A gestão da pessoa com hipertensão arterial na unidade móvel de saúde

Enquadramento: A gestão da doença, designadamente da hipertensão arterial (HTA) através do apoio à auto-gestão, aconselhamento motivacional, acesso à informação resultam em maior adesão terapêutica. Objetivos: Identificar os fatores que determinam a adesão ao tratamento na pessoa com HTA numa amostra comunitária. Metodologia: Estudo transversal, descritivo-correlacional, com amostra de 235 hipertensos (63,8% do género feminino), idade média 75 ± 8,14 anos, 62,6% casados e a maioria com o 1.º ciclo de escolaridade. Recorremos ao questionário com variáveis sociodemográficas, dietéticas, clínicas, motivacionais, relacionadas com os profissionais e serviços de saúde, Escala de Apgar Familiar, Questionário de Dependência Alcoólica, Questionário Internacional de Atividade Física, Questionário de Determinação da Saúde Nutricional, Escala de Autocuidado com a Hipertensão, Questionário de Crenças Sobre a Doença, Escala de Crenças Acerca dos Medicamentos, Escala de Satisfação dos Utentes com os Cuidados de Enfermagem na Unidade Móvel de Saúde, Questionário abreviado da Perceção do Cliente sobre o Ambiente Terapêutico, Questionário de Autorregulação, Escala de Competência Percebida e Escala de Medida de Adesão aos Tratamentos para colheita de dados. Resultados: A pressão arterial estava controlada em 34,5% da amostra, 28,2% homens e 38% mulheres. A MAT revelou um mínimo de 3,86 e um máximo de 6 com uma média de 5,66±0,49. As variáveis preditoras da adesão foram: controlo pessoal (p=0,005), identidade (p=0,000), ambiente terapêutico (p=0,001), alimentação geral (p=0,041), atividade física (p=0,007) e toma de medicamentos (p=0,000). Conclusões: Compreender os fatores envolvidos na gestão do tratamento permite perceber como podem os enfermeiros contribuir para melhorar a adesão ao regime terapêutico. Palavras-chave: Hipertensão arterial, gestão da doença crónica, adesão ao tratamento e adultos.

Aprendizagem de um gênero de discurso e de atividade de autoconfrontação em ações de formação docente continuada na educação superior

The objective of this text is to discuss a central question in a doctorate study, in progress, about the learning of the speech genre in self-confrontation situations. This consists of a procedure, which a worker observes your own images, video recorded at the time it performs activities related to their craft; It requests that he comment on what he was doing on the images in order to clarify matters for himself and another - be it a intervenant (simple self-confrontation) or a coworker (crossed self-confrotation). (CLOT, 2008/2010). In the context of this research, the confronted workers are university teachers and students who participate in an action of teacher continuing education. The object of the research is the process of speech genre of learning self-confrontation situation, having as subject a person who conducts self-confrontations training, which initially observed the conduct of dialogues and reflections, and will gradually participating in the self-confrontation activity and becoming also forming another. The theoretical foundations of the research seeks an articulation between sciences such as the Psychology of Labor, the Cultural-historical Psychology and Linguistics. The concepts that are employed come from Clot´s theory of the Psychology of Labor, that is, from the Clinic of Activity and from the activity genre studies (CLOT, 2008/2010); they also come from the Vygotskian theory of human development, with the concepts of thinking and speech (VIGOTSKI, 1934/1998); and from the Bakhtinian dialogic principle (BAKHTIN, 1979/2011). We believe that the formation of the person conducting self-confrontation occurs through learning a gender of speech and a genre of activity.

Men's experiences of receiving objective feedback on physical activity and other indicators of health risk, within the context of a gender-sensitised weight loss intervention

Receiving personalised feedback on body mass index and other health risk indicators may prompt behaviour change. Few studies have investigated men’s reactions to receiving objective feedback on such measures and detailed information on physical activity and sedentary time. The aim of my research was to understand the meanings different forms of objective feedback have for overweight/obese men, and to explore whether these varied between groups. Participants took part in Football Fans in Training, a gender-sensitised, weight loss programme delivered via Scottish Professional Football Clubs. Semi-structured interviews were conducted with 28 men, purposively sampled from four clubs to investigate the experiences of men who achieved and did not achieve their 5% weight loss target. Data were analysed using the principles of thematic analysis and interpreted through Self-Determination Theory and sociological understandings of masculinity. Several factors were vital in supporting a ‘motivational climate’ in which men could feel ‘at ease’ and adopt self-regulation strategies: the ‘place’ was described as motivating, whereas the ‘people’ (other men ‘like them’; fieldwork staff; community coaches) provided supportive and facilitative roles. Men who achieved greater weight loss were more likely to describe being motivated as a consequence of receiving information on their objective health risk indicators. They continued using self-monitoring technologies after the programme as it was enjoyable; or they had redefined themselves by integrating new-found activities into their lives and no longer relied on external technologies/feedback. They were more likely to see post-programme feedback as confirmation of success, so long as they could fully interpret the information. Men who did not achieve their 5% weight loss reported no longer being motivated to continue their activity levels or self-monitor them with a pedometer. Social support within the programme appeared more important. These men were also less positive about objective post-programme feedback which confirmed their lack of success and had less utility as a motivational tool. Providing different forms of objective feedback to men within an environment that has intrinsic value (e.g. football club setting) and congruent with common cultural constructions of masculinity, appears more conducive to health behaviour change.

