Dissertations / Theses on the topic 'E-health intervention'

One way internet users determine the quality of a website is to look for so called 'credibility factors'. These factors can either be positive: the presence of a date, reference list, independent site certification; or negative: the presence of advertisements or broken links. This thesis investigates what role such factors play in the effectiveness of two e-health interventions. An e-health intervention is a health related website designed to change a person’s behaviour. Until now research into credibility has been largely theoretical. Studies have relied on subjective outcome measures such as Likert scales, website content recall, expressions of preference and self reported behaviour. This thesis describes two studies, the second of which investigates, for the first time, whether surface credibility manipulations change objective behavioural outcomes. Surface credibility is how much a perceiver believes a website on simple inspection. Based on a comprehensive literature review of credibility research, the following credibility factors were explored: presence of advertising, recognisable logos, contact details, physical address, references, third party certification, currency information, privacy statement, HTTPS encryption, top level domain and presence of a broken link. The first study involved the assembly of an exercise promotion website. Participants were randomised to receive the site modified to contain either factors heightening credibility or those lowering credibility. Participants using the high credibility version spent twice as long browsing the site as those using the low credibility version. There was no effect on attitude to exercise or self reported physical activity. The second study used the same methodology but with a website targeting an objectively measurable health behaviour (registration as an organ donor). In this study 889 university students were exposed to a website promoting organ donation. Information on the site was assembled based on theoretical domain interviewing and current research into organ donation interventions. 336 (37.79%) participants registered through the study website. The study detected no significant difference in registration rates between high and low credibility versions of the site. Of the 17 comments left on the low credibility site, only 3 were credibility related criticisms. It is the finding of this thesis that university students are willing to submit personal information and place trust in a website contravening many current credibility guidelines. Future studies into credibility are needed to explore why this is the case. One possibility is that the website was trusted simply because it was part of a research study. Another possibility is that the high quality of the textual content compensated for the lack of credibility of the site itself. It is the recommendation of this thesis that future studies focus on objective behavioural outcome measures and control for other forms of credibility such as participation in a research study.

Aim and objectives: The purpose of this study was to develop, implement and evaluate the effectiveness of a multicomponent school-based intervention that focused on promoting healthy eating and physical activity with school children (aged 9 to 11 years) in Lebanon, in order to prevent childhood obesity. Methods: A school-based intervention adapted to the culture of Lebanese and Arab populations and based on the constructs of the Social Cognitive Theory was developed. The intervention consisted of three components: classroom curriculum, food service, family involvement. Eight schools were selected from two different communities (high and low socioeconomic status) in Beirut and were randomly assigned (by a toss of a coin) to either the intervention or control group. Students aged nine to eleven years in intervention schools were exposed to the intervention components for three months. Students in control schools received their usual school curriculum. Anthropometric measurements, questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted with students, teachers and parents in intervention schools at the end of the study. Results: Changes were observed based on self-report measures. Daily breakfast intake increased significantly in the intervention group compared with the control group (3.5 times more p<0.001). Students in the intervention group reported consuming significantly less chips and sweetened drinks at post-test compared with controls (86% & 88% less respectively p<0.001). There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Knowledge and self-efficacy scores increased for the intervention (+2.8 & 1.7 points respectively p<0.001) but not for the control group. Interview data from focus groups showed that the programme was generally well accepted; students benefited in a pleasurable way and made attempts to change their eating and physical activity habits. Limitations for better outcomes include the length of the programme and the school environment. Conclusion: “Health-E-PALS” (Healthy Eating and Physical Activity in Lebanese School children) is a promising innovative, theory-based, culturally sensitive intervention to promote Healthy Eating and Physical Activity in Lebanese school children with a regional perspective.

This thesis examined the outcomes of a nurse-led, whole-of-lifestyle intervention delivered via an e-health platform to women after cancer treatment. The aim of the intervention was to improve two common and distressing adverse effects of cancer treatments; namely, impaired sexual well-being and altered body image. The e-health aspect of the intervention ensured it was available to women regardless of their place of residence or their access to conventional supportive care. Intervention participants demonstrated improved sexual well-being and body image compared to controls. These beneficial findings have implications for health promotion practice and health professional education in cancer settings.

Over 29 years into the epidemic, fighting HIV (Human Immunodeficiency Virus), the virus that causes AIDS (Acquired, Immune, Deficiency, Syndrome) continues to be a global concern. School-based computer-assisted HIV/AIDS interventions can provide innovative ways of preventing HIV among young people from diverse backgrounds in Africa. However, questions of technological, social and organisational readiness cannot be overlooked. This is because of: (1) being health interventions implemented in educational centres; (2) limited technological facilities and skills; (3) the prevailing norms that associate young people's sex education with sex experimentation. Despite these concerns, there are significantly few studies evaluating school-based computer-assisted HIV/AIDS interventions in developing countries. In addition, the commonly used health promotion theories have limited application in HIV prevention. These theories tend to lack sufficient attention to contextual mediators that influence implementation and impacts of HIV interventions.This research addresses some of these gaps by evaluating the implementation and the impacts of a computer-assisted HIV/AIDS intervention, known as the World Starts With Me (WSWM), which is implemented in schools in Uganda. To overcome some of the criticisms voiced above, this research employed mixed quantitative and qualitative methods to conduct three investigations. Investigation 1 is a quantitative controlled before-after intervention study that assessed the level of significance of the impacts of the WSWM intervention on in-school young people. Investigation 2 is a qualitative cross-case analysis study that explored in-depth why the WSWM intervention implementation was completed in one school but abandoned in another. Investigation 3 is a qualitative study that assessed in-depth the impacts and the computer-mediated benefits of the WSWM intervention on out-of-school young people. Overall, this research involved 584 quantitative questionnaires answered by 292 participants, 53 interviewees and 2 focus group discussions comprising of 50 participants.Findings indicate that: (1) the intervention significantly improved the in-school young people's HIV/AIDS knowledge, attitudes self-efficacy, sex abstinence and fidelity, but had no significant impact on condom use. (2) Implementation factors include technological facilities, perceived usefulness, confidence and skills, cultural-religious compatibility, management support, match with routine workflow, and institutional climate, all of which were more favourable in the school that completed the intervention than in the school that abandoned it. (3) The intervention had positive impacts on the out-of-school young people's sexual behaviours, HIV/AIDS knowledge and perception of vulnerability, attitudes and self-efficacy. (4) Contextual mediators such as familial mediators, relationship characteristics, peer influence, gender-biased social norms, economic constraints and religious beliefs influence young people's uptake of HIV preventive measures. (5) Computer-mediated benefits of the intervention include privacy and confidentiality of the otherwise sensitive information, unlimited geographical accessibility, source of the otherwise denied sexuality and HIV/AIDS information, and interactivity and social support.

Substantial resources are being directed towards use of the Internet in K-12 Education with over $2.25 billion annually distributed to K-12 schools from the Federal government alone (Maiden & Beckham, 1999). In 1998, 90% of schools had Internet access while only 2% of funds spent on software in K-12 schools were directed towards Web-based courseware (Jerald & Orlofsky, 1999). The Web-based instructional module Healthy Hearts was developed as a self-contained instructional unit delivered over the Internet, popularly referred to as â e-Learningâ , for fifth grade students to use as part of the classroom curriculum. Healthy Hearts teaches children about risk factors associated with heart disease, including physical activity, tobacco, and nutrition. After piloting and formatively evaluating Healthy Hearts in two fifth grade classrooms, Elliott (1997) made recommendations for future modification and implementation. No research regarding effects the Web-based instructional unit Healthy Hearts has on fifth grade children exists. The purpose of this study is to evaluate the impact Healthy Hearts has on fifth grade childrenâ s physical activity knowledge, attitudes, and behavior. Participants included 233 fifth grade boys and girls and 11 teachers who implemented Healthy Hearts during Spring 2001. A repeated measures experimental-control design was employed to measure Healthy Hearts effects on physical activity knowledge, attitudes, and behavior. The questionnaire used for this study included three attitude items adapted from Sport, Play, and Active Recreation for Kids (SPARK) (Sallis, Alcaraz, McKenzie, & Hovell, 1999a), six criterion referenced knowledge items developed from Healthy Hearts objectives, and a Weekly Activity Checklist to assess physical activity behavior, which was developed and validated for SPARK (Sallis et. al., 1993a). Classroom teachers administered the baseline test before students began using the module. For five weeks following the baseline test, the group 1 engaged in Healthy Hearts lessons by going to a computer lab for 45 minutes twice a week while group 2 participated in regularly scheduled classroom activities. After group 1 finished Healthy Hearts, both groups completed test 1 and then teachers from group 2 implemented Healthy Hearts with their classes. When group 2 finished using Healthy Hearts, both groups completed test 2. Dependent variables were physical activity knowledge, attitude, and behavior with group as independent variables. Other independent variables included school socioeconomic status, time allocated to Healthy Hearts, non-Healthy Hearts instruction time for related objectives, and speed of Internet connection. Repeated measures ANOVA revealed significant effects of Healthy Hearts on physical activity knowledge and attitude, however Healthy Hearts had no significant effects on behavior. Results of this study indicate Healthy Hearts could be an effective means of using the Internet to deliver health and physical activity instruction to fifth grade children, and suggest a need for further design, development, and evaluation of Healthy Hearts.
Ph. D.

This thesis investigates the acceptability and efficacy of Functional Imagery Training (FIT), a motivational intervention for weight-management. FIT is based on Elaborated Intrusion Theory, delivered in the style of Motivational interviewing (MI), and designed to promote sustained behaviour change and address cravings. It trains the habitual use of affective, goal-directed mental imagery of personal incentives, using imagery to plan behaviours, anticipate obstacles, and mentally try out solutions from previous successes. Participants are taught to update their imagery from their experience, and to generalise their imagery skills to new goals. In study 1, focus groups explored problems and wishes in regards to weight-management, including reactions to Functional Imagery Training (FIT) as a possible intervention. The issue of waning motivation and the desire for motivational app support was expressed in all groups. Participants were positive about FIT. Study 2 was an uncontrolled pilot trial of FIT. Eleven out of 17 participants (65%) lost 5% body weight or more by three months. Participants continued to lose weight during an unsupported 12-month period and experienced mean weight loss of 6kg (SD= 5.7; d=1.06) and mean waistline reduction of 11.5 cm (SD= 7.4; d=1.56) at 15 months. Study 3 compared the impact of FIT with MI on motivation and self-efficacy, over the first month of a randomised controlled trial (RCT) for weight-loss. Structured elicitation and training in goal-related imagery, i.e., FIT, increased motivation and self-efficacy for weight-loss relative to MI. Study 4 was the RCT for weight-loss, comparing FIT and MI over an intervention-supported six-month period, followed by six months unsupported. The FIT group achieved clinically meaningful weight-loss at 6 months (M kg-loss=4.11) and continued weight-loss at 12 months (M kg-loss=6.44); the MI group stabilised by 12 months (M kg-loss=.67), after minimal weight loss at 6 months (M kg-loss=.74). Study 5 qualitatively explored experiences of MI and FIT RCT participants, upon completing the 6-month intervention phase. MI participants wished for continued therapist- support and feared relapse. FIT participants described a mind-set-change and were confident they could maintain changes and overcome challenges using imagery techniques. Given the demonstrated benefit of motivational imagery in weight-control, FIT should be considered and further tested as an intervention for health behaviour change.

