Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers. Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function. Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers. Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.

Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option psychologie clinique (Ph.D) / Evaluating treatment programs specialized in treating sexual offenders and reducing recidivism, especially sexual recidivism, is of great importance to the general public and policy makers because of the many physical and psychological consequences these crimes have on the victims and their families. The present study evaluated the changes that occurred in moderate to high risk sexual offenders who followed a specialized community treatment program. In order to accomplish this, gains during treatment and their ability to predict lower recidivism rates was examined using three different methods of measurement: risk assessment, self-reports, and phallometric testing. Change scores were derived from the Stable-2007 and its three dimensions (i.e., antisociality, sexual deviance, and hypersexuality); the Molest and Rape Scale; the Sexual Interest Cardsort Questionnaire; and phallometric testing. Measures were administered pre- and posttreatment in a sample of 105 adult male sexual offenders with adult and child victims. Recidivism data were obtained from official criminal records. The average follow-up period for participants was of 12 years postrelease. Findings were indicative of significant positive changes in dynamic risk factors as measured by the Stable-2007 and its three dimensions; in PSIs as measured by the Sexual Interest Cardsort Questionnaire and phallometric testing; but not in cognitive distortions as measured by the Molest and Rape Scale. The majority of change scores were non significantly associated with reductions in sexual, violent, or general recidivism after controlling for pretreatment and static risk. Comparing the different methods of measurement in their ability to capture changes and predict recidivism was unable to be done due to the lack of significant results. The following study is only the second to examine treatment change on the Stable-2007 and its relationship to recidivism, and the first examining treatment change in its three different dimensions. Although the program seemed to be effective in reducing certain dynamic risk factors, the relationships between treatment change and lower recidivism rates, especially sexual recidivism remains unclear. More studies examining treatment change on specific dynamic risk factors using different measures are needed to establish more comprehensive conclusions about which dynamic risk factors are more susceptible to change and most effective if reducing recidivism rates. / L’évaluation des traitements visant la réduction des taux de récidives, surtout sexuelle, chez les agresseurs sexuels est un sujet de grande importance due aux conséquences physiques et psychologiques que ces crimes ont sur les victimes et leurs familles. Pour ces raisons, la présente étude avait comme objectif principal d’évaluer des changements suivant la participation d’un programme de traitement en communauté spécialisé dans le traitement d’agresseur sexuel à risque et aux besoins modérés à élevés. Pour accomplir ceci, les gains acquis sur différents facteurs de risques dynamiques et leurs capacités de prédire la récidive ont été examinés. Les gains ont été mesurés en utilisant une échelle d’évaluation du risque dynamique de récidive, des questionnaires auto-rapportées et des évaluations phallométriques. La Stable-2007 et ses trois dimensions (c.-à-d. antisocial, déviance sexuelle, et hypersexualité) ont été utilisées pour mesurer plusieurs facteurs de risques dynamiques, le Molest and Rape Scale ont été utilisés pour mesurer les distorsions cognitives, et le Sexual Interest Cardsort Questionnaire et l’évaluation phallométrique ont été utilisés pour mesurer les intérêts sexuels paraphiliques. Toutes les mesures ont été administrées pré et posttraitement à 105 agresseurs sexuels avec des victimes soit adultes et/ou enfants ayant complété le programme de traitement. Les données de récidives ont été obtenues des dossiers criminels officiels avec une période de suivi moyenne de 12 ans. Suite à la complétion du programme de traitement, il y a eu des gains significatifs sur les facteurs de risque dynamiques mesurés par la Stable-2007 et ses trois dimensions, et sur les intérêts sexuels paraphiliques mesurés par le Sexual Interest Cardsort Questionnaire et l’évaluation phallométrique. Cependant, aucune amélioration n’a été trouvée pour les distorsions cognitives. En examinant la relation prédictive entre les gains sur ces mesures et les taux de récidives, la majorité des changements positifs n’étaient pas significativement associés à des réductions de taux de récidive sexuel, violent et général, après avoir contrôlé pour le risque prétraitement et statique. Due aux résultats non-significatives, la capacité des différentes mesures à identifier des changements et prédire la récidive n’a pas pu être comparé. Cette étude est la deuxième étude examinant des changements pré à posttraitement sur la Stable-2007 et la première à examiner ses changements sur les trois dimensions de la Stable-2007. Même si le programme de traitement évalué semble être capable de produire des changements positifs dans certains facteurs de risque dynamiques, la relation entre ces gains et leurs capacités de prédire des taux plus bas de récidives reste contradictoire et incertaine. Plus d’études examinant les gains sur des facteurs risques dynamiques spécifiques en utilisant différentes mesures sont nécessaires avant de pouvoir vraiment établir les facteurs dynamiques les plus susceptibles à changer et prédire des taux de récidive plus bas.

