) and LBNP. In Study 3, the effects of HIIE training combined with a Mediterranean-style eating plan and fish oil supplement (Fish oil, Exercise, Mediterranean diet; FEM) on cardiovascular function during mental challenge (Stroop) and physical tasks (handgrip and reactive hyperaemia) were examined in 32 overweight untrained premenopausal women (22.0??0.6 years). In these studies, forearm blood flow (FBF) was assessed using Hokanson Plethysmography with the venous occlusion technique. The surface electrocardiogram and continuous beat-to-beat arterial blood pressure were also monitored. Peak oxygen uptake was assessed using open-circuit spirometry (True Max 2400, ParvoMedics). In addition, body composition was measured using DEXA (dual energy X-ray absorptiometry; DPX-IQ, Lunar Radiation). Results from Study 1 indicate that FBF response to mental challenge in young females was smaller compared to previously obtained data from age-matched males. Furthermore, this FBF response to mental challenge was negatively correlated to insulin resistance estimated by the homeostasis model assessment (HOMA-IR) (r = - .52, p < .05). In addition, when cardiopulmonary baroreceptors were unloaded by a mild level of LBNP (-20 mmHg) during Stoop, FBF response to mental challenge (vasodilation) was abolished suggesting a large dependency of vasodilation response during mental challenge on cardiopulmonary baroreflex. After 15 weeks of supervised HIIE training, aerobic fitness improved (p < .05) whereas percent of body fat was significantly decreased (p < .05). In addition, recovery BP following Stroop was significantly reduced. Insulin resistance (HOMA-IR) was marginally decreased (p = .056). Women who had higher insulin resistance (HOMA-IR) lost less fat than women with lower HOMA-IR (r = .60, p = .088). In addition, change in FBF during Stroop after training was directly related to pretest insulin resistance levels (r = .68, p < .05). Therefore, HIIE training had a normalising effect on FBF response to mental challenge. PEP/LVET ratio at rest and during LBNP was also significantly increased in women with higher HOMA-IR suggesting a reduction in cardiac contractility via a decrease in sympathetic stimulation (r = .62, p = .076, r = .62, p = .75 respectively). In Study 3 results indicated that 12 weeks of the FEM trial significantly reduced percent of body fat (p < .001), fasting insulin (p < .05), interleukin-6 (p < .05) and cortisol (p < .05), and significantly improved aerobic fitness ( ; p < .001). With respect to cardiovascular and cardiac autonomic measures, rate pressure product (RPP) was significantly reduced at rest (p < .05) and during recovery after Stoop (p < .05), suggesting decreased myocardial oxygen consumption. In addition, baseline heart rate determined in the sitting position was significantly reduced (p < .05), while both baseline high frequency power (HF) determined in supine (p < .01) and cardiac baroreflex sensitivity (BRS) determined in the sitting position (p < .05) were increased after the FEM trial. In addition, BRS determined during mental challenge also marginally increased (p = .051). In summary, lifestyle intervention including HIIE training, Mediterranean-style eating plan, and a fish oil supplement significantly enhanced parasympathetic influence of the heart and improved fitness, blood profiles, and body composition.

<p>Bakgrund: Övervikten i den svenska befolkningen och i västvärlden har de senaste 25 åren ökat och gått allt längre ned i åldrarna. Övervikt och fetma utgör en riskfaktor för sjukdomar av såväl somatiska som psykosocial karaktär.</p><p>Syfte: Litteraturstudiens syfte var att beskriva hälsopromotiva interventioner för barn och ungdomar.</p><p>Metod: En litteraturstudie med artikelsökning och granskning utifrån syftet gjordes. Fem kvantitativa och en kvalitativ artikel inkluderades efter kvalitetsbedömningen.</p><p>Resultat: Resultatet visar på att problemet med övervikt måste ses ur flera perspektiv och åtgärdas från flera håll. Mönster som växte fram var: skolpersonalens interventioner, föräldrars interventioner, hälso- och sjukvårdspersonalens interventioner samt andra aktörers påverkan. Interventionernas tyngdpunkt ligger på kost och motion.</p><p>Slutsats: Framförallt en god kosthållning och fysisk aktivitet är viktiga faktorer för en lyckad intervention. För ett bestående resultat är också långsiktighet viktigt.</p> / <p>Background: The overweight in Sweden and the western world has increased in the last 25 years and gone further down the ages. Overweight and obesity are risk factors for diseases of both somatic and social characteristics.</p><p>Aim: The aim of this study was to describe health promoting interventions for children and adolescents.</p><p>Method: A literature review was made based on 5 quantitative studies and 1 qualitative study.</p><p>Result: The result shows that the problem with overweight has to be viewed from several perspectives and adjusted from several directions. The patterns that were found were: the interventions of school-staff, the interventions of parents, the interventions of health-staff and the influence of other participants. The main topics of the interventions were nutrition and physical activity.</p><p>Conclusion: Especially a healthy diet and physical activity are important factors for a successful intervention. Continuity is also important for a remaining result.</p>

