Neonatal abstinence syndrome (NAS) refers to the withdrawal symptoms experienced when an infant has been exposed to certain substances (e.g., opioids) in-utero, resulting in health challenges for infants. Previous studies have reported substantial variations in the clinical management of NAS, suggesting that some infants may not be receiving optimal care. High-quality clinical practice guidelines are crucial to support optimal patient outcomes and standardize care. In response, I conducted a systematic review and quality appraisal of available NAS guidelines and recommendations using the AGREE-II and AGREE-REX tools. I also developed and piloted a tool to measure family-centred care in guidelines. Most guidelines received low-quality appraisal scores on the AGREE-II and the AGREE-REX appraisals (16/20 and 10/20, respectively) and have conflicting pharmacological recommendations. Findings will improve clinicians’ awareness of the variation in the quality of guidelines and assist them to make care decisions that are from the best available evidence and family-centred.

Neonatal abstinence syndrome (NAS) in infants presents unique challenges in feeding and weight gain. The unpredictable clinical manifestations associated with the newborns withdrawal from exposure to drugs in utero can lead to costly delays in transition of the infant out of the Neonatal Intensive Care Unit (NICU).The purpose of this review of literature was to explore feeding positions and nutritional intake with the greatest impact on weight gain in infants with neonatal abstinence syndrome (NAS) following delivery. The secondary purpose was to compare the clinical manifestations of infants with NAS that influence nutritional intake and their relationship to length of time and cost of stay in the NICU. A review of literature was performed using multiple databases. Articles focusing on feeding position and nutrition intake were identified for interventions to effectively promote weight gain, while reducing clinical manifestations common in infants with NAS. Articles exploring improved feeding and weight gain in infants with NAS and reduced length of stay in the NICU were also synthesized for cost reductions to the facility. Results from 12 studies comparing various feeding positions that optimized nutrition, and reduced negative clinical manifestations in infants with NAS were synthesized for content relevant to the research questions. Results suggest a relationship between placing infants in the c-position, and side-lying position to reduce sensory stimulation, with reducing clinical manifestations for infants actively experiencing withdrawal symptoms from NAS. Providing chin and cheek support as needed, decreasing eye contact during feeding periods, and providing darker quiet environments all play an important role in allowing infants with NAS to optimize their weight gain. As previously stated, to manage nutritional intake and optimize weight gain, reduction of clinical manifestations through pharmacological and non-pharmacological interventions must be actively incorporated into the infants' plan of care.

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Sexuality education in public schools in the United States excludes a large population of students. These exclusions are due to a long history of legal and economic battles, as well as the politicized nature of adolescent sexuality. This critical interpretive inquiry explored the long history of sexuality education through the lens of economics, law, and psychological paradigms and examined the way in which each of these lenses furthered the exclusion of nonheterosexual males in curricula. Using a framework comprised of critical feminist theory, critical pedagogy, and queer theory, this manuscript provides an understanding of the social structures of sexuality education and how they continue to marginalize students labeled as “other.” Using critical discourse analysis, this study reviewed legal and political documents, state and private curricula, and works in the sociology and psychology fields. The outcomes of interpretive research do not lend themselves to specific answers, but to a greater understanding of the experience of marginalized individuals and the structures in place that keep this experience intact. Through a critical review of current programming initiatives, recommendations are made to continue moving toward a more gender- and identity-inclusive sexuality education curriculum. These recommendations, which are grounded in current legal and economic requirements, include teacher certification requirements, implementation of the Advocates for Youth 3Rs curriculum, utilization of a rights-based approach to program design, and adoption of national sexuality education by the Department of Health and Human Services, rather than by the Department of Education.

The quantitative study focuses on the perceptions of Nigerian adolescent students to HIV/AIDS and their attitudes to prevention methods. From the literature reviewed it was ascertained that adolescent students do have positive and optimistic perceptions of HIV/AIDS, and also adequate knowledge, but this has not translated into positive attitudes to prevention methods. The literature also indicated that peer group pressure, parental control and the mass media are some variables that probably influence adolescents’ sexual behaviour. This researcher developed the ‘Adolescent Students’ Perception of HIV/AIDS and Attitude to Prevention Methods Questionnaire’ to solicit information from the adolescent students. The results were coded and duly analysed. The results from the empirical study indicated that Nigerian adolescent students have positive perceptions regarding HIV/AIDS, as well as positive attitudes to prevention methods. Recommendations were made for curriculum experts, educators and parents based on current research methods. / Psychology of Education / Thesis (D. Ed. (Psychology of Education)

