Stress management in mothers of children with Autism Spectrum Disorder : psychological characteristics, coping strategies and biological correlates

Un figlio con un Disturbo dello Spettro Autistico, caratterizzato da gravi difficoltà nelle relazioni, nei comportamenti e nella comunicazione, costringe tutto il sistema familiare a gestire un notevole stress dovuto alla gestione quotidiana di una patologia così complessa. Per questi motivi, i genitori necessitano di un sostegno il più possibile personalizzato rispetto alle caratteristiche del loro contesto familiare. Per fare questo sarebbe importante individuare quali siano i parametri correlati ai livelli di stress nei familiari di pazienti con autismo e che potrebbero avere un’influenza sul benessere familiare. Lo scopo di questo studio è quello di valutare quali caratteristiche di personalità, stili di coping e capacità di gestire le emozioni possano essere in relazione con la reattività individuale alle situazioni di stress, valutata attraverso alcuni correlati biologici, quali il livello di cortisolo (l’ormone dello stress) e la variabilità della frequenza cardiaca. L’ottica di ricerca applicata fa sì che gli obiettivi ultimi di questo lavoro siano anche quelli di diminuire l’accesso ai servizi per questi soggetti, considerando il fatto che progetti individualizzati di sostegno genitoriale costituiscono un fattore protettivo rispetto a conseguenze fisiche e psicologiche di disagio se implementati tenendo conto della variabilità individuale rispetto alle caratteristiche sopra citate.

Educação Alimentar e Nutricional na Atenção Primária à Saúde na perspectiva do profissional não nutricionista

Introdução: O Direito Humano a Alimentação Adequada (DHAA), na perspectiva da Segurança Alimentar e Nutricional (SAN), destacou-se devido à compreensão dos determinantes para a Promoção da Saúde (PS). A Educação Alimentar e Nutricional (EAN) é uma ferramenta capaz de promover a reflexão dos cidadãos sobre como realizar esse direito. No Brasil, o quadro de insegurança alimentar entre crianças e adolescentes torna os profissionais de saúde da Atenção Primária à Saúde (APS) atores promissores para a reversão desse quadro, já que esses trabalham com os principais influenciadores desse público: a família. Objetivo: Analisar a atuação de profissionais de saúde não nutricionistas coordenadores de grupos educativos com conteúdo de alimentação e nutrição, desenvolvidos na APS do município de São Paulo. Métodos: Estudo qualitativo, com aplicação de entrevistas semiestruturadas e análise por meio do Discurso do Sujeito Coletivo. Foram levantados os dados a respeito da formação desses profissionais e identificadas suas percepções sobre seus papéis nos grupos que coordenam e a importância atribuída a eles. Resultados: A profissão dos 21 entrevistados reflete a atual configuração da Estratégia Saúde da Família. Há predominância de profissionais do sexo feminino com pós-graduação em temas de saúde coletiva. Foram identificadas 13 Ideias Centrais dividas em 2 Eixos Temáticos. Levantaram-se percepções contrárias e outras a favor aos referenciais teóricos trabalhados. Como favoráveis, identificou-se a valorização dos grupos como espaços de participação, troca de experiências e criação de vínculo entre seus membros, sendo o coordenador do grupo responsável pela condução desses. A importância na atuação interprofissional para o atendimento integral à saúde e atualização entre os profissionais também foi destacada. Já as desfavoráveis trouxeram a desvalorização das atividades em grupo, ou a atribuição de sua importância como forma de acesso a serviços, medicamentos ou informação, a identificação dos coordenadores como responsáveis por mudanças de comportamentos nos participantes, modelos a serem seguidos, e sendo considerados detentores do conhecimento, o que parece sobrecarregá-los, desmotivá-los e frustrá-los. Assim, alguns buscam seu reconhecimento trazendo atividades que agradam os usuários, independentemente da constatação das necessidades do território. Conclusões: A percepção dos profissionais parece refletir a forma em que atuam, evidenciando um momento heterogêneo sobre as formas de se abordar os aspectos relacionados à alimentação, além do despreparo para a coordenação de grupos. Dessa forma, recomenda-se a aproximação entre os campos da saúde e da educação, visando práticas mais significativas e libertadoras, bem como a reflexão sobre a formação desses profissionais, já que suas atuações parecem refletir a educação na qual foram moldados. Os princípios da PS, do DHAA, da SAN, da EAN e das características essenciais a um coordenador de grupos, devem ser trabalhados com esses atores, e, para tanto, como produto dessa pesquisa, sugeriu-se um curso de atualização.

