673 resultados para Cardiac-Diabetes Self-Management Program (CDSMP)


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Background: Clozapine is an atypical antipsychotic medicine which can cause significant side-effects. It is often prescribed off-license in severe cases of borderline personality disorder contrary to national treatment guidelines. Little is known about the experiences of those who take clozapine for borderline personality disorder. We explored the lived-experience of women in secure inpatient care who were prescribed clozapine for borderline personality disorder. Findings: Adult females (N=20) participated in audio-taped semi-structured interviews. Transcripts were subject to thematic analysis. The central themes related to evaluation, wellbeing, understanding and self-management; for many, their subjective wellbeing on clozapine was preferred to prior levels of functioning and symptomatology, sometimes profoundly so. The negative and potentially adverse effects of clozapine were explained as regrettable but relatively unimportant. Conclusions: When psychological interventions are, at least initially, ineffective then clozapine treatment is likely to be evaluated positively by a group of women with borderline personality disorder in secure care despite the potential disadvantages.

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The main issues related to water conservation in urban centers are the increase in water supply cost, demand growth, pollution and differences in the distribution of water resources. Water conservation, the controlled and efficient use of water, includes both measures as reasonable means of water reuse. Thus, conservation practices are an effective way to meet demand and supply water to new activities and users without jeopardizing the supplying water bodies and preserving the natural environment. This study aims to examine the water management of a shopping mall and the use of rainwater harvesting combined with greywater reuse. For buildings in general, water loss is common due to leaks in the hydraulic and restroom equipment. These losses, which are caused by a high volume of water used and wasted in the system, are often the result of design errors, incorrect maintenance procedures and users' bad habits In southern Brazil, where there is rainfall almost all year long, water shortages occasionally occur, particularly in some winter mouths. One difficulty that appears on rainwater studies is the proper determination of rainwater volume that can be used to address water supply systems. In this work, the simulation method was used to determine this volume. Thus, simulations with the following variables: rainfall, catchment area and water consumption were performed. For mall's hydraulic systems, segmented alternatives are adopted. That is, focusing on the use of rainwater or greywater reuse. Other alternatives of effluent reuse have been slightly discussed due to sanitary issues, those are effluents from toilets and kitchen sinks. The adoption of greywater may be feasible if there is a significant flow of greywater to comply water demand for toilet flushing. The inspections made in this study found that the quantity of sinks was insufficient to supply an adequate amount of water to toilets and urinals. The greywater reuse system was found to be infeasible in terms of demand and supply of water. Conversely, the rainwater harvesting system was entirely feasible and easily supplied water to all restrooms and contributed to the cooling of the air conditioning system with a short payback period. One of the challenges of this work was the need to compare the actual water consumption with a water consumption parameter used in buildings. Thus, a method that addresses the generation of specific consumption indexes for specific activity (like a mall) was used. The water consumption indices showed that this mall has a satisfactory water management program.

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In Australia, along with many other parts of the world, fumigation with phosphine is a vital component in controlling stored grain insect pests. However, resistance is a factor that may limit the continued efficacy of this fumigant. While strong resistance to phosphine has been identified and characterised, very little information is available on the causes of its development and spread. Data obtained from a unique national resistance monitoring and management program were analysed, using Bayesian hurdle modelling, to determine which factors may be responsible. Fumigation in unsealed storages, combined with a high frequency of weak resistance, were found to be the main criteria that led to the development of strong resistance in Sitophilus oryzae. Independent development, rather than gene flow via migration, appears to be primarily responsible for the geographic incidence of strong resistance to phosphine in S. oryzae. This information can now be utilised to direct resources and education into those areas at high risk and to refine phosphine resistance management strategies.

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Non-adherence to health recommendations (e.g. medical prescriptions) presents potential costs for healthcare, which could be prevented or mitigated. This is often attributed to a person’s rational choice, to not adhere. However, this may also be determined by individual and contextual factors implied in the recommendations communication process. In accordance, this chapter focuses specifically on barriers to and facilitators of adherence to recommendations and engagement with the healthcare process, particularly concerning the communication between health professionals and patients. For this, the authors present examples of engagement increment through different degrees of participation, from a one-way/directive towards a two-way/engaging communication process. This focuses specifically on a vulnerable population group with increasing healthcare needs: older adults. Future possibilities for two-way engaging communications are discussed, aimed at promoting increased adherence to health recommendations and people’s self-regulation of their own health.