Introdução: Novas condutas terapêuticas e de prevenção frente à obesidade tornam-se objetos de estudo, entre elas a abordagem Health at Every Size® (HAES®). A abordagem HAES® aponta para o prazer em comer como crucial para a promoção de saúde e sustentabilidade no tratamento. A condenação cultural do prazer em paralelo à negligência do prazer no tratamento da obesidade forma um cenário de crítica, em que a mulher obesa é alvo de múltiplas desvantagens, entre elas a culpabilização do comer. Assumimos, para este estudo, a importância de aprofundar-se nas relações entre novas perspectivas no cuidado à mulher obesa e o estímulo ao prazer em comer. Objetivos: Investigar as percepções de mulheres na condição de obesidade acerca do prazer em comer antes e após uma intervenção interdisciplinar, não prescritiva e pautada na abordagem do HAES®. Métodos: Estudo qualitativo a partir de um ensaio clínico randomizado controlado com seguimento de sete meses nos anos de 2015 e 2016. Incluiu 97 mulheres na condição de obesidade de 25 a 50 anos de idade, com índice de massa corporal entre 30 e 39,9Kg/m², sendo alocadas em dois grupos: Intervenção e Controle. Ao final do estudo, 39 mulheres concluíram no grupo Intervenção (62,90 por cento ) e 19 concluíram no Controle (54,28 por cento ). Para os dois grupos, as atividades tiveram como linha condutora a abordagem do HAES®. O grupo Intervenção trouxe uma proposta original, com oferta de atividade física 3 vezes na semana, acompanhamento nutricional individual e oferta de discussões no formato de cinco oficinas filosóficas. O grupo Controle baseou-se ao modelo tradicional de aplicação da abordagem HAES®, com palestras expositivas bimestrais. A construção dos dados ocorreu a partir de grupos focais. Para análise das transcrições dos grupos, foi realizado o método de Análise de Conteúdo, sendo construídos temas pela técnica de Cutting e Sorting, os quais fundamentaram a argumentação teórica neste estudo. Resultados: Vinte e três temas sobre as percepções do prazer em comer das mulheres estudadas foram construídos. Após a intervenção, foram construídos de maneira significativa para o grupo Intervenção temas sobre maior autocontrole e reflexão sobre os próprios desejos; sensação de empoderamento para escolher o que e quando comer; aumento do prazer em comer acompanhada; aumento do prazer em comer comidas feitas por si própria; aumento dos discursos sobre comer sem culpa; diminuição da sensação de não sentir prazer e ainda diminuição do comer por emoções como ansiedade. Conclusão: A nova intervenção proposta promoveu efeitos positivos na relação das mulheres com o prazer em comer, evidenciando a desculpabilização do prazer em comer e melhora de outros aspectos da prática alimentar, como a comensalidade. Percebemos que este efeito se deu sobretudo a partir do estímulo a um processo reflexivo sobre corpo, comida e saúde, ficando claro que o prazer em comer sem culpa é um desfecho necessário quando falamos da saúde da mulher obesa
Introduction: New therapies and prevention practices directed to obesity become objects of study. The Health at Every Size® (HAES®) approach is one of them. The HAES® approach indicate the pleasure in eating as crucial for health promotion and sustainability of treatments. The cultural condemnation of pleasure and its disregard in the treatment of obesity created a critic scenario in which the obese woman is target of multiple disadvantages, such as blame for eating. We assume, for this study, the importance to deepen the relationship between new approaches to the care of obese woman and the encouragement of pleasure of eating. Objectives: To investigate obese women perceptions about the pleasure of eating, before and after an interdisciplinary, non-prescriptive and based on HAES® approach intervention. Methods: Qualitative study branch of a randomized controlled clinical trial, conducted over seven months in 2015 and 2016. It included 97 obese women, with 25 to 50 years old, with a body mass index between 30 and 39, 9 kg/m². The women were randomized to two groups: intervention and control. At the end, 39 women concluded in the Intervention Group (62.90 per cent ) and 19 in Control Group (54.28 per cent ). The two groups received activities based on HAES® approach. The Intervention Group, however, brought an original proposal, with physical activity 3 times a week, individual nutritional counseling and philosophical discussions in form of workshops. The Control Group received traditional model of HAES® approach application, with bimonthly expository lectures. The data construction occurred from Focus Groups. Analysis of the Focus Groups transcripts was conducted with Analysis of Content method, in which themes were built of Cutting and Sorting technique, and were used to theoretical arguments that substantiated this study. Results: Twenty-three themes about the perceptions of pleasure in eating of the studied women were built. After the intervention, more significantly for the Intervention Group, themes manifested greater self-control on the own desires; increased hunger and satiety response; sense of empowerment to choose what and when to eat; increase of the pleasure in eating accompanied; increase of the pleasure in eating food made by herself; increase of speeches about \"eat without guilt\"; decreased perception of not feeling pleasure and even decreased eating by emotions such as anxiety. Conclusion: The new proposed intervention promoted positive effects on women\'s relationship with pleasure in eating, showing decrease of guilt on pleasure in eating and improvements of other aspects of the eating practices, such as commensality. We realize that this effect occurred mainly due to stimulus to a reflection about body, food and health, becoming clear that the pleasure in eating without guilt is a necessary outcome when we talk about obese woman health

Orientador: Rosana Teresa Onocko Campos
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Essa é uma pesquisa multicêntrica, desenvolvida nas cidades de Rio de Janeiro/RJ, Salvador/BA e Campinas/SP. Objetivamos contribuir com o planejamento, gestão e a sustentação clínica de uma rede de serviços de saúde mental a partir da compreensão da experiência subjetiva da crise em pessoas diagnosticadas com transtorno do espectro esquizofrénico para que possa dar resposta a essas situações. A metodologia é qualitativa, baseada na Hermenêutica Filosófica de Hans-Georg Gadamer e a Hermenêutica Crítica de Paul Ricoeur. Para isto nos valemos da observação participante em Centros de Atenção Psicossocial, e de grupos focais com usuários desses serviços como principais ferramentas de construção do material de campo. Nossos achados apontam que são diferentes as intervenções na crise experimentadas pelos usuários em hospitais psiquiátricos e em Centros de Atenção Psicossocial. Também diversas são as estratégias implementadas por eles para antecipar e/ou lidar com esse difícil momento. Finalmente são destacadas contribuições e desafios para o planejamento, a gestão e a sustentação clínica dos serviços públicos de saúde mental encarregados de dar resposta à crise
Abstract: This is a multicenter study, developed in the cities of Rio de Janeiro / RJ, Salvador / BA and Campinas / SP. We aim to contribute to the planning, management and clinical support of a network of mental health services from the understanding of the subjective experience of the crisis on people diagnosed with schizophrenic spectrum disorder, in order to respond to these situations. The methodology is qualitative, based on the Philosophical Hermeneutics of Hans-Georg Gadamer and Paul Ricoeur's Critical Hermeneutics. Participant observation in Psychosocial Care Centers and focus groups with users of such services was the main tools for building material field. Our findings suggest that crisis interventions are different in the experience of patients at psychiatric hospitals and Psychosocial Care Centers. Also different are the strategies implemented by them to anticipate and / or deal with this difficult moment. Finally are highlighted contributions and challenges for the planning, management and clinical support of public mental health services responsible for crisis interventions
Doutorado
Saude Coletiva
Doutor em Saude Coletiva

Stress is a ubiquitous phenomenon in modern society, as a risk factor for several chronic diseases. This study investigated the feasibility of utilizing a four-week online e-health yoga video series to provide adults with a potential mechanism for stress management. While 128 subjects provided informed consent, 92 provided baseline data, 63 joined the study by following instructions to receive the videos, 27 provided end of week # 1 data; and, 14 of 27 provided a discernable personal code for matching files (51.85% adherence rate to personal code instructions). Thus, the final sample was N=14 (of 63 with video access) for a 22.22% study completion rate/63.5% attrition rate. Study completers (N=14) were 85.7% )n=12) White female (n=12) with mean age of 43.86 years (min=21, max=61, SD=10.52), mean education (M=5.07, min=2, max=6, SD=1.072) closest to a Master’s Degree, and mean household income (M=5.31,min=1, max=7, SD=1.494) closest to $50,000-$99,000.

Post-video, the mean dose of exposure to the yoga videos was closest to watching all of the videos, as a measure of very good adherence; barriers to adherence included not enough time due to other responsibilities. The yoga video series was rated between good and very good, while 64.3% (n=9) reported intention to continue to practice this form of yoga, and recommend the series to others. As the main study variable of interest, the Perceived Stress Scale (PSS-10) pre-video Cronbach’s Alpha was .916, suggesting excellent internal consistency. Using paired t-tests, the pre-video PSS-10 mean (Mean= 15.0, min 3 max 31, SD= 8.421) was higher than the post-video mean PSS-10 (Mean= 9.21, min 2 max 16, SD= 4.457), achieving significance (t= 3.377, df=13, p =.0055) at the Bonferroni Significance level (p=.005)—suggesting the intervention was an effective brief intervention for reducing past month stress. Qualitative data showed positive emergent themes supporting feasibility and acceptability of planning to continue the practice due to personal benefits, easily accessible, relaxing, and effective; and, negative themes of yoga sequencing/format issues, general preference for in-person instruction, and general dislike. Overall, the pilot study’s findings support the feasibility of providing online four-week yoga e-health intervention. Implications and recommendations are discussed.

