El ritual en los "Textos de las Pir��mides": sintaxis, texto y significado

Este trabajo pretende explorar la dimensi��n ritual en los Textos de las Pir��mides, el corpus de literatura religiosa extensa m��s antiguo de la humanidad. La naturaleza variada de sus componentes textuales ha impedido que los egipt��logos comprendan en profundidad las complejidades de la colecci��n y los contextos originales en los que estos textos (ritos) aparecieron. La aplicaci��n de la teor��a del ritual, principalmente la aproximaci��n de la sintaxis ritual, ofrece a los investigadores un marco excelente de an��lisis e interpretaci��n del corpus, su estructura y funci��n. Sujeto a las reglas de la sintaxis ritual es posible exponer los m��ltiples niveles de significado en el corpus para la resurrecci��n y salvaci��n del difunto.

EuroClonality/BIOMED-2 guidelines for interpretation and reporting of Ig/TCR clonality testing in suspected lymphoproliferations.

PCR-based immunoglobulin (Ig)/T-cell receptor (TCR) clonality testing in suspected lymphoproliferations has largely been standardized and has consequently become technically feasible in a routine diagnostic setting. Standardization of the pre-analytical and post-analytical phases is now essential to prevent misinterpretation and incorrect conclusions derived from clonality data. As clonality testing is not a quantitative assay, but rather concerns recognition of molecular patterns, guidelines for reliable interpretation and reporting are mandatory. Here, the EuroClonality (BIOMED-2) consortium summarizes important pre- and post-analytical aspects of clonality testing, provides guidelines for interpretation of clonality testing results, and presents a uniform way to report the results of the Ig/TCR assays. Starting from an immunobiological concept, two levels to report Ig/TCR profiles are discerned: the technical description of individual (multiplex) PCR reactions and the overall molecular conclusion for B and T cells. Collectively, the EuroClonality (BIOMED-2) guidelines and consensus reporting system should help to improve the general performance level of clonality assessment and interpretation, which will directly impact on routine clinical management (standardized best-practice) in patients with suspected lymphoproliferations.

The Associations Between the Maladaptive Personality Dimensions of Neediness and Self-Criticism, Defense Styles, Selfobject Needs, and Attachment Styles in an Iranian Sample

The present study extends previous findings by examining whether defense styles, selfobject needs, attachment styles relate to Neediness and Self-Criticism, as maladaptive personality dimensions focused, respectively, on relatedness and self-definition in an Iranian sample. Three hundred and fifty two participants completed a socio-demographic questionnaire as well as the Persian forms of the Depressive Experiences Questionnaire, Experience of Close Relationships-Revised, Defense Style Questionnaire, Beck Depression Inventory���II and Selfobject Needs Inventory. Two Multiple Linear Regression Analyses, entering Self-criticism and Neediness as criterion variables, were computed. According to the results high Attachment anxiety, high Immature defenses, high depressive symptoms, and high need for idealization were related to self-criticism, and explained 47% of its variance. In addition, high attachment anxiety, low mature defenses, high neurotic defenses, high avoidance of mirroring, and low avoidance of idealization/twinship were related to neediness, and explained 40% of its variance. A Principal Component Analysis was performed, entering all the studied variables. Three factors emerged; one describing a maladaptive form of psychological functioning and two describing more mature modes of psychological functioning. The results are discussed in their implications for the understanding of neediness and self-criticism as maladaptive personality dimensions focused, respectively, on relatedness and self-definition.

Adapta����o e valida����o da escla ASKAS - Aging Sexual Knowledge and Attitudes Scale em idosos brasileiros

Universidade Estadual de Campinas . Faculdade de Educa����o F��sica

Modification of composition of a nanoemulsion with different cholesteryl ester molecular species: Effects on stability, peroxidation, and cell uptake

