Efeitos de intervenção cognitivo-comportamental sobe a percepção de doença de pessoas que vivem com HIV/AIDS

Tese (doutorado)—Universidade de Brasília, Instituto de Psicologia, Programa de Pós-Graduação em Processos de Desenvolvimento Humano e Saúde, 2016.

Estudo dos efeitos da aplicação de um programa de promoção da resiliência e de competências sociais e emocionais com crianças em situação de risco da cidade de Tijuana

Artigo teórico: O presente artigo tem como objetivo permitir uma visão global sobre as circunstâncias que podem influenciar, positiva ou negativamente, a vida das crianças e apresentar programas desenhados para promover o seu correto desenvolvimento, mesmo em casos menos favoráveis. Para isto, são revistos os conceitos mais importantes associados às noções de risco, perigo, proteção e resiliência, sintetizadas as relações que estes estabelecem entre si e abordados quais os principais contextos nos quais o profissional pode intervir. Este trabalho foca-se principalmente nas crianças da cidade de Tijuana, pelo que é realizado um trabalho de comparação de estatísticas oficiais entre Portugal e México (quando aplicável, cingido ao estado da Baja Califórnia) de modo a contextualizar os diferentes perigos e proteções que as respetivas culturas providenciam. Para concluir, são apresentados alguns exemplos de intervenções recentes que visam promover a resiliência através de abordagens distintas e em contextos culturais diversos, de modo a deixar no leitor uma ideia das possibilidades e da importância da intervenção nesta área. Artigo teórico-prático: O presente artigo tem como objetivo avaliar o impacto de uma adaptação do programa “Ultrapassar Dificuldades e Vencer Desafios: Manual de Promoção da Resiliência na Adolescência” numa população de crianças em situação de risco, do 1.º ao 6.º ano de escolaridade, da cidade de Tijuana (Baja California, México). Foram realizadas intervenções com dois grupos de crianças que se encontravam em contexto familiar e com um grupo de crianças em contexto institucional. As sessões realizadas, que adaptaram o programa dando-lhe um enfoque psicomotor, compreenderam a duração total de 20 horas e foram realizadas nas instituições de ensino. A intervenção demonstrou ter alguns efeitos positivos ao nível da auto-perceção de competências relacionadas com a resiliência, bem como um efeito de diminuição de alguns fatores de riscos intra-individuais. Na ótica dos prestadores de cuidados, foram ainda encontrados resultados significativos ao nível da diminuição da hiperatividade, dos problemas de comportamento e do total de dificuldades (avaliados pelo instrumento Strenghts and Difficulties Questionnaire). Este programa apresenta assim resultados encorajadores, num contexto diferente ao que serviu de substrato para o desenho do programa, e reforça a noção de que as competências sociais e emocionais são vitais para o correto desenvolvimento infantil em qualquer cultura.

Internação compulsória e o respeito à autonomia da população em situação de rua usuária de álcool e outras drogas sob o olhar da equipe do consultório na rua do Plano Piloto DF

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2016.

Chronic condition management and self-management in Aboriginal communities in South Australia : outcomes of a longitudinal study

OBJECTIVES: This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. METHODS: The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. RESULTS: Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. CONCLUSIONS: The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs.

Gestures of judgement and welcome in public spaces: hypervisible migrant newcomers in Darwin, Australia

This paper draws on ethnographic research to show how pigmentation intensities of skin and facial characteristics make bodies of colour recognisable in public spaces of Darwin, a small multiethnic and multiracial north Australian city. This paper shows that the visibility of newcomers, in particular, humanitarian migrants from countries in Africa, the Middle East and Asia, circulates negative sentiments of fear, anxiety and discomfort in public spaces when instantaneous judgements are made. These judgements of misrecognition made by residents of diverse ethnic and racial backgrounds lead to simmering tensions that unfold as visceral events of vulnerability in public spaces such as bus interchanges, neighbourhood streets, shopping centres and car parks. These events that have the potential to wound and numb bodies contribute to the “urban unconscious” of Darwin as a city where public spaces are safe with heightened surveillance. This paper argues, however, that events of hypervisibility, judgement and interracial tensions can unfold quite differently in public spaces if humanitarian migrants sense gestures of welcome, particularly from Aboriginals. Such fleeting moments of welcome in Darwin have the potential to bring together bodies with different histories and geographies of racialisation, so that multiple publics emerge through everyday habits of living with difference.

