2,291 research outputs found

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    Effects of a psychosocial intervention on the quality of life or primary caregivers of women with breast cancer in Abuja, Nigeria

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    Studies have shown that limited attention has been paid to the psychosocial wellbeing of caregivers of patients undergoing care and treatment for breast cancer in Nigeria. There are no interventions in place to cater for their needs despite, the psychological problems faced by this group of people. This study investigated the effectiveness of a psychosocial intervention in term of impact on the quality of life (QOL) of primary caregivers of women with breast cancer in Abuja, Nigeria. Using a quasiexperimental design, sample of 108 participants assigned to the intervention and control groups, the study made use of the Zarit Burden Interview (ZBI) and Caregiver Quality of Life Index-Cancer (CQOLC) to measure caregiver burden and QOL respectively. The hypothesis for the study was that the primary caregivers of women with breast cancer who receive a psychosocial intervention programme will report improved QOL compared with caregivers who do not attend a psychosocial intervention programme. The study established that there were a negative linear relationship between caregiver burden and QOL (R = -0.45, p < 0.001) as a basis for intervention, and also that 29% variance of QOL could be explained by caregiver burden. The intervention results showed that at baseline 51.9% participants reported moderate to severe burden and 48.1% reported severe burden. These figures reduced to 22.3% and 12.6% for moderate to severe and severe burden respectively at 6 weeks after intervention, and further reduced to 18.6% and 4.9% respectively at 12 weeks after intervention. Comparing the QOL of the intervention and control groups, the results showed a significant difference on the score at baseline, 6 and 12 weeks. However, looking at performance of the intervention group, there was no significant different at baseline and 6 weeks (t=0.83, p < 0.05), and baseline and 12 weeks (t=1.65, p < 0.05). With reference to the caregiver burden of the intervention and control groups, it was found that a significant difference existed at baseline (t=9.33, p < 0.001). In respect of the impact of the intervention on caregiver burden of the intervention group, results showed a significant difference between baseline and 6 weeks (t=30.34, p < 0.001) and between baseline and 12 weeks (t = 36.80, p < 0.001) after intervention. The study concluded that the psycho-education intervention significantly affected caregiver burden but did not affect caregivers' QOL. Therefore, there is a need for a psycho-education intervention for caregivers of patients with breast cancer, in order to reduce the burden and help them cope with the work of caregiving. Appropriate supportive interventions should be made available to support the close family members of patients with breast cancer in order to reduce caregiver burden. Relevant stakeholders in the healthcare sector especially in palliative care should promote awareness of carer needs. The provision of intervention programmes for caregivers requires further research to develop contextually specific programmes and services which will improve the QOL of caregivers

    The influence of discouragement, anxiety and anger on pain: an examination of the role of endogenous opioids

