Effects of Coping Skills Training in School-age Children with
Type 1 Diabetes
Margaret Grey, DrPH, RN, FAAN[Dean and Annie Goodrich Professor],
Yale School of Nursing, New Haven, CT
Robin Whittemore, PhD, APRN[Associate Professor],
Yale School of Nursing
Sarah Jaser, PhD[Post-doctoral Associate],
Yale School of Nursing
Jodie Ambrosino, PhD[Clinical Instructor],
Department of Pediatrics, Yale School of Medicine
Evie Lindemann, LMFT, ATR[Assistant Professor],
Albertus Magnus College, New Haven, CT
Lauren Liberti, MS[Trial Coordinator],
Yale School of Nursing
Veronika Northrup, MPH, and
Yale Center for Clinical Investigations, New Haven, CT
James Dziura, PhD
Yale Center for Clinical Investigations, New Haven, CT
Abstract
Children with type 1 diabetes are at risk for negative psychosocial and physiological outcomes,
particularly as they enter adolescence. The purpose of this randomized trial (n=82) was to
determine the effects, mediators, and moderators of a coping skills training intervention (n=53) for
school-aged children compared to general diabetes education (n=29). Both groups improved over
time, reporting lower impact of diabetes, better coping with diabetes, better diabetes self-efficacy,
fewer depressive symptoms, and less parental control. Treatment modality (pump vs. injections)
moderated intervention efficacy on select outcomes. Findings suggest that group-based
interventions may be beneficial for this age group.
Keywords
coping skills training; child; type 1 diabetes
Effects of Coping Skills Training in School-age Children with Type 1
Diabetes
Type 1 diabetes (T1D) is one of the most common severe chronic illnesses in children,
affecting 1 in every 400 individuals under the age of 20, over 176,000 American youth
Corresponding Author: Robin Whittemore, Yale School of Nursing, 100 Church Street South, New Haven, CT 06536-0740,
[email protected]
NIH Public Access
Author Manuscript
Res Nurs Health. Author manuscript; available in PMC 2010 August 1.
Published in final edited form as:
Res Nurs Health. 2009 August ; 32(4): 405–418. doi:10.1002/nur.20336.
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(National Institute of Diabetes and Digestive and Kidney Disease, 2002). Diabetes is the
seventh leading cause of death in the United States, and adults with T1D are twice as likely
to die prematurely from complications compared to adults without T1D National Institute of
Diabetes and Digestive and Kidney Disease, 2007). Management of T1D is demanding,
requiring frequent monitoring of blood glucose levels, monitoring and controlling
carbohydrate intake, daily insulin treatment (3-4 injections/day or infusion from a pump),
and adjusting insulin dose to match diet and activity patterns (American Diabetes
Association, 2008). Such an intensive treatment regimen and maintenance of near-normal
glycemic control may delay or prevent long-term complications of T1D by 27-76%
(Diabe ...
1) The document describes a randomized trial that tested the effects of a coping skills training (CST) intervention for school-aged children (ages 8-12) with type 1 diabetes compared to general diabetes education.
2) Both groups showed improvements over time in outcomes like impact of diabetes, coping abilities, self-efficacy, depressive symptoms and parental control. However, treatment modality moderated some intervention effects.
3) The CST intervention aimed to teach children and parents more constructive coping behaviors to help with the transition to adolescence and diabetes management responsibilities. Preliminary short-term results were promising for improved family functioning and life satisfaction compared to education.
1) The document describes a randomized trial that tested the effects of a coping skills training (CST) intervention for school-aged children (ages 8-12) with type 1 diabetes compared to general diabetes education.
2) Both groups showed improvements over time in outcomes like impact of diabetes, coping, self-efficacy, depressive symptoms, and parental control. However, treatment modality moderated some intervention effects.
3) The CST intervention aimed to teach children and parents more constructive coping behaviors to help with the transition to adolescence and diabetes management responsibilities. Preliminary short-term results were promising for family functioning and life satisfaction.
E D I T O R I A LInvited Commentary Childhood and Adolesc.docxbrownliecarmella
E D I T O R I A L
Invited Commentary: Childhood and Adolescent Obesity:
Psychological and Behavioral Issues in Weight Loss Treatment
David B. Sarwer • Rebecca J. Dilks
Received: 5 May 2011 / Accepted: 11 May 2011 / Published online: 31 May 2011
� Springer Science+Business Media, LLC 2011
Abstract The prevalence of childhood and adolescent
obesity has tripled in the past three decades. This increase
has been accompanied by a dramatic rise in obesity-related
health complications among American youth. Thus, many
obese youth are now experiencing illnesses that will
threaten their life expectancy in the absence of significant
weight loss. Despite these concerns, a relatively modest
body of research has focused on the treatment of adolescent
obesity. Results from trials investigating the efficacy of
behavioral and pharmacological treatments, like studies of
these interventions with adults, suggest that individuals
typically lose 5–10% of their initial weight. Unfortunately,
weight regain is common. Given the increase in the number
of obese adolescents, coupled with the modest results from
more conservative treatment approaches, it is not surprising
that bariatric surgery for adolescents who suffer from
extreme obesity has grown in popularity. The weight losses
after surgery are impressive and many adolescents, like
adults, experience significant improvements in their phys-
ical and mental health postoperatively. However, only a
small fraction of adolescents and adults who are heavy
enough for bariatric surgery present for surgical treatment.
Among those who undergo surgery, a significant minority
appear to struggle with a number of behavioral and psy-
chosocial issues that threaten their lifelong success. With
all of this in mind, the current obesity problem in the
United States and other Westernized countries likely will
present a significant challenge to both current and future
medical and mental health professionals who work with
adolescents and young adults.
The Childhood and Adolescent Obesity Problem
Obesity is a growing problem among America’s youth. The
rate of obesity or overweight ([95th percentile for age and
gender) has doubled among children and tripled among
adolescents over the last 20 years (Ogden et al. 2002). The
most recent data suggests that 31% of children in the United
States are currently overweight or obese (Ogden et al. 2010),
which translates into approximately 5 million children.
Furthermore, recent estimates suggest that 4% of American
children and adolescents are above the 99th percentile and,
thus, are extremely obese (Freedman et al. 2007). This
percentage is larger than the number of American youth
affected by cancer, cystic fibrosis, HIV and type I diabetes
mellitus combined (Freedman et al. 2007).
Instead of using the term ‘‘obesity’’ with children and
adolescents, several authorities recommend using the
Centers for Disease Control’s (CDC) BMI tables
(Kuczmarski et.
Running head PICOT STATEMENT 1PICOT STATEMENT 5.docxtoltonkendal
Running head: PICOT STATEMENT 1
PICOT STATEMENT 5
PICOT Statement: Childhood Obesity
P-I-C-O-T Statement
P- Patients who suffer from obesity (BMI of more than 30)
I- Undertaking nutritional education, diet, and exercise
C- Comparison to nutritional education, endoscopic bariatric surgical intervention
O- Improved health outcomes in terms of overall weight
T - A year’s time limit
PICOT Statement: Childhood Obesity
Introduction
Childhood obesity poses serious health problems in the US as the number of overweight and obese population increases at a rapid pace every year. The effects of this problem have arrested the attention of policymakers, societal members, and government agencies. This has resulted in ranking childhood obesity as a national health concern. The adverse impacts of this disease go beyond the health realms to include economic burden on both personal and national budgets. While there are numerous risk factors and various evidence-based interventions to address this challenge, no single approach is consistently efficacious in curbing the disease. Consequently, it is imperative that efficacious initiatives and policies be developed to address the never-ending problem of childhood obesity. Multidisciplinary approaches are often broad and cut across all dimensions of personal health problems. Instead of placing emphasis solely on biomedical models, health care professionals should also seek to promote behavior change among obesity patients and their family members. A PICOT statement can be utilized as an effective tool to seek interventions of addressing childhood obesity.
PICOT Statement
Population
In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Intervention
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative ...
This document summarizes research on parental influence on childhood obesity. It reviews studies that examine three areas of parental influence: control, attitudes, and behaviors. Regarding control, some studies found that less parental control over food intake was associated with higher child BMI, while others found the opposite. For attitudes, studies found that parental beliefs that heavier children are healthier and using food to control behavior were linked to higher child BMI. Parental concern over child weight and perception of child eating behaviors were also linked to higher BMI. The document concludes by addressing gaps in research on this topic.
Social and Behavioral FactorsPublic Health Issue AnalysisType .docxrosemariebrayshaw
Social and Behavioral Factors
Public Health Issue Analysis
Type 1 juvenile diabetes, also known as insulin-dependent, is a chronic autoimmune disease that afflicts children and teens and is one of the most prevalent chronic diseases among these age groups (Barnetz, Z., & Feigin, R. (2012). That afflicts approximately 30 million people in the United States, about 1.25 million have type 1 diabetes. Recent studies have shown fifty percent of people diagnosed with type 1 diabetes are over the age of 20. Every year, approximately 40,000 people diagnosed with type 1 diabetes, and this number is on the rise. Insulin and glucose are processed after a person eats a meal; food is broken down into glucose and nutrients, which absorbed into the bloodstream. This process will cause sugar levels in the blood to rise and will trigger the pancreas to process the hormone insulin and send it into the bloodstream (Nakayasu, E. S., et al., 2020).
In-person(s) with diabetes, the body either cannot make or cannot respond to insulin appropriately. It means the sugar stays in the bloodstream rather than getting into cells, where the sugar is used for energy. Because they were not converted into energy, the people with type 1 diabetes take artificial insulin throughout the day to offset high blood sugars. They take this medicine multiple doses of insulin daily, through injections or an insulin pump worn on the body. On the one hand, these measures are undoubtedly helpful for maintaining a steady blood sugar level (Basso RVJ, & Pelech WJ., 2008). Many variables go into diabetes management, such as diet, exercise, hormones, stress levels, and many more. Unfortunately, as it is today, there is no cure for diabetes, maybe in the future. Each child who is diagnosed with type 1 diabetes. Will have the condition for the rest of his/her life until there is a cure. The risk of developing diabetes is higher than virtually every other childhood, chronic illness. Studies estimated one out of every three babies born each day will probably have diabetes in their lifetime (Nakayasu, E. S., et al., 2020).
Social and behavioral factors
The social and behavioral factors that cause an increase in childhood diabetes, also called juvenile diabetes, are complicated — discussing the cause of childhood diabetes with pediatricians in Sinai Hospital Baltimore, Maryland, my place of volunteer work. The doctor's told me, the origin of the factors is complicated. The doctor's said there are two sides to look at childhood diabetes. First, I was told that children who are born with the condition; the cause might be a result of the parent's social behavior during pregnancy — for example, unhealthy eating, alcohol, smoking, etc. Second, the children that got condition after birth may have got it from the unhealthy nutrition from the parents, the groups they keep, or the community.
Program or Intervention Analysis
The intervention is three one-year cycles of an evaluation study of a mentoring progra.
1) The document describes a randomized trial that tested the effects of a coping skills training (CST) intervention for school-aged children (ages 8-12) with type 1 diabetes compared to general diabetes education.
2) Both groups showed improvements over time in outcomes like impact of diabetes, coping abilities, self-efficacy, depressive symptoms and parental control. However, treatment modality moderated some intervention effects.
3) The CST intervention aimed to teach children and parents more constructive coping behaviors to help with the transition to adolescence and diabetes management responsibilities. Preliminary short-term results were promising for improved family functioning and life satisfaction compared to education.
1) The document describes a randomized trial that tested the effects of a coping skills training (CST) intervention for school-aged children (ages 8-12) with type 1 diabetes compared to general diabetes education.
2) Both groups showed improvements over time in outcomes like impact of diabetes, coping, self-efficacy, depressive symptoms, and parental control. However, treatment modality moderated some intervention effects.
3) The CST intervention aimed to teach children and parents more constructive coping behaviors to help with the transition to adolescence and diabetes management responsibilities. Preliminary short-term results were promising for family functioning and life satisfaction.
E D I T O R I A LInvited Commentary Childhood and Adolesc.docxbrownliecarmella
E D I T O R I A L
Invited Commentary: Childhood and Adolescent Obesity:
Psychological and Behavioral Issues in Weight Loss Treatment
David B. Sarwer • Rebecca J. Dilks
Received: 5 May 2011 / Accepted: 11 May 2011 / Published online: 31 May 2011
� Springer Science+Business Media, LLC 2011
Abstract The prevalence of childhood and adolescent
obesity has tripled in the past three decades. This increase
has been accompanied by a dramatic rise in obesity-related
health complications among American youth. Thus, many
obese youth are now experiencing illnesses that will
threaten their life expectancy in the absence of significant
weight loss. Despite these concerns, a relatively modest
body of research has focused on the treatment of adolescent
obesity. Results from trials investigating the efficacy of
behavioral and pharmacological treatments, like studies of
these interventions with adults, suggest that individuals
typically lose 5–10% of their initial weight. Unfortunately,
weight regain is common. Given the increase in the number
of obese adolescents, coupled with the modest results from
more conservative treatment approaches, it is not surprising
that bariatric surgery for adolescents who suffer from
extreme obesity has grown in popularity. The weight losses
after surgery are impressive and many adolescents, like
adults, experience significant improvements in their phys-
ical and mental health postoperatively. However, only a
small fraction of adolescents and adults who are heavy
enough for bariatric surgery present for surgical treatment.
Among those who undergo surgery, a significant minority
appear to struggle with a number of behavioral and psy-
chosocial issues that threaten their lifelong success. With
all of this in mind, the current obesity problem in the
United States and other Westernized countries likely will
present a significant challenge to both current and future
medical and mental health professionals who work with
adolescents and young adults.
The Childhood and Adolescent Obesity Problem
Obesity is a growing problem among America’s youth. The
rate of obesity or overweight ([95th percentile for age and
gender) has doubled among children and tripled among
adolescents over the last 20 years (Ogden et al. 2002). The
most recent data suggests that 31% of children in the United
States are currently overweight or obese (Ogden et al. 2010),
which translates into approximately 5 million children.
Furthermore, recent estimates suggest that 4% of American
children and adolescents are above the 99th percentile and,
thus, are extremely obese (Freedman et al. 2007). This
percentage is larger than the number of American youth
affected by cancer, cystic fibrosis, HIV and type I diabetes
mellitus combined (Freedman et al. 2007).
Instead of using the term ‘‘obesity’’ with children and
adolescents, several authorities recommend using the
Centers for Disease Control’s (CDC) BMI tables
(Kuczmarski et.
Running head PICOT STATEMENT 1PICOT STATEMENT 5.docxtoltonkendal
Running head: PICOT STATEMENT 1
PICOT STATEMENT 5
PICOT Statement: Childhood Obesity
P-I-C-O-T Statement
P- Patients who suffer from obesity (BMI of more than 30)
I- Undertaking nutritional education, diet, and exercise
C- Comparison to nutritional education, endoscopic bariatric surgical intervention
O- Improved health outcomes in terms of overall weight
T - A year’s time limit
PICOT Statement: Childhood Obesity
Introduction
Childhood obesity poses serious health problems in the US as the number of overweight and obese population increases at a rapid pace every year. The effects of this problem have arrested the attention of policymakers, societal members, and government agencies. This has resulted in ranking childhood obesity as a national health concern. The adverse impacts of this disease go beyond the health realms to include economic burden on both personal and national budgets. While there are numerous risk factors and various evidence-based interventions to address this challenge, no single approach is consistently efficacious in curbing the disease. Consequently, it is imperative that efficacious initiatives and policies be developed to address the never-ending problem of childhood obesity. Multidisciplinary approaches are often broad and cut across all dimensions of personal health problems. Instead of placing emphasis solely on biomedical models, health care professionals should also seek to promote behavior change among obesity patients and their family members. A PICOT statement can be utilized as an effective tool to seek interventions of addressing childhood obesity.
