Life expectancy in countries of Central and Eastern Europe (CCEE) is substantially shorter than in Western Europe, and similar divide exists in self-rated health. The project described in this thesis was set up to study the effects of socio-economic factors (such as material deprivation, education and inequalities) and psychosocial factors (perceived control, psychosocial work environment) on self-rated health (a predictor of mortality in prospective studies). Cross-sectional surveys were conducted in seven CCEE: Russia, Lithuania, Latvia, Estonia, Poland, Czech Republic and Hungary. Data were collected by interviews in randomly selected national samples in all seven countries (total 7,599 subjects), and by questionnaires in random community samples in 4 countries (total 6,642 subjects). The data included socio-economic and psychosocial factors, self-rated health (SRH) and behavioural risk factors. Overall, 17% of men and 23% of women rated their health as worse than average. In the national samples, perceived control, material deprivation and education were strongly related to poor SRH. In the pooled data, adjusted odds ratio (OR) of poor health for 1 standard deviation (SD) increase in perceived control was 0.59 (95% Cl 0.54-0.63). The OR for 1 SD increase in the material deprivation score was 1.35 (95% Cl 1.26-1.46). The ORs for vocational, secondary and university education, compared with primary education, were 0.75,0.58 and 0.53, respectively. We also examined the ecological effects of income inequality; the OR for the most versus the least unequal populations (using the Gini coefficient of income inequality) was 1.88 (95% Cl 1.55-2.28). In multivariate analyses, however, the effect of inequality was eliminated by adjustment for material deprivation and perceived control. In the community samples, the results were similar. Among psychosocial factors at work, the effort-reward imbalance appeared to be the strongest predictor of self-rated health; work variety was also a predictor of self-rated health. Job strain was not associated with SRH. Our results suggest that (a) the prevalence of poor SRH in CCEE is high, and (b) socioeconomic and psychosocial factors are strongly related to self-rated health in these populations. The gradients were present in all populations, and were of the same direction and similar magnitude as in the West. Prospective studies are needed to address the problems of temporality and reporting bias, which are the major problems of these results.

Indiana University-Purdue University Indianapolis (IUPUI) / Women describe pelvic organ prolapse (POP) surgery as difficult to recover from. Expectancy is related to recovery in other surgeries but has not been examined in POP. There is no established measure of surgery expectancy or utility in women with POP. This research had four aims: 1) to establish the factor structure of a new measure of POP surgery expectancy; 2) to establish predictive validity of the expectancy measure by examining its ability to predict self-rated recovery over time; 3) to establish concurrent validity of the expectancy measure; and 4) to examine the ability of utility to predict additional variance in recovery. Exploratory factor analysis revealed a three-factor solution. Factors are conceptualized as: 1) Bladder/Bowel Function; 2) Sexual Function; and 3) Physical Function. Bladder/Bowel Function correlated with optimism and self-efficacy (r = .17, p = .03 and r = .27, p = .00, respectively). Physical Function was predictive of recovery at 42 days (standardized coefficient = .25; p < .05). However, these factors were generally poor and inconsistent predictors of recovery. Utility did not predict additional variance in recovery. Potential explanations for the poor predictive ability of the measure are discussed. The development of a measure that amends these limitations may still be beneficial. Further, exploring and establishing the relationship between surgery expectancy, utility, and recovery may guide physician-patient discussions and lead to improved surgical outcomes.

Social psychologists have noted that compliance strategies based on the social norm of reciprocity can be an effective tool for changing behavior (e.g., Cialdini, 2001). In contrast to expectancy-based behavior-change strategies, which offer a reward after a behavior is completed (post-behavior reward); reciprocity-based strategies present the reward first in the form of a gift (pre-behavior reward). Although there are no explicit contingencies attached to the gift, a sense of obligation to reciprocate may be a powerful motivator to comply with the request. It was hypothesized that pre-behavior rewards would be more effective than post-behavior rewards at low magnitudes of reward, and that both strategies would be effective at higher levels. This study examined effects of the timing and magnitude ($1 vs. $10) of a cash reward on compliance with a request to use a specially designed thank-you card recognizing prosocial and proenvironmental behavior. The hypotheses were not supported. The highest rate of compliance occurred in the post-behavior $10 condition, where 35.5% of participants complied, followed by post-behavior $1 (18.8%), pre-behavior $1 (12.9%) and pre-behavior $10 (8.8%). Pairwise comparisons revealed compliance in the $10 post-behavior condition was significantly higher than the rate of compliance in the $1 and $10 pre-behavior conditions, Chi-Square (1, n = 62) = 4.31, p < .05 and Chi-Square (1, n = 65) = 6.82, p < .01 respectively. The lack of evidence for the effectiveness of pre-behavior reward strategy is discussed and contrasted with previous findings. / Master of Science