Purpose: Use of lipid nanoemulsions as carriers of drugs for therapeutic or diagnostic purposes has been increasingly studied. Here, it was tested whether modifications of core particle constitution could affect the characteristics and biologic properties of lipid nanoemulsions. Methods: Three nanoemulsions were prepared using cholesteryl oleate, cholesteryl stearate, or cholesteryl linoleate as main core constituents. Particle size, stability, pH, peroxidation of the nanoemulsions, and cell survival and uptake by different cell lines were evaluated. Results: It was shown that cholesteryl stearate nanoemulsions had the greatest particle size and all three nanoemulsions were stable during the 237-day observation period. The pH of the three nanoemulsion preparations tended to decrease over time, but the decrease in pH of cholesteryl stearate was smaller than that of cholesteryl oleate and cholesteryl linoleate. Lipoperoxidation was greater in cholesteryl linoleate than in cholesteryl oleate and cholesteryl stearate. After four hours' incubation of human umbilical vein endothelial cells (HUVEC) with nanoemulsions, peroxidation was minimal in the presence of cholesteryl oleate and more pronounced with cholesteryl linoleate and cholesteryl stearate. In contrast, macrophage incubates showed the highest peroxidation rates with cholesteryl oleate. Cholesteryl linoleate induced the highest cell peroxidation rates, except in macrophages. Uptake of cholesteryl oleate nanoemulsion by HUVEC and fibroblasts was greater than that of cholesteryl linoleate and cholesteryl stearate. Uptake of the three nanoemulsions by monocytes was equal. Uptake of cholesteryl oleate and cholesteryl linoleate by macrophages was negligible, but macrophage uptake of cholesteryl stearate was higher. In H292 tumor cells, cholesteryl oleate showed the highest uptakes. HUVEC showed higher survival rates when incubated with cholesteryl stearate and smaller survival with cholesteryl linoleate. H292 survival was greater with cholesteryl stearate. Conclusion: Although all three nanoemulsion types were stable for a long period, considerable differences were observed in size, oxidation status, and cell survival and nanoemulsion uptake in all tested cell lines. Those differences may be helpful in protocol planning and interpretation of data from experiments with lipid nanoemulsions.

'You can criticise because you care': How attributions affect responses to ingroup and outgroup critics

There are times when people feel compelled to stand up and articulate their group's shortcomings, an act that carries with it enormous social risks. Indeed, a mechanistic reading of social identity theory might lead one to believe that ingroup critics are doomed to face hostility because they are attacking a fundamental part of people's self-concept. But often ingroup critics are doing more than attacking their group ��� they are trying to incite positive change. Criticism is the cornerstone of protest, and it is difficult to imagine how a group can be reinvigorated, reinvented, or reformed without some process of critical self-reflection. Thus, although the ingroup critic might create tension within the group, it is possible that internal criticism could be seen by other group members as beneficial in terms of promoting positive change and stimulating innovation, creativity, and flexibility in decision making. In this talk I examine the 'identity rules' that ingroup critics need to follow to avoid defensiveness, and look at empirical evidence of how factors such as language, the intergroup context, and choice of audience shape people's attributions regarding criticism and their subsequent evaluations of critics.

The John Dewey`s epistemology and informational literacy

The `reflexive thinking` concept is discussed in this article as a means of contextualizing John Dewey`s intellectual legacy. `Reflection` represents a fundamental element for the construction of the necessary competences to information seeking and use, and consequently to individual and collective development. Since the reflexive thinking habit in information literacy is a way of learning, some questions concerning teaching and learning processes are also investigated. The discussion is, therefore, supported by the supposition that reflexive thinking is a cognitive strategy that allows a deeper comprehension of related problems, phenomena, and processes by means of the perception of the relations and the identification of involved elements, as well as the analysis and interpretation of meanings, empowering the information literacy process.

The family attitude scale: Reliability and validity of a new scale for measuring the emotional climate of families

Research on outcomes from psychiatric disorders has highlighted the importance of expressed emotion (EE), but its cost-effective measurement remains a challenge. This article describes development of the Family Attitude Scale (FAS), a 30-item instrument that can be completed by any informant. Its psychometric characteristics are reported in parents of undergraduate students and in 70 families with a schizophrenic member. The total FAS had high internal consistency in all samples, and reports of angry behaviour in FAS items showed acceptable inter-rater agreement. The FAS was associated with the reported anger, anger expression and anxiety of respondents. Substantial associations between the parents' FAS and the anger and anger expression of students was also observed. Parents of schizophrenic patients had higher FAS scores than parents of students, and the FAS was higher if disorder duration was longer or patient functioning was poorer. Hostility, high criticism and low warmth on the Camberwell Family Interview (CFI) were associated with a more negative FAS. The highest FAS in the family was a good predictor of a highly critical environment on the CFI. The FAS is a reliable and valid indicator of relationship stress and expressed anger that has wide applicability. (C) 1997 Elsevier Science Ireland Ltd.

Imaging in osteoarthritis: what have we learned and where are we going?