PICOT Statement
Population
In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Intervention
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative ...
This document summarizes research on parental influence on childhood obesity. It reviews studies that examine three areas of parental influence: control, attitudes, and behaviors. Regarding control, some studies found that less parental control over food intake was associated with higher child BMI, while others found the opposite. For attitudes, studies found that parental beliefs that heavier children are healthier and using food to control behavior were linked to higher child BMI. Parental concern over child weight and perception of child eating behaviors were also linked to higher BMI. The document concludes by addressing gaps in research on this topic.
Social and Behavioral FactorsPublic Health Issue AnalysisType .docxrosemariebrayshaw
Social and Behavioral Factors
Public Health Issue Analysis
Type 1 juvenile diabetes, also known as insulin-dependent, is a chronic autoimmune disease that afflicts children and teens and is one of the most prevalent chronic diseases among these age groups (Barnetz, Z., & Feigin, R. (2012). That afflicts approximately 30 million people in the United States, about 1.25 million have type 1 diabetes. Recent studies have shown fifty percent of people diagnosed with type 1 diabetes are over the age of 20. Every year, approximately 40,000 people diagnosed with type 1 diabetes, and this number is on the rise. Insulin and glucose are processed after a person eats a meal; food is broken down into glucose and nutrients, which absorbed into the bloodstream. This process will cause sugar levels in the blood to rise and will trigger the pancreas to process the hormone insulin and send it into the bloodstream (Nakayasu, E. S., et al., 2020).
In-person(s) with diabetes, the body either cannot make or cannot respond to insulin appropriately. It means the sugar stays in the bloodstream rather than getting into cells, where the sugar is used for energy. Because they were not converted into energy, the people with type 1 diabetes take artificial insulin throughout the day to offset high blood sugars. They take this medicine multiple doses of insulin daily, through injections or an insulin pump worn on the body. On the one hand, these measures are undoubtedly helpful for maintaining a steady blood sugar level (Basso RVJ, & Pelech WJ., 2008). Many variables go into diabetes management, such as diet, exercise, hormones, stress levels, and many more. Unfortunately, as it is today, there is no cure for diabetes, maybe in the future. Each child who is diagnosed with type 1 diabetes. Will have the condition for the rest of his/her life until there is a cure. The risk of developing diabetes is higher than virtually every other childhood, chronic illness. Studies estimated one out of every three babies born each day will probably have diabetes in their lifetime (Nakayasu, E. S., et al., 2020).
Social and behavioral factors
The social and behavioral factors that cause an increase in childhood diabetes, also called juvenile diabetes, are complicated — discussing the cause of childhood diabetes with pediatricians in Sinai Hospital Baltimore, Maryland, my place of volunteer work. The doctor's told me, the origin of the factors is complicated. The doctor's said there are two sides to look at childhood diabetes. First, I was told that children who are born with the condition; the cause might be a result of the parent's social behavior during pregnancy — for example, unhealthy eating, alcohol, smoking, etc. Second, the children that got condition after birth may have got it from the unhealthy nutrition from the parents, the groups they keep, or the community.
Program or Intervention Analysis
The intervention is three one-year cycles of an evaluation study of a mentoring progra.
This document discusses eating disorders in children and adolescents. It begins by defining eating disorders and their core characteristics, noting they have high mortality risks. Early intervention is key to recovery. Family-based treatment has the best evidence and leads to higher remission rates than individual treatment. The document urges knowing signs like weight loss, rigidity around food, and withdrawal from friends. It suggests bringing concerns compassionately to professionals, avoiding fat talk, and allowing open discussion of emotions. Schools can help through pastoral care, staff training, and specific eating disorder policies.
The care of adolescents with type 1 diabetes presents unique challenges. About 50% of adolescents do not comply with recommended healthcare, putting them at risk for poor health outcomes. Factors like depression, family conflict, and lack of support from healthcare providers negatively impact compliance. Cox's Interactive Model of Client Health Behavior provides a framework for nursing interventions focused on education, identifying risk factors, encouraging family support, and giving adolescents decision-making power to improve motivation and self-care compliance, leading to better health outcomes and fewer medical interventions.
The study examined how parent illness uncertainty in children with juvenile rheumatic diseases relates to caregiver demand, parent distress, and child depressive symptoms. Fifty-seven children and their primary caregivers completed questionnaires. The results supported the hypothesis that higher parent illness uncertainty leads to increased caregiver demand, which in turn leads to greater parent distress and more depressive symptoms in the child. Specifically, caregiver demand and parent distress sequentially carried the indirect effect of parent illness uncertainty on child depressive symptoms. Interventions to help parents manage illness uncertainty and caregiver demand may help reduce distress and depression in children with these conditions.
SDolan_A New Focus in the Standards of Care Set Forth for T1Ds in TransitionScott Dolan, MS
This document discusses the need for a new focus in the standards of care for young adults with type 1 diabetes. It notes that while the lifespan of those diagnosed with type 1 diabetes in childhood is increasing, young adulthood brings new challenges and risks for disease management and complications. The current standards of care do not adequately address the specific needs and characteristics of young adults, such as increased risk-taking, relocating, and psychosocial stressors. You recommendations include developing care strategies tailored to individual goals and lifestyles, as well as more research to guide clinicians in effectively managing type 1 diabetes in this population.
Case Number 7Student’s NameInstitution Affiliation.docxjasoninnes20
Case Number 7
Student’s Name
Institution Affiliation
Case Number 7. The case of physician do not heal thyself
Questions
1. Have you recently engaged in risky behaviors such as binge eating, unsafe sex, gambling, drug and substance abuse, or risky driving?
1. How would you describe your relationships with people such as your spouse, friends, neighbors, colleagues, and strangers while considering aspects of anger, irritability, and violence?
1. Do you have a recurring problem of variant moods that result to interpersonal stress, feeling of emptiness, and other challenges that are stress-related and they push you towards suicidal thoughts?
People to speak to
It is crucial to identify the right people to provide essential details for the assessment of the patient. Some of the most important people include the spouses, siblings, family friends, personal friends, and neighbors. Furthermore, the patient’s colleagues can provide important information regarding the behaviors of the patient and help in identifying issues that the patient could be hiding. Speaking to the people to whom the patient exercises authority is important in attaining the true image of the person.
Physical exam and diagnostic test
The disorder is mental, but it can be assessed through physical exams that indicate how the brain is working in relation to actions ( Stahl 2013). Fixing a puzzle would be an effective way of testing the patient and how stable they can be. The other approach is engaging the patient in a physical exercise and observing their participation. Physical exams provide a diagnostic insight to test how the patient relates with others.
Diagnoses
Personality Disorder
Mood Disorder
Depression with psychotic features
Pharmacological agents
Application of antidepressants
Use of antipsychotics
Administering mood-stabilizing drugs
Contradictions or Alterations
It is a complex situation to treat a complex and long-term unstable disorder of mood because the patients experience different emotions even during therapy (Yasuda & Huang 2008). It becomes difficult to separate mood disorder from personality disorder especially for difficult patient like in this case. Furthermore, there are no specific drugs that can be used for treatment without additional therapy since this patient is able to adjust or play with their own treatment as a physician. The mental condition observed in the patient requires a careful approach due to the delicate situations involving suicidal thoughts and aggression.
Lessons Learned
In the case study “The case of physician do not heal thyself,” the lessons include the importance of conducting a complete assessment of the patient and including other people who interact with the patient. It would be more effective to treat such conditions if the patients had stable emotions, but strategic approaches can help to streamline the treatment process ( Stahl 2014b).
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacol ...
Case Number 7Student’s NameInstitution Affiliation.docxdewhirstichabod
Case Number 7
Student’s Name
Institution Affiliation
Case Number 7. The case of physician do not heal thyself
Questions
1. Have you recently engaged in risky behaviors such as binge eating, unsafe sex, gambling, drug and substance abuse, or risky driving?
1. How would you describe your relationships with people such as your spouse, friends, neighbors, colleagues, and strangers while considering aspects of anger, irritability, and violence?
1. Do you have a recurring problem of variant moods that result to interpersonal stress, feeling of emptiness, and other challenges that are stress-related and they push you towards suicidal thoughts?
People to speak to
It is crucial to identify the right people to provide essential details for the assessment of the patient. Some of the most important people include the spouses, siblings, family friends, personal friends, and neighbors. Furthermore, the patient’s colleagues can provide important information regarding the behaviors of the patient and help in identifying issues that the patient could be hiding. Speaking to the people to whom the patient exercises authority is important in attaining the true image of the person.
Physical exam and diagnostic test
The disorder is mental, but it can be assessed through physical exams that indicate how the brain is working in relation to actions ( Stahl 2013). Fixing a puzzle would be an effective way of testing the patient and how stable they can be. The other approach is engaging the patient in a physical exercise and observing their participation. Physical exams provide a diagnostic insight to test how the patient relates with others.
Diagnoses
Personality Disorder
Mood Disorder
Depression with psychotic features
Pharmacological agents
Application of antidepressants
Use of antipsychotics
Administering mood-stabilizing drugs
Contradictions or Alterations
It is a complex situation to treat a complex and long-term unstable disorder of mood because the patients experience different emotions even during therapy (Yasuda & Huang 2008). It becomes difficult to separate mood disorder from personality disorder especially for difficult patient like in this case. Furthermore, there are no specific drugs that can be used for treatment without additional therapy since this patient is able to adjust or play with their own treatment as a physician. The mental condition observed in the patient requires a careful approach due to the delicate situations involving suicidal thoughts and aggression.
Lessons Learned
In the case study “The case of physician do not heal thyself,” the lessons include the importance of conducting a complete assessment of the patient and including other people who interact with the patient. It would be more effective to treat such conditions if the patients had stable emotions, but strategic approaches can help to streamline the treatment process ( Stahl 2014b).
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacol.
This document summarizes a research paper on school-based nutrition intervention programs and whether increasing nutrition knowledge changes behaviors. It discusses how over 1/3 of children are overweight or obese and interventions aim to establish healthy habits early. Common program components include increasing fruit and vegetable intake, knowledge, attitudes, and self-efficacy. However, research is inconclusive if knowledge alone promotes behavior change. The Harvest of the Month program incorporates multiple strategies and shows effectiveness, but more evaluation is needed. The purpose of this study is to examine the effectiveness of increasing knowledge on behaviors.
1
WEEK 2 - ASSIGNMENT 1
4
Week 2 - Assignment 1: Associate Research Concept and Research Question
Question one
Question stem: How do differences in age group contribute to chronic disease?
Participants
The main participants in this research study are people of different age groups ranging from youths and older adults of both genders who are at high risk of chronic disease victims. Participants to use in this research study will be grouped to help in collecting reliable information for better decision making.
Research context
Statistically, chronic diseases are common among old age people. The high rate of such infections among older adults is due to a low metabolic rate because to reduce physical activities among older adults. As well, chronic disease is also common among young adult who lives poor lifestyle choices like poor diet, overconsumption of alcohol and frequent smoking (Woolf, Aron, National Academies & Institute of Medicine, 2013)
Purpose and impact of the research
The purpose of this research is to study how differences in age group affect the rate of infection of chronic diseases among people living in the United States. In doing so, data will be collected from different age groups ranging from young adults to old adults.
The main impact of this study is to identify the most affected age group with chronic diseases to find possible causes of action that should be then to reduce the chances of infections. For example, a high rate of infection among young people due to the high rate of smoking can be reduced by advising them to stop engaging such activities (Busse & Blümel, 2011).
Aspects of the main focus
The critical element to address in this study is to find possible ways of reducing infection of chronic diseases among the different age groups in the United States. To achieve the goal of the research study, a random sampling method will be done to collect data about how age group differences infection of chronic diseases. In doing so, relevant information will be collected from participants for analysis to answer the research question. Another essential step that should be done in this study is to identify the right participants that will help in collecting relevant information (Busse & Blümel, 2011).
The main research focus
The main focus of this research study is to address or answer the research question. It will pay more attention to how differences in age group contribute to many infections of chronic diseases. Based on past research studies, it evident that differences in age groups affect the risk of being chronic diseases. However, to confirm whether research results that have been discussed by others, it is essential to conduct this to find a possible solution that can help solve the research question (Busse & Blümel, 2011).
Question stem: How does the relationship between ages influence chronic disease affection among different groups of people?
Participants
The key participants in this research study are adults .
1
WEEK 2 - ASSIGNMENT 1
4
Week 2 - Assignment 1: Associate Research Concept and Research Question
Question one
Question stem: How do differences in age group contribute to chronic disease?
Participants
The main participants in this research study are people of different age groups ranging from youths and older adults of both genders who are at high risk of chronic disease victims. Participants to use in this research study will be grouped to help in collecting reliable information for better decision making.
Research context
Statistically, chronic diseases are common among old age people. The high rate of such infections among older adults is due to a low metabolic rate because to reduce physical activities among older adults. As well, chronic disease is also common among young adult who lives poor lifestyle choices like poor diet, overconsumption of alcohol and frequent smoking (Woolf, Aron, National Academies & Institute of Medicine, 2013)
Purpose and impact of the research
The purpose of this research is to study how differences in age group affect the rate of infection of chronic diseases among people living in the United States. In doing so, data will be collected from different age groups ranging from young adults to old adults.
The main impact of this study is to identify the most affected age group with chronic diseases to find possible causes of action that should be then to reduce the chances of infections. For example, a high rate of infection among young people due to the high rate of smoking can be reduced by advising them to stop engaging such activities (Busse & Blümel, 2011).
Aspects of the main focus
The critical element to address in this study is to find possible ways of reducing infection of chronic diseases among the different age groups in the United States. To achieve the goal of the research study, a random sampling method will be done to collect data about how age group differences infection of chronic diseases. In doing so, relevant information will be collected from participants for analysis to answer the research question. Another essential step that should be done in this study is to identify the right participants that will help in collecting relevant information (Busse & Blümel, 2011).
The main research focus
The main focus of this research study is to address or answer the research question. It will pay more attention to how differences in age group contribute to many infections of chronic diseases. Based on past research studies, it evident that differences in age groups affect the risk of being chronic diseases. However, to confirm whether research results that have been discussed by others, it is essential to conduct this to find a possible solution that can help solve the research question (Busse & Blümel, 2011).
Question stem: How does the relationship between ages influence chronic disease affection among different groups of people?
Participants
The key participants in this research study are adults ...
Researchers used the Health Belief Model (HBM) to account for respondents’ lack of knowledge and the negative effects of cultural variations on their actions. Using the most up-to-date ideas during planning and development is essential for achieving desired outcomes (Ghosh & Saboo, 2022). Education is a useful tool in treating insulin resistance in people with diabetes. As a strength of the research, patients with diabetes with education had better glycemic control, higher medication adherence, and more developed self-management abilities, as documented by Liu et al. (2021). Unfortunately, it is difficult to draw firm conclusions from the studies because of the limitations that exist in some of them. Some research, for instance, relies on participants’ self-reports, which could be inaccurate or biased, which is one of the study’s shortcomings. The difficulty in comparing the efficacy of education to that of other interventions or standard care is compounded by the fact that some studies need a control group. Furthermore, the effects of education on other outcomes, such as quality of life or healthcare utilization, are rarely evaluated in studies (Tucker et al., 2021). So, more studies are required to evaluate the long-term effects of education on insulin resistance treatment and its cost-effectiveness compared to alternative interventions. In addition, further research is needed to determine the best methods for customizing patient education to meet each person’s unique requirements.
