Introdução: O agrupamento de cuidados é uma estratégia que visa evitar a manipulação intermitente dos neonatos pré-termos, proporcionando um período maior de repouso, fundamental para seu adequado crescimento e desenvolvimento. Esta prática é amplamente utilizada nas Unidades de Terapia Intensiva Neonatal (UTIN). Objetivo: Estabelecer evidências acerca da efetividade do agrupamento de cuidados na organização do ciclo sono-vigília, na estabilidade das respostas fisiológicas e mímica facial em pré-termos com idade gestacional até 32 semanas. Método: Revisão sistemática que identificou estudos publicados e indexados nas bases eletrônicas Cochrane, LILACS, EMBASE, CINAHL, PubMed, Web of Science. Foram utilizados os descritores/termos livres clustered care, neonatal individualized developmental care program OR NIDCAP, kangaroo mother care OR KMC e skin to skin para identificação dos estudos. Além destas bases, foram realizadas buscas por estudos não publicados em revistas indexadas como anais de eventos científicos, teses e dissertações indexadas nas bases eletrônicas de bancos de teses disponibilizados em páginas eletrônicas de universidades e pela ferramenta Google scholar. A análise e seleção das publicações foram realizadas por dois revisores independentes, as publicações com análises discrepantes para inclusão ou não na revisão foram submetidas à avaliação de um terceiro revisor. As publicações que atenderam os critérios de inclusão foram selecionadas para a leitura e análise na íntegra. Após esta avaliação, as que preencheram os critérios de inclusão, foram incluídas na revisão sistemática. Resultados: Foram identificadas 1255 publicações nas bases de dados, das quais 18 foram selecionadas como prováveis inclusão e analisadas na íntegra. Destas, cinco ensaios clínicos randomizados do tipo cross-over foram incluídos na presente revisão. Os sujeitos que compuseram a amostra dos ensaios clínicos analisados foram os neonatos pré-termos com idade gestacional igual ou inferior a 32 semanas. O agrupamento de cuidados foi comparado com um procedimento doloroso. Os resultados mostraram que os RNs apresentam alterações na mímica facial (olhos espremidos), alterações comporamentais (extenção de braços, língua protusa, mãos abertas com adução dos dedos, bocejo) e diminuição na saturação de oxigênio mais significativamente no grupo submetido ao procedimento doloroso comparado ao grupo de cuidados agrupados (p<0,004). No entanto, valores semelhantes nas alterações faciais e fisiológicas ocorreram no grupo submetido ao agrupamento de cuidados e os sinais de estresse avaliados após o agrupamento de cuidados, persisitiu por maior tempo, comparado com a fase de recuperação do neonato no grupo do procedimento doloroso. Quanto à frequência cardíaca, os neonatos com idade gestacional inferior a 30 semanas apresentaram elevados índices quando o procedimento doloroso foi precedido pelo agrupamento de cuidados (p<0,0001). Conclusões: As evidências encontradas sugerem que o agrupamento de cuidados causa alterações na resposta comportamental (ciclos sono-vigília), instabilidade nos parâmetros fisiológicos (frequência cardíaca e saturação de oxigênio) e sinais de estresse demonstrado através da mímica facial (sobrancelhas salientes e sulco nasolabial) em recém-nascidos com idade gestacional menor ou igual a 32 semanas. A adoção da prática de agrupamento de cuidados não garante que os neonatos pré-termos submetidos a este tipo de cuidado apresentem respostas fisiológicas e comportamentais mais estáveis. / Introduction: The clustered care is a strategy to avoid the intermittent preterm infants handling, providing them a longer rest period, essential to their health growth and development. This procedure is widely used in the context of Neonatal Intensive Care Units (NICU). Objective: To establish evidence concerning the effectiveness of the clustered care in organizing the sleep-wake cycle in the physiological responses and facial expressions in gestational age up to 32 weeks preterm infants. Methods: A systematic review that identified the studies published in the Cochrane, LILACS, EMBASE, CINAHL, PubMed and Web of Science electronic databases. The descriptors used to identify the studies were: \"clustered care, neonatal individualized developmental care program OR NIDCAP, kangaroo mother care OR KMC e skin to skin. Also these database, it was identified the studies not published in indexed journals including studies presented in scientific events and thesis and dissertations