Projecte RIU: cambios percibidos por agentes de salud y profesionales tras una intervención en salud en un barrio en situación de vulnerabilidad

Objetivo: Describir los cambios percibidos por la población y los profesionales en relación con la salud y el uso de servicios tras la intervención RIU con agentes comunitarios en un barrio vulnerable. Diseño: Estudio descriptivo cualitativo con entrevistas individuales y grupales y observación participante de octubre de 2008 a julio de 2009. Emplazamiento: Barrio Raval (Algemesí-Valencia). Participantes: Selección por muestreo opinático de 7 mujeres agentes de salud, todas las que finalizaron la intervención, y 10 profesionales implicados en la misma. Método: Con las mujeres se mantuvo una entrevista grupal a los 6 meses, y una entrevista grupal y 7 individuales a los 9 meses de intervención. Se realizó un análisis temático de tipo descriptivo desde el modelo de promoción de salud. Con los profesionales se utilizó observación participante en una reunión a los 9 meses, analizándose las notas de campo según: valoración del proyecto, cambios detectados, dificultades y recomendaciones. Resultados: Las mujeres adquirieron información sobre salud, anticoncepción, embarazo y servicios sanitarios; señalaron cambios en autocuidados y habilidades sociales y liderazgo; interiorizaron el rol de agente de salud difundiendo lo aprendido y manifestando mejor autoestima y reconocimiento social. Provocaron cambios en su entorno relativos al cuidado de la salud y el acceso a los servicios. Los profesionales no incorporaron a su trabajo la perspectiva comunitaria; valoraron el proyecto, coincidieron con las mujeres en la mejora del acceso y uso de servicios y en el acercamiento población-profesionales. Conclusiones: RIU aumenta las capacidades de las personas participantes, su reconocimiento social y mejora el acceso y uso de servicios sanitarios.

Organizational aspects of e-referrals

Three different, well established systems for e-referral were examined. They ranged from a system in a single country handling a large number of cases (60,000 per year) to a global system covering many countries which handled fewer cases (150 per year). Nonetheless, there appeared to be a number of common features. Whether the purpose is e-transfer or e-consultation, the underlying model of the e-referral process is: the referrer initiates an e-request; the organization managing the process receives it, the organization allocates it for reply; the responder replies to the initiator. Various things can go wrong and the organization managing the e-referral process needs to be able to track requests through the system; this requires various performance metrics. E-referral can be conducted using email, or as messages passed either directly between computer systems or via a Web-link to a server. The experience of the three systems studied shows that significant changes in work practice are needed to launch an e-referral service successfully. The use of e-referral between primary and secondary care improves access to services and can be shown to be cost-effective.

Optimism health-related hardiness and well-being among older Australian women

This article examines whether optimism and health-related hardiness contribute to health and well-being among older women. Positive psychological characteristics, including optimism and health-related hardiness, are correlated with good self-rated health, but these variables are all affected by socioeconomic status, social support, physical illness and access to services. Using data from 9501 Australian women aged 73 to 78, we show that optimism and health-related hardiness explain a significant proportion of variance in all subscales of the SF-36, and in stress, even after these confounders are taken into account. The data, although cross-sectional, suggest that positive personal characteristics may contribute to well-being.

Models of psychological service provision under Australia's better outcomes in mental health care program

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Managing crisis:the role of primary care for people with serious mental illness

Background and Objectives: More than 30% of patients with serious mental illness in the United Kingdom now receive all their health care solely from primary care. This study explored the process of managing acute mental health crises from the dual perspective of patients and primary care health professionals. Methods: Eighteen focus groups involving 45 patients, 39 general practitioners, and eight practice nurses were held between May and November 2002 in six Primary Care Trusts across the British West Midlands. The topic guide explored perceptions of gold standard care, current issues and critical incidents in receiving/providing care, and ideas on improving services. Results: Themes relevant to the management of acute crisis included issues of process, such as access, advocacy, communication, continuity, and coordination of care; the development of more structured care that might reduce the need for crisis responses; and issues raised by the development of a more structured approach to care. Conclusions: Access to services is a complicated yet crucial feature of managing care in a crisis, with patients identifying barriers at the level of primary care and health professionals at the interface with secondary care. The development of more structured systems as a solution may generate its own ethical and pragmatic challenges.