Elsa Köhler (1879-1940): Eine fast vergessene Pionierin der Bildungsforschung

Nach der Biographie der österreichischen Pädagogin und Psychologin Elsa Köhler (1879-1940) werden in diesem Beitrag ihre Pionierleistungen bei der Grundlegung der empirischen Bildungsforschung beschrieben. Als Lehrerin war sie früh um den Einbezug des Entwicklungsstands von Schülern in die Didaktik im Sinne der Entwicklung differentieller Unterrichtsansätze bemüht. Am Psychologischen Institut der Universität Wien lernte sie bei Karl Bühler die für longitudinale Einzelfallanalysen der Entwicklung von Kindern und Jugendlichen konzipierten quantitativen und qualitativen Beobachtungs- und Protokolltechniken kennen und weitete diese Methoden als erste auf die pädagogische Situation im Unterricht, auf Schülergruppen und auf die Analyse der Entwicklung ganzer Schulklassen aus. Sie trug Wesentliches dazu bei, dass empirische Forschungsmethoden in reformpädagogische Ansätze der 1920er und 1930er Jahre Eingang fanden und machte ihre in der pädagogischen Situation durchgeführten Entwicklungsanalysen für die Entwicklungsberatung zur Optimierung der Selbststeuerung von Schülern fruchtbar. Elsa Köhler verband Grundlagenforschung mit einem starken Anwendungsbezug in den klassischen Bereichen der auf die Kindheit und das Jugendalter bezogenen Entwicklungspsychologie sowie in den Bereichen der Pädagogischen Psychologie und Pädagogik, die heute unter der Bildungsforschung subsumiert werden. Die Beschäftigung mit ihr ist von fachhistorischer Bedeutung und kann zudem auch Impulse für die moderne interdisziplinär ausgerichtete Bildungsforschung geben. (DIPF/Orig.)

Evidence in promoting positive parenting through the Program-Guide to Develop Emotional Competences

This study aims at providing evidence of the effectiveness of the Program-Guide to Develop Emotional Competences in promoting positive parenting. Contextual, institutional, methodological and professional issues were taken into account to develop a social innovation experience to support parenting as a preventive measure to family conflicts. The study describes both the contents of the Program-Guide and the methodological and evaluation issues that trained professionals need to consider when delivering the Program-Guide to families in natural contexts. Information was gathered and analyzed from 259 parents with children of ages 1-18 who participated in 26 parent training groups. A pre- and post-test design showed that after finishing the sessions parents perceived themselves more competent as parents according to the five dimensions of parenting competences considered: (1) emotional self-regulation abilities; (2) self-esteem and assertiveness; (3) communication strategies; (4) strategies to solve conflicts and to negotiate; and (5) strategies to establish coherent norms, limits and consequences to promote positive discipline. The study presents a discussion on these results from evidence-based parenting programs, as well as some strengths and limitations of the study, together with some suggestions for further research.

Qualidade de vida, percepção de saúde, resiliência, auto-regulação e suporte social nos adolescentes portugueses com a doencça crónica

Tese de Doutoramento em Psicologia na área de especialidade Psicologia da Saúde

Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.

Relationship between subjective wellbeing and weight perception in children and adolescents: Gender and age differences

The relation between weight status (Body Mass Index - BMI), weight perception and subjective wellbeing remains unclear. Several studies conclude that discrepancies can be found between weight status and weight perception, among children and adolescents. The present study aims at investigating the associations between subjective wellbeing and individual characteristics, among children and adolescents. The sample included 1200 children and adolescents (51.7 % girls, aged 9 to 17). Their mean age was 12.55 years (SD = 1.61). The questionnaire was completed in school context, asking about the subjective wellbeing, use of self-regulation, eating behavior awareness/care, weight perception and sociodemographic questions such as age, gender and BMI. The study found a strong association between BMI and weight perception, although subjective wellbeing was better explained by weight perception than by BMI. Eating awareness and self-regulation also played an important role in subjective controlling for age and gender. Age and gender interfere in the relation between subjective wellbeing and other variables. The multiple regression model is more robust and explicative for girls and older children. Psychological factors related to weight, such as weight perception, self-regulation and eating awareness have a stronger explicative impact in subjective wellbeing compared to physical aspects, such as Body Mass Index. The relation between subjective wellbeing and weight is influence by age and gender.

