No description available.

Aim: To describe the predictive validity of reaching low disease activity (LDA) at 1 year on future disability and joint damage in patients with early rheumatoid arthritis (ERA). Methods: First a systematic literature review of prognostic studies assessing the association between disease activity and functional or radiographic outcomes in ERA was performed. Then data from the Study Of New-Onset RA (SONORA) were used to evaluate the impact of year-one LDA on 3-year disability and 2-year radiographic progression using multivariate regression analyses. Results: Our review demonstrated evidence for relationship between baseline disease activity and future disability and join damage. However evidence for the impact of early treatment response on long-term outcomes in ERA is sparse. Analysis of 984 patients showed year one LDA predicts lower HAQ (p<.0001) and less damage (p=0.04) in future. Conclusion: Reaching LDA early is associated with better long-term functional and radiographic outcomes in patients with early RA.

Goal: To determine whether the Cortisol Awakening Response (CAR) associates with treatment response and course in hospital for inpatients with major depressive disorder (MDD). Methods: The CAR was measured at admission and discharge in patients completing a four-week inpatient program for MDD. Self-report questionnaires were used to assess changes in depression, anxiety, and perceived stress. Results: Over the four week hospital stay measures of CAR reactivity (Delta, AUCi) decreased, but there was no significant correlation between the change in CAR reactivity and change in clinical symptoms. Cross-sectional measurements of the CAR reactivity at both admission and discharge were strongly correlated with the drop in depression scores in hospital. Furthermore, poor treatment responders had a significantly lower CAR reactivity at both admission and discharge than did good responders. Conclusion: Individuals with higher CAR reactivity at admission and discharge had the greatest reduction in depression over the course of treatment.

Aim: To describe the predictive validity of reaching low disease activity (LDA) at 1 year on future disability and joint damage in patients with early rheumatoid arthritis (ERA). Methods: First a systematic literature review of prognostic studies assessing the association between disease activity and functional or radiographic outcomes in ERA was performed. Then data from the Study Of New-Onset RA (SONORA) were used to evaluate the impact of year-one LDA on 3-year disability and 2-year radiographic progression using multivariate regression analyses. Results: Our review demonstrated evidence for relationship between baseline disease activity and future disability and join damage. However evidence for the impact of early treatment response on long-term outcomes in ERA is sparse. Analysis of 984 patients showed year one LDA predicts lower HAQ (p<.0001) and less damage (p=0.04) in future. Conclusion: Reaching LDA early is associated with better long-term functional and radiographic outcomes in patients with early RA.

Goal: To determine whether the Cortisol Awakening Response (CAR) associates with treatment response and course in hospital for inpatients with major depressive disorder (MDD). Methods: The CAR was measured at admission and discharge in patients completing a four-week inpatient program for MDD. Self-report questionnaires were used to assess changes in depression, anxiety, and perceived stress. Results: Over the four week hospital stay measures of CAR reactivity (Delta, AUCi) decreased, but there was no significant correlation between the change in CAR reactivity and change in clinical symptoms. Cross-sectional measurements of the CAR reactivity at both admission and discharge were strongly correlated with the drop in depression scores in hospital. Furthermore, poor treatment responders had a significantly lower CAR reactivity at both admission and discharge than did good responders. Conclusion: Individuals with higher CAR reactivity at admission and discharge had the greatest reduction in depression over the course of treatment.

Because tobacco smoking causes 430,000 U.S. deaths annually, wide-reaching smoking bans are needed. Bans reduce cigarette consumption, encourage cessation, protect nonsmokers from second-hand smoke, and promote an attitude that smoking is undesirable. Therefore, bans may prevent future generations from suffering many smoking-related health problems. The federal government has not implemented widereaching smoking bans so it falls on individual states, counties, or communities to devise appropriate smoking policy. To date, smoking policy has been determined by legislators, who may have conflicts that prevent them from acting in the publics best interest. However, this method of implementing smoking policy may be changing. In 2005, Washington residents voted by ballot initiative to strengthen existing state smoking regulations. In 2006, Arizona, Nevada, and Ohio residents voted by ballot initiatives to implement strict statewide smoking bans. This research presents a way to predict how residents of other states might vote if given the opportunity. Two research hypotheses are tested and accepted: a positive relationship between favorable votes and urbanness, and a preference favoring smoking bans where smoking regulations already exist. Finally, a projection is made that a smoking ban vote in Kentucky would yield favorable results, and a map showing projected county votes is provided.

The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.

In this study, two primary hypotheses drawn from Cognitive-Experiential Self-Theory (Epstein, 1994, 1998, 2003) and the treatment preference literature (Arnkoff, Glass, & Shapiro, 2002) were tested in the broader contexts of similarity/matching research and eclecticism in psychotherapy. Specifically, it was hypothesized that client-therapist similarity/dissimilarity in terms of (a) their Rational and Experiential Thinking styles (Pacini & Epstein, 1999), and (b) their preferences for a Cognitive ("Thinking") versus an Experiential ("Feeling") theoretical orientation (Hutchins, 1984), would affect the process and outcome of early therapy. Forty-seven client-therapist dyads participated in the study. In the seven hierarchical linear regressions conducted, no statistically significant effects were found on any of the dependent variables (working alliance, empathic understanding, session depth, session smoothness, satisfaction with treatment, perceived change, and objective change). Study limitations included its modest statistical power to detect small and moderate effect sizes.Three exploratory questions were also investigated in a sample of 89 clients and 79 therapists and were found to be statistically significant. Specifically, client rational and experiential thinking styles made substantial contributions in the expected direction in predicting client preference for a cognitive versus an experiential treatment. Similarly, therapist experiential thinking style was predictive of therapist treatment preference. These findings suggest that client and therapist personality (thinking styles) are more significant predictors of treatment preference than variables such as gender and clinical experience (as a therapist or a client). Last, rational thinking style was predictive of client intrapersonal adjustment, and experiential thinking style was predictive of client social adjustment. / Department of Counseling Psychology and Guidance Services

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.

Emotional intelligence and self-determined motivation have been independently identified as important personal variables that are liable to foster optimal work functioning. However, the relationship between these two variables has never been assessed. Furthermore, research has also provided evidence that supervisor support, a social variable, is considered to be a significant source of influence on self-determined behaviour regulation. Thus the primary objective of the project was to jointly assess emotional intelligence and supervisor support as antecedents of self-determined work motivation; secondly, to assess the associations of self-determined work motivation on work outcome variables and psychological welfare; and thirdly, to examine the association between emotional intelligence and psychological well-being on 512 police source handlers. Specifically, it was proposed that emotional intelligence would be positively associated to self-determined work motivation and would display a unique association with work motivation, once the variance from supervisor support has been controlled for. It was further proposed that self-determined work motivation would, in turn, be positively associated with positive work outcomes; specifically, job satisfaction, job performance, future work intentions, and psychological well-being. Lastly, it was hypothesized that emotional intelligence would be positively associated to psychological well-being. Data was analyzed using structural equations modeling. Results revealed that emotional intelligence and supervisor support were both uniquely associated with work motivation. Together, these two variables explained a high proportion of the variance of work motivation. Work motivation, in turn, was positively associated with job satisfaction, job performance, future work intention, and psychological well-being. Emotional intelligence and psychological well-being were also positively associated. Overall, the findings of this thesis provide a basis for future research aimed at determining the causal relationship between emotional intelligence and self-determined motivation. It is further suggested that findings gleaned from this study can provide a better understanding of how certain interpersonal behaviours can impact specific work outcomes, which can provide researchers and practitioners with information to improve individual and organizational outcomes of interest.