Delineating and diagnosing depression and anxiety in the presence of a medical condition, such as diabetes, is complicated by the presence of overlapping symptoms that, therefore, are etiologically ambiguous. These overlapping symptoms include feelings of fatigue, concentration difficulties, restlessness, changes in appetite, irritability and autonomic arousal. The difficulty in understanding these overlapping symptoms has been proposed to lead to an underdiagnosis of depression and anxiety disorders among adults with diabetes, which is problematic given that such disorders are associated with poorer health outcomes. The goal of the current study is to test whether or not these overlapping symptoms are affected by the presence of diabetes by comparing structural models of these symptoms in adults with diabetes versus those free of major medical conditions. Participants include 226 adults with diabetes and 379 adults free of diabetes who completed a series of questionnaires assessing symptoms of depression, anxiety and health status. In addition, for adults with diabetes, the most recent hemoglobin A1c lab result was collected from patient medical records. Results indicate that overlapping symptoms were strongly related to mood for adults with and without diabetes. In conclusion, it is recommended that when these overlapping symptoms are present in adults with diabetes, depression and anxiety should be considered as possible contributors to their presence.

<div>In 1972, visual arts giftedness was recognized as an aspect of giftedness that needed to be nurtured and developed (Marland, 1972). However, students with gifts and talents in visual arts continued to be overlooked in the field of gifted education. Addressing these gaps in the field of gifted art education, I conducted a mixed methods study to examine the issues. The quantitative part of the study consisted of developing a survey instrument, Perceptions about Art Giftedness, and conducting an exploratory factor analysis (EFA) to investigate construct validity of the instrument. The initial instrument consisted of 23 items. Due to the focus of the study and the specificity of the survey, it was necessary to be selective in recruiting the participants. The inclusion criteria are: (a) they must be art teachers in an arts school or a public school that serves middle or high school grade levels; and/or (b) they must be teaching visual arts or fine arts. A total of 150 participants completed the survey. For the qualitative part of the study, I contacted the participants who completed the survey and asked if they were willing to be interviewed (n=11). Since this was an exploratory study, I began with the qualitative analysis. Three major themes were developed from the qualitative analysis: (a) attitudes and behaviors aligned with Art, (b) attitudes and behaviors aligned with giftedness, and (c) the participants’ use of the selection process and the limitations. These themes highlighted how differently art teachers perceived visual art giftedness from the common understanding about giftedness and the importance of creative behaviors in art giftedness. Additionally, these art teachers also commented on the similarities between visual arts giftedness and conventional understanding of giftedness. They shared examples of characteristics, such as being self-directed and able to work independently that they observed among their gifted art students. From the quantitative analysis, the EFA results indicated a two-factor model with Factor 1 had a Cronbach's Alpha of .89 and Factor 2 has a Cronbach's Alpha of .91, suggesting that they were reliable estimates of the data’s internal consistency. After examining the factor loading for the items, four items were eliminated due cross-loading and low communalities. Of the 19 items were retained, 10 items (.467 to .895) loaded onto Factor 1 and nine items (-.451 to -.937) loaded onto Factor 2. After examining the items for each of the factor and based on the results from the qualitative analysis, new descriptors were developed. Factor 1 (dispositions towards creative giftedness) consisted of items focusing the artistic attitudes and behaviors demonstrated by students who were gifted in visual arts. Factor 2 (dispositions towards conventional giftedness) contained items focusing on attitudes and behaviors that were traditionally associated with giftedness. In summation, results from qualitative and quantitative analysis helped to illustrate how participants were looking for characteristics in gifted visual arts students that goes beyond those highlighted by researchers in gifted education. The participants were not only focused on creative behaviors when identifying gifted art students, but they were also looking for conventional gifted characteristics; such as self-directedness, independence, and task commitment. The participants recognized that for students with gifts and talents in visual arts to develop their potential, they would need to possess both sets of characteristics. Interestingly, although there was consensus among the participants about the characteristics and behaviors observed in gifted art students, there was no agreement among them when asked about specific art making skills.</div>

No description available.