Osteoarthritis (OA) is a widely prevalent disease of the whole joint including cartilage, bone and soft tissues. Increasing importance of imaging including assessment of all joint structures has been recognized recently. Conventional radiography is still the first and most commonly used imaging technique for evaluation of a patient with a known or suspected diagnosis of OA. However, limitations have been revealed by recent MRI-based knee OA studies. MRI plays a crucial role in understanding the natural history of the disease and in guiding future therapies due to its ability to image the knee as a whole organ and to directly and three-dimensionally assess cartilage morphology and composition. It is crucial to use the appropriate MR pulse sequences to assess various OA features, and thus support from experienced musculoskeletal radiologists should be sought for study design, image acquisition and interpretation. The aim of this article is to describe the roles and limitations of conventional radiography and MRI in imaging of OA, and also to give insight into the use of other modalities such as ultrasound, scintigraphy, computed tomography (CT) and CT arthrography in clinical practice and research in OA, particularly focusing on the assessment of knee OA in the tibiofemoral joint.

Coordination and movement pathology: models of structure and function

Here we consider the role of abstract models in advancing our understanding of movement pathology. Models of movement coordination and control provide the frameworks necessary for the design and interpretation of studies of acquired and developmental disorders. These models do not however provide the resolution necessary to reveal the nature of the functional impairments that characterise specific movement pathologies. In addition, they do not provide a mapping between the structural bases of various pathologies and the associated disorders of movement. Current and prospective approaches to the study and treatment of movement disorders are discussed. It is argued that the appreciation of structure-function relationships, to which these approaches give rise, represents a challenge to current models of interlimb coordination, and a stimulus for their continued development. (C) 2002 Elsevier Science B.V. All rights reserved.

Invisible cities: the table of contents and the labyrinths of reality

In Invisible Cities (1972), Italo Calvino contrasts a rigid outline structure with a flexible textual content. The tension comprised by the numerical structure proposed in the table of contents stands out against the set of polissemic texts which make up the subject matter of the book. The opposition between form and content point to a fruitful dichotomy in the conception of the novel linked to the theories of the open and closed work. This essay will investigate the structural construction of Invisible Cities by looking at its table of contents, seeking to discuss some models of formalistic representation proposed by the criticism and the specific contribution they may, or may not, provide. The objective is to analyse the pertinence of such theories in the light of historical and cultural approaches. Aiming to uncover possible meanings which arise from the debate, this essay will question to what extent structural complexities can be considered literary if they are not ultimately related to the culture in which a text is found.

A dimens��o cr��tica na interpreta����o musical

Disserta����o para obten����o do grau de Mestre em M��sica - Interpreta����o Art��stica

Some reflections on acquisition, processing and analysis of statistical data in forest soils

Beyond the classical statistical approaches (determination of basic statistics, regression analysis, ANOVA, etc.) a new set of applications of different statistical techniques has increasingly gained relevance in the analysis, processing and interpretation of data concerning the characteristics of forest soils. This is possible to be seen in some of the recent publications in the context of Multivariate Statistics. These new methods require additional care that is not always included or refered in some approaches. In the particular case of geostatistical data applications it is necessary, besides to geo-reference all the data acquisition, to collect the samples in regular grids and in sufficient quantity so that the variograms can reflect the spatial distribution of soil properties in a representative manner. In the case of the great majority of Multivariate Statistics techniques (Principal Component Analysis, Correspondence Analysis, Cluster Analysis, etc.) despite the fact they do not require in most cases the assumption of normal distribution, they however need a proper and rigorous strategy for its utilization. In this work, some reflections about these methodologies and, in particular, about the main constraints that often occur during the information collecting process and about the various linking possibilities of these different techniques will be presented. At the end, illustrations of some particular cases of the applications of these statistical methods will also be presented.

Portuguese strategy for occupational safety and health 2008-2012 for public administration : priorites for action, progress in the implementation of the proposed measures and their impact on occupational safety outcomes

Apresenta����o realizada no OH&S Forum 2011 - International Forum on Occupational Health and Safety: Policies, profiles and services, na Finl��ndia de, 20 a 22 Junho de 2011.

