Continuity of care for people with psychotic illness: its relationship to clinical and social functioning.

Background: The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. Aims: To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning. Methods: The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables. Results: Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms. Conclusion: Continuity is a dynamic process, influenced significantly by care structures and organizational change.

Continuity of care for carers of people with severe mental illness: results of a longitudinal study

Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being. Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving. Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer’s assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer’s assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user’s immediate family, lived with them and had had a carer’s assessment. Conclusion: The vast majority of the carers had not had a carer’s assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers’ reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.

Designing a questionnaire to gather carer input to pain assessment for hospitalized people with dementia

We describe development of a questionnaire to elicit pain symptoms and experience, for use by people with dementia or their carers, at hospital admission. The questionnaire provided contextual information to support professionals’ use of the Abbey Pain Scale, a validated tool used by nursing staff internationally. Appropriate information and physical design were required in order, not only to create an approachable questionnaire for patients and carers, but also to ensure fit with hospital processes. Fit with hospital process had significant influence on the final form of the questionnaire, compromising some aspects of design for patients and carers, but this compromise was considered essential to ensure pain management procedures were supplemented by wider, contextual information.

Mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder and with anxiety disorders

Objective. To compare mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder (OCD), anxiety disorders, and no known mental health problems. Method. Parents of young people with OCD (N=28), other anxiety disorders (N=28), and no known mental health problems (N=62) completed the Brief Symptom Inventory (Derogatis, 1993), the Coping Responses Inventory (Moos, 1990), and the McMaster family assessment device (Epstein, Baldwin, & Bishop, 1983). Results. Parents of children with OCD and anxiety disorders had poorer mental health and used more avoidant coping than parents of non-clinical children. There were no group differences in family-functioning. Conclusion. The similarities across the parents of clinically referred children suggest that there is a case for encouraging active parental involvement in the treatment of OCD in young people.

Cognitive appraisals in young people with obsessive-compulsive disorder

Background: A number of cognitive appraisals have been identified as important in the manifestation of obsessive-compulsive disorder (OCD) in adults. There have, however, been few attempts to explore these cognitive appraisals in clinical groups of young people. Method: This study compared young people aged between 11 and 18 years with OCD (N ¼ 28), young people with other types of anxiety disorders (N ¼ 28) and a non-clinical group (N ¼ 62) on three questionnaire measures of cognitive appraisals. These were inflated responsibility (Responsibility Attitude Scale; Salkovskis et al., 2000), thought–action fusion – likelihood other (Thought–Action Fusion Scale; Shafran, Thordarson & Rachman, 1996) and perfectionism (Multidimensional Perfectionism Scale; Frost, Marten, Luhart & Rosenblate, 1990). Results: The young people with OCD had significantly higher scores on inflated responsibility, thought–action fusion – (likelihood other), and one aspect of perfectionism, concern over mistakes, than the other groups. In addition, inflated responsibility independently predicted OCD symptom severity. Conclusions: The results generally support a downward extension of the cognitive appraisals held by adults with OCD to young people with the disorder. Some of the results, however, raise issues about potential developmental shifts in cognitive appraisals. The findings are discussed in relation to implications for the cognitive model of OCD and cognitive behavioural therapy for young people with OCD. Keywords: Cognitive models, inflated responsibility, obsessive-compulsive disorder, perfectionism, thought–action fusion. Abbreviations: ADIS-C: Anxiety Disorders Interview Schedule for Children; ADIS-P: Anxiety Disorders Interview Schedule for Parents; E/RP: Exposure/Response Prevention; LOI-CV: Leyton Obsessional Inventory – Child Version; MPS: Multidimensional Perfectionism Scale; OCD: Obsessive-Compulsive Disorder; RAS: Responsibility Attitude Scale; TAF-LO: Thought–Action Fusion – (Likelihood Other).

