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This is a qualitative study that was intended to analyse the role of South African Police Services (SAPS) railway policing in crime prevention in South Africa (SA). Commuters are exposed to various criminal activities in the railway environment. The Metro Rail trains are the most affordable trains and for that reason, the majority of commuters use these trains to travel to and from their workplaces. This study focused on the large stations in the Gauteng province, South Africa, as there is a high influx of people coming from various provinces for job opportunities. Alexander (2019:np) states that Gauteng is the smallest province, but has the largest population and economy. The non-random sampling procedure was used to select participants. Data was collected by means of perusing the existing literature, SAPS information notes, official documents and articles. Interviews were conducted with South African Police Service Rapid Rail Unit (SAPSRRPU) members. Each unit was represented by a maximum of eight members. The information obtained from the participants was analysed by using the Atlas-ti software. This is a computer program used to analyse data in qualitative research. / Iyi ndi ngudo ya ndeme i itelwaho u saukanya mushumo wa yunithi ya vhupholisa ha raliwei ya Tshumelo ya Tshipholisa ya Afrika Tshipembe (SAPS) kha u thivhela vhugevhenga Afrika Tshipembe (SA). Vhaṋameli vha livhanwa na nyito dzo fhambanaho dza vhugevhenga kha vhupo ha raliwei. Zwidimela zwa Metrorail ndi zwone zwidimela zwi sa ḓuresi, nahone nga ṅwambo wa izwo vhunzhi ha vhaṋameli vha shumisa zwidimela izwi u enda u ya na u bva mishumoni yavho. Ngudo iyi yo sedza kha zwiṱitshi zwihulwane zwa vundu ḽa Gauteng, Afrika Tshipembe, saizwi hu na vhathu vhanzhi vha bvaho kha mavundu o fhambanaho vhane vha khou ṱoḓana na zwikhala zwa mushumo. Alexander (2019:np) u bula uri Gauteng ndi vundu ḽiṱukusa, fhedzi ḽi na tshitshavha tshinzhisa na ikonomi. Tsumbonanguludzwa dzi songo tou khethwa dzo shumiswa u nanga vhadzheneleli. Data yo kuvhanganywa nga kha u fhenḓa maṅwalwa a re hone. Notsi dza mafhungo dza SAPS, maṅwalo a tshiofisi na athikili. Inthaviwu dzo itwa na miraḓo ya Yunithi ya Tshipholisa tsha Raḽiwei tshi Ṱavhanyaho tsha Tshumelo ya Tshipholisa tsha Afrika Tshipembe (SAPSRRPU). Yunithi iṅwe na iṅwe yo vha yo imelelwa nga gumofulu ḽa miraḓo ya malo. Mafhungo o wanalaho u bva kha vhadzheneleli o senguluswa nga u shumisa sofuthiwee ya Atlas-ti. Phurogireme ya khomphiyutha iyi I shumiswa u saukanya data kha ṱhoḓisiso dza ndeme. / Ndzavisiso lowu wa qualitative wu na xikongomelo xo xopaxopa ndzima ya yuniti ya vutirheli bya maphorisa ya Afrika Dzonga ku nga South African Police Services (SAPS) eka ku sivela vugevenga eAfrika Dzonga. Vakhandziyi va xungetiwa hi vugevenga bya mixaka yo hambanana eka tirhalaweyi ta switimela. Switimela swa Metrorail swi chipile swinene, hikokwalaho, vanhu vanyingi va vakhandziyi va tirhisa switimela ku ya na ku vuya emitirhweni. Ndzavisiso lowu wu languta ngopfu switici leswikkulu swa switimela eka xifundzhankulu (provhinsi) ya Gauteng eAfrika Dzonga hikuva ku na vanhu vanyingi lava va sukaka eka swifundzhankulu swin'wana ku ta ejoni ku ta lava mitirho. Alexander (2019:np) u vula leswo Gauteng i xifundzhankulu xitsongo swinene eka swin'wana, kambe xi na vanhu vanyingi swinene na ikhonomi leyikulu swinene. Ku tirhisiwe fambiselo leri vuriwaka non-random sampling ku hlawula vanhu vo va na xiavo eka ndzavisiso. Data yi hlengeletiwe hi ku hlaya matsalwa lama nga kona, tinoti ta vutivi ta SAPS, na tidokumente ta ximfumo na tiatikili. Ku endliwe ti-inthavhyu na swirho swa maphorisa ya rhalaweyi ku nga South African Police Service Rapid Rail Police Unit (SAPSRRPU). Yuniti yin'wana na yin'wana a yi yimeriwe hi swirho swa nhungu. Vutivi lebyi byi nga kumeka eka lava a va ri na xiavo byi ve byi xopaxopiwa hi ku tirhisa Atlas-ti software. Leyi i program ya khompyuta leyi tirhisiwaka ku xopaxopa data eka rhiseche leyi endliwaka hi ndlela ya qualitative eka mindzavisiso. / Criminology and Security Science / Ph. D. (Criminal Justice)