This study responds to the globally increasing rate of caesarean section, and specifically to the very high rate of elective caesarean section among Taiwanese mothers as evidence suggests that such elective caesareans pose potential health risks for mothers and babies. The purpose of this study was to develop and evaluate a multi-component instrument based on the theory of planned behavior (TPB) to better understand Taiwanese pregnant women's decisions regarding their childbirth delivery options (spontaneous vaginal delivery or elective caesarean section). The study was a four-phased mixed method design. First, the TPB guided item development and instrument drafting. Second, pretesting and instrument refinement used cognitive interviewing with a small sample of Taiwanese pregnant women. Third, the instrument was administered to 310 such women to examine psychometric properties of the component scales. Fourth, the phase 3 instrument was re-administered to 30 women to estimate item stability. Confirmatory factor analyses (CFA) were used to assess construct validity of the multi-item, multi-component measurement model with LISREL 9.1. Based on the TPB, the 52-item self-administered Childbirth Delivery Options Questionnaire (CDOQ) was developed to measure three components: intention regarding delivery options, attitudes toward delivery options, and perceptions of significant others' (partner, mother, and mother-in-law) feelings about delivery options. Respondents from phase two thought that the items on the CDOQ were easy to read and comprehend; they reported favorably on the wording and formatting. Preliminary item analysis revealed that the items referring to dangerousness of delivery options did not function as intended and were dropped because they did not differentiate between the two delivery options, leaving 36 items. Test-retest reliability indicated that responses to each item were positively correlated and those referring to spontaneous vaginal delivery were more stable than those referring to elective caesarean section. Corrected item-to-total correlations and expected change in Cronbach's alpha if item deleted revealed that four items might form a measure of general social norms associated with the Taiwanese culture. The Cronbach's alphas for the components of the CDOQ ranged from .55 to .89. The measurement model incorporating the design features of the CDOQ fitted the data well using the CFA. Because serious problems with multicollinearity and suppression were revealed, Beckstead's (2012) criterion-irrelevant-variance-omitted (CIVO) regression method was used to untangle the suppressor effects when predicting intention from the other components of the CDOQ. The results indicated that attitude and partner's feelings were significant and explained the bulk of the variance in intentions. The TPB-based instrument developed here will be of considerable use to maternal-child health researchers. The findings of this study suggest that decisions regarding delivery options may be modified by interventions geared toward pregnant women's attitudes within family- and cultural-centered prenatal programs.

Attributional style is hypothesised to causally contribute to depression vulnerability through influencing both emotional response and rumination following life events. Consistent with this hypothesis, Peters et al. (2011) found that training individuals towards a pessimistic attributional style, characterised by internal-stable attributions for negative events and external-unstable attributions for positive events, resulted in greater negative mood and emotional reactivity to perceived failure, relative to training a resilient attributional style characterized by the reverse pattern of attributions. To date, however, the relative contribution of the internal-external and stable-unstable dimensions, their interaction, and their application to positive or negative events upon influencing emotional response and, by theoretical extension, risk for depression, remains unresolved. To resolve this question, 80 participants received training manipulating attributional style along four dimensions (i.e., internal versus external attributions for negative events; internal versus external attributions for positive events; stable versus unstable attributions for negative events; stable versus unstable attributions for positive events) in a 24 orthogonal factorial design. Participants then completed a perceived failure induction task. Measures of emotion and state rumination were completed pre-manipulation, post- manipulation, and post-induction. The internality dimension for positive and, separately, negative events influenced both immediate emotional response and emotional reactivity. Stable attributions for negative events increased negative emotional response and moderated the effect of internal attributions for negative events: internal attributions to negative resulted in greater emotional reactivity relative to external attributions, but only in the context of stable attributions for negative events. Both internal and stable dimensions also had independent effects. These findings identifying the active components driving the effect of attributional style upon emotional reactivity suggest slight revisions and refinements to attribution models of depression vulnerability. Furthermore, it provides further evidence that attributional style can be modified and furthers understanding of how CBM-attribution training could be developed as a potential intervention for the treatment of depression.

