Background: Chronic pain is prevalent worldwide and is estimated to range from 2% to 55% in the general population. There is a limited understanding of the prevalence and incidence of chronic pain in Canada. Furthermore, our understanding of the sociodemographic predictors of chronic pain is limited; thus we are poorly positioned to identify potential populations at risk. Objectives: The primary objectives for this study included: 1) to determine the prevalence and incidence of chronic pain and pain-related interference in Canada over time and, 2) to determine the influence of sociodemographic predictors on the development of chronic pain by sex in the Canadian adult population over 12 years. Methods: Using data from the cross-sectional components of the National Population Health Survey (NPHS) (1994/95, 1996/97, 1998/99) and the Canadian Community Health Survey (2000/01, 2003, 2005, 2007/08), we examined the prevalence and interference of chronic pain. The longitudinal component of the NPHS was used to determine the incidence and sociodemographic predictors of chronic pain. Chronic pain was defined as the presence of “usual pain”. Results: The prevalence in the cross-sectional samples ranged from 15.1% to 18.9%. In the longitudinal sample, the incidence ranged from 5.4% to 7.8% and the prevalence ranged from 15.3% to 19.5%. Women, compared to men, had a higher prevalence, but not incidence of chronic pain each year. Of those individuals reporting chronic pain, the majority reported at least a few activities prevented. Women who were older, with lower education, and widowed, separated, or divorced were more likely to develop chronic pain. There were no sociodemographic risk factors for chronic pain in men. Conclusion/Implications: This population-based study supports previous research findings indicating that chronic pain affects daily activities of many Canadians. Furthermore, this is the first population-based prospective study examining the incidence and sociodemographic predictors of chronic pain in Canadians. Further study with more detailed definitions of pain and pain-related interference is warranted. Moreover, our findings suggest that older women are more likely to develop chronic pain and that men and women may have different risk factors for chronic pain, suggesting the need for gender-based preventative interventions. / Thesis (Master, Nursing) -- Queen's University, 2010-07-20 13:38:13.996

No description available.

The three studies reported in this thesis investigated the contributing factors of L2 writing among adult ESL learners in the academic setting. The major purpose of this research was to explore the relationship between L2 proficiency, writing strategies, writing attitude, writing errors and L2 writing performance. This thesis aimed to provide insights for the contributing factors that are predictive of L2 writing performance in adult ESL learners, studying in English and non-English dominant settings. Study 1 (reported in Chapter 3) focused on determining the appropriate measures for investigating the individual factors of writing performance; particularly learners’ writing strategies, learners’ second language proficiency, first language (L1) interference and their relation to writing performance. Thirty-one intermediate students of L2 served as participants. A measure of vocabulary size and a writing strategy questionnaire were administered to the students. Findings in this study indicated that most of the participants’ planning strategies were limited to having a mental or written plan whereas over half of the respondents reported that they always start with an introduction and were more likely to stop drafting after a few sentences. In terms of drafting strategies, it was found that most respondents reread what they had written to get ideas on how to continue but did not go back to their outline to make changes in it. With regard to L1 use, a majority of participants do not write bits of text in their native language. Nevertheless, quite a number of participants indicated that they would write in their L1 if they don’t know a word in English. Findings in this study also suggested that participants’ biggest concerns were related to grammar and vocabulary, which resulted in them making surface level changes and checking. An overall analysis of participants’ writing output and responses from the questionnaire also provided important insights to the improvement of the measures. The revision process included rewording and rephrasing ambiguous items, removing irrelevant items from the questionnaire and restructuring the writing task for the next study. In Study 2 (presented in Chapter 4), a follow-up study was conducted to examine L2 writers’ proficiency level, writing attitude, writing errors and writing strategies in an English-dominant setting. Nine research questions were designed to guide the study framework and gather specific data regarding the research aims. A writing measure, vocabulary tests and a questionnaire were administered to the students. Findings from Study 2 indicated that L2 proficiency, particularly vocabulary size, was related to writing performance. In addition, it was also discovered that L2 writers who performed poorly were prone to performing writing strategies related to surface level checking. Therefore, it was concluded that linguistic barriers in L2 affect both writing performance and students’ ability in applying the effective strategies in writing. Apart from that, Study 2 also found that the use of L1 and translation into L2 was associated with lower writing performance. Additionally, Study 2 found that pronoun, word and sentence errors were the most prevalent errors among ESL students. A possible reason for this is because L2 students need to work with two languages while writing, mainly the grammar rules in English which are not found in their L1 as well as their own native language. Thus, L2 students face the challenge of working out English grammar rules while writing. Overall, findings in this study suggest that prevalent writing errors in English may be a sign of L1 interference and that as the use of L1 increases, writing performance decreases. In Study 3 (reported in Chapter 5), the role of proficiency level, writing attitude, writing errors and writing strategies was explored by measuring the relationship between writing attitude scores, errors in writing, strategy use and essay scores. Additionally, the role of L2 proficiency in writing performance was also investigated by assessing the relationship between vocabulary size scores, writing errors and writing performance. Findings from Study 3 revealed unexpected findings with regard to the relationship between L1 use and writing performance among the three sample groups. L1 use was found to be correlated with writing performance for Group A but not Groups B and C. It was argued that L2 writers of different L2 proficiency level and academic experience may have different orientations of L1 use. Further work on the impact of L1 use on L2 writing will be needed in order to provide insights into this area. With regard to writing errors, a relationship between errors and writing performance was reported. It was found that subject verb agreement error appeared to be a common factor for the three groups in the study that was related to writing performance. In addition, errors were also significantly correlated with L2 proficiency, suggesting that as L2 proficiency increased, errors decreased. Overall, Study 3 argues for the importance of developing and enhancing learners’ L2 proficiency to reduce errors and improve learners’ writing performance. Additionally, Study 3 also argues for the need to emphasize effective writing strategies in the ESL writing classroom.