No description available.

Many older adults desire to maintain their quality of life by living and aging independently in their own homes. However, it is difficult for older adults to notice and track the subtle changes in their own abilities because these abilities can change gradually over a long period of time. Technology in the form of ubiquitous sensors embedded in objects in the home can play a role in keeping track of the functional abilities of individuals unobtrusively, objectively, and continuously over a long period of time. This work introduces a sensing technique called “task-based embedded assessment” that monitors how well specific tasks important for independence are carried out using everyday objects found in the home with which individuals regularly interact. Following formative studies on the information needs of older adults and their caregivers, a sensing system called “dwellSense” that can monitor, assess, and provide feedback about how well individuals complete tasks, such as taking medications, using the phone, and making coffee, was designed, built, and evaluated. Multiple longterm (over 10 months) field deployments of dwellSense were used to investigate how the data collected from the system could support greater self-awareness of abilities and intentions to improve in task performance. Presenting and reflecting on data from ubiquitous sensing systems such as dwellSense is challenging because it is both highly dimensional as well as large in volume, particularly if it is collected over a long period of time. Thus, this work also investigates the time dimension of reflection and has identified that real-time feedback is particularly useful for supporting behavior change, and longer-term trended feedback is useful for greater awareness of abilities. Traditional forms of assessing the functional abilities of individuals tend to be either biased, lacking ecological validity, infrequent, or expensive to conduct. An automated sensor-based approach for assessment is compared to traditional performance testing by a trained clinician and found to match well with clinician-generated ratings that are objective, frequent, and ecologically valid. The contributions from this thesis not only advance the state of the art for maintaining quality of life and care for older adults, but also provide the foundations for designing personal sensing systems that aim to assess an individual’s abilities and support behaviors through the feedback of objective, timely sensed information.

No description available.

Extensive research has documented the relationship between listening to certain genres of music and negative effects on social behavior such as aggressive and antisocial behavior. The present study explored whether there are genres of music associated with altruism. Altruistic behavior is defined as behavior that is consistently more caring, helpful, considerate of other's feelings, and self- sacrificing. These behaviors promote our ability to thrive as a community. Yet, few studies have addressed the relationship between music and altruism. Data was collected from 608 college students who completed a self-report altruism scale, music preference measure, the Marlowe Crowne social desirability scale, and a demographic information form in order to see if there is a relationship between choice of music and altruism. A multiple hierarchal regression analysis found music genre choice accounted for 15.9 percent of variance in self-reported altruism. Significant, positive correlations emerged also between altruism and several music genres including alternative, country, classical, and emo.