Parental stress, affective symptoms and marital satisfaction in parents of ch...James Cook University
Lovisotto, R., Caltabiano, N., & Hajhashemi, K. (2015). International Journal of Humanities and Social Science, 5(10), 30-38.
Abstract: Parents of children with Autism Spectrum Disorder (ASD), a life-long developmental disorder, responded to an online survey considering their stress experience, affective symptoms and marital satisfaction. As these parents sourced different programs for their children, type of program was used to assign parents to different groups in order to consider their stress, affective symptoms and marital satisfaction. The type of programs parents used included the Applied Behaviour Analysis (n=15); Early Intervention Centre (n=13) and no formal program (n=16). Parents of children with ASD in the ABA group reported significantly lower parental stress scores, lower affective symptoms scores and higher marital satisfaction scores compared to the other two groups. These results are suggestive of the beneficial effect that an ABA program can have on the family unit.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
This document summarizes research on the relationship between childhood abuse and obesity/food addiction. It finds that adverse childhood experiences like physical, emotional, or sexual abuse are associated with higher risks of obesity in adulthood, possibly due to induced stress, inflammation, and metabolic disturbances. Studies also find similarities between addictive-like eating behaviors and substance abuse disorders. The concept of "food addiction" is discussed and operationalized using the Yale Food Addiction Scale. Prevalence of food addiction varies in studies but is higher in obese individuals, particularly those with binge eating disorder. Childhood abuse is strongly linked to reports of food addiction in adulthood.
This document summarizes a literature review on the management of chronic pain in adolescents. It finds that chronic pain is common in adolescents and is best treated through a multidisciplinary approach using psychological therapies and functional restoration, along with medical care and pharmaceutical interventions as needed. While multidisciplinary care has shown benefits, there is limited high-quality research on pharmacological treatments for chronic pain in adolescents. More research is needed to guide safe and effective use of medications for managing chronic pain in this population.
This document is a thesis presented by Jill Marie Parsh to Hawthorn University for a Master's degree in Health and Nutrition Education in 2012. The thesis discusses the problem of childhood obesity in the United States and proposes a nutrition and garden education program to increase fruit and vegetable consumption in middle school students. The literature review evaluates previous studies that implemented similar nutrition and garden curricula in schools. The methodology section outlines how to build a successful nutrition program based on the results of prior studies. The thesis concludes that a program including weekly nutrition education and experiential gardening over at least one year while incorporating parental involvement can effectively promote increased consumption of fresh fruits and vegetables in students.
This document discusses how psychology and family dynamics can impact diabetes management and outcomes. It summarizes that children with diabetes are at risk for adjustment problems, and that the whole family is affected by the diagnosis. Poor parental coping and parenting styles can negatively influence children's diabetes control and adherence. Shared parent-child responsibility is linked to better outcomes compared to child or parent responsibility alone. Peer relationships and coping skills training can also impact diabetes management and outcomes.
Running head PICOT STATEMENT 1PICOT STATEMENT 3PICOT .docxtoltonkendal
Running head: PICOT STATEMENT 1
PICOT STATEMENT 3
PICOT Statement: Childhood Obesity
Introduction
Childhood obesity is one of the emerging health problems that affect the American population. This disorder places children at a higher risk of suffering from preventable non-communicable chronic diseases, such as Type 2 diabetes, hypertension, and asthma (McGrath, 2017). Other challenges that affect children as a result of this disease include depression and sleep apnea. Obese children are often predisposed to become obese adults who suffer from many chronic diseases related to increased mortality rate of 40 percent. Obese children and adolescents tend to have more adverse health challenges compared to the counterparts with normal BMI. The task of addressing the chronic conditions related to childhood obesity is normally costly, with approximately $14 billion price tag and increasing (McGrath, 2017). Survey reports released by government agencies such as the National Conference of State Legislature, the total cost of obesity-associated nears $150 billion yearly, with taxpayers covering approximately sixty billion dollars. There is need to identify patterns that related to childhood obesity for professionals to seek better ways to address them. This PICOT statement evaluates childhood obesity in the United States.
PICOT Statement
Population
Childhood obesity is a major health concern in the United States and other parts of the world since the disease is increasing. In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In 2013, 16 percent of children in the country were categorized as obese. The prevalence was highest at ages of 12 to 19 years and lowest at ages of 2 to 5 years. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Intervention
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative intervention, especially ...
Obesity is quickly becoming one of the most common chronic.docxhopeaustin33688
Obesity is quickly becoming one of the most common chronic diseases among children. These rates have increased at an alarming rate and is a major public health problem because of related physical and psychological comorbidities, including type II diabetes, insulin resistance, metabolic syndrome, cardiovascular disease and mental health disorders. Dramatic increase in the number of overweight and obese children in recent years.
Studies indicate that children's lives may be shortened as a result of this alarming health problem. Estimates state that for any degree of overweight/obesity, younger adults (20-30 years of age) may have greater years of life lost due to obesity than older adults. Childhood obesity has been determined to be an independent risk factor for adult overweight/obesity.
To combat childhood obesity, there is a great need for public health interventions as well as education parents regarding childhood obesity and its consequences. Parents differ on causation of obesity, and differ in focus on nutrition and physical exercise. Many parents in the research do not see obesity as a barrier to physical activity. The parents need to recognize their child as overweight. Prevention is the most effective method for dealing with this growing health concern. The evidence reviewed, confirmed that family-centered interventions were associated with short-term reduction in obesity and improved medical parameters. The goal should be to involve community resources and provider referrals. Nurse Practitioners have a unique role in being the best facilitators to deliver health messages and are able to educate parents and increase awareness about the causes and consequences of childhood obesity.
Parents of young children need to interact with their child's primary healthcare provider for health advice and preventive health information during regularly scheduled physical examinations. It is up to the parents of these young children to combat intervention strategies such as:
a combination of nutritional and activity information, a cognitive-behavioral aspect to the intervention parent-directed activities
limiting sedentary child behaviors, provide positive approaches with children by parents and practitioners (e.g., emphasize positive rewards for healthy behaviors, encourage self-efficacy)
Future research is required to identify moderators and mediators to produce enduring changes in weight status of children.
The Objective was to determine in children who are at risk for becoming overweight or obese, does education with parental involvement on exercise and nutrition compared to individual education with the child alone decrease the risk of developing obesity and the health problems associated with obesity?
(P) In overweight, obese, or at risk young children (2-18years of age) Is family centered education/treatment interventions
(C) versus control or comparison interventions
(O) more effective in decreasing childhood obesity and compli.
What are the causes and effects of childhood obesity, and what strategies can health and government bodies use to tackle the issue? Nathalie Farpour-Lambert, President of the European Association for the Study of Obesity (EASO), examines scientific data and presents recommendations. This presentation was delivered as part of a Global Active City and Ciudad Activa Summit in Buenos Aires in October 2018. EASO is a supporting partner of the Active Well-being Initiative, which runs the Global Active City programme. The world’s first Global Active Cities are Buenos Aires, Hamburg, Lillehammer, Liverpool, Ljubljana, and Richmond, British Columbia, Canada. Visit http://www.activewellbeing.org or follow @AWBInitiative on Twitter.
AFRICAResearch Paper AssignmentInstructionsOverview.docxSALU18
AFRICA
Research Paper Assignment
Instructions
Overview
In developing your expertise in transnational
organized crime (TOC) you will be writing a series of research papers. All
together the writing contained in all these papers combined would be quite
significant project! You will find that in some modules, the research papers
mimic our readings with respect to subject matter and some modules, the
research papers do not mimic the reading. Again, the goal of these research
papers is to stretch the depth and breadth of your knowledge. You should feel
well prepared to teach a course in TOCs after completing this course. The
research papers and PowerPoints you create could serve as the basis for such
class. Additionally, you will find that this course and the course CJUS701
Comparative Criminal Justice Systems complement each other very well.
Instructions
·
Each
research paper should be a minimum of 6 to 8 pages.
·
The
vast difference in page count is because some countries and/or crime/topics are
quite easy to study and some countries and/or crime/topics have very limited
information.
·
In
some instances, there will be a plethora of information and you must use
skilled writing to maintain proper page count.
·
Please
keep in mind that this is doctoral level analysis and writing – you are to take
the hard-earned road – the road less travelled – the scholarly road in forming
your paper.
·
The
paper must use current APA style, and the page count does not include the title
page, abstract, reference section, or any extra material.
·
The
minimum elements of the paper are listed below.
·
You
must use a
minimum
of 8 recent (some
countries/crimes/topics may have more recent research articles than others),
relevant, and academic (peer review journals preferred and professional
journals allowed if used judiciously) sources, at least 2 sources being the
Holy Bible, and one recent (some countries/crime/topics have more recent than
others) news article. Books may be used
but are considered “additional: sources beyond the stated minimums. You may use
.gov sources as your recent, relevant, and academic sources if the writing is
academic in nature (authored works). You may also use United Nations and
Whitehouse.gov documents as academic documents.
·
Again,
this paper must reflect graduate level research and writing style. If you need to go over the maximum page count
you must obtain professor permission in advance! Please reference the Research
Paper Rubric when creating your research paper.
These are minimum guidelines – you may expand the
topics covered in your papers.
1)
Begin
your paper with a
brief
analysis of the following elements:
a.
Country
analysis
i.
Introduction
to the country
ii.
People
and society of the country
iii.
What
is the basic government structure?
2)
Analyze
the nature of organized crime in the assigned area (you may narrow the scope of
your analysis through your introduction or thesis stat.
Adversarial ProceedingsCritically discuss with your classmates t.docxSALU18
Adversarial Proceedings
Critically discuss with your classmates the claim that adversarial proceedings can be distinguished as relying more on the government’s ability to prove guilt (following specific rules of criminal procedure the defendant’s guilt whereas the inquisitorial process spends more time on investigations to determine if the defendant truly committed the crime).
.
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This document discusses eating disorders in children and adolescents. It begins by defining eating disorders and their core characteristics, noting they have high mortality risks. Early intervention is key to recovery. Family-based treatment has the best evidence and leads to higher remission rates than individual treatment. The document urges knowing signs like weight loss, rigidity around food, and withdrawal from friends. It suggests bringing concerns compassionately to professionals, avoiding fat talk, and allowing open discussion of emotions. Schools can help through pastoral care, staff training, and specific eating disorder policies.
The care of adolescents with type 1 diabetes presents unique challenges. About 50% of adolescents do not comply with recommended healthcare, putting them at risk for poor health outcomes. Factors like depression, family conflict, and lack of support from healthcare providers negatively impact compliance. Cox's Interactive Model of Client Health Behavior provides a framework for nursing interventions focused on education, identifying risk factors, encouraging family support, and giving adolescents decision-making power to improve motivation and self-care compliance, leading to better health outcomes and fewer medical interventions.
The study examined how parent illness uncertainty in children with juvenile rheumatic diseases relates to caregiver demand, parent distress, and child depressive symptoms. Fifty-seven children and their primary caregivers completed questionnaires. The results supported the hypothesis that higher parent illness uncertainty leads to increased caregiver demand, which in turn leads to greater parent distress and more depressive symptoms in the child. Specifically, caregiver demand and parent distress sequentially carried the indirect effect of parent illness uncertainty on child depressive symptoms. Interventions to help parents manage illness uncertainty and caregiver demand may help reduce distress and depression in children with these conditions.
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This document discusses the need for a new focus in the standards of care for young adults with type 1 diabetes. It notes that while the lifespan of those diagnosed with type 1 diabetes in childhood is increasing, young adulthood brings new challenges and risks for disease management and complications. The current standards of care do not adequately address the specific needs and characteristics of young adults, such as increased risk-taking, relocating, and psychosocial stressors. You recommendations include developing care strategies tailored to individual goals and lifestyles, as well as more research to guide clinicians in effectively managing type 1 diabetes in this population.
Case Number 7Student’s NameInstitution Affiliation.docxjasoninnes20
Case Number 7
Student’s Name
Institution Affiliation
Case Number 7. The case of physician do not heal thyself
Questions
1. Have you recently engaged in risky behaviors such as binge eating, unsafe sex, gambling, drug and substance abuse, or risky driving?
1. How would you describe your relationships with people such as your spouse, friends, neighbors, colleagues, and strangers while considering aspects of anger, irritability, and violence?
1. Do you have a recurring problem of variant moods that result to interpersonal stress, feeling of emptiness, and other challenges that are stress-related and they push you towards suicidal thoughts?
People to speak to
It is crucial to identify the right people to provide essential details for the assessment of the patient. Some of the most important people include the spouses, siblings, family friends, personal friends, and neighbors. Furthermore, the patient’s colleagues can provide important information regarding the behaviors of the patient and help in identifying issues that the patient could be hiding. Speaking to the people to whom the patient exercises authority is important in attaining the true image of the person.
Physical exam and diagnostic test
The disorder is mental, but it can be assessed through physical exams that indicate how the brain is working in relation to actions ( Stahl 2013). Fixing a puzzle would be an effective way of testing the patient and how stable they can be. The other approach is engaging the patient in a physical exercise and observing their participation. Physical exams provide a diagnostic insight to test how the patient relates with others.
Diagnoses
Personality Disorder
Mood Disorder
Depression with psychotic features
Pharmacological agents
Application of antidepressants
Use of antipsychotics
Administering mood-stabilizing drugs
Contradictions or Alterations
It is a complex situation to treat a complex and long-term unstable disorder of mood because the patients experience different emotions even during therapy (Yasuda & Huang 2008). It becomes difficult to separate mood disorder from personality disorder especially for difficult patient like in this case. Furthermore, there are no specific drugs that can be used for treatment without additional therapy since this patient is able to adjust or play with their own treatment as a physician. The mental condition observed in the patient requires a careful approach due to the delicate situations involving suicidal thoughts and aggression.
Lessons Learned
In the case study “The case of physician do not heal thyself,” the lessons include the importance of conducting a complete assessment of the patient and including other people who interact with the patient. It would be more effective to treat such conditions if the patients had stable emotions, but strategic approaches can help to streamline the treatment process ( Stahl 2014b).
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacol ...
Case Number 7Student’s NameInstitution Affiliation.docxdewhirstichabod
Case Number 7
Student’s Name
Institution Affiliation
Case Number 7. The case of physician do not heal thyself
Questions
1. Have you recently engaged in risky behaviors such as binge eating, unsafe sex, gambling, drug and substance abuse, or risky driving?
1. How would you describe your relationships with people such as your spouse, friends, neighbors, colleagues, and strangers while considering aspects of anger, irritability, and violence?
1. Do you have a recurring problem of variant moods that result to interpersonal stress, feeling of emptiness, and other challenges that are stress-related and they push you towards suicidal thoughts?
People to speak to
It is crucial to identify the right people to provide essential details for the assessment of the patient. Some of the most important people include the spouses, siblings, family friends, personal friends, and neighbors. Furthermore, the patient’s colleagues can provide important information regarding the behaviors of the patient and help in identifying issues that the patient could be hiding. Speaking to the people to whom the patient exercises authority is important in attaining the true image of the person.
Physical exam and diagnostic test
The disorder is mental, but it can be assessed through physical exams that indicate how the brain is working in relation to actions ( Stahl 2013). Fixing a puzzle would be an effective way of testing the patient and how stable they can be. The other approach is engaging the patient in a physical exercise and observing their participation. Physical exams provide a diagnostic insight to test how the patient relates with others.