This research project explores whether the delivery of positive psychology interventions in the workplace through an employee assistance program (EAP) can improve employees’ authentic happiness/flourishing as well as decrease symptoms of depression. A small convenience sample of 13 Manitoba public school educators accessing employee assistance were recruited for a quasi-experimental research design. Nine participants were randomly assigned to the experimental group and the remaining participants assigned to the control. Experimental group members participated in a six session psychoeducational, experiential, and process-oriented positive psychotherapy group that met once a week over six weeks. Experimental group participants’ scores on the authentic happiness/flourishing measure increased by a statistically significant 9% and depression scores decreased by a statistically significant 45% from pre-intervention to one month post-intervention. The study’s findings therefore provide promising confirmation that positive psychology interventions delivered through EAPs can make a meaningful difference as both secondary prevention and primary enhancement strategies in the workplace.

Rapid escalation of Subclinical Eating Disorders (SED) in the form of high levels of body–dissatisfaction (BD) and drive for thinness (DT) globally and locally, and the at–risk status of university females are underscored by recent studies. As yet there exists no South African program tailored to the needs of afflicted female students and which includes a risk–protective focus grounded in Positive Psychology theory. In this chapter a theoretical overview on the nature and definition of SED, its prevalence and the rationale for a risk–protective focus grounded in Positive Psychology theory are provided. Thereafter three preliminary South African studies, namely two correlation studies (De Pãz Fransisco, 2007; Kirsten, Du Plessis & Swanepoel, 2010) and the Weight Over–concern and Well–being program of Kirsten, Du Plessis and Du Toit (2007) are discussed. Findings of these preliminary studies highlight the promise of utilizing Positive Psychology theoretical approaches to practically significantly reduce risk factors and promote protective factors. As such, Well–being therapy (Fava & Ruini, 2003) that promotes the six dimensions of psychological well–being (Ryff & Keyes, 1995), and Self–Determination Theory (Ryan & Deci, 2000) that can promote true self–esteem in the form of self–determination and mindfulness (Kabat–Zinn, 1998), with its inherent self–compassion, kindness and self–forgiving manner, show promise. More in–depth studies with larger samples are however needed. / Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2012.

This research project explores whether the delivery of positive psychology interventions in the workplace through an employee assistance program (EAP) can improve employees’ authentic happiness/flourishing as well as decrease symptoms of depression. A small convenience sample of 13 Manitoba public school educators accessing employee assistance were recruited for a quasi-experimental research design. Nine participants were randomly assigned to the experimental group and the remaining participants assigned to the control. Experimental group members participated in a six session psychoeducational, experiential, and process-oriented positive psychotherapy group that met once a week over six weeks. Experimental group participants’ scores on the authentic happiness/flourishing measure increased by a statistically significant 9% and depression scores decreased by a statistically significant 45% from pre-intervention to one month post-intervention. The study’s findings therefore provide promising confirmation that positive psychology interventions delivered through EAPs can make a meaningful difference as both secondary prevention and primary enhancement strategies in the workplace.