Les dérèglements émotionnels ont été largement avancés dans le développement et le maintien des conduites addictives. Ces perturbations des processus émotionnels sont associées à l’utilisation privilégiée de stratégies compensatoires mal adaptées qui vont à leur tour entériner les conduites addictives et entraver une consolidation de l’abstinence. Ce travail vise une meilleure compréhension des facteurs de vulnérabilité de la rechute à l’alcool par l’étude de l’évolution des compétences émotionnelles avec l’abstinence à travers trois volets expérimentaux. Pour cela, nous étudierons spécifiquement les mécanismes de régulation émotionnelle considérés comme centraux dans la problématique addictive. Nous utiliserons des outils particuliers pour étudier ces mécanismes que sont des indicateurs physiologiques du système nerveux autonome.Dans un premier volet, nous avons étudié les réponses du système sympathique par la mesure du diamètre pupillaire en réponse à la présentation d’images neutres etémotionnelles (positives et négatives). Nous avons démontré qu’en situation d’induction émotionnelle les patients abstinents à court terme présentent une activation plus forte du système d’alerte sympathique que les abstinents à long terme et les participants contrôles. Le niveau intermédiaire de la réponse pupillaire observé chez les abstinents à long terme suggère une amélioration partielle dans l’activation sympathique à la présentation d’une information émotionnelle (étude 1). La variabilité de la fréquence cardiaque (VFC) est un indicateur du système parasympathique, est reconnue comme marqueur de la régulation émotionnelle. L’étude de la VFC avant pendant et après une situation d’induction émotionnelle a montré une normalisation de la VFC en réponse aux stimuli émotionnels avec une abstinence à long terme. Cependant, les résultats pour les stimuli à valence négative ne sont pas différents entre les groupes abstinents à court et à long terme. Ce pattern de réponse appuie l’hypothèse d’un maintien de vulnérabilité aux émotions négatives en dépit d’une abstinence prolongée. De plus, une corrélation négative a été observée pour les deux groupes de patients entre les scores de craving et une augmentation de la VFC (étude 2). Enfin, dans un dernier volet expérimental, nous avons investigué les compétences et difficultés de régulation émotionnelle par des autoquestionnaires(CERQ et DERS) auprès de patients abstinents de quelques semaines à plusieurs années. Les résultats supportent l’hypothèse d’une limite de récupération capacités après deux ans d’abstinence (étude 3). L’étude de l’étendue des récupérations des compétences émotionnelles est une piste majeure dans la consolidation de l’abstinence. Ces trois études confirment la récupération des compétences émotionnelles avec l’abstinence mais surtout la persistance d’une vulnérabilité dans les processus émotionnels. Le caractère partiel des récupérations de ces mécanismes suppose non seulement le maintien d’une vulnérabilité en dépit d’une abstinence prolongée et met également en évidence la nécessité d’un travail d’accompagnement dans la remédiation de ces compétences à long terme. Un ensemble de perspectives de recherches et d’applications cliniques s’ouvrent au regard de ces résultats, et seront ici discutées. / Emotional disorders are recognized as a major factor of development andcontinuity of addictive behavior. These perturbations of the emotional processes areassociated with the preference given to ill-suited compensatory strategies which will inturn perpetuate addictive behaviors and interfere with the consolidation of abstinence.This study aimed to give a better understanding of the vulnerability factors of alcoholrelapse by studying the evolution of emotional competence with abstinence over threeexperimental chapters. For this purpose, we looked more closely at the mechanisms ofemotional regulation, which are considered as crucial in the addiction problem. In orderto study these mechanisms we used specific tools like the physiological cues of theautonomic nervous system.In a first chapter, we studied sympathetic system response by measuringpupillary diameter after exposure to neutral and emotional pictures (positive andnegative). We showed that when exposed to emotional induction, short-term abstinentpatients showed a stronger activation of the sympathetic nervous system than long-termabstinent patients as well as the control group. The intermediary level of pupillaryresponse found among long-term abstinent patients suggests a partial improvement ofsympathetic activation when exposed to emotional information (study 1). Heart RateVariability (HRV) is an indicator of the parasympathetic system and is viewed as amarker of emotional regulation. The study of HRV before, during and after a situation ofemotional induction showed a normalization of HRV in response to emotional stimuliwith long-term abstinence. However, results for stimuli with negative valence are notdifferent between the long-term and short-term abstinence groups. This responsepattern supports the hypothesis that there is still a vulnerability to negative emotionsdespite the prolonged abstinence. Moreover, a negative correlation between cravingscores and increase of HRV has been observed for the two patient groups (study 2).Finally, in a last experimental chapter, emotional competence and emotional regulationdifficulties were assessed by presenting the Difficulties in Emotion Regulation Scale(DERS) and the Cognitive Emotion Regulation Questionnaire (CERQ) to few weeks tofew years abstinent patients. Results support the hypothesis of a recovery shift of twoyears of abstinence for these abilities (study 3).The study of the extent of the recoveries of emotional competence is a major leadfor the consolidation of abstinence. Those three studies confirm the retrieval ofemotional competence with abstinence but they particularly show the persistence of avulnerability in the emotional processes. The fact that there is a recovery shift for thosemechanisms not only involves the continuity of a vulnerability despite a prolongedabstinence, but also underlines the need of a work of support for the remediation ofemotional competence in the long term. These results can lead to several researchprospects and clinical applications that will be discussed here.

