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Distraction is an effective pain management intervention and children’s coping styles are important to consider when designing interventions. The purpose of this study was to examine two movie distractions in children 3 to 11 years old receiving venipunctures and to evaluate the relations between the effectiveness of the interventions and coping styles. Results revealed no interaction and no main effects of condition or coping style. However, coping on caregiver-report of child pain approached significance. T-tests revealed significant differences between approach and avoidance coping styles, with children with an approach coping style experiencing significantly less pain compared to children with an avoidance coping style. Descriptive statistics revealed the presence of a mixed coping style, suggesting that children’s coping styles may be continuous. This study highlights the importance of examining coping styles in the context of pediatric painful medical procedures and the need to further examine the effectiveness of distraction interventions.

Thesis (Ph. D.)--University of Chicago, Dept. of Political Science, June 1999. / Includes bibliographical references. Also available on the Internet.

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L’épilepsie est une des maladies neurologiques la plus fréquentes dans le monde. Cette maladie constitue un problème de santé publique dans les pays en développement où les ressources médicales et économiques sont faibles pour la prise en charge de cette pathologie. Ce travail de doctorat a été raisonné comme une recherche en santé publique qui vise à analyser la mise en place progressive de la prise en charge des personnes vivant avec une épilepsie (PVE) en République Démocratique Populaire Lao (RDP Lao). Nos travaux de recherche ont été conduits dans un premier temps par des recherches observationnelles,sanctionnées par 5 publications scientifiques concernant le personnel de santé, les médicaments antiépileptiques, l’adhérence au traitement antiépileptique et la prise en charge des enfants épileptiques. Dans un deuxième temps, des recherches interventionnelles ont expérimenté le dépistage actif des PVEs et un suivi à fréquence régulière par des visiteurs (personnels de santé) à domicile. Ce travail a identifié les enjeux de la prise en charge de l’épilepsie en RDP Lao : les croyances socioculturelles, la faible qualification des personnels de santé, le faible approvisionnement en médicaments antiépileptiques et leurs prix élevés. Nos interventions ont été efficaces et ont augmenté le nombre de PVEs traitées dans le système de soin. L’extension spatiale de la prise en charge efficace de l’épilepsie à l’échelle nationale nécessite le renforcement de la capacité des soins au niveau communautaire, d’une gouvernance dédiée, de la contribution de l’Association pour les Personnes avec une Epilepsie (APE) et des acteurs de recherches. / Epilepsy is one of the most common neurological diseases worldwide. It is a public health issuein developing countries, where the medical and economic resources are poor for the case management. This doctoral work was set-up as a public health research, assessing the progressive implementation of the management of people living with epilepsy (PWE) in Lao People’s Democratic Republic (Lao PDR). Our research was conducted first through observational research and produces five scientific publications on the health staff,antiepileptic drugs, management of pediatric cases and treatment adherence. Secondly, interventional research focused on a one-year PWE’s follow-up using active screening and domestic health visitors. This work has identified the challenges of the management of epilepsy in Lao PDR: the socio-cultural beliefs, the low qualification of health staff for epilepsy management, the low antiepileptic drug supply and the high price of the drugs. Our interventions were successful, increasing the number of PWEs treated in the healthcare system. The extension of effective management for epilepsy at a national level requires the strengthening of capacity of healthcare at community level, the governance, the contributions of civil society and research actors.