available in the electronic databases hosted in the universities homepages and publications identified by the Google scholar gate. The selection of publications and analysis of them were performed by two independent reviewers. The publications with conflicting evaluation between the two reviewers were submitted to evaluation by a third reviewer. The publications that met the inclusion criteria were selected for analysis of the full text. After this analysis, those studies that met the inclusion criteria were included in the systematic review. Results: We identified 1255 publications in databases, 18 of them were selected as probable inclusion and were analyzed in its entirety. From these 18 studies, five cross-over randomized clinical trials were included in this systematic review. The subjects who comprised the samples of analyzed trials were premature infants up to 32 week gestational age. The clustered care group was compared with a painful procedure. The results showed that newborns exhibited alterations in the facial expressions (eyes squeezed), behavior changes (arms extension, protruding tongue, open hands with fingers adduction, yawn) and oxygen saturation decreasing more significant in the group undergoing painful procedure compared with the clustered care group (p <0.004). However, similar values in facial and physiological changes occurred in the clustered care group and stress signals evaluated after grouping care, persisted for a longer time compared to the recovery phase in the newborn of painful procedure group. As for heart rate, neonates with gestational age below 30 weeks showed high levels when the painful procedure was preceded by clustered care (p <0.0001). Conclusions: The evidence suggests that the clustered care causes changes in the behavioral responses (sleep-wake cycles), instability in physiological parameters (heart rate and oxygen saturation) and stress signals demonstrated through facial expressions (protruding eyebrows and nasolabial folds) in the premature infants up to 32 weeks gestational age. he grouping of care does not guarantee that the preterm group undergoing care exhibit more stability in physiological and behavioral responses. The adoption of the clustered care practice does not guarantee that the preterm infant underwent to it exhibit more stability in the physiological and behavioral responses.

High levels of personal car use have negative effects on the environment and on human health. This thesis presents four empirical studies that aimed to develop our knowledge of personal travel choices, focussing on the malleability of attitudes and their sensitivity in relation to specific contexts and goals. The first study (Chapter 2) presents a systematic review and meta-analysis of mechanisms of travel mode choice. The study provides a comprehensive overview of antecedents of car use and non-car use, including sub-group analyses of different contextual factors. Results also highlight the need for standardised measures and consideration of implicit thought processes. The second study (Chapter 3) employs a repertory grid technique to elicit perceptions of seven different transport modes from high mileage car users and non-car users. Comparisons between car users and non-car users highlight potentially effective and ineffective intervention targets. Findings show how sustainable transport might be promoted amongst a portfolio of travel choices. The third study (Chapter 4) utilises qualitative methods to explore the extent to which individuals’ attitude expressions are changeable. The study demonstrates that all participants hold ambivalent and conflicting attitudes, highlighting specific situations in which those attitudes are more likely to be unstable. Two related priming experiments are presented in the final empirical chapter (Chapter 5). Both use survey methodology to investigate whether manipulating the salience of car-use-incongruent goals can lead to more positive attitudes towards and increased willingness to use non-car travel modes. The study confirms that people who are motivated to make changes are a potentially optimal target group for interventions based on subliminal messages. Overall, the research presented in this thesis introduces context sensitivity into the transport literature and offers novel insights into perceptions of a range of travel modes. Recommendations include relevant avenues for future research, findings are discussed in light of implications for transport policy and practice.