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    Animal research suggests that exposure to inescapable stressors can lead to an endogenous opioid-mediated form of pain inhibition, known as stress-induced analgesia (SIA). Similar results have been found with humans, although the literature is much less extensive and at times contradictory where uncontrollable stressors have led to an increase, rather than a decrease in pain. More recently, there has been some suggestion that emotions play an important role in pain modulation, and that particular negative moods are associated with opioid-mediated hypoalgesia. This research aimed to clarify the psychological (cognitive and affective) factors underlying endogenous opioid-mediated pain inhibition in humans. The purpose of Study 1 was to examine the effects of stressor controllability and predictability on pain intensity (PI) and unpleasantness (UP) ratings during a cold pressor task (CPT) in 56 male and female subjects. The stressor involved a timed mental arithmetic task during which three moderately noxious electrical shocks were delivered. Although subjects were informed that shock delivery was contingent on math performance, the shock schedule was preset and identical across conditions. Perceived control over the shocks was manipulated between subjects by altering the difficulty of the math task. Shock predictability was manipulated by changing the colour of the computer screen to warn of an impending shock. Subjects were randomly allocated to four experimental conditions (controllable-predictable, controllable-unpredictable, uncontrollable-predictable, and uncontrollable-unpredictable shocks). Visual analogue ratings of 'perceived self-efficacy' (to avoid the shocks) and mood (anxiety, confusion, discouragement, anger, sluggishness, liveliness) were completed before, during and after the math task. Significantly greater discouragement and lower self-efficacy was reported in 'uncontrollable' conditions indicating that 'controllability' was manipulated effectively. Results indicated that a perceived lack of control over shocks during the math task led to significantly greater decreases in PI, but not UP, ratings during the last stages of a 4-minute fixed interval CPT after the math task. Shock predictability failed to influence subjective pain ratings alone; however, unpredictability interacted with lack of control to initially increase pain, followed by analgesia. Stress-induced increases in negative affect (anxiety, discouragement, anger) were associated with decreases in cold pressor PI, but with increased shock PI and UP during the math task. It was concluded that lack of control over an aversive event and negative affect led to SIA during a prolonged pain stimulus, whereas shock predictability had little influence on pain. In Study 2, 70 male and female subjects received either an opioid antagonist (naltrexone) or a placebo before the math task (using a double-blind, counterbalanced design), in order to determine the role of endogenous opioids in SIA. Subjects were randomly assigned to one of three experimental conditions to investigate whether the shocks themselves may have contributed to analgesia observed after the math task: (1) easy task-few shocks, (2) hard task-few shocks, (3) hard task-many shocks. Increases in systolic blood pressure (SBP), diastolic blood pressure (DBP), anxiety, anger and discouragement indicated that negative affect and sympathetic arousal were induced during the math task. Endogenous opioids inhibited the rise in anger, but not discouragement or anxiety, during the math task. There was some evidence that perceived lack of control over shocks, and not the shocks themselves, led to opioid-mediated decreases in cold pressor UP after the math task. In correlational analyses, discouraged subjects under opioid blockade reported more cold pressor UP after the math task than their placebo counterparts. However, this effect was not strong enough to reach statistical significance in regression analyses. Anxiety, anger, discouragement and lack of control over shocks increased shock PI and UP during the math task. A growing body of research with normotensive subjects has linked increased cardiovascular activity with insensitivity to pain, but the role of endogenous opioids remains contentious. In addition to the investigations outlined above, Study 2 aimed to examine the contribution of endogenous opioids in the cardiovascular-pain relationship. However, there was no evidence of an interaction between pain and cardiovascular activity in this study. Study 3 was carried out to investigate opioid involvement in the effects of an uncontrollable stressor and stress-induced negative mood on cold pressor PI, UP and pain tolerance, and onset/thresholds of the nociceptive flexion reflex (RIII). Forty-three male and female subjects were administered either naltrexone or a placebo using a double-blind, counterbalanced design before completing a timed mental arithmetic stressor (identical to the 'hard task-many shocks' condition in Study 2). Increases in