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

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The theme of this dissertation is social technology for self-management: a study in economic enterprise supportive of Rio Grande do Norte. The research aimed to obtain evidence that the reapplication of technology management, basic economic-financial and pricing, as production costs, has the potential to contribute to the self-management of APABV. The social technology and self-management are theoretical frameworks used and where workers are central figures in both the generation and replication of technologies that are compatible with their realities, as in the conduct and management approach adopted by them in their venture, they are makers decisions. To achieve the proposed objective was accomplished participatory research, which was used in addition to document analysis, participatory methodologies such as the construction of the DRP, group interview, experience in the production environment and family of entrepreneurs APABV. This research allowed the management technologies such as spreadsheets controls basic economic and financial costs, when socialized and understood by workers has the potential informational and become part of their daily decision-making process of the project, making up social technology

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

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Dissertação de Mestrado Integrado em Medicina Veterinária

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This dissertation is about Architect and town planner inserts in the technical support of the Rural establishment and of the possibilities of changes in their habitat. It also looks for its participation through the production of those spaces with or without its performance through two references cases, in Rio Grande do Norte , one called settlement Eldorado de Carajás and another one called Maria da Paz. At first the process represents the model that was adopted systematically by Incra until the middle of the year 2000 with the sub-contracting of their construction work through small companies. These standardized projects which are executed without registration in the system CONFEA/CREA without demand of professional authorship and of technical responsibility of the work. But the process taken place at Maria da Paz s area was configured as one of the first initiatives that stopped with those practices. Consolidated through a partnership among UFRN MST and INCRA/RN, the Architect s technical support and town planner brought new technician-scientific organization and execution of the soil parcels and its habitat. The participation of UFRN was done through a group of studies in land reform and Habitat (GERAH) being this author and coordinator of the methodological proposal, based on the regressive-progressive method and in the inclusion of the conflict as responsible of the ruptures and transductions both done by Henry Léfèbvre and in the research action approached by Carlos Brandão. Therefore it included the process of social learning and collective production of new knowledge and attitudes in relation to the environment in the process called as attended self management in spite of the transformations happened with this new agent s participation. The people re-located to the new areas that got involved in the process and finished their constructions reelaborating the daily practice of the collective effort passed to the self management without technical support. Years later the implantation of those two experiences our research verified that there is a positive image concerning the Architect and town planner, related, most of all to the conception of the activities, orientation and execution of constructions projects and of acceptance of those professionals to the processes of implementation of the Habitats of the Rural establishments. This dissertation analyses this form of performance, from and beyond these images trying to find the professional, specificities or methodological in such a way to demonstrate the importance of its insertion in the formulation and attendance of the more of 100.000 habitats of Rural establishments of the land reform of the country that correspond to most of the housing social interest in the country side

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Esta tesis indaga en la interacción entre los aspectos estéticos y relacionales que tienen lugar en un proceso de creación colectiva. Durante los últimos años han proliferado multitud de formas de colaboración artística, a menudo asociadas a movimientos de preocupación social o a comunidades ideológicas y alejadas de los circuitos institucionales, moviéndose entre nuevas posibilidades de autogestión y espacios alternativos de difusión. A fin de entender en primera persona cuáles son las implicaciones de la inclusión del "otro" en el proceso creativo individual, realizamos una experiencia autogestionada de creación colectiva en Barcelona entre los años 2007 y 2011. El presente estudio propone una doble lectura crítica del experimento, planteada en dos niveles paralelos: el nivel de la propia construcción artístico-estética y el nivel de las relaciones que se establecieron entre los participantes a lo largo del proceso. A través del abordaje empírico, la doble lectura crítica y el estudio teórico del contexto, demostramos que la colectivización y "relacionalización" del hecho creativo contribuyen a la rehumanización de la práctica artística, socializando los procesos, contextualizando los mensajes y proponiendo el diálogo como principal herramienta de creación. ———— ABSTRACT This thesis explores the interaction between the aesthetic and relational aspects that take place in a process of collective creation. During the last few years, many new forms of artistic collaboration have proliferated, often associated with socially engaged movements or ideological communities, away from institutional art circuits, moving between new possibilities of self-management and alternative show spaces. In order to understand first-hand what the implications of the inclusion of the “other” are in the individual creative process, we conducted a self-managed collective creation experience in Barcelona from 2007 to 2011. This study proposes a double critical reading of the experiment, displayed in two parallel levels: the level of artistic-aesthetic construction itself and the level of relations established between participants throughout the process. Through the empirical approach, double critical reading and a theoretical study of the context, we demonstrate that the collectivization and "relationalization" of the creative act contribute to re-humanizing the artistic practice, socializing processes, contextualizing messages and proposing dialogue as the main tool of creation.