Diagnoses
Personality Disorder
Mood Disorder
Depression with psychotic features
Pharmacological agents
Application of antidepressants
Use of antipsychotics
Administering mood-stabilizing drugs
Contradictions or Alterations
It is a complex situation to treat a complex and long-term unstable disorder of mood because the patients experience different emotions even during therapy (Yasuda & Huang 2008). It becomes difficult to separate mood disorder from personality disorder especially for difficult patient like in this case. Furthermore, there are no specific drugs that can be used for treatment without additional therapy since this patient is able to adjust or play with their own treatment as a physician. The mental condition observed in the patient requires a careful approach due to the delicate situations involving suicidal thoughts and aggression.
Lessons Learned
In the case study “The case of physician do not heal thyself,” the lessons include the importance of conducting a complete assessment of the patient and including other people who interact with the patient. It would be more effective to treat such conditions if the patients had stable emotions, but strategic approaches can help to streamline the treatment process ( Stahl 2014b).
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacol.
This document summarizes a research paper on school-based nutrition intervention programs and whether increasing nutrition knowledge changes behaviors. It discusses how over 1/3 of children are overweight or obese and interventions aim to establish healthy habits early. Common program components include increasing fruit and vegetable intake, knowledge, attitudes, and self-efficacy. However, research is inconclusive if knowledge alone promotes behavior change. The Harvest of the Month program incorporates multiple strategies and shows effectiveness, but more evaluation is needed. The purpose of this study is to examine the effectiveness of increasing knowledge on behaviors.
1
WEEK 2 - ASSIGNMENT 1
4
Week 2 - Assignment 1: Associate Research Concept and Research Question
Question one
Question stem: How do differences in age group contribute to chronic disease?
Participants
The main participants in this research study are people of different age groups ranging from youths and older adults of both genders who are at high risk of chronic disease victims. Participants to use in this research study will be grouped to help in collecting reliable information for better decision making.
Research context
Statistically, chronic diseases are common among old age people. The high rate of such infections among older adults is due to a low metabolic rate because to reduce physical activities among older adults. As well, chronic disease is also common among young adult who lives poor lifestyle choices like poor diet, overconsumption of alcohol and frequent smoking (Woolf, Aron, National Academies & Institute of Medicine, 2013)
Purpose and impact of the research
The purpose of this research is to study how differences in age group affect the rate of infection of chronic diseases among people living in the United States. In doing so, data will be collected from different age groups ranging from young adults to old adults.
The main impact of this study is to identify the most affected age group with chronic diseases to find possible causes of action that should be then to reduce the chances of infections. For example, a high rate of infection among young people due to the high rate of smoking can be reduced by advising them to stop engaging such activities (Busse & Blümel, 2011).
Aspects of the main focus
The critical element to address in this study is to find possible ways of reducing infection of chronic diseases among the different age groups in the United States. To achieve the goal of the research study, a random sampling method will be done to collect data about how age group differences infection of chronic diseases. In doing so, relevant information will be collected from participants for analysis to answer the research question. Another essential step that should be done in this study is to identify the right participants that will help in collecting relevant information (Busse & Blümel, 2011).
The main research focus
The main focus of this research study is to address or answer the research question. It will pay more attention to how differences in age group contribute to many infections of chronic diseases. Based on past research studies, it evident that differences in age groups affect the risk of being chronic diseases. However, to confirm whether research results that have been discussed by others, it is essential to conduct this to find a possible solution that can help solve the research question (Busse & Blümel, 2011).
Question stem: How does the relationship between ages influence chronic disease affection among different groups of people?
Participants
The key participants in this research study are adults .
1
WEEK 2 - ASSIGNMENT 1
4
Week 2 - Assignment 1: Associate Research Concept and Research Question
Question one
Question stem: How do differences in age group contribute to chronic disease?
Participants
The main participants in this research study are people of different age groups ranging from youths and older adults of both genders who are at high risk of chronic disease victims. Participants to use in this research study will be grouped to help in collecting reliable information for better decision making.
Research context
Statistically, chronic diseases are common among old age people. The high rate of such infections among older adults is due to a low metabolic rate because to reduce physical activities among older adults. As well, chronic disease is also common among young adult who lives poor lifestyle choices like poor diet, overconsumption of alcohol and frequent smoking (Woolf, Aron, National Academies & Institute of Medicine, 2013)
Purpose and impact of the research
The purpose of this research is to study how differences in age group affect the rate of infection of chronic diseases among people living in the United States. In doing so, data will be collected from different age groups ranging from young adults to old adults.
The main impact of this study is to identify the most affected age group with chronic diseases to find possible causes of action that should be then to reduce the chances of infections. For example, a high rate of infection among young people due to the high rate of smoking can be reduced by advising them to stop engaging such activities (Busse & Blümel, 2011).
Aspects of the main focus
The critical element to address in this study is to find possible ways of reducing infection of chronic diseases among the different age groups in the United States. To achieve the goal of the research study, a random sampling method will be done to collect data about how age group differences infection of chronic diseases. In doing so, relevant information will be collected from participants for analysis to answer the research question. Another essential step that should be done in this study is to identify the right participants that will help in collecting relevant information (Busse & Blümel, 2011).
The main research focus
The main focus of this research study is to address or answer the research question. It will pay more attention to how differences in age group contribute to many infections of chronic diseases. Based on past research studies, it evident that differences in age groups affect the risk of being chronic diseases. However, to confirm whether research results that have been discussed by others, it is essential to conduct this to find a possible solution that can help solve the research question (Busse & Blümel, 2011).
Question stem: How does the relationship between ages influence chronic disease affection among different groups of people?
Participants
The key participants in this research study are adults ...
Researchers used the Health Belief Model (HBM) to account for respondents’ lack of knowledge and the negative effects of cultural variations on their actions. Using the most up-to-date ideas during planning and development is essential for achieving desired outcomes (Ghosh & Saboo, 2022). Education is a useful tool in treating insulin resistance in people with diabetes. As a strength of the research, patients with diabetes with education had better glycemic control, higher medication adherence, and more developed self-management abilities, as documented by Liu et al. (2021). Unfortunately, it is difficult to draw firm conclusions from the studies because of the limitations that exist in some of them. Some research, for instance, relies on participants’ self-reports, which could be inaccurate or biased, which is one of the study’s shortcomings. The difficulty in comparing the efficacy of education to that of other interventions or standard care is compounded by the fact that some studies need a control group. Furthermore, the effects of education on other outcomes, such as quality of life or healthcare utilization, are rarely evaluated in studies (Tucker et al., 2021). So, more studies are required to evaluate the long-term effects of education on insulin resistance treatment and its cost-effectiveness compared to alternative interventions. In addition, further research is needed to determine the best methods for customizing patient education to meet each person’s unique requirements.
Parental stress, affective symptoms and marital satisfaction in parents of ch...James Cook University
Lovisotto, R., Caltabiano, N., & Hajhashemi, K. (2015). International Journal of Humanities and Social Science, 5(10), 30-38.
Abstract: Parents of children with Autism Spectrum Disorder (ASD), a life-long developmental disorder, responded to an online survey considering their stress experience, affective symptoms and marital satisfaction. As these parents sourced different programs for their children, type of program was used to assign parents to different groups in order to consider their stress, affective symptoms and marital satisfaction. The type of programs parents used included the Applied Behaviour Analysis (n=15); Early Intervention Centre (n=13) and no formal program (n=16). Parents of children with ASD in the ABA group reported significantly lower parental stress scores, lower affective symptoms scores and higher marital satisfaction scores compared to the other two groups. These results are suggestive of the beneficial effect that an ABA program can have on the family unit.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
This document summarizes research on the relationship between childhood abuse and obesity/food addiction. It finds that adverse childhood experiences like physical, emotional, or sexual abuse are associated with higher risks of obesity in adulthood, possibly due to induced stress, inflammation, and metabolic disturbances. Studies also find similarities between addictive-like eating behaviors and substance abuse disorders. The concept of "food addiction" is discussed and operationalized using the Yale Food Addiction Scale. Prevalence of food addiction varies in studies but is higher in obese individuals, particularly those with binge eating disorder. Childhood abuse is strongly linked to reports of food addiction in adulthood.
This document summarizes a literature review on the management of chronic pain in adolescents. It finds that chronic pain is common in adolescents and is best treated through a multidisciplinary approach using psychological therapies and functional restoration, along with medical care and pharmaceutical interventions as needed. While multidisciplinary care has shown benefits, there is limited high-quality research on pharmacological treatments for chronic pain in adolescents. More research is needed to guide safe and effective use of medications for managing chronic pain in this population.
This document is a thesis presented by Jill Marie Parsh to Hawthorn University for a Master's degree in Health and Nutrition Education in 2012. The thesis discusses the problem of childhood obesity in the United States and proposes a nutrition and garden education program to increase fruit and vegetable consumption in middle school students. The literature review evaluates previous studies that implemented similar nutrition and garden curricula in schools. The methodology section outlines how to build a successful nutrition program based on the results of prior studies. The thesis concludes that a program including weekly nutrition education and experiential gardening over at least one year while incorporating parental involvement can effectively promote increased consumption of fresh fruits and vegetables in students.
This document discusses how psychology and family dynamics can impact diabetes management and outcomes. It summarizes that children with diabetes are at risk for adjustment problems, and that the whole family is affected by the diagnosis. Poor parental coping and parenting styles can negatively influence children's diabetes control and adherence. Shared parent-child responsibility is linked to better outcomes compared to child or parent responsibility alone. Peer relationships and coping skills training can also impact diabetes management and outcomes.
Running head PICOT STATEMENT 1PICOT STATEMENT 3PICOT .docxtoltonkendal
Running head: PICOT STATEMENT 1
PICOT STATEMENT 3
PICOT Statement: Childhood Obesity
Introduction
Childhood obesity is one of the emerging health problems that affect the American population. This disorder places children at a higher risk of suffering from preventable non-communicable chronic diseases, such as Type 2 diabetes, hypertension, and asthma (McGrath, 2017). Other challenges that affect children as a result of this disease include depression and sleep apnea. Obese children are often predisposed to become obese adults who suffer from many chronic diseases related to increased mortality rate of 40 percent. Obese children and adolescents tend to have more adverse health challenges compared to the counterparts with normal BMI. The task of addressing the chronic conditions related to childhood obesity is normally costly, with approximately $14 billion price tag and increasing (McGrath, 2017). Survey reports released by government agencies such as the National Conference of State Legislature, the total cost of obesity-associated nears $150 billion yearly, with taxpayers covering approximately sixty billion dollars. There is need to identify patterns that related to childhood obesity for professionals to seek better ways to address them. This PICOT statement evaluates childhood obesity in the United States.
PICOT Statement
Population
Childhood obesity is a major health concern in the United States and other parts of the world since the disease is increasing. In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In 2013, 16 percent of children in the country were categorized as obese. The prevalence was highest at ages of 12 to 19 years and lowest at ages of 2 to 5 years. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Intervention
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative intervention, especially ...
Obesity is quickly becoming one of the most common chronic.docxhopeaustin33688
Obesity is quickly becoming one of the most common chronic diseases among children. These rates have increased at an alarming rate and is a major public health problem because of related physical and psychological comorbidities, including type II diabetes, insulin resistance, metabolic syndrome, cardiovascular disease and mental health disorders. Dramatic increase in the number of overweight and obese children in recent years.
Studies indicate that children's lives may be shortened as a result of this alarming health problem. Estimates state that for any degree of overweight/obesity, younger adults (20-30 years of age) may have greater years of life lost due to obesity than older adults. Childhood obesity has been determined to be an independent risk factor for adult overweight/obesity.
To combat childhood obesity, there is a great need for public health interventions as well as education parents regarding childhood obesity and its consequences. Parents differ on causation of obesity, and differ in focus on nutrition and physical exercise. Many parents in the research do not see obesity as a barrier to physical activity. The parents need to recognize their child as overweight. Prevention is the most effective method for dealing with this growing health concern. The evidence reviewed, confirmed that family-centered interventions were associated with short-term reduction in obesity and improved medical parameters. The goal should be to involve community resources and provider referrals. Nurse Practitioners have a unique role in being the best facilitators to deliver health messages and are able to educate parents and increase awareness about the causes and consequences of childhood obesity.
Parents of young children need to interact with their child's primary healthcare provider for health advice and preventive health information during regularly scheduled physical examinations. It is up to the parents of these young children to combat intervention strategies such as:
a combination of nutritional and activity information, a cognitive-behavioral aspect to the intervention parent-directed activities
limiting sedentary child behaviors, provide positive approaches with children by parents and practitioners (e.g., emphasize positive rewards for healthy behaviors, encourage self-efficacy)
Future research is required to identify moderators and mediators to produce enduring changes in weight status of children.
The Objective was to determine in children who are at risk for becoming overweight or obese, does education with parental involvement on exercise and nutrition compared to individual education with the child alone decrease the risk of developing obesity and the health problems associated with obesity?
(P) In overweight, obese, or at risk young children (2-18years of age) Is family centered education/treatment interventions
(C) versus control or comparison interventions
(O) more effective in decreasing childhood obesity and compli.
What are the causes and effects of childhood obesity, and what strategies can health and government bodies use to tackle the issue? Nathalie Farpour-Lambert, President of the European Association for the Study of Obesity (EASO), examines scientific data and presents recommendations. This presentation was delivered as part of a Global Active City and Ciudad Activa Summit in Buenos Aires in October 2018. EASO is a supporting partner of the Active Well-being Initiative, which runs the Global Active City programme. The world’s first Global Active Cities are Buenos Aires, Hamburg, Lillehammer, Liverpool, Ljubljana, and Richmond, British Columbia, Canada. Visit http://www.activewellbeing.org or follow @AWBInitiative on Twitter.
Similar to Effects of Coping Skills Training in School-age Children with.docx (20)
AFRICAResearch Paper AssignmentInstructionsOverview.docxSALU18
AFRICA
Research Paper Assignment
Instructions
Overview
In developing your expertise in transnational
organized crime (TOC) you will be writing a series of research papers. All
together the writing contained in all these papers combined would be quite
significant project! You will find that in some modules, the research papers
mimic our readings with respect to subject matter and some modules, the
research papers do not mimic the reading. Again, the goal of these research
papers is to stretch the depth and breadth of your knowledge. You should feel
well prepared to teach a course in TOCs after completing this course. The
research papers and PowerPoints you create could serve as the basis for such
class. Additionally, you will find that this course and the course CJUS701
Comparative Criminal Justice Systems complement each other very well.
Instructions
·
Each
research paper should be a minimum of 6 to 8 pages.
·
The
vast difference in page count is because some countries and/or crime/topics are
quite easy to study and some countries and/or crime/topics have very limited
information.
·
In
some instances, there will be a plethora of information and you must use
skilled writing to maintain proper page count.
·
Please
keep in mind that this is doctoral level analysis and writing – you are to take
the hard-earned road – the road less travelled – the scholarly road in forming
your paper.
·
The
paper must use current APA style, and the page count does not include the title
page, abstract, reference section, or any extra material.
·
The
minimum elements of the paper are listed below.
·
You
must use a
minimum
of 8 recent (some
countries/crimes/topics may have more recent research articles than others),
relevant, and academic (peer review journals preferred and professional
journals allowed if used judiciously) sources, at least 2 sources being the
Holy Bible, and one recent (some countries/crime/topics have more recent than
others) news article. Books may be used
but are considered “additional: sources beyond the stated minimums. You may use
.gov sources as your recent, relevant, and academic sources if the writing is
academic in nature (authored works). You may also use United Nations and
Whitehouse.gov documents as academic documents.
·
Again,
this paper must reflect graduate level research and writing style. If you need to go over the maximum page count
you must obtain professor permission in advance! Please reference the Research
Paper Rubric when creating your research paper.
These are minimum guidelines – you may expand the
topics covered in your papers.