What can the philosophy of science contribute to the ethics of science and technology?

Nascida para permitir que seus criadores possam atender suas próprias necessidades, a técnica científica sempre desempenhou papel significativo na civilização humana. Este é o contexto em que podemos vislumbrar o advento da tecnociência moderna, que tem contribuído significativamente para o incremento do controle humano sobre a natureza. Este estudo tem por objetivo analisar, sob o enfoque da bioética, reflexões sobre como a filosofia da ciência entende a neutralidade da ciência e sua convergência com a racionalidade epistêmica, bem como relacionar essas reflexões ao processo de tomada de decisões na administração da tecnociência. O estudo levantou dúvidas sobre a capacidade do conhecimento tecnocientífico para legitimar e justificar as decisões no âmbito dos sistemas de ciência e tecnologia nacionais, sinalizando assim a necessidade de promover ligação entre a auto-regulação tecnocientífico e hetero-regulação bioética. ______________________________________________________________________________ ABSTRACT

Psicomotricidade na promoção de competências pessoais e sociais : intervenção com jovens adultos em acompanhamento no âmbito de medidas de execução na comunidade

O presente relatório descreve as atividades realizadas no âmbito do Mestrado em Reabilitação Psicomotora, Ramo de Aprofundamento de Competências Profissionais da Faculdade de Motricidade Humana, realizado na Direção Geral de Reinserção e Serviços Prisionais, Equipa Lisboa 1. O trabalho pressupôs a conceção e implementação de um Programa de Competências Pessoais e Sociais, dirigido a jovens adultos em acompanhamento no âmbito de medidas de execução na comunidade. O Programa encontra-se dividido em três áreas de intervenção: Comunicação Interpessoal, Autorregulação e Resolução de problemas e é composto por 22 sessões, tendo sido implementado na Casa de São Bento, a oito sujeitos, com idades compreendidas entre os 18 e 25 anos. Os resultados obtidos na intervenção permitiram observar melhorias, tanto a nível relacional, como emocional e comportamental, verificando-se uma evolução positiva por parte dos participantes. Na parte final deste relatório é realizada uma análise dos resultados obtidos, por forma a avaliar o impacto do programa, e são apresentadas as dificuldades, conclusões e sugestões para intervenções futuras.

Representações de doença, espriritualidade e adesão ao tratramentos em pacientes com diagnóstico de esquizofrenia

Esta investigação tem como objetivo estudar as representações de doença em pacientes com o diagnóstico de esquizofrenia e a forma como estas são varáveis preditoras da adesão ao tratamento. Este estudo teve como base o modelo de auto­regulação de Leventhal, que tem sido largamente aplicado à doença física e começa a dar os primeiros passos em trabalhos a nível da saúde mental. A investigação empírica deste trabalho foi assim conduzida tendo em conta o papel ativo que os sujeitos possuem na elaboração das suas próprias doenças. O estudo consistiu na aplicação de questionários de perceção de doença (IPQS), Crenças sobre os medicamentos (BMQ) adesão ao tratamento (RAM) e espiritualidade. Os resultados demonstram que algumas representações de doença são preditoras significativas da adesão ao tratamento. Também as crenças acerca dos medicamentos possuem um efeito preditor ainda que de uma forma menos acentuada. A interação entre representações de doença e crenças espirituais também possuem efeitos preditores na adesão ao tratamento. /ABSTRACT: This study has the objective of make an approach about the illness perceptions of patients with the diagnosis of schizophrenia and the way by witch this variable are predictors of treatment adherence. Using the model of self-regulation of Leventhal, that has been largely applied to physical disease and starts now to develop investigations in the area of mental health problems. The empirical investigation has been conducted having in mind the active role that subjects have in elaborating their own diseases. The present study was made by means of application of the disease illness perception questionnaire (IPQS), beliefs about medicines (BMQ), treatment adherence (RAM) and spirituality. Our results show that some illness cognitions are significative predictors of treatment adherence, as well as the beliefs about medicines have a predictive effect but in a less strong way. Also the interactions between illness representations and spiritual beliefs have predicted the treatment adherence.