ABSTRACT - The problem of how to support “intentions to make behavioural changes” (IBC) and “behaviour changes” (BC) in smoking cessation when there is a scarcity of resources is a pressing issue in public health terms. The present research focuses on the use of information and communications technologies and their role in smoking cessation. It is developed in Portugal after the ratification of WHO Framework Convention on Tobacco Control (on 8 November 2005). The prevalence of smokers over fifteen years of age within the population stood at 20.9% (30.9% for men and 11.8% for women). While the strategy of helping people to quit smoking has been emphasised at National Health Service (NHS) level, the uptake of cessation assistance has exceeded the capacity of the service. This induced the search of new theoretical and practical venues to offer alternative options to people willing to stop smoking. Among these, the National Health Plan (NHP) of Portugal (2004-2010), identifies the use of information technologies in smoking cessation. eHealth and the importance of health literacy as a means of empowering people to make behavioural changes is recurrently considered an option worth investigating. The overall objective of this research is to understand, in the Portuguese context, the use of the Internet to help people to stop smoking. Research questions consider factors that may contribute to “intentions to make behavioural changes” (IBC) and “behavioural changes” (BC) while using a Web-Assisted Tobacco Intervention Probe (WATIP). Also consideration is given to the trade-off on the use of the Web as a tool for smoking cessation: can it reach a vast number of people for a small cost (efficiency) demonstrating to work in the domain of smoking cessation (efficacy)”? In addition to the introduction, there is a second chapter in which the use of tobacco is discussed as a public health menace. The health gains achieved by stopping smoking and the means of quitting are also examined, as is the use of the Internet in smoking cessation. Then, several research issues are introduced. These include background theory and the theoretical framework for the Sense of Coherence. The research model is also discussed. A presentation of the methods, materials and of the Web-Assisted Tobacco Intervention Probe (WATIP) follows. In chapter four the results of the use of the Web-Assisted Tobacco Intervention Probe (WATIP) are presented. This study is divided into two sections. The first describes results related to quality control in relation to the Web-Assisted Tobacco Intervention Probe (WATIP) and gives an overview of its users. Of these, 3,150 answered initial eligibility questions. In the end, 1,463 met all eligibility requirements, completed intake, decided on a day to quit smoking (Dday) and declared their “intentions to make behavioural changes” (IBC) while a second targeted group of 650 did not decide on a Dday. With two quit attempts made before joining the platform, most of the participants had experienced past failures while wanting to stop. The smoking rate averaged 21 cigarettes per day. With a mean age of 35, of the participants 55% were males. Among several other considerations, gender and the Sense of Coherence (SOC) influenced the success of participants in their IBC and endeavour to set quit dates. The results of comparing males and females showed that, for current smokers, establishing a Dday was related to gender differences, not favouring males (OR=0.76, p<0.005). Belonging to higher Socio-economic strata (SES) was associated with the intention to consider IBC (when compared to lower SES condition) (OR=1.57, p<0.001) and higher number of school years (OR=0.70, p<0.005) favoured the decision to smoking cessation. Those who demonstrated higher confidence in their likelihood of success in stopping in the shortest time had a higher rate of setting a Dday (OR=0.51, p<0.001). There were differences between groups in IBC reflecting the high and low levels of the SOC score (OR=1.43, p=0.006), as those who considered setting a Dday had higher levels of SOC. After adjusting for all variables, stages of readiness to change and SOC were kept in the model. This is the first Arm of this research where the focus is a discussion of the system’s implications for the participants’ “intentions to make behavioural changes” (IBC). Moreover, a second section of this study (second Arm) offers input collected from 77 in-depth interviews with the Web-Assisted Tobacco Intervention Probe (WATIP) users. Here, “Behaviour Change” (BC) and the usability of the platform are explored a year after IBC was declared. A percentage of 32.9% of self-reported, 12-month quitters in continuous abstinence from smoking from Dday to the 12-month follow- up point of the use of the Web-Assisted Tobacco Intervention Probe (WATIP) has been assessed. Comparing the Sense of Coherence (SOC) scores of participants by their respective means, according to the two groups, there was a significant difference in these scores of non smokers (BC) (M=144,66, SD=22,52) and Sense of Coherence (SOC) of smokers (noBC) (M=131,51, SD=21,43) p=0.014. This WATIP strategy and its contents benefit from the strengthening of the smoker’s sense of coherence (SOC), so that the person’s progress towards a life without tobacco may be experienced as comprehensible, manageable and meaningful. In this sample the sense of coherence (SOC) effect is moderate although it is associated with the day to quit smoking (Dday). Some of the limitations of this research have to do with self-selection bias, sample size (power) and self-reporting (no biochemical validation). The enrolment of participants was therefore not representative of the smoking population. It is not possible to verify the Web-Assisted Tobacco Intervention Probe (WATIP) evaluation of external validity; consequently, the results obtained cannot be applied generalized. No participation bias is provided. Another limitation of this study is the associated limitations of interviews. Interviewees’ perception that fabricating answers could benefit them more than telling the simple truth in response to questions is a risk that is not evaluated (with no external validation like measuring participants’ carbon monoxide levels). What emerges in this analysis is the relevance of the process that leads to the establishment of the quit day (Dday) to stop using tobacco. In addition, technological issues, when tailoring is the focus, are key elements for scrutiny. The high number of dropouts of users of the web platform mandates future research that should concentrate on the matters of the user-centred design of portals. The focus on gains in health through patient-centred care needs more research, so that technology usability be considered within the context of best practices in smoking cessation.

O estudo teve como objetivo identificar as possíveis relações entre atitudes e percepções de estudantes de Enfermagem sobre o cuidado religioso e espiritual oferecido nos serviços de saúde aos usuários de álcool e/ou drogas, antes e após uma intervenção educativa. Foram objetivos específicos realizar a adaptação transcultural e a avaliação do desempenho psicométrico das versões brasileiras dos instrumentos Treatment Spirituality/Religiosity Scale (TSRS-br) e Drug and Drug Problems Perceptions Questionnaire (DDPPQ-br). Trata-se de um estudo analítico, longitudinal e prospectivo, com uma etapa de avaliação psicométrica. A amostra foi constituída por estudantes de Enfermagem de nível técnico e superior, vinculados a instituições públicas e privadas do município de Barra do Garças/MT. Na etapa de intervenção educativa, foram incluídos 62 estudantes de nível superior e, na de estudo psicométrico, participaram também estudantes de nível técnico. De acordo com os critérios de inclusão e exclusão, totalizou-se 246 indivíduos para avaliação do DDPPQ-br e 188 no estudo da TSRS-br. O questionário de pesquisa foi aplicado antes e após um mês de uma intervenção que consistiu de um curso sobre assistência para usuários de substâncias psicoativas, contendo questões sobre informações gerais; conhecimentos em assistência de enfermagem ao usuário de álcool e outras drogas; escala de percepção sobre ênfase no cuidado religoso e espiritual nos serviços (TSRS-br) e duas escalas de atitudes, sendo a DDPPQ-br e a SAAPPQ (Short Alcohol and Alcohol Problems Perceptions Questionnaire). A idade média dos entrevistados foi de 23 anos (Dp?4,83). Os resultados evidenciaram aumento dos conhecimentos e melhora significativa das atitudes dos estudantes após a intervenção educativa, mas o mesmo não foi encontrado em relação às suas percepções a respeito da ênfase no cuidado religioso e espiritual nos atendimentos que envolvem a temática do uso de álcool e drogas prestados nos serviços. Também não se observaram relações entre essas variáveis. Em relação às propriedades psicométricas do DDPPQ-br, uma Análise de Componentes Principais confirmou a validação de construto do referido instrumento com 16 itens, divididos em cinco fatores. A consistência interna global encontrada foi de Alfa=0,85. O TSRS- br, tal como o instrumento original, manteve-se com 10 itens, divididos em dois fatores. A confiabilidade por teste-reteste apresentou kappa variando de ?=0,22 a 0,47 e consistência interna global de Alfa=0,85. Conclui-se que o meio acadêmico deve continuar investindo na ampliação da discussão sobre o uso e abuso de substâncias e suas interfaces com a implementação do cuidado religioso e espiritual, o qual pode ser desenvolvido por meio de uma relação de ajuda, além de aprimorar formas de se examinar a efetividade de intervenções educacionais para o trabalho nesta área. Os instrumentos utilizados no presente estudo com tal finalidade mostraram medidas satisfatórias de confiabilidade e de validade de construto.
The aim in this study was to identify the possible relations between attitudes and perceptions of Nursing students about religious and spiritual care offered at health services for users of alcohol and/or drugs, before and after an educative intervention. Specific aims were to develop the cross-cultural adaptation and assess the psychometric performance of the Brazilian values of the Treatment Spirituality/Religiosity Scale (TSRS-br) and Drug and Drug Problems Perceptions Questionnaire (DDPPQ-br). An analytic, longitudinal and prospective study was undertaken with a psychometric assessment phase. The sample consisted of technical and higher-education Nursing students, affiliated with public and private institutions in Barra do Garças/MT, Brazil. In the educative intervention phase, 62 higher-education students were included and, in the psychometric study, technical students participated as well. In compliance with the inclusion and exclusion criteria, 246 individuals took part in the evaluation of the DDPPQ-br and 188 in the TSRS-br study. The research questionnaire was applied before and one month after an intervention, which involved questions on general information; knowledge in Nursing care delivery to alcohol and other drugs users; scale of perception about the emphasis on religious and spiritual care in health services (TSRS-br) and two attitude scales, the DDPPQ-br and the SAAPPQ (Short Alcohol and Alcohol Problems Perceptions Questionnaire). The interviewees\' mean age was 23 years (Sd?4.83). The results evidenced increased knowledge and a significant improvement in students\' attitudes after the educative intervention, but the same was not found with regard to their perception concerning the emphasis put on religious and spiritual care during care delivery involving alcohol and drugs use at the services. No relations among these variables were observed either. As regards the psychometric properties of the DDPPQ-br, a Main Components Analysis confirmed the construct validity of the 16-item instrument, divided in five factors. The global internal consistency found corresponded to Alpha=0.85. Like the original instrument, the TSRS-br continued with ten items, divided in two factors. The kappa coefficient to evaluate test-retest reliability varied between ?=0.22 and 0.47, while the global internal consistency coefficient equaled Alpha=0.85. In conclusion, the academic world should continue investing in a broader discussion about substance use and abuse and its interfaces with the implementation of religious and spiritual care, which can be developed through a help relation, besides improving forms of examining the effectiveness of educational interventions to work in this area. The instruments used in this study for that purposed showed satisfactory reliability and construct validity coefficients.

Introdução: O baixo consumo de frutas e hortaliças é um importante fator de risco para diversas doenças crônicas e obesidade. Na população brasileira, o consumo destes alimentos é tradicionalmente abaixo das recomendações internacionais. Dentro deste cenário, os locais de trabalho vêm atraindo cada vez mais interesse como ambientes propícios para o desenvolvimento de ações de promoção de alimentação saudável direcionadas à população adulta. Objetivo: Avaliar o impacto de uma intervenção para aumentar a oferta e o consumo de frutas e hortaliças em empresas cadastradas no Programa de Alimentação do Trabalhador. Métodos: Trata-se de um estudo de intervenção com amostra de 29 empresas divididas em dois grupos: intervenção (n=15) e controle (n=14). Avaliou-se uma amostra de trabalhadores em todas as empresas participantes do estudo para verificar os efeitos da intervenção sobre o consumo de frutas e hortaliças. A intervenção foi baseada no modelo ecológico de promoção de saúde, teve quatro etapas com duração total de seis meses. A coleta de dados ocorreu em dois momentos: antes e após a intervenção. O efeito da intervenção foi investigado por meio de dois indicadores: oferta em gramas de frutas e hortaliças nas refeições servidas nas empresas e o consumo em gramas destes alimentos pelos trabalhadores. De forma secundária, avaliou-se o impacto da intervenção sobre a oferta de energia, macronutrientes e fibras nas refeições. Para avaliar o efeito da intervenção sobre a oferta de alimentos e nutrientes nas refeições, realizou-se comparação entre os grupos intervenção e controle e a comparação intra-grupos antes e após a intervenção. Para o consumo dos trabalhadores, utilizou-se análise de regressão linear para avaliar a mudança no consumo no grupo intervenção após a intervenção. Resultados: A oferta de frutas e hortaliças aumentou de forma significativa após a intervenção nos cardápios oferecidos pelas empresas no grupo intervenção, cerca de + 49g, enquanto não houve variação no grupo controle. Também se observaram efeitos positivos na oferta de fibras e redução na oferta de gorduras. A intervenção também aumentou o consumo de frutas e hortaliças entre os trabalhadores nas refeições oferecidas pelas empresas, o aumento médio foi de 11g, após ajustes pelas variáveis sociodemográficas dos trabalhadores. Conclusão: A intervenção apresentou impacto positivo sobre a oferta e consumo de frutas e hortaliças no ambiente de trabalho
Introduction: The low consumption of fruits and vegetables is an important risk factors for several chronic diseases and obesity. In the Brazilian population the consumption of these foods is traditionally lower of international recommendations. In this context, the workplace environment is considered to promote healthy food, comprising large portion of the adult population. Objective: To evaluate the impact of an intervention to increase the availability and consumption of fruits and vegetables in companies participating in the Worker Food Program. Methods: It was a randomized intervention involving a sample of 29 companies divided in two groups: intervention (n=15) and control (n=14). A sample of workers in all companies participating in the study was evaluated in order to assess the effects of intervention on the consumption of fruits and vegetables. The intervention was based on the ecological model of health promotion, with 4 different stages for 6 months. Data collection occurred in two stages, before the intervention and after intervention. The effect of the intervention was investigated using two indicators: the availability in grams of fruit and vegetables in meals served in companies and consumption in grams of food by employees. Secondarily, the impact of intervention on the availability of energy, macronutrients and fiber in meals was assessed. It was made a comparison between the intervention and control groups and intra-group comparison before and after intervention to evaluate the effect of intervention on the availability of food and nutrients in meals. For the consumption of workers we used linear regression analysis to evaluate the change in consumption in the intervention group after the intervention. Results: The availability of fruits and vegetables in the meals offered by companies in the intervention group increased about +49g, while no changes in the control group. Also, it was observed positive effects on the availability of fiber and fat reduction in meals. The intervention also increased fruits and vegetables consumption among workers, the mean increase was 11g, after adjusting for sociodemographic variables of workers. Conclusion: The intervention has presented a positive impact on the availability and consumption of fruits and vegetables in the workplace