1)
Begin
your paper with a
brief
analysis of the following elements:
a.
Country
analysis
i.
Introduction
to the country
ii.
People
and society of the country
iii.
What
is the basic government structure?
2)
Analyze
the nature of organized crime in the assigned area (you may narrow the scope of
your analysis through your introduction or thesis stat.
Adversarial ProceedingsCritically discuss with your classmates t.docxSALU18
Adversarial Proceedings
Critically discuss with your classmates the claim that adversarial proceedings can be distinguished as relying more on the government’s ability to prove guilt (following specific rules of criminal procedure the defendant’s guilt whereas the inquisitorial process spends more time on investigations to determine if the defendant truly committed the crime).
.
Advances In Management Vol. 9 (5) May (2016)
1
Generation Gaps: Changes in the Workplace due to
Differing Generational Values
Carbary Kelly, Fredericks Elizabeth, Mishra Bharat and Mishra Jitendra*
Management Department, Grand Valley State University, 50 Front Ave, SW Grand Rapids Michigan 49504-6424, USA
*[email protected]
Abstract
The purpose of this study is to discuss the
generational gaps that are found in the workplace
today. With multiple generations working together,
and the oldest generation having to work longer and
retire later, generational changes are occurring in the
workplace and for management. There is a lack of
communication and understanding between the
different generations caused through differing values
and goals. Younger generations are also entering
different fields than those that were popular for older
generations. There is a serious new problem in the
workplace, and it has nothing to do with downsizing,
global competition, pointy-haired bosses, stress or
greed. Instead, it is the problem of distinct
generations — the Veterans, the Baby Boomers, Gen
X and Gen Y — working together and often colliding
as their paths cross.
Individuals with different values, different ideas,
different ways of getting things done and different
ways of communicating in the workplace have always
existed. So, why is this becoming a problem now? At
work, generation differences can affect everything
including recruiting, building teams, dealing with
change, motivating, managing, and maintaining and
increasing productivity All of these ideas are
explored, discussed, and evaluated, through looking
at current research on the topic and case studies that
have been conducted not only in the United States but
around the world.
Keywords: Generation gap, workplace, values.
Introduction
Throughout the years, as the population has continued to
both grow and age, it has caused generational changes to
take place in the various aspects of life. With the changes in
the demographics of the world’s population, there have also
been changes in how each group thinks and what they
value. This not only affects the way people behave in their
personal lives, but it also affects the workplace. As
generational changes occur in the workplace, a lack of
communication has caused adisconnect to occur between
the values and goals present among the different age groups
along with newer generations choosing different career
paths.
* Author for Correspondence
In order to understand where these differences stem from,
you need to analyze how each generation is different when
it comes to their beliefs and values. So, it is best to identify
the different groups present in workplace which range from
those born in 1922 to those born in the early 1990’s.
Moving chronologically, the fi.
African-American Literature An introduction to major African-Americ.docxSALU18
African-American Literature: An introduction to major African-American writers from the earliest expressions to the present. An examination of the cultural milieu from which the writing arose, the ideological stance of each writer studied, and the styles and structure of the works considered
8 wks
.
African American Women and Healthcare I want to explain how heal.docxSALU18
African American women face unique healthcare challenges. This paper will explore how healthcare is perceived in the African American community, especially among women, and whether their concerns are justified. The paper will follow a standard structure including an introduction, abstract, literature review, methods, results, and discussion sections.
Advocacy & Legislation in Early Childhood EducationAdvocacy & Le.docxSALU18
Advocacy & Legislation in Early Childhood Education
Advocacy & Legislation in Early Childhood Education
Advocating for Early Childhood Education
Rasmussen College
COURSE#: EEC 4910
Doreen Anzalone
July 15, 2019
Advocating for Early Childhood Education
· What is advocacy?
Advocacy is how we support our children. We as teachers give advice for our children or we listen. We let the children and families know that we believe in them and we will be there for them. Teachers, admin, staff can advocate for children as long as they are in school. Advocates are also trained people and they are not lawyers. One of their responsibility is to stay up to date with the regulations of the educational laws.
· Why is advocacy important to early childhood education?
Its important to help the families because they might be vulnerable in society. We as teachers need to make sure our children and families are being heard. We as teachers need to make sure their wishes and views are being considered when it’s about their child or family. Its because we are helping the family make life decisions about their children and even their family life. Its also important to make sure we are not judging the family or having or our own personal opinions about what is going on when we are helping advocate for the family, we need to make sure we are stating the facts for the family.
· What is your role as an early childhood educator in making legislative changes?
Our role is to be able to email them or decide how to get a hold of them and let them know our questions, comments or suggestions on things that need to be changed, updated. We need to let them know so we can support our school, children, and families. It is our role as educators to stay aware of the laws. The Federal laws we need to make sure we are aware of the
· Family Education Rights & Poverty Act
· The No Child Left Behind
· Individuals with Disabilities Education Act
With these laws and many more they need to hear from schools in the United States. The federal laws mean we need to address the issues. These issues usually involve infringement of the student’s rights and they are to protect the rights. The state laws depend on the state you are in. The state laws this is where you would go if you have a problem or need to voice about
· Teacher Retirement
· Teacher evaluations
· Charter schools
· State Testing requirements
· The required learning standards
· Much more
Your school board is also a great place to help with policies and regulations and any revisions that need to be done.
· What ethical issues must early childhood education professionals consider related to advocacy and why do those issues exit?
In NAEYC the code of Ethical Conduct and in their it describes how any educator is required to act and what they do and not to do. At times as an educator as staff we tend to do what is the simplest or sometimes, we want to please others but when it comes to this, we must remember to follow our responsi.
Advertising is one of the most common forms of visual persuasion we .docxSALU18
Advertising is one of the most common forms of visual persuasion we encounter in everyday life. The influence of advertising in our society is persuasive and subtle. Part of its power comes from our habit of internalizing the intended messages of words and images without thinking deeply about them. Once we begin decoding the ways in which advertisements are constructed, once we view them critically, we can understand how, or if, they work as arguments. We may then make better decisions about whether to buy products and what factors convinced us or failed to convince us.
What are the different forms of advertising?
Modern media comes in many different formats, including print media (books, magazines, newspapers), television, movies, video games, music, cell phones, various kinds of software, and the Internet. Each type of media involves both content and also a device or object through which that content is delivered.
TEAM TASK:
As a team you are going to Review Chapter 4: Visual Rhetoric: Thinking About Images as Arguments. You will
be assigned a Section of the Chapter (written, visual, unfit, political, caricature, photography-maps graphs charts ) and as a Team you willResearch
the content of that Chapter Area (you will see topic page overlap ) and implement the following:
You will look at and interpret a media campaign or advertisement. Focus on social or ethical aspects * Seek to find one or more of the FALLACY TYPES identified Chapter 9 pages 363- 380. Include this information in your findings. Consider and incorporate as many of the following 16 categories :
The objectives: What role does the ad play in the economy?
The audience: Is it targeted to a group that could be considered vulnerable?
Effectiveness: Does it promote something that is socially desirable?
Role in marketing mix: What role does the ad play in the economy?
Image, product differentiation and branding: Is the ad misleading?
Other promotion factors
The unique selling proposition.
The basis for the appeal(s).
How would you make improvements?
The creative philosophy
The slogan
Secondary or supporting points or claims
The tone or mood and manner: Is the ad misleading?
Type of presenter
The motivational appeal: Does it promote something that is socially desirable?
Executional style
Each TEAM will develop a
15 minute class presentation
about their researched area. You have
options to use
power points, maps, videos, and other resources that will help educate your audience about your research.
Your Presentation should include:
A Power Point, the media piece or some type of visual presentation~~
A Question and Answer {Q & A} & Interactive session, quiz,.
Adult Health 1 Study GuideSensory Unit Chapters 63 & 64.docxSALU18
Adult Health 1 Study Guide
Sensory Unit
Chapters 63 & 64
Remember that assigned textbook readings should be supplemental to reviewing & studying the Powerpoint presentations. Answers to these study guide questions can be obtained from the textbook chapters, Powerpoint presentations, as well as class lectures & in-class activities.
Chapter 63: Assessment & Management of Patients with Eye & Vision Disorders
Conditions to Know
: Glaucoma, Cataracts, Retinal Detachment, Macular Degeneration, Conjunctivitis, Eye trauma
· Know the basic structures & functions of the eye – lens, pupil, iris, cornea, conjunctiva, retina, and sclera
· Questions to ask patients regarding issues with the eyes/vision – Chart 63-1
· Snellen Chart is used to assess visual acuity – 20/20 is considered perfect vision (patient can read line 20 of chart while standing 20 feet away) – this is tested in each eye
1. What are some of the most common causes of blindness?
2. What is responsible for the damage to the optic nerve in patients diagnosed with glaucoma?
3. Glaucoma can lead to what primary complication if not treated properly?
4. What are the differences between open-angle & closed-angle glaucoma?
5. What are the primary signs & symptoms of glaucoma?
6. What are the primary treatment goals for patients with glaucoma?
7. What is the first line treatment of glaucoma? What medication teaching points would you want to include in your patient education?
8. What are some common risk factors for the development of cataracts? See Chart 63-7.
9. What are the primary signs & symptoms of cataracts?
10. The most common treatment for cataracts is outpatient surgery, in which the lens affected by the cataract is replaced with a man-made one. Explain the pre and post-operative nursing management & education that is needed for patients undergoing cataract surgery. See Chart 63-8.
11. Retinal detachment is considered a medical emergency. What happens during retinal detachment?
12. What are some symptoms of retinal detachment?
13. Macular degeneration is the most common cause of vision loss in people > 60 years old. What is macular degeneration?
14. What are some risk factors for dry macular degeneration?
15. What are some signs and symptoms of macular degeneration?
16. Nursing management for patients diagnosed with macular degeneration focus on safety & supportive measures. What are some accommodations we should make or educate patients on regarding how to help improve their vision & ADLs when they have this condition?
17. Conjunctivitis is also called “pink eye”. What are the different types of conjunctivitis and what are some symptoms of this condition? Are any of these types considered contagious?
18. What are some teaching points to include when educating a patient diagnosed with viral conjunctivitis? See Chart 63-11.
19. Explain the emergency nursing treatment needed when a patient presents with eye trauma.
Chapter 64: Assessment & Manag.
Advertising Campaign Management Part 3Jennifer Sundstrom-F.docxSALU18
The document discusses parameters for effective advertising campaigns, including goals, media selection, slogans, consistency, duration, and the creative brief. It provides details on each parameter and explains that carefully planning these elements is important for successful campaigns. It also covers implications of advertising management globally and working with external agencies.
Adopt-a-Plant Project guidelinesOverviewThe purpose of this.docxSALU18
Adopt-a-Plant Project guidelines
Overview:
The purpose of this project is for you to choose a plant, conduct online research into the biology of the plant, and communicate what you have learned. You will be preparing an annotated bibliography on the plant you choose. The entire project is worth 50 points
Annotated Bibliography (50 points)
You will prepare an annotated bibliography with a list of the top 10 most interesting facts about your plant.
· Each fact should be paraphrased (i.e. written in your own words, no quotations allowed).
· Then tell me why this is interesting to you – make connections to your life or to currents issues in our world.
· Finally, give a full citation and tell me why you think this is a reliable, trustworthy source. Use this libguide to help you come up with reasons why your source is trustworthy.
· At least one of your sources should be from a peer-reviewed, science journal article.
Here is an example:
Fact 1: Taxol is a chemotherapy agent derived from the bark of the Pacific Yew Tree. The chemical itself is derived from a fungal endophtye within the bark. I thought this was very interesting, because the Pacific Yew tree is native to the state of Washington, and my aunt Jane received Taxol while undergoing chemotherapy for ovarian cancer. I also thought it was interesting because of the mutualistic relationship between the plant and the fungus.Citation: Plant natural products from cultured multipotent cells
Roberts, Susan; Kolewe, Martin. Nature Biotechnology28.11 (Nov 2010): 1175-6.
This is a reliable source because it is published in a peer-reviewed science journal article, written by two PhDs that are providing a review of the current literature on the topic
To complete the assignment, you should first choose a plant, gather articles discussing your plant, read the articles sufficiently enough to discuss the plant, and finally write the annotated bibliography. You are expected to produce original work, and any plagiarism will receive a zero. The paper should be double-spaced, and typed in 12 point font size, with normal margins. The instructions for how to properly cite your sources are at the end of this handout.
*** Reminder: The scientific name of a plant should always be typed in italics, with the first letter of the Genus capitalized. For ex.: Digitalis lanata. When you search for information on your plant online, make sure to use the scientific name, which will bring back a wider variety of results
The bibliography is worth 50 points and will be graded on:
1. Effort
• Quality of references
•Depth/breadth/quality of material covered
2. Following directions/ requirements
I will use the following rubric to grade your bibliography:
Research, Critical Reading and Documentation
Balanced, authoritative sources; correctly cited sources; effectively integrated outside sources. Most sources from science journals
10 pts
Effective sources, correctly cited, Could have a few more.
ADM2302 M, N, P and Q Assignment # 4 Winter 2020 Page 1 .docxSALU18
ADM2302 M, N, P and Q Assignment # 4
Winter 2020 Page 1
Assignment # 4
Decision Analysis and Project Scheduling
ADM2302 students are reminded that submitted assignments must be typed (i.e. can NOT be hand
written), neat, readable, and well-organized. Assignment marks will be adjusted for sloppiness, poor
grammar, spelling, for technical errors as well as if you submit a PDF file.
The assignment is to be submitted electronically as a single Word Document file via Brightspace by
Friday April 3rd prior to 23:59. Front page of the Word document has to include title of the assignment,
course code and section, student name and student number. Second page is the individual/group
statement of integrity that must be signed.
E-mail questions related to the assignment should be sent to the Teaching Assistant or posted on the
Brightspace course website “Discussion page” (viewed by all).
Section M: Parisa Keshavarz ([email protected])
Section N: : Niki Khorasanizadeh ([email protected])
Section P: Makbule Kandakoglu ([email protected])
Section Q: Afshin Kamyabniya ([email protected])
Problem 1: Payoffs/Decision Table (13 points)
A small building contractor has recently experienced two successive years in which work opportunities
exceeded the firm’s capacity. The contractor must now make a decision on capacity for next year.
Estimated profits (in $ thousands) under each of the two possible states of nature are as shown in the
table below.
NEXT YEAR’S DEMAND
Alternative Low High
Do nothing
Expand
Subcontract
$50**
20
40
$60
80
70
** Profit in $ thousands.
Which alternative should be selected if the decision criterion is:
a. The optimistic approach? (3 points)
b. The conservative approach? (3 points)
c. Minimize the regret? (7 points)
Problem 2: Payoffs/Decision Table (15 points)
Dorothy Stanyard has three major routes to take to work. She can take Tennessee Street the entire way,
she can take several back streets to work, or she can use the expressway. The traffic patterns are,
however, very complex. Under good conditions, Tennessee Street is the fastest route. When Tennessee
is congested, one of the other routes is preferable. Over the past two months, Dorothy has tried each of
route several times under different traffic conditions. This information is summarized in minutes of
travel time to work in the following table:
mailto:[email protected]
mailto:[email protected]
mailto:[email protected]
mailto:[email protected]
ADM2302 M, N, P and Q Assignment # 4
Winter 2020 Page 2
No Traffic Congestion
(Minutes)
Mild Traffic
Congestion
(Minutes)
Severe Traffic
Congestion
(Minutes)
Tennessee Street
Back roads
Expressway
15
20
30
30
25
30
45
35
30
In the past 60 days, Dorothy encountered severe traffic congestion 10 days and mild traffic congestion
20 days. Assume that the past 60 days are typical of traffi.