Key-elements of family interventions for psychosis : a qualitative research

RESUMO:As perturba����es psic��ticas s��o doen��as mentais complexas sendo influenciadas na sua etiologia e progn��stico por factores biol��gicos e psicossociais. A interfer��ncia do ambiente familiar na evolu����o da doen��a espelha bem esta realidade. Quando em 1962 George Brown e colaboradores descobriram que ambientes familiares com elevada Emo����o Expressa (EE) contribu��am para um aumento significativo do n��mero de reca��das de pessoas com esquizofrenia (Brown et al., 1962), estava aberto o caminho para o desenvolvimento de novas interven����es familiares. A EE inclui cinco componentes: tr��s componentes negativos, i.e. criticismo, hostilidade e envolvimento emocional excessivo; e dois componentes positivos, i.e. afectividade e apre��o (Amaresha & Venkatasubramanian, 2012; Kuipers et al., 2002). No final dos anos 1970 surgiram os primeiros trabalhos na ��rea das interven����es familiares nas psicoses (IFP). Dois grupos em pa��ses diferentes, no Reino Unido e nos Estados Unidos da Am��rica, desenvolveram quase em simult��neo duas abordagens distintas. Em Londres, a equipa liderada por Julian Leff desenhava uma interven����o combinando sess��es unifamiliares em casa, incluindo o paciente, e sess��es em grupo, apenas para os familiares (Leff et al., 1982). Por seu turno, em Pittsburgh, Gerard Hogarty e colaboradores desenvolviam uma abordagem que compreendia a dinamiza����o de sess��es educativas em grupo (Anderson e tal., 1980). Para designar este trabalho, Hogarty e colaboradores propuseram o termo ���psicoeduca����o���. As IFP come��aram a ser conhecidas por esta designa����o que se generalizou at�� aos dias de hoje. Neste contexto a educa����o era vista como a partilha de informa����o acerca da doen��a, dos profissionais para os familiares. Nas sess��es os profissionais eram informados acerca das manifesta����es, etiologia, tratamento e evolu����o das psicoses, bem como de formas para lidar com as situa����es dif��ceis geradas pela doen��a, e.g. risco de reca��da. Os trabalhos pioneiros das IFP foram rapidamente sucedidos pelo desenvolvimento de novos modelos e a prolifera����o de estudos de efic��cia. Para al��m dos modelos de Leff e Hogarty, os modelos IFP que ficaram mais conhecidos foram: (1) a Terapia Familiar-Comportamental, desenvolvida por Ian Falloon e colaboradores (Falloon et al., 1984); e (2) a Terapia Multifamiliar em Grupo, desenvolvida por William McFarlane e colaboradores (McFarlane, 1991). O incremento de estudos de efic��cia contribuiu rapidamente para as primeiras meta-an��lises. Estas, por sua vez, resultaram na inclus��o das IFP nas normas de orienta����o cl��nica mais relevantes para o tratamento das psicoses, nomeadamente da esquizofrenia (e.g. PORT Recomendations e NICE Guidelines). No geral os estudos apontavam para uma diminui����o do risco de reca��da na esquizofrenia na ordem dos 20 a 50% em dois anos (Pitschel-Walz et al., 2001). No final dos anos 1990 as IFP atingiam assim o apogeu. Contudo, a sua aplica����o pr��tica tem ficado aqu��m do esperado e as barreiras �� implementa����o das IFP passaram a ser o foco das aten����es (Gon��alves-Pereira et al., 2006; Leff, 2000). Simultaneamente, alguns autores come��aram a levantar a quest��o da incerteza sobre quais os elementos-chave da interven����o. O conhecimento sobre o processo das IFP era reduzido e come��aram a surgir as primeiras publica����es sobre o assunto (Lam, 1991). Em 1997 foi dinamizada uma reuni��o de consenso entre os tr��s investigadores mais relevantes do momento, Falloon, Leff e McFarlane. Deste encontro promovido pela World Schizophrenia Fellowship for Schizophrenia and Allied Disorders surgiu um documento estabelecendo dois objectivos e quinze princ��pios para as IFP (WFSAD, 1997). N��o obstante os contributos que foram feitos, continua a existir uma grande falta de evid��ncia emp��rica acerca do processo das IFP e dos seus elementos-chave (Cohen et al., 2008; Dixon et al., 2001; Lam, 1991; Leff, 2000; McFarlane et al., 2003). Tamb��m em Portugal, apesar da reflex��o te��rica nesta ��rea e do registo de ensaios de efectividade de grupos para familiares ��� estudo FAPS (Gon��alves-Pereira, 2010), os componentes fundamentais das IFP nunca foram analisados directamente. Assim, o projecto de investiga����o descrito nesta tese teve como objectivo identificar os elementos-chave das IFP com base em investiga����o qualitativa. Para tal, conduzimos tr��s estudos que nos permitiriam alcan��ar dados emp��ricos sobre o