INTRODUÇÃO: Apesar da importância dos medicamentos antidepressivos no tratamento dos transtornos de humor e de ansiedade, sua ação sobre sistemas cerebrais responsáveis pela expressão emocional ainda não foram claramente estabelecidos. Estudos recentes têm examinando o sinal dependente de nível de oxigenação sanguínea (do inglês, \"BOLD\") durante estímulos emocionais em indivíduos saudáveis sob uso de antidepressivos. Nesse estudo, pretendemos estender essa avaliação às alterações do humor e comportamento emocional devido ao uso prolongado de um antidepressivo bloqueador de serotonina e noradrenalina em pessoas saudáveis. MÉTODOS: foram selecionados dezesseis voluntários, sem antecedentes psiquiátricos pessoais ou familiares, que participaram de um ensaio farmacológico simples-cego de quatro semanas de doses baixas de clomipramina (até 40 mg/dia). Ao final desse período, dez sujeitos foram selecionados como não responsivos, e os restantes seis sujeitos foram selecionados como responsivos por apresentarem claras mudanças em três dos quatro seguintes critérios: tolerância interpessoal, eficiência, bem estar, e mudança substancial em sua auto percepção. O grupo de sujeitos classificados como responsivos foram submetidos a um ensaio controlado duplo-cego confirmatório. A aquisição de imagens cerebrais ocorreu após quatro semanas de uso de medicação (simples cego) e quatro semanas após a sua suspensão, ao final da participação no ensaio farmacológico. O imageamento cerebral foi realizado durante a indução de estados afetivos de felicidade, irritabilidade e neutros por relatos autobiográficos. A resposta emocional desses estados foi obtida por escalas de auto avaliação de ansiedade, irritabilidade e felicidade. As diferenças de sinal entre os estados afetivos foram utilizadas para a análise estatística da interação dos efeitos estado medicamentoso e grupo por testes ANOVA. RESULTADOS: Foi encontrada uma interação significativa entre o efeito de grupo e o estado medicamentoso sobre os estados afetivos de irritabilidade, mas não sobre os de felicidade. Se observou redução na auto avaliação de ansiedade no grupo responsivo com o uso de medicação na diferença entre os estados induzidos de irritabilidade e felicidade, em comparação com o efeito no grupo não responsivo; e também, redução na auto avaliação de felicidade com o uso de clomipramina na totalidade da amostra, na diferença entre o estados induzidos de irritabilidade e neutro. A alteração sobre o efeito BOLD (p < 0,005) foi localizada em regiões adjacentes à junção frontoparietal para a indução de irritabilidade em relação à felicidade e em relação aos estados neutros, no grupo responsivo em relação ao não responsivo, durante o período em uso relativo àquele sem uso de clomipramina, e na junção têmporo-paríeto-occipital, exclusivamente para a diferença irritabilidade-felicidade. CONCLUSÕES: a modificação favorável que sujeitos saudáveis apresentaram ao uso prolongado de um antidepressivo bloqueador da serotonina e noradrenalina, pode estar relacionada à modificação no processamento cerebral da memória autobiográfica de emoções negativas / INTRODUCTION: despite the importance of antidepressant agents to the treatment of anxiety and depressive disorders, there is not yet a clear understanding of their actions upon specific brain systems relevant to emotional processing. Recent studies have examined blood oxygen level dependent (BOLD) signal during emotion stimuli in healthy individuals in antidepressant use. The study intends to extend these measures to the changes over mood and emotional behavior by prolonged use of a serotonin and noradrenaline blocker antidepressant. METHODS: we selected sixteen subjects, with no personal or family history of psychiatric disorders, which participated of a four-week single-blind trial with low doses of clomipramine (up to 40mg/day). After this period, ten subjects were classified as non responsives, the remaining six subjects being classified as responsives because clomipramine provided positive changes in three of four of the following criteria: interpersonal tolerance, self-efficacy, mood and self-perception of a substantial change. Responsives were included in a placebo-controlled confirmatory trial. Imaging sessions occurred at the end of the four-week course of clomipramine and again after a four-week clomipramine washout period, at the end of pharmacological trial. Subjects were scanned during the induction of irritability, happiness and neutral affective states by autobiographical recall. Self-report assessment was performed for each induction by anxiety, irritability and happiness scales. Inter-condition differences (affective induction) were used in the analysis of interaction of medication status and group effects by ANOVA tests. RESULTS: A significant interaction was found between group and treatment during irritability, but not during happiness emotions. It was observed a reduction in the scale of self-evaluation of anxiety in responsive group with the use of medication to the difference between irritability-happiness states, compared to the non responsive group; and a reduction in auto evaluation of happiness, in the totality of the sample in use of clomipramine, in difference irritability-neutral. There was a significant increase of BOLD effect in the responsive group during use relative to the period without use of clomipramine, compared to the effect on non-responsive group (p < 0.005). This effect was located in regions that surround the frontoparietal junction to the irritability relative to happiness and to irritability relative to neutral induction, and in the temporo-parieto-occipital junction, exclusively to the irritability relative to happiness induction. CONCLUSIONS: The favorably changes in healthy subjects who respond to prolonged serotonin and noradrenaline blocker use, may relate to changes in neural processes of autobiographical memory of negative emotions

