Adesão ao tratamento anti-retroviral por cuidadores de crianças e adolescentes soropositivos de uma Unidade de Saúde do Estado do Pará

O tema da adesão ao tratamento tem recebido muita atenção dentro da Psicologia da Saúde nos últimos anos. Estudos nessa área revelam que os pacientes que não aderem ao tratamento podem não se beneficiar dos ganhos trazidos pela intervenção terapêutica. A literatura sobre adesão ao tratamento anti-retroviral revela que é o cuidador que geralmente assume a responsabilidade pelo gerenciamento do tratamento de crianças e adolescentes soropositivos. O objetivo principal do presente estudo foi descrever o padrão de adesão ao tratamento de cuidadores de crianças e adolescentes soropositivos que vivem no Estado do Pará, identificando as variáveis que interferem na adesão. Buscou-se, ainda, revelar os tipos de estratégias de enfrentamento utilizadas para lidar com as condições adversas trazidas pela soropositividade. Para tanto, realizou-se um estudo descritivo, de corte transversal, com 30 cuidadores, matriculados na Unidade de Referência Materno-Infantil e Adolescente do Estado do Pará (UREMIA), utilizando como instrumentos de coleta de dados, junto aos cuidadores, um roteiro de entrevista que investigava aspectos sociodemográficos, clínicos e psicossociais das crianças e adolescentes e a Escala Modos de Enfrentamento de Problemas (EMEP). Em relação à adesão pelos cuidadores, observou-se que algumas condições facilitaram o seguimento do tratamento. Essas condições estiveram relacionadas a variáveis de organização familiar (como o número de pessoas que moravam na residência), à história de interrupção do tratamento e ao auto-relato dos cuidadores sobre o padrão de desempenho a ser emitido mediante o sucesso (ou insucesso) da adesão. A influência dessas variáveis demonstrou a influência do controle do comportamento mediante regras, pois os cuidadores emitiram o desempenho classificado como adesão para evitar entrar em contato com as conseqüências aversivas do não seguimento do tratamento. Em relação às estratégias de enfrentamento, foi demonstrada maior média para o Fator 3, demonstrando a ênfase no uso de estratégias focalizadas em práticas religiosas e/ou pensamentos fantasiosos. Este trabalho propôs que os cuidadores da amostra lidaram com o problema da soropositividade de maneira a esquivar-se de pensar no problema do modo como ele realmente se constituiu diante dos mesmos, utilizando pensamentos religiosos ou mágicos para continuar lidando com a rotina diária de enfrentamento das questões que envolviam a condição de soropositividade da criança e/ou do adolescente. A partir dos dados encontrados, indica-se a realização de estudos que investiguem questões relacionadas ao papel exercido por contingências sociais sobre o comportamento dos cuidadores de crianças e adolescentes que vivem no Pará, bem como a investigação sobre aspectos relacionados à revelação do diagnóstico.

Quando é da família, é melhor!: família e casamento entre cearenses em Santarém-Pará

A presença de migrantes na Região Amazônica constitui fato histórico que atenta a pensar fixação e interação com os demais grupos existentes. Pensando a migração como um processo histórico e social, nestas análises, busco entender os elementos que compõem a identidade dos cearenses na cidade de Santarém - Pará, à medida que, quando empreendem em seus discursos e práticas sua diferenciação com os paraenses a partir das relações de família e casamento. Assim, torna-se necessário categorizar a naturalidade e pensar as práticas de casamento como homogâmicas, mapear as estratégias utilizadas no intuito de estabelecer uniões preferenciais. O confronto e interação entre gerações ajuda perceber como ocorre o processo educativo na busca da permanência dos valores do grupo e na continuidade da compreensão e do sentido de família.