tema. O primeiro estudo (descrito no Cap��tulo 2) consistiu na realiza����o de uma revis��o sistem��tica da literatura cient��fica acerca das vari��veis relacionadas com o processo das IFP. A nossa pesquisa esteve focada essencialmente em estudos qualitativos. Contudo, decidimos n��o restringir demasiado os crit��rios de inclus��o tendo em conta as dificuldades em pesquisar sobre investiga����o qualitativa nas bases de dados electr��nicas e tamb��m devido ao facto de ser poss��vel obter informa����o sobre as vari��veis relacionadas com o processo a partir de estudos quantitativos. O m��todo para este estudo foi baseado no PRISMA Statement para revis��es sistem��ticas da literatura. Depois de definirmos os crit��rios de inclus��o e exclus��o, inici��mos v��rias pesquisas nas bases de dados electr��nicas utilizando termos booleanos, trunca����es e marcadores de campo. Pesquis��mos na PubMed/MEDLINE, Web of Science e nas bases de dados inclu��das na EBSCO Host (Academic Search Complete; Education Research Complete; Education Source; ERIC; and PsycINFO). As pesquisas geraram 733 resultados. Depois de serem removidos os duplicados, 663 registos foram analisados e foram seleccionados 38 artigos em texto integral. No final, 22 artigos foram inclu��dos na s��ntese qualitativa tendo sido agrupados em quatro categorias: (1) estudos examinando de forma abrangente o processo; (2) estudos acerca da opini��o dos participantes sobre a interven����o que receberam; (3) estudos comparativos que individualizaram vari��veis sobre o processo; e (4) estudos acerca de vari��veis mediadoras. Os resultados evidenciaram um consider��vel hiato na investiga����o em torno do processo das IFP. Identific��mos apenas um estudo que abordava de forma abrangente o processo das IFP (Bloch, et al., 1995). Este artigo descrevia uma an��lise qualitativa de um estudo experimental de uma IFP. Contudo, as suas conclus��es gerais revelaramse pobres e apenas se podia extrair com certeza de que as IFP devem ser baseadas nas necessidades dos participantes e que os terapeutas devem assumir diferentes pap��is ao longo da interven����o. Da revis��o foi poss��vel perceber que os factores terap��uticos comuns como a alian��a terap��utica, empatia, apre��o e a ���aceita����o incondicional���, podiam ser eles pr��prios um elemento isolado para a efic��cia das IFP. Outros estudos enfatizaram a educa����o como elemento chave da interven����o (e.g. Levy-Frank et al., 2011), ao passo que outros ainda colocavam a ��nfase no treino de estrat��gias para lidar com a doen��a i.e. coping (e.g. Tarrier et al., 1988). Com base nesta diversidade de resultados e tendo em conta algumas propostas pr��vias de peritos (McFarlane, 1991; Liberman & Liberman, 2003), desenvolvemos a hip��tese de concebermos as IFP como um processo por etapas, de acordo com as necessidades dos familiares. No primeiro n��vel estariam as estrat��gias relacionadas com os factores terap��uticos comuns e o suporte emocional,no segundo n��vel a educa����o acerca da doen��a, e num n��vel mais avan��ado, o foco seria o treino de estrat��gias para lidar com a doen��a e diminuir a EE. Neste estudo conclu��mos que nem todas as fam��lias iriam precisar de IFP complexas e que nesses casos seria poss��vel obter resultados favor��veis com IFP pouco intensas. O Estudo 2 (descrito no Cap��tulo 3) consistiu numa an��lise qualitativa dos registos cl��nicos do primeiro ensaio cl��nico da IFP de Leff e colaboradores (Leff et al., 1982). Este ensaio cl��nico culminou numa das evid��ncias mais substanciais alguma vez alcan��ada com uma IFP (Leff et al., 1982; Leff et al., 1985; Pitschel-Walz et al., 2001). Este estudo teve como objectivo modular a EE recorrendo a um modelo misto com que compreendia sess��es familiares em grupo e algumas sess��es unifamiliares em casa, incluindo o paciente. Os resultados mostraram uma diminui����o das reca��das em nove meses de 50% no grupo de controlo para 8% no grupo experimental. Os registos analisados neste estudo datam do per��odo de 1977 a 1982 e podem ser considerados como material hist��rico de alto valor, que surpreendentemente nunca tinha sido analisado. Eram compostos por descri����es pormenorizadas dos terapeutas, incluindo excertos em discurso directo e estavam descritos segundo uma estrutura, contendo tamb��m os coment��rios dos terapeutas. No total os registos representavam 85 sess��es em grupo para familiares durante os cinco anos do ensaio cl��nico e 25 sess��es unifamiliares em casa incluindo o paciente. Para a an��lise qualitativa decidimos utilizar