The primary aim of this thesis was to increase healthcare professionals’ understanding surrounding the emotional distress of paediatric oncology patients prior to reaching five-year survivorship status, to inform resource allocation and evidence-based clinical interventions. Paper 1 systematically reviewed the extant literature that has assessed the emotional distress severity of paediatric oncology patients who had not yet reached five-year survivorship status. Contradictory findings were evident from the 21 studies reviewed. These inconsistencies in findings were discussed in relation to methodological limitations present within the studies and the heterogeneous oncology and control groups studied. The review concluded that further multiple-centre studies, using appropriate self-report and parent-proxy standardised measures, and larger, representative samples comprising patients with CNS and non-CNS malignancies at differing points in their treatment journeys, are needed to identify demographic, illness and treatment variables that leave paediatric oncology patients vulnerable to emotional distress. The empirical paper presented in Paper 2 utilised a rigorous methodology to address this need, and additionally explored modifiable psychological risk factors for emotional distress in this population. 74 paediatric oncology patients (aged 12-18 years), who were within five years of treatment completion, completed self-report measures of emotional distress, self-concept and health related quality of life (HRQOL), whilst their parents provided background information regarding patients’ demographics, diagnoses and treatment protocols. 72 parents also provided ratings surrounding patients’ self-concepts and HRQOL. The mean emotional distress rating indicated that the sample was clinically distressed. Demographic, illness and treatment factors explained little variance in emotional distress, whilst global self-concept, global-generic and cancer-specific HRQOL were significant predictors. Provisional analyses indicated that experiencing pain, illness-related worries, communication difficulties and negative self-views in relation to maths abilities, parent relations and opposite-sex peer relations were specific risk factors in the sample studied. Patient- and parent-reports of patients’ self-concepts and HRQOL were highly consistent. These findings suggest that paediatric oncology patients would benefit from frequent routine screening for emotional distress to allow early identification and intervention. Furthermore, prevention-oriented interventions surrounding emotional distress, and indirect interventions targeting global self-concept and HRQOL could be beneficial. Paper 3 critically appraises the systematic review and empirical paper in terms of their methodologies and clinical contexts. It is acknowledged that some of the results are preliminary in nature and need replicating in larger samples. Nevertheless, this research was successful in exploring demographic, illness, treatment and psychological risk factors for emotional distress for paediatric oncology patients prior to reaching five-year survivorship status, providing guidance for future clinical interventions, and making suggestions for future studies, in terms of their aims and methodologies.

PURPOSE: The objective was to determine if particular magnetic resonance, clinical and demographic findings were associated with functional status prior to surgery and predictive of functional outcomes at follow-up. RESULTS: The study included 65 consecutive CSM patients. The modified Japanese Orthopaedic Association Scale (mJOA) was used as the primary outcome measure. Higher baseline mJOA scores were associated with younger age, shorter duration of symptoms, fewer compressed segments and less severe cord compression. Better post-operative mJOA scores were associated with younger age, shorter duration of symptoms and higher baseline scores. Using multivariate analysis, baseline and follow-up mJOA scores adjusted for baseline mjOA score were best predicted by age. CONCLUSION: Age and clinical severity scores at admission can both provide valuable information. However, MR imaging features of the spinal cord before surgery cannot accurately predict the functional prognosis for patients with CSM and hence alternative imaging approaches may be required.

