Enhancing recovery rates: lessons from year one of IAPT

BACKGROUND: The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. METHOD: Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). RESULTS: Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. CONCLUSIONS: Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer

Background Depression and anxiety are common after diagnosis of breast cancer. We examined to what extent these are recurrences of previous disorder and, controlling for this, whether shame, self-blame and low social support after diagnosis predicted onset of depression and anxiety subsequently. Method Women with primary breast cancer who had been treated surgically self-reported shame, self-blame, social support and emotional distress post-operatively. Psychiatric interview 12 months later identified those with adult lifetime episodes of major depression (MD) or generalized anxiety disorder (GAD) before diagnosis and onset over the subsequent year. Statistical analysis examined predictors of each disorder in that year. Results Of the patients, two-thirds with episodes of MD and 40% with episodes of GAD during the year after diagnosis were experiencing recurrence of previous disorder. Although low social support, self-blame and shame were each associated with both MD and GAD after diagnosis, they did not mediate the relationship of disorder after diagnosis with previous disorder. Low social support, but not shame or self-blame, predicted recurrence after controlling for previous disorder. Conclusions Anxiety and depression during the first year after diagnosis of breast cancer are often the recurrence of previous disorder. In predicting disorder following diagnosis, self-blame and shame are merely markers of previous disorder. Low social support is an independent predictor and therefore may have a causal role.

What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs. CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

Alfabetizar crianças na escola pública: fazeres docentes em discussão

The most recent data of the Brazilian Test (BRAZIL, 2005) and of the SAEB (BRAZIL, 2007) have reaffirmed the serious situation of the Brazilian public school, where great part of the students, after to conclude 4º year of basic education, does not present minimum knowledge of reading and writing. In this picture, the situation of the state of Rio Grande do Norte, whose students had presented, in the last evaluation is particularly difficult, the worse performances of the country, in this area. The data also discloses that the failure pertaining to school, closely tied with the failure in the literacy, not only remains, as takes other aspects. In consequence of this picture, the literacy, even so widely argued in the last few decades, still instigates inquiries, as it is the case of this work. Our study got shaped due to reflections, as much to the theorizations to which we had access, as of the emergent questions of ours pedagogical practice. Through the past three decades, the studies in the area of literacy with the purpose to understand the constituent nature of the process, its aspects and its determinative ones has been intensified. The produced knowledge has contributed for the overcoming of the reductionist form as if it thought/thinks, in some contexts - this process. Such statements impel them to reflect concerning what is happening in the school, limiting or making possible the pertaining to school success. With these concerns, we delimit, as focus of study, the teaching action, having the following stunning question: What to make professors, in the context of the public school, to propitiate or hinder the process of literacy of the children? In this direction, our object of study is to make them professors who can propitiate or hinder the process of literacy of the children, in the context of the public school. The objective work to investigate, from practical of professors the teachers, that to make professors related to the literacy process - they can propitiate or hinder the learning of the written language, for the pupils of the public school, at the beginning of the school process. The work if inscribes in the qualitative boarding of research and if it configures as a case study, with characteristics of Research-Action, inspired by the following principles: authenticity and commitment and systematic restitution. For the retraction of the data, they had been used: half-structuralized interview; participant comment; meeting of studies and reflection; register in daily of field. We define as locus of study, a school of public net and, more specifically, a group of the initial years of school process that integrates the cycle of literacy . Of the five invited teachers, only one demonstrated interest in participating of the work. Its group of first year of the First Cycle of basic education is composed for 34 children, with ages between six the nine years. The data constructed by means of the described procedures, as well as its analysis, make possible to identify, between the many aspects and to make that they compose the pedagogical dynamics in the context of classroom, the following categories to make articulated with the literacy process: 1. To make of practical the relative ones to the planning, understood as To make relative: 1,1 distribution of the time-space/routine; 1.2 to the didactic activities and/or sequences and teaching interventions; 1.3 to the organization/election of the contents; 1.4 to the materials/didactic resources and 1.5 to the evaluation. 2. To make relative to the interaction professor-pupil, systemize in: 2.1 attention to the diversity; 2.2 to the affectivity. These to make, in the form as if materialized in the practical one observed, had been reflected, jointly with the teacher, as constituting parts of obstacles to a perspective of literacy. By means of the sharing of the reflections, anchored in theoretical conceptions concerning the practical one of teach-learning and, more specifically, of literacy, we register indications of new meanings of these to make on the part of the teacher in conducting them as providers of learning of its pupils, first purpose of its teaching performance. This finishing, possible synthesis at this moment is, therefore, point of fond and departure for new studies