Marketing the Damaged Self: The Construction of Identity in Advertisements Directed Towards People with HIV/AIDS

This paper explores the identities projected in advertisements directed towards HIV positive individuals and people with AIDS. Fifty such advertisements were collected from three popular American magazines for gay men over a period of seven months. Analysis of the ads reveals a paradoxical presentation of people with HIV/AIDS, which offers simultaneous conflicting images of hope and fear, power and weakness, innocence and guilt. An interactive sociolinguistic model through which this contradictory discourse might be understood is presented, drawing on Goffman’s insights on stigma management and the presentation of the self in social interaction. Advertisements directed towards people with HIV/AIDS, it is suggested, present a contradictory discourse in which the advertisers are positioned as ‘the wise’, offering to mediate the conflicting identities of the stigmatized. The identity values enacted in this contradictory discourse are further measured against American conceptions of communication and the self as observed by Carbaugh and others. The possible consequences of these positionings on the roles made available to people with HIV/AIDS in the wider social context are discussed.

Could in-home sensors surpass human observation of people with Parkinson’s at high risk of falling? An ethnographic study

Self-report underpins our understanding of falls among people with Parkinson’s (PwP) as they largely happen unwitnessed at home. In this qualitative study, we used an ethnographic approach to investigate which in-home sensors, in which locations, could gather useful data about fall risk. Over six weeks, we observed five independently mobile PwP at high risk of falling, at home. We made field notes about falls (prior events and concerns) and recorded movement with video, Kinect, and wearable sensors. The three women and two men (aged 71 to 79 years) having moderate or severe Parkinson’s were dependent on others and highly sedentary. We most commonly noted balance protection, loss, and restoration during chair transfers, walks across open spaces and through gaps, turns, steps up and down, and tasks in standing (all evident walking between chair and stairs, e.g.). Our unobtrusive sensors were acceptable to participants: they could detect instability during everyday activity at home and potentially guide intervention. Monitoring the route between chair and stairs is likely to give information without invading the privacy of people at high risk of falling, with very limited mobility, who spend most of the day in their sitting rooms.

October 2002: Righting Writing; Web Sites Offer Help in Combating Digital Plagiarism

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Comunidades mediadas pela Internet : uma pesquisa multimétodos para estruturação de base conceitual e projeto de web sites

O objeto de estudo da presente pesquisa são as comunidades mediadas pela Internet (CMIs). Uma CMI consiste de um conjunto de pessoas que compartilham interesses e que, durante algum tempo, utilizam recursos em comum na Internet (por exemplo, um web site – objeto preferencial deste trabalho) para trocarem informações umas com as outras relativamente aos interesses compartilhados. A pesquisa realizada é exploratória e qualitativa, tendo feito uso de estudos de caso, pesquisa-ação e entrevistas em profundidade para estruturar uma base conceitual para as CMIs e reunir elementos relevantes a serem considerados quando da construção de web sites para as mesmas. Realizou-se estudo de caso de 5 (cinco) web sites de CMIs, a fim de serem identificadas as principais tecnologias e métodos em uso atualmente para a estruturação de web sites para CMIs. Na pesquisa-ação, 7 (sete) grupos de pessoas foram identificados e, para cada um, construiu-se 1 (um) web site, de modo que se ofereceu um espaço na Internet para a interação dos seus integrantes. A observação da interação das pessoas através dos web sites permitiu concluir-se que, dos sete grupos iniciais, apenas 1 (um) poderia ser caracterizado como CMI, conforme critérios de Jones (1997): associação sustentável, variedade de comunicadores, espaço virtual para a comunicação em grupo, e interatividade. Para as entrevistas em profundidade, elaborou-se um questionário com base no referencial teórico, nos estudos de caso e na pesquisa-ação, sendo aplicado a 17 (dezessete) pessoas (da única CMI e de dois dos sete grupos). O objetivo das entrevistas foi levantarem-se percepções sobre os web sites utilizados pelos grupos, percepções essas que, sob análise de conteúdo, ajudaram na formação de um conjunto de 12 (doze) recomendações para a construção de web sites para CMIs. As recomendações são de natureza diversa, mas deixam clara a necessidade de haver um entendimento profundo do contexto de uma CMI previamente ao projeto do seu web site.