Modero eu? Moderamos nós?: Efeito moderador dos traços de personalidade e da cultura organizacional na relação entre metacognição e engagement laboral

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção do grau de Mestre em Psicologia especialidade em Psicologia Social e das Organizações

Adolescent’s subjective perceptions of chronic disease and related psychosocial factors: Highlights from an outpatient context study

Background: Adolescents with chronic disease (CD) can be more vulnerable to adverse psychosocial outcomes. This study aims: 1) to identify differences in psychosocial variables (health-related quality of life, psychosomatic complaints, resilience, self-regulation and social support) among adolescents who feel that CD affects or does not affect school/peers connectedness (measured by self-reported participation in school and social activities); and 2) to assess the extent to which psychosocial variables are associated with connectedness in school and peer domains. Methods: A cross-sectional study was conducted in 135 adolescents with CD (51.9% boys), average age of 14 ± 1. 5 years old (SD = 1.5). Socio-demographic, clinical, and psychosocial variables were assessed, using a self-reported questionnaire, which included the Chronic Conditions Short Questionnaire, KIDSCREEN-10 Index, Symptoms Check-List, Healthy Kids Resilience Assessment Module Scale, Adolescent Self-Regulatory Inventory, and Satisfaction with Social Support Scale. Descriptive statistics, GLM-Univariate ANCOVA and Logistic Regression were performed using the IBM Statistical Package for Social Sciences (SPSS), version 22.0. The significance level was set at p < 0.05. Results: Thirteen to eighteen percent of the adolescents felt that CD affected participation at school (PSCH) and participation in leisure time with friends (PLTF). These adolescents presented lower results for all psychosocial study variables, when compared with adolescents who did not feel affected in both areas of participation. From the studied psychosocial variables, the most important ones associated with PSCH (after controlling for age, gender, diagnosis, and education level of father/mother) were self-regulation and psychosomatic health. Concerning the PLTF, social support was the sole variable explaining such association. Conclusions: The present study pointed out the association between psychosocial variables; and living with a CD and school/peers connectedness. The need to focus on the assessment of the effects of a CD on adolescents’ lives and contexts is suggested, as well as on the identification of vulnerable adolescents. Such identification could help to facilitate the maximization of social participation of adolescents with CD, and to plan interventions centered on providing support and opportunities for a healthy youth development. For that purpose, a complex and multifactorial approach that includes clinicians, schools, family, and peers may be proposed.

Yoga and loss: an autoethnographical exploration of grief, mind, and body

The author explores her experience of yoga as a therapeutic tool in recovering from the impact of losing a close friend to suicide. The benefits of yoga include improved emotional self-regulation, a more positive relationship with self, and the emergence of a new personal physical reality. An autoethnographical approach permits a necessarily ambiguous and messy in-depth exploration of yoga as a resource for well-being. Nevertheless, it is hoped that it will serve as a means of promoting further study into the role of cultural resources, particularly body-based practices, as means of coming to terms with traumatic loss.

Identificación de redes nacionales y mundiales de distribución de petróleo y gas natural y su relación con la conformación de comunidades

El presente proyecto investiga la relación entre las organizaciones con el medio y marketing, para lo cual se debe mencionar el conflicto de intereses de la comunidad y de la organización, y como se intenta percibir a la organización como un buen vecino dentro de la comunidad. A su vez éste estudio cuenta con objetivos basados en la identificación de redes de distribución de petróleo y gas natural, tanto nacionales como internacionales, para así abarcar un sector estratégico más preciso, y mostrar las relación entre las organizaciones y la conformación de comunidades. Se tienen en cuenta factores elementales en el estudio de este sector energético, como son sus principales componentes, así como un marco teórico específico que permita desarrollar el concepto de conformación de comunidades para lograr una exitosa aplicación del mismo. Del mismo modo se incluirán temas relacionados con marketing, pero desde un punto de vista más cercano a la comunidad, tomando los medios y el marketing como un concepto más importante en el impacto de las organizaciones en la comunidad, es decir tomando el concepto de marketing como aquellas comunidades que rodean las organizaciones, como éstas dos interactúan, y que impactos tienen una sobre la otra. De la misma manera se tienen resultados en cuanto a planteamientos más profundos sobre conceptos de marketing que no son desarrollados muy a menudo, los cuales conservan su esencia fundamental y siguen impactando en silencio a las organizaciones, pero que si lo estudiamos y aprovechamos de algún modo lograremos beneficios para nuestra organización y para los intereses colectivos.