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Dissertação (mestrado)—Universidade de Brasília, Faculdade de Economia, Administração e Contabilidade, Programa de Pós-Graduação em Administração, 2016.

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Con il termine "Mobile-Health" si intende l’uso di tecnologie mobili in ambito medico-sanitario. Questa tesi si propone di fornire un quadro generale di come i sistemi di Mobile-Health possano aiutare nell'assistenza e nel monitoraggio della gravidanza. Attraverso l'analisi delle ricerche effettuate in questo campo, e lo studio dei sistemi attualmente utilizzati in ambito ospedaliero, si cerca di valutare se effettivamente questo tipo di tecnologie può fornire un contributo significativo nell'assistere le donne incinte. Viene trattato il tema del Self-Management che riguarda appunto l'auto-gestione della propria condizione di salute attraverso l’uso di tecnologie mobili. Vengono introdotti problemi e complicazioni della gravidanza e i corrispettivi trattamenti. Si analizzano studi e ricerche che riguardano dispositivi e software per le donne incinte, compreso il tema delle “app mediche”. Infine, grazie al contributo delle dottoresse Iliana Colonna e Marina Carfagna (coordinatrici ostetriche negli ospedali di Rimini e Cesena), si presenta una panoramica sull’attuale uso di tecnologie nei reparti ospedalieri di ostetricia.

