Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making:a multi-perspective IPA design

OBJECTIVE: To explore patients' and physicians' experiences of atrial fibrillation consultations and oral anticoagulation decision-making. DESIGN: Multi-perspective interpretative phenomenological analyses. METHODS: Participants included small homogeneous subgroups: AF patients who accepted (n=4), refused (n=4), or discontinued (n=3) warfarin, and four physician subgroups (n=4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective IPA analyses to attend to individuals within subgroups and making comparisons within and between groups. RESULTS: Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision, and Negotiating systemic factors. CONCLUSIONS: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care, and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

In the name of the father, son, and grandson:succession patterns and the Kim dynasty

This paper seeks to understand North Korea’s Kim Il Sung to Kim Jong Il and Kim Jong Il to Kim Jong Un’s hereditary transition by proposing a comparative analysis of several dictatorship families. The paper utilizes totalitarian successions in Nicaragua with García and Debayle, in Haiti with the Duvalier family, in Syria with the al-Assads, in Azerbaijan with the Aliyevs, in Congo with the Kabilas in order to draw parallels and difference with the North Korea. Eventually, North Korea’s control over information and its management of myths are highlighted as factors that have enabled the country’s hereditary transition, though new patterns of domestic governance might lead to a different political environment over the Korean peninsula.

The braids of the virgin: Taino roots of the early cult of La Virgen de la Caridad del Cobre in Cuba

Since her discovery in Cuban waters in 1611, La Virgen de la Caridad del Cobre (The Virgin of Charity) has become the leading transnational religious symbol for Cubans. The oldest stories about the appearance of La Virgen in Cuba suggest the presence of Cuban Taino in the early years of her cult. Yet historians have minimized Taino influence when examining Cuba's sixteenth and seventeenth centuries, pivotal years in the cult's development. This thesis demonstrated the significant role of the Taino in the formation of the early cult of La Virgen de la Caridad del Cobre, by employing revisionist historiography to the years between 1492 and 1687, to better understand the demographics and religious culture of Eastern Cuba, where the cult originated. It also found specific contributions from Taino religious culture in the myths, beliefs, and material culture associated with the early cult of La Virgen. ^

Lions and roses: An interpretive history of Israeli-Iranian relations

This multi-disciplinary research project explores the religious and cultural foundations within the "master commemorative narratives" that frame Israeli and Iranian political discourse. In articulating their grievances against one another, Israeli and Iranian leaders express the tensions between religion, nationalism, and modernity in their own societies. The theoretical and methodological approach of this dissertation is constructivist-interpretivist. The concept of "master commemorative narratives" is adapted from Yael Zerubavel's study of ritualized remembrance in Israeli political culture, and applied to both Israeli and Iranian foreign policy. Israel’s master commemorative narrative draws heavily upon the language of the Hebrew Bible, situating foreign policy discourse within a paradigm of covenantal patrimony, exile, and return, despite the unrelenting hostility of eternal enemies and "the nations." Iran’s master commemorative narrative expresses Iranian suspicion of foreign encroachment and interference, and of the internal corruption that they engender, sacralizing resistance to the forces of evil in the figurative language and myths of pre-Islamic tradition and of Shi'a Islam. Using a constructivist-interpretive methodological approach, this research offers a unique interpretive analysis of the parallels between these narratives, where they intersect, and where they come into conflict. It highlights both the broad appeal and the diverse challenges to the components of these "master" narratives within Israeli and Iranian politics and society. The conclusion of this study explains the ways in which the recognition of religious and cultural conflicts through the optic of master commemorative narratives can complement the perspectives of other theoretical approaches and challenge the conventions of Security Studies. It also suggests some of the potential practical applications of this research in devising more effective international diplomacy.

