科学研究費補助金 研究種目:基盤研究(C)(2) 課題番号:09610114 研究代表者:村上 隆 研究期間:1997-1998年度

Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on August 27, 2009). School of Social Work, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Cathy Pike, Hea-Won Kim, Margaret Adamek, Drew Appleby. Includes vita. Includes bibliographical references (leaves 317-330).

This study investigated teachers' attitudes towards a career in rural schools. The aims of this study were broken into two, namely, the primary and secondary aims. The primary aim was to find out whether rural secondary school teachers hold a positive or a negative attitude towards a career in rural schools. The secondary aim was also broken into two. The first secondary aim was to find out whether rural secondary school teachers' personal characteristics such as age, sex, marital status, rank, qualification and teaching experience in rural school(s), as well as the school in which the teacher teaches, have a significant influence on their attitudes towards a career in rural schools. The second secondary aim was to determine the nature of attitudes with regard to A-B-C components of attitudes. To this end, a questionnaire was compiled and used as an attitude rating scale. The questionnaire was administered to a representative sample of one hundred and thirty four rural secondary school teachers from six schools, under Mehlwesizwe circuit in KwaZulu-Natal. Statistical analyses were conducted to fulfil the aims of the study and to test the research hypotheses stated. This study revealed that rural secondary school teachers hold a negative attitude towards a career in rural schools. It also revealed that, irrespective of teachers' personal characteristics, their attitude towards a career in rural school is the same, that is, it is negative. Therefore it was concluded that teachers' personal variables have no significant influence on their attitudes. This study also revealed that, statistically, there were significant differences in the affective and cognitive components of attitude but differences in the behavioural component were not significant. This indicated that the affective and cognitive components are more closely related to each other than they are with the behavioural component. On the basis of teachers' responses to attitude statements, the researcher offered two lines of direction as recommendation, namely, "Rethink resource allocation" and "Direction of restructuring". The former will assist in improving the conditions under which rural teachers work and the circumstances surrounding their workplace. The latter will assist in collaborating the Reconstruction and Development Programme (RDP) structures at national, regional and local level with the Department of Education and Culture, as well as with the private sector, for improving the conditions under which rural teachers work. In that case teachers' attitudes towards a career in rural schools might be changed from negative to positive. / Psychology of Education / M. Ed. (Psychology of Education)

Background: Patient empowerment is viewed as a priority by policy makers, patients and practitioners worldwide. Although there are a number of measures available, none have been developed specifically for patients in the UK with long-term conditions. It is the aim of this study to report the development and preliminary validation of an empowerment instrument for patients with long-term conditions in primary care.Methods: The study involved three methods. Firstly, a systematic review was conducted to identify existing empowerment instruments, and to describe, compare and appraise their content and quality. The results supported the need for a new instrument. Item content of existing instruments helped support development of the new instrument. Secondly, empowerment was explored in patients with long-term conditions and primary care practitioners using qualitative methods, to explore its meaning and the factors that support or hinder empowerment. This led to the development of a conceptual model to support instrument development. Thirdly, a new instrument for measuring empowerment in patients with long-term conditions in primary care was developed. A cross-sectional survey of patients was conducted to collect preliminary data on acceptability, reliability and validity, using pre-specified hypotheses based on existing theoretical and empirical work. Results: Nine instruments meeting review inclusion criteria were identified. Only one instrument was developed to measure empowerment in long-term conditions in the context of primary care, and that was judged to be insufficient in terms of content and purpose. Five dimensions (‘identity’, ‘knowledge and understanding’, ‘personal control’, personal decision-making’, and ‘enabling other patients’) of empowerment were identified through published literature and the qualitative work and incorporated into a preliminary version of the new instrument. A postal survey achieved 197 responses (response rate 33%). Almost half of the sample reported circulatory, diabetic or musculoskeletal conditions. Exploratory factor analysis suggested a three factor solution (‘identity’, ‘knowledge and understanding’ and ‘enabling’). Two dimensions of empowerment (‘identity’ and ‘enabling’) and total empowerment showed acceptable levels of internal consistency. The measure showed relationships with external measures (including quality of chronic illness care, self-efficacy and educational qualifications) that were generally supportive of its construct validity.Conclusion: Initial analyses suggest that the new measure meets basic psychometric criteria and has potential for the measurement of patient empowerment in long-term conditions in primary care. The scale may have a role in research on quality of care for long-term conditions, and could function as a patient-reported outcome measure. However, further validation is required before more extensive use of the measure.