Today's arid and semi-arid zones of the Mediterranean are affected by desertification, resulting from various factors, including climatic variations and human activities such as overcultivation, overgrazing and deforestation. Afforestation programs are one of the most effective means in preventing desertification. For many years Libya has had afforestation programs in order to restore degraded land and in response to rapid desert encroachment in the north east of Libya, in the area called the Jabal Akhdar (Green Mountain), which has been investigated in this study. The purpose of this research was to investigate the relative roles of exotic compared to native tree species in preventing desertification and enhancing degraded land restoration in the Jabal Akhdar. The effect of environmental factors on exotic compared to native tree species have been assessed by observations on growth and reproductive success of the species, including variables of stocking rate, trunk diameter, tree height, crown diameter, tree coverage, natural mortality, felling and seedling regeneration, as well as calculated variables, derived from these measurements. The effects of methods and age of afforestation on the promotion of biological diversity have been investigated using the Shannon-Wiener diversity index. The effects of tree species on soil depth have also been investigated. Multivariate statistical analyses of site, species and environmental data, using both cluster analyses and factor analyses have been performed, with the aim of determining what is influencing the species, crops or differentiating between the sites, based on soil depth, angle of slope, altitude, rainfall and air temperature values. Pinus halepensis showed success in its growth and regeneration, particularly at higher altitudes and steeper slopes. Cupressus sempervirens was successful in growth and regeneration in the mountains. The exotic Eucalyptus gomphocephala was very successful in its growth, but did not regenerate well, while the exotic Acacia cyanophylla trees had a failure of both growth and regeneration. E. gomphocephala species appeared to favour relativley the flatter (non-mountain) sites, while A. Cyanophylla appeared to favour relativly the mountain sites. All the species responded positively to greater rainfall and deep soil, but they differed in where they were most likely to be successful. Environmental factors such as climate, terrain and soil are the main determinants of species distribution in the study area, in addition to their impact on the growth of the main trees. There appeared not to be any relationship between biodiversity and whether the main trees were native or exotic, and only P. halepensis showed any negative effect on the abundance of shrubs. There was greater diversity of trees and shrubs generally at the younger sites than the old sites. The present study emphasises the current mismanagement of planted forests, particularly with overgrazing contributing to desertification, through preventing tree growth and eliminating most sapling regeneration. This study concludes by making recommendations for more effective choice of tree species to plant, and for subsequent management to improve afforestation programmes in the Jabal Akhdar area.

Research on smoking has to a great deal been conducted within a public health or a medical context, or focused on policy making. Fewer studies have taken their point of departure in a social sciences context, and still fewer have analysed why individuals start and cease to smoke, and how and why smoking patterns on an aggregate level change over time and vary between different population groups. The aim of this dissertation is to analyse changes in the Swedish tobacco consumption with special emphasis at elucidating the decrease in smoking during the past half-century from different angels. Thus, the first paper explore if and how changes in smoking patterns can be understood and explained with reference to Sweden’s development as a welfare state, and in relation to socio-demographic and socio-economic circumstances. The second paper focuses on the long-term pathways to smoking cessation, by discerning several distinct trajectories from smoker to non-smoker. The third paper analyses gender differences with regard to reasons to smoke, experiences of smoking, and central elements in the cessation process. Finally, in the fourth paper, the issue of to what extent smoking cessation can be described as a process of identity change is explored.   Smoking initiation and cessation vary by socio-demographic and socio-economic factors, and the rapid decrease in smoking has resulted in a rather vulnerable group of smokers in these aspects. The results also indicate that the cessation process is complex, with personal and structural factors interacting in the long-term process, leading to multiple pathways to a smoke-free life. Moreover, they point to gender differences in reasons to smoke and to quit, and in strategies to quit smoking. In addition, identity change seems to be important in remaining smoke-free. The stated inequality in gender and class points in the direction that structural changes and social policies might be of need to decrease smoking even further. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Submitted. Paper 3: Accepted. Paper 4: Manuscript.</p> / Women, Health and Substance use