Considerando a família como foco de atenção em enfermagem de saúde mental e psiquiatria, foi realizada a análise da prática clínica de enfermagem no âmbito da prestação de cuidados em visita domiciliária, através dos registos de enfermagem existentes nesse contexto. Partindo dos conceitos de enfermagem de saúde mental e psiquiatria, família, modelos teóricos de avaliação e intervenção familiar e visita domiciliária; procurou-se compreender que modelos de abordagem familiar emergem dos registos de enfermagem das visitas domiciliárias, assim como identificar intervenções dirigidas a utentes e familiares numa perspectiva sistémica. Embora sem identificação completa com modelos teóricos existentes, concluímos que existe, sem dúvida, atenção dada aos familiares, sendo realizada frequentemente avaliação de relacionamentos, padrões de interacção, apoios e recursos, necessitando de melhorias que permitam que seja realizada de uma forma sistematizada, criteriosa, fundamentada e claramente documentada; ABSTRACT: Considering family care central, in psychiatric mental health nursing, an analyses of nursing clinical practice in home care context, was accomplished; using the nursing notes existents in that context. Based on concepts of psychiatric mental health nursing, family, conceptual models of family assessment and intervention and home care; we tried to understand what kind of family approach emerges from the nursing notes, as well as identify what interventions are directed to patients and families in a systemic perspective. Although without clear identification of the conceptual models existents, we realise that attention giving to families, exists, without doubted, with frequent relationships assessments, interaction patterns, supports and resources, however with the need to improve in a more grounded, systematic and discerning way and clearly documented.

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Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq
This dissertation presents the results of an ?intervention-research?, which is so named due to the relevance of the intervention in the whole process. In this way, the objectives were to promote an intervention in a reflection group about work and health with workers from an automobile industry and to analyze the health-disease process experienced by them. It was attended by 14 workers from the same company whose form of organization of work and the productive processes is characteristic of Toyotism, a model of organization that stimulates individualism, competitiveness, outsourcing, flexibility and thus may favor the processes of work-related mental disorders. These workers shared their daily experiences related to work and reflected on them in a group, performed at CEREST in Campinas ? SP, over 11 meetings, during the period of six months. The group had an open character and was built together to the participants. The information shared by them showed that, initially, they wanted a lot to join the company, and while being admitted, they felt they have achieved a dream. During time, however, that dream has become a nightmare, as they experienced a context of psychological violence and demands for a high rate of production, which ended up favoring the development of physical injuries. As a result, the work-related mental suffering was intensified, as the injured workers were excluded, humiliated and reinserted to work in incompatible functions. In this sense, in the reflection group, subjects such as work under capitalism, flexible speech, the workers? guilt for illness, their life stories, new life projects, the union and solidarity among them, among other examples were discussed through conversation wheels and use of mediating materiality. It is possible to say that this kind of group assisted in the promotion of elements for the development of more critical reflections by the workers, who closed the meetings feeling less blame, stronger, united, in solidarity to each other, more active and responsible for social transformation.
Esta disserta??o apresenta os resultados de uma ?interven??o-pesquisa?, que est? sendo assim denominada devido ? relev?ncia da interven??o em todo o processo. Desse modo, os objetivos foram promover uma interven??o em um grupo de reflex?o sobre trabalho e sa?de com trabalhadores de uma ind?stria automobil?stica e analisar o processo de sa?de-adoecimento vivenciado por eles. Participaram 14 trabalhadores de uma mesma empresa, cuja forma de organiza??o do trabalho e dos processos produtivos ? caracter?stica do Toyotismo, um modelo de organiza??o que estimula o individualismo, a competitividade, a terceiriza??o, a flexibiliza??o e, assim, pode favorecer os processos de adoecimento mental relacionados ao trabalho. Tais trabalhadores compartilharam suas viv?ncias cotidianas relacionadas ao trabalho e refletiram sobre elas em um grupo, realizado no CEREST de Campinas - SP, ao longo de 11 encontros, durante o per?odo de seis meses. O grupo tinha um car?ter aberto e foi constru?do juntamente aos participantes. As informa??es compartilhadas por eles mostraram que, inicialmente, desejavam muito ingressar na empresa e, ao serem admitidos, sentiam ter realizado um sonho. Com o passar do tempo, no entanto, esse sonho se tornou pesadelo, na medida em que vivenciavam um contexto de viol?ncia psicol?gica e exig?ncias por alto ritmo de produ??o, o que acabava favorecendo o desenvolvimento de les?es f?sicas. Com isso, o sofrimento mental relacionado ao trabalho foi se intensificando, pois os trabalhadores lesionados eram exclu?dos, humilhados e reinseridos ao trabalho em fun??es incompat?veis. Nesse sentido, no grupo de reflex?o, se discutiu, por meio de rodas de conversa e utiliza??o de materialidades mediadoras, temas como o trabalho no capitalismo, o discurso flex?vel, a culpabiliza??o dos trabalhadores pelo adoecimento, suas hist?rias de vida, novos projetos de vida, a uni?o e a solidariedade entre eles, entre outros exemplos. Pode-se dizer que essa modalidade de grupo auxiliou na promo??o de elementos para o desenvolvimento de reflex?es mais cr?ticas pelos trabalhadores, que encerraram os encontros sentindo-se menos culpados, mais fortalecidos, unidos, solid?rios uns aos outros, mais ativos e respons?veis pela transforma??o social.

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Sem bolsa
Introdução e objetivos: Baixos níveis de atividade física têm sido observados em crianças e adolescentes. Nesse sentido, intervenções para promoção da atividade física e saúde na escola têm o intuito de alterar esse quadro. Dessa forma, o objetivo deste estudo foi avaliar a efetividade de uma intervenção de promoção de atividade física e saúde entre estudantes do ensino fundamental da rede pública da cidade de Pelotas, RS - “Educação Física +: praticando saúde na escola”. Métodos: Foi desenvolvido um estudo experimental de base escolar. Foram alocadas de forma aleatória 19 escolas para grupo intervenção e 19 escolas para grupo controle. Os desfechos analisados foram o nível de atividade física dos alunos e conhecimento sobre atividade física e saúde. Para avaliar o nível de atividade física dos alunos (ativos ≥300 minutos por semana; minimamente ativo ≥0 minutos por semana). A coleta de dados foi realizada em dois momentos (linha de base e pós intervenção). O tempo de intervenção foi de sete meses. Resultados: Os grupos se mostraram similares na linha de base em relação aos aspectos sociodemográficos e também os níveis de atividade física e de conhecimento. Após o período de intervenção, não houve diferença significativa no nível de atividade entre os grupos, porém houve uma significativa diferença no conhecimento, sendo que o grupo intervenção melhorou o seu conhecimento de forma estatisticamente superior ao grupo controle. Assim, uma intervenção escolar de sete meses foi efetiva para aumentar o nível de conhecimento dos alunos sobre atividade física e saúde, mas não para modificar seu comportamento.
Introduction and objectives: Low levels of physical activity were observed in children and adolescents. In this sense, interventions for the promotion of physical activity and health at school are intended to change this framework. Thus, the objective of this study is to evaluate the effectiveness of a physical health and health promotion intervention among the elementary school students in the city of Pelotas, RS - "Physical Education +: practicing health at school". Methods: An experimental school-based study was developed. We randomly allocated 19 schools to intervening groups and 19 schools to the control group. The outcomes analyzed were the level of physical activity of the students and knowledge about physical activity and health. To assess the level of physical activity of the students (active ≥300 minutes per week, minimally active ≥0 minutes per week). A data collection was performed in two moments. The intervention time was seven months. Results: The groups were similar at the baseline in relation to sociodemographic aspects and also in the levels of physical activity and knowledge. After the intervention period, there is no difference between the level of activity between groups and the level of activity between groups. Thus, a seven-month school intervention was effective to increase students' level of knowledge about physical activity and health, but not to modify their behavior.

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O presente estudo tem por objeto a análise do modo tecnológico de gestão da assistência à saúde no hospital de ensino: HU/CAS/UJFJ, a partir da inter-relação da macro e micropolítica. Por macropolítica entende-se a relação entre o HU/CAS e a rede SUS e micropolítica, a relação institucional entre profissionais e gestores. A pesquisa foi iniciada com a revisão de literatura sobre os fundamentos da gestão do SUS e do conceito de assistência, com base no cuidado em saúde. O instrumento utilizado foi a pesquisa qualitativa com aporte na abordagem dialética, com o sentido de avaliar a concepção dos gestores e profissionais acerca dos processos de gestão e de assistência, considerando as atuais diretrizes organizacionais e políticas do HU/CAS/UFJF. Ao final, a análise dos dados contribuiu para a apresentação de um ensaio sobre o conceito de gestão da assistência, por acreditar no seu potencial de reorientar a operacionalidade das diretrizes do SUS no interior do espaço do hospital de ensino, tendo em vista uma administração qualificada e centrada nas necessidades e demandas da população-usuária.
The aim of this study was to analyze the technological way of health care’ management in the university hospital: HU/CAS/UFJF, from the inter-relationship of macro and micro-policies. It’s defined by macro-policies the relation between the HU/CAS and the SUS, and by micro-policies, the institutional relation between the professionals and the managers. The research started with a review of the literature, based in the health care, about the fundamentals of management of SUS and about the concepts of the health care. The qualitative research, with input in the dialectic approach, was used with the aim of evaluate the conception of managers and the professionals about the management and health care’s process, taking account the current organizational guidelines and policies of the HU/CAS/UFJF. At the end, the analysis of the results contributed for the presentation of a test about the health care’ management concept, that has a great potential at redirect the operationality of the SUS’ organizational guidelines in the university hospital, in a view of an administration qualified and focused on the necessities and demands of the population.

