737 resultados para qualitative longitudinal research practices


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Pós-graduação em Planejamento e Análise de Políticas Públicas - FCHS

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

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

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AIM: To investigate the quality of life of patients with HIV and tuberculosis co-infection and grasping the changes imposed in order to live with both transmissible diseases simultaneously. METHODS: Qualitative-quantitative research, undertaken at a specialized outpatient clinic in Fortaleza, Brazil, between 2009 and 2010, involving 34 co-infected patients. For data collection, a quality of life scale called HAT-QoL was used, which consists of 42 items, as well as open questions to perceive the changes the disease causes. RESULTS: Most participants suffered from pulmonary tuberculosis, were male and their education level was low. Quality of life was impaired in those domains related to economic, sexual and secrecy issues. It was also evidenced that the co-infection imposes changes in daily life that underline and further harm quality of life. CONCLUSION: Experiencing co-infection, despite appropriate treatment, causes changes in the patients' lives, whose repercussions can be mitigated through health-promoting interventions.

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Extensive literature outlined that the quality of the mother-foetus relationship is considered the main feature with regard to the quality of postnatal mother-infant interaction and also to the child’s psychical development. Nowadays the relationship between the pregnant woman and her foetus is viewed as the central factor of the somatic dialogue between the functioning of the maternal and the foetal organisms. This dialogue is responsible for the physic development of the child, as well as of its psychosomatic structure. Therefore the research area has necessarily had to extend to the analysis of psychological processes concerning: the pregnancy, the couple that is bound by parenthood, the influence of intergenerational dynamics. In fact, the formation of maternal identity, as well as that of the relationship between the woman and the foetus, refers to the pregnant woman’s relationship with her parents, especially with her mother. The same pregnancy, considered as a psychosomatic event, is directly influenced by relational, affective and social factors, particularly by the quality of the interiorized parental relations and the quality of the current relationships (such as that with her partner and with her family of origin). Some studies have begun to investigate the relationship between the pregnant woman and the foetus in term of “prenatal attachment” and its relationship with socio-demographic, psychological e psychopathological aspects (such as pre and post partum depression), but the research area is still largely unexplored. The present longitudinal research aimed to investigate the quality of the pregnant womanfoetus relationship by the prenatal attachment index, the quality of the interiorized relationship with woman’s parents, the level of alexithymic features and maternity social support, in relation with the modulation of the physiology of delivery and of postpartum, as well as of the physical development of the child. A consecutive sample of 62 Italian primipara women without any kind of pathologies, participated in the longitudinal study. In the first phase of this study (third trimester of the pregnancy), it has investigated the psychological processes connected to the affective investment of the pregnant women towards the unborn baby (by Prenatal Attachment Inventory), the mothers’ interiorized relationship with their own parents (by Parental Bonding Instrument), the social and affective support from their partner and their family of origin are able to supply (by Maternity Social Support Scale), and the level of alexithymia (by 20-Toronto Alexithymia Scale). In the second phase of this study, some data concerning the childbirth course carried out from a “deliverygram” (such as labour, induction durations and modalities of delivery) and data relative to the newborns state of well-being (such as Apgar and pH indexes). Finally, in the third phase of the study women have been telephoned a month after the childbirth. The semistructured interview investigated the following areas: the memory concerning the delivery, the return to home, the first interactions between the mother and the newborn, the breastfeeding, the biological rhythms achieved from newborns. From the data analysis a sample with a good level of prenatal attachment and of support social and a good capability to mental functioning emerged. An interesting result is that the most of the women have a great percentage of “affectionless control style” with both parents, but data is not sufficient to interpret this result. Moreover, considering the data relative to the delivery, medical and welfare procedures, that have been necessary, are coherent with the Italian mean, while the percentage of the caesarean section (12.9%) is inferior to the national percentage (30%). The 29% of vaginal partum has got epidural analgesia, which explains the high number (37%) of obstetrician operations (such as Kristeller). The data relative to the newborn (22 male, 40 female) indicates a good state of well-being because Apgar and pH indexes are superior to 7 at first and fifth minutes. Concerning the prenatal phase, correlation analysis showed that: the prenatal attachment scores positively correlated with the expected social support and negatively correlated with the “externally oriented thinking” dimension of alexithymia; the maternity social support negatively correlated with total alexithymia score, particularly with the “externally oriented thinking” dimension, and negatively correlated with maternal control of parental bonding. Concerning the delivery data, there are many correlations (after all obvious) among themselves. The most important are that the labour duration negatively correlated with the newborn’s index state of well-being. Finally, concerning the data from the postpartum phase the women’ assessments relative to the partum negatively correlated with the duration of the delivery and positively correlated with the assessment relative to the return to home and the interaction with the newborn. Moreover the length of permanence in the hospital negatively correlated with women’s assessments relative to the return to home that, in turn, positively correlated with the quality of breastfeeding, the interaction between the mother and the newborn and the biological regulation of the child. Finally, the women’ assessments relative to breastfeeding positively correlated with the mother-child interactions and the biological rhythms of children. From the correlation analysis between the variables of the prenatal phase and the data relative to the delivery, emerged that the prenatal attachment scores positively correlated with the dilatation stage scores and with the newborn’s Apgar index at first minute, the paternal care dimension of parental bonding positively correlated with the lengths of the various periods of childbirth like so the paternal control dimension with placental stage. Moreover, emerged that the expected social support positively correlated with the lengths of the various periods of childbirth and that the global alexithymia scores, particularly “difficulty to describe emotions” dimension, negatively correlated with total childbirth scores. From the correlation analysis between the variables of the prenatal phase and variable of the postpartum phase emerged that the total alexithymia scores positively correlated with the time elapsed from the childbirth to the breastfeeding of the child, the difficulty to describe emotions dimension of the alexithymia negatively correlated with the quality of the breastfeeding, the “externally oriented thinking” dimension of the alexithymia negatively correlated with mother-child interactions, and finally the paternal control dimension of the parental bonding negatively correlated with the time elapsed from the child to the breastfeeding of the child. Finally, from the analysis of the correlation between the data of the partum and the women’s assessments of the postpartum phase, emerged the negative correlation between the woman’s assessment relative to the delivery and the quantitative of obstetrician operations and the lengths of the various periods of childbirth, the positive correlation between the women’s assessment about the length of delivery periods and the real lengths of the same ones, the positive relation between woman’s assessment relative to the delivery and the Apgar index of children. In conclusion, there is a remarkable relation between the quality of the relationship the woman establishes with the foetus that influences the course of the pregnancy and the delivery that, in turn, influences the postpartum outcome, particularly relative to the mother-children relationship. Such data should be confirmed by heterogeneous populations in order to identify vulnerable women and to project focused intervention.