Indiana University-Purdue University Indianapolis (IUPUI) / GREGORY RESEARCH BELIEFS SCALE: FACTOR STRUCTURE AND PSYCHOMETRIC PROPERTIES The study at hand involves developing the Gregory Research Beliefs Scale (GRBS) to reliably and validly measure social work students’ beliefs about the function of research in social work practice. Research has considerable actual and potential benefits for practice. Social work students’ beliefs about this construct are vital. A description of the advantages of using research to inform practice is given. Additionally, the Council on Social Work Education and National Association of Social Workers’ policies that mandate the merger of research and practice are also provided to further justify the need for adequate psychometric evaluation of the construct. Details of the literature search strategy are described and critical evaluations of the empirical articles are conducted. Based on critical evaluations of instruments which have previously measured the same construct, a number of psychometric shortcomings are outlined to validate the need for further scale development of the construct. The present study’s objectives were to develop a scale which has an empirically and theoretically supported factor structure, acceptable coefficient alpha levels, empirically supported discriminant (divergent) validity, concurrent criterion validity, and known–groups criterion validity. Steps for developing the GRBS’s items, response format, sample, research design, and statistical tests are specified and conducted to determine the factor structure and psychometric properties. Finally, the strengths, limitations, and areas for future research are discussed.

Introdução: O AVC (acidente vascular cerebral) é uma das mais importantes causas de alterações neuropsicológicas. Uma avaliação cognitiva inicial realizada por telefone implicaria em um diagnóstico mais precoce de prejuízo cognitivo e demência, reduzindo custos e tempo. Objetivo: Examinar as propriedades psicométricas da versão brasileira da Entrevista Telefônica para Avaliação do Estado Cognitivo - Modificada (TICS-M) em pacientes pós-AVC. Métodos: Previamente à validação da TICS-M em indivíduos acometidos por AVC, foi realizada tradução para o Português do Brasil e adaptação transcultural da versão original da TICS-M em uma amostra de 30 sujeitos não clínicos. Após esta fase, um subgrupo de 61 pacientes com AVC, participantes do Estudo da Mortalidade e Morbidade do AVC (EMMA) que ocorre no Hospital Universitário da Universidade de São Paulo, foram convidados a participar da validação da TICS-M, seis meses após o evento agudo. A TICS-M foi aplicada em três momentos: avaliação inicial (entrevista presencial), uma e duas semanas após a primeira avaliação. Na avaliação inicial, além da TICS-M, questionários adicionais foram aplicados para avaliar a cognição: MoCA (Montreal Cognitive Assessment), MEEM (Mini Exame do Estado Mental); e para a depressão, HDRS (Hamilton Depression Rating Scale). Todos os questionários foram aplicados por duas entrevistadoras treinadas para o estudo. A confiabilidade intra-observador da TICS-M foi testada através dos coeficientes de Pearson, Intraclasse e alfa de Cronbach. As características internas do TICS-M também foram avaliadas através de uma análise exploratória utilizando o método Análise de Componentes Principais. A validade discriminatória do instrumento para rastreamento de demência pós-AVC foi avaliada em comparação a MEEM pela análise da área sob a curva (AUC) determinada pela curva ROC. Foram calculadas sensibilidade e especificidade para o ponto de corte ideal para rastrear demência. Resultados: De maneira geral, a TICS-M traduzida para o português apresentou um bom entendimento dos itens na mostra de indivíduos não clínicos. Foi observada uma frequência de 23% sugestiva de demência pós-AVC. O nível de escolaridade esteve positivamente associado ao estado demencial rastreado pelo MEEM. O estado depressivo assim como outras