Rapid escalation of Subclinical Eating Disorders (SED) in the form of high levels of body–dissatisfaction (BD) and drive for thinness (DT) globally and locally, and the at–risk status of university females are underscored by recent studies. As yet there exists no South African program tailored to the needs of afflicted female students and which includes a risk–protective focus grounded in Positive Psychology theory. In this chapter a theoretical overview on the nature and definition of SED, its prevalence and the rationale for a risk–protective focus grounded in Positive Psychology theory are provided. Thereafter three preliminary South African studies, namely two correlation studies (De Pãz Fransisco, 2007; Kirsten, Du Plessis & Swanepoel, 2010) and the Weight Over–concern and Well–being program of Kirsten, Du Plessis and Du Toit (2007) are discussed. Findings of these preliminary studies highlight the promise of utilizing Positive Psychology theoretical approaches to practically significantly reduce risk factors and promote protective factors. As such, Well–being therapy (Fava & Ruini, 2003) that promotes the six dimensions of psychological well–being (Ryff & Keyes, 1995), and Self–Determination Theory (Ryan & Deci, 2000) that can promote true self–esteem in the form of self–determination and mindfulness (Kabat–Zinn, 1998), with its inherent self–compassion, kindness and self–forgiving manner, show promise. More in–depth studies with larger samples are however needed. / Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2012.

Made available in DSpace on 2011-05-04T12:36:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Trata-se de uma avaliação tecnológica parcial da prevenção secundária da fratura de fêmur osteoporótica, através de screening com densitometria óssea e drogas antiosteoporóticas, comparada com a alternativa expectante, com relação a mulheres de 65 anos ou mais; essas alternativas foram complementadas ou por cuidado regular, corrente no SUS, ou pela atenção dispensada no Instituto Nacional de Traumatologia e Ortopedia INTO, considerada de excelência, incluindo, de rotina, o cuidado reabilitativo hospitalar e domiciliar. Mais que selecionar as alternativas mais efetivas para a gestão da atenção ao problema fratura osteoporótica de fêmur, o estudo teve a finalidade de fornecer subsídios para a condução de análises subseqüentes de custo-efetividade e de custo-utilidade. Duas análises de decisão, complementares, foram elaboradas para desenvolver o estudo; elas foram baseadas em um modelo subjacente da história clínica da fratura osteoporótica de fêmur. A 1ª análise de decisão focalizou alternativas de prevenção secundária rastreamento da osteoporose, com tecnologia de densitometria óssea, e administração de antiosteoporótico ou, apenas, o uso de cálcio e vitamina D versus a alternativa expectante, tendo como desfecho fraturas de fêmur. A segunda análise de decisão abrangeu a alternativa antiosteoporótica mais efetiva, segundo a análise anterior, e a alternativa expectante, ambas complementadas ou por cuidado regular, corrente no SUS, ou pela atenção dispensada no Instituto Nacional de Traumatologia e Ortopedia INTO, nos casos de fraturas de fêmur, tendo como desfechos vidas salvas e anos de vida ganhos. As árvores de decisão foram preenchidas com valores sugeridos pela melhor evidência disponível. Especificamente, a comparação dos efeitos dos antiosteoporóticos avaliados teve por base os resultados de ensaios clínicos bem desenhados. Dados do SIH-SUS foram utilizados para a estimativa relativa à atenção regular no SUS; dados de pacientes do Instituto Nacional de Traumatologia e Ortopedia INTO foram obtidos a partir de estudo prospectivo específico conduzido naquele serviço. O presente estudo não mostrou diferença na efetividade dos diferentes antiosteoporóticos avaliados em termos de fraturas evitadas. A maioria dos poucos estudos existentes apresenta limitações metodológicas, havendo necessidade de mais avaliação desses medicamentos para se conhecer o real benefício do uso dos mesmos, principalmente, no longo prazo. Os resultados do presente trabalho indicam que as medidas de prevenção secundária de fraturas osteoporóticas são pouco efetivas, acrescentando um pequeno número de anos de vida ganhos à alternativa expectante. Não é possível afirmar que a prevenção secundária deve ser indicada para implementação e difusão no