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Magister Artium (Sport, Recreation and Exercise Science) - MA(SRES) / The job demands of naval members are such that they experience high levels of stress. Stress is often introduced during military training so that real-world stress is more familiar and easy to mitigate. This is often referred to as “train how you fight”. In order to train a stressful task, a stressful environment is often created in the military. The aim of the study was to develop a standardised appraisal tool for the Therapeutic Recreation Stress Management Intervention Model measuring stress, stress coping and leisure behaviour of military staff in the South African context. This study utilised a qualitative research design and followed a multi stage procedure in developing the appraisal tool while making use of the model of instrument development to achieve the aim. The model identified four stages of instrument development: Phase 1, preliminary phase; Phase 2, questionnaire development, Phase 3 pilot testing, Phase 4 Evaluation phase. For the purpose and scope of this study, the researcher focused on phases 1 and 2. Phase 1, the Preliminary phase focused on the translation of the study needs into variables, current literature, interviews and focus group discussions. Three focus groups comprised of eight participants per group and were purposefully selected from military naval staff. In addition, semi-structured interview guides were used for interviews conducted with key informants. Five senior officers and two psychologists from the Institute of Maritime Medicine (IMM) were interviewed. Data was analysed deductively due to the existence of pre-determined themes. In Phase 2, based on the data collected in phase 1, the researcher developed the appraisal tool. The appraisal tool was constructed within the scope of the theoretical framework focusing on the perceptions of naval staff on stress; previous and current leisure experiences; knowledge, skills, resources, behaviour; leisure-coping beliefs; and stress- coping strategies. The literature in the present study revealed that there were six pre-determined themes. The themes included: Theme 1 – Stressors in the military, Theme 2 –support in the military, Theme 3- operational deployment of military members, Theme 4- Impact of stress on military families have been identified as theme four, Theme 5- leadership and Theme 6- sport and recreation in the military. Salient topics included the following: Stress assessment salient topics are personal stress, occupational stress, wellness and operational deployment. Leisure behaviour salient topics include social activities, passive activities, physical activities and outdoor activities. The findings in the study revealed that stress had an adverse effect on military readiness and the wellbeing of staff. This study reiterated the need for greater attention in the rendering of support services needed to military members and their families, preparing families for separation and improved communication between deployed soldiers and the home front. Job-induced separations affect not only the soldier and the spouse, but also their children. The role of the supervisor played a large part in how satisfied and committed the members were regarding their job. Sport and Recreation programs are vital to alleviate the symptoms of stress. The appraisal tool developed needs to be piloted and evaluated in order to recommend it for use in SANDF information systems.

Patients with cancer transitioning from completing their final cancer treatments to survivorship are particularly at risk for experiencing psychosocial stress, and the Institute of Medicine (IOM) has referred to these cancer patients as “lost in transition.” In this study, patients with cancer in their transition phase after completing their final radiation treatment were defined as cancer survivors (CS). CS must deal with chronic stressors such as the fear of cancer recurrence as well as the resumption of their roles in their family and work lives. Chronic stress impacts the nervous system and increases secretion of stress hormones (e.g. cortisol) from the endocrine system, which in turn influences immune function. These systems are particularly relevant for CS since research has shown associations between abnormal cortisol patterns and increased mortality in breast CS and immune dysfunction in CS can increase susceptibility to infections. The theoretical framework of psychoneuroimmunology (PNI), which describes the interactions between the psychosocial, neuroendocrine and immune systems, guided the choice of outcomes for this study. The IOM has identified a lack of theory-driven interventions for managing psychosocial stress in CS. We reviewed the literature and identified two major types of PNI-based psychosocial interventions for cancer patients, namely cognitive-behavioral and complementary medical. One promising brief and inexpensive psychosocial intervention was expressive writing, which involved participants disclosing their deepest thoughts and feelings regarding their cancer in four 20-30 minute writing sessions over four consecutive days. We conducted a two-arm randomized controlled trial to determine the efficacy of an online expressive writing (EW) intervention delivered to CS who were 2-12 months post-radiation treatment completion. The results of this study revealed that EW was effective in regulating stress in our sample of CS over a period of six weeks as measured by lowered salivary cortisol levels and lowered self-reported fear of cancer recurrence. Online EW is a low-cost and convenient approach for delivering stress-management interventions for CS during survivorship. However, coordinated efforts are needed from health researchers, professionals and policy makers to define standardized approaches for testing psychosocial interventions and using PNI biomarkers to help develop evidence-based psychosocial cancer-care for CS during survivorship.