Today's arid and semi-arid zones of the Mediterranean are affected by desertification, resulting from various factors, including climatic variations and human activities such as overcultivation, overgrazing and deforestation. Afforestation programs are one of the most effective means in preventing desertification. For many years Libya has had afforestation programs in order to restore degraded land and in response to rapid desert encroachment in the north east of Libya, in the area called the Jabal Akhdar (Green Mountain), which has been investigated in this study. The purpose of this research was to investigate the relative roles of exotic compared to native tree species in preventing desertification and enhancing degraded land restoration in the Jabal Akhdar. The effect of environmental factors on exotic compared to native tree species have been assessed by observations on growth and reproductive success of the species, including variables of stocking rate, trunk diameter, tree height, crown diameter, tree coverage, natural mortality, felling and seedling regeneration, as well as calculated variables, derived from these measurements. The effects of methods and age of afforestation on the promotion of biological diversity have been investigated using the Shannon-Wiener diversity index. The effects of tree species on soil depth have also been investigated. Multivariate statistical analyses of site, species and environmental data, using both cluster analyses and factor analyses have been performed, with the aim of determining what is influencing the species, crops or differentiating between the sites, based on soil depth, angle of slope, altitude, rainfall and air temperature values. Pinus halepensis showed success in its growth and regeneration, particularly at higher altitudes and steeper slopes. Cupressus sempervirens was successful in growth and regeneration in the mountains. The exotic Eucalyptus gomphocephala was very successful in its growth, but did not regenerate well, while the exotic Acacia cyanophylla trees had a failure of both growth and regeneration. E. gomphocephala species appeared to favour relativley the flatter (non-mountain) sites, while A. Cyanophylla appeared to favour relativly the mountain sites. All the species responded positively to greater rainfall and deep soil, but they differed in where they were most likely to be successful. Environmental factors such as climate, terrain and soil are the main determinants of species distribution in the study area, in addition to their impact on the growth of the main trees. There appeared not to be any relationship between biodiversity and whether the main trees were native or exotic, and only P. halepensis showed any negative effect on the abundance of shrubs. There was greater diversity of trees and shrubs generally at the younger sites than the old sites. The present study emphasises the current mismanagement of planted forests, particularly with overgrazing contributing to desertification, through preventing tree growth and eliminating most sapling regeneration. This study concludes by making recommendations for more effective choice of tree species to plant, and for subsequent management to improve afforestation programmes in the Jabal Akhdar area. / The Libyan Higher Education Ministry

La recherche sur l’utilisation des connaissances issues de la recherche (CIR) est en pleine expansion. Plusieurs études ont montré que l’utilisation des CIR contribue à améliorer la réussite scolaire des élèves. Toutefois, il semble que les enseignants les utilisent très peu. Pour améliorer cette utilisation, il est nécessaire de développer un modèle explicatif de l’utilisation des connaissances issues de la recherche. Ce modèle permet de rendre compte des mécanismes menant à l’utilisation des connaissances issues de la recherche en milieu de pratique. Il permet également de mettre en évidence les facteurs les plus influents et l’agencement de ces différents facteurs dans le but de favoriser une meilleure utilisation des connaissances issues de la recherche. Ce dernier aspect constitue l’objectif principal de cette thèse pour le domaine spécifique de l’éducation. Pour ce faire, un questionnaire sur l’utilisation des connaissances issues de la recherche (QUC) est validé et un modèle est proposé. Le premier article de la thèse examine la fiabilité, la validité et la structure factorielle du QUC avec un échantillon francophone et anglophone d’un milieu défavorisé. Le QUC, composé de 43 items, mesure six dimensions, soit : l’utilisation des connaissances issues de la recherche, le contexte organisationnel, la stratégie de soutien, l’opinion des utilisateurs et leur expertise ainsi que la fréquence d’accès aux sources des connaissances issues de la recherche. Au total, 2270 enseignants ont complété le questionnaire. Les résultats des différentes analyses montrent que le QUC doit être réduit à 20 items regroupés en cinq facteurs : l’utilisation des connaissances issues de la recherche, l’opinion des utilisateurs, la stratégie de soutien, l’expertise des utilisateurs et les facteurs organisationnels. Le second article de cette thèse examine quel modèle permet de mieux expliquer l’utilisation des CIR. Pour ce faire, deux modèles sont testés avec le même échantillon que dans le premier article, soit un modèle