Cognitive difficulties can persist for months and years after stroke and adversely impact confidence, mood and functional recovery. Stroke survivors, carers and healthcare professionals collectively agree that improving cognition is the number one research priority for life after stroke. Future research should include measurements of outcome that service users deem important. Patient reported outcome measures (PROMs) are a means of gaining patient perspectives that can be standardised for use in a trial. PROMs should be developed with service users to incorporate their priorities but people with cognitive difficulties are often systematically excluded from the development and use of PROMs. Study 1 used qualitative interviews (N=16) to explore stroke survivor perspectives on the important and measureable impacts of persisting cognitive problems. The results of this study generated requirements for a PROM that related to conceptual underpinning and face validity of a measurement tool. Study 2 was a systematic review of existing PROMs related to cognition. 20 Identified PROMs were critically appraised against the requirements generated in the qualitative study. No existing PROMs were identified that met all of the qualitative study review criteria. The next stage described in chapter 3, was to develop a new PROM that: utilised the strengths of existing tools; met qualitative study requirements; and was refined through consultation with different stakeholders, prioritising feedback of stroke survivors with cognitive difficulties. The result of this work was the Patient Reported Evaluation of Cognitive State (PRECiS) scale. Study 3 was a psychometric study with stroke survivors (N=164) to test PRECiS in a large sample. Quantitative and qualitative data were collected on acceptability, feasibility and other psychometric properties of validity and reliability. PRECiS demonstrated good acceptability to stroke survivors and performed well psychometrically. Future validation work required for PRECiS is described in discussion chapter 4. Subject to further validation work, PRECiS may be particularly useful for pragmatic trials of cognitive rehabilitation after stroke.

Motivational interviewing (MI) has been used extensively and often effectively in medical settings to support behaviour change in adults. There is emerging evidence that MI may also be a useful approach for working with young people in schools. This thesis investigated the effectiveness of MI in educational settings and is presented in three sections. The first paper is an evaluative systematic literature review examining the evidence for student-focused MI in educational settings. Eleven studies were included in the review, although just eight were identified as 'best evidence' and included in the synthesis. Overall there is evidence for the effectiveness of student-focused MI in the areas of behaviour, school-based motivation and academic achievement. However, a number of methodological weaknesses were identified in the existing literature, which provides clear pointers for future research. Previous research has highlighted the potential usefulness of MI when used as a therapeutic intervention with disaffected students. However, to date, there has been little published research investigating students' views on MI. The second paper aims to investigate students' views on an MI intervention. Three disaffected students took part in an individual MI intervention, which was delivered by three educational psychologists (EPs). Semi-structured interviews were used to obtain the students' views, immediately after the intervention and again at a follow-up interview three months later. The results indicated that students were enthusiastic about the intervention and most perceived that there had been a positive impact on their learning motivation and classroom behaviour. However, these results were not consistent with questionnaire responses and two of the students experienced exclusions around the time of the intervention. The implications of these ambiguous findings are discussed in relation to the use of therapeutic interventions by EPs and the possible factors that are crucial to the success of MI interventions. The third paper provides a critical appraisal of the overall research process, including implications of the work, wider context of the research and dissemination of evidence to professional practice.