Socioemotional outcomes of children sexually abused during early childhood

This study investigated the nature and impact of the sexual abuse of children ages birth through 6 years. The purpose was to enhance knowledge about this understudied population through examination of: (1) characteristics of the abuse; (2) socioemotional developmental outcomes of young victims; and (3) potential moderating effects of family dynamics. An ecological-developmental theoretical framework was applied. Secondary data analysis was conducted using data collected from the consortium Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). A sample of 250 children was drawn from LONGSCAN data, including children who were sexually abused (n=125) and their nonabused counterparts (n=125), matched on demographic variables. Results revealed that young victims of sexual abuse were disproportionately female (91 girls; 73%). The sexual abuse committed against these youngsters was severe in nature, with 111 children (89%) experiencing contact offenses ranging from fondling to forcible rape. Sixty-two percent of child victims demonstrated borderline, clinical, or less than adequate functioning on normative, expected socioemotional outcomes. Child victims reported low degrees of perceived competence and satisfaction in the social environment. When compared with their nonabused counterparts, child victims demonstrated significantly poorer socioemotional functioning, as evidenced by aggressive behaviors, attention and thought problems. Sexually abused youngsters also reported lower self-perceptions of cognitive and physical competence and maternal acceptance. Family dynamic factors did not significantly moderate the relationships between abuse and socioemotional outcomes, with one exception. The caregivers’ degree of empathy for their children had a significant moderating effect on the children’s social problems. This study contributes to an otherwise scant body of literature on the sexual abuse of preschoolers. Findings provide implications for social work practice, especially in the development of assessment and prevention strategies.

Rewarding Non-productivity In the Hospitality Industry

The industry has not clearly focused on many important problems, such as rewarding service workers based on productivity. Instead, many industry leaders have focused on "straw men issues," issues that are more rhetoric than substance. The authors examine some of these so-called is- sues in detail: governmental wage policies, immigration laws, the quality of the work force, service worker training, and gratuity management, to provide a fresh look at worker productivity beyond the rhetoric and myths that prevail

A Land That Has Yet to Heal: The Burmese Civil War (1948 – present)

Since its independence from Great Britain in 1948, the state of Burma has been at war with itself. Ethnic and religious tension fuel the conflict and has led to territorial disputes while no resolution to this strife is expected under a fragile and corrupt central government. Additionally, proxy wars have delayed any peaceful negotiations. The combinations of failing social welfare programs and prolonged peace talks have led many Burmese people join the military as soldiers in either the Burmese military or any one of the numerous ethnic paramilitary groups in the country. Human rights violations are common in Burma, including rape, pillaging, and ethnic cleansing. Essentially, Burma has had the longest ongoing civil war due to combination of grievances, many of which predate the 21st century.

Lions and Roses: An Interpretive History of Israeli-Iranian Relations

This multi-disciplinary research project explores the religious and cultural foundations within the “master commemorative narratives” that frame Israeli and Iranian political discourse. In articulating their grievances against one another, Israeli and Iranian leaders express the tensions between religion, nationalism, and modernity in their own societies. The theoretical and methodological approach of this dissertation is constructivist-interpretivist. The concept of “master commemorative narratives” is adapted from Yael Zerubavel’s study of ritualized remembrance in Israeli political culture, and applied to both Israeli and Iranian foreign policy. Israel’s master commemorative narrative draws heavily upon the language of the Hebrew Bible, situating foreign policy discourse within a paradigm of covenantal patrimony, exile, and return, despite the unrelenting hostility of eternal enemies and “the nations.” Iran’s master commemorative narrative expresses Iranian suspicion of foreign encroachment and interference, and of the internal corruption that they engender, sacralizing resistance to the forces of evil in the figurative language and myths of pre-Islamic tradition and of Shi‘a Islam. Using a constructivist-interpretive methodological approach, this research offers a unique interpretive analysis of the parallels between these narratives, where they intersect, and where they come into conflict. It highlights both the broad appeal and the diverse challenges to the components of these “master” narratives within Israeli and Iranian politics and society. The conclusion of this study explains the ways in which the recognition of religious and cultural conflicts through the optic of master commemorative narratives can complement the perspectives of other theoretical approaches and challenge the conventions of Security Studies. It also suggests some of the potential practical applications of this research in devising more effective international diplomacy.