de liens directs et un modèle avec médiation. Pour le premier modèle, un lien direct entre l’utilisation des connaissances issues de la recherche et les facteurs qui favorisent cette utilisation est postulé : l’expertise, l’opinion, la stratégie de soutien et le facteur organisationnel auront des liens directs avec l’utilisation des connaissances issues de la recherche. Le second modèle (modèle avec médiation) se base quant à lui sur les théories de l’action raisonnée et du comportement planifié et postule que le lien entre les facteurs et l’utilisation n’est pas direct; certains facteurs ont des effets directs et d’autres des effets indirects. Concrètement, ce second modèle postule que l’expertise et l’opinion agissent comme médiateurs entre, d’une part, les deux variables indépendantes (le facteur organisationnel et la stratégie de soutien), et, d’autre part, la variable dépendante (l’utilisation des connaissances issues de la recherche). Les résultats des analyses montrent que le modèle avec médiation permet de mieux comprendre l’utilisation des connaissances issues de la recherche. Cette étude a permis de valider un questionnaire sur l’utilisation des connaissances issues de la recherche et aboutit à la proposition d’un modèle qui permet d’expliquer l’utilisation des connaissances issues de la recherche spécialement conçu pour le domaine de l’éducation. Elle fournit des outils (un questionnaire validé et un modèle) qui permettent de mieux cerner le paradigme de l’utilisation des connaissances issues de la recherche, ce qui pourrait favoriser une plus grande utilisation des CIR par les intervenants scolaires. En effet, les résultats de cette recherche peuvent guider les décideurs dans l’implantation des programmes menant à l’utilisation des connaissances issues de la recherche qui s’adressent aux enseignants. Ces résultats indiquent sur quels facteurs agir en premier lieu afin d’améliorer l’utilisation des CIR chez les enseignants du secondaire dans les milieux défavorisés. Le présent modèle pourrait être utilisé dans d’autres milieux scolaires (par exemple les milieux non défavorisés ou les milieux scolaires primaires) après validation. / Research on knowledge transfer is growing rapidly. Numerous studies have shown that the use of research-based Knowledge (RBK) contributes to student academic success. However, it seems that teachers make little use of RBK. To improve RBI use, a model for explaining knowledge use needs to be developed. This model shows the mechanisms of knowledge transfer in the practice setting. It also helps to highlight the most influential factors and the arrangement of these different factors in order to promote a better use of RBK. This is the primary objective of the present thesis, specifically with regard to the field of education. To do so, a questionnaire on the use of research-based knowledge (QURBK) is validated and a model proposed. The first article in this thesis examines the reliability, validity and factor structure of the QURBI with a sample of French and English teachers in the disadvantaged sections of the population. The QURBK, which comprises 43 items, measures six dimensions: knowledge use, organizational factors, support strategies, user opinions, user expertise and frequency of access to knowledge sources. In all, 2270 teachers completed the questionnaire. The results of the various analyses indicate that the QURBK should be reduced to 20 items, grouped into five factors: knowledge use, user opinions, support strategies, user expertise and organizational factors. The second article in this thesis explores what model best explains RBK use. Two models are tested using the same sample considered in the first article. In the case of the first model, a direct link is postulated between knowledge use and factors that promote use: expertise, opinions, support strategies and organizational factors are thus directly linked to knowledge use. The second model, which is based on the theories of reasoned action and planned behaviour, postulates that the link between factors and use is not direct; certain factors have direct effects and others have indirect effects. Specifically, the model, named mediation model, suggests that expertise and opinion serve as mediators between the two independent variables (organizational factors, support strategies) on the one hand, and the dependent variable (knowledge use) on the other. Following analysis, it appears that the mediation model is helpful to better understanding of the use of research-based knowledge. This study was used to validate a questionnaire on the use of research-based Knowledge and allows the proposal of a model explaining RBK use, designed specifically for the field of education. As well, it provides tools (a validated questionnaire and a model) that could contribute to the greater use of research-based knowledge. As a matter of fact, the results of this research could be helpful to the decision makers in setting up knowledge transfer programs, which lead to better use of RBK, made for teachers. These results indicate on which factor one should act first in order to improve the use of RBI by secondary schools teachers in the disadvantaged sections of the population. After its validation, the present model could be used in other schools (for example in non-disadvantaged or in primary schools).