The prevalence, age distribution and comorbidity of personality disorders in Australian women

OBJECTIVE: We aimed to describe the prevalence and age distribution of personality disorders and their comorbidity with other psychiatric disorders in an age-stratified sample of Australian women aged ⩾25 years. METHODS: Individual personality disorders (paranoid, schizoid, schizotypal, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive), lifetime mood, anxiety, eating and substance misuse disorders were diagnosed utilising validated semi-structured clinical interviews (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition and Structured Clinical Interview for DSM-IV Axis II Personality Disorders). The prevalence of personality disorders and Clusters were determined from the study population (n = 768), and standardised to the Australian population using the 2011 Australian Bureau of Statistics census data. Prevalence by age and the association with mood, anxiety, eating and substance misuse disorders was also examined. RESULTS: The overall prevalence of personality disorders in women was 21.8% (95% confidence interval [CI]: 18.7, 24.9). Cluster C personality disorders (17.5%, 95% CI: 16.0, 18.9) were more common than Cluster A (5.3%, 95% CI: 3.5, 7.0) and Cluster B personality disorders (3.2%, 95% CI: 1.8, 4.6). Of the individual personality disorders, obsessive-compulsive (10.3%, 95% CI: 8.0, 12.6), avoidant (9.3%, 95% CI: 7.1, 11.5), paranoid (3.9%, 95% CI: 3.1, 4.7) and borderline (2.7%, 95% CI: 1.4, 4.0) were among the most prevalent. The prevalence of other personality disorders was low (⩽1.7%). Being younger (25-34 years) was predictive of having any personality disorder (odds ratio: 2.36, 95% CI: 1.18, 4.74), as was being middle-aged (odds ratio: 2.41, 95% CI: 1.23, 4.72). Among the strongest predictors of having any personality disorder was having a lifetime history of psychiatric disorders (odds ratio: 4.29, 95% CI: 2.90, 6.33). Mood and anxiety disorders were the most common comorbid lifetime psychiatric disorders. CONCLUSIONS: Approximately one in five women was identified with a personality disorder, emphasising that personality disorders are relatively common in the population. A more thorough understanding of the distribution of personality disorders and psychiatric comorbidity in the general population is crucial to assist allocation of health care resources to individuals living with these disorders.

'Are you sure you're going to have another one of those?': a qualitative analysis of the social control and social support models in type 2 diabetes

While there is evidence that spouses can impact the self-management of adults with type 2 diabetes mellitus, less is known about the influence of the wider social network. This qualitative study explored the perceived impact of the family as well as friends and work colleagues on type 2 diabetes mellitus self-management. A total of 25 adults with type 2 diabetes mellitus participated in semi-structured interviews regarding their social experiences of living with diabetes. Deductive thematic analysis was applied to the data. Pre-existing themes of health-related social control and social support were identified in the wider social network, with additional themes of non-involvement and unintentional undermining also emerging.

The Influence of Neurocognitive Impairment, Alcohol and other Drug (AOD) Use, and Psychosocial Factors on Antiretroviral Treatment Adherence, Service Utilization and Viral Load Among HIV-Seropositive Adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

Cancro da mama vivido na relação mãe-filhos e na parentalidade

O diagnóstico de Cancro da Mama (CM) desencadeia uma crise na doente e no seu sistema familiar, levando a mudanças no seu modo de funcionamento. O presente estudo tem como objetivos analisar as mudanças percebidas, a curto e a longo prazo, na relação mãe-filhos e na parentalidade na sequência do diagnóstico de CM materno, bem como analisar de que forma “ser mãe” influenciou o modo como as pacientes lidaram com o CM. Foram entrevistadas 17 mulheres sobreviventes de CM com filhos dependentes no momento do diagnóstico através de uma entrevista semiestruturada. Os dados foram analisados segundo a Grounded Theory. Os resultados demonstraram que esta experiência desencadeia mudanças, temporárias e permanentes, nos padrões de funcionamento familiar. Perante as mudanças nos comportamentos dos filhos, as mães adotam novas estratégias para promover bem-estar nos descendentes. Após a família se conseguir descentrar da doença, as mulheres conseguem refletir sobre os contributos da vivência do CM na relação mãe-filhos. Clinicamente, estes resultados permitem conhecer as necessidades destas mães e apoiar a elaboração de programas de intervenção psicológica, capazes de responder a essas necessidades, salientando a importância de uma intervenção sistémica e que potencie a expressão emocional.

