Abstract Antipsychotic medication forms a cornerstone in the treatment of schizophrenia and its effect on positive symptoms and relapse prevention after the first episode has been shown. After the first episode, the treatment guidelines for schizophrenia recommend the continuation of antipsychotic medication at a minimum from six months to five years. The long-term and life-span benefits and harmful side-effects are not fully known. The aim of this naturalistic study was to analyze long-term use of antipsychotic medication with a special interest in medication tapering and discontinuation in schizophrenia. Non-medicated subjects were more often males and in remission, less often on a disability pension, and had better clinical outcomes when compared to medicated subjects at age 34 years. No differences were found when comparing relapse rates during the 8.7 years of follow-up after 34 years between non-medicated and medicated subjects. Not having been hospitalized during the previous 5 years before the follow-up predicted long-term successful antipsychotic discontinuation without relapse. In the long-term, use of antipsychotic medication became steadier after the first five years. A favorable outcome was associated with low and steady antipsychotic medication, and unfavorable with high long-term cumulative use and antipsychotic polypharmacy. Subjects with antipsychotic medication had non-significantly lower total gray matter (TGM) volume compared with non-medicated subjects. Time without antipsychotic medication preceding magnetic resonance imaging was associated with increased TGM and with increased regional volume in the right precentral gyrus and right middle frontal gyrus. This study has a unique description of long-term use of antipsychotics. It provides new information on medication discontinuation and its effect in schizophrenia in the long-term in terms of relapses and brain morphometry. / Tiivistelmä Psykoosilääkkeet muodostavat perustan skitsofrenian hoidolle, ja niiden on osoitettu tehoavan positiivisiin oireisiin ja relapsin (psykoosin uusiutumisen) estoon ensipsykoosin jälkeen. Skitsofrenian hoitosuosituksissa suositellaan psykoosilääkityksen jatkamista ensipsykoosin jälkeen vähintään puolesta vuodesta viiteen vuoteen. Psykoosilääkityksen pitkäaikaiset ja elämänkestoiset hyödyt ja haittavaikutukset eivät ole täysin tiedossa. Tämän naturalistisen tutkimuksen tavoitteena oli analysoida antipsykoottisen lääkityksen pitkäaikaiskäyttöä ja erityisesti lääkityksen lopettamista skitsofreniassa. Lääkkeettömät tutkittavat olivat 34-vuotiaina useammin miehiä sekä remissiossa (elpymävaiheessa), harvemmin työkyvyttömyyseläkkeellä, ja heillä oli parempi toimintakyky verrattuna lääkkeitä käyttäviin. Lääkkeettömien ja lääkkeitä käyttävien välillä ei havaittu 8,7 vuoden seurannassa eroa relapsien määrissä 34 ikävuoden jälkeen. Psykoosilääkkeiden onnistunutta, pitkäaikaista lopettamista ilman relapsia ennusti seurannassa se, ettei tutkittava ollut ollut sairaalahoidossa seurantaa edeltävien viiden vuoden aikana. Pitkällä aikavälillä psykoosilääkityksen käyttö tasaantui ensimmäisten viiden vuoden jälkeen. Suotuisa ennuste liittyi vähäiseen ja jatkuvaan lääkitykseen. Epäsuotuisa ennuste puolestaan liittyi korkeaan kumulatiiviseen lääkemäärään ja useamman psykoosilääkkeen yhtäaikaiskäyttöön. Lääkkeitä käyttävien tutkittavien harmaan aineen kokonaistilavuus oli ei-merkitsevästi pienempi kuin lääkkeettömien tutkittavien. Psykoosilääkityksetön aika ennen magneettikuvausta oli yhteydessä suurempaan harmaan aineen kokonaistilavuuteen sekä paikallisesti suurempaan tilavuuteen oikeassa etukeskipoimussa ja keskiotsapoimussa. Tämä tutkimus kuvaa ainutlaatuisesti pitkäaikaista psykoosilääkkeiden käyttöä. Se tarjoaa uutta tietoa lääkityksen lopettamisesta ja sen pitkän aikavälin vaikutuksista relapseihin ja aivojen rakenteeseen skitsofreniassa.