Submitted by Shaira Ferrari Rodor Bissoli (shaira.rodor@hotmail.com) on 2019-01-25T17:25:35Z No. of bitstreams: 1 Dissertação e anexos RS - FIM.pdf: 39316469 bytes, checksum: 0f72c48cf723b5f54bf6795ac4173112 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2019-01-29T13:02:19Z (GMT) No. of bitstreams: 1 bissoli_sfr_me_bot.pdf: 39316469 bytes, checksum: 0f72c48cf723b5f54bf6795ac4173112 (MD5) / Made available in DSpace on 2019-01-29T13:02:19Z (GMT). No. of bitstreams: 1 bissoli_sfr_me_bot.pdf: 39316469 bytes, checksum: 0f72c48cf723b5f54bf6795ac4173112 (MD5) Previous issue date: 2018-11-27 / Bissoli SFR. Mapeamento das evidências das revisões sistemáticas de oftalmologia da base de dados Cochrane. [dissertação]. Botucatu, SP: Faculdade de Medicina, Universidade Estadual Paulista; 2018. Justificativa e objetivos: A Colaboração Cochrane visa oferecer, por meio da publicação de revisões sistemáticas, informações atualizadas, objetivas e com evidências consistentes para a prática clínica e para o estabelecimento de políticas de saúde. Entretanto, verifica-se, frequentemente, uma inconsistência de evidências e incapacidade de gerar recomendações. O objetivo desse estudo foi analisar as revisões sistemáticas do Grupo Oftalmologia da Colaboração Cochrane e mapear sua utilidade para a prática clínica e para a pesquisa científica. Método: Realizou-se estudo transversal com análise de todas as revisões sistemáticas publicadas no Grupo Oftalmologia da Colaboração Cochrane até maio de 2018, verificando-se qual o tipo de recomendação para a prática clínica e para a pesquisa científica, por meio da análise das conclusões de seus autores. Além disso, computou-se o número de ensaios clínicos e meta-análises por revisão sistemática e por subespecialidade, por ano. Resultados: 202 revisões foram obtidas no período. Evidências que apoiam a intervenção, com recomendação para a realização de mais estudos ou sem recomendação para mais estudos: 36,3% [IC 95% 36,2-36,4] e 5,0% [IC 95% 4,8-5,1], respectivamente. Evidências contrárias à intervenção, com recomendação para realização de mais estudos ou sem recomendação para mais estudos: 3,0% [IC 95% 2,8-3,1] e 3,5% [IC 95% 3,3-3,6], respectivamente. Ausência de evidências, com recomendação para a realização de mais estudos ou sem recomendação para mais estudos: 51,2% [IC 95% 55,1-55,3] e 1% [IC 95% 0,9-1,1], respectivamente. Do total, 90,5% das revisões sugerem a realização de mais estudos independentemente dos resultados obtidos. O número médio de ensaios clínicos nas revisões foi de 7,4, variando entre zero e 137, e o número médio de meta-análises foi igual a 3,1, variando entre zero e 26. Conclusão: A maioria das revisões sistemáticas do Grupo de Oftalmologia da Cochrane apresenta insuficiência ou ausência de evidências para recomendar determinada intervenção na prática clínica e recomenda a realização de novos estudos clínicos controlados e aleatorizados. / Bissoli SFR. Mapping of the evidences of systematic reviews of Ophthalmology Cochrane database. [dissertation]. Botucatu, SP: Botucatu Medical School, State University of São Paulo 2018. Rationale and objectives: The Cochrane Collaboration aims to provide, through the publication of systematic reviews, up-to-date, objective information and with consistent evidence for clinical practice and for the establishment of health policies. However, there is often an inconsistency of evidence and inability to generate recommendations. The objective of this study was to analyze the systematic reviews of the Cochrane Collaboration Ophthalmology Group and to map its usefulness to clinical practice and to scientific research. Methods: A cross-sectional study was carried out with an analysis of all the systematic reviews published in the Ophthalmology Group of the Cochrane Collaboration until May 2018, confirming the type of recommendation for clinical practice and for scientific research, through analysis of the conclusions of its authors. In addition, we counted the number of clinical trials and meta-analyzes by systematic review and by subspecialty, per year. Results: 202 revisions were obtained in the period. Evidence that supports the intervention, with recommendation for further studies: 36.3% [CI 95% 36.2-36.4] or no recommendation for further studies: 5.0% [CI 95% 4.8-5.1]. Evidence contrary to intervention, with recommendation for further studies 3.0% [CI 95% 2.8-3.1] or no recommendation for further studies 3.5% [CI 95% 3.3-3.6). Absence of evidence, with recommendation for further studies: 51.2% [CI 95% 55.1-55.3] or no recommendation for further studies 1% [CI 95% 0.9-1.1] . Of the total, 90.5% of the reviews suggest further studies regardless of the results obtained. The mean number of clinical trials in the reviews was 7.4 (ranging from zero to 137), and the mean number of meta-analyzes was 3.1 (ranging from zero to 26).Conclusion: Most systematic reviews of the Cochrane Ophthalmology Group show insufficiency or lack of evidence to recommend a particular intervention in clinical practice and recommends further controlled and randomized clinical trials.