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Abstract : This paper examines the factors motivating students to enrol in the Tourism Management program at Champlain College, St-Lambert and why a large number of students abandon the program before obtaining their DEC. There is a great deal of literature on student attrition, however there is little consensus on why students withdraw from college programs and the results cannot be easily generalized to this particular set of students at this time. Understanding the factors that influenced the students to choose Tourism Management at Champlain, St-Lambert and why they then leave before completing the six semesters will help with student success and with the marketing of the program. The theoretical framework guiding the study is metacognition, a branch of cognitive psychology that deals with the awareness and understanding of one’s thinking processes. Through a survey, students were asked to rank the general and specific factors that influenced their choice of Tourism Management as a program of study. Exit interviews were carried out with students who abandoned the program within the first year of study to determine the reasons for dropping out. Students who persisted in the program wrote journals describing their first year experience in order to identify any differences in metacognitive abilities with those who abandoned the program. The academic records of all students were also analyzed. The major factors influencing students to choose the Tourism Management program were interest in travel and job opportunities available after graduating. The results from the exit interviews and journals also showed that interest in travel was the primary reason for enrolment. The knowledge that students had of Cegep and the Tourism Management program before enroling however was negligible, particularly among the group that abandoned the program within the first year of study. The analyses of the academic records of the 2007 incoming students showed that the students with the lower high school grades were more likely to abandon the Tourism Management program than those with higher grades. The same is true for first semester and second semester Cegep grades. The major reason why the students abandoned the program during the 2007/2008 academic year was a lack of interest or a dislike of the program, followed by financial difficulties. It is not clear however what the lack of interest can be attributed to and this may be an avenue for future research. As opposed to the students who persisted in the program, those who abandoned their studies had unrealistic expectations of the academic requirements, were unprepared for the workload, had more difficulty analyzing their own performance and had not set concrete goals for themselves. The study shows several problem areas within the program. Of main concern is the lack of knowledge that students have of Cegep life and the Tourism Management program in general and the lack of preparation for Cegep level courses. The scheduling of courses and teaching methods within the program are other areas that need to be addressed. The paper concludes with a set of recommendations to possibly help remedy some of the problems.||Résumé : Ce travail s’intéresse aux facteurs qui motivent les étudiants à s’inscrire au programme de tourisme offert au Collège Champlain de St-Lambert. Il cherche à établir les raisons qui font en sorte qu’un si grand nombre d’étudiants abandonnent le programme avant d’obtenir leur DEC. Plusieurs recherches ont été effectuées sur l’abandon scolaire, mais il n’y a pas de consensus quant aux raisons pour lesquelles les étudiants se retirent du programme collégial. Actuellement, il est difficile d’établir des liens entre les résultats de ces recherches et ce groupe d’étudiants. La compréhension des facteurs qui influencent les étudiants à choisir le tourisme au Collège Champlain et les raisons qui font en sorte qu’ils quittent avant d’avoir complété leur formation, nous permettront d’améliorer le taux de rétention des étudiants dans ce programme. De plus, cela favorisera le marketing du programme. Le cadre théorique de cette recherche est la métacognition, une composante importante de la psychologie cognitive qui examine la connaissance et le contrôle qu’une personne a sur sa façon de penser. La métacognition est une variable qui différencie les étudiants qui réussissent de ceux qui abandonnent (Tardif 1997). La méthodologie de cette recherche comprend : un sondage, des entrevues, des comptes-rendus sous forme de journal et une analyse des résultats scolaires. Le sondage fut complété par tous les étudiants qui ont commencé le programme en tourisme en août 2007. Ce sondage avait pour but d’établir les facteurs qui ont motivé les étudiants à choisir cette discipline. Ceux-ci étaient divisés en deux volets soient : les facteurs généraux et les facteurs spécifiques. Les facteurs généraux comprennent l’intérêt pour les voyages et les informations obtenues auprès des orienteurs, des enseignants, de la publicité faite par les cégeps, des parents et des amis. Les facteurs spécifiques incluent les différents cours offerts tels que la géographie, l’informatique, l’administration, le programme de voyages, le stage en milieu de travail, la réputation du programme et de ses professeurs. Les entrevues ont été effectuées auprès de sept étudiants qui ont abandonné le programme entre décembre 2007 et juin 2008. Le but de ces entrevues était de déterminer les raisons de ces abandons. Les étudiants qui ont poursuivi leur formation en tourisme ont rédigé un journal dans lequel ils décrivaient leur expérience tout au long de leur première année d’études. Dans ce journal, ils devaient répondre à sept questions qui avaient pour but de déterminer les différences entre leurs habiletés métacognitives et celles de ceux qui se sont retirés du programme. L’analyse des dossiers des étudiants tenait compte des résultats scolaires du secondaire ainsi que des résultats académiques de la première année de cégep. Les principaux facteurs qui ont motivé les étudiants à choisir le programme gestion du tourisme étaient l’intérêt pour les voyages et les opportunités d’emploi après l’obtention de leur DEC. La connaissance que les étudiants ont du cégep et du programme de gestion du tourisme avant de s’inscrire était toutefois négligeable, particulièrement parmi le groupe qui a abandonné le programme durant la première année d’études. L’analyse des résultats académiques des étudiants a démontré que les candidats ayant des notes inférieures à l’école secondaire sont plus susceptibles d’abandonner le programme de gestion du tourisme que ceux ayant des notes supérieures. L’analyse arrive aux mêmes conclusions en ce qui concerne les candidats qui ont obtenu de faibles résultats académiques lors de la première et de la deuxième session du cégep. Les raisons principales qui ont fait en sorte que les étudiants ont abandonné le programme durant l’année académique 2007-2008 étaient le manque d’intérêt pour le programme et les difficultés financières. Par ailleurs, nous ne pouvons établir de façon générale les causes de ce manque d’intérêt. Cela pourrait faire l’objet d’une recherche ultérieure. Par opposition aux étudiants qui ont poursuivi le programme, ceux qui ont abandonné leurs études avaient des attentes irréalistes en ce qui a trait aux exigences académiques, ils n’étaient pas préparés pour la charge de travail, ils avaient plus de difficultés à analyser leur propre performance et ils ne s’étaient pas fixé d’objectifs concrets. L’étude a identifié plusieurs secteurs problématiques à l’intérieur du programme. L’une des problématiques principales est le manque de connaissance que les étudiants ont de la vie au cégep et du programme de tourisme en général sans compter le manque de préparation pour des cours de niveau cégep. L’horaire des cours et les méthodes d’enseignement à l’intérieur du programme sont d’autres éléments qui méritent d’être revus. Les limites de cette recherche comprennent le nombre restreint d’étudiants qui ont accepté d’être interviewés et l’effet d’intervieweur. Étant donné que l’intervieweur était le professeur des étudiants et malgré le fait que ceux-ci n’étudient plus en gestion du tourisme, ils peuvent se sentir obligés de répondre à l’intervieweur de façon subjective. Les recherches futures pourront inclure un plus grand nombre d’entrevues menées par des intervieweurs expérimentés n’ayant eu au préalable aucun contact avec les étudiants et ce dans le but de favoriser une plus grande objectivité. Un autre domaine de recherche pourrait être l’analyse du fait que des étudiants très intéressés par les voyages finissent par se désintéresser complètement du programme. Enfin et possiblement l’un des facteurs qui nous semble des plus importants est le besoin pour les étudiants du secondaire d’en connaître plus sur la vie au cégep et sur le programme de gestion du tourisme. Le document se termine par un ensemble de recommandations pour le Collège, le programme et les professeurs pour éventuellement aider à remédier aux problèmes identifiés.