um m��todo de an��lise dedutivo, com uma abordagem mec��nica de codifica����o dos registos em categorias previamente definidas. Tom��mos esta decis��o com base na extens��o apreci��vel dos registos e porque t��nhamos dispon��vel informa����o v��lida acerca das categorias que ir��amos encontrar nos mesmos, nomeadamente a informa����o contida no manual da interven����o, publicado sob a forma de livro, e nos resultados da 140 nossa revis��o sistem��tica da literatura (Estudo 1). Deste modo, foi constru��da uma grelha com a estrutura de codifica����o, que serviu de base para a an��lise, envolvendo 15 categorias. De modo a cumprir com crit��rios de validade e fidelidade rigorosos, opt��mos por executar uma dupla codifica����o independente. Deste modo dois observadores leram e codificaram independentemente os registos. As discrep��ncias na codifica����o foram revistas at�� se obter um consenso. No caso de n��o ser poss��vel chegar a acordo, um terceiro observador, mais experiente nos aspectos t��cnicos das IFP, tomaria a decis��o sobre a codifica����o. A an��lise foi executada com recurso ao programa inform��tico NVivo�� vers��o 10 (QSR International). O n��mero de vezes que cada estrat��gia foi utilizada foi contabilizado, especificando a sess��o e o participante. Os dados foram depois exportados para uma base de dados e analisados recorrendo ao programa inform��tico de an��lise estat��stica SPSS�� vers��o 20 (IBM Corp.). Foram realizadas explora����es estat��sticas para descrever os dados e obter informa����o sobre poss��veis rela����es entre as vari��veis. De modo a perceber a signific��ncia das observa����es, recorremos a testes de hip��teses, utilizando as equa����es de estima����o generalizadas. Os resultados da an��lise revelaram que as estrat��gias terap��uticas mais utilizadas na interven����o em grupo foram: (1) a cria����o de momentos para ouvir as necessidades dos participantes e para a partilha de preocupa����es entre eles ��� representando 21% de todas as estrat��gias utilizadas; (2) treino e aconselhamento acerca de formas para lidar com os aspectos mais dif��ceis da doen��a ��� 15%; (3) criar condi����es para que os participantes recebam suporte emocional ��� 12%; (4) lidar com o envolvimento emocional excessivo 10%; e (5) o reenquadramento das atribui����es dos familiares acerca dos comportamentos dos pacientes ��� 10%. Nas sess��es unifamiliares em casa, as estrat��gias mais utilizadas foram: (1) lidar com o envolvimento emocional excessivo ��� representando 33% de todas as estrat��gias utilizadas nas sess��es unifamiliares em casa; (2) treino e aconselhamento acerca de formas para lidar com os aspectos desafiadores da doen��a ��� 22%; e (3) o reenquadramento das atribui����es dos familiares acerca dos comportamentos dos pacientes, juntamente com o lidar com a zanga, o conflito e a rejei����o ��� ambas com 10%. A an��lise longitudinal mostrou que a cria����o de momentos para ouvir as necessidades dos familiares tende a acontecer invariavelmente ao longo do programa. Sempre que isso acontece, s��o geralmente utilizadas estrat��gias para ajudar os familiares a lidarem melhor com os aspectos dif��ceis da doen��a e estrat��gias para fomentar o suporte emocional. Por sua vez, foi poss��vel perceber que o trabalho para diminuir o envolvimento emocional excessivo pode acontecer logo nas primeiras sess��es. O reenquadramento e o lidar com a zanga/ conflito/ rejei����o tendem a acontecer a partir da fase interm��dia at�� ��s ��ltimas sess��es. A an��lise das diferen��as entre os familiares com baixa EE e os de elevada EE, mostrou que os familiares com elevada EE tendem a tornar-se o foco da interven����o grupal. Por sua vez, os familiares com baixa EE recebem mais estrat��gias relacionadas com alian��a terap��utica, comparativamente com os familiares com elevada EE. S��o de real��ar os dados relativamente ��s estrat��gias educativas. Foi poss��vel observar que estas tendem a acontecer mais no in��cio dos grupos, n��o estando associadas a outras estrat��gias. Contudo �� de notar a sua baixa utiliza����o, a rondar apenas os 5%.O Estudo 3 (descrito no Cap��tulo 4) surgiu como uma forma de completar a an��lise do Estudo 2, permitindo uma vis��o mais narrativa do processo e focando, adicionalmente, as mudan��as que ocorrem nos participantes. Com base nos mesmos registos utilizados no Estudo 2, codific��mos de forma secund��ria os registos em duas categorias i.e. marcadores de mudan��a e marcadores emocionais. Os marcadores de mudan��a foram cotados sempre que um participante exibia comportamentos