O objetivo desta revisão sistemática foi analisar os estudos que relacionam doença periodontal e nascimento prematuro e baixo peso, verificando o efeito da doença periodontal materna no desfecho da gestação. Foi realizada pesquisa nas seguintes bases de dados: PubMed, Scielo e LILACS até Dezembro de 2007. A revisão sistemática foi conduzida de forma a identificar os estudos capazes de preencher os critérios de inclusão, apresentando aspectos clínicos, microbiológicos e radiográficos da doença periodontal, assim como os desfechos da gestação, ou seja, nascimento prematuro e baixo peso. Foram então selecionados 35 (trinta e cinco) artigos, sendo 9 (nove) coorte, 16 (dezesseis) casos controles, e 10 (dez) ensaios clínicos. A associação entre a doença periodontal materna e o nascimento de bebê prematuro com baixo peso foi encontrada em 26 (vinte e seis) estudos: 7 (sete) coorte, 11 (onze) casos controles e 8 (oito) ensaios clínicos. Não foi possível realizar uma meta-análise devido à grande heterogeneidade entre os estudos, particularmente no que se refere aos métodos de mensuração da doença periodontal. Um melhor controle em relação aos fatores de confusão também permitiria uma confiança maior nos resultados e conclusões apresentadas. Ainda não é possível ter conclusões adequadas do real efeito da doença periodontal sobre os desfechos da gestação devido a limitações nas metodologias dos presentes estudos. Portanto, a evidência da relação da doença periodontal com o nascimento de bebê prematuro e baixo peso é limitada. Ainda existe a necessidade de novos e bem desenhados estudos observacionais e de intervenção, que possam confirmar o que até agora é visto apenas como uma possível associação, explorando a validade dessas possíveis associações em diferentes populações e controlando adequadamente as variáveis de confusão. / The objective of this systematic review was to analyse the studies that relate the periodontal disease and the preterm and low birth weight deliveries, assessing the effect of the maternal periodontal disease in the pregnancy outcome. A research was conducted in the following databases: PubMed, Scielo and LILACS until December 2007. The systematic review was undertaken to identify the researches that met the inclusion criterias, addresssing aspects of periodontal disease: clinical, radiographic, microbiological and immunological, and pregnancy outcomes, like preterm low birth weight as well. In that case, 35 (thirty five) studies were selected, 9 (nine) cohort, 16 (sixteen) case controls, and 10 (ten) clinical trials. The association between maternal periodontal disease and preterm low birth weight was found in 26 (twenty six) studies: 7 (seven) cohort, 11 (eleven) case controls and 8 (eight) clinical trials. A meta-analysis was not performed due to the extensive and clear heterogenity of the studies, particulary regarding the periodontal disease measures. An adequate control for confounders would permit results and conclusions more reliable. It is not possible to know the real effect of the periodontal disease in the pregnancy outcomes until now, because of the methodology limitations of the current studies. Therefore, the evidence of the relation of the periodontal disease with the preterm low birth weight is limited. There is a need for new and well designed observational and interventional studies to confirm, what so far is only a possible association, to explore the validity of the association in different populations, correctly control for confounders.