Acompanhamento do crescimento e desenvolvimento da criança: a participação das mães da área rural

The accompaniment of growth and development is the central thrust of child care in primary health care in order to contribute to the reduction of infant morbidity and mortality and promote healthy development. Despite its importance, the family health unit located in rural Parazinhocounty experiences the problem of frequent absences of children to follow-up consultations. Thus, this study aims to analyze the participation of mothers in the accompaniment of growth and development of children in the Family Health Strategy. This is an exploratory, descriptive study with a qualitative approach with the method action research, developed with mothers who are part of the monitoring of the growth and development of children in the rural area of the municipality of Parazinho/RN from May to October 2014. Data collection was performed using the focus group techniques, participant observation and individual interviews. Data were analyzed using thematic analysis of categorization. The study was approved by the Research Ethics Committee, under the opinion embodied 617,559 and CAAE 28598014.7.0000.5537. In step situation analysis, were conducted two focus groups, attended by a total of 14 mothers of different rural locations. From the speeches, one realizes that they have a satisfactory understanding of the monitoring of the growth and development of the childwas a learning moment. The nurse was mentioned as key professional that actionof accompaniment. The main reason that mothers to abandon consultations is access to health services, due to the distance from their homes to the basic unit, the shortage of public transport for the movement of users and delay between the service and the back home. As a strategy to try to tackle these problems, at the suggestion of their mothers was created Monitoring of Growth and Development Itinerant, where the FHS team moved to rural locations, performing activities related to children's health. Mothers who participated in the action approved the initiative as improving access and care of health needs, despite indicate dissatisfaction as the poor infrastructure and little privacy in consultations. Therefore, it is concluded that, despite the difficulties encountered often for lack of management support and involvement of some professionals, the monitoring of growth and development itinerant proved to be an important tool in solving the problem of access to services oriented to the health of child, in addition to functioning as a space for the realization of health education, becoming, since then, an activity inherent in family health team schedule.

A articulação entre a estratégia saúde da família e o Centro de Atenção Psicossocial: análise de experiência em município do Nordeste brasileiro

The antimanicomial psychiatric reform is a process that seeks to deconstruct the exclusionary logic caused by hospitalizations, providing strategies for social reintegration of individuals. In this sense, the primary care through the Family Health Strategy - FHS comes progressively becoming strategic space in mental health interventions, configured as a field of practice and production of new modes of care. In this perspective, there has been a process of implementing this proposal in the Areia Branca City/RN, through the articulation of Psychosocial Care Network and the Family Health Strategy / ESF. However, this process has not been able to bring changes in practices. From the view that the relationship between mental health and primary care is a challenge currently being faced, that improving the care provided and the expansion of the access to services with guaranteed continuity of care depend on the effectiveness of this joint, established themselves as research objective: To investigate how is the relationship between the FHS team and CAPS team in care mental health in the town of Areia Branca - RN from the speeches of professionals. And if you had specific purposes: 1) Know the demand in existing mental health in the town of White Sand - RN served by FHS; 2) Identify limits and difficulties in the relationship between the ESF teams and CAPS; 3) Identify potential for linkages between ESF teams and CAPS for the establishment of local RAPS. This was a descriptive, exploratory study with a qualitative methodological design, whose subjects were professionals from the Family Health Strategy, professionals Psychosocial Care Center and responsible for the conduct / management of mental health in the municipality. The research tools used informal observations, semistructured interviews and focus groups were used. The data obtained were analyzed for the content analysis of Bardin, allowing discuss the relevance of the theoretical framework with data obtained through observation and interpretation of the relationship between the Family Health Strategy and the network of Psychosocial Care in Areia Branca-RN. On the one hand, there was strong demand for mental health arising from users and their families and / or caregivers. On the other, it was verified that although there is some progress with regard to perceptions of mental health, there are still practical, historical and contextually rooted, which act as barriers to effective response to this demand in view of deinstitutionalization. In this sense, it is considered important to emphasize that the teams of the Family Health Strategy should be trained to ensure the health practice with integrity and incorporating the mental health network in the municipality. This training must occur through continuing health education.

Law, Rights and Reproduction: Reproductive Autonomy in Ethical Rationalism

As medical technology has advanced, so too have our attitudes towards the level of control we can expect to hold over our procreative capacities. This creates a multi-dimensional problem for the law in terms of access to services which prevent conception, access to services which terminate a pregnancy and recompensing those whose choices to avoid procreating are frustrated. These developments go to the heart of our perception of autonomy. In order to evaluate these three issues in relation to reproductive autonomy, I set out to investigate how the Gewirthian theory of ethical rationalism can be used to understanding the intersection between law, rights, and autonomy. As such, I assert that it is because of agents’ ability to engage in practical reason that the concept of legal enterprise should be grounded in rationality. Therefore, any attempt to understand notions of autonomy must be based on the categorical imperative derived from the Principle of Generic Consistency (PGC). As a result, I claim that (a) a theory of legal rights must be framed around the indirect application of the PGC and (b) a model of autonomy must account for the limitations drawn by the rational exercise of reason. This requires support for institutional policies which genuinely uphold the rights of agents. In so doing, a greater level of respect for and protection of reproductive autonomy is possible. This exhibits the full conceptual metamorphosis of the PGC from a rational moral principle, through an ethical collective principle, a constitutional principle of legal reason, a basis for rights discourse, and to a model of autonomy. Consequently, the law must be reformed to reflect the rights of agents in these situations and develop an approach which demonstrates a meaningful respect of autonomy. I suggest that this requires rights of access to services, rights to reparation and duties on the State to empower productive agency.

Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006

NORO, Luiz Roberto Augusto et al. Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006, Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 4, p. 783-790, abr. 2009.

Le continuum des violences genrées dans les trajectoires migratoires des Colombiennes en situation de refuge en Équateur

La migration internationale, expérience centrale et de plus en plus féminisée de la mondialisation, semble fortement structurée par les rapports de genre qui peuvent faciliter ou limiter la trajectoire. En outre, une attention particulière doit être portée à la vulnérabilité différenciée des femmes face aux violences dans les processus de recrutement, de déplacement et de passage des frontières. Le contexte de déplacement forcé en étant un particulier, il est essentiel de prendre en compte la situation et le point de vue des femmes en situation de refuge tout comme il est nécessaire de questionner les structures mises en place pour assurer leur accès aux services ainsi que le respect de leurs droits. Dans ce contexte, cette recherche s’intéresse à l’importance de l’interaction entre les différents axes d’inégalités sociales dans la production et la transformation des formes de violences basées sur le genre vécues par les déplacées colombiennes tant dans la phase prédépart, dans l’étape de déplacement que lors de leur insertion dans le pays voisin où elles cherchent refuge : l’Équateur. En plus de s’amalgamer aux autres axes de différenciation sociale tels que l’âge, l’ethnie, la classe sociale et l’orientation sexuelle les caractéristiques vulnérabilisantes liées au genre se dévoilent dans un continuum de violences qui vient à son tour influencer les rapports inégaux. L’utilisation d’un concept comme celui du continuum permet une réflexion sur la nature multi-facétique de la violence. En plus d’aller plus loin que la hiérarchisation des abus, ce concept favorise l’exploration de formes de violences qui, contrairement aux violences extrêmes et directes, sont moins communément étudiées. En effet, les violences basées sur le genre ne sont pas des phénomènes isolés, mais des manifestations qui s’entrecroisent le long d’un continuum au cours duquel elles se supportent, se nourrissent mutuellement et parfois se fusionnent pour se transformer.

Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006

NORO, Luiz Roberto Augusto et al. Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006, Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 4, p. 783-790, abr. 2009.

Tantalus and the tyranny of territory : pursuing the dream of parity in rural and metropolitan population health outcomes through primary health care programs

Many health professionals and rural health academics are motivated by the challenge of achieving equitable access to health care in rural communities with the implicit vision that fairer access to services might ultimately lead to more equitable health outcomes for people living in rural and remote settings. The purpose of this paper is to put the issue of rural and urban health outcome parity into perspective and assess recent progress towards achieving the ultimate goal of improving rural health status. I will also explore ways in which rural communities might increase their access to and use of primary health care revenue in the future to improve community health outcomes. While some improvements have been achieved across the rural health system in recent times, the fundamental problem of maintaining infrastructure to service community needs in rural areas remains as daunting as ever. Extensive evidence has now been assembled to show that rural people generally enjoy a much lower standard of health care, health outcomes and life expectancy than their urban cousins. The question underlying all of this evidence, however, is... must this always be so? Is it possible to redress the current inequities between rural and urban populations and could new primary health care initiatives, such as the Enhanced Primary Care (EPC) program, be vehicles for achieving more equitable health care arrangements and health outcomes for people living in rural communities?

Implementing the Flinders Model of self-management support with Aboriginal people who have diabetes : findings from a pilot study

A pilot program for Aboriginal people with diabetes on Eyre Peninsula, South Australia, aimed to test the acceptability and impact of using the Flinders model of self-management care planing to improve patient self-management. A community development approach was used to conduct a twelve-month demonstration project. Aboriginal health workers (AHWs) conducted patient-centred, self-management assessment and care planning. Impacts were measured by patient-completed diabetes self-management assessment tool, goal achievement, quality of life and clinical measures at baseline and 12 months. Impact and acceptability were also assessed by semi-structured interviews and focus groups of AHWs. Sixty Aboriginal people with type 2 diabetes stated their main problems as family and social dysfunction, access to services, nutrition and exercise. Problems improved by 12% and goals by 26%, while quality of life scores showed no significant change. Self-management scores improved in five of six domains. Mean HbA1c reduced from 8.74-8.09 and mean blood pressure was unchanged. AHWs found the process acceptable and appropriate for them and their patients. It was concluded that a diabetes self-management program provided by AHWs is acceptable, improves self-management and is seen to be useful by Aboriginal communities. Barriers include lack of preventative health services, social problems and time pressure on staff. Enablers include community concern regarding the prevalence and mortality associated with diabetes.