Influência da tecnologia educacional na avaliação do conhecimento de portadores de hepatite C crônica sobre sua doença e aderência ao tratamento antiviral

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

O desenvolvimento sustentável e o controle social da natureza e do trabalho: um estudo a partir da Fábrica de Preservativos Masculinos de Xapuri (AC)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The independence of adaptations: the metanarrativity and metafictionality of Ian McEwan´s Atonement adapted for the cinema

Conceiving of cinematographic adaptations as being independent of their source material has come to be the standard approach for most specialists in this area. The stress on fidelity has made way for many other approaches, such as those focused on intertextuality, on the dilemma of form v. content, or on questions of genre and gender. The objective of this article is to present an overview of the principal theories which have been developed in the area as from 2000 in order to support this notion of independence, which will be exemplified by an exposition of the strategies used to adapt the metafictional and metanarrative elements in Atonement (2001) for the cinema.

Demanda energética na sessão de exercício resistido com características de hipertrofia e resistência muscular localizada

Pós-graduação em Ciências da Motricidade - IBRC

A relação entre hospital e usuários na ótica da comunicação

This article evaluates the influence of culture and elements from organizational bonds in the perception of communicative process between a public teaching hospital and its users, and the strategies used to overcome difficulties in this dialogue. It was possible to evaluate how the dialogue is perceived in a scenario marked by organizational bonds such as identification, belonging feeling, idealization of the organization and solidarity.

Mulheres fazem isso? Análise das estratégias de gestão do rúgbi feminino no Brasil

This paper presents the integrated sports marketing to female rugby management in Brazil and analyzes the strategies used to popularize this sport. The Brazilian Confederation of Rugby in 2011 developed a strategic planning with the objective of restructuring mode and has been using sports marketing concepts to promote rugby, aiming its growth, both in numbers of practitioners, as supporters and fans. To perform the proposed objective was conducted a survey exploratory on the rugby modality that will be present at the Olympic Games in 2016. We analyze also the history of women's Rugby Team and the tools of marketing and sportive management used by the Confederation. At the end is a study of the strategies of sports management female rugby in Brazil, taking into consideration also the gender issue, especially the obstacles women face athletes in a sport that is blended with the virility and strength male.

Semantic Equivalence of the Brazilian Portuguese version of the "Body Change Inventory"

With the increase in research on the components of Body Image, validated instruments are needed to evaluate its dimensions. The Body Change Inventory (BCI) assesses strategies used to alter body size among adolescents. The scope of this study was to describe the translation and evaluation for semantic equivalence of the BCI in the Portuguese language. The process involved the steps of (1) translation of the questionnaire to the Portuguese language; (2) back-translation to English; (3) evaluation of semantic equivalence; and (4) assessment of comprehension by professional experts and the target population. The six subscales of the instrument were translated into the Portuguese language. Language adaptations were made to render the instrument suitable for the Brazilian reality. The questions were interpreted as easily understandable by both experts and young people. The Body Change Inventory has been translated and adapted into Portuguese. Evaluation of the operational, measurement and functional equivalence are still needed.

Keeping your balance while balancing a cylinder: interaction between postural and voluntary goals

The present study investigated whether postural responses are influenced by the stability constraint of a voluntary, manual task. We also examined how task constraint and first experience (the condition with which the participants started the experiment) influence the kinematic strategies used to simultaneously accomplish a postural response and a voluntary task. Twelve healthy, older adults were perturbed during standing, while holding a tray with a cylinder placed with the flat side down (low constraint, LC) or with the rolling, round side down (high constraint, HC). Central set changed according to the task constraint, as shown by a higher magnitude of both the gastrocnemius and tibialis anterior muscle activation bursts in the HC than in the LC condition. This increase in muscle activation was not reflected, however, in changes in the center of pressure or center of mass displacement. Task constraint influenced the peak shoulder flexion for the voluntary tray task but not the peak hip flexion for the postural task. In contrast, first experience influenced the peak hip flexion but not the peak shoulder flexion. These results suggest an interaction between two separate control mechanisms for automatic postural responses and voluntary stabilization tasks.