Submitted by Jorge Silva (jorgelmsilva@ufrrj.br) on 2018-05-09T17:55:46Z No. of bitstreams: 1 2014 - Thiene Salazar Livio de Moraes.pdf: 2466223 bytes, checksum: 10b082d56f8727cf87f75df80791376b (MD5) / Made available in DSpace on 2018-05-09T17:55:46Z (GMT). No. of bitstreams: 1 2014 - Thiene Salazar Livio de Moraes.pdf: 2466223 bytes, checksum: 10b082d56f8727cf87f75df80791376b (MD5) Previous issue date: 2014-04-30 / Adjustment disorder is a diagnostic criterion associated with stress, which can occur during or after the occurrence of one or more stressful situations. It is a clinical condition which impairs the performance and social functioning and / or occupational functioning of the individual. However, it is noticed that the scientific studies on this topic are scarce. This master?s dissertation investigates the treatment kinds of Adjustment Disorder through a literature review and his prevalence among university students. Thus, this work is presented through two articles. The first is a systematic review of scientific literature of the articles about treatments for the Adjustment Disorder, published in the virtual library collections PsychInfo and PubMed / Medline. The result showed that, among the articles selected through some criteria, none is of Brazilian origin; all are from other countries, and most of the European continent. Therapies indicated in the studies were classified as psychotherapy, pharmacotherapy and herbal medicine. The second article focuses on the mental health of college students at the Universidade Federal Rural do Rio de Janeiro - Serop?dica. The study estimates the occurrence of the Adjustment Disorder among undergraduate students of the UFRRJ and detected the stressors preceding through a quantitative cross search, into a sample of 635 subjects. The results revealed that 19.4% of students matched the diagnostic criteria for the disorder Adaptation, according to the Inventory Valuation Adjustment Disorder (Self Report of the assessment of Adjustment Disorder) and 45.6 % showed susceptibility to development of psychopathological symptoms. Therefore, it is concluded that the mental health of the students in Brazilian universities, especially those that are located far from urban centers, requires scientific attention. Moreover, it is observed that little scientific attention has been given to Adjustment Disorder has collaborated that information on its prevalence in the general population and in specific populations as well as its diagnosis and its treatment remain scarce and inaccurate. / Transtorno de Adapta??o ? um crit?rio diagn?stico associado ao estresse, que pode se manifestar ap?s ou durante a ocorr?ncia de uma ou mais situa??es estressantes. ? um quadro cl?nico que entrava o desempenho e o funcionamento social e/ou ocupacional do indiv?duo. No entanto, percebe-se que os estudos cient?ficos sobre esse tema ainda s?o escassos. Esta disserta??o de mestrado se prop?s a investigar o Transtorno de Adapta??o a partir de uma revis?o de literatura, em torno dos tipos de tratamento e de sua preval?ncia entre estudantes universit?rios. Desse modo, esse trabalho ? apresentado atrav?s de dois artigos. O primeiro trata de uma revis?o sistem?tica da literatura cient?fica no que tange os artigos sobre tratamentos indicados para o Transtorno de Adapta??o, publicados nos acervos bibliogr?ficos virtuais Psycinfo e Pubmed/Medline. O resultado obtido mostrou que, dentre os artigos selecionados a partir dos crit?rios estabelecidos, nenhum ? de origem brasileira; todos s?o oriundos de outros pa?ses, sendo a maior parte do continente Europeu. As terapias indicadas nos estudos foram classificadas como Psicoterapia, Farmacoterapia e Fitoterapia. O segundo artigo enfoca a sa?de mental dos estudantes universit?rios da Universidade Federal Rural do Rio de Janeiro do campus Serop?dica. O trabalho estimou a ocorr?ncia do Transtorno de Adapta??o entre universit?rios da UFRRJ e detectou os fatores estressantes precedentes a ele, atrav?s de uma pesquisa Quantitativa Transversal, em uma amostra de 635 sujeitos. Os resultados revelaram que 19,4% dos alunos corresponderam aos crit?rios para o quadro de Transtorno de Adapta??o, segundo o Invent?rio de Avalia??o de Transtorno de Adapta??o (Self Report of the assessment of Adjustment disorder) e 45,6% demonstraram suscetibilidade ao desenvolvimento de sintomas psicopatol?gicos. Sendo assim, conclui-se que a sa?de mental dos graduandos das universidades brasileiras, principalmente naquelas que est?o localizadas distantes dos centros urbanos, requer aten??o do campo cient?fico. Al?m disso, observa-se que a pouca aten??o cient?fica dada ao Transtorno de Adapta??o tem corroborado para que informa??es sobre sua preval?ncia na popula??o geral e em popula??es espec?ficas, seu diagn?stico e seu tratamento continuem escassos e imprecisos.