Women describe pelvic organ prolapse (POP) surgery as difficult to recover from. Expectancy is related to recovery in other surgeries but has not been examined in POP. There is no established measure of surgery expectancy or utility in women with POP. This research had four aims: 1) to establish the factor structure of a new measure of POP surgery expectancy; 2) to establish predictive validity of the expectancy measure by examining its ability to predict self-rated recovery over time; 3) to establish concurrent validity of the expectancy measure; and 4) to examine the ability of utility to predict additional variance in recovery. Exploratory factor analysis revealed a three-factor solution. Factors are conceptualized as: 1) Bladder/Bowel Function; 2) Sexual Function; and 3) Physical Function. Bladder/Bowel Function correlated with optimism and self-efficacy (<i>r</i> = .17, <i>p</i> = .03 and <i>r</i> = .27, <i>p</i> = .00, respectively). Physical Function was predictive of recovery at 42 days (standardized coefficient = .25; <i>p</i> < .05). However, these factors were generally poor and inconsistent predictors of recovery. Utility did not predict additional variance in recovery. Potential explanations for the poor predictive ability of the measure are discussed. The development of a measure that amends these limitations may still be beneficial. Further, exploring and establishing the relationship between surgery expectancy, utility, and recovery may guide physician-patient discussions and lead to improved surgical outcomes.

Thesis advisor: C. Patrick Proctor / During adolescence, students engage in identity-formation processes that impact motivation to learn, as well as education and career choices moving forward. Adolescents with learning disabilities (LD) face particular challenges in developing a positive identity as a learner: feelings of decreased academic competence (Gans, Kenny, & Ghany, 2003; Terras, Thompson, & Minnis, 2009), increased school dropout rates (Deshler, 2005), and decreased feelings of global self-worth (Boetsch, Green, & Pennington, 1996) as compared to non-LD peers. Literacy is an area of particular concern. Given the importance placed on literacy skills in our society, it is unsurprising that difficulties in literacy learning impact the beliefs that students with LD develop about themselves (Burden, 2008). This study presents the results of an investigation into a group of students’ identity beliefs with regard to motivation, literacy and LD; how those beliefs were related to one another; and how those beliefs both shaped, and were shaped by, literacy experiences, using data collected during the 2014-2015 school year at one of the seven schools participating in the National Center on the Use of Emerging Technologies to Improve Literacy Achievement for Students with Disabilities in Middle School (CET; CAST, Inc, 2015; PIs: David Rose and Ted Hasselbring). Data gathered for the 11 participants included a literacy motivation battery; classroom observations; student interviews; and teacher interviews, informed by the Reading Engagement Index (REI; Wigfield et al., 2008). Both directed content analysis (Hsieh & Shannon, 2005) and thematic analysis (Braun & Clarke, 2006) were used to analyze the data. Developing a greater awareness of the role of motivation in the literacy practices of adolescents with LD will enable educators to better understand the conditions under which these students read and write most willingly. This knowledge can be incorporated into school-based curricula, interventions, and professional development, such that these students have reason both to value the learning challenges placed before them, and to expect to succeed at meeting those challenges.

The Common Factors Model was introduced in 1992 by Michael Lambert suggesting that four factors that exist in all forms of psychotherapy are what account for positive therapeutic outcomes. The four common factors posited by Lambert include: Extratherapeutic Factors, The Therapeutic Relationship, Hope and Expectancy and Specific Factors. Marriage and family therapy is one form of psychotherapy that has taken an interest in The Common Factors Model and dedicated various amounts of research to understand connections between the two philosophies. Despite the efforts to understand common factors that exist in marriage and family therapy, very little research has been done studying the relationship between the common factor Hope and Expectancy, and marriage and family therapy. The current study aimed to fill that gap, by exploring the relationship between marriage and family therapy, and the common factor hope and expectancy through the lens of Snyder’s Hope Theory. In this study, a mixed methods sequential embedded designed was implemented to examine the relationship that exists between marriage and family therapy and the common factor Hope and Expectancy. The results indicated that levels of hope and expectancy were high in parents/guardians who were going to start participating family therapy with their child. The high levels of hope and expectancy were likely due to the activation of an interaction between extratherapeutic factors and hope and expectancy. Some of the extratherapeutic factors involved in the interaction were specific to marriage and family therapy, while others can be found in all forms of psychotherapy.