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Habitusbildung im Studium der Sozialpädagogik. Eine explorative Studie zur Strukturtypik studentischer Professionalisierungsprozesse Die qualitativ-empirische Studie untersucht die als studentischen und pädagogischen Habitus bezeichnete pädagogische Professionalisierung im Studium. Das zugrunde gelegte strukturtheoretische Modell einer professionalisierten sozialpädagogischen Praxis ist eine widersprüchliche Einheit von Theorie- und Fallverstehen. Schütze (1996) analysiert das im Kern paradoxale Verhältnis zwischen Professionellen und Klientel, die widersprüchliche Handlungslogik der Profession und die Konsequenzen ihrer herrschaftlicher Kontexte. In Oevermanns Skizze einer revidierten Theorie professionalisierten Handelns (1996) werden wissenschaftliches Verstehen und hermeneutisches Fallverstehen zur Grundlage des professionalisierten Handelns. Von besonderer Bedeutung ist Oevermanns Konzeption der stellvertretenden Deutung, der Deutung des latenten Sinns einer Interaktion, einer Handlung, einer latenten Sinnstrukur. Aus objektiv-hermeneutischer Sicht sind die Handlungsspielräume einer je konkreten Lebenspraxis durch Regeln gesetzt, bereits die Welt sozialer Regeln bestimmt Möglichkeiten und Folgen einer Handlung, nicht erst die Lebenspraxis. Die Kontrastierung von vier Fallrekonstruktionen mündet in der Formulierung zweier Strukturtypen. Beim Strukturtyp 1, „Scheitern der Habitusformation durch Verweigerung von Emergenz“, wird eine auf ein, maximal zwei sozialpädagogische Handlungsfelder gerichtete Berufskonzeption ausgeformt. Neue Inhalte, die sich nicht widerspruchsfrei in dieses minimalistische Konzept sozialer Praxis integrieren lassen, werden abgewehrt. Das Strukturpotential, das in dieser krisenhaften Übergangssituation angesprochen wird mit dem Anspruch, neue perzeptions- und handlungsleitende Sinnstrukturen zu bilden, stagniert in biografisch bewährten Bearbeitungsstrategien. Für die Fallstrukturgesetzlichkeit des Strukturtyps 2, „Krisenbearbeitung und Transformation biografietypischer Strukturen“, ist ein hohes Potential, in einem Prozess der Emergenz Krisen durch neue Handlungs- und Sinnstrukturen zu lösen, signifikant. Die gelingende Habitusformation vollzieht sich dort, wo diese emergenten Strukturen in die Vermitteltheit einer professionalisierten Routine überführt werden. Die Rückbindung der Strukturtypen an die Studienmodelle des „wissenschaftlich gebildeten Praktikers“ und des fallrekonstruktiven Modells fundiert die These, dass der durch die Einsozialisation in ein hermeneutisches Fallverstehen eröffnete Bildungsprozess vertiefte Kenntnisse um Lebensgesetzlichkeiten, Regelkenntnisse und eine entmystifizierte Haltung zur Theorie als einer „verwissenschaftlichten Rationalität“ vermittelt.

