Clinical Psychology Doctorate

When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given e.g. Zitz, C. (2011) Friendships in the lives of transgender individuals. D.Clin.Psych. thesis, Canterbury

Background: In countries with high incomes, frailty indicators predict adverse outcomes in older people, despite a lack of consensus on definition or measurement. We tested the predictive validity of physical and multidimensional frailty phenotypes in settings in Latin America, India, and China. Methods: Population-based cohort studies were conducted in catchment area sites in Cuba, Dominican Republic, Venezuela, Mexico, Peru, India, and China. Seven frailty indicators, namely gait speed, self-reported exhaustion, weight loss, low energy expenditure, undernutrition, cognitive, and sensory impairment were assessed to estimate frailty phenotypes. Mortality and onset of dependence were ascertained after a median of 3.9 years. Results: Overall, 13,924 older people were assessed at baseline, with 47,438 person-years follow-up for mortality and 30,689 for dependence. Both frailty phenotypes predicted the onset of dependence and mortality, even adjusting for chronic diseases and disability, with little heterogeneity of effect among sites. However, population attributable fractions (PAF) summarising etiologic force were highest for the aggregate effect of the individual indicators, as opposed to either the number of indicators or the dichotomised frailty phenotypes. The aggregate of all seven indicators provided the best overall prediction (weighted mean PAF 41.8 % for dependence and 38.3 % for mortality). While weight loss, underactivity, slow walking speed, and cognitive impairment predicted both outcomes, whereas undernutrition predicted only mortality and sensory impairment only dependence. Exhaustion predicted neither outcome. Conclusions: Simply assessed frailty indicators identify older people at risk of dependence and mortality, beyond information provided by chronic disease diagnoses and disability. Frailty is likely to be multidimensional. A better understanding of the construct and pathways to adverse outcomes could inform multidimensional assessment and intervention to prevent or manage dependence in frail older people, with potential to add life to years, and years to life.

Background: The treatment of type 1 diabetes includes daily injections of insulin and requires attention to diet, exercise, and monitoring of blood glucose levels. Coping Skills Training is an intervention based on social learning theory and aims to develop an individual's skills and ability to cope with the stressful situations related to managing diabetes on a daily basis. Aim: This paper has reviewed the literature examining the impact of Coping Skills Training on metabolic control and psychosocial outcomes in children and adolescents and aims to: (1) Describe and compare the characteristics of CST across the available literature, (2) Provide a quality assessment of studies evaluating CST, (3) Describe the impact of CST on metabolic control and psychosocial variables in children and adolescents, in light of the quality assessment. Method: A keyword search in Embase, Medline, PsycINFO and Pubmed Central databases yielded a total of 15 quantitative articles using a variety of designs. Results: The small number of well-designed studies indicated that metabolic control is not improved in a limited population of children who participate in CST. However the results in adolescents are more promising. Conclusions: The evidence on whether CST can improve psychosocial outcomes in children and adolescents is mixed and appeared dependent on the mode of delivery and whether CST is compared to routine care or diabetes related education. A summary of recommendations for future research is provided along with the clinical implications of the results described in this review.