The Multidimensional Model for Coping with Bullying (MMCB; Parris, in development) was conceptualized based on a literature review of coping with bullying and by combining relevant aspects of previous models. Strategies were described based on their focus (problem-focused vs. emotion-focused) and orientation (avoidance, approach – self, approach – situation). The MMCB provided the framework for the development of the Coping with Bullying Scale for Children (CBSC; Parris et al., 2011), which was administered as part of a research project in an urban, southeastern school district. The Student Survey of Bullying Behaviors – Revised 2 (SSBB-R2; Varjas et al., 2008) and the Behavior Assessment System for Children, 2nd Edition (BASC-2; Kamphaus & Reynolds, 2004) also were completed. The first research aim was to examine the factor structure of the CBSC in relation to the MMCB and investigate the relationship between coping style and student outcomes of depression, anxiety, and social stress. This study also examined the relationships between coping, victimization, and student engagement in bullying behavior, as well as the moderating effect of age, gender, and ethnicity on these relationships. The fourth research question was is there a relationship between student coping with bullying and their perceptions of control or self-reliance? Data analysis resulted in a four factor coping structure: constructive, externalizing, cognitive distancing, and self-blame. Externalizing coping was found to be a predictor of depression while constructive and self-blame coping was associated with more social stress. Self-blame also predicted higher rates of anxiety. Results indicated that more frequent victimization predicted the use of constructive and self-blame strategies, while students more often engaged in bullying behaviors indicated a higher use of externalizing and self-blame. Gender, age, and ethnicity were not found to be associated with levels of victimization, bullying behaviors, or the use of any of the four types of coping. Further, these demographic variables did not moderate the relationship between victimization and coping or bullying and coping. Finally, feelings of control were not associated with student coping; however, more self-reliance was predictive of constructive coping, cognitive distancing, and self-blame. Implications for future research and interventions for students involved in bullying are discussed.

Many school facilities in the United States are old, out-of-date, poorly maintained, and lack specific design elements that are likely to enhance teaching, learning, behavior, and other desirable outcomes. This study proposed that one reason why previous research regarding the effects of the physical school environment on educational outcomes has had little impact on the quality of schools is because there is a lack of knowledge about these relationships. A multi-method approach was used to solicit information from educators and researchers familiar with school facility effects literature to develop a set of research priorities to guide future research. In Phase I, a literature analysis provided important physical and outcome variables to seed brainstorming lists used in following phases of the research and provided the basis for a gap analysis to identify unavailable information. A concept mapping methodology was utilized in Phase II to solicit feedback from a group of seventeen experienced educators who were asked to brainstorm a list of measures of student, school, or school district success, sort their final list of more than 100 items into categories that made sense to them, and rate each item regarding how important it is to monitor or otherwise track. Using a Delphi method, a series of four questionnaires was given to a group of experienced researchers who developed a list of physical variables plausibly related to educational outcomes, rated the importance of those items, developed hypotheses that included top-rated physical variables and top-rated outcome variables (i.e., measures of success rated by educators), and then selected from those hypotheses several that became the basis of the recommended research priorities for the field. These research priorities propose investigations of the relationships between a set of physical variables (including the provision of team work stations and faculty collaborative spaces, well-designed circulation spaces, spaces for quiet reflection, adaptable seating, daylighting in classrooms, and overall maintenance and building quality) and a variety of educational outcomes (e.g., achievement, behavior, satisfaction, affective performance).

Introduction: Proton pump inhibitors (PPI) may impair the biotransformation of clopidogrel leading to increased major adverse cardiac events (MACE). Available studies have focused solely on patients receiving clopidogrel following a cardiac event. Given the widespread use of this combination, (about 64% in a recent study), this represents a major interaction that deserves further study. The objective of this thesis was to determine if the potential interaction between PPIs and clopidogrel leads to an increase in MACE in high-risk atherosclerotic patients receiving clopidogrel and PPIs as compared to clopidogrel alone. Methods: We conducted a retrospective chart review of patients in the University Hospital System who received clopidogrel between January 1, 2007 and April 30, 2009. Patients were included if they were hospitalized for acute coronary syndromes, stroke/TIA, revascularization (coronary, cerebral or peripheral arteries), or aspirin allergy. The primary outcome was the composite of myocardial infarction (MI), stroke/transient ischemic attack (TIA), coronary artery revascularization, or death (all cause) during the first year following discharge. Secondary outcomes included the composite of MI, stroke /TIA, revascularization (coronary, cerebral or peripheral arteries), or death. Bivariate analyses were conducted using Student’s t test, Mann Whitney U and Chi-square tests where appropriate. Multivariate analysis was conducted to adjust for baseline differences. Results: Overall, 1700 charts were reviewed and 572 patients met study criteria. The median follow-up was 332 days. The most common indication for clopidogrel use was coronary artery revascularization (66%). There were 201 patients in the clopidogrel with PPI group and 371 patients in the clopidogrel without PPI group. Baseline characteristics were evenly matched between both groups except for smoking, liver disease, and prior receipt of a PPI. The primary endpoint occurred in 21 patients in the clopidogrel with PPI group and 38 patients in the clopidogrel without PPI group (10% vs. 10%, p = 0.9, OR 1.02, 95% CI 0.58 – 1.80). The primary endpoint was unchanged after multivariate adjustments for baseline differences (adjusted OR 0.98, 95% CI 0.54 – 1.75). Likewise, there was no difference in the secondary endpoint (14% vs. 15%, p = 0.8, OR 1.02; 95% CI 0.58 – 1.80). The secondary endpoint was also unchanged after multivariate adjustments for baseline differences (adjusted OR 1.04, 95% CI (0.61 – 1.75) Conclusion: Patients receiving clopidogrel with a PPI demonstrated similar rates of MACE when compared to patients receiving clopidogrel without a PPI. / text