INTRODUÇÃO: Apesar da importância dos medicamentos antidepressivos no tratamento dos transtornos de humor e de ansiedade, sua ação sobre sistemas cerebrais responsáveis pela expressão emocional ainda não foram claramente estabelecidos. Estudos recentes têm examinando o sinal dependente de nível de oxigenação sanguínea (do inglês, \"BOLD\") durante estímulos emocionais em indivíduos saudáveis sob uso de antidepressivos. Nesse estudo, pretendemos estender essa avaliação às alterações do humor e comportamento emocional devido ao uso prolongado de um antidepressivo bloqueador de serotonina e noradrenalina em pessoas saudáveis. MÉTODOS: foram selecionados dezesseis voluntários, sem antecedentes psiquiátricos pessoais ou familiares, que participaram de um ensaio farmacológico simples-cego de quatro semanas de doses baixas de clomipramina (até 40 mg/dia). Ao final desse período, dez sujeitos foram selecionados como não responsivos, e os restantes seis sujeitos foram selecionados como responsivos por apresentarem claras mudanças em três dos quatro seguintes critérios: tolerância interpessoal, eficiência, bem estar, e mudança substancial em sua auto percepção. O grupo de sujeitos classificados como responsivos foram submetidos a um ensaio controlado duplo-cego confirmatório. A aquisição de imagens cerebrais ocorreu após quatro semanas de uso de medicação (simples cego) e quatro semanas após a sua suspensão, ao final da participação no ensaio farmacológico. O imageamento cerebral foi realizado durante a indução de estados afetivos de felicidade, irritabilidade e neutros por relatos autobiográficos. A resposta emocional desses estados foi obtida por escalas de auto avaliação de ansiedade, irritabilidade e felicidade. As diferenças de sinal entre os estados afetivos foram utilizadas para a análise estatística da interação dos efeitos estado medicamentoso e grupo por testes ANOVA. RESULTADOS: Foi encontrada uma interação significativa entre o efeito de grupo e o estado medicamentoso sobre os estados afetivos de irritabilidade, mas não sobre os de felicidade. Se observou redução na auto avaliação de ansiedade no grupo responsivo com o uso de medicação na diferença entre os estados induzidos de irritabilidade e felicidade, em comparação com o efeito no grupo não responsivo; e também, redução na auto avaliação de felicidade com o uso de clomipramina na totalidade da amostra, na diferença entre o estados induzidos de irritabilidade e neutro. A alteração sobre o efeito BOLD (p < 0,005) foi localizada em regiões adjacentes à junção frontoparietal para a indução de irritabilidade em relação à felicidade e em relação aos estados neutros, no grupo responsivo em relação ao não responsivo, durante o período em uso relativo àquele sem uso de clomipramina, e na junção têmporo-paríeto-occipital, exclusivamente para a diferença irritabilidade-felicidade. CONCLUSÕES: a modificação favorável que sujeitos saudáveis apresentaram ao uso prolongado de um antidepressivo bloqueador da serotonina e noradrenalina, pode estar relacionada à modificação no processamento cerebral da memória autobiográfica de emoções negativas / INTRODUCTION: despite the importance of antidepressant agents to the treatment of anxiety and depressive disorders, there is not yet a clear understanding of their actions upon specific brain systems relevant to emotional processing. Recent studies have examined blood oxygen level dependent (BOLD) signal during emotion stimuli in healthy individuals in antidepressant use. The study intends to extend these measures to the changes over mood and emotional behavior by prolonged use of a serotonin and noradrenaline blocker antidepressant. METHODS: we selected sixteen subjects, with no personal or family history of psychiatric disorders, which participated of a four-week single-blind trial with low doses of clomipramine (up to 40mg/day). After this period, ten subjects were classified as non responsives, the remaining six subjects being classified as responsives because clomipramine provided positive changes in three of four of the following criteria: interpersonal tolerance, self-efficacy, mood and self-perception of a substantial change. Responsives were included in a placebo-controlled confirmatory trial. Imaging sessions occurred at the end of the four-week course of clomipramine and again after a four-week clomipramine washout period, at the end of pharmacological trial. Subjects were scanned during the induction of irritability, happiness and neutral affective states by autobiographical recall. Self-report assessment was performed for each induction by anxiety, irritability and happiness scales. Inter-condition differences (affective induction) were used in the analysis of interaction of medication status and group effects by ANOVA tests. RESULTS: A significant interaction was found between group and treatment during irritability, but not during happiness emotions. It was observed a reduction in the scale of self-evaluation of anxiety in responsive group with the use of medication to the difference between irritability-happiness states, compared to the non responsive group; and a reduction in auto evaluation of happiness, in the totality of the sample in use of clomipramine, in difference irritability-neutral. There was a significant increase of BOLD effect in the responsive group during use relative to the period without use of clomipramine, compared to the effect on non-responsive group (p < 0.005). This effect was located in regions that surround the frontoparietal junction to the irritability relative to happiness and to irritability relative to neutral induction, and in the temporo-parieto-occipital junction, exclusively to the irritability relative to happiness induction. CONCLUSIONS: The favorably changes in healthy subjects who respond to prolonged serotonin and noradrenaline blocker use, may relate to changes in neural processes of autobiographical memory of negative emotions

No / Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.