A Síndrome de Burnout entre os profissionais da área da saúde vem sendo estudada em vários países e sua associação com transtornos depressivos tem sido relatada por vários estudos. Os resultados indicam validade para o burnout, diferenciando-o da depressão e por outro lado, associação dos índices de burnout e a sintomatologia depressiva. O Maslach Burnout Inventory-Human Service Survey (MBI-HSS) é o instrumento mais utilizado para avaliar o burnout. A estrutura de três fatores do MBI tem sido confirmada em várias amostras de diversos países. Entretanto, não encontramos estudos investigando a influência da depressão nas características psicométricas do MBI-HSS. Portanto, neste estudo, investigamos a validade do MBI-HSS em uma amostra de 521 auxiliares de enfermagem de um hospital universitário utilizando a análise fatorial exploratória, análise fatorial confirmatória e consistência interna pelo alfa de Cronbach. A amostra total foi dividida em um grupo com depressão maior e outro sem depressão maior. Tanto a amostra total, quanto as subamostras apresentaram elevados valores de alfa de Cronbach para a subescala de esgotamento emocional e valores intermediários para as subescalas de realização pessoal e de despersonalização. A análise do gráfico Scree plot, diferente da análise fatorial exploratória sem fixar os fatores, indicou a solução de três fatores, como na versão original da MBI-HSS. Fixando-se em três fatores, a análise fatorial exploratória revelou maior carga fatorial em Esgotamento Emocional (EE) de dois itens de Despersonalização (DE) na subamostra com depressão maior, mas não na subamostra sem depressão maior. Diferentemente, os itens 6 e 16 de EE apresentaram maior carga fatorial em DE na subamostra sem depressão mas não a amostra com depressão. Nossos resultados indicam que a presença de depressão maior pode influenciar as propriedades psicométricas da MBI-HSS. Sugerimos que pesquisadores considerem a avaliação da validade da MBI-HSS na amostra em questão anteriormente ao uso do MBI-HSS, incluindo a avaliação dos indivíduos com e sem depressão separadamente. / The burnout syndrome among health professionals has been studied in several countries and its association with depressive disorders have been reported by several studies. The results indicate validity for burnout, differentiating it from depression and on the other hand, association between burnout and depressive symptomatology. The Maslach Burnout Inventory-Human Service Survey (MBI-HSS) has been the most used instrument to evaluate burnout. The three-factor structure of the MBI has been confirmed in several samples from different countries. However, we did not find studies investigating the influence of depression on the psychometric characteristics of the MBI-HSS. Therefore, we investigated the validity of the MBI-HSS in a sample of 521 nursing assistants in a university hospital using exploratory factor analysis, confirmatory factor analysis and internal consistency (Cronbachs alpha coefficient). The total sample was divided into a group with major depression and one without major depression. Both the total sample and the subsamples showed high values of Cronbach\'s alpha for the subscale of emotional exhaustion and intermediate values for the subscales of personal accomplishment and depersonalization. The Scree plot analysis, unlike exploratory factor analysis without fixing the factors, indicated the three-factor solution, as in the original MBI-HSS. Settling into three factors, the exploratory factor analysis revealed the highest load factor in Emotional Exhaustion (EE) of two items in the subsample of Depersonalization (DE) with major depression but not in the subsample without major depression. In contrast, items 6 and 16 of EE had higher factor loading in DE in the subsample without depression but not in the sample with depression. Our results indicate that the presence of major depression may influence the psychometric properties of the MBI-HSS. We suggest that researchers consider the evaluation of the validity of the MBI-HSS in the sample prior to the use of the MBI-HSS, including assessment of individuals with and without depression separately