Relatório do Trabalho apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem de Saúde Mental e Psiquiatria
O problema das crianças e jovens maltratados, as caraterísticas socioeconómicas das suas famílias e o impacto dos maus-tratos no funcionamento destes indivíduos constituem um dilema mundial. Os maus-tratos fazem parte da história da humanidade, mas se inicialmente a hostilidade contra os mais novos era socialmente aceite, atualmente os esforços das entidades preocupadas com a Infância e Juventude vão no sentido de proteger e promover percursos de vida saudáveis. Este relatório encontra-se dividido em duas partes: o projeto de intervenção em serviço realizado numa Comissão de Proteção de Crianças e Jovens da Margem Sul do Tejo e a aquisição das competências como Enfermeiro Especialista em Saúde Mental e Psiquiátrica. No presente projeto de intervenção em serviço, que teve por base a metodologia de projeto, procurou-se conhecer as causas que conduziram à reabertura dos processos das crianças/jovens, seguidos numa CPCJ da Margem Sul do Tejo. O diagnóstico de situação suportou-se: na análise documental, nas entrevistas aos técnicos, aos jovens e suas famílias, nos questionários realizados aos mesmos, nas visitas domiciliares para verificação das condições socioeconómicas, da articulação com outras estruturas da comunidade e na aplicação do um instrumento de recolha de dados FMEA. Os focos de intervenção foram dirigidos para os jovens/famílias com processo reaberto por negligência a nível da educação – abandono e absentismo escolar, com especial relevância no âmbito da saúde mental, e para os profissionais que trabalham junto destes (professores). Quanto ao planeamento das intervenções tivemos em consideração cada jovem/família e as suas caraterísticas psicológicas, socioeconómicas e culturais. Em relação ao foco abandono escolar e absentismo foram realizadas sessões de psicoeducação aos jovens/família individualmente, de modo a sensibilizar para a importância da escola e perceber quais as razões que levaram ao seu abandono. As intervenções desenvolvidas durante estes atendimentos tiveram por base o suporte psicológico, de modo a ajudar na diminuição da ansiedade, do medo e do stress. Relativamente a entidade sinalizadora (escolas) que mais, sinalizações realizou à CPCJ, foram desenvolvidas sessões de psicoeducação para os professores (PIEF), com o objetivo de reconhecerem precocemente sintomas e sinais de alteração comportamental e por sua vez realizar encaminhamentos para as autoridades competentes, de modo a prevenirem a ocorrência de psicopatologias. Para avaliar a implementação do projeto foram solicitados no final do ano letivo aos estabelecimentos de ensino os relatórios de assiduidade dos jovens em absentismo escolar e um comprovativo das inscrições dos que se encontravam em abandono escolar, foi também pedido aos professores (PIEF) uma reflexão sobre a importância da sessão realizada. O conhecimento adquirido durante o percurso formativo foi fundamental no reforço de competências e desenvolvimento pessoal e profissional, possibilitando uma intervenção mais precisa em Enfermagem de Saúde Mental e Psiquiátrica, na comunidade.
Abstract: The problem of maltreated Children and younger people, the socioeconomics facts of their families and the impact of abuse on the behavior of these individuals, are a global problem. Maltreatment has been a part of the human history, but if this hostility was initially accepted, currently, the efforts of organizations concerned with children and youth, are building pathways to protect and promote healthy lives. This report is divided in two parts: an investigation project occurred at CPCJ and the acquisition of skills as a mental health nurse. The current study was based on a methodology project and the objective, is to know the causes that led to the reopening of cases of children/ youth, previously followed by the Commission on Protection of children and Youth of the south bank of Tejo. This study was based on informal interviews to technicians, the young and their families, data analysis, application of data collection of FMEA, home visits to verify their socioeconomics conditions and based on the coordination with others community facilities. The focus of intervention was directed at young people / families with reopened cases for negligence in education - school absenteeism and dropout, with particular relevance in the context of mental health and for professionals who work with them (teachers). Regarding the planning, we took into account each young people / family and their psychological, socioeconomic and cultural characteristics. In relation to the dropout and absenteeism focus, we performed individual psychoeducation appointments with young people / families in order to raise awareness of the importance of school and realize the reasons that led to the dropout. The interventions developed during these appointments were based in psychological support in order to help decrease anxiety, fear and stress. In the institution (school) with more cases flagged, we developed psycho-education sessions for teachers (of PIEF) with the aim to recognize early signs as behavior changes and symptoms of child abuse and forwarding these cases to competent authorities, to prevent the occurrence of psychopathology. To evaluate the project we asked the attendance reporting of school absenteeism and a certificate of registration of the dropouts at the end of the school year. It was also asked a reflection from the teachers (PIEF) about the psycho-education meeting. The knowledge acquired during the training path was fundamental to enhance skills and personal and professional development, enabling a more precise intervention in Mental Health and psychiatric nursing at the community.

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Pain disorders are usually related to lower level of general health, quality of life and poores work performance. Brazilian studies show that pain disorders have been described as the second or third leading cause of absence from work. Therefore this replication study was conducted to evaluate a brief intervention program developed by Nash et al (2004) that could be implemented in companies or organizations, which would represent an important advance in dealing with this problem. This study aimed to evaluate the effects of a brief intervention protocol, using behavioral and cognitive-behavioral techniques for administrative employees with chronic pain diagnoses. The impacts were evaluated along three dimensions: 1) self-perception of both pain and work impacts; 2) mental health indicators, including measures of depression, anxiety and stress; and 3) measures of functionality and quality of life. The study included five public service workers, between 36 and 61 years of age. Three women had been diagnosed with Fibromyalgia, one with Migraines and the other with neuritis. Time since diagnosis ranged from 2 to 7 years. The intervention was programmed using a multiple baseline procedure in four phases: 1) Baseline; 2) Module 1 (Psychoeducation about pain processes); 3) Module 2 (Relaxation Techniques); and 3) Module 3 (Stress and coping strategies). During the Initial Evaluations and over the course of the intervention, the following instrumentes were used: General Interview, Inventory of Stress Symptoms for Adults - Lipp (ISSL), Beck Depression and Anxietyies Inventory, FAST and the WHOQOL-BREF Scale. The Individual records showed a correlation between the intensity of pain and effectiveness in working conditions in general (r = 0.86, p <0.001) and for each of the participants. It was possible to observe the effect of the intervention at different times, for all participants. Initially, all participants had health care needs related to stress (four presented scores of resistance and one of almost exhaustion). Two had health care needs related to depression (P4 and P6) and two had process related to anxiety (P2 and P4). One participant (P4) had health care needs on all three measures. With regards to functionality, three respondents reported having difficulty in performing cognitive activities and one of the participants reported having difficulties in both controlling money and managing daily financial routines. The participants had average scores close to 50 points in the four areas assessed by the WHOQOL-BREF. Following the intervention, three of the five subjects had an increase in their total score for quality of life. Four participants also reported less difficulty with functionality, considering all the domains evaluated, with better performance observed in the autonomy domain. The strong points of the protocol were discussed along with challenges in its execution. Further research are needed to.
Os transtornos dolorosos são usualmente relacionados a perdas na saúde em geral, na qualidade de vida e do trabalho; processos dolorosos têm sido descritos como a segunda e terceira causa de afastamento do trabalho, em todo o País. Desta forma, programas de intervenções breves, replicando estudo anterior (Nash et al, 2004) que pudessem ser implementados nas próprias empresas ou organizações, podem representar avanços importantes para lidar com este problema. O presente estudo teve como objetivo avaliar os efeitos de um protocolo de intervenção breve, utilizando técnicas comportamentais e cognitivo-comportamentais, para funcionários administrativos de uma universidade pública, portadores de dor crônica. Foram avaliados impactos em três dimensões: 1) auto percepção da dor e do impacto no trabalho; 2) indicadores de saúde mental, particularmente depressão, ansiedade e estresse; e, 3) indicadores de funcionalidade e qualidade de vida. Participaram do estudo cinco funcionárias públicas, com idade variando entre 36 e 61 anos; três mulheres tinham o diagnóstico de Fibromialgia, uma Enxaqueca e uma Neurite. O tempo desde o diagnóstico variou de 2 a 7 anos. A intervenção foi programada utilizando um procedimento de linha de base múltipla, em quatro fases: 1) Linha de base; 2) Módulo 1 (Psicoeducação sobre dor); 3) Módulo 2 (Técnicas de Relaxamento); e 3) Módulo 3 (Estresse e estratégias de enfrentamento). Para avaliação inicial e ao longo do processo de coleta e intervenção foram utilizados: Roteiro da Entrevista, Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário Beck de Depressão e de Ansiedade, Escala FAST e Inventário WHOQOL-BREF. Registros individuais mostraram uma relação entre a intensidade da dor e a pouca efetividade nas condições de trabalho em geral (r=0,86, p<0,000) e para cada uma das participantes. Foi possível observar o efeito da introdução da intervenção, em diferentes momentos, para todos os participantes. Na avaliação inicial, todos os participantes apresentaram indicadores de cuidado de saúde em estresse (quatro apresentando escore de resistência e um de quase exaustão). Duas apresentavam indicador de cuidado em depressão (P4 e P6) e duas em ansiedade (P2 e P4). Um participante (P4) apresentava indicador de cuidado em todas as condições. Quanto a funcionalidade três dos participantes relataram ter dificuldade no desempenho de atividades cognitivas e uma das participantes relata ter dificuldades no controle de dinheiro e aspectos financeiros diários. Os participantes apresentaram resultados médios próximos aos 50 pontos nos quatro domínios avaliados pelo WHOQOL-BREF. Ao final, três das cinco participantes apresentaram aumento no indicador total de qualidade de vida. Com exceção de P5 todas as participantes apresentaram menor dificuldade de funcionalidade na média de todos os domínios avaliados, sendo a autonomia o domínio com melhor desempenho. Foram discutidas as vantagens de protocolos como implementado, as dificuldades observadas na sua execução e propostas para estudos posteriores.

L’influence d’Internet est profonde dans la vie personnelle et sociale, mais aussi dans le domaine éducatif. La révolution e-learning décrit la tendance de ces dernières années adoptée par le domaine de la formation. Le domaine de la santé doit s’adapter à cette nouvelle réalité en adoptant des outils numériques et en proposant la formation en ligne. Dans cette perspective, ce projet de recherche décrit le processus d’adaptation d’un programme de formation aux habiletés parentales destiné aux parents d’enfants avec autisme, dans une version en ligne. Ce projet de recherche est une monographie décrivant les étapes nécessaires pour la proposition de ce programme de formation parentale dans une version en ligne. En adoptant la méthode de la recherche design en éducation nous nous basons sur des théories et des concepts pertinents que nous utilisons pour notre contribution pratique ; celle de la conception pédagogique et de l’implantation d’un prototype mis à la disposition des utilisateurs
The Internet has deeply influenced our personal and social life, as well as the educational field. The e-learning revolution refers to recent advances in the educational field and the usage of digital tools for teaching and the delivery of educational content. The field of health can profit by adapting to this new reality and by adopting digital tools suitable to offer online training. From this perspective, this research project describes the process of developing an online adaptation of a psycho-educational program targeted to parents of children with autism disorder. This thesis is a monograph describing the steps required to design and implement this training program in an online version. By adopting the method of Educational Design Research, we investigate relevant theories and concepts that are later used to guide our practical contribution : the instructional design and implementation of a prototype, that is implemented and tested with the first users