Socioemotional Outcomes of Children Sexually Abused during Early Childhood

This study investigated the nature and impact of the sexual abuse of children ages birth through 6 years. The purpose was to enhance knowledge about this understudied population through examination of: (1) characteristics of the abuse; (2) socioemotional developmental outcomes of young victims; and (3) potential moderating effects of family dynamics. An ecological-developmental theoretical framework was applied. Secondary data analysis was conducted using data collected from the consortium Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). A sample of 250 children was drawn from LONGSCAN data, including children who were sexually abused (n=125) and their nonabused counterparts (n=125), matched on demographic variables. Results revealed that young victims of sexual abuse were disproportionately female (91 girls; 73%). The sexual abuse committed against these youngsters was severe in nature, with 111 children (89%) experiencing contact offenses ranging from fondling to forcible rape. Sixty-two percent of child victims demonstrated borderline, clinical, or less than adequate functioning on normative, expected socioemotional outcomes. Child victims reported low degrees of perceived competence and satisfaction in the social environment. When compared with their nonabused counterparts, child victims demonstrated significantly poorer socioemotional functioning, as evidenced by aggressive behaviors, attention and thought problems. Sexually abused youngsters also reported lower self-perceptions of cognitive and physical competence and maternal acceptance. Family dynamic factors did not significantly moderate the relationships between abuse and socioemotional outcomes, with one exception. The caregivers’ degree of empathy for their children had a significant moderating effect on the children’s social problems. This study contributes to an otherwise scant body of literature on the sexual abuse of preschoolers. Findings provide implications for social work practice, especially in the development of assessment and prevention strategies.

Histórias de adoção tardia: considerações a partir da analítica existencial heideggeriana

Adoption establishes a filiation status, resulting from a legal act, which attributes to the child and parents the rights and obligations associated with such condition, being legally irrevocable. Nevertheless, in practice there are adoptions that do not concretize and the child returns to justice during or even after the legal process is closed. Late adoption is the denomination of the adoption of children over two years and it is still permeated by myths and stigmas, leading to a frequent return of the child to justice in these cases. The late adoption involves a process of building a unique relationship with a child whose backstory is commonly marked by the dissolution of the relationship with the family of origin, due to violation of rights and, in some cases, the experience of institutional care. Given such a scenario, this research, based on the Existential Analytic proposed by Martin Heidegger, seeks to understand the experience of mothers and children in the process of late adoption, in order to obtain subsidies to psychological attention in this context. This is a qualitative, phenomenological study with a comprehensive focus. The participants were two mothers and two children who have gone through late adoption for about two years. The procedures of data generation contemplated narrative interviews with mothers and individual meetings with children, in which ludic resources were used as mediators of expression (free drawings, unfinished children's story and "Story-Drawings" on late adoption). The procedures were audiotaped and transcribed. Data analysis was grounded in Heidegger's hermeneutics. The late adoption process, permeated by historical, social and cultural determinants and the web of meanings that create the historical singularity of each person involved have proved to be complex as seen in the narratives. The construction of the meanings of parenthood and filiation has been developing in the families in the study, from the experience of being-with-the-other, caring and dwelling in their peculiar modes of expression. The family of origin and the adoptive family mingle and differentiate by means of the experience of children, especially because of the existence of biological siblings. Data point to the importance of psychological care to family core in late adoption processes

Avaliação do ensino da obstretícia e da assistência ao parto sob a percepção dos graduandos em medicina e enfermagem na Universidade Federal do Rio Grande do Norte

OBJETIVE: To evaluate the perception of Medical and Nursing students of Medicine and Nursing graduation courses at the Federal University of Rio Grande do Norte (UFRN), on obstetrics teaching and labor assistance in the context of the maternal care provided by the Maternity Hospital Januário Cicco (MEJC) and contribute to curricular updating planning of teaching obstetrics, in accordance with the principles of humanization. METHODS: It was conducted a study of cross-cutting approach and qualitative and quantitative descriptive method, with students in medicine and nursing of UFRN, who were attending or had been attended the midwifery disciplines medicine; and women's health in nursing. The data were collected through a questionnaire with objective and subjective questions, and stored in a database, spreadsheet software Excel / Office 2010 with all the variables. RESULTS: We interviewed 169 students, 118 of medical school and 51 from the nursing program, of which 46.75% were male and 53.25% female. The largest number of medical respondents is the 11th period (40.67%), and nursing, on 10, (43.15%). These students witnessed 1,073 births, and (61.8%) vaginal deliveries. The obstetricians were the most performed vaginal deliveries (40%). Nurses performed only (8.13%). The assistance provided to women during the process of labor and delivery, was configured as suitable for 87.58% of respondents and these glimpsed humane conduct. Students who performed deliveries, 76.27% were medical and 11.76% were nursing. All had guidance while doing them. A total of 19.50% medical students reported that there is a prejudice against vaginal delivery, particularly for the humanized birth, unlike all nursing students (100%) who reported that there is this prejudice. Most students (73%) showed preference for vaginal delivery, especially nursing students. On the knowledge of myths in relation to vaginal delivery, 60.35% answered that they know some. CONCLUSION: This study presents itself as a highly relevant, since the results may contribute to curricular changing and updating related to obstetrics teaching, but also serve as a resource for analysis of humanization practices that should be developed in educational institutions and which are recommended by the Ministry of Health.