Purpose The purpose of this thesis is to identify performance outcome criteria for accelerator programs with university links. Hereby, the study aims to extend the knowledge about important evaluation criteria and influencing factors on performance outcome and to close the gap between incubator and accelerator literature. The objective of the study was to investigate, (1) how participating persons evaluate the performance outcome of the accelerator program, (2) how the evaluation between accelerator and incubator differs and (3) why the evaluation differs. Frame of references Literature about science and technology parks, incubators, accelerators and performance evaluation was used to create the theoretical foundation for this thesis. A research gap about the performance outcome evaluation of accelerators was found, due to the newness of the model. Method The study followed an inductive approach and was of exploratory nature. A qualitative case study was chosen to investigate an accelerator within a science and technology park environment. Semi-structured interviews were used to collect the primary data and the methods of coding and categorizing were used to structure and analyse the data. Due to the inductive approach, literature was used to discuss the findings in the end.  Findings Proposition 1: Accelerator performance outcome is mainly evaluated by subjective criteria: “goal realization”, “entrepreneurial motivation” and “entrepreneurial education”. Proposition 2: The performance outcome gets influenced by micro level criteria like “practical experience”, “network support”, “personal development”, “program structure” and “individualization”.

AimsParticipant drop out is a major barrier to high-quality patient-reported outcome (PRO) data analysis in cancer research as patients with worsening health are more likely to dropout. To test the hypothesis that ovarian cancer patients with worse PROs would drop out earlier, we examined how patients differed by time of dropout on health-related quality of life (HRQOL), anxiety, depression, optimism and insomnia. MethodsThis analysis included 619 participants, stratified by time of dropout, from the Australian Ovarian Cancer Study - Quality of Life substudy, in which participants completed PRO questionnaires at three-monthly intervals for 21 months. Trends in PROs over time were examined. Pearson correlations examined the relationship between time of dropout and baseline PROs. Multiple linear regression models including age, disease stage and time since diagnosis examined relationships between baseline and final PRO scores, and final PRO scores and dropout group. ResultsParticipants who dropped out earlier had significantly worse baseline HRQOL (p<0.0001) and higher depression (p<0.0001). For all five PROs, final scores were significantly associated with baseline scores (p<0.0001). Time of dropout was significantly associated with final HRQOL (p=0.003), anxiety (p=0.05), depression (p=0.02) and optimism (p=0.02) scores. Depression, HRQOL and anxiety worsened at a faster rate overtime in dropouts than study completers. ConclusionsPoorer HRQOL and higher depression at baseline, and final HRQOL, anxiety, depression and optimism scores were predictive of time of dropout. These results highlight the importance of collecting auxiliary data to inform careful and considered handling of missing PRO data during analysis, interpretation and reporting.

This thesis investigates computerised cognitive training in older adults, with a focus on training working memory and fluid intelligence. A series of studies is reported, with two broad aims. The first was to develop and validate outcome measures appropriate for use in this population, and the second was to examine whether established gains in cognitive functioning generalised to everyday life. In relation to the first aim, two studies were conducted which concerned the development of a sensitive measure of organisational abilities within a computerised paradigm, the Games Evaluation Task (GET). A further study made use of an existing naturalistic measure, the Multiple Errands Task (MET, Shallice & Burgess, 1991), and investigated whether it was possible to obtain reliable ratings of performance on the basis of video footage taken from the participant’s perspective by means of a body-worn camera. Both the GET and MET were used as outcome measures in the subsequent training studies. In relation to the second aim, three studies of cognitive training are reported. The first is a case study of a man with problems in working memory and time perception following a stroke. He underwent training on an intensive working memory package within a single-case experimental design that incorporated an active control condition. This approach was then extended in a larger sample of healthy older adults, who trained intensively on tasks that focussed either on working memory, or fluid intelligence and problem solving. In the final study participants trained on a combination of both working memory and fluid intelligence tasks. In addition, they watched training videos that focused on teaching various cognitive strategies. The aim of this video supplement was to help participants draw links between the computer training and real-life situations, and hence to foster generalisation of any benefits to everyday life. The thesis concludes with a general discussion which examines the major findings of the studies presented, their clinical applications, the limitations of the research and possible future directions.

No description available.

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.

Background: In September 2005, scientific journals began requiring trial protocol registration to increase transparency and accountability. Objective: My primary objectives were: develop a database of linked protocols and publications for surgical randomized control trials (RCTs); estimate the proportion published; and determine the proportion exhibiting selective outcome reporting. Methods: A systematic search of the clinicaltrials.gov database was conducted identifying surgical RCTs, completed between 2006 and 2012. Protocols were linked with publications. Primary outcomes were compared. Results: We identified a cohort of 743 surgical RCT protocols. The proportion of registered trials which published their primary results was 0.49 (n=364). The proportion of selective outcome reporting was estimated to be 0.244, significantly lower than the previous estimate (p<0.001). Conclusion: More than half of the completed surgical RCTs were unpublished, and one quarter of those published selectively reported their primary outcome. This supports the notion that significant bias is present in the surgical literature.