physiological (SBP, DBP) and affective measures (anxiety, anger and discouragement) indicated that the math task induced a marked state of stress. Negative affect increased shock PI and UP during the task, whereas self-efficacious subjects taking the placebo experienced less shock pain. However, uncontrollable stress led to an opioid-antagonised increase in cold pressor UP. Stressor controllability had a similar, but marginal, effect on cold pressor PI, but not pain tolerance. Tolerance of cold pressor pain was not associated with subjective PI and UP ratings, but was positively associated with endurance to non-painful, but unpleasant tasks (Valsalva Manoeuvre, Letter-Symbol Matching Task), indicating that pain tolerance was measuring the ability to tolerate discomfort, in addition to pain. Results of hierarchical multiple regressions demonstrated that increases in discouragement were positively related to increases in cold pressor UP after the math task, for naltrexone recipients only. These findings suggest that discouragement inhibits the UP of a prolonged pain stimulus via opioid mechanisms. RIII latencies and thresholds were not affected by the math task or by opioid blockade; however, these null effects may be due to methodological limitations. Unlike Study 2, higher blood pressure was associated with shock and cold pressor pain inhibition in normotensive subjects, and this relationship appeared to be mediated by opioids. The strong association between chronic pain and depression has led to speculation that the endogenous opioid system and pain modulatory mechanisms may be impaired in depression. At the time that this research was carried out, no studies had examined whether this was the case. In Study 4, the effect of a cognitive stressor (math task used in Study 3) on foot cold pressor PI, UP and pain tolerance and the nociceptive, or R2 component, of the blink reflex was investigated in 61 participants with or without major depression (as met by DSM-IV diagnostic criteria and confirmed by psychometric testing). Naltrexone or placebo was administered to subjects an hour before the math task using a double-blind, counterbalanced design. Increases in physiological (SBP, DBP) and affective measures (anxiety, anger and discouragement) confirmed that the math task induced the targeted emotional state. An opioid-mediated reduction in anxiety occurred mid-way through the math task. Opioid-mediated decreases in foot cold pressor PI and UP were observed in depressed and non-depressed subjects after the math task. R2 onset to 10 mA was facilitated after the task regardless of opioid blockade, suggesting that endogenous opioids are not involved in the modulation of the BR. Increased anxiety and discouragement led to opioid-mediated inhibition of shock PI and UP during the task and, to a lesser extent, foot cold pressor PI and UP after the math task. Anger increased shock pain without being influenced by opioid blockade. Pain tolerance was not influenced by depression, opioid blockade or mood. These findings failed to support the idea that SIA is impaired in major depression, suggesting instead that uncontrollable aversive events and negative mood (anxiety, discouragement) lead to opioid activation and insensitivity to acute pain. Multiple regression analyses revealed that the inverse relationship between resting blood pressure and foot cold pressor PI and UP was opioid-mediated in controls only, suggesting that opioid dysregulation in depression might influence regulatory functions other than SIA. In Study 4, opioid involvement in hetero-segmental pain inhibitory phenomena termed diffuse noxious inhibitory controls (DNIC) was examined separately, before psychological stress. Specifically, the effect of a heterotopic noxious conditioning stimulus (CS i.e., hand CPT) on R2 onset latency was compared before and after drug absorption (before the math task). An inhibitory effect of the first CS was detected at each electrical stimulus intensity consistent with a DNIC effect. However, this effect was not detected during the second CS, suggesting that some other process masked the DNIC effect. In summary, the findings indicate that uncontrollable aversive events and negative emotion (primarily discouragement) activates endogenous opioids and inhibits pain in human subjects, whether depressed or not. Notably, opioids inhibited the affective component of pain perception, or pain UP, more consistently than PI, suggesting that the antinociceptive function of opioids may be secondary to an important emotional-modulatory role. Endogenous opioids also appeared to mediate the cardiovascular-pain relationship in normotensive non-depressed subjects, suggesting an important stress-regulatory role for these peptides. Opioid-mediated masking of this relationship in major depression suggests that functioning of the endogenous opioid system may be impaired in baroreceptor-mediated analgesia. This finding provides preliminary support for the notion that opioid antinociceptive system dysfunction may contribute to cardiovascular disease in depression

