Thesis Portfolio Abstract Background Whilst the role of Psychological Flexibility on psychosocial outcomes has been assessed in some chronic health conditions and cancers, its role in psychosocial outcomes in men with prostate cancer has not been established. Fear of cancer recurrence has been shown to be associated with poorer psychosocial outcomes. The relationship of Psychological Flexibility on the impact of fear of cancer recurrence has not be evaluated. Research into the measurement of Psychological Flexibility in individuals with chronic ill health has not revealed a definitive measure. Methods A systematic review of the reliability and validity of measures of Psychological Flexibility in individuals with chronic health conditions was conducted. A quality assessment of the included studies was conducted and relevant results were synthesised. A cross-sectional study utilising a survey methodology was conducted to establish the role of Psychological Flexibility and fear of cancer recurrence in psychological distress and quality of life in men with prostate cancer. Regression analyses were used to establish whether fear of cancer recurrence or Psychological Flexibility significantly predicted any variance in distress or quality of life. Whether Psychological Flexibility mediated or moderated the relationship between fear of cancer recurrence and psychosocial outcomes was assessed with conditional process analysis. Results The systematic review revealed no single definitive measure of Psychological Flexibility, and that many measures currently in use within research and clinical settings have not been fully validated in individuals with chronic ill health conditions. The cross-sectional study found that Psychological Flexibility and fear of cancer recurrence each significantly predict variance in psychological distress and quality of life. Psychological Flexibility mediated and moderated the relationship between fear of cancer recurrence and psychological distress and mediated the relationship between fear of cancer recurrence and quality of life. Conclusions In the absence of a definitive measure of Psychological Flexibility, information on the measures identified were provided to allow clinicians and researchers to choose the most appropriate measure for their use. Future research might focus on further validation of existing measures of Psychological Flexibility rather than the development of additional measures. The challenges underlying using a psychometric approach to measure contextual science concepts was discussed. Due to the role of Psychological Flexibility within psychosocial outcomes in prostate cancer, it was suggested as a potential treatment target. The relevance of treatments such as Acceptance and Commitment Therapy, which aim to increase Psychological Flexibility, for men with prostate cancer was discussed. Future research avenues to further assess the role of Psychological Flexibility in psychosocial outcomes was discussed.

Background An increasing body of research is suggesting that childhood trauma and adversity may be associated with various adverse mental health outcomes, including psychosis. Cognitive functioning is often compromised in psychosis, and research has shown that there may be a link between early trauma and cognitive impairment in people with psychosis. No systematic review of the literature of this link has been undertaken, and very few studies have examined samples of individuals at high clinical risk for psychosis, to assess whether the potential link between adversity and cognitive functioning exists, without the confounding factors of length of illness, antipsychotic medication and chronicity of symptoms. Method The systematic review of all relevant electronic databases investigates the research to date on the association between childhood adverse experiences and cognitive ability in psychosis, and the conclusions that can be drawn from the existing literature, taking into account relevant considerations regarding sample, methodology and statistical analysis. The subsequent empirical study utilizes a sample at clinical high risk of developing psychosis, and a healthy control group to investigate whether any putative association in specific domains of cognitive functioning, or global cognitive ability and childhood adversity exist in those at clinical high risk, compared to controls. Results The systematic review indicated that at present, the literature looking into childhood adversity and cognitive ability in relation to psychosis is heterogeneous, with some studies finding that this association only occurs in patients, whilst others suggest it only occurs in the control groups. Some studies found it to be specific to certain cognitive domains, whilst others suggest it was a more global impairment. Methodology, samples and analysis differed considerably across studies, and likely contribute to the heterogeneity of the literature. The empirical paper showed a significant interaction effect between group (high risk versus controls) in the high childhood adversity group, in relation to global cognitive ability. Interestingly, this was not related to psychotic symptom severity or distress. Conclusion Several limitations of the existing studies limit the conclusions that can be drawn from the existing evidence regarding the link between childhood adversity and cognitive ability, and future research in prodromal samples is essential. The empirical study showed that there is a link between childhood adversity and cognitive ability in those at clinical high risk of developing psychosis, before disorder onset, that is not present in controls. This suggests that this may form a vulnerability in those at high risk for psychosis, rather than a more general mechanism present in the typical population.