Trata-se de um estudo exploratório, do tipo intervenção pedagógica, cujo objetivo foi o de reformular o plano de ensino de uma das disciplinas que compõem um Curso de Especialização em Instrumentação Cirúrgica, incorporando mudanças nos processos de ensino-aprendizagem. O referencial teórico para a intervenção propriamente dita se pautou em autores que estimulam um processo de ensino-aprendizagem que instigue a participação dos estudantes, com o uso de metodologias ativas. Com o apoio da instituição, foram incorporadas estratégias pedagógicas diversificadas ao longo das 12 aulas da disciplina, para os 22 estudantes matriculados no primeiro semestre de 2018. Quanto ao método de avaliação da intervenção, ao final da disciplina os estudantes refletiram e escreveram sobre a própria evolução ao longo do percurso, de que forma as estratégias interferiram nesse processo e quais as estratégias mais marcantes. Recordaram os temas e detalhes apresentados no decorrer da mesma, fato que pode inferir que o uso de diferentes estratégias contribuiu para a fixação e construção de conhecimento. As aulas mais marcantes foram as que os aproximaram dos cenários de prática. Quando se auto-avaliaram nesse processo, se perceberam como corresponsáveis pelo ensino-aprendizagem, elemento fundamental nas metodologias ativas. Corpo docente e coordenação sentiram-se instigados com a intervenção pedagógica e pretendem investir mais no desenvolvimento de estratégias que qualifiquem cada vez mais o curso, para o desenvolvimento de um perfil profissional único, para o exigente mercado de trabalho atual.
It is an exploratory study, of the type pedagogical intervention, whose objective was to reformulate the teaching plan of one of the disciplines that make up a Specialization Course in Surgical Instrumentation, incorporating changes in the teaching-learning processes. The theoretical reference for the intervention itself was based on authors who stimulate a teaching-learning process that instigates student participation, using active methodologies. With the support of the institution, diverse pedagogical strategies were incorporated throughout the 12 classes of the discipline, for the 22 students enrolled in the first semester of 2018. As for the method of evaluation of the intervention, at the end of the course the students reflected and wrote about the own along the way, how the strategies interfered in this process and which strategies were the most striking. They recalled the themes and details presented during the course, which may infer that the use of different strategies contributed to the fixation and construction of knowledge. The most remarkable classes were those that brought them closer to the practice scenarios. When they self-evaluated in this process, they perceived themselves as co-responsible for teaching-learning, a fundamental element in active methodologies. Teaching staff and coordination have felt instigated by the pedagogical intervention and intend to invest more in the development of strategies that increasingly qualify the course, for the development of a unique professional profile, for the current demanding job market.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico
This paper discusses the conceptions and interventions proposed by the Parenthood Clinic as a health promoting basis. The disharmony between parents-baby revealed during the visits to the pediatrician can arise from conflicts of the parents´psychism and interfere in the emotional availability necessary to the practice of preventive parenthood against pathologies and global development disorders. The method used was the open interview with six pediatricians according to their different personal ways: allopathy, psychoanalysis, anthroposophy, acupuncture, family. We based ourselves on the hypothesis that by knowing better the pedriatrician´s experience, it is possible to put same, during the consultation, into interdisciplinary dialogue with the findings available in the literature about the Parenthood Clinic developed by psychologists and psychoanalysts. The discussion of the material was effected using the winnicottan concepts and the more debated subjects in papers already published on Parenthood. We concluded that the disharmony between parents-baby reveals itself under the form of dysfunctional symptoms in the child or the caregiver. The pediatricians´intervention includes advice and encouragement to the parents, however there is no symbolic elaboration of the symptom, leaving the baby or even the foetus defenseless against more complex parental conflicts but that affect its health, with possibilities of affective, social and cognitive limitations in the adult phase. Vulnerabilities in the building of parenthood, since gestation, can hinder the caregiver´s emotional availability to follow the doctor´s advice and the practice of a healthy parenting. The interviews with the pediatricians brought evidences that they cannot treat the dysfunctional symptoms like a psychoanalyst due to their formation, the time and frequency of the puericulture consultation, but can understand them as a psychoanalyst can, promoting more integrating interdisciplinary interventions for the human coming about
Este trabalho discute as concepções e intervenções propostas pela Clínica da Parentalidade como base promotora de saúde. As desarmonias entre paisbebê que se revelam nas consultas pediátricas, podem emergir de conflitos do psiquismo dos pais e interferir na disponibilidade emocional necessária para o exercício da parentalidade preventiva das patologias e dos distúrbios globais do desenvolvimento. O método utilizado foi a realização de entrevista aberta com seis pediatras segundo diferentes percursos pessoais: alopatia, psicanálise, antroposofia, acupuntura, família. Partiu-se da hipótese que conhecendo melhor a experiência do pediatra durante as consultas é possível colocá-la em diálogo interdisciplinar com os achados encontrados na literatura sobre a Clínica da Parentalidade desenvolvida por psicólogos e psicanalistas. A discussão do material foi feita utilizando os conceitos winnicottianos e os temas mais discutidos em trabalhos já publicados sobre a Parentalidade. Concluiu-se que as desarmonias entre pais-bebê revelam-se sob a forma de sintomas disfuncionais na criança ou no cuidador; a intervenção dos pediatras inclui orientação e encorajamento aos pais, porém não há elaboração simbólica do sintoma, deixando o bebê ou mesmo o feto desprotegido dos conflitos parentais que afetam sua saúde com possibilidades de limitações afetivas, sociais e cognitivas na fase adulta. Vulnerabilidades na construção da parentalidade, desde a gestação, podem impedir o cuidador da disponibilidade emocional necessária para seguir as orientações do médico e o exercício da maternagem saudável. As entrevistas com os pediatras trouxeram evidencias de que eles não podem tratar os sintomas disfuncionais como um psicanalista, em função da especialidade, da formação, do tempo e da freqüência que dispõe na consulta de puericultura, mas podem entendê-los como um psicanalista promovendo intervenções interdisciplinares mais integradoras para o acontecer humano

The overall aim of this thesis was to describe experiences of emergency treatment among people injured in traffic accidents, and to test and evaluate the effects of follow-up telephone calls from a nurse during the subsequent phase. The thesis is based on four sub-studies of motorists, bicyclists, and pedestrians who had fallen in traffic during the years 2002-2005. The participants were aged 18 to 70 years old and had minor (MAIS 1) or nonminor (MAIS 2+) injuries. Sub-study I was a qualitative study in which individual narrative interviews were conducted with nine persons who had sustained traffic injuries. The aim of this study was to describe the injured individuals’ experiences of pre-hospital and hospital care and subsequent rehabilitation. The interviews were analysed using content analysis, and the experiences of the interviewees were formulated into four themes: facing commotion, experiencing trust and security, lacking security and support, and struggling to return to everyday life. The results showed that a sensitive caregiver who provides comprehensible information facilitates both the emergency treatment and the subsequent period of care and rehabilitation. Sub-study II was a cross-sectional study in which the participants (n=565) estimated their perceptions of the quality of care in the accident and emergency department (A&E) after an injury event. The Mini-KUPP (“Quality from the Patient’s Perspective”) questionnaire was used to estimate quality of care at the A&E. The questionnaire was posted to the subjects’ home addresses three weeks after the visit to the A&E. The results showed that the quality of care was scored on the top half of the scale by all three road user categories. In a multiple logistic regression analysis, significant connections emerged between good quality of care and a short waiting time, non-minor injuries (MAIS2+), higher age, and higher levels of education. The factor most closely associated with the perception of good quality of care was a short waiting time. Sub-study III was a stratified and randomised intervention study including 568 injured persons. In addition to modern trauma care, the intervention group received follow-up via telephone, three weeks after the injury, by a nurse who provided advice and support during the rehabilitation period. The control group received modern trauma care but no follow-up. Both groups estimated their health-related quality of life two weeks (baseline) and six months after the injury. After six months, estimates of health-related quality of life were generally higher in the intervention group than in the control group. A sub-group analysis found that the differences were most pronounced for the group who had received adequate advice in connection with the telephone follow-up. Of the three road user categories, the motorists gained the greatest benefit from the telephone intervention, with milder problems with regard to pains/difficulties and essential activities. Sub study IV was a health economic study. The calculations were built on the results from study III (n=568). A cost utility analysis was performed, including the costs for the intervention and the QALYs gained. The results showed that the telephone intervention was cost-effective. The total gain in the intervention group was 2.60 QALYs, while the car occupants gained 1.54 QALYs. The cost per QALY gained was 16 000 SEK overall and 8 500 SEK for car occupants. Conclusion: A sensitive caregiver who also provides good information can instil security and trust in the patient. For the purposes of generally improving the quality of care in an A&E, the aim above all should be a short waiting time, but the treatment of minor injuries should also be improved. Access to a supportive nurse who is able to provide advice during the subsequent phase has the potential to improve health-related quality of life in a cost-effective way.

O estudo teve como objetivo avaliar o efeito de um curso de intervenção breve sobre o uso de álcool, as atitudes e os níveis de conhecimento dos estudantes de enfermagem quanto ao uso, uso nocivo e dependência de álcool. A amostra foi constituída por 120 estudantes de um curso de graduação em enfermagem. Trata-se de estudo da abordagem quantitativa, analítico, experimental, de coorte prospectiva. Os estudantes foram divididos em dois grupos, um grupo que recebeu o curso (grupo experimental) e um grupo que não recebeu o curso (grupo comparado). O instrumento de coleta de dados foi um questionário estruturado, contendo: identificação sociodemográfica, o Teste de Identificação do Uso do Álcool.,o conhecimentos sobre o consumo de álcool e a assistência, e a escala de atitudes The Seaman & Mannello Nurse\'s Attitudes Toward Alcohol and Alcoholism Scale. Os dados foram coletados antes do curso e um mês após a realização do mesmo. Verificou-se que a média de idade foi de 20,7 anos, predominantemente do sexo feminino, solteiros, católicos, 81,6% não possuíam outro curso técnico ou de graduação, residindo com os pais; 63,3% dos alunos grupo experimental e 36,6% dos alunos do grupo comparado frequentam festas uma vez por mês ou menos. A maioria dos estudantes respondeu que não dorme em sala ou chega atrasado após frequentarem festa na noite anterior. Quanto ao consumo de álcool, após o curso houve pequena diminuição do número de estudantes do grupo experimental (de 93,3 para 85%) que consumiam álcool em níveis de baixo risco. Entre os estudantes do grupo comparado, essa relação foi inversa, (de 81,6 para 90%); houve uma diminuição do consumo de álcool entre oito estudantes do grupo comparado. Quanto ao nível de conhecimento, os estudantes do grupo experimental apresentaram melhoras após o curso. Em relação às atitudes, verificou se que as mesmas se tornam mais positivas após receberem um curso de intervenção breve. Percebeu-se que, entre os estudantes de ambos os grupos, quanto maior a idade, melhores serão as atitudes relacionadas à disponibilidade para tratar alcoolistas. Entre os alunos do grupo experimental, antes do curso, foi verificado que, quanto maior o consumo de álcool, mais positivas foram as atitudes relacionadas às atitudes pessoais e às habilidades para trabalhar com alcoolistas. Pode-se concluir que o curso de intervenção breve tem potencial positivo para gerar mudanças nas atitudes do futuro profissional enfermeiro, responsável por essa assistência, merecendo, assim, estar incluído enquanto conteúdo curricular dos cursos de enfermagem.
This study evaluates the effect of a brief intervention addressing alcohol consumption, and attitudes and level of knowledge of nursing students regarding alcohol use, harmful use and dependency. The sample was composed of 120 students of a nursing undergraduate program. This is a quantitative, analytical, experimental and prospective cohort study. The students were divided into two groups, one received the course (experimental group) and the other did not receive the course (control group). Data were collected through a structured questionnaire addressing socio-demographic information, the Alcohol Use Disorder Identification Test, another questionnaire addressing knowledge concerning alcohol consumption and care, and The Seaman & Mannello Nurse\'s Attitudes Toward Alcohol and Alcoholism Scale. Data were collected before and one month after the course was administered. The average age was 20.7 years old, the sample was predominantly female, single, Catholic, 81.6% did have another technical or undergraduate degree, lived with their parents; 63.3% of the experimental group and 36.6% of the control group attended to parties once a month or less. Most of the students reported they did not sleep during classes nor arrive late at classes after attending a party in the night before. After the course, a slight reduction in the number of students from the experimental group who consumed alcohol in low risk levels was observed (from 93.3% to 85%). This relationship was reverse among students from the control group (from 81.6% to 90%); eight students from the control group diminished their alcohol consumption. Students from the experimental group also presented improved knowledge and their attitudes were more positive after the brief intervention. Results from students from both groups revealed that the older the student the more positive the attitudes related to their availability to care for alcoholics. It was verified among students from the experimental group before the intervention that the higher the alcohol consumption the more positive attitudes in relation to personal attitudes and skills to work with alcoholics. The conclusion is that the brief intervention has positive potential to generate changes in the attitudes of future nurses who will be responsible to provide this type of care. Therefore, this course should be included in the curriculum of nursing programs.