sistema de saúde público brasileiro. Para isso, é necessária a condução de análises de custo-efetividade e de custo-utilidade, levando em conta as alternativas comparadas até a fase terapêutica e reabilitadora. Em termos de vidas salvas e anos de vida ganhos, os serviços do SUS em geral mostraram melhores resultados do que o INTO para a taxa geral de letalidade hospitalar e para as taxas de letalidade segundo sexo, faixa etária e tipo de fratura. No entanto, esses resultados, provavelmente, não refletem diferenças de efetividade técnica, considerando que o INTO é um centro de excelência do SUS e centro de referência em traumatologia, que compreende procedimentos eficazes de reabilitação, em nível hospitalar e doméstico, de rotina, o que é infreqüente no SUS em geral. Para melhor comparar a efetividade técnica do SUS e do INTO é imprescindível uma análise da estrutura de risco dos respectivos pacientes e o corrrespondente ajuste, o que não foi possível, dado a limitação dos dados disponíveis no SIH-SUS. Também, para melhor comparar as alternativas de prevenção secundária e expectante, dos pontos de vista do SUS e da sociedade, é necessária a condução de análises de custo-efetividade e de custo-utilidade, considerando a avaliação da efetividade com o ajuste de risco, de forma a subsidiar o gestor do SUS quanto à melhor alternativa, daqueles pontos de vista, na tomada de decisão quanto à oportunidade do uso de recursos escassos na melhoria da efetividade técnica e eficiência do SUS em relação ao problema fratura de fêmur osteoporótica. / The present study constitutes a partial health technology assessment of secondary prevention of osteoporotic hip fractures through screening, composed by bone densitometry and antiosteoporotic drugs, compared with the expectant alternative, regarding women ≥ 65 year old; those alternatives were complemented by either average care or special care for the corresponding hip fractures. Other than selecting the most effective strategies for the management of the problem osteoporotic hip fractures, the present study had the purpose of providing information to conduct costeffectiveness and cost-utility analyses. Two decision analyses were elaborated to carry out the study; they were based on a previously designed subjacent model of the clinical history of osteoporotic fractures. The first decision analysis focused on the screening composed by bone densitometry and antiosteoporotic drugs compared with the expectant alternative. The second decision analysis encompassed the most effective secondary prevention strategy,according to the first analysis, and the expectant strategy, both alternatives complemented by either average care or special care (National Institute of Traumatology and Orthopedics) for the corresponding hip fractures. Decision tree figures were filled in using the best evidence available. Specifically, the comparison of the effects of antiosteoporotic drugs was carried out through the analysis of the evidence produced by well designed trials; Brazilian Hospital Information System- SIH/SUS databases as well as clinical data produced by a prospective study conducted at the National Institute of Traumatology and Orthopedics were used to provide the figures related to hip fractures care. The first decision analysis suggests that secondary prevention measures have low effectiveness in preventing hip fractures as compared to the expectant alternative. The second decision analysis showed low effectiveness of secondary preventive technologies in terms of saved lives and years of live saved. In order to recommend or not the implementation and dissemination of the most favorable screening alternative in the Brazilian public health system, it is essential to conduct a cost-effectiveness analysis. The study showed that the average overall hospital mortality rates as well as the average hospital mortality according to sex and according to age strata at the Brazilian public Health System were lower than those observed at the National Institute. However, these results do not probably reflect differences in effectiveness of hospital plus rehabilitative care as many other powerful prognostic factors, such as interval time 8 between fracture and hospital admission, as well as comorbidities, were not taken into account to adjust the outcomes because they are not registered by the Brazilian Hospital Information System- SIH/SUS.

Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers. Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function. Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers. Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.

Dans les pays industrialisés tels que le Canada, les maladies chroniques non transmissibles comme le diabète et les maladies cardiovasculaires sont responsables de la majorité de la mortalité prématurée. Les comportements liés à la santé, comme le tabagisme, ont un impact majeur sur le développement de ces maladies. Les infirmières et les infirmiers , par le biais d’une approche motivationnelle nommée counseling bref en changement de comportement (CBCC), peuvent soutenir les patients dans le changement de comportement lié la santé. Toutefois, les études soulignent des barrières inhérentes à la mise en œuvre du CBCC par les infirmières en milieu hospitalier, comme le manque d’habiletés et des normes sociales défavorables. Cette thèse par articles présente les résultats d’une étude visant à (1) développer un programme de formation numérique adaptatif basé sur la théorie portant sur le CBCC pour la promotion de la cessation tabagique, l’adoption de saines habitudes alimentaires et l’adhésion aux traitements médicamenteux (E_MOTIVA) et (2) évaluer son effet auprès d’infirmières et d’étudiantes en sciences infirmières par un essai clinique à répartition aléatoire (ECR) en comparaison avec un programme de formation numérique standardisé partiellement basé sur la théorie (E_MOTIVB). Le programme E_MOTIVA a été développé selon une démarche systématique en fonction d’appuis empiriques et théoriques, incluant la Théorie du Comportement Planifié, la Théorie de la Charge Cognitive et le concept d’engagement. Le contenu du programme E_MOTIVA a été développé de manière à cibler les barrières et les déterminants théoriques associés à la mise en œuvre du CBCC chez des infirmières et des étudiantes en sciences infirmières (p. ex., attitude, normes subjectives, connaissances, intention). L’adaptation du programme E_MOTIVA a été opérationnalisée à différents moments lors du parcours d’apprentissage afin d’optimiser la charge cognitive et l’engagement des infirmières et étudiantes. Le programme E_MOTIVA incluait trois sessions de formation durant respectivement un maximum de 50, 60 et 20 minutes. Il pouvait être complété en ligne depuis un téléphone intelligent, une tablette ou un ordinateur. Nous avons mené un ECR à deux groupes parallèles en simple aveugle auprès de 102 infirmières et étudiantes inscrites dans un programme de baccalauréat en sciences infirmières au Canada afin d’évaluer le programme E_MOTIVA (groupe expérimental ; n = 51) en comparaison avec le programme E_MOTIVB (groupe contrôle ; n = 51). L’effet des programmes a été évalué sur 1) le changement dans l’intention de mettre en œuvre du CBCC pour la promotion de la cessation tabagique, l’adoption de saines habitudes alimentaires et l’adhésion aux traitements médicamenteux (H1) ; 2) les changements dans les variables de la Théorie du Comportement Planifié (H2 à H7) ; 3) la charge cognitive (H8 à H10) ; et 4) l’engagement (H11, H12). Les analyses de covariance n’ont indiqué aucune différence significative dans les scores de changement dans l’intention de mettre en œuvre du CBCC entre deux groupes de l’étude. Cependant, le score de changement dans l’intention était plus élevé dans le groupe expérimental (10,22 ± 3,34) que dans le groupe contrôle (9,04 ± 2,80) (p = 0,787). Il n’y avait pas de différence significative entre les groupes quant aux changements sur le plan des autres variables de la Théorie du Comportement Planifié. Dans les deux groupes, les scores d’intention (H1), d’attitude (H2), de normes subjectives (H3), de contrôle comportemental perçu (H4), de croyances comportementales (H5) et de croyances de contrôle (H7) se sont tous améliorés de manière significative entre les mesures de base et finales. Aucune différence significative n’a été observée entre les groupes concernant la charge cognitive et l’engagement. Cette étude a permis de développer un programme de formation numérique adaptatif basé sur la théorie (E_MOTIVA) portant sur le CBCC destiné aux infirmières et aux étudiantes en sciences infirmières. Les