This thesis is an exploration of two interconnected areas: Acceptance and Commitment Therapy (ACT) training for helping professionals (HPs) and psychological flexibility in helping professionals. The ACT model holds that HPs need to be psychologically flexible (or, herein, flexible) in order to be effective ACT practitioners, and thus a primary goal of ACT training is to enhance participant flexibility. The first chapter is a systematic review of studies that have evaluated the effectiveness of ACT training. It focused on ACT training practices and outcomes related to knowledge, skills, and psychological flexibility in HPs. The results of this review suggested that ACT training can be effective in providing HPs from a range of occupational background with the necessary knowledge and competency to deliver ACT interventions. Furthermore, ACT training can increase HP flexibility. However, confidence in these findings is limited due to methodological weaknesses, particularly variability in ACT training practices, inconsistent use of available measures, a lack of psychometrically robust measures to assess ACT knowledge, and the absence of a flexibility measure designed for use with HP populations. Recommendations were made regarding future research needs in this area, including the development of a HP-specific measure of flexibility. The second chapter reports on the development and initial validation of a measure designed to assess flexibility in the specific context of professional helping, called the Mindful Healthcare Scale (MHS). The results of two studies employing two separates samples of HPs provided good preliminary evidence of the MHS's factor structure and internal validity. The MHS was also found to converge in theoretically-consistent ways with other measures of flexibility and constructs related to the occupational functioning of HPs including burnout syndrome, self-compassion, and empathy. These findings suggest that the MHS may have considerable utility in relation to ACT training for HPs and may also advance our understanding of flexibility's role in HP occupational well-being and functioning.

In order to examine the literature on acceptance and mindfulness in parents of children with developmental disabilities a systematic review was conducted. Twelve studies were included in the review and provided some support for the relevance of these concepts in helping to support parents of children with developmental disabilities. However, general study quality was poor and methodological limitations hampered confidence in these findings. Research considerations are discussed. An empirical study was conducted to examine the relationship between psychological acceptance and family quality of life in parents of children with intellectual disabilities. One-hundred and twenty-nine parents of children with intellectual disabilities participated in a questionnaire based study. Participants completed measures of family quality of life, psychological acceptance, emotional adjustment, mental well-being and impact of the child. Parental psychological acceptance was positively associated with family quality of life and was found to account for around 1.9 per cent of its variance. Parental emotional adjustment was also positively associated with family quality of life, however, when parental psychological acceptance was added to the regression model emotional adjustment was no longer a statistically significant variable. The results of this study suggest that parental psychological acceptance may explain some of the variance in family quality of life. Further research is needed to ascertain whether interventions that improve parents' psychological acceptance also improve family quality of life.

Os fatores que possam promover e incrementar a osseointegração, ou prejudicar o processo biológico, aumentando o índice de falhas, têm sido cada vez mais investigados com o objetivo de ampliar indicações e as taxas de sobrevivência dos implantes dentais assim como controlar fatores adversos. O objetivo desta tese foi identificar, analisar e sintetizar as evidências científicas quanto a influência das estatinas, do envelhecimento e da experiência do cirurgião no processo osseointegração e na sobrevivência de implantes dentais. Este volume apresenta um compilado de três revisões sistemáticas orientadas pelas recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). O processo de revisão foi realizado por meio de uma busca sistemática em cinco bases de dados eletrônicas (PubMed, Scopus, Web of Science, Embase e Cochrane Library), além de busca manual nas referências bibliográficas dos estudos incluídos. A meta-análise, quando cabível, foi realizada com o auxílio do software Review Manager (RevMan, Versão 5.3). O grau de heterogeneidade entre os estudos foi verificado por meio do teste Q de Cochran e I2. O viés das publicações foi avaliado com o auxílio das escalas Newcasttle-Ottawa e Cochrane Collaboration\'s Tool. A síntese dos dados permitiu a publicação de três artigos científicos dispostos nesta tese. / Factors that may promote and enhance osseointegration, or impair the biological process, have been increasingly investigated in order to expand the indications and survival rates of dental implants and control the adverse factors. The aim of this thesis is to identify and summarize the scientific evidence of statins, ageing and surgeon related factors that can influence osseointegration and survival of dental implants. This volume presents a compilation of three systematic reviews structured by PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review process was carried out through a systematic search in five electronic databases (PubMed, Scopus, Web of Science, Embase and Cochrane Library) and bibliographical references of the included studies. Meta-analyses, when appropriate, were performed using the software Review Manager (RevMan version 5.3). The degree of heterogeneity in the studies was verified by Q Cochran test and I2. The bias of the publications was assessed with the assistance of Newcastle-Ottawa Scale and Cochrane Collaboration Tool\'s. The synthesis of the data was included in three papers prepared for this thesis.