Reflexões e contribuições para o ensino de gravitação clássica no nível médio

The subject of Classic Gravitation is part of the actual curriculum for High School in Brazil, and it is taught in the first year of that education level. This master thesis presents a research regarding the subject Classic Gravitation in High School. This research was based in two complementary guidelines of research and action. The first guideline was the analysis of 21 didactic books of physics which are the more frequently used in High School, in the city of Natal/RN. The second guideline, worked after being verified the most common deficiencies presents in the didactic books, was the elaboration, followed by a practical application, of a course suggesting how to approach that subject in the classroom. The Parâmetros Curriculares Nacionais para o Ensino Médio (National Curricular Parameters for High School PCNEM) defend that Classic Gravitation is very important in the student s formation and that its study helps the comprehension of many nature s phenomena. Because of this vision of that subject by the PCNEM, the 21 analyzed books were separated in two groups: the first one, containing 10 books, was edited before the spreading of PCNEM, and the second, with 11 books, after that spreading. Whatever the group to which the didactic books belonged, the great majority of them let that subject in a second plan; two of them even suggesting, in the teacher s orientations, that the subject Gravitation can be suppressed in case of insufficient time . These analyses points that the PCNEM had produced no changes in the conception of the authors that wrote books regarding that subject. To analyze the didactic books, we elaborated a script which was used as an analysis tool, in which we put in evidence the relative importance of the historic and philosophic contextualization of the subject, the quotidian experience of the students and the interdisciplinary approach, among other aspects. It became evident that the didactic books give very little emphasis to historic aspects of the knowledge construction, to the relations with the day-by-day questions and to the interdisciplinary character of the subject Gravitation. It calls attention the non concordance among the authors opinions regarding the necessary previous knowledge or prerequisites the students should fulfill in order to begin to study Gravitation. The course we elaborated was given to a group of teachers as well as to students. In those courses we treated theoretical and practical aspects and emphasized historical questions and the ones which are related to people s daily life. The course for teachers was realized as an extra-mural activity of the UFRN and was given by the author of this thesis at the Escola Estadual Francisco Ivo Cavalcanti (a state public school in Natal/RN). There were 23 teachers present, from several public schools and several fields of knowledge. The thesis supervisor and the master degree s colleagues of the author acted as collaborators , reporting the participants opinions and speeches. The course to the students, on the other hand, had the participation of 300 regular students who belonged to 6 different 1st year classes of the High School Escola Marista de Natal (RN), in which the author acts as a physics teacher. The student s course was realized as part of the regular curriculum activities, in which three classes stood under the responsibility of the author and other three classes in charge of another Marista s teacher, who participated as a collaborator . The teacher s course as well as the students one were given in two stages, with five hours each. The first stage was divided in two moments, the first one focused on the survey of the spontaneous conceptions about gravitation, in which we worked basically with experiments of free throwing and pendulum, and the second one focused in theoretical presentations and quarrels about universe s models. In the second stage of the course we improved the study of Kepler s laws and the Newton s Universal Gravitation law, and we used as motivating tools some practices involving the construction of the solar system in scale. As instruments for evaluating both courses we used questionnaires and reported the speeches with participants opinions, beyond usual written evaluations in the course for the students. The teachers who participated in the course showed very good wills in realizing interdisciplinary practices; nevertheless, according their own speeches, they frequently came across the difficulty of how to do . From the experience we had in both courses, we conclude that the approach we propose hear to the teaching of the subject Classic Gravitation , supported on the tripod theory, practice and historical and philosophical aspects, is viable and effective. One hopes that this research may contribute in the formation of a opinion, among the teachers, concerning how to approach the subject of Classic Gravitation, and may offer suggestions in order those who want to apply that approach may develop classroom practices aiming to improve the teaching of that subject, which has a singular importance in the formation of High School students

O uso da abordagem CTSA para o ensino de energia tendo o desenvolvimento sustentável como eixo temático

In recent decades, humanity has become increasingly concerned with environmental problems. Proofs of this are increasing initiatives in civil society organizations, private institutions and government actions, either local, state or national actions to promote environmental protection. The goal of this research is to contribute to the formation of citizens more aware of their responsibilities to sustainable development issues, simultaneously to their learning of physics in the secondary school. Thus, we have designed a research project that aims to evaluate the effectiveness of the adoption of the concept of sustainable development as a central theme in physics classes in high school. From this goal, we designed, implemented and evaluate lesson plans that aim not only to construct and apply the concept of energy, but also to understand their transformations and conservation law, as well as their processes of production, distribution and consume in the context of physical laws in which it is involved. Then, it was deliberately provided to students, during classes, to read, interpret and produce texts, by this way being able to think and start to have a critical view of the world around him, as well as absorb the energy concept and understand his occurrence in phenomena of nature and in technologies. The approach used for this was that constraining science, technology, society and environment - STSE. This teaching methodology has been applied in the IFRN Ipanguaçu campus, for students of two classes of first year of high school integrated course in agroecology and in technical computing. The survey results show the effectiveness of both methods with respect to the viewpoints of students in relation to the guidelines of sustainable development and the learning of physics content proposed. It is hoped with this dissertation to contribute to the formation of future men and women as citizens environmentally friendly, but also as a source of inspiration for teachers who wish to foster in its students such a critical position about civic education, from their classes