résultats suggèrent que les programmes E_MOTIVA et E_MOTIVB ont eu des effets positifs similaires sur le plan de l’intention de mettre en œuvre du CBCC chez les infirmières et les étudiantes. Des recommandations sont formulées à l’effet d’orienter la recherche vers la distinction entre l’approche basée sur la théorie et le processus d’adaptation et d’explorer des avenues de recherche visant la transformation de l’intention de mettre en œuvre du CBCC en sa mise en œuvre effective en pratique. / In industrialized countries such as Canada, chronic noncommunicable diseases such as diabetes and cardiovascular disease are the cause of most premature mortality. Unhealthy behaviors, such as smoking, have a major impact on the development of these diseases. Nurses can support patients in initiating and sustaining health behavior change through a motivational and collaborative approach called brief behavior change counseling (BBCC). However, studies highlight several barriers to nurses’ implementation of BBCC in hospitals, including lack of skills and unfavorable social norms. This thesis by articles presents the result of a study aiming to (1) develop a theory-based adaptive e-learning program on BBCC for the promotion of smoking cessation, the adoption of healthy eating habits and medication adherence (E_MOTIVA), and then (2) to evaluate its effect with nurses and nursing students in a randomized controlled trial (RCT) compared with a standardized e-learning program partially based on theory (E_MOTIVB). The E_MOTIVA program was developed following a systematic approach and informed by empirical data and theory, including the Theory of Planned Behavior, Cognitive Load Theory and the concept of engagement. The content of the E_MOTIVA program has been developed in such a way as to target the barriers and theoretical determinants of BBCC implementation in nurses and nursing students (e.g., attitude, subjective norms, knowledge, intention). The adaptation of the E_MOTIVA program was operationalized at different times during learning to optimize cognitive load and engagement in nurses and students. The E_MOTIVA program included three training sessions lasting respectively a maximum of 50, 60 and 20 minutes. It could be completed over the Internet from a smartphone, tablet or computer. We then conducted a two group, single blind, RCT with 102 nurses and students enrolled in a baccalaureate nursing program in Canada to evaluate the E_MOTIVA program (experimental group; n = 51) compared to the E_MOTIVB standardized e-learning program partially based on theory (control group; n = 51). The effect of the programs was assessed on: 1) change in intention to implement BBCC for promoting smoking cessation, adoption of healthy eating habits, and medication adherence (H1); 2) changes in the theoretical variables of the Theory of Planned Behavior (H2 to H7); 3) cognitive load (H8 to H10); and 4) experiential and behavioral engagement (H11, H12). Analyzes of covariance indicated no significant difference in the scores of change in intention to provide BBCC between the two study groups. However, the change in intention score was higher in the experimental group (10.22 ± 3.34) than in the control group (9.04 ± 2.80) (p = 0.787). There was also no significant difference between the two groups in the changes in the other variables of the Theory of Planned Behavior. In both groups, scores for intention (H1), attitude (H2), subjective norms (H3), perceived behavioral control (H4), behavioral beliefs (H5) and control beliefs (H7) all improved significantly between baseline and final measures. No significant difference was observed between groups in cognitive load and engagement. This study led to the development of a theory-based adaptive e-learning program (E_MOTIVA) on BBCC for nurses and nursing students. The results suggest that the E_MOTIVA and E_MOTIVB programs had similar positive effects in terms of intention to implement BBCC in nurses and students. Recommendations are made to guide future research towards the distinction between the theory-based approach and the adaptation process and to explore research avenues related to the transformation of the intention to provide BBCC into its actual provision in clinical practice.