During a signal malfunction, traffic signals are operated in the flash mode. During this event, drivers are presented with one of two possible scenarios: (1) flashing yellow on the major street and flashing red on the minor street or (2) flashing red on all approaches. Yellow/red flash is typically the default mode utilized based on the expectation that red/red flash would produce an intolerable amount of delay. However, little research has been conducted to date on flashing operations, with exception of low-volume nighttime conditions. A traffic signal malfunction can occur during any time of the day, potentially placing the signal into flash mode under moderate to peak traffic volume conditions. In order to assess the safety implications of these events and improve the process by which the mode of flash (yellow/red versus red/red) is selected, the research contained in this study evaluated driver behavior and the operational characteristics of intersections operating in malfunction flash mode under a wide spectrum of traffic demands. Analysis of field data collected at thirteen study intersections in the Atlanta, Georgia area found that confusion exists among drivers approaching a signal in flash mode. The analysis found that a significant percentage of vehicles stop on a yellow indication. It was seen that an intersection flashing yellow/red could operate as a two-way stop or four-way stop, potentially transitioning between these two alternatives on a minute-by-minute basis. This creates an increased potential for crashes and further compounds the problem of driver expectancy by creating a constantly changing control environment. The stopping on yellow also introduces additional delay, which reduces the operational benefit of utilizing the yellow/red flash mode. Furthermore, a high level of traffic violations was observed for the flashing red indications for both yellow/red and red/red flashing operation. Based upon the study results, providing one consistent mode of flashing operation may be a reasonable solution to improving driver expectancy and safety. Red/red flashing operation is the preferred mode as it reduces vehicle speeds and the variability in the number of vehicles stopping, while improving driver expectancy.

No description available.

Background: Life expectancy (LE) estimation is an important part of both screening and treatment decision-making for potentially curable prostate cancer. Clinicians’ estimation of patient life expectancy is typically made using population-based life tables and intuition and it is often inaccurate. This study explores methods to improve LE prediction by formally considering patient co-morbid illness status, in addition to age, in the development of a LE prediction tool. Methods: We conducted a population-based retrospective cohort study of patients from the Ontario Cancer Registry who were curative treatment candidates, identified between 1990-1998. We analyzed data on three sub-populations of this cohort, and we used LE estimates from the Ontario Life Tables. Each model utilized Cox proportional hazards analysis, and/or the declining exponential approximation of LE, to estimate the survival experience of potential curative treatment candidates, including the impact due to both age and co-morbid illness status. We developed five separate models, tested them using a random subset of the cohort study sample, and compared their predictive accuracy by measuring both discriminative ability and calibration to determine the ‘best’ model. We also conducted a supplementary analysis using logistic regression to develop a model to predict the probability of 10-year survival. Results: The ‘best’ of our models demonstrated a c-index of 0.65 and very good calibration. Further analysis revealed that our ‘best’ model violated the Cox PH assumption for age and it’s predictions consistently over-estimated observed LE. Supplementary analysis of the logistic regression prediction model demonstrated a c-index of 0.70. Conclusions: Our exploration of methods to predict LE resulted in modest predictive accuracy. However, based on the results of the logistic regression model, we conclude that the results of our LE prediction models are reasonable, and obtaining a high level of predictive accuracy may not be possible given just age and co-morbidities as predictors. Further studies should continue to explore these and other methods for LE prediction. External validation of the ‘best’ model from the current study is required before the model and its accompanying LE reference tables can be recommended for use in a clinical setting for screening or treatment decision-making. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-04-07 19:11:34.216

Extensive evidence linking exercise with stress reduction has prompted many organisations to implement exercise stress management interventions in order to combat employee stress. These interventions however, have generally yielded low levels of effectiveness. Determining factors that can enhance the effectiveness of exercise stress management interventions is important for organisations implementing such interventions. The main purpose of the present study was to investigate the role that outcome expectancy has in the relationship between exercise and stress. Stress perceptions and exercise behaviours were assessed in 54 university students over the 4 weeks leading up to final examinations. Outcome expectancy was assessed once during this period. Heart rate was also assessed in 20 students on two occasions, including the exam. In contrast to the majority of research linking exercise with lower stress, individuals who exercised more than their own average during the study period had higher levels of exam stress over time, whilst variance in exercise levels from the group average was not significantly related to exam stress over time. Conversely, there was a significant difference in physiological exam stress (heart rate) between high and low exercise groups overtime for the overall heart rate average, but not the sleep or exam period heart rate averages. More specifically, it was found that the low exercise group had a stronger negative physiological reaction to the exam overall. No significant moderation effects of outcome expectancy on the relationship between exercise and stress were found. The results indicate that exercise is related to both self-reported and physiological indicators of stress, and that exercise at different levels (within-person and between-person) have differing effects on exam stress.