Reações ácido-base: conceito, representação e generalização a partir das energias envolvidas nas transformações

Undergraduate students on the first year of Chemistry Courses are unfamiliar with the representation of acid-base reactions using the ionic equation H+ + OH- → H2O. A chemistry class was proposed about acid-base reactions using theory and experimental evaluation of neutralization heat to discuss the energy involved when water is formed from H+ and OH- ions. The experiment is suggested using different strong acids and strong base pairs. The presentation of the theme within a chemistry class for high school teachers increased the number of individuals that saw the acid-base reaction from this perspective.

Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Dornase alfa improves the health-related quality of life among Brazilian patients with cystic fibrosis - A one-year prospective study

Background: Health-related quality of life (HRQOL) measurements provide valuable information about the psychological and social impact of treatment on patients with cystic fibrosis (CF). This study evaluated the HRQOL of Brazilian patients with CF and assessed the changes in HRQOL domains over 1 year after dornase alfa (Pulmozyme) introduction. Patients and Methods: One hundred fifty-six stable patients with CF and 89 caregivers answered the Portuguese-validated version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (T 0), and at 3 (T 1), 6 (T 2), 9 (T 3), and 12 (T 4) months of follow-up. Eighteen patientswere excluded because they did not fulfill the inclusion criteria. The patients were analyzed in two groups: those aged 6-11 years and those aged 14 years and older. ANOVA for observed repeated results and the last observation carried forward (LOCF) method for missing data were used for the statistical analysis. Results: After 1 year of follow-up, there was significant improvement in respiratory symptoms (T 4-T 0=8.1; 95% confidence interval (95% CI)=[2.1;14.0]; effect size (ES)=0.35; P<0.001), Emotional Functioning (T 4-T 0=5.6; 95% CI=[1.1;10.1]; ES=0.31; P<0.05), Social Functioning (T 4-T 0=6.0; 95% CI=[1.3;11.7]; ES=0.31; P<0.05), Body Image (T 4-T 0=11.9; 95% CI=[4.1;19.7]; ES=0.42; P<0.05), and Treatment Burden (T 4-T 0=5.3; 95% CI=[0.3;10.3]; ES=0.24; P<0.05) domains in the younger group. A significant improvement in Role Functioning (T 4-T 0=6.1; 95% CI=[1.1;11.1]; ES=0.40; P<0.05), Body Image (T 4-T 0=12.6; 95% CI=[3.5;21.7]; ES=0.46; P<0.05), and Weight (T 4-T 0=11.7; 95% CI=[1.8;21.6]; ES=0.40; P<0.05) was obtained in the older group. The caregivers' CFQ-R showed improvements in the Digestive Symptoms (T 4-T 0=5.5; 95% CI=[1.5;9.4]; ES=0.30; P<0.05), Respiratory Symptoms (T 4-T 0=7.6; 95% CI=[3.9;11.4]; ES=0.48; P<0.05), and Weight (T 4-T 0=10.1; 95% CI=[1.6;18.6]; ES=0.26; P<0.05) domains. Conclusion: The introduction of dornase alfa improved the HRQL of the patients with CF during the first year of treatment. © 2010 Wiley-Liss, Inc.

Práxis intervencionista na escola: experiências de ressignificação, deslocamento e insurgência

Pós-graduação em Artes - IA

Um retrato do primeiro ano do ensino fundamental: o que revelam crianças, pais e professoras

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Sucessão ecológica: análise das concepções de estudantes ingressantes em um curso de Biologia por meio da história e transposição deste conceito

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O Movimento das tendências na relação escola-família-matemática

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

As representações matemáticas mediadas por softwares educativos em uma perspectiva semiótica: uma contribuição para o conhecimento do futuro professor de matemática

Pós-graduação em Educação Matemática - IGCE

Grupos de estudo como possibilidade de formação de professores de matemática no contexto da geometria dinâmica

Pós-graduação em Educação Matemática - IGCE