Adlerian-Based Positive Group Counseling Interventions w ith.docxSALU18
This summarizes an Adlerian-based positive group counseling program for emotionally troubled youth that integrated positive psychology interventions. The 12-week program used interventions from positive psychotherapy curriculum to increase positive emotion, engagement, and meaning by emphasizing strengths. Sessions focused on identifying signature strengths, cultivating strengths through goals, developing gratitude, processing good and bad memories, and expressing forgiveness as a way to increase social interest. The positive interventions aligned well with Adlerian principles of emphasizing strengths, social interest, and encouragement to help youth overcome problems.
After completing the assessment, my Signature Theme Report produ.docxSALU18
After completing the assessment, my Signature Theme Report produced the following results: Communication, Relator, Individualization, Consistency, and Strategic. When I first saw the themes presented, I was a little skeptical at first but after reading the detailed descriptions I felt like it made a lot of sense and mirrored a lot of what I had already thought about myself.
A core value that I would like to continue to strengthen would be the value of acceptance. One of my top five themes was relator which explained that I have a comfortability with gravitating towards people I already know and building relationships from there. I don’t have issues with making new relationships, but I can see that sometimes I close myself off initially to embracing new ones. With acceptance, you have to understand that there are some situations you can control and some that you can’t but embracing the latter can lead to new experiences that could be beneficial (Riley, 2021). Another core value that I would like to improve upon would be calmness. This fits in well with my theme of consistency. While I am a firm believer of things being fair and consistent, I can get easily upset when things don’t balance out like they are expected to. I know that working on being calm in tense situations will help me adapt easier when things don’t always work out as they should.
One of the strengths that I would like to embrace fully and continue to improve upon is communication. It was no surprise to me that communication was at the top of my list for my themes. When I am in a position of leadership at work, I make it a priority to keep my staff updated on everything that is going on for that night and it is something I expect from my charge nurse when I am working the floor also. A communicator is only effective when they are aware of their style of communicating and how others perceive or respond to it (Marshall & Broome, 2021). As a communicator I know that I can always work on how I communicate non-verbally and with body language especially. The other strength that I would like to continue to work on is of being strategic. The report explained that the strategic theme fit me because I am able to sort through the clutter and find the best route when I am trying to accomplish something. I really believe this about myself because when I have a task I need to accomplish, whether I am in a leader position or not, I will break everything down and reorganize it to make sure I have come up with the best solution. I feel like the best way to do something is the way that makes it concise and without a lot of excess getting in the way.
A characteristic of mine that I would like to strengthen would be that of instinct. My theme of individualization points out that I have an instinct about others and how they work and function. I have always felt that I easily read people and can get a sense of who they truly are and for example in the workplace how they are as a staff member. S.
After careful reading of the case material, consider and fully answe.docxSALU18
After careful reading of the case material, consider and fully answer the following questions:
1. What were the primary reasons for changing the current system at Butler?
2. What role did Butler's IS department play?
3. List the objectives of the pilot. Were there any problems?
4. Do you think Butler made the right decision to utilize this new technology? What implications does this decision hold for Butler's IT department in the long run?
NOTE: Butler refers to it's IT department as IR. You may consider these two acronyms as synonymous (i.e. IT = IS = IR for purposes of this assignment)
.
Affluent
Be unique to
Conform
Debatable
Dominant
Enforce
Ethnic
Internalize
Rank
Restrict
You will write your own sentences using each of the vocabulary words. The sentence
must be an
original sentence
created by you, AND it must use the vocabulary word correctly.
Your sentence
MUST
demonstrate that you understand the meaning of the word.
.
Advanced persistent threats (APTs) have been thrust into the spotlig.docxSALU18
Advanced persistent threats (APTs) have been thrust into the spotlight due to their advanced tactics, techniques, procedures, and tools. These APTs are resourced unlike other types of cyber threat actors.
Your chief technology officer (CTO) has formed teams to each develop a detailed analysis and presentation of a specific APT, which she will assign to the team.
.
Your report should use
The Cybersecurity Threat Landscape Team Assignment Resources
to cover the following five areas:
Part 1: Threat Landscape Analysis
Provide a detailed analysis of the threat landscape today.
What has changed in the past few years?
Describe common tactics, techniques, and procedures to include threat actor types.
What are the exploit vectors and vulnerabilities threat actors are predicted to take advantage of?
Part 2: APT Analysis
Provide detailed analysis and description of the APT your group was assigned. Describe the specific tactics used to gain access to the target(s).
Describe the tools used. Describe what the objective of the APT was/is. Was it successful?
Part 3: Cybersecurity Tools, Tactics, and Procedures
Describe current hardware- and software-based cybersecurity tools, tactics, and procedures.
Consider the hardware and software solutions deployed today in the context of defense-in-depth.
Elaborate on why these devices are not successful against the APTs.
Part 4: Machine Learning and Data Analytics
Describe the concepts of machine learning and data analytics and how applying them to cybersecurity will evolve the field.
Are there companies providing innovative defensive cybersecurity measures based on these technologies? If so, what are they? Would you recommend any of these to the CTO?
Part 5: Using Machine Learning and Data Analytics to Prevent APT
Describe how machine learning and data analytics could have detected and/or prevented the APT you analyzed had the victim organization deployed these technologies at the time of the event. Be specific.
Part 6: Ethics in Cybersecurity.
Ethical issues are at the core of what we do as cybersecurity professionals. Think of the example of a cyber defender working in a hospital. They are charged with securing the network, medical devices, and protecting sensitive personal health information from unauthorized disclosure. They are not only protecting patient privacy but their health and perhaps even their lives. Confidentiality, Integrity, Availability - the C-I-A triad - and many other cybersecurity practices are increasingly at play in protecting citizens in all walks of life and in all sectors. Thus, acting in an ethical manner is one of the hallmarks of cybersecurity professionals.
Do you think the vulnerability(ies) exploited by the APT constitutes an ethical failure by the defender? Why or why not?
For the APT scenario your group studied, were there identifiable harms to privacy or property? How are these harms linked to C-I-A? If not, what ethically si.
Advanced persistent threatRecommendations for remediation .docxSALU18
Advanced persistent threat
Recommendations for remediation of the threat
Research the use of network security controls associated to your threat and industry
Do Not use topics network security,VPN,FIREWALL,ETC
10-12 pages. Double spaced APA style
At least 10 REFERENCES
5 ATLEASt PEER REVIEWED SCHOLARLY
.
Adultism refers to the oppression of young people by adults. The pop.docxSALU18
Adultism refers to the oppression of young people by adults. The popular saying "children should be seen and not heard" is used as a way to remind a child of his or her place and reaffirm the adult's power in the relationship. The saying suggests that children's voices are not as important or as valid as an adult's and they should remain quiet. Children are often relegated to subordinate positions due to socially constructed beliefs about what they can or cannot accomplish or what they should or should not do; this in turn compromises youth's self-determination. This oppression is further highlighted when considering the intersection of age with race, ethnicity, socioeconomic status, and sexual orientation. You will be asked to consider all of these when reviewing the Logan case and Parker case.
By Day 3
Post
an analysis of the influence of adultism in the Logan case. Then, explain how gender, race, class, and privilege interact with adultism to influence the family's discourse related to Eboni's pregnancy as well as other family dynamics.
.
ADVANCE v.09212015
•
APPLICANT DIVERSITY STATEMENT IN FACULTY SEARCH PROCESS
FREQUENTLY ASKED QUESTIONS
1) How does University of California define “diversity?”
A: The academic senate adopted in 2009 the following broad definition of diversity:
Diversity - defining features of California past, present and future - refers to a variety of
personal experiences, values, and worldviews that arise from differences of culture and
circumstance. Such differences include race, ethnicity, gender, age, religion, language,
abilities/disabilities, sexual orientation, socioeconomic status, geographic region and more.
2) Why does UC Irvine expect a diversity statement from applicants for faculty positions?
A: UC Irvine’s commitment to inclusive excellence is integral to our ascendancy among globally
preeminent universities. It provides applicants with an opportunity to discuss how their past or
future contributions will advance this enduring campus commitment. For more information,
please see the Provost’s memo on Inclusive Excellence.
3) Is the diversity statement consistent with University of California policy?
A: Yes. APM 210.1-d, which governs appointment, appraisal and promotion, recommends that
faculty be both encouraged and rewarded for activity that promotes inclusive excellence:
“The University of California is committed to excellence and equity in every facet of its mission.
Teaching, research, professional and public service contributions that promote diversity and
equal opportunity are to be encouraged and given recognition in the evaluation of the
candidate's qualifications. These contributions to diversity and equal opportunity can take
a variety of forms including efforts to advance equitable access to education, public
service that addresses the needs of California's diverse population, or research in a
scholar's area of expertise that highlights inequities.”
4) Is UC Irvine alone among UC campuses in adopting this statement?
A: No. UC San Diego adopted this statement in 2010.
5) How will applicants learn about the diversity statement expectation?
A: Per Provost Gillman’s memo of June 2014, all ads for faculty positions will include the following
sentence: “Applicants are encouraged to share how their past and/or potential contributions to
diversity, equity and inclusion will advance UC Irvine’s commitment to inclusive excellence.”
6) How do applicants provide their diversity statement?
A: There is a dedicated field in UC Recruit for applicants to submit their diversity statement.
7) If an applicant does not provide a diversity statement, will his or her application be considered
incomplete?
A: Yes
http://www.provost.uci.edu/news/InclusiveExcellence.html
http://www.ucop.edu/academic-personnel/_files/apm/apm-210.pdf
http://www.provost.uci.edu/news/Diversity-Statement-June-2014.html
ADVANCE v.09212015
8) What are the components of a diversity statement?
.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Effects of Coping Skills Training in School-age Children with.docx
1. Effects of Coping Skills Training in School-age Children with
Type 1 Diabetes
Margaret Grey, DrPH, RN, FAAN[Dean and Annie Goodrich
Professor],
Yale School of Nursing, New Haven, CT
Robin Whittemore, PhD, APRN[Associate Professor],
Yale School of Nursing
Sarah Jaser, PhD[Post-doctoral Associate],
Yale School of Nursing
Jodie Ambrosino, PhD[Clinical Instructor],
Department of Pediatrics, Yale School of Medicine
Evie Lindemann, LMFT, ATR[Assistant Professor],
Albertus Magnus College, New Haven, CT
Lauren Liberti, MS[Trial Coordinator],
Yale School of Nursing
Veronika Northrup, MPH, and
Yale Center for Clinical Investigations, New Haven, CT
James Dziura, PhD
Yale Center for Clinical Investigations, New Haven, CT
Abstract
Children with type 1 diabetes are at risk for negative
psychosocial and physiological outcomes,
particularly as they enter adolescence. The purpose of this
2. randomized trial (n=82) was to
determine the effects, mediators, and moderators of a coping
skills training intervention (n=53) for
school-aged children compared to general diabetes education
(n=29). Both groups improved over
time, reporting lower impact of diabetes, better coping with
diabetes, better diabetes self-efficacy,
fewer depressive symptoms, and less parental control.
Treatment modality (pump vs. injections)
moderated intervention efficacy on select outcomes. Findings
suggest that group-based
interventions may be beneficial for this age group.
Keywords
coping skills training; child; type 1 diabetes
Effects of Coping Skills Training in School-age Children with
Type 1
Diabetes
Type 1 diabetes (T1D) is one of the most common severe
chronic illnesses in children,
affecting 1 in every 400 individuals under the age of 20, over
176,000 American youth
Corresponding Author: Robin Whittemore, Yale School of
Nursing, 100 Church Street South, New Haven, CT 06536-0740,
[email protected]
NIH Public Access
Author Manuscript
Res Nurs Health. Author manuscript; available in PMC 2010
August 1.
Published in final edited form as:
Res Nurs Health. 2009 August ; 32(4): 405–418.
doi:10.1002/nur.20336.
4. Disease, 2002). Diabetes is the
seventh leading cause of death in the United States, and adults
with T1D are twice as likely
to die prematurely from complications compared to adults
without T1D National Institute of
Diabetes and Digestive and Kidney Disease, 2007). Management
of T1D is demanding,
requiring frequent monitoring of blood glucose levels,
monitoring and controlling
carbohydrate intake, daily insulin treatment (3-4 injections/day
or infusion from a pump),
and adjusting insulin dose to match diet and activity patterns
(American Diabetes
Association, 2008). Such an intensive treatment regimen and
maintenance of near-normal
glycemic control may delay or prevent long-term complications
of T1D by 27-76%
(Diabetes Control and Complications Trial [DCCT] Research
Group, 1994). Interventions
are needed to assist children and families in coping with the
considerable demands of living
with T1D. The purpose of this study was to evaluate the
efficacy of a coping skills training
(CST) intervention, specific to school-aged children and their
parents, on metabolic control
and psychosocial outcomes, and to examine mediators and
moderators of these outcomes.
Tasks of childhood development can compromise diabetes
management. Metabolic control
declines during adolescence (Travis, Brouhard, & Schreiner,
1987). Although the
physiological changes of puberty contribute to insulin
resistance, a premature transfer of
responsibility for diabetes-related tasks from parents to children
also may result in poor
5. adherence and metabolic control (Anderson, Ho, Brackett,
Finkelstein, & Laffel, 1997;
Holmes et al., 2006; Schilling, Knafl, & Grey, 2006). As
children enter adolescence and
strive for autonomy, parents' attempts to monitor or control
their child's treatment may be
viewed as intrusive or nagging, which may result in adolescents
becoming resistant, defiant,
and noncompliant (Berg et al., 2007; Cameron et al., 2008;
Weinger, O'Donnell, & Ritholz,
2001). Low levels of family support and increased family
conflict have been consistently
associated with poor diabetes self-management, metabolic
control, psychosocial adaptation,
and quality of life (QOL) in adolescents with T1D (Pendley et
al., 2002; Whittemore,
Kanner, & Grey, 2004; Wysocki, 1993). In addition, T1D is a
risk factor for depression in
youth, with the prevalence of clinically significant depressive
symptoms ranging from
12-15% in children to 15-27% in adolescents with T1D (Hood et
al., 2006; Kokkonen,
Lautala, & Salmela, 1997; Kovacs, Goldston, Obrosky, &
Bonar, 1997; Whittemore et al.,
2002).
Due to the risks associated with poor metabolic control and
psychosocial adjustment for
adolescents with T1D, increasing attention is being paid to the
developmental transition
between pre-adolescence and adolescence for the promotion of
better health outcomes.
Parents may need to adjust their level of involvement, so that
children can exercise
developmentally-appropriate gains in autonomy, while
continuing to rely upon parents for
6. support, guidance, and encouragement (Anderson, Auslander,
Jung, Miller, & Santiago,
1990). Research supports the need for children and parents to
work cooperatively with open
communication and flexible problem-solving skills in order to
negotiate shared
responsibility for treatment management (Schilling et al., 2006;
Wysocki, 1993). Parental
guidance, warm and caring family behaviors, open
communication, and expression of
feelings have demonstrated protective effects on metabolic
control and psychosocial
adjustment (Davis et al., 2001; Faulkner & Chang, 2007; Grey,
Boland, Davidson, &
Tamborlane 2001).
Family-based psychosocial interventions have been developed
to improve family
interactions and enhance the well-being of youth with T1D. In
several randomized trials
family-based interventions improved family relations,
communication, problem-solving
skills, treatment adherence, and metabolic control. For example,
Anderson and colleagues
showed that a low-intensity office-based, family intervention
increased parental
involvement, while decreasing diabetes-related family conflict
(Anderson, Brackett, Ho, &
Grey et al. Page 2
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August 1.