PURPOSE: The objective was to determine if particular magnetic resonance, clinical and demographic findings were associated with functional status prior to surgery and predictive of functional outcomes at follow-up. RESULTS: The study included 65 consecutive CSM patients. The modified Japanese Orthopaedic Association Scale (mJOA) was used as the primary outcome measure. Higher baseline mJOA scores were associated with younger age, shorter duration of symptoms, fewer compressed segments and less severe cord compression. Better post-operative mJOA scores were associated with younger age, shorter duration of symptoms and higher baseline scores. Using multivariate analysis, baseline and follow-up mJOA scores adjusted for baseline mjOA score were best predicted by age. CONCLUSION: Age and clinical severity scores at admission can both provide valuable information. However, MR imaging features of the spinal cord before surgery cannot accurately predict the functional prognosis for patients with CSM and hence alternative imaging approaches may be required.

国立情報学研究所で電子化したコンテンツを使用している。

The effectiveness of a Group CBT programme for Social Phobia was assessed using 18 participants recruited from a routine practice setting. Therapy was based on CBT techniques as practiced routinely by the clinical practice, and were not modified for the study by factors such as strict exclusion criteria and adherence to rigid manualised treatments. Pre- to post-treatment effect sizes compared favourably with those reported in a meta-analysis (Taylor, 1996). The findings provide support for the accessibility and effectiveness of group CBT techniques for Social Phobia in field settings. While some individuals within the sample experienced dramatic improvement, some remained severely impaired even at post-treatment. The results of Hierarchical Multiple Regressions indicated that lower levels of pre-treatment depression severity, higher levels of attendance, and greater homework compliance, were predictive of more improvement on some, but not all, measures of outcome. Implications for treatment are discussed.

O objetivo deste estudo foi investigar os fatores de personalidade, de motivação e dados sociodemográficos que interferem na adesão e permanência dos estudantes em cursos na modalidade de Educação a Distância. A investigação destes temas teve o propósito de preencher as lacunas existentes entre a EaD e suas interfaces com a Psicologia. No transcorrer da pesquisa foram percorridas algumas etapas diretamente relacionadas aos objetivos específicos, para tanto, a pesquisa foi didaticamente dividida em dois estudos. Estudo 1 para tradução, adaptação transcultural e validação da escala EMITICE no Brasil que realizou-se em duas fases: (1) tradução, adaptação e teste piloto (N=91), (2) teste de campo e validação (N=466) em alunos de cursos a distância, idades entre 18 a 61 anos (M=34,48; DP=9,56), 171 homens (36,7%) e 295 mulheres (63,3%), de todo o Brasil. Análise fatorial confirmatória dos 5 fatores apresentou boa adequação ao modelo e boa consistência interna para a amostra ( = 0,84). Os resultados são apresentados no artigo 2. O estudo 2 foi dividido em três fases: (1) estudo de cunho bibliográfico sobre a temática adesão, permanência, persistência e evasão na EaD, que está apresentado no artigo 1, (2) estudo exploratório com abordagem dos dados numa perspectiva mista (quali-quantitativa) sobre os motivos da adesão e permanência nessa modalidade. A amostra constituiu-se por 600 sujeitos, com idades entre 18 a 61 anos (M = 32,39; DP = 9,25), 216 homens (36,0%) e 384 mulheres (64%). Os resultados permitiram a categorização de 13 itens para os motivos de adesão e 13 itens para permanência, que, por sua vez, foram organizados em 3 dimensões: questões pessoais ou endógenas ao aluno; questões acadêmicas ou exógenas ao aluno e questões contextuais relacionadas ao que envolve tanto o aluno quanto o curso, apresentados no artigo 3, (3) estudo quantitativo correlacional que objetivou analisar as relações entre motivação, personalidade, variáveis psicossociais e desempenho na EaD, com a mesma amostra da fase 1. Utilizaram-se os instrumentos: BFP, EMITICE e questionário sóciodemográfico. Realizaram-se análises multivariadas e a partir das análises estatísticas os resultados apontam alguns fatores preditores que aumentam a chance de ter um bom desempenho na EaD. Destaca-se que a renda familiar e o empenho, uma faceta do fator Realização contribuem, sendo a habilidade com tecnologia a variável que mais interfere, aumentando em 97% o desempenho na EaD como pode ser lido no artigo 4. / The purpose of this study was to explore factors of personality, motivation and social demographic data that interfere with the student adherence and retention in the Distance Education Courses. The investigation of these topics was focused on filling the gaps which exist between the DE and their interfaces using Psychology. During the research, some stages were passed directly related to specific objectives, therefore the research was didactically divided into two studies. Study 1 for translation, cultural adaptation and validation of the scale EMITICE in Brazil that took place in two phases: (1) translation, adaptation and pilot testing (N = 91), (2) field test and validation (N = 466) in the distance education students, ranging in ages from 18 to 61 years (M = 34.48, SD = 9.56), 171 men (36.7%) and 295 women (63.3%), throughout Brazil. Confirmatory factor analysis of the five factors showed a good model adequacy and good internal consistency for the sample ( = .84). The results are presented in article 2. The study 2 was divided into three phases: (1) a bibliographical study on adherence, retention, persistence and dropout in DE, which is presented in article 1 (2) an exploratory study that approaches the data in a mixed outlook (qualitative and quantitative) concerning the matters of adherence and permanence in this modality. The sample was composed by 600 people, aged between 18 and 61 years (M = 32.39, SD = 9.25), 216 men (36.0%) and 384 women (64%). The results allowed the categorization of 13 items for reasons of adherence and 13 items of permanence, which were organized into three dimensions: personal or endogenous issues in students; academic issues or exogenous in students and contextual issues related to involving both the student and the course presented in Article 3, (3) correlational quantitative study aimed to analyze the relationship between motivation, personality, psychosocial variables and performance in DE, with the same sample of phase 1. BFP, EMITICE and demographic questionnaire were the used instruments. Multivariate analyzes were performed, and from the multivariate statistical analysis, the results show some predictor factors that increase the chance of having a good performance in distance education. It is noteworthy that the family income and its commitment, a facet of the Achievement factor contribute, being the ability with technology the variable that most affects, increasing performance of students by 97% in DE as can be read in Article 4.

