CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A prioridade no tratamento do diabetes à garantir ao paciente seu equilÃbrio metabÃlico e mantÃlo assim, propiciando um estado o mais prÃximo possÃvel da fisiologia normal do organismo. Entretanto, um dos problemas que os profissionais de saÃde encontram à a dificuldade dos pacientes seguirem o tratamento de forma regular e sistemÃtica, pois estes frequentemente sÃo portadores de outras condiÃÃes mÃrbidas, fazendo uso de vÃrias medicaÃÃes alÃm das especÃficas para o diabetes. Este fato dificulta a adesÃo e o uso correto dos esquemas propostos. O objetivo deste estudo foi investigar as caracterÃsticas de adesÃo terapÃutica de portadores de Diabetes mellitus atendidos na rede pÃblica de saÃde no municÃpio de Fortaleza, Cearà e seus fatores relacionados. Foi realizado um estudo transversal, onde foram incluÃdos 140 pacientes atendidos do AmbulatÃrio de Diabetes do Hospital UniversitÃrio Walter CantÃdio (HUWC) e 116 pacientes do Centro de SaÃde AnastÃcio MagalhÃes (CSAM) no ano de 2010, selecionados de forma sequenciada. Para mensurar a prevalÃncia da nÃo adesÃo ao tratamento foi empregado o mÃtodo do autorrelato e considerado adesÃo quando o paciente fazia uso de pelo menos 90% do tratamento proposto. Na anÃlise dos dados foram utilizados o teste de Kalmogorov-Smirnov, teste t de Student, kendall tau b e o coeficiente de contingÃncia, com nÃvel de significÃncia estatÃstica de 5% (p<0,05), utilizando-se o software SPSS (Z14.0). Dos 256 pacientes, houve predomÃnio do sexo feminino (66,8%), casados (53,5%), aposentados (39,1%), com ensino fundamental incompleto (32,4%) e renda familiar mÃdia de 1 salÃrio mÃnimo (39,8%). Quanto à doenÃa, 93,7% possuÃam diabetes tipo 2, com uma mÃdia de 10 anos de diagnÃstico, 75,4% tambÃm eram hipertensos e a principal complicaÃÃo crÃnica encontrada foi a retinopatia (35,9%). As associaÃÃes medicamentosas foram prevalentes entre os pacientes (50,4%) e as drogas de escolha foram sulfonilureia (36,3%) e metformina (66%). A atividade fÃsica foi referida por 43,8% dos pacientes e a dieta por 57%. A adesÃo ao tratamento medicamentoso foi de 74% no CSAM e 77% no HUWC. Fatores relacionados à relaÃÃo profissional-paciente, como a qualidade e frequÃncia das orientaÃÃes, mostraram-se fortemente associados à adesÃo ao tratamento (p<0,001), assim como, os fatores relacionados à doenÃa, onde pacientes com controle bom ou aceitÃvel do diabetes (p<0,007) e que nÃo possuÃam internaÃÃes obtiveram melhor adesÃo (p<0,018). Quanto à influÃncia do sistema de saÃde, pessoas mais satisfeitas e que melhor qualificaram o serviÃo apresentaram melhor adesÃo (p<0,045). Na anÃlise clÃnica houve predomÃnio do sobrepeso (39,5%) e obesidade (32%). As medidas alteradas de circunferÃncia abdominal (65,6%), cervical (68,8%) e relaÃÃo cintura-quadril (78,1%) estiveram presentes em grande parte dos pacientes do CSAM e HUWC. Os valores antropomÃtricos alterados nÃo apresentaram diferenÃa na anÃlise da adesÃo. Quanto aos exames laboratoriais, em ambos os locais, a maioria dos pacientes que apresentaram adesÃo estava com glicemia de jejum (65,1%), pÃs-prandial (61,7%) e hemoglobina glicada (68,1%) acima dos valores recomendados. Identificou-se um elevado nÃmero de fatores que podem influenciar na adesÃo ao tratamento, sendo um problema frequente na prÃtica clÃnica. As taxas nÃo satisfatÃrias de adesÃo à terapÃutica farmacolÃgica podem justificar possivelmente o mau controle metabÃlico entre os pacientes. Traduzem a necessidade de se ampliar o foco na atenÃÃo integral a estas pessoas.