La influencia de la estética oriental en la autotraducción: análisis de la novela bicultural The Good Earth de la autora P.S. Buck

[EN]This dissertation analyses the Eastern cultural influences present in the aesthetic of Buck’s best seller The Good Earth. The objective is to study the characteristics of Buck’s aesthetic as a product of a creative process of self-translation between Mandarin and English. The methodology of analysis has focused on the characters of the novel, the strategies used to refer to them, the characters’ idiolect and their social interaction (facework). Finally, these cultural aspects have been compared with one of the Spanish translations available of the novel. The results obtained show a novel highly influenced by the Eastern tradition, where the idiolect of the characters show an influence from both East and West possible thanks to the mechanism of self-translation.

Rehabilitation Engineering in Parkinson's disease

Impairment of postural control is a common consequence of Parkinson's disease (PD) that becomes more and more critical with the progression of the disease, in spite of the available medications. Postural instability is one of the most disabling features of PD and induces difficulties with postural transitions, initiation of movements, gait disorders, inability to live independently at home, and is the major cause of falls. Falls are frequent (with over 38% falling each year) and may induce adverse consequences like soft tissue injuries, hip fractures, and immobility due to fear of falling. As the disease progresses, both postural instability and fear of falling worsen, which leads patients with PD to become increasingly immobilized. The main aims of this dissertation are to: 1) detect and assess, in a quantitative way, impairments of postural control in PD subjects, investigate the central mechanisms that control such motor performance, and how these mechanism are affected by levodopa; 2) develop and validate a protocol, using wearable inertial sensors, to measure postural sway and postural transitions prior to step initiation; 3) find quantitative measures sensitive to impairments of postural control in early stages of PD and quantitative biomarkers of disease progression; and 4) test the feasibility and effects of a recently-developed audio-biofeedback system in maintaining balance in subjects with PD. In the first set of studies, we showed how PD reduces functional limits of stability as well as the magnitude and velocity of postural preparation during voluntary, forward and backward leaning while standing. Levodopa improves the limits of stability but not the postural strategies used to achieve the leaning. Further, we found a strong relationship between backward voluntary limits of stability and size of automatic postural response to backward perturbations in control subjects and in PD subjects ON medication. Such relation might suggest that the central nervous system presets postural response parameters based on perceived maximum limits and this presetting is absent in PD patients OFF medication but restored with levodopa replacement. Furthermore, we investigated how the size of preparatory postural adjustments (APAs) prior to step initiation depend on initial stance width. We found that patients with PD did not scale up the size of their APA with stance width as much as control subjects so they had much more difficulty initiating a step from a wide stance than from a narrow stance. This results supports the hypothesis that subjects with PD maintain a narrow stance as a compensation for their inability to sufficiently increase the size of their lateral APA to allow speedy step initiation in wide stance. In the second set of studies, we demonstrated that it is possible to use wearable accelerometers to quantify postural performance during quiet stance and step initiation balance tasks in healthy subjects. We used a model to predict center of pressure displacements associated with accelerations at the upper and lower back and thigh. This approach allows the measurement of balance control without the use of a force platform outside the laboratory environment. We used wearable accelerometers on a population of early, untreated PD patients, and found that postural control in stance and postural preparation prior to a step are impaired early in the disease when the typical balance and gait intiation symptoms are not yet clearly manifested. These novel results suggest that technological measures of postural control can be more sensitive than clinical measures. Furthermore, we assessed spontaneous sway and step initiation longitudinally across 1 year in patients with early, untreated PD. We found that changes in trunk sway, and especially movement smoothness, measured as Jerk, could be used as an objective measure of PD and its progression. In the third set of studies, we studied the feasibility of adapting an existing audio-biofeedback device to improve balance control in patients with PD. Preliminary results showed that PD subjects found the system easy-to-use and helpful, and they were able to correctly follow the audio information when available. Audiobiofeedback improved the properties of trunk sway during quiet stance. Our results have many implications for i) the understanding the central mechanisms that control postural motor performance, and how these mechanisms are affected by levodopa; ii) the design of innovative protocols for measuring and remote monitoring of motor performance in the elderly or subjects with PD; and iii) the development of technologies for improving balance, mobility, and consequently quality of life in patients with balance disorders, such as PD patients with augmented biofeedback paradigms.

