Treatment of child anxiety in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

Background Cognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. Objectives This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. Design Participants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI). Setting A NHS university clinic in Berkshire, UK. Participants Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. Interventions All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. Main outcome measures Primary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty. Results MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. Conclusions Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. Trial registration Current Controlled Trials ISRCTN19762288. Funding This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38.

Improving the health forecasting alert system for cold weather and heat-waves in England: a proof-of-concept using temperature-mortality relationships

Objectives In this study a prototype of a new health forecasting alert system is developed, which is aligned to the approach used in the Met Office’s (MO) National Severe Weather Warning Service (NSWWS). This is in order to improve information available to responders in the health and social care system by linking temperatures more directly to risks of mortality, and developing a system more coherent with other weather alerts. The prototype is compared to the current system in the Cold Weather and Heatwave plans via a case-study approach to verify its potential advantages and shortcomings. Method The prototype health forecasting alert system introduces an “impact vs likelihood matrix” for the health impacts of hot and cold temperatures which is similar to those used operationally for other weather hazards as part of the NSWWS. The impact axis of this matrix is based on existing epidemiological evidence, which shows an increasing relative risk of death at extremes of outdoor temperature beyond a threshold which can be identified epidemiologically. The likelihood axis is based on a probability measure associated with the temperature forecast. The new method is tested for two case studies (one during summer 2013, one during winter 2013), and compared to the performance of the current alert system. Conclusions The prototype shows some clear improvements over the current alert system. It allows for a much greater degree of flexibility, provides more detailed regional information about the health risks associated with periods of extreme temperatures, and is more coherent with other weather alerts which may make it easier for front line responders to use. It will require validation and engagement with stakeholders before it can be considered for use.

Kommunal marknadsföring- Competitive identity och institutionell problematik : En komparativ fallstudie om två svenska kommuner och deras marknadsföring

Historiskt sett finns det etablerade normer i samhället som säger att en kommun endast ska bedriva traditionell kommunal verksamhet som innefattar att tillgodose välfärden (vård, skola & omsorg). Dock så har globaliseringen och urbaniseringen skapat en konkurrens om invånare vilket har lett till att kommuner idag bedriver en allt mer utvecklad marknadsföring för att attrahera fler invånare. Den här fallstudien innehåller två objekt (kommuner). Vi vill undersöka den kommunala marknadsföringen genom att fokusera på begreppen competitive identity (CI) och institutionell problematik (IP). Begreppet CI innehåller en teoretisk genomgång av komponenter i kommunal marknadsföring och IP beskriver kommunernas komplexa situation med olika institutionella krav. Genom att analysera dessa begrepp mot praktiska fall kan vi bidra till ökad förståelse om kommunal marknadsföring som är vårt syfte. Vi presenterar även en egen modell i samband med begreppet CI som ger en nyanserad bild av ämnet. Studiens resultat identifierar att kommunerna har speciella målgrupper som likt ett företag varierar beroende på deras ställning på marknaden. Genom skapandet av en CI deklarerar kommunen en önskvärd image där företeelser som inte bidrar till den blir exkluderade. Det gestaltar sig på olika sätt vilket analyseras grundligt i studien. Samtidigt illustreras motsägelsen när respondenterna i fallen säger att det är medborgarna som håller uppe imagen. Studien visar att det inte finns en enhetlig bild hur man som kommun ska hantera den institutionella komplexitet som uppstår. Fallen presenterar två olika synsätt som de finner mer lämpligt.

BEMÖTA BARNENS BEHOV : En kvalitativ studie av personalens upplevelser av yrkesroll och arbetsuppgifter på hem för vård eller boende för ensamkommande barn

The present study explores how members of staff at HVB for unaccompanied minors experience their work tasks, their roles as care givers, and what they mean it takes to meet the needs of the children. The data consists of six semi-structured interviews conducted at three different HVB. The interviews were analysed using reports made by the National Board of Health and Welfare (Socialstyrelsen) and the health and Social Care Inspectorate (IVO), and theories about resilience from mental illness. Furthermore, the current paper draws on previous research on the needs of unaccompanied minors and on international professionals’ roles and work tasks. The results show that the staff’s main task is to meet some of the needs of the children as their need of security, support, stability and sense of belonging. Time, knowledge, personal suitability and formal training were emphasized as important characteristics in order for them to adequately respond to the children’s needs.

A gestão estratégica no terceiro setor: estudo de caso numa organização eclesiástica

This study has the objective to evaluate until which extent the adoption of the strategic planning by the Presbyterian Church of Manaus (IPM) expresses its effective fitting within the strategic management paradigm, whose ethos is the predominance of the instrumental-strategic rationality and the market-orientated logic in the managerial actions. It is assumed as a research initial hypothesis that the adoption of this technique by IPM represented an instrumental-strategic managerial action and a deliberated incorporation of market-orientated managerial parameters, strengthening some of the organizational studies¿ ultimate conclusions about the colonization of the third sector¿s organizations by the capitalist system logic. The research method foresees: (a) a bibliographical review about the themes ¿critical social theories¿, ¿strategic management¿, ¿third sector¿ and ¿religious organizations sociology¿; and (b) a case study at IPM, religious organization established at the state of Amazonas, branch of the Presbyterian Church of Brazil (IPB) and socially active according to religious aims and related (social care, cultural, etc.).