Military staff are repeatedly exposed to stressful and unpleasant traumatic life events. These can cause psychological injury, leading to mental and emotional stress. The stigma of mental health problems in military settings runs deeper than in civil society. Being admitted with mental health problems while serving can be a career stopper, but at times can also be associated with cowardice or malingering. It is the primary responsibility of the military to maintain and promote high military/combat readiness among staff. The change in focus of modern military forces, such as the Botswana Defence Force (BDF), with units being deployed more often, places greater demands on troops. Such operations call for increased training exercises, planning sessions and equipment inspections. Training emphasizes discipline and integrity as the core values of the BDF. These form a foundation for healthy and successful coping strategies. The morale of employees is the starting point for measuring their wellness. Morale in the military is embedded in the fitness programs. These are biased towards military training, creating physical fitness, mental alertness and the qualities of military preparedness. The programs are normally involuntary, mandated through the commander, and form part of a soldier‘s military duties. Military recreation, morale and welfare programs were introduced as a way to provide soldiers with the opportunity to relax and rejuvenate. Recreation serves as a powerful tool for achieving an optimal experience, motivating people to change and improve their health and wellness. The problem identified for this study was that members of the BDF were exposed to situations in a military context, as well as in their personal lives, which caused stress. It was postulated that BDF members had little knowledge or the resources to utilize appropriate recreation-related coping strategies. The study aimed primarily to explore the use of sport and recreation activities in military settings as means to reduce and manage stress. To achieve this goal, it was necessary first to determine the current sport and recreation participation of BDF staff members, then to assess their existing stress levels, their overall psychological well-being, and any dysfunctional behaviours resulting from stress. On the basis of these findings, a Therapeutic Recreation Stress Management Intervention Model was proposed, designed to reduce stress and promote the psychological well-being of BDF members. A survey was carried out using a questionnaire. Descriptive statistics were used to summarize the collected data, offering a basic description of the data through frequency distributions, measures of central tendency, variances and relationships. Inferential statistics were used to draw conclusions from the data collected, giving the various factors. The results revealed that the BDF was a male-dominated institution, recruiting soldiers between the ages of 18 and 44, most of whom had some level of education. Most of the staff members came from the lower ranks and had experienced one or more deployments since being recruited into the military. The results further indicated that BDF staff members participated in sport and recreation activities, reflecting an active and healthy lifestyle, with satisfactory levels of involvement. Analysis of stress responses revealed that members experienced stress and that this was related not just to operational or non-operational military stressors but also to personal stressors resulting from their social, financial or emotional conditions. Members of the BDF did not receive the necessary social support from family members and friends to cope with these stressors. The findings on stress in relation to sport and recreation participation revealed that BDF members were intrinsically motivated to embrace healthy lifestyles which could contribute to lower levels of stress. This could even lead to a decrease in stress, supporting the literature which indicates that engaging in physical activities, as part of living a healthy lifestyle, might lead to a reduction in stress levels. The results on the stress-coping measures used by BDF members revealed that recreation activities were deliberately used to cope with stress. Although physical exercise was used as a way of coping with stress, sedentary recreation activities were more prevalent among BDF members. Positive stress-coping measures were adopted by respondents, contrary to the findings of previous studies which indicated that military staff adopted dysfunctional behaviour as a coping measure (e.g. excessive drinking) that formed part of the military culture. The stress-coping abilities of BDF members differed in terms of personal and military demographics from those of previous studies, posting a new contribution to military literature. The results further revealed that BDF members were not sufficiently skilled in coping with stress during military training. This study concluded that the Botswana Defence Force is no different from other military forces, experiencing operational and non-operational stress, as well as personal stress, which need to be addressed. Recommendations were made for further research on stress in military contexts and further guidelines were suggested to the BDF on the use of sport and recreation, together with more specific therapeutic recreation, as ways to reduce stress. A Therapeutic Recreation Stress Management Intervention Model was recommended for further testing in the BDF, as well as in other military forces. / Thesis (DPhil)--University of Pretoria, 2013. / gm2014 / Biokinetics, Sport and Leisure Sciences / unrestricted

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