Background/Aims: Understanding predictors, moderators and mediators of child externalising behaviour problems could lead to improvements in engagement and outcomes for children and their families. Parental cognitions, including self-efficacy and attributions, have been proposed as mediators in the relationship between parenting and child behaviour problems. Although mediation is increasingly recognised as an effective way of examining relationships between variables, only a small proportion of studies that identify potential mediators actually conduct a mediation analysis. This thesis consists of two studies: a systematic review (Journal Article 1) and an empirical study (Journal Article 2). The systematic review investigated the ways in which mediation analysis has been used to examine the role of parental cognitions in studies of child behavioural problems, and to assess the methodological quality of these studies. The empirical study investigated the role of parental cognitions and characteristics in relation to pre-school child externalising behaviour problems. Methods: In Journal Article 1, a systematic search of three electronic databases, a quality assessment of included studies, and a subsequent narrative synthesis were conducted. In Journal Article 2, 125 parents of children aged 3-6 years old attending a community-based parent management training programme, across three local authorities, completed a battery of self-report questionnaires before and after the intervention. Correlational and mediation analyses were conducted to investigate relationships between child behaviour and parental attachment style, metacognition, dysfunctional attributions and parental stress. We also tested the possibility that parents' reported levels of stress and child behaviour problems, and their demographic variables, played a role in whether they completed the intervention. Results: In Journal Article 1, after screening, 14 studies were reviewed using an adapted quality criteria tool. The most commonly studied parental cognition was parental self-efficacy, with a small number of studies investigating parental attributions. A variety of approaches to mediation analysis had been used and caution should be exercised when interpreting the results of many of the reviewed studies. Despite a growing recognition of the limitations of some traditional methods (e.g. causal steps approach), research into mediators of child externalising behaviour could be improved by a wider adoption of more appropriate tools, in line appropriate theoretical frameworks. In Journal Article 2, as hypothesised, the results indicated significant relationships between parents' attachment insecurity and baseline levels of parental stress, parental attributions and child behaviour problems. Support was found for the hypothesis that parental attributions mediated the relationship between attachment insecurity and child externalising behaviour problems. We did not find significant that any demographic variables other than parent age predicted whether parents completed the programme. Conclusions: Taken together, the two studies provide evidence of a complex relationship between parental factors, particularly parental cognitions, and externalising child behaviour problems. The systematic review found some evidence that parental cognitions mediate how aspects of parenting (e.g. behaviour and affect) and child externalising behaviour problems are associated, and the empirical study also showed that parental attributions are important in relation to child behaviour problems. Of particular interest was the finding that they mediate the relationship between child behaviour problems and attachment insecurity. However, to advance the field both theoretically and clinically, future studies should endeavour to ensure adequate sample size and power, using optimal study designs, in conjunction with strong theoretical grounding. Exploring cognitive mediators beyond self-efficacy, such as parental attributions, will allow us to further develop our understanding of the relationship between child behaviour and parenting.

Objective: The concept of recovery has become an integral part of modern mental health care. Understanding the outcomes and underlying mechanisms of key recovery interventions, such as Wellness Recovery Action Planning (WRAP), is essential in order to expand the theoretical understanding of recovery and inform how to target recovery in treatment. Therefore a systematic review of the literature was conducted to evaluate the mental health outcomes of WRAP for adults. The empirical study then explored three constructs in relation to WRAP and recovery. These were social problem solving, cognitive defusion and social identification. Method: The systematic review of the mental health outcomes of WRAP was conducted by searching four databases, contacting the authors of WRAP research and seeking evaluative information from organisations that deliver WRAP. Fourteen relevant studies met the inclusion criteria. Whereas, the empirical study recruited participants on a trans-diagnostic basis from across Scotland. Using a quantitative cross sectional design, 109 participant's completed 5 self-report questionnaires. These were the Knowledge, Attitudes and Beliefs about WRAP Questionnaire (WRAP beliefs), the Recovery Assessment Scale - Short (RAS-S), the Social Problem Solving Inventory - Revised - Short (SPSI-R-S), the Four Item Measure of Social Identification (FISI) and the Cognitive Fusion Questionnaire (CFQ). Correlation, regression and mediation analysis were used to