Strategies to optimize birth outcomes are a top priority in the current health care delivery system, where the examination and elimination of health disparities in childbearing women remain an important public health objective. Several studies have examined the relationships between socioeconomic status (SES), occupational status, ethnicity, insurance status, health care utilization, and educational level on birth outcomes, all known to influence gestational age and newborn mortality. Lesser-known variables are the influence of provider practice and hospital characteristics on birth outcomes.The purpose of this study was to evaluate several dimensions of birth outcomes employing birth certificate records and information available from provider licensing surveys for a one year period to calculate how much variation was due to differences in; a) hospital organizational characteristics; b) provider characteristics; and c) patient socio-demographic characteristics.The Quality Health Outcomes Model by Mitchell et al. (1998) provided a valuable framework which allowed the analysis of the interplay between intervention, client, and system characteristics, and their impact on birth outcomes for Maricopa County in 2005.The study design was a retrospective descriptive study using secondary data analysis with a dataset (Arizona HealthQuery, housed at the Center for Health Information and Research at Arizona State University) that included birth certificate information and the physician licensing renewal surveys.Secondary data analysis of this large administrative dataset provided the advantage of having a large sample size (62,816) of demographically diverse cases, thus minimizing concerns related to sample size and generalizability. Multiple regression and non-linear estimation models were deployed to control for confounding and effect modifying variables that could influence the relationship of labor induction on birth outcomes, including prolonged labor, use of forceps or vacuum extractors, cesarean births, Apgar scores, and newborn intensive care unit (NICU) admission.

The purpose of this investigation is to test the mediational effect of parenting style on the association between child health status and child behavioural outcomes in children. Using cross-sectional data of children 4 and 5 years old from National Longitudinal Survey of Children and Youth (NLSCY) Cycle 4 2000-2001 the paper explores the degree to which child health status is related to child behavioural outcomes. In addition, the present study investigates the extent to which child health status is linked to parenting style. Another aim of this study is to explore the association between parenting style and child behavioural outcomes. Child outcome measures assessed in this study include: hyperactivity-inattention, emotional-disorder anxiety, conduct disorder — physical aggression, and indirect aggression. Child health status is assessed using the Health Utility Index Mark 3. The Health Utility Index gives a description of an individual's overall functional health, founded on eight attributes that include: vision, hearing, speech, mobility, dexterity, cognition, emotion, pain and discomfort. Parenting style is measured using several parenting scales that consist of: positive interaction, hostile/ineffective parenting, consistent parenting, and rational (punitive/aversive) parenting. Statistical analysis was conducted using Ordinary Least Squares (OLS) and logistic regression to test the conceptual model and the significance of relationships between the variables of interest. There was partial support for the mediational model of parenting style on the association between child health status and children behavioural outcomes. Specifically, both ineffective and rational parenting each showed a mediational effect. Child health status and child behavioural outcomes were found to have a strong relationship to each other. However, ineffective parenting was more strongly related to child behavoiural outcomes than child health status. This suggests that children that are exposed to ineffective parenting are at greater risk for developing behavioural difficulties than children receiving other forms of parenting. Moreover, children who receive this type of parenting and have poorer health are at even greater risk for developing these behavioural problems. However, these conclusions are tentative as the directionality of these relationships is uncertain because of the cross-section design of this study.

Children’s health outcomes are affected by multiple variables, including biological, environmental, psychological and social factors. Many determinants are decided after birth depending on the surrounding physical, psychological and social environment that the child enters. Elements such as socioeconomic status, marital status, race, education level and access to healthcare greatly affect a mother’s health literacy, and, thus, her ability to adequately care for her child(ren). This project examines the impact of maternal health literacy training on the knowledge of mothers, who have been homeless. Ninety-one women completed a six-hour maternal health literacy training. A pre-posttest design was used to measure maternal knowledge change as the result of the training. The same measure was used at both time points, and the measure was designed in a multiple-choice format. Outcomes indicate that the maternal health literacy training positively impacted reported maternal child health knowledge. Additionally, a follow-up survey was given to 11% of the total sample, to examine the sustainability of the knowledge gains 2-4 months post-training. Findings indicate that the women who took the follow-up survey retained a considerable amount of health literacy knowledge. This is a first step into research examining how maternal health literacy training improves short and long term knowledge in a high risk sample of mothers. The positive outcomes suggest that this program could be beneficial to agencies across the country serving maternal needs in similar circumstances. Recommendations for further research are discussed.