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8. systems therapy improved outcomes in families with high levels
of conflict. Ellis and
colleagues (2007) demonstrated that a comprehensive home- and
community-based
intervention improved outcomes in families with low
socioeconomic status. The majority of
these family-based interventions targeted adolescents and were
focused primarily on
problem solving and communication. However, variables such
as coping and self-efficacy
also have been associated with improved adherence, family
functioning, psychosocial
adjustment, and metabolic control in youth with T1D (Graue,
Wentzel-Larsen, Bru,
Hanestad, & Sovik, 2004; Grey, Lipman, Cameron, & Thurber,
1997; Griva, Myers, &
Newman, 2000).
Coping skills training (CST) is based on social cognitive theory,
which proposes that
individuals can actively influence many areas of their lives,
particularly coping and health
behaviors (Bandura, 1997). A major premise of this approach is
that practicing and
rehearsing a new behavior, such as learning how to cope
successfully with a problem
situation, can enhance self-efficacy and promote positive
behaviors (Marlott & Gordon,
1985). The goal of CST is to increase competence and mastery
by retraining non-
constructive coping styles and behaviors into more constructive
behaviors. There is evidence
supporting the potential efficacy of CST to promote positive
health outcomes in youth with
and without a chronic illness (see review by Davidson, Boland,
& Grey, 1997). A
9. randomized clinical trial of a CST program, based on Forman's
(1993) protocol, and
modified for adolescents with T1D (Grey, Boland, Davidson,
Yu, & Tamborlane, 1999),
demonstrated improvements in metabolic control, psychosocial
adjustment, and QOL at 6
and 12 month follow-up (Grey, Boland, Davidson, Li, &
Tamborlane, 2000). Because a CST
intervention demonstrated efficacy for adolescents with T1D,
the potential to provide the
intervention to other developmental phases, such as school-aged
children, seems warranted.
In this study, we report long-term treatment effects of a coping
skills training (CST)
program for school age children (8-12 years old) and their
parents compared to an attention
control group who received supplemental diabetes education. A
report of the preliminary
short-term efficacy indicated that children and parents who
received CST showed promising
trends for more adaptive family functioning and greater life
satisfaction than those families
in group education (Ambrosino et al., 2008). These results
support the potential application
of CST in the developmental phase of 8-12 year olds. If school-
aged children and parents
can learn effective coping skills, a positive transition to
adolescence may occur, one in
which parents and children collaborate to maintain effective
diabetes management.
Conceptual Framework
Stress-adaptation models provide a framework for the study of
interventions to promote
adaptation to chronic illness and posit that adaptation may be
10. viewed as an active process
whereby the individual adjusts to the environment and the
challenges of a chronic illness.
(Grey et al., 2001; Grey & Thurber, 1991; Pollock, 1993).
Adaptation, in this framework, is
the degree to which an individual adjusts both physiologically
and psychosocially to the
stress of living with a long-term illness. The framework
suggests that individual
characteristics, such as age, socioeconomic status, and in
children with T1D, treatment
modality (pump vs. injections), individual responses (depressive
symptoms), and context
(coping, self-efficacy, family functioning) influence the level of
individual adaptation. In
this model, adaptation has both physiologic (metabolic control)
and psychosocial (QOL)
components (see Figure 1). The CST was hypothesized to
influence the individual's
responses (depressive symptoms) and context (coping, self-
efficacy, family functioning)
directly and level of adaptation (metabolic control, QOL) both
indirectly and directly.
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Purpose
The primary aim of this randomized clinical trial was to
determine the effect of group-based
CST for school-aged children with T1D and their parents
compared to an attention-control
group receiving supplemental general diabetes education (GE)
over a period of a year on
children's metabolic control, QOL, depressive symptoms,
coping, self-efficacy, and family
12. functioning at 12-month follow-up. The data in this analysis
include only child outcomes.
The secondary aim was to explore mediators (coping, self-
efficacy, family functioning) and
moderators (age, sex, socioeconomic status, treatment modality)
of intervention efficacy
based on the conceptual framework. The following hypotheses
were tested:
1. Children with T1D who participate in CST will demonstrate
better metabolic
control (lower HbA1c levels), better QOL, fewer depressive
symptoms, fewer
issues in coping, better diabetes self-efficacy, and better family
functioning (stable
or less family guidance and control and more family warmth and
caring) compared
to children with T1D who participate in GE.
2. Age, sex, socioeconomic status, and treatment modality will
moderate the
intervention effect on metabolic control and QOL.
3. Changes in coping, self-efficacy, and family functioning will
mediate the
intervention effect on metabolic control and QOL.
Method
Design and Sample
A two-group experimental design was used. Data were collected
at baseline and 1, 3, 6, and
12 months post-randomization by trained research assistants
who were blinded to group
assignment. Children were eligible to participate if they were:
(a) between the ages of 8 and
13. 12 years; (b) diagnosed with T1D and treated with insulin for at
least 6 months; (c) free of
other significant health problems; and, (d) in school grade
appropriate to within 1 year of
child's age.
A sample of 100 subjects was determined by a power analysis
based on the effect size seen
in our adolescent study (Grey et al., 2000) and in our pilot work
with younger children
(difference in HbA1c was .7%). A two-way analysis of variance
with 100 subjects with a .05
significance level would have 98% power to detect a variance
among the 2 group means of .
04, 99% power to detect a variance among the 3 time means of
.051, and 80% power to
detect a interaction among the 2 group levels and the 3 time
levels of .022, assuming that the
common standard deviation is .04, when the sample size in each
group is 50 (Elashoff,
1995). Due to problems scheduling groups, we were unable to
meet our projected goal of
100 subjects (Figure 2).
Of those approached for participation, approximately 58%
agreed; 18% expressed interest
and asked to be approached later, and 21% refused (e.g., too
busy). Twenty-four percent of
participants were unable to be scheduled for the group-based
intervention and were excluded
from the analysis due to lack of exposure to any aspects of the
intervention (18% in the CST
group and 33% in the GE group). This report is based on the 82
children who were exposed
to the interventions. There were 53 children in the CST group
and 20 in the GE group.
14. Comparison of those who received the intervention (CST or GE)
to those who enrolled but
did not receive either intervention demonstrated that groups
were comparable on baseline
measures, other than an increased likelihood for white children
and children whose mothers
had higher education to receive the intervention. Data
comparing attenders to nonattenders
has previously been reported (Ambrosino et al., 2008). Attrition
was low with only 10
participants dropping out or lost to follow up over the 1-year
period (14%). Once scheduled,
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attendance at sessions was good. Participants of CST attended
an average of 4.6 of 6
sessions (range=1-6; SD = 1.21); those in GE attended on
average 3.3 of 4 sessions
(range=1-4; SD = .75).
Descriptive statistics for the sample are provided in Table 1.
Children were predominately
white and of high income, which is consistent with the overall
clinic composition. On
average, children's duration of diabetes was 3.5 years; most
were on pump therapy and had
metabolic control comparable with the ADA's recommendations
for age.
Setting and Procedures
Children and their parents were approached for participation in
the trial during regularly
scheduled visits at a pediatric diabetes clinic in the northeast.
Families interested in the study
16. completed a consent/assent process approved by the university's
Human Subjects Research
Review Committee, as well as baseline questionnaires. Children
who scored above criteria
for elevated depressive symptoms on standardized
questionnaires were referred for follow
up, but not excluded from the intervention unless they required
hospitalization for
suicidality. After consent, participants were randomized by a
sealed envelope technique to
either CST or GE. Both groups received diabetes team care
throughout the course of the
study, and clinicians at the recruitment site were blinded to
study group assignment.
Interventions
Coping Skills Training (CST)—The goal of CST in this age
group is to increase a child's
and his or her parents' sense of competence and mastery by
retraining inappropriate or non-
constructive coping styles and forming more positive styles and
patterns of behavior. Unlike
previous research with CST in T1D where the intervention was
provided only to youth, CST
in this study was provided as a family intervention, to both
parents and youth. Specific
coping skills that were addressed in the intervention included:
communication, social
problem solving, recognition of associations between thoughts,
feelings, and behavior and
guided self-dialogue, stress management, and conflict resolution
around diabetes-specific
stressors (Table 2). Six weekly sessions were conducted in
small groups of 2-6 children;
parents met simultaneously but separately. At the end of each
session, children and their
17. parents met together to share salient issues and discuss possible
connections between group
themes and family concerns.
Within each session, coping skills were presented and
discussed. Role-play also was used
for participants to practice a specific coping skill in a
potentially difficult social situation.
Trainers provided coaching on child or parent responses to the
situation to enable
participants to learn more skillful responses. All participants
were encouraged to practice the
specific skills at home in between sessions. Each 1.5 hour
session was facilitated by a
mental health professional. All CST groups were audio taped
and reviewed for treatment
fidelity.
Group Education (GE)—Because the usual method of working
with youth with T1D is
education, GE was provided as an attention-control condition,
supplementing the individual
diabetes education provided in clinic to all study participants.
All children in this study
received ongoing diabetes education within the context of
quarterly clinic visits. The session
content of the control condition provided a review of intensive
insulin regimens (multiple
daily injections and pump), carbohydrate counting and nutrition,
sports and sick days, and
updates on diabetes care and technology (Table 3). Age-
appropriate written materials were
provided at each session. Participants were encouraged to
discuss the materials in each
session and apply it to their individual family situations. Four
weekly sessions were
18. conducted in small groups of 2-6 children and their parent(s).
Each 1.5 hour session was
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taught by an advanced practice nurse, and all sessions were
audio taped and reviewed for
treatment fidelity.
Measures
Data were collected from children on metabolic control, QOL,
depressive symptoms,
coping, self-efficacy, and family functioning. Self-report
instruments were completed by the
children, and demographic data were collected from a parent.
The HbA1c and other
treatment-related values were extracted from medical charts.
Metabolic control was assessed with HbA1c, a measure of the
glycosylation of the
hemoglobin molecule that reflects the child's average blood
sugar over the past 3 months.
Analyses were performed using the Bayer Diagnostics
DCA2000®, which has evidence of
high reliability (Tarrytown, NY, normal range = 4.2-6.3%). The
ADA recommendation for
the treatment goal for children age 6-12 years is <8%
(Silverstein et al., 2005).
Child QOL was measured by the Diabetes Quality of Life Scale
which has 3 subscales to
assess youth perceptions of the impact of T1D management (21
items), their general
satisfaction with life (18 items), and worries related to T1D (8
items). Scores range from
20. 21-84 for impact, 18-72 for satisfaction, and 8-32 for worry.
Higher scores indicate greater
impact of diabetes on child's life (poorer QOL), more worry
(poorer QOL), and greater life
satisfaction (better QOL). The scale has evidence of adequate
construct validity and internal
consistency reliability (.82 – .85 for subscales; Ingersoll &
Marrero, 1991). In our sample,
alpha = .90 for impact, .84 for satisfaction, and .89 for worries.
Child depressive symptoms were measured with the Children's
Depression Inventory (CDI)
which assesses disturbance in mood and hedonic capacity, self-
evaluation, vegetative
functions, and interpersonal behaviors (Kovacs, 1985). The
scale has 27 multiple choice
items that yield total scores from 0 to 54 with higher scores
reflecting more symptoms. The
CDI has been used extensively in studies of school-aged
children and adolescents, in groups
with known mental health problems (Kovacs, Brent, Feinberg,
Paulauskas, & Reid, 1986;
Kovacs et al., 1990). Reliability estimates have been adequate,
with internal consistency
reliability between .71 and .87 (.84 in our data) and test-retest
reliability at .80 to .87. The
inventory has concurrent and discriminant validity, and a score
of 13 may be interpreted as
the criterion score for elevated depressive symptoms (Smucker,
Craighead, Craighead &
Green, 1986). As in other studies, because depression is not
normally distributed, CDI
scores were treated with a square root transformation prior to
analysis.
Coping was measured by the Issues in Coping with T1D- Child
21. Scale which has two
subscales that assess child perceptions of how hard or difficult
it is to handle T1D
management (14 items, range 0-42) or how upsetting T1D
management is (12 items, range
12-36; Kovacs et al., 1986). Items are rated with a 4-point
Likert-type scale, with higher
scores indicating that children find it more difficult or upsetting
to cope with diabetes. The
scale has been used in previous studies of adaptation to diabetes
over time, and internal
reliability has ranged from .78-.90 (alpha = .72 for the How
Hard subscale and .66 for the
How Upsetting subscale in our sample).
Self-efficacy was measured by the Self-Efficacy for Diabetes
Scale, which evaluates self-
perceptions or expectations held by children with T1D about
their personal competence,
power, and resourcefulness for successfully managing their T1D
(Grossman, Brink, &
Hauser, 1987). The scale consists of 35 items in three subscales:
diabetes-specific self-
efficacy (24 items), medical situations self-efficacy (5 items),
and, general situations (6
items). Participants are asked to rate their degree of confidence
for all items on a 5-point
scale (very sure I can to very sure I can't), with higher scores
indicating lower self-efficacy.
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23. subscale has been reported at .
92 and validity studies demonstrate that the scale has content
and discriminant validity
(Grossman et al., 1987). The alpha coefficient for the diabetes-
specific subscale was .84 in
our data.
Family functioning was measured by the Diabetes Family
Behavior Scale (DFBS;
McKelvey et al., 1993) that evaluates diabetes-specific family
behaviors thought to be
important in helping or hindering a child in following a T1D
regimen. The scale has two
subscales measuring specific areas of family support: guidance-
control (15 items) and
warmth-caring (15 items). Higher scores on the guidance-
control subscale indicate greater
parental involvement in diabetes care (range 15-75), and higher
scores on the warmth-caring
subscale indicate more warmth and support with interactions
related to diabetes care (range
15-75). Previous reliability coefficients were .81 for the
guidance and control subscale and .
79 for the warmth and caring subscale (McKelvey et al., 1993).
Internal consistency for the
present sample was .40 for guidance-control and .73 for
warmth-caring.
Demographic and clinical data consisted of family
sociodemographic data (i.e., race/
ethnicity, education, socioeconomic status), child sex, child
duration of illness, and
treatment modality (pump vs. injections).
Data Analysis
All data were double-entered into a database and checked for
24. accuracy. Analyses were
conducted using SAS 9.2 (SAS Institute, Cary, NC). Groups
were compared on baseline
characteristics using t-tests for continuous variables and
Fisher's Exact tests for categorical
variables.
Comparison of CST with GE—To determine the effect of CST
for children with T1D
compared to the attention-control group (GE), a random
coefficient regression analysis was
used with an intent-to-treat approach (ITT). The ITT approach
included all subjects in the
data analysis, as randomized, regardless of whether they
withdrew or deviated from the
protocol (Fisher, et. al., 1990). The purpose is to preserve
balance in the characteristics of
groups achieved by randomization, and to guard against a
potential bias in the outcomes
from differential drop-outs.
SAS Proc Mixed was used to perform the random coefficient
regression analysis, in which
missing outcome data are treated as missing at random (MAR,
i.e. given the previous
outcome values and covariables, the missingness is independent
of unobserved outcomes;
Rubin, 1976). Outcomes of interest included metabolic control
(HbA1c), diabetes QOL
(impact, worry, and satisfaction), depressive symptoms, coping,
self-efficacy, and family
functioning (warmth/caring and guidance/control). Random
coefficient models included
intervention group, time, and the group by time interaction as
fixed effects, along with
random effects for subject-specific intercepts and slopes. This
25. allowed each participant to
have his or her own initial value of the outcome and the
trajectory of change in the outcome.