A interatividade como medida de eficiência : um estudo sobre efeitos cognitivos resultantes da interação com web sites e suas implicações para o marketing da web

A pesquisa realizada avalia a relação entre o projeto de um Web Site1 comercial e o Flow, e a influência desse estado cognitivo sobre a comunicação de marketing do Site. É desenvolvida a partir de três perspectivas: perspectiva tecnológica do meio, mercadológica da organização e psicológica do usuário. O enfoque da pesquisa está voltado para a perspectiva humana, onde sugere que o Flow, um estado cognitivo decorrente de um processo de interação, traz reflexos positivos às comunicações de marketing de Web Sites comerciais. As três hipóteses levantadas para responder a questão de pesquisa são: H1: As características do design gráfico e arquitetura do Web Site influenciam no nível da experimentação do Flow. H2: O usuário que experimenta o Flow interage com mais profundidade com o ambiente mediado, visitando mais páginas e permanecendo mais tempo no Web Site e, por conseqüência, ficando mais exposto as comunicações emanadas pelo Site. H3: A experimentação do Flow aumenta a probabilidade do usuário avaliar positivamente o Site, aumenta a sua predisposição em retornar ao Site ou recomendá-lo a terceiros. A pesquisa empregou um método quase experimental, utilizando como instrumento um site experimental e para os testes e análises um grupo de teste e um grupo de controle. Os resultados obtidos concluem que, primeiro, as características do design e da 1 Os termos em língua inglesa apresentados ao longo deste trabalho encontram-se no glossário. VIII arquitetura do Web Site estimulam a experimentação do Flow. Segundo, o indivíduo que experimenta o fenômeno detém-se por mais tempo no Site. E terceiro, o usuário que experimenta o Flow tende a uma atitude positiva em relação ao Site.

O valor para o consumidor virtual : análise da utilização da internet por meio de web sites de empresas

A rápida expansão da Internet vem trazendo conseqüências substanciais para a sociedade, na forma como as pessoas se relacionam, estudam, trabalham, adquirem e consomem produtos e serviços. Para as empresas é inquestionável a importância da adequação deste novo meio aos seus compostos de marketing, principalmente no sentido de estabelecer um canal de comunicação que possa conectá-las ainda mais aos seus clientes. Porém, para que esta aproximação ocorra, é necessário que sejam conhecidos os desejos e valores que norteiam e influenciam o processo de compra do consumidor online. Esta dissertação busca, justamente, uma aproximação entre estas duas questões: por um lado, as iniciativas de marketing das empresas, por meio de seus Web sites; por outro, os valores que influenciam o comportamento dos consumidores virtuais. O objetivo consiste em comparar as ações de marketing realizadas pelas empresas, por meio de seus Web sites, com o valor para o cliente manifestado pelos consumidores. Para atingir tal objetivo, optou-se por um estudo com múltiplas fontes de coletas de dados e triangulação de dados na análise. Primeiramente, foram realizadas entrevistas pessoais, individuais e em profundidade com 05 (cinco) consumidores de Internet, visando identificar os valores subjetivos relacionados ao consumo no ambiente online. Nesta fase da pesquisa foi utilizado o Modelo de Valor para o Cliente de Woodruff e Gardial (1996). Em seguida, foram analisados Web sites de empresas, a fim de detectar a coerência existente entre os pontos considerados de valor pelos consumidores e as estratégias e ações efetivamente implementadas pelas empresas. Optou-se pela utilização do modelo de Ho (1997), cujo trabalho propõe um método de avaliação de Web sites a partir da perspectiva de valor criado para o consumidor. Os resultados demonstraram que, apesar do crescimento da Internet, alguns desses valores ainda estão latentes, com pouca ou nenhuma iniciativa das empresas no sentido de supri-los.