características de base não se associou à demência sugerida pelo MEEM. A confiabilidade teste-reteste intra-observador revelou taxas quase totais nos três momentos avaliados (Pearson Coeficiente > 0,85, Coeficientes de Correlação Intraclasse > 0,85 e Coeficiente alfa de Cronbach: 0,96). A análise fatorial determinou três domínios: memória de trabalho e atenção; memória recente e de evocação e orientação. A área sob a curva (AUC) determinada para a TICS-M em comparação com MEEM foi de 0,89 (intervalo de confiança 95%: 0,80-0,98). O ponto de corte sugerido para TICS-M foi de 14 pontos (escala de 0-39 pontos) para rastrear demência com sensibilidade de 91,5% e especificidade de 71,4%. Resultados semelhantes foram observadas com o MoCA. Conclusão: A versão brasileira da TICS-M sugere ser um instrumento de pesquisa útil e confiável para rastrear demência em pacientes pós-AVC / Introduction: Stroke is one most important cause of neuropsychological disorders. An initial cognitive assessment performed by telephone resulting in an early diagnosis of cognitive impairment and dementia, reducing costs and time. Objective: To examine the psychometric properties of the Brazilian version of the Modified Telephone Interview for Cognitive Status Assessment (TICS-M) for assessment of dementia in post-stroke patients. Methods: Prior to validation of TICS-M in post-stroke patients, translation was performed for the Brazilian-Portuguese and cross-cultural adaptation of the original version of TICS-M in a non-clinical sample of 30 subjects. After this phase, 61 stroke patients enrolled in the Stroke Mortality and Morbidity Study (The EMMA study) that occurs at the University Hospital of the University of São Paulo, were invited to participate in this sub-study to validate the TICS-M six months after the acute event. The TICS-M was applied in three moments: first evaluation (personal interview), one and two weeks after of the first evaluation. At the first evaluation, beyond the TICS-M, additional questionnaires were applied to assess cognition: MoCA (Montreal Cognitive Assessment), MMSE (Mini-Mental Status Examination), and for depression, HDRS (Hamilton Depression Rating Scale). All questionnaires were administered by two trained interviewers for the study. Reliability of the TICS-M was tested by intra-observer rates using Pearson, Intraclass and Cronbach´s alpha coefficients. The internal characteristics of TICS-M were also evaluated by an exploratory analysis using Principal Component Analysis. The discrimination validity of the instrument to assess dementia was evaluated by comparison to the MMSE analysis of the area under the curve (AUC) determined by the ROC curve. Sensitivity and specificity for the ideal cutoff to assess dementia were calculated. Results: In general, the TICS-M translated into Portuguese version showed a good understanding of the items in non-clinical individuals. A frequency of 23% suggestive of post-stroke dementia was observed. The level of education was positively associated with dementia status assessed by MMSE. The depressive status, as well as, other baseline characteristics was not associated with dementia suggested by MMSE. Test-retest reliability intra-observer revealed almost total rates in the three evaluation moments (Pearson coefficient > 0.85, Intraclass Correlation Coefficient > 0.85 and Cronbach\'s alpha coefficient: 0.96). The factorial analysis determined three domains: working memory and attention, recent and recall memory and orientation. The area under the curve (AUC) determined by TICS-M compared to MMSE was 0.89 (95% confidence interval: 0.80-0.98). The cutoff suggested for TICS-M was equal or greater than 14 points (range 0-39 points) to assess dementia (91.5% sensitivity, 71.4 % specificity). Similar results were observed with the MoCA. Conclusion: The Brazilian version of TICSM suggests being a useful and reliable research instrument to evaluate dementia in poststroke patients in epidemiological studies