This qualitative study of six Indigenous youth HIV prevention peer educators is presented to help understand how Indigenous youth perceive HIV/AIDS education. The research used a semi-structured questionnaire as a guide to conducting in depth individual interviews. The research followed decolonizing methodologies to explore the views of peer educators about the HIV/AIDS education they delivered, and the issues around perceptions of infection and risk. It examines the youth’s views on peer education, the importance of cultural revitalization in relation to health education and how peer education can be most effective. This study has included examples of programs with marginalized communities in several parts of the world and compared them with Indigenous experiences in Canada, in order to develop an understanding and recommendations of the most effective approaches in Indigenous youth health interventions. There have been very few research studies on Indigenous youth involvement in STD interventions. Indigenous youth have only been marginally included in the design of most of the social programming they receive, even though they have the unique knowledge, skills, language and cultural perspective necessary to reach their peers. HIV infection is on the rise with Indigenous youth because of historical and ongoing socio-economic and political inequities. Therefore, it is crucial that young Indigenous people be welcomed as integral participants in the strategies for improving Indigenous health.

Made available in DSpace on 2015-03-26T13:33:42Z (GMT). No. of bitstreams: 1 texto completo.pdf: 544419 bytes, checksum: 7454a3247dedc4f593051bd86e2a4cbb (MD5) Previous issue date: 2006-03-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present work demonstrates the importance of the inclusion of the evaluation research, in the planning of the interventions, if constituting in source of information and of data for financial agents and managers, addressing the intervention for the reach of the objectives and goals. Specifically, was used the research of pro-active evaluation of Owen & Rogers (1999), that proposes the content analysis and organizational structure of the interventions, breaking of the presupposition that yours no effectiveness, it can live of the inadequacy of the planning. They were studied hundred and twenty-six interventions of rural development, between political, programs and projects, guided by multiple problems and understood as those returned to the improvement of the conditions of life of the populations and the conservation of the natural resources, evidencing the State of Pará as study locus. An index that measured the orientation of the interventions was built, allowing basing the pro-active evaluation. The results demonstrate that, although almost all of the interventions have been delineated under the development need, most of them is not guided and structured in appropriate way for the effectiveness of the need and the for resolution of the problems that are identified. In the longitudinal analysis of the interventions, it identified that most of the programs and projects have been losing its structural rigidity, what can be due to the control lack on the part of the financial agents, that they cannot have a structure, in amount terms and quality of human material for execution of the planning evaluation and the own call of the announcement and its presented methodology. These results demonstrate the lack of evaluations in the extent of the planning of the interventions and, consequently, when demonstrating its importance and need, the research in subject it innovates. / O presente trabalho demonstra a importância da inclusão da pesquisa de avaliação, no planejamento das intervenções, se constituindo em fonte de informação e de dados para agentes financeiros e gestores, direcionando a intervenção para o alcance dos objetivos e metas. Especificamente, utilizou-se a pesquisa de avaliação pró-ativa de Owen & Rogers (1999) que propõe a análise de conteúdo e estrutura organizacional das intervenções, partindo-se da pressuposição de que a sua não efetividade, pode residir da inadequação do planejamento. Foram estudadas cento e vinte e seis intervenções de desenvolvimento rural, dentre políticas, programas e projetos, orientados por múltiplos problemas e entendidos como aqueles voltados à melhoria das condições de vida das populações e à conservação dos recursos naturais, evidenciando o Estado do Pará como locus de estudo. Um índice que medisse a orientação das intervenções foi construído, permitindo fundamentar a avaliação pró-ativa. Os resultados demonstram que, embora quase todas as intervenções tenham sido delineadas sob a necessidade de desenvolvimento, a maior parte delas não está orientada e estruturada de forma adequada para efetividade da necessidade e resolução dos problemas que são identificados. Na análise longitudinal das intervenções, identificou-se que, a maioria dos programas e projetos tem perdido o seu rigor estrutural, o que pode ser devido à falta de controle por parte dos agentes financeiros, que podem não ter uma estrutura, em termos de quantidade e qualidade de material humano para execução da avaliação de planejamento e, a própria chamada do edital e a sua metodologia apresentada. Estes resultados demonstram a carência de avaliações no âmbito do planejamento das intervenções e, conseqüentemente, ao demonstrar sua importância e necessidade, a pesquisa em questão inova.