A produção textual no ensino fundamental: processo de retextualização com o gênero memórias

Teaching Portuguese language in Brazilian public schools is still limited mostly to studying decontextualized text fragments, memorizing classifications and cult of grammar rules. Considering the language as a social, cultural practice which emerges from the intersubjective interaction, we sought to propose an educational intervention that prioritizes the retextualization processes from speech to the writing of memoirs as a textual genre, so as to contribute for improving learner’s discursive performances. Therefore, paying attention to these concerns and in attempt to contribute for improving the teaching of Portuguese language in elementary school, we chose as privileged locus a 9th grade class from a state school in Bento Fernandes, RN. The corpus is formed by texts produced and retextualized by students from the elders’ oral reports within local community. We sought thus to understand what memory is, its importance for registering local spoken language and culture, as much as to carry out didactic actions that favor students’ learning in the activities of textual production. In light of the theoretical overviews about linguistic-discursive relations, based on Marcuschi’s (1993, 1997, 2001, 2002, 2006, 2008, 2010) conception of oralitiy-writing continuum and the debates proposed by Antunes (2003, 2014), Alves Filho (2011), Koch (2012) and Bakhtin (1992, 2011), we aimed to understand, by analyzing the retextualized memoirs, how these practices complement each other within the process of orality and writing. As for the proposal of didactic sequences, the study has been oriented by Dolz and Scheneuely (2004); as for the memoirs, by the guidelines of Coracine and Ghiraldelo (2011) and Le Goff (2010, 2013). In this way, this work followed the action-research methodology in a qualitative approach, considering the teacher (researcher) as an active agent involved in the process of knowledge production in his own educational practice, so as to interfere in the mediation, knowledge production and its dissemination in classroom context, which is the privileged locus for constructing and transforming process. There is much to be research within the area of retextualization. Yet we verified that this educational intervention, based on discursive operators of retextualization, has been proven viable as an efficient path so that we teachers can work the peculiarities of usages and functions of textual genres in oral and written modalities of a language, without grasping both as a dichotomy. This accredited us to strengthen a discourse that undoes many myths still present in that order, especially the one that causes more damage for the learners of Portuguese language – that writing is a representation of speech.

Tratamento tópico para xerostomia pós-radioterapia para câncer de cabeça e pescoço – Revisão Sistemática

The purpose of this systematic review was to compare the effectiveness of topical treatments to minimize post-radiotherapy xerostomia. PubMed, Cochrane Library (CENTRAL) and LILACS databases were searched without restriction on date or language until the 6thAugust, 2015. Key-wordsused for searching were radiotherapy, xerostomia and saliva. Two independent reviewers screened titles and abstracts, carried out data extraction and assessed risk of bias. The first search identified 429 articles. From these, 117 studies were selected for full-text reading, from which 18 were included in the qualitative synthesis. From the eighteen articles included, seven were non- controlled clinical trial, one article was controlled clinical trial and ten studies were randomized clinical trials (three clinical trials were placebo controlled and seven were crossover). By the assessment of the quality of the studies included, ten showed high risk of bias, four showed moderate risk of bias and four presented low risk of bias. All interventions were considered effective in treating xerostomia (mucin, polysaccharides, aloe vera, rape oil, linseed oil, carboxymethylcellulose, polyethylene oxide, pilocarpine and systems of care for xerostomia - gel, paste and mouthwash). Meta-analysis could not be performed due to heterogeneity between thestudiesand interventions. This systematic review showed that a single and general protocol for topical treatment of xerostomia post-radiotherapy does not exist and that follow-up visits should be performed to validate the individualized treatment plan.