O Papel dos profissionais de gestão de pessoas no processo de inclusão de pessoas com deficiência no mercado de trabalho na cidade de São Luis - MA

A inclusão de pessoas com deficiência é um desafio, não só, para as organizações, quanto também, para as pessoas com deficiência que desejam um trabalho onde possam ter seus direitos respeitados e resguardados. Nesse processo o profissional de Gestão de Pessoas tem um papel que é o de tornar o ambiente acessível a todos, mapear os cargos e postos de trabalho, sensibilizar as pessoas da empresa, capacitar os gestores para a minimização do impacto da integração ao ambientes de trabalho e domínio das ferramentas de contratação dos profissionais com deficiência, validação do programa de inclusão, e de capacitação de profissionais com deficiência. Este trabalho objetiva pesquisar se os profissionais de Gestão de Pessoas estão aptos para o desafio de implantar e desenvolver as políticas internas de inclusão das pessoas com deficiência, nas empresas em que atuam. Para tanto, foi feito uma pesquisa juntos aos profissionais responsáveis pelos programas de inclusão, em empresas com mais de 1.000 funcionários no município de São Luís – MA, para avaliar as práticas adotadas pelas organizações.

Acessibilidade no ambiente escolar: reflexões com base no estudo de duas escolas municipais de Natal-RN

This work was originated through the results of the analysis of the services for the needs of people with disabilities that were permitted by the physical space of two schools of the municipality of Natal/RN. The general objective/goal was to subsidize the elaboration of alternatives for the planning of environments that could be used by any person. The study used the empirical research through the adoption of a multimethod approach including: (i) technical visits oriented by the NBR 9050, (ii) contact with users that have reduced mobility (visually impaired and wheelchair or crutch users) through escorted travels and interviews, and (iii) interview with school managers. The evidence from the research, even though with significant development of laws that guarantee people with disabilities their right to citizenship, the physical environment of our schools still present with many obstacles that prevent the mobility of people with disabilities which proves their lack of readiness to accommodate them. Therefore, the actions taken to address the accessibility has been the adoption of temporary solutions that makes the adaptation more difficult, adds obstacles and reinforces the undesirable segregation, however still very present in our society. Finally, there is the indication that in order to achieve the spatial configuration that promotes social contact and integration in between the persons with different physical status, it is necessary to completely comprehend the activities developed in each space, from the conception of the equipment to the individual learning needs, having in mind creating environments that stimulates the execution of the tasks in an independent manner without the assistance of others. The inclusion regarding attention to accessibility in the decision making process, directed to the arquitectural and urban project, would decrease the constant need to redevelop and adapt spaces, and should be definitely incorporated as an important component in the production of space

Inclusão da criança com deficiência na estratégia de saúde da família

The objective of analyze the shift of the working process of the ESF team in care of children with disabilities, from awareness-raising actions. It is a qualitative study, with the action-research method. Thirteen health professionals were involved from two teams of ESF unit area of the Unidade de Saúde da Família Dr. Chico Porto (UBSFCP) in Mossoró, from March to August 2011. Data were analyzed following the direction of freirean s thematic analysis. In the situational diagnosis of the current reality of CwD assistance in that UBSFCP, through participant observation and application of semi-structured interviews with professionals, we realize that despite these actions carry some assistance to the CwD, in practice few are used for inclusion and accessibility. The monitoring of the CwD is done through individual consultations by each team professional, home visits when possible, both ruled on the complaints and problems, with little solving in the used actions. Since the need for a change in the treatment model and training requirements as pointed out by professionals in the interview, then we decided to build the proposed of training suggested by the multidisciplinary team and put together collectively the achievement of this moment in all its phases. In the step of implementation (action), aspects related to the current situation in Brazil and Mossoró (Laws, policies and health care) for the CwD and CwD Assistance and their family in the ESF in the first two moments of the first training (action) were contemplate. On the second day we discussed the specialized care to CwD, contribution of the Handicapped Parents and Friends Association of Mossoró and in a second moment a workshop was held in which awareness for inclusion of CwD and actions of ESF were discussed. All these moments were discussed and collectively constructed. In the evaluation, we found that implementation (action) allowed to the professional the comprehension of new understandings about people with disabilities, on ways to include, guiding, caring, watching, and mainly to have a new vision on health assistance of the CwD, expanding assistance beyond clinical aspects and recognizing the educational aspects of the rights and duties of citizens and the inclusion of these children in the social spaces area. As difficulties, we face the need for some professionals to be absent to attend another job, solve personal problems, and little or no participation. Thus, during this action-research, the subjects were able to realize the importance of carrying out their practice to the quality of life for him and to the one they care