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The purpose of this study was to evaluate whether measurements on conventional cephalometric radiographs are comparable with 3D measurements on 3D models of human skulls, derived from cone beam CT (CBCT) data. A CBCT scan and a conventional cephalometric radiograph were made of 40 dry skulls. Standard cephalometric software was used to identify landmarks on both the 2D images and the 3D models. The same operator identified 17 landmarks on the cephalometric radiographs and on the 3D models. All images and 3D models were traced five times with a time-interval of 1 week and the mean value of repeated measurements was used for further statistical analysis. Distances and angles were calculated. Intra-observer reliability was good for all measurements. The reproducibility of the measurements on the conventional cephalometric radiographs was higher compared with the reproducibility of measurements on the 3D models. For a few measurements a clinically relevant difference between measurements on conventional cephalometric radiographs and 3D models was found. Measurements on conventional cephalometric radiographs can differ significantly from measurements on 3D models of the same skull. The authors recommend that 3D tracings for longitudinal research are not used in cases were there are only 2D records from the past.

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A growing number of patients search for medical information on the Internet. Understanding how they use the Internet is important, as this might impact their health, patient-practitioner roles, and general health care provision. In this article, we illustrate the motives of online health information seeking in the context of the doctor-patient relationship in Switzerland. We conducted semistructured interviews with patients who searched for health information online before or after a medical consultation. Findings suggest that patients searched for health information online to achieve the goals of preparing for the consultation, complementing it, validating it, and/or challenging its outcome. The initial motivations for online health information seeking are identified in the needs for acknowledgment, reduction of uncertainty, and perspective. Searching health information online was also encouraged by personal and contextual factors, that is, a person's sense of self-responsibility and the opportunity to use the Internet. Based on these results, we argue that online health information seeking is less concerned with what happens during the consultation than with what happens before or after it, in the sociocultural context.

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Aim To assess the predictors of a significant decrease or cessation of substance use (SU) in a treated epidemiological cohort of first-episode psychosis (FEP) patients. Method Participants were FEP patients of the Early Psychosis Prevention and Intervention Centre in Australia. Patients' medical files were reviewed using a standardized file audit. Data on 432 patients with FEP and baseline co-morbid substance use disorder (SUD) were available for analysis. Predictors of reduction/cessation of SU at follow up were examined using logistic regression analyses. Results In univariate analyses, a reduction/cessation of SU was predicted by baseline measures reflecting higher education, employment, accommodation with others, cannabis use disorder (CUD) only (rather than poly-SUDs), better global functioning and better premorbid social and occupational functioning, later age at onset of psychosis, and a diagnosis of non-affective psychosis. In multivariate analysis, CUD alone and better premorbid social and occupational functioning remained significant predictors. Conclusions Addressing SUDs and social and occupational goals in people with FEP may offer opportunities to prevent SUDs becoming more severe or entrenched. Further longitudinal research on recovery from SU and FEP is needed to disentangle directions of influence and identify key targets for intervention.