Employment is an important goal for many individuals with disabilities. Research indicates that behavioral techniques are effective in increasing task completion of individuals with disabilities in vocational training settings. Yet, limited research has examined the use of self-monitoring for increasing task completion of adults with disabilities receiving vocational training for future employment. Furthermore, few studies have focused on promoting the maintenance of improved vocational task completion among this population. Therefore, the primary purpose of this study was to extend the literature by examining the impact of self-monitoring on independent correct vocational task completion of four adults with disabilities within a vocational training setting. The results indicated that across participants the levels of their target vocational task completion performance remained low during baseline, even with repeated exposure. During the intervention there was immediate level changes for all participants, three out of four reaching 3 or more consecutive sessions with 100%. During the maintenance follow-up their performance levels still remained higher than baseline with minor decline trends compared to intervention. Implications, limitations, and recommendations for future research are discussed.

This thesis explored relationships (1) between composite and constituent processes of self-regulated learning (SRL) and three sport performance groups, (2) between SRL and different practice variables, and (3) whether these associations depended on an athlete’s consideration of future consequences (CFC). Athletes (N = 272; 200 males; 18-35 yrs; M practice = 13.55 hours/week) completed survey measures for SRL, weekly training including deliberate practice (DP), performance level and CFC. Higher scores in composite SRL were associated with a greater chance of belonging to an elite group, compared to a less-elite and a recreationally competitive group. Self-monitoring predicted greater likelihood of membership in less-elite and elite groups compared to the recreationally competitive group. Self-monitoring predicted greater engagement in total DP hours, and DP in supervised and unsupervised settings. Effort, self-efficacy, and planning were notable in some results, but contributions were less significant. CFC had no moderating effect, however it was correlated with SRL.

Students with challenging behavior, including those with or at risk for emotional and behavioral disorders, demonstrate emotional, social, academic and behavioral problems that need support within and outside of school. To this end, self-monitoring has been identified through the literature as a promising approach for remediating challenging behaviors like off-task behaviors, disruptive behavior, and non-academic engagement. Although reinforcement is often included as a component of self-monitoring interventions, the literature is unclear whether reinforcement is necessary. Thus, in this study, a single subject research design ABCBC multi-treatment design was used to investigate the effects of a technology-based self-monitoring intervention with and without reinforcement for two elementary students with behavioral problems. Overall, students benefitted from the intervention, but reinforcement did not result in differential effects. Limitations and implications for further research is streamlined.

Autism spectrum disorder (ASD) affects the lives of 1 in 54 children in the United States. By definition, these children often have social communication deficits as well as restrictive and repetitive behaviors that are socially isolating. Inclusion of participants with disabilities such as ASD in classroom or group settings with peers is a high-priority goal for building skills that lead to independent living and higher quality of life for all. Balancing an individual’s class or group participation is not always easy with different levels of social skills, however. In a classroom, this can translate to difficulty in knowing how to participate in a way that is equal to that of their peers—oftentimes children with ASD do not realize that others also need a turn to speak or that other children are not as interested in their restricted ¬interests as they are. We used differential reinforcement and self-monitoring within an existing token system to reduce excess participation in group settings for some individuals, with the goal of better balancing opportunities for all group members to participate. Called "Stack the Deck," this simple intervention allowed for more uninterrupted instruction time with fewer talk outs and meltdowns from adolescents with ASD. Our intervention occurred in a clinical setting, a once-weekly social skills group utilizing the PEERS Social Skills manualized intervention for adolescents with ASD. Groups ran for 12–14 weeks in duration and taught skills such as how to make friends, how to enter and exit conversations, as well as how to host "get-togethers." Our sample size was 33, with 26 males and 7 females. These participants met criteria for autism spectrum disorder and/or had significant social impairment, and had age-appropriate verbal and cognitive abilities by parent report (later measured within the study). Across our A-B intervention, we saw changes over time when it came to participation rates for over-responders (participants who attempted to respond far above the group average during baseline) and under-responders (participants who attempted to respond at rates far below the group average during baseline), with no changes (the desired result) for individuals who were already participating at an appropriate rate. Over-responders showed the most significant changes. A secondary finding of reduced talk-outs overall within the groups was also found. These results suggest that a fairly simple group behavioral intervention was able to produce a group environment more conducive to direct instruction that has direct application to inclusive classrooms as well as clinical environments. Further research can determine if the effects within individuals seen in one setting carry over to others.