Federalismo cooperativo no Brasil: da Constituição de 1988 aos sistemas de políticas públicas

A tese se dedica à discussão da relação de reciprocidade entre federalismo e políticas sociais no Brasil, analisando os sistemas de políticas públicas nas áreas da saúde, assistência social e educação. A tese se apóia na literatura internacional sobre federalismo e Estado de Bem-Estar Social para construir um referencial teórico que analisa os sistemas de políticas públicas como uma matriz, que aprofunda o compartilhamento federativo, com base na negociação intergovernamental. Argumenta-se que esse modelo resulta da interação entre o desenho institucional produzido pela Constituição de 1988 e as diretrizes de universalização de políticas sociais implementadas, por meio de ações federais, a partir da segunda metade da década de 1990. Com esse estudo,pretende-se propor uma nova abordagem sobre o federalismo brasileiro, alternativa à dicotomia entre centralização e descentralização que predomina na literatura nacional; além de chamar atenção para a figura dos sistemas de políticas públicas enquanto arranjos institucionais que permitem a combinação de nacionalização de políticas sociais, com fortalecimento da negociação federativa.

Main problems with the taxation of civil society organizations in Brazil: certifications and impact on payroll

The objective of this paper is to identify and analyze the main problems in the taxation—regarding both taxes themselves and compliance costs of taxation—of civil society organizations in Brazil. This study is qualitative descriptive research. A multiple case study with 26 organizations was performed. The results show that the problems mainly affect organizations with lower revenue and that do not work in the areas of education, health or social care. The main problems involve the taxation of the payroll and the difficulties related to obtaining and maintaining certifications. The study concludes with suggestions for the improvement of the regulatory framework.

Ações de profissionais relativas ao banco de leite humano : uma perspectiva de mudança

This is an exploratory and descriptive study that aimed to investigate the actions of professionals in the context of breastfeeding, on the assumption that the actions taken by employees working together to postpartum and newborn are not competing to effect the distribution of pasteurized human milk so that it meets the needs of infants who depend on it. Thus, the study aimed to analyze the actions of medical and nursing staff of the distribution of pasteurized human milk to the newly born. The investigation was developed by action research in a federal hospital, located in the capital the state of Rio Grande do Norte, Brazil, reference assistance to women during pregnancy, childbirth and postpartum high risk in 2010. Study participants were fifty-five professionals chosen from the following inclusion criteria: to act in the NICU or rooming, being a pediatrician and / or neonatologists, nurses and technical nursing. According to the methodology of action research a questionnaire was applied, techniques in focus groups and courses were developed, and, finally, action evaluation. The project was submitted to the Ethics Committee at the Federal University of Rio Grande do Norte and approved with no protocol 448/2009. The problems identified in the responses issued by the social research were grouped into categories according to the similarity between them. The answer to the question of the survey - How is the need for pasteurized human milk for the newborns in neonatal intensive care unit and rooming identified? - Brought subsidies for action planning and implementation of strategies for change in the practice of professionals working in rooming and ICU. Thus, the study has relevance in social care and, when at the local level, will compete for the distribution pasteurized human milk to take effect as best as possible, as recommended by the Ministry of Health. It is also conceived that, in a macro view of society, it could contribute to minimizing the health problem that involves the child population

Análise do modelo de gestão implantado no Centro de Atenção Psicossocial CAPS II OESTE de 1995 a 2005, situado no distrito sanitário Oeste do município de Natal/RN, à luz da Co-gestão

This dissertation has as aim the praxis of co-management of the health service of CAPS II OESTE of Natal-RN, where health workers, family members got to materialize guidelines and principles of psychiatric Brazilian reform in real possibilities of subjectivity construction, whereas they changed social relations in daily life. The path chosen to record was from testimonials and contributions of those who meant their done. Redeeming this story from social representations of the majority of their builders was an instigating, delicate and rewarding task, emphasizing the living memory, rebuilt in a line of time which could not be found in simple documentary collections. Mainly, by knowing that service routine was intense and had as characteristic the singular mobility itself from a creation process and therefore not always its dynamic allowed adequate records. At the same time, from this occurred the field and bibliographic research which allowed the detailed information from the prior milestones and motivated to the practice here reported. The rereading of concepts in an interface with the reports of the interviewees enabled the verification that the model of mental health advocated by psychiatric reform was understood. Once noticed the presence of the beliefs and values of people in motivating energy for the progress of reform, it has gone to fetch theoretical subsidies of administrative order to understand how they saw this building and that uniqueness has been printed. The theoretical way and praxis have tracked here has allowed to analyze how occurred such a process of production and subjectivity and collectives that when organize enabled themselves for analysis and intervention, including in crisis situations. Therefore, it was revealed that ethical and multi-disciplinarity, the humanitarian sense, the coresponsibility, co-production and horizontal management were the key factors for spread from a changing protagonist. One can thus conclude that co-management from that collective has been multi-disciplinary weaving a cross