Differences in slopes (rates of change) between the two
treatment groups, obtained from an
interaction of treatment group-by-time in the regression model,
were used to evaluate
intervention efficacy. For an overall effect of time on each
outcome of interest, regardless of
group assignment, the group-by-time interaction was removed,
and we evaluated the main
effect of time. Analyses were adjusted for duration of diabetes
diagnosis, child's sex,
diabetes treatment modality (i.e., insulin injections or pump),
and parental income. Results
were presented as annual rates of change for each intervention
group and combined across
both groups. For outcomes that demonstrated differences at
baseline an alternative mixed
model was used to evaluate group differences at 3 months, 6
months, and 12 months,
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adjusting for the baseline value in the outcome. Additional
analyses were performed using
the last observation carried forward (LOCF; Hollis & Campbell,
1999) but did not result in
substantial alterations in conclusions and are therefore not
presented.
Mediators and Moderators of Intervention Efficacy—To explore
mediators and
moderators of intervention efficacy, additional analyses of rates
of change in the outcomes
27. were conducted to determine for whom and how the treatment
may have worked (Kraemer,
Wilson, Fairburn, & Agras, 2002). Based on previous research
and the conceptual
framework, the pre-existing characteristics of child age, sex,
socioeconomic status, and
treatment modality (i.e., insulin injections or pump) were
evaluated as moderators of
treatment by including their two and three-way interaction with
treatment group and time in
the regression models. Proposed mediators (coping, diabetes
self-efficacy, and family
functioning) of changes in outcomes (HbA1c and QOL) were
evaluated by correlating 3-
month changes in mediators (post intervention) with 1-year
changes in outcomes using
Pearson correlation coefficients. Associations among the 3-
month changes and 6- and 12-
month outcomes were further examined using random effect
models and adjusting for
baseline outcome(s), treatment modality, sex, income and
group.
Results
Psychosocial variables
For psychosocial variables, children reported good coping, self-
efficacy, family functioning
and QOL. At baseline 11% of the children demonstrated
elevated depressive symptoms.
Children randomized to CST reported lower QOL and less
family warmth and caring
compared to children in GE (Table 4).
Intervention Efficacy
There were no significant differences between CST and GE
28. groups over time on metabolic
control, QOL, depressive symptoms, coping, self-efficacy or
family functioning. Group
effect sizes at 12 months indicated a small effect of CST on
QOL Impact (ES = .32) and a
small effect of GE on one coping subscale (Upsets, ES =.41).
No significant effects of
treatment were observed for metabolic control, self-efficacy, or
family outcomes.
When rates of change over time were examined across both
groups, the following outcomes
indicated improvement: diabetes QOL Worry (p=.013),
depression (p<.001), both coping
scales (How Hard, p=.003; How Upsetting, p=.008), and self-
efficacy (p<.001). These
improvements were observed although children were taking on
additional responsibility for
their diabetes care as evidenced by a significant reduction over
time in both groups in
parental guidance and control (p<.001).
Moderators
Child age, sex, socioeconomic status (income), and treatment
modality (insulin pump vs.
injections) were included as interaction terms in the model to
test for moderation. Children
on a pump had lower HbA1c across all time points (p<.05) and
there was a significant
treatment group-by-modality–by-time interaction (p=.007).
Nevertheless treatment group
differences were not apparent at 6 and 12 months. Among
children on the pump, there were
no significant group by time interactions with HbA1c.
There was a significant difference between groups on the
29. Warmth and Caring subscale of
the DFBS and treatment modality. Children receiving injections
reported a decrease in
warmth and caring over time; children on a pump reported
stable warmth and caring (p<.
05). There was also a treatment group-by-treatment modality-
by-time interaction (p=.004).
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Stratified analysis by modality revealed that at 6 months
Warmth and Caring was not
significantly higher in GE compared to CST among children
using the pump (p=.07). Child
age, sex, and socioeconomic status were not significant
moderators of treatment effects on
outcomes.
Mediators
Based on our conceptual model, coping, self-efficacy, and
family functioning were tested as
potential mediators of the intervention on QOL and metabolic
control. Although we did not
find significant effects of the intervention on these outcomes or
the proposed mediators
(Table 5), in line with Kraemer and colleagues (2002), we
tested whether changes in the
proposed mediators (i.e., difficulty coping, upset related to
coping, self-efficacy for diabetes,
family warmth/caring, and family guidance/control) were
related to changes in outcomes
(i.e. QOL impact, QOL worry, and HbA1c) across intervention
groups. Correlation analyses
revealed that 3-month increases in family warmth/caring were
associated with lower 1-year
31. changes in worry QOL (r = -.29, p = .02) and impact on QOL (r
= -.42, p < .001). No
significant correlations were observed between changes in self-
efficacy, upset related to
coping, or family guidance/control and any of the outcome
variables. Further, none of the
potential mediators were associated with change in HbA1c.
The change from baseline to 3 months post-intervention for
each of the mediators also was
entered into a mixed model predicting outcomes at 6 months and
12 months, after adjusting
for baseline outcome, treatment modality, sex, income and
group. Three-month changes in
family warmth/caring significantly predicted QOL impact (B = -
.26, p = .02); each 1 unit
increase in family warmth/caring over 3-months was associated
with a .26 reduction at 6 and
12 months for QOL impact. None of the other proposed
mediators were significant
predictors of outcomes in these adjusted analyses.
Discussion
The purpose of this study was to examine the efficacy of a
group-based CST intervention for
school-aged children with T1D and their parents compared to an
attention control group
(GE). The primary hypothesis, that children of the CST
intervention would demonstrate
better metabolic control, QOL, depressive symptoms, coping,
self efficacy, and family
functioning, was not supported.
The intention of this intervention was to provide a preventive
intervention for school-aged
children and their parents, prior to adolescence, when metabolic
32. control typically worsens
and psychosocial and family issues arise. The International
Society for Pediatric and
Adolescent Diabetes (ISPAD) clinical consensus guidelines
advocate for preventive
interventions for youth with T1D (Delamater, 2007). A
considerable research challenge with
a prevention intervention, however, is that improvement may be
difficult to demonstrate in a
population with good physiological and psychosocial
adjustment, such as the current
sample. However, equivalence or lack of decline over time may
be equally important.
School-aged children in this sample demonstrated excellent
metabolic control and good
psychosocial adjustment at baseline and across the intervention
period. Recruitment yield
for this sample of school-aged children was less than in
previous studies with adolescents,
and scheduling of the group sessions was more difficult, which
may indicate that families
were not experiencing significant challenges warranting
participation in a psycho-
educational intervention.
The lack of differential effects of CST may be due to the small
sample size and significant
time effects demonstrated in this study. Children who received
either CST or GE reported
significantly better QOL, fewer depressive symptoms, fewer
issues in coping, less parental
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34. diabetes self-efficacy over time.
Perceptions of family warmth remained stable over time. These
are important findings, as
increased psychosocial difficulties would be expected as
children transition into
adolescence, particularly with depressive symptoms and family
functioning (Anderson, et
al., 2002; Kovacs et al., 1997). Although further research is
indicated, group-based
interventions during pre-adolescence for both children and their
parents may be warranted. It
is possible that receiving T1D education in a group format at
this developmental phase is
equally as beneficial as CST, because there are considerable
challenges to successful
management of T1D in a maturing child such as the transfer of
responsibility from a parent
to a teen that may be addressed in an educational group setting.
Providing education in a
group context may also expose participants to peer-identified
coping skills and peer social
support. Indeed, anecdotal reports from parents and the study
interventionist for the GE
sessions indicated that a supportive group process occurred
within the context of providing
diabetes-specific education.
The lack of support for the proposed mediators of coping, self-
efficacy, and family
functioning on intervention efficacy could also be attributable
to the small sample size and
significant time effects without a differential intervention
effect. Recent advocates for
evaluating mediation effects in clinical trials recommend
exploring mediation effects despite
non-significant intervention effects, as such analysis could still
35. identify mechanisms of
change (Kraemer et al., 2002). Although exploratory in nature,
results of this mediation
analysis did not support coping or self-efficacy as mediators of
change in metabolic control
or QOL in this school-aged sample. However, across
intervention groups, there was support
for improvement in coping and family warmth/caring as
mediators of improved QOL. It is
possible that unmeasured factors such as social support which
were present in both
interventions, may influence metabolic control and psychosocial
adjustment in school-aged
children living with T1D. Previous research supports the
beneficial effect of peer support,
such as that experienced in the groups for parents and children
with T1D (La Greca et al.,
1995; Sullivan Bolyai et al., 2004).
Moderators considered in evaluating intervention efficacy in
children with T1D included
age, sex, and socioeconomic status as well as treatment
modality (pump or injections). Only
treatment modality moderated intervention efficacy, and only
with certain outcomes
(HbA1c, family warmth and caring). Children using the pump,
regardless of group
assignment, had better metabolic control and reported more
family warmth and caring
compared to children treated with multiple injections. Results of
the moderation analysis
indicated that children exposed to GE who were treated with
injections had a greater
increase in HbA1c at 3 months. Children exposed to GE who
were treated with a pump had
greater family warmth and caring at 6 months. Although
36. previous research has demonstrated
better metabolic control and QOL in children treated with a
pump vs. injections (Doyle et
al., 2004; Hilliard, Goeke-Morey, Cogen, Henderson, &
Streisand, 2008; Nimri et al., 2006),
more information is needed on the impact of treatment modality
on family functioning.
It is important to note that the lack of variability in this sample
in socioeconomic status also
may have influenced results of this study. The sample was
predominately of middle to upper
income, reflective of the clinic population. Previous research
supports considerable variation
in metabolic control and psychosocial adjustment with
differences in socioeconomic status.
For example, youth with lower socioeconomic status have
demonstrated poorer metabolic
control, greater stress, and lower adherence compared to youth
of higher socioeconomic
status (Naar-King et al., 2006; Overstreet, Holmes, Dunlap, &
Frentz, 1997). Future research
with more diverse samples is indicated.
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Findings of this study must also be interpreted in light of
several limitations. In addition to
the small sample of primarily white and upper socioeconomic
status families and the fact
that the majority of children demonstrated excellent metabolic
control and good
psychosocial adjustment at baseline, the majority also were
using an insulin pump. This is
not reflective of other studies of youth with T1D (Valenzuela et
38. al., 2006), and may be
because pump therapy is strongly encouraged at our clinic
recruitment site. Also, several
subscales (DFBS Guidance and Control, Coping How Upsetting)
had low internal
consistency reliability, leading to increased measurement
variance. Lastly, inability to
schedule groups in a substantial number of children that
enrolled in the study may have also
created a selection bias, in that participants who were able to be
scheduled for groups may
have been more motivated with overall better adjustment to
T1D.
Despite these limitations and the primarily non-significant
findings, there are several
important clinical and research implications. School-aged
children and their parents were
successful in implementing intensive treatment of T1D as
evidenced by excellent metabolic
control. Although the children generally demonstrated good
psychosocial adjustment, 11%
reported elevated depressive symptoms at baseline. Thus, these
findings highlight the
importance of screening for depressive symptoms in school-
aged children with T1D, as
recommended by the American Diabetes Association
(Silverstein et al., 2005).
Positive outcomes associated with the use of the insulin pump
provide some evidence for the
benefit of the pump modality as an option for school-aged
children with T1D. In our sample,
treatment type was a moderator of metabolic control on family
warmth/caring, suggesting
that children on the pump may have better family functioning in
39. addition to better metabolic
control. These findings may be a result of decreased need for
parental reminders for children
using insulin pumps.
Lastly, findings of this study also lend support to group-based
psycho-educational
interventions for school-aged children with T1D and parents.
Children participating in both
programs demonstrated improvements on important
psychosocial outcomes, particularly in
self-efficacy, coping, depressive symptoms, worry, and impact
of diabetes on QOL. Perhaps
the non-specific factor of social support (received by both
groups) is one of the mediators of
the treatment. Further research is indicated.
Conclusion
CST did not have the expected effect on child and family
outcomes in this relatively well-
adjusted sample of school-aged children with T1D. Both CST
and GE improved
psychosocial outcomes for children. A better understanding of
the potential moderation of
pump therapy in school-age children has been elucidated.
Further research is indicated on
preventive interventions with longer follow-up to capture the
targeted transition to
adolescence. In addition, future research is indicated to
determine the intervention efficacy
in children of more diverse race, ethnicity, and socioeconomic
status; children with higher
HbA1c levels; and children with more variable psychosocial
adjustment and family
functioning.
40. Acknowledgments
Supported by a grant from the National Institute for Nursing
Research (National Institute of Health R01NR004009;
PI: Margaret Grey, DrPH, RN, FAAN).
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Figure 1. Conceptual Framework
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65. CST
(N=53)
n (%) or mean (SD)
GE
(N=29)
n (%) or mean (SD)
Racial Group
White 44 (83%) 26 (90%)
Sex
Girls 30(57%) 20 (69%)
Treatment modality at study entry
Pump 38 (72%) 22 (76%)
Family Income
66. <$39 999 8 (15%) 1 (4%)
$40 000-$79 999 13 (25%) 7 (24%)
>$80 000 32 (60%) 21 (72%)
Parent's relationship (mother) 49 (92%) 28 (97%)
Age (yr) 9.9 (1.5) 9.9 (1.4)
Diabetes duration (yr) 3.7 (2.78) 3.6 (3.0)
Mother's education(yr) 15.4 (2.2) 15.9 (2.4)
Using Fisher's Exact test for categorical variables and t-test for
continuous variables, there were no significant differences
between groups.
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Table 2
Coping Skills Training (CST) Session Content
Session Description
1. Introduction to CST Session content, structure, rules, CST
framework.
Diabetes experience – discussion of commonalities and
differences.
2. Communication Skills Forms of communication, including
verbal and non-verbal cues.
Puzzle game to explore styles of communication (passive,
aggressive, and assertive) and assumptions about others.
Skill practice and discussion to probe for managing difficult or
embarrassing moments.
3. Social Problem Solving Use of a step-by-step model with
69. diabetes specific situations including possible responses and
alternatives to
explore steps through role-playing.
4. Conflict Resolution Discussion about different conflict styles
(avoidance, giving in, confrontation, being humorous, and
problem
solving).
Animal photos depicting styles, participants identifying style.
Situation role-playing to discover the most positive ways to
handle conflict and difficult situations.
5. Stress Management Teaching of a variety of stress
management techniques, including deep breathing, muscle
relaxation, and guided
imagery.
6. Self-Talk Identification of feelings to understand associations
between feelings, thoughts, and behaviors.
Presentation of a cognitive model to help further explore links
and responses.
Role-play of specific situations and discussion to encourage
application of self-talk skills.
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Table 3
Group Education (GE) Session Content
Session Description
1. Intensive Insulin
Regimen
Glucose control, target glucose, and blood sugar trends
Emphasis on how participants feel when blood sugar is well
controlled, and how good blood sugar control prevents
health complications
72. Instruction in adjusting insulin when using multiple daily
injections or the pump with examples
2. Nutrition Carbohydrate counting
Three basic food groups (carbohydrates, protein, and fats) and
the value of fiber
Discussion of choosing food wisely (limiting sugar, reading
food labels, and increasing intake of fruits and vegetables)
Healthy recipes
3. Sports and Sick
Days
Health benefits of exercise
Consideration of diabetes and exercise
Sick day guidelines for pump and injection users
Discussion of the importance of sleep
Review of exercise and sick-day problem solving.
4. Updates and
Technology
New developments in diabetes technology and research (meters,
pumps and pump features, continuous glucose
monitoring systems, real-time glucose monitoring systems,
73. pump and real-time glucose monitoring systems)
Diabetes organizations that could be used as resources for
information or referral.
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