Background: There is still a paucity of information on maternal biological mechanisms specific to adverse birth outcomes despite maternal environmental exposure and health status being known to influence neonatal morbidity and mortality. The purpose of this study was to explore maternal biomarkers pertinent to infant development in utero, specifically matrix metalloproteinases (MMPs), and determine their relationships to environmental heavy metals such as arsenic, cadmium, lead, mercury, and manganese as well as their relationships to outcomes such as preterm birth, low birth weight and small for gestational age infant outcomes. Methods: A secondary data analysis on 1533 mother-infant pairs from the Maternal and Infant Research on Environmental Chemicals (MIREC) cohort was conducted to statistically test relationships between metals and biomarkers, as well as biomarkers and outcome. A systematic literature review and meta-analysis was also conducted to identify the interdependencies between maternal blood biomarkers relating to adverse pregnancy outcomes. Results: Multivariate regression models were used to estimate odds ratios (OR) for the association between metal concentrations in quartiles and both high (90%) and low (10%) maternal MMP levels. Significant metal-related effects were observed with different MMP responses. A total of 54 studies (35 for meta-analysis), including 43,702 women and evaluating 50 biomarkers, met the inclusion criteria and all subgroups of biomarkers showed significant associations with birth outcomes with no apparent publication bias. Conclusions: Maternal plasma markers may serve as potentially valuable tools in the investigation of maternal molecular mechanisms, especially select toxicity pathways underlying metal-mediated adverse infant outcomes. Further research is still needed to evaluate biomarkers such as proteomic and genetic profiles in other various maternal biological samples.

Youth Futures is a community-based intervention intended to improve post-secondary education (PSE) access rates among high school youth from low-income families, who tend to be under-represented in higher education (Berger, Motte, & Parkin, 2009; Norrie & Zhao, 2011). The bilingual (French and English) program spans seven months and consists of mentoring by university students, leadership training, workplace training and skill development activities, paid summer employment, and exposure to college and university settings. This thesis examined the outcomes of the Youth Futures program through three distinct studies. First, a quasi-experimental study was conducted to investigate short-term outcomes among program participants (N = 44, mean age of 16 years old at baseline) in comparison to a group of their peers (N = 40, mean age of 16 years old at baseline). Second, a qualitative study was conducted with a purposeful sample of program participants (N = 20, mean age of 17 years old) to explore their first-hand experiences through semi-structured, open-ended interviews. Third, program alumni (N = 79, mean age of 19 years old) were briefly interviewed via telephone to investigate longer-term outcomes, including employment experience and enrolment and persistence in PSE. Overall, no evidence was found to suggest that exposure to the Youth Futures program contributed to increased access to PSE among participants. Some characteristics of the Youth Futures sample recruited in the three studies raised questions about whether participants were at risk of not accessing PSE in the absence of the intervention (Berger et al., 2009; Childs, Finnie, & Mueller, 2015; Finnie, Childs, & Wismer, 2011). Findings indicated several program improvement strategies that may be useful in modifying the Youth Futures program to ensure that students in need of the intervention receive tailored programming and that the timing of the intervention is effective. Experts have called for a stronger evidence base in this area to facilitate sound decision-making about which potential program models to establish or expand and how to match students to the programs that best address their particular needs (Barnett et al., 2012; Brock, 2010; Le, Mariano, & Faxon-Mills, 2016; Shultz & Mueller 2006; Tierney & Hagedorn, 2007).

The dissertation deals with the links between health care systems and health outcomes in the so-called 'transition' countries. The main questions to be addressed are: ''Do health care systems and their transitions influence health outcomes in the transition area and i f they do - how?" The combination o f qualitative techniques and econometric methods allowed for a creation o f the structural classifications o f the health care systems in transition and produced important findings. Firstly, health care transitions, and especially their structural component, are found to be significant in determining health status in the CEE and CIS countries. Secondly, however, the socio-economic determinants o f health were established to also play a major role in determining health inequalities in the transition area. Powered by TCPDF (www.tcpdf.org)