Transtorno mental: dificuldades enfrentadas pela família

Utilizando uma metodologia qualitativa (entrevistas abertas, desenho-estória e análise temática) identificamos e analisamos 4 categorias (descompasso temporal, culpa, conflitos e perdas) presentes no discurso de mães (e uma irmã) de pacientes psiquiátricos do Núcleo de Atenção Psicossocial (NAPS) de Ribeirão Preto/SP, e avaliamos sua importância conforme o objetivo de se entender a dinâmica da relação entre serviço de saúde mental, paciente psiquiátrico e sua família.

O político, o jurídico e o assistencial no discurso administrativo sobre a mulher

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Violência doméstica contra crianças e adolescentes: da denúncia ao atendimento

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Sistema atende mulher: sistema de informação no centro de referência da mulher Ednalva Bezerra

The physical, psychological, sexual, moral and patrimonial violence affects women of different ages, social classes, ethnic and racial groups, levels of education and religion, all over Brazil. One of the obstacles in the strategies of prevention and facing violence against women, in public care services, focuses on the absence of an information system, automation of data and care flows. The existence of reliable data is essential for performing diagnoses, goals and conducting research on women in situations of violence who access the service agencies. In this sense, the goal of research is to present the experience of implementing a policy of data management called Woman System, in Ednalva Bezerra Women's Reference Center, which offers host/psychological and social care, guidance and legal referral for women that face any violence situation. As methodological paths, we adopt research in action. In our analyzes, we found that in this kind of public service, the use of the data system may improve the full and humanized care to women in situations of violence. Thus, the System Woman Care, still a developing phase, appears to improve the flow of relevant information within the institution, driving a process of knowledge, decision-making and intervention against gender violence.

Role of common mental and physical disorders in partial disability around the world

Background Mental and physical disorders are associated with total disability, but their effects on days with partial disability (i.e. the ability to perform some, but not full-role, functioning in daily life) are not well understood. Aims To estimate individual (i.e. the consequences for an individual with a disorder) and societal effects (i.e. the avoidable partial disability in the society due to disorders) of mental and physical disorders on days with partial disability around the world. Method Respondents from 26 nationally representative samples (n=61 259, age 18+) were interviewed regarding mental and physical disorders, and day-to-day functioning. The Composite International Diagnostic Interview, version 3.0 (CIDI 3.0) was used to assess mental disorders; partial disability (expressed in full day equivalents) was assessed with the World Health Organization Disability Assessment Schedule in the CIDI 3.0. Results Respondents with disorders reported about 1.58 additional disability days per month compared with respondents without disorders. At the individual level, mental disorders (especially post-traumatic stress disorder, depression and bipolar disorder) yielded a higher number of days with disability than physical disorders. At the societal level, the population attributable risk proportion due to physical and mental disorders was 49% and 15% respectively. Conclusions Mental and physical disorders have a considerable impact on partial disability, at both the individual and at the societal level. Physical disorders yielded higher effects on partial disability than mental disorders.

Astrobiology in Brazil: early history and perspectives

This review reports the Brazilian history in astrobiology, as well as the first delineation of a vision of the future development of the field in the country, exploring its abundant biodiversity, highly capable human resources and state-of-the-art facilities, reflecting the last few years of stable governmental investments in science, technology and education, all conditions providing good perspectives on continued and steadily growing funding for astrobiology-related research. Brazil is growing steadily and fast in terms of its worldwide economic power, an effect being reflected in different areas of the Brazilian society, including industry, technology, education, social care and scientific production. In the field of astrobiology, the country has had some important landmarks, more intensely after the First Brazilian Workshop on Astrobiology in 2006. The history of astrobiology in Brazil, however, is not so recent and had its first occurrence in 1958. Since then, researchers carried out many individual initiatives across the country in astrobiology-related fields, resulting in an ever growing and expressive scientific production. The number of publications, including articles and theses, has particularly increased in the last decade, but still counting with the effort of researchers working individually. That scenario started to change in 2009, when a formal group of Brazilian researchers working with astrobiology was organized, aiming at congregating the scientific community interested in the subject and to promote the necessary interactions to achieve a multidisciplinary work, receiving facilities and funding from the University de Sao Paulo and other funding agencies. Received 29 February 2012, accepted 17 May 2012, first published online 18 July 2012