Resumo: O relatório de estágio compreende a descrição das atividades desenvolvidas no âmbito do Estágio Curricular do Mestrado em Psicomotricidade, que se realizou na Unidade de Pedopsiquiatria da Infância e da Adolescência do Hospital Garcia de Orta. Neste relatório será realizado um enquadramento teórico da prática psicomotora no geral e no contexto de estágio, assim como uma descrição dos casos acompanhados em grupo e individualmente. Serão ainda apresetandos, de forma mais detalhada, as intervenções psicomotoras desenvolvidas com dois estudos de caso encaminhados para a consulta de psicomotricidade devido a problemas na regulação emocional e de comportamento. Para cada estudo de caso, será apresentada uma análise da história pessoal e clínica, os resultados da avaliação inicial, as hipóteses explicativas, o projeto pedagógico-terapêutico e os resultados da intervenção. Com o trabalho desenvolvido durante o estágio, foi possível verificar algumas melhorias decorrentes dos programas de intervenção psicomotora desenvolvidos e refletir sobre a importância da Psicomotricidade na Saúde Mental Infanto-juvenil; Abstract: The internship report includes a description of the activities developed within the scope of the Curricular Internship of the Master in Psychomotricity, which took place at the Child and Adolescent Pedopsychiatry Unit of Hospital Garcia de Orta. This report will provide a theoretical framework for psychomotor practice in general and in the context of the internship, as well as a description of the cases followed up in groups and individually. The psychomotor interventions developed with two case studies referred to the psychomotricity consultation due to problems in emotional and behavioral regulation will also be presented in more detail. For each case study, an analysis of the personal and clinical history, the results of the initial assessment, the explanatory hypotheses, the pedagogical-therapeutic project and the results of the intervention will be presented. With the work developed during the internship, it was possible to verify some improvements resulting from the psychomotor intervention programs developed and reflect on the importance of Psychomotricity in Child and Youth Mental Health.

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The problem of violence practiced in the family environment presents itself as a reality which is lived by a large number of children and adolescents nowadays, bringing about, together with the abusive use of parents’ authority, consequences to the children’s health. Facing such a problem, this research aimed at raising the discussion on home violence against children and adolescents and the fight against it in the Health System, through the Family Health Program in the city of Ponta Grossa. The general objective of this work is to discuss the phenomenon of home violence and analyze the interference of professionals in the Family Health Teams in this town. In order to achieve this objective, within a proposal of quantitative and qualitative research, an ample literature review was carried out to provide the basis and approach the reality directly, as well as to support the analysis of data collected. A questionnaire with open and closed questions and a semi-structured interview were used. The work is divided into four chapters. In the first chapter, the violence in social relations, including home violence against children and adolescents, is approached, considering its historical aspects and the legal constituted basis for its combat. The second chapter discusses home violence against children and adolescents, its concepts, manifestations, characteristics and its expression in the current social context. The relation between violence fighting and the Brazilian Health Policy as well as the role of the Family Health Program intervention on the problem are surveyed. Chapter four deals with the data analysis, the fight against home violence against children and adolescents by the Family Health Program in Ponta Grossa - PR. The research tried to contribute to the widening of the discussion about home violence against children and adolescents, pointing out the importance of the Family Health Program professionals’ interference. As final considerations we present suggestions to optimize these teams work towards the problem.
A problemática da violência praticada no meio familiar apresenta-se como uma realidade vivida por um grande número de crianças e adolescentes na conjuntura atual, trazendo, juntamente como o uso indevido da autoridade dos pais, conseqüências à saúde de quem a sofre. Diante dessa constatação, buscamos, com a presente pesquisa, trazer à tona discussão sobre a violência familiar contra crianças e adolescentes e seu enfrentamento na área da saúde, através do Programa Saúde da Família no Município de Ponta Grossa. Temos como objetivo geral discutir o fenômeno violência familiar contra crianças e adolescentes e analisar a atuação dos profissionais das Equipes de Saúde da Família desse Município junto aos casos de ocorrência desse problema. Para tanto, dentro de uma proposta de pesquisa quantitativa e qualitativa, valemo-nos de ampla revisão bibliográfica para fundamentar a abordagem direta da realidade, procedida através questionário com perguntas abertas e fechadas e de entrevista semi-estruturada, bem como para subsidiar a análise das informações obtidas através desses instrumentos. Nosso trabalho encontra-se dividido em quatro capítulos. No primeiro capítulo, abordamos a violência nas relações sociais, incluindo a violência ocorrida no meio familiar contra crianças e adolescentes, considerando seus aspectos históricos e as bases legais constituídas para seu combate. No segundo capítulo, discutimos o fenômeno violência familiar contra crianças e adolescentes, seus conceitos, suas manifestações, suas características e sua expressão na conjuntura atual. No terceiro capítulo, abordamos a relação entre o combate à violência e a política de saúde brasileira e o papel do Programa Saúde da Família na intervenção sobre a problemática. E, por fim, no quarto capítulo, apresentamos, através da análise dos dados coletados, o enfrentamento da violência familiar contra criança e adolescente pelo Programa Saúde da Família do Município de Ponta Grossa – PR. Buscamos, com a pesquisa proposta, contribuir para a ampliação da discussão sobre violência familiar dirigida a crianças e adolescentes, apontando a importância da atuação dos profissionais do Programa Saúde da Família frente a essa realidade. Em considerações finais, apresentamos sugestões no sentido de otimizar a atuação dessas equipes em relação ao problema.

Na nossa prática profissional, observámos que os utentes portadores de esquizofrenia apresentam regularmente dificuldade em gerir o regime terapêutico. Esta realidade merece uma particular atenção por parte dos enfermeiros, pois é uma das principais causas de incapacidade e tem consequências importantes ao nível da qualidade de vida dos utentes, do seu bem-estar físico/mental e socioeconómico. Para dar resposta a esta problemática considerámos pertinente implementar e desenvolver um programa de intervenção terapêutica aos utentes portadores de esquizofrenia internados no Serviço de Psiquiatria e Saúde Mental do Hospital Garcia de Orta, EPE, que contribua para a integração dos diferentes aspetos da gestão do regime terapêutico e melhore a adesão após a alta hospitalar. Após a implementação e desenvolvimento do programa, constatámos que os utentes adquiriram um melhor autoconhecimento face à doença, capacidade de identificar sintomas e de pedir ajuda perante sinais de recaída, bem como, uma melhor adesão ao regime terapêutico; ### ABSTRAT: Therapeutic Regime Management of the Person with Schizophrenia: A Program of Therapeutic Intervention. In our professional practice, we observed that patients with schizophrenia have usually difficulty in the managing of the therapeutic regimen. This fact deserves special attention from nurses because it is a principal cause of disability and has important consequences on the quality of life of users, their physical/mental wellbeing and socio-economic. To respond to this problematic we consider appropriate to implement and develop a program of therapeutic intervention to schizophrenic patients hospitalized in the Department of Psychiatry and Mental Health of the Hospital Garcia de Orta, EPE, which contributes to the integration of different aspects of the management of therapeutic regimen and improve the adherence after the discharge. After the implementation and development of the program, we found that patients got a better Self-knowledge face to the disease, ability to identify symptoms and seek help before signs of relapse, as well as improved adherence to therapy regimen.

Ensaio clínico aleatorizado conduzido para avaliar o impacto de intervenção intensiva para mudança de estilo de vida em indivíduos com sobrepeso em um Centro de Saúde-Escola em São José do Rio Preto, Estado de São Paulo, Brasil. Dos 259 voluntários (203 mulheres e 56 homens; idade entre 25 e 72 anos) que concordaram em participar do estudo, 104 foram elegíveis (83 mulheres e 21 homens), sendo distribuídos aleatoriamente em dois grupos: grupo intervenção (10 homens e 41 mulheres), com acompanhamento nutricional individualizado, e grupo controle (11 homens e 42 mulheres), que receberam somente orientações gerais e folheto explicativo sobre estilo de vida saudável. A avaliação da composição corporal, indicadores bioquímicos, consumo alimentar e estilo de vida - incluindo-se a prática de atividades físicas, foi realizada no princípio, após 6 meses e 1 ano de estudo. A intervenção nutricional consistiu de incentivo ao consumo de frutas, vegetais, óleo de oliva e produtos lácteos pobres em gordura, associados com a redução do consumo de gorduras saturadas e doces, bem como o estímulo à prática de atividades físicas por pelo menos 30 minutos ao dia. O programa de intervenção mostrou-se efetivo na redução do consumo de calorias, gorduras totais, gorduras saturadas, colesterol, freqüência de carnes, óleos/gorduras e doces. Além disso, observamos um incremento no consumo de fibra total da dieta, fibras de frutas e vegetais, ß-caroteno, vitamina A, cálcio, freqüência de consumo de frutas em geral, vegetais em geral, vegetais verde escuros e leite/derivados. O programa mostrou-se viável em unidades básicas de saúde e efetivo na redução de peso, índice de massa corporal, pressão arterial, colesterol total, LDL colesterol, ácido úrico, homocisteína, aumento da prática de atividades físicas, contribuindo para a melhoria da qualidade de vida no grupo intervenção.
Randomized Nutritional Intervention trial was carried out to evaluate the impact of intensive intervention in changing life style of overweight adults attending at a primary health care in São José do Rio Preto, São Paulo State, Brazil. Of the 259 volunteers (203 women and 56 men; 25 to 72 years old) that agreed in participating in the study, 104 were eligible (83 women and 21 men), and were randomly allocated in two groups: Nutrition Counseling group (42 women, 11 men) with individualized dietary counseling, and Control Group (41 women, 10 men) who recieved only general information and leaflets about healthy life style. The assessment of body composition, biochemical indicators, food consumption and life style – including practice of physical activity were carried out at baseline, 6 months and 1 year. The dietary interventions included increased intake of fruits, vegetables, olive oil and skimmed dairy products, together with reduced intake of saturated fat and sweets, as well as instructions for regular practice of physical activity for at least 30 minutes per day. The intervention program demonstrated to be effective in reducing consumption of calories, total fat, saturated fat, cholesterol, and frequency of meets, fats/oils and sweet groups. Moreover, we observed an increment in the consumption of dietary fiber, fiber of fruits and vegetables, ß-carotene, vitamin A, calcium, and in the frequency of fruits, vegetables, dark green vegetables and dairy products. The program demonstrated to be feasible at a primary health care unit and was effective in reducing weight, body mass index, blood pressure, total cholesterol, LDL cholesterol, uric acid, homocysteine, and improved the physical activity level and quality of life in the intervention group.