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The aim of this study was to evaluate whether measurements performed on conventional frontal radiographs are comparable to measurements performed on three-dimensional (3D) models of human skulls derived from cone beam computed tomography (CBCT) scans and if the latter can be used in longitudinal studies. Cone beam computed tomography scans and conventional frontal cephalometric radiographs were made of 40 dry human skulls. From the CBCT scan a 3D model was constructed. Standard cephalometric software was used to identify landmarks and to calculate ratios and angles. The same operator identified 10 landmarks on both types of cephalometric radiographs, and on all images, five times with a time interval of 1 wk. Intra-observer reliability was acceptable for all measurements. There was a statistically significant and clinically relevant difference between measurements performed on conventional frontal radiographs and on 3D CBCT-derived models of the same skull. There was a clinically relevant difference between angular measurements performed on conventional frontal cephalometric radiographs, compared with measurements performed on 3D models constructed from CBCT scans. We therefore recommend that 3D models should not be used for longitudinal research in cases where there are only two-dimensional (2D) records from the past.

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Dynamik der Gewalteskalation bei kritischen Situationen am Beispiel des Fußballstadions Alain Brechbühl, Annemarie Schumacher-Dimech & Roland Seiler Institut für Sportwissenschaft, Universität Bern Schlüsselwörter: Zuschauergewalt, Wahrnehmung, Fußball, Massenveranstaltungen, Fan Einleitung Zuschauergewalt bei Fußballspielen ist in der Schweiz ein aktuelles Thema, wie etwa politische Debatten um Maßnahmen zur Prävention von Eskalationen zeigen. Während in anderen Ländern bereits verschiedene Studien durchgeführt wurden (bspw. Hylander & Granström, 2010), existiert in der Schweiz kaum Forschung zur Dynamik und den möglichen Faktoren, die den Unterschied zwischen einer Eskalation oder Nichteskalation ausmachen könnten. Insbesondere die Sicht beteiligter Personen ist dazu von entscheidender Bedeutung. Das vorliegende Projekt beschäftigt sich mit der subjektiv wahrgenommenen Gewaltsituation und deren zentralen Faktoren und Ursachen im Kontext des Fußballs. Methode Aufgrund der spärlichen Forschungslage in der Schweiz wurde eine explorative qualitative Studie mit involvierten und nichtinvolvierten Personen (Fußballfans, Sicherheitspersonal und die Polizei) durchgeführt, um Daten über kritische Situationen bei Spielen der Raiffeisen Super League zu erheben. Die ausgewählten Personen wurden einzeln mit narrativen Interviews zu der erlebten Situation befragt um genauere Erkenntnisse zur Situation zu erhalten. Zu vier Situationen wurden 34 Interviews durchgeführt (12 mit Polizeiangehörigen, 11 mit Fans, 9 mit Fanarbeitern und 2 mit Sicherheitsarbeitern). Die Auswertung erfolgte mit der interpretativen phänomenologischen Analyse. Ergebnisse Es zeigten sich individuelle und gruppenspezifische Wahrnehmungen in kritischen Situationen. Bei den befragten Personen herrschte häufig eine Tendenz zur (negativen) Stereotypisierung der gegenüberstehenden Gruppenmitglieder. Schnelle und klare Kommunikation, genügend Distanz zwischen den Gruppen und das Entfernen von gruppenspezifisch bedrohlichen Hinweisreizen (bspw. Polizei-Rüstungen) konnten als relevante Faktoren für gewaltfreie Lösungen festgestellt werden. Diskussion Die vorliegenden Ergebnisse sprechen für die Aufrechterhaltung einer differenzierten Betrachtungsweise und das Beiziehen von Vermittlungspersonen (von Fan- wie auch Polizeiseite) in kritischen Situationen, um Eskalationen vermeiden zu können. Es zeigen sich Ähnlichkeiten zu den Ergebnissen von Hylander & Granström (2010). Es werden noch weitere kritische Situationen analysiert, um konkrete Praxisempfehlungen zu formulieren. Literatur Hylander, I., & Granström, K. (2010). Organizing for a peaceful crowd: an example of a football match. Fo-rum Qualitative Social Research, 11 (2), Zugriff am 22.01.2014 unter http://www.qualitative-research.net/index.php/fqs/article/view/1462/2969.