ou pensamentos diferentes dos anteriores no sentido de uma eventual redu����o na EE. Os marcadores emocionais correspondiam �� express��o intensa de sentimentos por parte dos participantes nas sess��es e que estariam relacionados com assuntos-chave para essas pessoas. Os excertos que continham a informa����o destes marcadores foram posteriormente revistos e articulados com notas e coment��rios n��o estruturados que recolhemos durante a codifica����o do Estudo 2. Com base nesta informa����o os registos foram revistos e, utilizando um m��todo indutivo, elabor��mos uma narrativa acerca da interven����o. Os resultados da narrativa foram discutidos com dados de que disp��nhamos, referentes a reuni��es com os terapeutas envolvidos na interven����o em an��lise (Elizabeth Kuipers, Ruth Berkowitz e Julian Leff; Londres, Novembro de 2011). Reconhecemos que, pela sua natureza n��o estruturada e indutiva, a avalia����o narrativa est�� mais sujeita ao vi��s de observador. N��o obstante, os resultados deste Estudo 3 parecem revestir uma consist��ncia elevada. O mais relevante foi a evid��ncia de que na interven����o em an��lise ocorreram mudan��as emocionais significativas nos familiares ao longo das sess��es em grupo. Numa fase inicial os familiares tenderam a expressar sentimentos de zanga. Seguidamente, os terapeutas iam nterrompendo o discurso de reminisc��ncias, direccionavam o discurso para as suas preocupa����es actuais e os familiares pareciam ficar mais calmos. Contudo, �� medida que os 143 participantes ���mergulhavam��� nos problemas com que se confrontavam na altura, os sentimentos de zanga davam lugar a sentimentos de perda e ang��stia. Nessa altura os terapeutas enfatizavam o suporte emocional e introduziam progressivamente t��cnicas de reenquadramento para ajudar os participantes a avaliar de forma mais positiva as situa����es. Este trabalho dava lugar a sentimentos mais positivos, como a aceita����o, apre��o e a sensa����o de controlo. O Estudo 3 evidenciou tamb��m o que designamos como o ���Efeito de Passagem de Testemunho���. Este efeito aconteceu sempre que um membro novo se juntava ao grupo. Os membros antigos, que estavam a ser o alvo das aten����es e naturalmente a receber mais interven����o, mudam de papel e passam eles pr��prios a focar as suas aten����es nos membros mais recentes do grupo, contribuindo para a din��mica do grupo com as mesmas interven����es que os ajudaram previamente. Por exemplo, alguns membros antigos que eram altamente cr��ticos nos grupos em rela����o aos seus familiares passavam a fazer coment��rios de reenquadramento dirigidos para os novos membros. Por fim, o Cap��tulo 5 resume as conclus��es gerais deste projecto de investiga����o. Os estudos apresentados permitiram um incremento no conhecimento acerca do processo das IFP. Anteriormente esta informa����o era baseada sobretudo na opini��o de peritos. Com este projecto aument��mos o n��vel de evid��ncia ao apresentar estudos com base em dados emp��ricos. A an��lise qualitativa do Estudo 2 permitiu pela primeira vez, tanto quanto �� do nosso conhecimento, perceber de forma aprofundada o processo subjacente a uma IFP (no contexto de um ensaio cl��nico que se revelou como um dos mais eficazes de sempre). Identific��mos as estrat��gias mais utilizadas, as rela����es entre elas e a sua diferente aplica����o entre familiares com baixa EE e familiares com alta EE.O Estudo 3 completou a informa����o incluindo aspectos relacionados com as mudan��as individuais durante o programa. No final foi poss��vel perceber que as IFP devem ser um programa por etapas. Nos Estudo 2 e 3, evidenci��mos que numa fase inicial, os terapeutas dedicaram especial aten����o para que os familiares tivessem espa��o para partilharem as suas necessidades, disponibilizando logo de seguida estrat��gias para promover o suporte emocional e estrat��gias de coping. Num n��vel subsequente do programa, o trabalho terap��utico avan��ou para estrat��gias mais direccionadas para regular a EE, mantendo sempre as estrat��gias iniciais ao longo das sess��es. Assim apesar de a educa����o ter sido um componente importante na IFP em an��lise, houve outras estrat��gias mais relevantes no processo. A evid��ncia gerada pelos Estudos 2 e 3 baseou-se em registos hist��ricos de elevado valor, sendo que os constructos subjacentes na ��poca, nomeadamente a EE, continuam a ser a base da investiga����o e pr��tica das IFP a n��vel mundial em diferentes culturas (Butzlaff & Hooley, 1998). Conclu��mos que as IFP s��o um processo complexo com diferentes n��veis de