Motor control system in Parkinson’s disease: a modeling approach

Parkinson’s disease is a neurodegenerative disorder due to the death of the dopaminergic neurons of the substantia nigra of the basal ganglia. The process that leads to these neural alterations is still unknown. Parkinson’s disease affects most of all the motor sphere, with a wide array of impairment such as bradykinesia, akinesia, tremor, postural instability and singular phenomena such as freezing of gait. Moreover, in the last few years the fact that the degeneration in the basal ganglia circuitry induces not only motor but also cognitive alterations, not necessarily implicating dementia, and that dopamine loss induces also further implications due to dopamine-driven synaptic plasticity got more attention. At the present moment, no neuroprotective treatment is available, and even if dopamine-replacement therapies as well as electrical deep brain stimulation are able to improve the life conditions of the patients, they often present side effects on the long term, and cannot recover the neural loss, which instead continues to advance. In the present thesis both motor and cognitive aspects of Parkinson’s disease and basal ganglia circuitry were investigated, at first focusing on Parkinson’s disease sensory and balance issues by means of a new instrumented method based on inertial sensor to provide further information about postural control and postural strategies used to attain balance, then applying this newly developed approach to assess balance control in mild and severe patients, both ON and OFF levodopa replacement. Given the inability of levodopa to recover balance issues and the new physiological findings than underline the importance in Parkinson’s disease of non-dopaminergic neurotransmitters, it was therefore developed an original computational model focusing on acetylcholine, the most promising neurotransmitter according to physiology, and its role in synaptic plasticity. The rationale of this thesis is that a multidisciplinary approach could gain insight into Parkinson’s disease features still unresolved.

The unspoken disease: symptom experience in women with vulval neoplasia and surgical treatment: a qualitative study

Women with vulval neoplasia often experience severe post-surgical complications. This study focuses on symptom experience of women during the first 6 months following surgical treatment for vulval neoplasia considering their socio-cultural context. In this qualitative study using a critical hermeneutic approach, narrative interviews were conducted. A purposeful sample of 20 patients was recruited from one Swiss and two German university hospitals. Content analysis was employed to analyse the transcribed interviews considering women's experiences and social perceptions. Narratives showed eight interrelated themes: delayed diagnosis, disclosed disease, disturbed self-image, changed vulva care, experienced wound-related symptoms, evoked emotions, affected interpersonal interactions and feared illness progression. The women experienced a general lack of information pertaining to above themes and all described strategies used to handle their situation, which affected their distress. The communication, assessment and treatment of symptoms were hampered by the society's and the health system's tendency to overlook these symptoms and leave them in the realm of the unspeakable. Health professionals need new strategies to support these women to recognise, assess and evaluate the seriousness of symptoms, and to communicate their symptom experience so that timely medical treatment is sought. This support may minimise potentially preventable complications and symptom-related distress.

What do case-control studies estimate? Survey of methods and assumptions in published case-control research

To evaluate strategies used to select cases and controls and how reported odds ratios are interpreted, the authors examined 150 case-control studies published in leading general medicine, epidemiology, and clinical specialist journals from 2001 to 2007. Most of the studies (125/150; 83%) were based on incident cases; among these, the source population was mostly dynamic (102/125; 82%). A minority (23/125; 18%) sampled from a fixed cohort. Among studies with incident cases, 105 (84%) could interpret the odds ratio as a rate ratio. Fifty-seven (46% of 125) required the source population to be stable for such interpretation, while the remaining 48 (38% of 125) did not need any assumptions because of matching on time or concurrent sampling. Another 17 (14% of 125) studies with incident cases could interpret the odds ratio as a risk ratio, with 16 of them requiring the rare disease assumption for this interpretation. The rare disease assumption was discussed in 4 studies but was not relevant to any of them. No investigators mentioned the need for a stable population. The authors conclude that in current case-control research, a stable exposure distribution is much more frequently needed to interpret odds ratios than the rare disease assumption. At present, investigators conducting case-control studies rarely discuss what their odds ratios estimate.