Durante décadas, a visão prevalente em ecologia de microrganismos era de que os fatores ambientais locais seriam os únicos agentes estruturantes das comunidades e dos padrões de coexistência das espécies. Entretando, estudos recentes têm fornecido evidência de que processos ligados a dispersão possam ser tão importantes quanto o ambiente local na estruturação das comunidades, reacendendo o debate em torno da hipótese clássica sobre a ubiquidade dos microrganismos. Neste estudo, nós examinamos os padrões de coexistência do fitoplâncton e os possíveis determinantes da variação espacial na composição das comunidades em 9 lagoas do sul do Brasil. Nós testamos se as espécies fitoplanctônicas apresentam um padrão não aleatório de coexistência através de um modelo nulo e se distância espacial ou a distância ambiental possuem relação com a similaridade na composição das comunidades. Nós também investigamos se as variáveis ambientais locais são bons preditores da abundância das espécies. Na análise de coexistência, nós não observamos um padrão significativo de estruturação dentro das lagoas, mas encontramos um padrão não-aleatório e segregado das espécies ao longo das lagoas, indicando que as espécies coexistem menos do que o esperado ao acaso nesta escala. A similaridade na composição das comunidades mostrou correlação significativa com a distância ambiental, mas não foi correlacionada com a distância geográfica entre os sítios. Além disso, a variação na abundância das espécies apresentou correlação significativa com as variáveis ambientais locais (transparência da água, condutividade, nitrato e ortofosfato). Em conclusão, nossos resultados apoiam a visão de que a variação espacial do fitoplâncton é melhor explicada pelo ambiente local. Nós não testamos a influência de variáveis históricas e filogenéticas sobre esses padrões, que podem ser temas de estudos futuros, a fim de elucidar ainda mais essas questões. / For decades, the main hypothesis in microbial ecology was that local environment would be the only mechanism structuring communities and patterns of species coexistence. However, recent studies have provided evidence that processes related to dispersion can be as important as the local environment for shaping biological communities, stimulating new debates on the classical hypothesis about the ubiquity of microorganisms. In this study, we examined the phytoplankton coexistence patterns and possible determinants of spatial variation in community composition in 9 lakes of southern Brazil. First, we use a null model analysis for tested whether the phytoplankton species show a nonrandom pattern of coexistence. We also tested whether spatial distance or environmental distance act as potential factors controlling community composition. Finally, we investigated whether local environmental variables are good predictors of species abundance. We did not observe a significant pattern of coexistence species in the within-lakes analysis, but we found a nonrandom pattern of coexistence and segregation of species across-lakes analysis, indicating that the species coexist less than expected by chance on this scale. Phytoplankton community composition showed a strong positive correlation with the environmental distance but was not correlated with the geographical distance between sites. Moreover, the variation in the abundance of species showed significant correlation with local environmental variables (water transparency, conductivity, nitrate and orthophosphate). In conclusion, our results support the view that the spatial variation of phytoplankton is best explained by the local environmental conditions. We suggest that the influences of historical and phylogenetic variables on these patterns, here not measured, be analyzed in future studies, to further elucidate these questions.