Purpose: The overall aim of this thesis is to contribute new knowledge by examining psychosocial factors and return-to-work profiles of occupational low back pain patients in a rehabilitation clinic. Outcome measures for injured workers with subacute low back pain included: change in measures, program utilization, pain profiles and return-to-work. Methods: A total of 147 patients who met the eligibility criteria and consented, participated in a clinic-based, individualized, exercise-based treatment that included patient education and reassurance. A before-and-after design was used, with data collection on admission to and discharge from the program. Results: Pre-to-post analyses revealed that statistically significant improvements had occurred. However, subgroup analyses revealed differences in responses to treatment among the subgroups. Specifically, two sets of cluster analyses were conducted; each yielded two distinct subgroups of patients, one set with different lengths of time in the program, and another showing two pain intensity profiles. Furthermore, return-to-work rates varied between the groups although the overall return-to-work rate appeared high. Conclusion: Significant improvement was achieved following participation in the return-to-work rehabilitation program. However, participants with subacute nonspecific low back pain do not form a homogenous group in terms of their clinical presentation and responses to rehabilitation. Therefore, special attention might be warranted for subgroups within the sample, whom are at an increased risk for prolonged disability. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2007-09-28 15:40:39.13

Background: The current practice in northern Canada is to transfer pregnant women residing in communities without hospital facilities to larger centres at 37 weeks gestation. Little research has been conducted on how the practice of transferring women for childbirth affects available prenatal care continuity and prenatal care options, and whether or not this in turn affects health outcomes. Objectives: The aim of this study is to examine whether differences exist in prenatal care, risk factor distribution, and neonatal morbidity, between women who are transferred for childbirth, and women who are able to remain in their home community to give birth. Methods: Secondary analysis of the Canadian Maternity Experiences Survey 2006-2007 data was conducted in order to examine the relationship between transfer for childbirth, prenatal care, maternal risk factors, and neonatal morbidity. Crude odds ratios and adjusted odds ratios were calculated to assess the relationships between variables using multiple logistic regression, with bootstrap weights applied. Results: Women who were transferred for childbirth were more likely to experience a negative neonatal morbidity outcome (OR=1.9, 95% CIs 1.3-2.8), though this relationship disappeared when the relationship was adjusted for potential confounders. When these results were adjusted for potential confounding, smoking during pregnancy was the only risk factor shown to be significantly associated with neonatal morbidity in this study (OR=1.8, 95% CIs 1.0-3.0). Conclusion: More detailed and widespread data collection is needed to be able to properly assess prenatal care, maternal risk factors and neonatal morbidity in northern Canada. A perinatal database, constructed for surveillance purposes, would assist in further exploring the effect of transfer policy on prenatal care practices and maternal risk factor distribution, and the effect this has on neonatal health outcomes. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-09-29 14:55:33.977

Background: Treatment-resistant depression (TRD) encompasses a segment of individuals with major depressive disorder who are severely ill in terms of chronicity, comorbidity, and prognosis. Although functional impairment is a prominent and costly feature of treatment-resistance, very little is known about the factors that contribute to and maintain functional impairment in TRD. Purpose: This study examined the relationships among neurocognition, symptoms, and functional impairment in TRD. Specifically, I examined the neurocognitive impairments that relate to different symptom domains and to level of symptom severity, as well as the predictors of functional outcomes and real-world behaviour in TRD. Method: Patients (N = 29) with a diagnosis of major depressive disorder were recruited from the Mood Disorders Treatment and Research Service at Providence Care Mental Health Services in Kingston, Ontario. Data were collected during a baseline assessment for a neurocognitive enhancement therapy program. Results: Individuals with TRD show mild to moderate impairments across all neurocognitive domains, with a superimposed severe impairment in verbal working memory. Verbal working memory significantly correlated with depressive symptoms and anxiety, such that increased verbal working memory capacity was related to more severe clinical symptoms. Greater response inhibition significantly correlated with less anxiety. Interpersonal competence was predicted by sustained attention and severity of depressive symptoms. Adaptive competence was significantly predicted by age at baseline and set shifting. Real-world work behaviour, interpersonal relations, and general satisfaction were predicted by the severity of depressive symptoms, whereas observed mood and anxiety predicted real-world recreational activity. Conclusions: The current study pioneered some of the first data regarding the relationships among neurocognition, symptoms, and functional outcomes in treatment-resistant depression. Verbal working memory appears to play an important role in the symptomatology of TRD. Neurocognitive variables and depressive symptoms are important in predicting functional competence (what one can do) but only depressive symptoms predict functional performance (what one actually does in the real world). There may be additional intrinsic or extrinsic factors that mediate the relationships among neurocognition, symptoms, and functioning in TRD. / Thesis (Master, Psychology) -- Queen's University, 2011-09-07 11:55:40.708

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