    Exploring Mathematics Anxiety of Students At-Risk for Mathematics Difficulties

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    Students in mathematics classrooms are found to experience various levels of stress and anxiety during instructional time. Negative feelings associated with participation in math activities can lead to both physical and emotional manifestations, affecting performance, achievement, and even confidence with the academic subject. Students found to be at-risk for mathematics difficulties have greater risks when it comes to the possible experience of mathematics anxiety. Students with learning disabilities, students needing supplemental interventions, and students who are English learners can experience potential bouts of anxiety and stress, magnifying academic struggles in the math classroom. In addition, academic deficits can intensify levels of anxiety because of a shortage of working memory capacity that many students that are at-risk are found to have. Therefore, the purpose of this study was to explore the relationship of mathematics anxiety, mathematics achievement, and working memory capacity associated with students at- risk for mathematics difficulties. The understanding of the cognition process during math instruction, as well as the variables needed to develop effective mathematic interventions to support the decrease or onset of math anxiety were also investigated. This study further examined potential interconnections between math anxiety and age, inspecting the links between academic achievement and studying foundational math concepts. Participants were recruited from a Title I elementary school in a large urban environment located in the Southwestern United States. Through the implementation of math anxiety rating scales, math achievement scores, working memory measures, classroom observations, and student focus groups this research seeks to explore the existence of mathematics anxiety of students at-risk for mathematics difficulties. Results indicated that all participants identified as at-risk for mathematics difficulties experienced varying levels of math anxiety, with significant differences found across levels of working memory and English language proficiency. Students with learning disabilities reported the lowest levels of math anxiety while English learners reported the highest levels of math anxiety. Results also indicated that working memory is a predictor of math anxiety and a significant difference levels of math anxiety was found across both levels of working memory and English proficiency. Results of this study indicated may encourage future research to focus on interventions and support specifically for the prevention and reduction of mathematics anxiety for students at-risk for mathematics difficulties

    Factors that affect motivation towards english language acquisition in seventh grade students of a public elementary school in Parral

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    Tesis (Magíster en la enseñanza del inglés como lengua extranjera)The research presents the results of the identification and analysis of factors that characterize the motivation for the English Foreign Language Acquisition of seventh year students who belong to a Public Elementary school of Parral, seventh region, Maule in Chile. To investigate the factors that influence students’ motivation a mixed method research was carried out. The data was collected and analysed through qualitative approach and organized and presented in a quantitative manner represented by graphics. The information was compiled by two previously validated instruments, which consisted of a questionnaire for the teachers of the different subjects of the class and the psychosocial team who works with the students. A personal interview was applied to each student. Two major conclusions were obtained from the results of the analysis of the data collection; firstly students present a lack of motivation towards the subject of English as a Foreign Language as a product of the sociocultural environment in which they are immersed, secondly learners are exposed to language learning from puberty and not from the beginning of their first learning stages as postulates the Critical Period Hypothesis (CPH).La investigación presenta los resultados de la identificación y análisis de los factores que caracterizan la motivación hacia la adquisición del inglés como lengua extranjera de alumnos de séptimo año básico pertenecientes a un colegio básico y público de la comuna de Parral, séptima región del Maule en Chile. Para investigar los factores que inciden en la motivación de los estudiantes se utilizó un enfoque mixto tanto cualitativo para la recolección y análisis de los datos y cuantitativo para la organización y presentación de la información representada en gráficos. La obtención de la información se hizo mediante dos instrumentos previamente validados, los cuales consistieron en un cuestionario para los profesores de los diferentes sectores de aprendizaje del curso y para el equipo sicosocial que trabaja con los estudiantes. Una entrevista personal fue aplicada a cada alumno. Dos grandes conclusiones se obtuvieron del resultado del análisis de la recolección de datos; la primera es la falta de motivación de los alumnos hacia la asignatura de inglés como lengua extranjera producto del entorno sociocultural en el cual están inmersos y la segunda es que los alumnos son expuestos al aprendizaje de la lengua desde el inicio de la pubertad y no desde sus primeras etapas de aprendizaje como postula la hipótesis del período crítico

    Learning Disabilities

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    Learning disabilities are a heterogeneous group of disorders characterized by failure to acquire, retrieve, and use information competently. These disorders have a multifactorial aetiology and are most common and severe in children, especially when comorbid with other chronic health conditions. This book provides current and comprehensive information about learning disorders, including information on neurobiology, assessment, clinical features, and treatment. Chapters cover such topics as historical research and hypotheses of learning disorders, neuropsychological assessment and counselling, characteristics of specific disorders such as autism and ADHD, evidence-based treatment strategies and assistive technologies, and much more
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