Introdução: O AVC (acidente vascular cerebral) é uma das mais importantes causas de alterações neuropsicológicas. Uma avaliação cognitiva inicial realizada por telefone implicaria em um diagnóstico mais precoce de prejuízo cognitivo e demência, reduzindo custos e tempo. Objetivo: Examinar as propriedades psicométricas da versão brasileira da Entrevista Telefônica para Avaliação do Estado Cognitivo - Modificada (TICS-M) em pacientes pós-AVC. Métodos: Previamente à validação da TICS-M em indivíduos acometidos por AVC, foi realizada tradução para o Português do Brasil e adaptação transcultural da versão original da TICS-M em uma amostra de 30 sujeitos não clínicos. Após esta fase, um subgrupo de 61 pacientes com AVC, participantes do Estudo da Mortalidade e Morbidade do AVC (EMMA) que ocorre no Hospital Universitário da Universidade de São Paulo, foram convidados a participar da validação da TICS-M, seis meses após o evento agudo. A TICS-M foi aplicada em três momentos: avaliação inicial (entrevista presencial), uma e duas semanas após a primeira avaliação. Na avaliação inicial, além da TICS-M, questionários adicionais foram aplicados para avaliar a cognição: MoCA (Montreal Cognitive Assessment), MEEM (Mini Exame do Estado Mental); e para a depressão, HDRS (Hamilton Depression Rating Scale). Todos os questionários foram aplicados por duas entrevistadoras treinadas para o estudo. A confiabilidade intra-observador da TICS-M foi testada através dos coeficientes de Pearson, Intraclasse e alfa de Cronbach. As características internas do TICS-M também foram avaliadas através de uma análise exploratória utilizando o método Análise de Componentes Principais. A validade discriminatória do instrumento para rastreamento de demência pós-AVC foi avaliada em comparação a MEEM pela análise da área sob a curva (AUC) determinada pela curva ROC. Foram calculadas sensibilidade e especificidade para o ponto de corte ideal para rastrear demência. Resultados: De maneira geral, a TICS-M traduzida para o português apresentou um bom entendimento dos itens na mostra de indivíduos não clínicos. Foi observada uma frequência de 23% sugestiva de demência pós-AVC. O nível de escolaridade esteve positivamente associado ao estado demencial rastreado pelo MEEM. O estado depressivo assim como outras características de base não se associou à demência sugerida pelo MEEM. A confiabilidade teste-reteste intra-observador revelou taxas quase totais nos três momentos avaliados (Pearson Coeficiente > 0,85, Coeficientes de Correlação Intraclasse > 0,85 e Coeficiente alfa de Cronbach: 0,96). A análise fatorial determinou três domínios: memória de trabalho e atenção; memória recente e de evocação e orientação. A área sob a curva (AUC) determinada para a TICS-M em comparação com MEEM foi de 0,89 (intervalo de confiança 95%: 0,80-0,98). O ponto de corte sugerido para TICS-M foi de 14 pontos (escala de 0-39 pontos) para rastrear demência com sensibilidade de 91,5% e especificidade de 71,4%. Resultados semelhantes foram observadas com o MoCA. Conclusão: A versão brasileira da TICS-M sugere ser um instrumento de pesquisa útil e confiável para rastrear demência em pacientes pós-AVC / Introduction: Stroke is one most important cause of neuropsychological disorders. An initial cognitive assessment performed by telephone resulting in an early diagnosis of cognitive impairment and dementia, reducing costs and time. Objective: To examine the psychometric properties of the Brazilian version of the Modified Telephone Interview for Cognitive Status Assessment (TICS-M) for assessment of dementia in post-stroke patients. Methods: Prior to validation of TICS-M in post-stroke patients, translation was performed for the Brazilian-Portuguese and cross-cultural adaptation of the original version of TICS-M in a non-clinical sample of 30 subjects. After this phase, 61 stroke patients enrolled in the Stroke Mortality and Morbidity Study (The EMMA study) that occurs at the University Hospital of the University of São Paulo, were invited to participate in this sub-study to validate the TICS-M six months after the acute event. The TICS-M was applied in three moments: first evaluation (personal interview), one and two weeks after of the first evaluation. At the first evaluation, beyond the TICS-M, additional questionnaires were applied to assess cognition: MoCA (Montreal Cognitive Assessment), MMSE (Mini-Mental Status Examination), and for depression, HDRS (Hamilton Depression Rating Scale). All questionnaires were administered by two trained interviewers for the study. Reliability of the TICS-M was tested by intra-observer rates using Pearson, Intraclass and Cronbach´s alpha coefficients. The internal characteristics of TICS-M were also evaluated by an exploratory analysis using Principal Component Analysis. The discrimination validity of the instrument to assess dementia was evaluated by comparison to the MMSE analysis of the area under the curve (AUC) determined by the ROC curve. Sensitivity and specificity for the ideal cutoff to assess dementia were calculated. Results: In general, the TICS-M translated into Portuguese version showed a good understanding of the items in non-clinical individuals. A frequency of 23% suggestive of post-stroke dementia was observed. The level of education was positively associated with dementia status assessed by MMSE. The depressive status, as well as, other baseline characteristics was not associated with dementia suggested by MMSE. Test-retest reliability intra-observer revealed almost total rates in the three evaluation moments (Pearson coefficient > 0.85, Intraclass Correlation Coefficient > 0.85 and Cronbach\'s alpha coefficient: 0.96). The factorial analysis determined three domains: working memory and attention, recent and recall memory and orientation. The area under the curve (AUC) determined by TICS-M compared to MMSE was 0.89 (95% confidence interval: 0.80-0.98). The cutoff suggested for TICS-M was equal or greater than 14 points (range 0-39 points) to assess dementia (91.5% sensitivity, 71.4 % specificity). Similar results were observed with the MoCA. Conclusion: The Brazilian version of TICSM suggests being a useful and reliable research instrument to evaluate dementia in poststroke patients in epidemiological studies

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.