yes / This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30 min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5 min or less) that could be delivered in a primary care consultation. / Citation sent on from Donna. Emailed Laura Lamming for final draft 16/03/2017 -sm

<p><strong>Aim</strong>: The purpose of this study was to highlight in what forms and manifestations spirituality emerges in medical patients whether they consider themselves believers or not. The other aim was to analyse spiritual ideas of nursing scientists – authors of the patients’ oriented studies to come to the better understanding of the situation with spirituality in caring. <strong>Method</strong>: Descriptive meta-synthesis was chosen, in which 12 nursing studies were analyzed and compiled in a new integrity. <strong>Results</strong>: The analysis shows that caregivers must be ready to meet and confirm the spiritual dimension consisting of Faith, Meaning, Relationship and Questions without answers in the various forms and expressions they emerge in patient’s experience. Nursing scientists showed ideas broad enough to confirm patients’ experience. <strong>Relevance for clinical practice</strong>: By include spirituality only to religion and culture the dimension are easily forgotten, it can also in those forms mean that caregivers doesn’t see it as theirs to confirm. Nursing science do not with hold that small view of spirituality, instead the science presents a broad spectra of forms in which patients spirituality can appear. Newinsights about patients’ spirituality can be used by health care professionals to improve the care of patients as multidimensional human beings.</p>

<p>Background: Hypochondriasis is associated with marked impairments in physical and psychological functioning, work performance and increased health care utilization. The prevalence among medical outpatients is estimated to be between 4,2 % and 6,3 %. Notwithstanding there is deficient research in this area. Until recently no specific treatment has been clearly demonstrated to be effective. Objective: The aim was to investigate experiences of what it is like to live with hypochondriasis, but also to examine different treatment options. Methods: In order to illustrate the experiences a latent content analyses was made on a documentary named “Hypokondrikerna” and to examine the treatment options a systematic review was made. Result: The content analysis revealed three categories and nine sub-categories concerning the experiences. The three categories were “health anxiety”, “individual coping strategies” and “emotional consequences”. The systematic review revealed medical treatment which consisted of three different antidepressants as well as seven different kinds of psychological treatments and other interventions, which all reduced hypocondriacal symptoms. Discussion: The findings show that hypochondriasis causes a chronic suffering and indicates that potential treatments are available. Hypochondriasis causes an unproductive health care utilization. A more effective management could reduce the costs and ease the suffering. Therefore we suggest that this disease should be observed and treated. The nurse has an important function to maintain a positive relationship with the patient and create a therapeutic dialogue.</p>

This thesis presents the results of three studies examining the management of migraine in children. First we conducted a systematic review of all clinical trials conducted in children and adolescents of the acute migraine therapy. A meta-analysis of the 26 randomized controlled trials is presented. A single trial with a focus on Emergency Department (ED) management was identified. As such, we then examined current ED practice in two retrospective practice variation studies. The first compared four regional hospital EDs where practice patterns were significantly different between mixed population EDs (both adult and pediatric patients) and the tertiary pediatric ED. The second examined practice variation among ten tertiary pediatric EDs in Canada where significant differences were again observed. Factors that influenced the choice of medications included increasing patient age and the physicians diagnosis of migraine. Important areas of future investigation include: (1) the effectiveness of intravenous fluids alone; and (2) the use of combined medications. / Clinical Epidemiology

Background: Hypochondriasis is associated with marked impairments in physical and psychological functioning, work performance and increased health care utilization. The prevalence among medical outpatients is estimated to be between 4,2 % and 6,3 %. Notwithstanding there is deficient research in this area. Until recently no specific treatment has been clearly demonstrated to be effective. Objective: The aim was to investigate experiences of what it is like to live with hypochondriasis, but also to examine different treatment options. Methods: In order to illustrate the experiences a latent content analyses was made on a documentary named “Hypokondrikerna” and to examine the treatment options a systematic review was made. Result: The content analysis revealed three categories and nine sub-categories concerning the experiences. The three categories were “health anxiety”, “individual coping strategies” and “emotional consequences”. The systematic review revealed medical treatment which consisted of three different antidepressants as well as seven different kinds of psychological treatments and other interventions, which all reduced hypocondriacal symptoms. Discussion: The findings show that hypochondriasis causes a chronic suffering and indicates that potential treatments are available. Hypochondriasis causes an unproductive health care utilization. A more effective management could reduce the costs and ease the suffering. Therefore we suggest that this disease should be observed and treated. The nurse has an important function to maintain a positive relationship with the patient and create a therapeutic dialogue.