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Purpose – The authors sought to explain why and how protean career attitude might influence self‐initiated expatriates' (SIEs) experiences positively. A mediation model of cultural adjustment was proposed and empirically evaluated. Design/methodology/approach – Data from 132 SIEs in Germany containing measures of protean career attitude, cultural adjustment, career satisfaction, life satisfaction, and intention to stay in the host country were analysed using path analysis with a bootstrap method. Findings – Empirical results provide support for the authors' proposed model: the positive relations between protean career attitude and the three expatriation outcomes (career satisfaction, life satisfaction and intention to stay in the host country) were mediated by positive cross‐cultural adjustment of SIEs. Research limitations/implications – All data were cross‐sectional from a single source. The sample size was small and included a large portion of Chinese participants. The study should be replicated with samples in other destination countries, and longitudinal research is suggested. Practical implications – By fostering both a protean career attitude in skilled SIE employees and their cultural adjustment, corporations and receiving countries could be able to retain this international workforce better in times of talent shortage. Originality/value – This study contributes to the scarce research on the conceptual relatedness of protean career attitude and SIEs, as well as to acknowledging the cultural diversity of the SIE population.

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The main objective of this preliminary study was to further clarify the association between testosterone (T) levels and depression by investigating symptom-based depression subtypes in a sample of 64 men. The data were taken from the ZInEP epidemiology survey. Gonadal hormones of a melancholic (n  = 25) and an atypical (n = 14) depression subtype, derived from latent class analysis, were compared with those of healthy controls (n  = 18). Serum T was assayed using an enzyme-linked immunosorbent assay procedure. Analysis of variance, analysis of covariance, non-parametrical tests, and generalized linear regression models were performed to examine group differences. The atypical depressive subtype showed significantly lower T levels compared with the melancholic depressives. While accumulative evidence indicates that, beyond psychosocial characteristics, the melancholic and atypical depressive subtypes are also distinguishable by biological correlates, the current study expanded this knowledge to include gonadal hormones. Further longitudinal research is warranted to disclose causality by linking the multiple processes in pathogenesis of depression.

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Background. Ambulatory blood pressure (ABP) measurement is a means of monitoring cardiac function in a noninvasive way, but little is known about ABP in heart failure (HF) patients. Blood pressure (BP) declines during sleep as protection from consistent BP load, a phenomenon termed "dipping." The aims of this study were (1) to compare BP dipping and physical activity between two groups of HF patients with different functional statuses and (2) to determine whether the strength of the association between ambulatory BP and PA is different between these two different functional statuses of HF. ^ Methods. This observational study used repeated measures of ABP and PA over a 24-hour period to investigate the profiles of BP and PA in community-based individuals with HF. ABP was measured every 30 minutes by using a SpaceLabs 90207, and a Basic Motionlogger actigraph was used to measure PA minute by minute. Fifty-six participants completed both BP and physical activity for a 24-hour monitoring period. Functional status was based on New York Heart Association (NYHA) ratings. There were 27 patients with no limitation of PA (NYHA class I HF) and 29 with some limitation of PA but no discomfort at rest (NYHA class II or III HF). The sample consisted of 26 men and 30 women, aged 45 to 91 years (66.96 ± 12.35). ^ Results. Patients with NYHA class I HF had significantly greater dipping percent than those with NYHA class II/III HF after controlling their left ventricular ejection fraction (LVEF). In a mixed model analysis (PROC MIXED, SAS Institute, v 9.1), PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and ABP readings was not significantly different for the two groups of patients. ^ Conclusions. These preliminary findings demonstrate differences between NYHA class I and class II/III of HF in BP dipping status and ABP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hour physical activity and BP profiles of this patient population. ^ Key Words. Ambulatory Blood Pressure; Blood Pressure Dipping; Heart Failure; Physical Activity. ^