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A partir da nova ordem constitucional a efetivação dos direitos fundamentais exigiu do Estado a obrigação de promover saúde pública como um direito inerente a todo ser humano. O direito à saúde, previsto no artigo 196 da Constituição Federal de 1988, norma de eficácia plena e imediata, é direito público subjetivo que garante ao cidadão o direito de exigir, dentre outras, as prestações do Estado na promoção da saúde, não apenas na prevenção e no tratamento das doenças, mas também garantindo condições mínimas para assegurar uma existência digna. O fornecimento de medicamentos integra o mínimo existencial do indivíduo que dele necessite para sobreviver e não possua recursos suficientes para adquiri-lo. Para tanto o Estado mantém uma política nacional de assistência farmacêutica para financiar, adquirir e distribuir os medicamentos, também os utilizados no tratamento de patologias complexas, raras e crônicas (medicamentos excepcionais). Porém, o fornecimento desses itens fica restrito àqueles relacionados nas listas dos protocolos clínicos e diretrizes terapêuticas oficiais, que são elaboradas pelo próprio Estado, o que dá margem para atuação judicial, quando as drogas não se incluem nessa lista. Também ocorrem interferências no Judiciário quando políticas públicas previstas na legislação não são executadas pelo Executivo, o que ainda é visto por alguns doutrinadores como interferência do Poder Judiciário nas políticas públicas da área da saúde, ferindo a autonomia e independência dos poderes. A interferência excessiva do Judiciário vem causando o caos no Sistema Público de Saúde, sendo necessário que se redimensione a atuação judicial, considerando em suas decisões os limites e possibilidades do próprio Estado. Além disso, necessário que as decisões judiciais que envolvem o fornecimento de medicamentos tenham alguns parâmetros, como forma de evitar o caos no sistema. Apresenta-se também o fortalecimento da via administrativa como um meio adequado para reduzir a tensão entre os poderes e garantir a redução do número de demandas.
From the new constitutional order the enforcement of fundamental rights foisted the state the obligation to promote public health as a right inherent in every human being. The right to health under Article 196 of the Constitution of 1988, provision of full and immediate effect, is a subjective public right which guarantees citizens the right to require, among others, benefits the state in promoting health, not only inprevention and treatment of diseases, but also ensuring minimum conditions to ensure a dignified existence. The supply of medicines is part of the existential minimum of the individual who needs it to survive and not have sufficient funds to acquire it. For both the State maintains a national policy for pharmaceutical care to finance, acquire and distribute medicines, also used to treat complex diseases, rare and chronic (exceptional drugs). However, the supply of these items is restricted to those related to the lists of clinical protocols and treatment guidelines officers are issued by the State itself, which gives scope for judicial action, when the drugs are not included in this list. Interference in the judiciary also occur when policies are not under the laws enforced by the Executive, which is still seen by some scholars as an interference of the judiciary in public policy in the health area, injuring the autonomy and independence of powers. The excessive interference of the judiciary is causing havoc on the public health system, being necessary to resize the judicial action, considering their decisions on the limits and possibilities of the state. In addition, necessary that the judicial decisions involving the supply of drugs have some parameters in order to avoid chaos in the system. It also shows the strengthening of administrative as a practical means to reduce the voltage of power and ensure the reduction of the number of demands.

博士
國立臺灣師範大學
健康促進與衛生教育學系
101
This study aims to develop a set of effective e-health course and to further investigate its intervention effect. The experiments were designed based on Pretest-Posttest Control Group Design, and nurses in two regional hospitals in Chia-yi and Hsin-chu was recruited. Experimental group received the course designed based on adult learning theory, internet teaching tactics and self-efficacy through e-health intervention. E-health intervention provided peer support communities, tailored education and professionally facilitated education and support program. Control group received “Healthy Taiwan on the Move” brochure. The study tools included “Health promotion lifestyle profile” and “Sort Form-36”. After comparing data measured before and after intervention, 105 persons gave effective results excluding invalid questionnaires (50 persons in experimental group and 55 in control). The data was analyzed with chi-square test, independent sample t-test, paired t-test, one-way ANOVA analysis, ANCOVA analysis, and Johnson-Neyman method. Significant results were as followed: 1. After e-health intervention, the total score from “health promotion lifestyle profile” , “exercise behavior”, “health responsibility”, “SF-36”, “physiological health”, of experimental group measured after intervention was significantly higher than before. 2. After e-health intervention, the “body mass index” of experimental group measured after intervention was significantly lower than before. 3. After e-health intervention, the total score from “SF-36” in experimental group was significantly higher than that in control group. 4. When “physiological health” score measured before was lower than 306.81, the score measured after in experimental group was significantly higher than that in control group, and the lower the score measured before was, the greater efficacy achieved. It is important to pay attention to the lifestyles of nurses. Health education through internet is the tendency in future. E-health provides a more convenient and accessible way for the learners to discuss with each other and professionals, which is more effective than health education with brochure. We suggest to develop more e-health course, based on the adult learning theory.

博士
國立臺北護理健康大學
護理研究所
102
“Fast food,” “eating out,” “sleeping late,” and “lack of exercise” are lifestyles that are becoming increasingly common for adolescents. Additionally, the prevalence of metabolic syndrome is increasing. Previous studies have shown that adolescent girls are inclined to adopt extreme and unhealthy methods for weight control. Compared with adolescent boys, the proportion of adolescent girls who rarely exercise or have been teased about their figures is substantially high. However, few preventive health strategies have been proposed for adolescent girls. Understanding the subjective life experiences among adolescent girls with high risks of metabolic syndrome is necessary; enable the design of an e-health management platform that is customized to the lifestyles of young adults, and to promote nursing intervention that facilitate healthy lifestyles. This study was conducted in 3 stages, and the research purposes and results are provided in the following paragraphs. In the first stage, the qualitative approach and grounded theory were adopted to generate a descriptive theory regarding the life experiences of Taiwanese adolescent girls who are at high risk for metabolic syndrome. In-depth interviews were conducted with 20 adolescent girls with high risk of metabolic syndrome who were aged 16-20 years. The “struggle against fat” was the core theme for describing and guiding the process of weight loss among overweight adolescent girls. During this process, “Obesity as a stigma” was identified as the antecedent condition that included subcategories -being teased, being blamed, being bullied and lack of girls’ attractiveness. The overweight adolescent girls struggled between keeping on practicing new lifestyle and resuming previous lifestyle during trying weight loss process. This process was categorized as “try dieting tips”, “self-sabotage”, “confronting weakness”, and “adhere to a new life”. During this process, some girls would confront self-weakness to practice new healthy lifestyle such as stop consuming snacks and sweetened beverages, exercising daily, not using eating as a means to combat stress. They adhere to a new life by perceiving peer or family support, using incentive slogans and sharing experiences. Finally, these girls kept on maintaining their new lifestyle and reduced their body weight gradually. However, some girls would self-sabotage by eating too much again in response to the pressure of life or allure. Therefore, some girls would resume their previous lifestyle and regaining their body weight by entering into a vicious cycle of combating fat by try dieting tips and self-sabotage. Content analysis was adopted to process the data regarding e-health management platform requirements. The e-health management platform that was designed for these adolescent girls at high risk of metabolic syndrome required 5 major functions: an attractive and user-friendly website interface, access to reliable information and resources, provision of tailored health information, access to peer support, and self-monitoring and learning tools. The second stage involved developing a research tool and establishing validity and reliability. Moreover, the e-health management platform that was designed for adolescent girls at risk for metabolic syndrome was constructed based on a literature review, the qualitative results obtained during the first stage of the study, and interdisciplinary professional cooperation. The platform framework incorporates the following primary components: self-awareness of health (i.e., Start the Fight), self-monitoring of health status (i.e., recording weight and waist circumference measurements and monitoring changes in data trends); food and exercise diary maintenance; food intake compared with exercise involvement; participation in discussions or browsing forums (e.g., “Emotional Recharge Zone,” “What the Experts Say,” “Hate Fat Venting Room,” and the “Facebook fan page”); healthy lifestyle guidance and counseling (e.g., main topic area, links to recommended websites, and e-book downloads); reminder systems, which facilitated accountability and encouragement through e-mail, MSN, Facebook, Line, and the telephone; and finally, a token system of earning points in exchange for prizes. This e-health management platform is reliable and valid (expert validity: content validity index = 0.973 – 0.991; user-evaluated content validity: content validity index = 1.00; and test-retest reliability: intra-class correlation = 0.805 – 0.957). The third stage of platform development incorporated the longitudinal approach and repeated testing using a quasi-experimental design to evaluate the follow-up outcomes of the e-heath management platform intervention for adolescent girls with high risk of metabolic syndrome. In addition, a health management model was devised for the participants. Research data were collected from 2 schools with high homogeneity in Northern Taiwan. Overall, 137 adolescent girls participated in this intervention study. The experimental group consisted of 62 participants and the control group consisted of 75 participants. The experimental group received health management support and counseling that were conducted by the researchers through the e-health management platform, whereas the control group received the typical health education provided in schools. The experiment period was 1 year. Follow-up outcome data were collected 4 times for both groups. The collection times were as follows: before the intervention began, 3 months after the intervention began, 6 months after the intervention began, and 12 months after the intervention began. The following data were gathered regarding the 2 groups: physical activity, dietary behavior characteristics, adolescent health promotion scale, and measurement data of metabolic syndrome risk factors (i.e., waist circumference, fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein [HDL], and blood pressure). The data attrition rate measured during the year was 14.5% for the experimental group and 4% for the control group. SPSS version 18.0 software was used to compile and analyze the research data. Descriptive statistics, the chi-squared test, Student t test, and generalized estimating equations were used during analysis. The results showed that 3 months after the intervention began, the experimental group demonstrated significant improvements (β = -0.436, p = .004) compared with the results of the control group. Improvements were exhibited in the following risk factors for metabolic syndrome: the body mass index (BMI), waist circumference measurements, HDL levels, and systolic and diastolic blood pressure results. Both dietary behavior characteristics and adolescent health promotion scale improved (β = 11.514, p = .005). In addition, these outcomes remained statically significant 6 months after the intervention began. Six months after the intervention began, the following intervention outcomes were observed: a decline in fasting blood glucose levels (β = -7.174, p < .001) and an increase in time spent exercising (β = 0.256, p = .030). Twelve months after the intervention began, the risk factors for metabolic syndrome continued to improve (i.e., decreasing BMI, waist circumference measurements, HDL levels, lowered systolic and diastolic blood pressure, and reduced fasting blood glucose levels). However, no significant differences were observed regarding several of the dietary behavior characteristics, such as low caloric intake habits and high caloric intake frequencies. Moreover, the results obtained from the 3 posttests concerning the total cholesterol and triglyceride levels did not exhibit a significant difference between the two groups. Regarding metabolic syndrome reversal, 9 participants in the experimental group were diagnosed with metabolic syndrome during the pretest. Three months after the intervention began, metabolic syndrome was successfully reversed in 7 of the 9 participants. Only 1 participant continued to exhibit risks of metabolic syndrome after 12 months. Conversely, the number of participants who were diagnosed with metabolic syndrome increased in the control group. The posttests administered in the third month of intervention showed that the number in this group increased from 7 to 8. Twelve months after the intervention began, the number rose to 10. In both groups, the changes in risk factors for metabolic syndrome were significantly different (χ2 = 20.56, p < .001). The frequency of using the food and exercise diaries was negatively correlated to changes in the risk factors for metabolic syndrome (i.e., BMI and waist circumference measurements and triglyceride levels), but was positively correlated to changes in HDL levels. The frequency of using the website was negatively correlated to changes in the risk factors for metabolic syndrome (i.e., waist circumference measurements and systolic blood pressure and triglyceride levels). The results showed that the intervention provided through the e-health management platform effectively lowered the measurements of BMI, waist circumference, systolic and diastolic blood pressure, and fasting blood glucose levels, and increased HDL levels. Therefore, both dietary behavior characteristics and the results of the adolescent health promotion scale were effectively improved. In the early stage of the intervention, healthcare providers might need to adopt the Internet communication styles that are common among the participants. The care provided must be non-doctrinal to facilitate building rapport between the providers and users. Such communication is the key to successful intervention. This study also found that the first 3 months of intervention were the golden period for reversing metabolic syndrome. Interventions must be effective for users during this period to enable users to grow in confidence and continue their effort. Continual encouragement and support must be provided for adolescent girls who are struggling with obesity. A new healthy lifestyle can begin only if this weight struggle is ameliorated. In addition, websites providing such intervention must be updated constantly and provide novel events that will attract users to use the website functions, thereby facilitating lifestyle habit changes. This study suggests that the proposed e-health model be promoted and implemented. By using the Internet, which is not bound by time and space, this model is the most effective self-health management method for young people. Through the propagation of accurate information and bidirectional communication between care providers and users regarding diet and exercise, healthy lifestyle habits can be established to reverse diseases such as metabolic syndrome. Furthermore, the resulting healthy lifestyle habits contribute to the positive development of the personal character and academic performance of users.