Sexualidade e saúde mental: construindo sentidos entre pessoas usuárias de um CAPS

When expressed by mental health services users, sexuality is typically denied by professionals, viewed as another symptom or as if these people are not capable of practicing it. Once Brazilian health professionals haven’t shown lots of investment in this theme, and few are the studies in this field, it is necessary the attention to be focused on researches involving this public. Therefore, the main goal of this study was understand the meanings of sexuality of the mental health services users, which were negotiated in sexuality workshops. The secondary goals were: a) understand the meanings of themes about sexuality brought by users through their experiences of everyday life; b) to evaluate the facilitating experience of the workshops on sexuality at CAPS. Thus, 10 workshops on sexuality were held, with an average of an hour and twenty minutes each, distributed from December 2014 and April 2015. There were 43 participants, 29 women and 14 men. The meetings had the following central themes: sexuality; sexuality and mental health; myths, beliefs and sexual taboos; gender identity; sexual orientation; sexual and reproductive rights; safe sex; and STD/AIDS. The data collection was through audio-recording of these meetings. Later, was made the transcript of the workshops, a careful reading of these transcripts and then its analysis. It was identified categories to analyze the interfaces that permeate the focus of the study. Initially, the categories relating to mental health and sexuality: meanings about sexuality; gender issues; gender and religion; sexual rights, STD/AIDS prevention and attention or denial of sexuality at CAPS. Later, those relating to the workshops facilitating process: challenges in facilitating the workshops; and the perception of the participants. A variety of meanings about sexuality could be noticed in the users’ statements, relating it more with affection and respect than with intercourse. The gender issues that emerged during the workshops were related to marital relationship, sexism, domestic violence, psychological violence and male and female roles in society. Moreover, were also revealed some situations that associated gender differences with religious issues, such as the submission of women and homosexuality. It was also noticed some experiences of the participants involving worrying situations of family violence, suicidal ideation and chemical castration, were often mismanaged or ignored by the service professionals. With regard to the facilitation of the workshops, it was possible to legitimize it as places where users were able to talk openly about the suggested themes and highlight its importance to the study site. Besides, it’s possible to list a few challenges of its facilitation in a mental health service, which was in general positively evaluated by the participants. Thus, the research highlights the need for sexuality theme discussion in mental health services, in order to understand, discuss and inform the users. Also, it’s important to problematize the stigma created in the theme relation with the users, the professionals and the society, working its specificities and avoiding a pathological bias.

Estudo das condutas antissociais e delitivas e esquemas de personalidade numa amostra de presidiários

The increase of crime in Brazilian society has attracted the interest of a growing number of scholars. In psychology, among the aspects studied for the understanding of antisocial and criminal behaviors, there is the personality, object of study of the different fields of this discipline, such as Cognitive Psychology. Thus, in this study, it was used the Young‟s Personality‟s Schemas theory, which considers that schemas are dysfunctional cognitive or emotional patterns that are constituted in the personality (Young et al., 2008). Moreover, for antisocial and criminal conducts, it was considered the Seisdedos‟ design, which says that the first one represents a violation of social rules, that doesn‟t cause serious harm to others, while the second one causes serious injury (Formiga & Gouveia, 2003). The research aimed mainly, to verify the existence of differences in means of responses to the Scale of Antisocial and Criminal Conducts and Young Schema Questionnaire for different crimes (theft, robbery, murder, rape and drug trafficking). For this purpose, the research was applied on a sample of 355 inmates. First, it was analyzed the reliability of the questionnaires, resulting in excellents reliabilities for this sample. There were significant differences between mean responses only for criminal conducts. The schemas that presented significant differences were: Emotional Deprivation, Social Isolation, Entitlement/Grandiosity and Dependence / Incompetence. The type of conduct and schema prevalent for each offense and total sample were also verified. Antisocial conduct prevailed for total sample and all the offences, except for robbery. Moreover, Self-sacrifice was prevalent for total sample and all the offenses.