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Evidence-based management of Developmental Coordination Disorder (DCD) in school-age children requires putting into practice the best and most current research findings, including evidence that early identification, self-management, prevention of secondary disability, and enhanced participation are the most appropriate foci of school-based occupational therapy. Partnering for Change (P4C) is a new school-based intervention based upon these principles that has been developed and evaluated in Ontario, Canada over an 8-year period. Our experience to date indicates that its implementation in schools is highly complex with involvement of multiple stakeholders across health and education sectors. In this paper, we describe and reflect upon our team’s experience in using community-based participatory action research, knowledge translation, and implementation science to transform evidence-informed practice with children who have DCD.

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Antecedentes: El síndrome de fatiga crónica/encefalomielitis miálgica (SFC/EM), un trastorno debilitante y complejo que se caracteriza por un cansancio intenso, ha sido estudiado en población general, sin embargo, su exploración en población trabajadora ha sido limitada. Objetivo: Determinar la prevalencia de síntomas asociados a SFC/EM y su relación con factores ocupacionales en personal de una empresa de vigilancia en Bogotá, durante el año 2016. Materiales y métodos: Estudio de corte transversal en una empresa de vigilancia, utilizando como instrumento para la recolección de datos la historia clínica-ocupacional. En las variables cualitativas se obtuvieron frecuencias simples y porcentajes y en las variables cuantitativas medidas de tendencia central y de dispersión. Se determinaron asociaciones entre variables (Ji-cuadrado de Pearson o test exacto de Fisher, valores esperados <5), (mann-whitney.y un modelo de regresión logística incondicional (p<0.05)). Resultados: Se evaluaron 162 trabajadores, los síntomas de SFC/EM con mayor prevalencia fueron sueño no reparador (38,3%) y dolor muscular (30,2%). Se encontró asociación estadísticamente significativa entre fatiga severa y crónica por al menos 6 meses con alteración en sistema nervioso (p=0,016) y consumo de medicamentos (p=0,043), así mismo entre el sueño no reparador con el número de horas de sueño de 5 a 7 horas (p=0,002). Conclusión: En los vigilantes el síntoma de SFC/EM más prevalente fue sueño no reparador y este se asoció con el número de horas de sueño de 5 a 7 horas. Con el estudio se pudieron determinar los casos probables de SFC/EM los cuales se beneficiarían de una valoración médica integral para un diagnóstico oportuno.