interven����o, podendo gerar mudan��as emocionais nos participantes durante as sess��es. No futuro ser�� importante replicar o nosso trabalho (nomeadamente o Estudo 2) com outras abordagens de IFP, de modo a obter informa����o acerca do seu processo. Esse conhecimento ser�� fundamental para uma poss��vel evolu����o do paradigma das IFP. ----------- ABSTRACT: Background: Psychotic-spectrum disorders are complex biopsychosocial conditions and family issues are important determinants of prognosis. The discovery of the influence of expressed emotion on the course of schizophrenia paved the road to the development of family interventions aiming to lower the ���emotional temperature��� in the family. These treatment approaches became widely recognised. Effectiveness studies showed remarkable and strong results in relapse prevention and these interventions were generalised to other psychotic disorders besides schizophrenia. Family interventions for psychosis (FIP) prospered and were included in the most important treatment guidelines. However, there was little knowledge about the process of FIP. Different FIP approaches all led to similar outcomes. This intriguing fact caught the attention of authors and attempts were made to identify the key-elements of FIP. Notwithstanding, these efforts were mainly based on experts��� opinions and the conclusions were scanty. Therefore, the knowledge about the process of FIP remains unclear. Aims: To find out which are the key-elements of FIP based on empirical data. Methods: Qualitative research. Three studies were conducted to explore the process of FIP and isolate variables that allowed the identification of the key-elements of FIP. Study 1 consisted of a systematic literature review of studies evaluating process-related variables of FIP. Study 2 subjected the intervention records of a formerly conducted effective clinical trial of FIP to a qualitative analysis. Records were analysed into categories and the emerging data were explored using descriptive statistics and generalised estimating equations. Study 3 consisted of a narrative evaluation using an inductive qualitative approach, examining the same data of Study 2. Emotional markers and markers of change were identified in the records and the content of these excerpts was synthesised and discussed. Results: On Study 1, searches revealed 733 results and 22 papers were included in the qualitative synthesis. We found a single study comprehensively exploring the process of FIP. All other studies focused on particular aspects of the process-related variables. The key-elements of FIP seemed to be the so-called ���common therapeutic factors���, followed by education about the illness and coping skills training. Other elements were also identified, as the majority of studies evidenced a multiple array of components. Study 2,revealed as the most used strategies in the intervention programme we analysed: the addressing of needs; sharing; coping skills and advice; emotional support; dealing with overinvolvement; and reframing relatives��� views about patients��� behaviours. Patterns of the usefulness of the strategies throughout the intervention programme were identified and differences between high expressed emotion and low expressed emotion relatives were elucidated. Study 3 accumulated evidence that relatives experience different emotions during group sessions, ranging from anger to grief, and later on, to acceptance and positive feelings. Discussion: Study 1 suggested a stepped model of intervention according to the needs of the families. It also revealed a gap in qualitative research of FIP. Study 2 demonstrated that therapists of the trial under analysis often created opportunities for relatives to express and share their concerns throughout the entire treatment programme. The use of this strategy was immediately followed by coping skills enhancement, advice and emotional support. Strategies aiming to deal with overinvolvement may also occur early in the treatment programme. Reframing was the next most used strategy, followed by dealing with anger, conflict and rejection. This middle and later work seems to operate in lowering criticism and hostility, while the former seems to diminish overinvolvement. Single-family sessions may be used to augment the work developed in the relatives groups. Study 3 revealed a missing part of Study 2. It demonstrated that the process of FIP promotes emotional changes in the relatives and therapists must be sensitive to the emotional pathway of each participant in the group.