Cette thèse de doctorat explore les trajectoires de deux types de déviance, celle de joueurs excessifs (N=100) et celle de délinquants (N=172). Le questionnaire utilisé dans chacun des cas possède un important volet destiné à recueillir des renseignements de manière chronologique par différentes thématiques; la méthode des calendriers d’histoire de vie. L’intérêt d’une analyse de calendrier est qu’elle permet de tenir compte des changements ponctuels de comportement et d’évaluer les effets à court terme de la prise en charge des sujets au cours de leur carrière déviante. La démonstration se base sur trois dimensions des trajectoires : l’intensité de l’engagement, les épisodes d’abstinence volontaire et les épisodes de rechutes. Le résultat majeur de ma thèse montre que les circonstances de vie (facteurs dynamiques) rendent bien compte des dimensions des trajectoires alors que les caractéristiques des individus (facteurs fixes ou statiques) ont souvent très peu de force explicative. Une analyse attentive des effets indirects montre la pertinence de continuer à s’intéresser à ces facteurs. En effet, l’impact des caractéristiques dynamiques est souvent conditionnel à certaines variables statiques. Aucune étude, tant américaine que canadienne, ne s’est penchée sur la dynamique des trajectoires de joueurs excessifs. Le troisième chapitre examine les fluctuations mensuelles des sommes englouties dans les jeux de hasard et d’argent. On s’efforce de comprendre ce qui incite les joueurs à dépenser davantage certains mois et moins à d’autres. Une attention particulière est aussi consacrée aux mois où les joueurs cessent de participer aux jeux de hasard et d’argent et aux facteurs qui favorisent cette abstinence provisoire. Le quatrième chapitre se concentre sur les trajectoires de délinquants. Dans ce cas-ci, la performance criminelle, les revenus illégaux mensuels, mesure l’intensité de l’engagement criminel. On s’intéresse dans ce chapitre aux conditions régissant à la fois les épisodes de réussite criminelle et les épisodes concomitants de désistement temporaire. Les mesures « officielles » de récidive (nouvelle condamnation, nouvelle entrée en thérapie) présentent un problème de chiffre noir (les rechutes effectives sont plus nombreuses que les rechutes connues des autorités officielles). L’intérêt du chapitre cinq est de miser sur une analyse autorévélée des rechutes et du « moment » où ces rechutes se produisent. Le deuxième objectif de cette étude est de comparer les épisodes de rechutes dans ces deux trajectoires de déviance. La logique de ce chapitre suit celles des précédents, on s’intéresse à la dynamique qui entoure ces épisodes, on se demande si elle est similaire au sein des deux trajectoires déviantes. / This thesis explores the trajectories of two types of deviance, that of excessive gamblers (N = 100) and of persistent offenders (N = 172). The questionnaire used in each case has an important component to collect information chronologically on different themes; the life history calendar method. The interest of a calendar analysis is that it takes into account the specific changes in behaviour and evaluates the short-term effects during their deviant careers. The demonstration is based on the three dimensions of the trajectories: the intensity of the commitment, the episodes of voluntary abstinence and relapse episodes. The major result of my thesis demonstrates that the circumstances of life (dynamic factors) have a greater influence on the dimensions of the trajectories, whereas the individual characteristics (fixed or static factors) often have very little explanatory power. A careful analysis of the indirect effects illustrates the relevance of maintaining an interest in these factors. Indeed, the impact of dynamic characteristics is often conditional on certain static variables. No study, either American or Canadian, has examined the dynamic trajectories of excessive gamblers. The second chapter examines the monthly fluctuations of amounts spent on gambling and games of chance. We attempted to understand what motivates gamblers to spend more certain months and less at others. Particular attention is also devoted to the months when the players cease to gamble, and the factors that promote this provisional abstinence. The third chapter focuses on the trajectories of persistent offenders. Here, the criminal performance (illegal monthly income), measure the intensity of the criminal commitment. In this chapter, we are interested in the conditions that favour both the success of criminal episodes and episodes of temporary desistance. The “official” measures of recidivism (new conviction, new admission into therapy) present a problem when it comes to unrecorded events; the actual relapses outnumber the relapse known by the official authorities. The interest of chapter four is to focus on an auto-revealed analysis of relapse and of the “moment in time" when these relapses occur. The second objective of this study is to compare the relapse episodes between the two trajectories. The logic of this chapter follows that of the preceding ones, we are interested in the dynamics surrounding these episodes and we wish to see if it is similar in both deviant trajectories.