<p>Research shows the significance that communication patterns, beliefs, and behaviors hold within a multitude of relationship types. Unfortunately, the same research also shows that effective or positive communication is still not occurring as often as we think. Communicative interaction breaks down, fails, or is utilized negatively more often when emotionally charged topics are at the forefront of the conversation, most often due to reported personal discomfort. This negative interaction, and the subsequent breakdown in communication, can foster a snowball effect – decreasing relationship and sexual satisfaction. This study was aimed to discover how perceived comfort levels contributes to the lack of communication of certain topics and how it is affecting relationship and sexual satisfaction. The type of communicative process that occurs will affect the sexual satisfaction and relationship satisfaction. Through an online survey, participants anonymously responded to statements related to these concepts in order to test relationships. Overall, it was found that respondents’ participation in self-monitoring, as well as what method of communication they use, strongly influenced their comfort disclosing on different topics. Their comfort did not have significant influence on their then communication process. It was also found that communication processes influence couple’s relationship and sexual satisfaction. These results urge marriage and family therapists to update their clinical toolboxes and add self-monitoring to their conceptualization when working with couples. </p>

School Wide Positive Behavior Supports includes three tiers of support for students. Some students continue to struggle with following school expectations with only tier one supports in place and thus need additional supports. Because of this, tier two interventions have been created to help support these students. Self-monitoring and Check-In/Check-Out (CICO) are both tier two interventions and have been used independently to decrease problem behavior. This study combined these two interventions to teach students to monitor their own behavior and in addition get feedback from their teacher which is already a component of the CICO intervention. A multiple baseline across participants design was used to evaluate the effects of CICO with self-monitoring. Results indicated that CICO with self-monitoring was effective in reducing off-task behavior for one participant while two other participants required the addition of more immediate reinforcement to decrease off-task behavior.

One of the greatest challenges facing school staff is problem behavior in the classroom (Public Agenda, 2004). Children who engage in problem behavior in the classroom setting greatly challenge teachers and diminish the ability to learn. This study evaluated the effects of self-monitoring using the Individualized Behavior Rating Scale Tool (IBRST) on problem behavior and on-task behavior in a classroom setting using a multiple-baseline across participants design. This study also evaluated the extent to which students self-rating on the IBRST correlated with direct observation data. Results indicate that self-monitoring using the IBRST was an effective strategy for increasing on-task behavior and decreasing problem behavior for all three students. Results also indicate that the IBRST may be an accurate and reliable means of measuring data when direct observation data may not be feasible or possible. There were 56/60 perfect agreements, with the other four opportunities being only 1-pt value apart. Limitations and future research are discussed.

The current literature on self-monitoring provides limited information on increasing functional communication skills in students with disabilities by incorporating function-based intervention. The purpose of this study was to extend self-monitoring literature by incorporating functional communication training (FCT) into self-monitoring intervention and targeting students who engage in problem behavior due to communication difficulties. Three students with disabilities served in kindergarten through 3rd grade and their corresponding teachers participated in this study. A multiple baseline across participants design with an ABC sequence was used to investigate the impact of function-based self-monitoring (SM) with FCT only and function-based SM with FCT augmented with differential reinforcement of alternative behavior (DRA) on student functional communicative behavior, academic engagement, and problem behavior. The results indicated that the function-based SM with FCT was effective in increasing functional communicative behavior and academic engagement behavior and decreasing problem behavior for all participating students. The addition of DRA further improved behavioral outcomes for one student. Results were maintained for three participants while fading the magnitude of the intervention. Students and teachers rated the function-based SM treatment package as effective and acceptable.

This thesis is examining in which way the quantified self approach can have the effect on motivation in the process of education. The aim of this thesis is to determine whether the usage of application which is tracking and recording the study progress can have the influence on motivation of users and moreover, to evaluate the most effective motivational techniques used in these kinds of applications. Firstly, terms like motivation, self-regulated learning and the Quantified Self movement are clarified. Moreover, some of the researches from the field of tracking of educational and self-educational progress are described. Furthermore, various of motivational techniques are examined. In the part of the research, by the in-depth interviews it is examined the influence of the application Todait on the motivation of users and by the quantitative survey of questionnaire it is inquired what other functions would users prefer.