explore relationships, and in particular, the predictors and mediators of recovery. Results: The systematic review provided strong evidence that WRAP has a significant positive impact on hope and also reduces the symptoms of mental illness. However, whether WRAP improves personal levels of recovery was unclear and a possible risk of disempowerment was found. Promising preliminary mental health outcomes in the areas of confidence in managing mental health, quality of life, service use, self-advocacy and knowledge attitudes and beliefs about recovery were highlighted. Only studies that did not use peer facilitators failed to find significant increases in hope compared to treatment as usual control groups. In the empirical study, the results indicated that all the constructs examined were correlated to recovery. In the regression analysis, WRAP beliefs, social problem solving and cognitive defusion also demonstrated a predictive relationship with recovery. Mediation analysis indicated that, social problem solving mediated two distinct relationships. One between WRAP beliefs and recovery, and another between cognitive defusion and recovery. The social problem solving subscales also showed how the two predictors relate to recovery through social problem solving in different ways. Social identification with the WRAP group did not significantly predict or mediate recovery. Conclusions: The systematic review indicated having peer facilitators delivering WRAP is key to helping participants foster hope and that a further randomised control trial could help clarify if improved personal recovery is an outcome of WRAP. It additionally suggested how the relationship between WRAP beliefs and recovery could be explored, as per the design of the empirical study. Findings from the empirical study implied that improving participants' social problem solving and cognitive defusion should be specifically targeted in WRAP delivery. The studies combined indicate that to achieve the best recovery results interventions, like WRAP, should target inspiring hope through peer support, improving knowledge, attitudes and beliefs about recovery and cognitive defusion from unhelpful thoughts.

Background: Difficulties with anxiety among children and young people are common and can impact upon their developmental trajectory leading to adverse outcomes in later life. There is, therefore, a need to increase access to early intervention services. Existing research has indicated that school-based cognitive behavioural interventions are effective for children and young people experiencing difficulties with anxiety, yet there remains a proportion of the population for whom they are not effective. In addition, there is a lack of research on how these may be implemented in real world settings as opposed to a research trial. The present research focuses on the provision of cognitive behavioural school-based interventions in two parts: a systematic review of psychological, interpersonal and social variables as predictors, mediators and moderators of mental health outcomes following a school-based intervention and an empirical mixed methods evaluation of the facilitators and barriers to the implementation of a school-based intervention. Method: A systematic search of electronic databases for studies examining interpersonal, psychological and social predictors, moderators and mediators of mental health outcome following school-based cognitive behavioural interventions was conducted. Effect sizes for these analyses were calculated and the quality of eligible studies was assessed using a standardised rating tool. Within the empirical project, the implementation of a school-based cognitive behavioural intervention was evaluated through a mixed methods approach. Semi-structured interviews with stakeholders in the intervention were analysed using grounded theory integrated with framework analysis. Quantitative data on the reach of the intervention, practitioner evaluation of training and coaching as well as routine outcome measures from children and young people receiving the intervention was collected. Results: Within the systematic review, twenty-two studies (N=22) met the predefined eligibility criteria. There was heterogeneity in the variables explored, effect size of these on treatment outcome and the quality of the literature within the included studies. Cognitive style was found to mediate treatment outcome, but there was limited evidence for other predictors, mediators and moderators of treatment outcome within the review. Quantitative results of the empirical project indicated that the model of the intervention was acceptable to both practitioners and children and young people, and preliminary data indicated a significant improvement in mental health outcomes. Facilitators that emerged from qualitative data included an enabling context, therapeutic engagement, motivation and congruence, self-efficacy and containment and encouragement. The exclusivity of the intervention, a lack of systemic understanding and transparency as well as demands and pressure on resources were barriers to implementation. Conclusions: Although preliminary evidence for potential predictors, mediators and moderators is presented, further research with improvements in the design and reporting of explanatory variables on treatment outcome is required prior to informing clinical decision-making. The successful implementation of school-based interventions requires multi-agency integration and collaboration as well as on-going support in managing systemic pressures and skill development.