Adolescent’s subjective perceptions of chronic disease and related psychosocial factors: Highlights from an outpatient context study

Background: Adolescents with chronic disease (CD) can be more vulnerable to adverse psychosocial outcomes. This study aims: 1) to identify differences in psychosocial variables (health-related quality of life, psychosomatic complaints, resilience, self-regulation and social support) among adolescents who feel that CD affects or does not affect school/peers connectedness (measured by self-reported participation in school and social activities); and 2) to assess the extent to which psychosocial variables are associated with connectedness in school and peer domains. Methods: A cross-sectional study was conducted in 135 adolescents with CD (51.9% boys), average age of 14 ± 1. 5 years old (SD = 1.5). Socio-demographic, clinical, and psychosocial variables were assessed, using a self-reported questionnaire, which included the Chronic Conditions Short Questionnaire, KIDSCREEN-10 Index, Symptoms Check-List, Healthy Kids Resilience Assessment Module Scale, Adolescent Self-Regulatory Inventory, and Satisfaction with Social Support Scale. Descriptive statistics, GLM-Univariate ANCOVA and Logistic Regression were performed using the IBM Statistical Package for Social Sciences (SPSS), version 22.0. The significance level was set at p < 0.05. Results: Thirteen to eighteen percent of the adolescents felt that CD affected participation at school (PSCH) and participation in leisure time with friends (PLTF). These adolescents presented lower results for all psychosocial study variables, when compared with adolescents who did not feel affected in both areas of participation. From the studied psychosocial variables, the most important ones associated with PSCH (after controlling for age, gender, diagnosis, and education level of father/mother) were self-regulation and psychosomatic health. Concerning the PLTF, social support was the sole variable explaining such association. Conclusions: The present study pointed out the association between psychosocial variables; and living with a CD and school/peers connectedness. The need to focus on the assessment of the effects of a CD on adolescents’ lives and contexts is suggested, as well as on the identification of vulnerable adolescents. Such identification could help to facilitate the maximization of social participation of adolescents with CD, and to plan interventions centered on providing support and opportunities for a healthy youth development. For that purpose, a complex and multifactorial approach that includes clinicians, schools, family, and peers may be proposed.

Identificação dos principais fatores determinantes do envelhecimento ativo na população idosa do distrito de Castelo Branco - Portugal

Tese de Doutoramento em Gerontologia apresentada à Universidade de Extremadura, Espanha

Exploring psychometric properties of the SF-6D, a preference-based health-related quality of life measure, in the context of spinal cord injury

PURPOSE: The validity of the SF-6D, a preference-based measure of health-related quality of life, is not well explored in the context of spinal cord injury (SCI). The aim of this analysis was to assess appropriate measurement properties of the SF-6D in a sample of individuals living with SCI. METHODS: Longitudinal data from the Rick Hansen Spinal Cord Injury Registry were used. Responses to the 36-item short-form health survey were transformed into SF-6D utility scores. We investigated practicality, floor and ceiling effects, and responsiveness to change. Responsiveness to change was explored using three different anchors that reflected changes in self-reported health, functional independence, and life satisfaction. Discriminative validity was assessed by ten a priori defined hypotheses, with a distinction made between 'strong' and 'weak' hypotheses. RESULTS: Three hundred and fifty-eight individuals with SCI were included in this analysis. Practicality was deemed acceptable based on a completion rate of 94%. The SF-6D showed low responsiveness to detect important health changes over time, and differences in responsiveness were found between individuals with paraplegia and tetraplegia. All five strong hypotheses and three weak hypotheses were confirmed. CONCLUSION: The SF-6D demonstrated good practicality and discriminative validity in this sample. The failure to detect self-reported and clinically important health changes requires further consideration. Comparative performance of the SF-6D (i.e., how the SF-6D performs against other preference-based measures) is unknown in the SCI context and requires further research.

The patient experience of a peripherally inserted central catheter (PICC): A qualitative descriptive study.

UNLABELLED: Abstract Aim: To investigate the patient experience of Peripherally Inserted Central Catheter (PICC) insertion, the significance of arm choice and the impact of the device on activities of daily living. BACKGROUND: Arm choice for PICC insertion is often determined by PICC nurses with little input from consumers. There are few studies that have investigated the patient experience of living with a PICC and none that have examined the impact of arm choice from the consumer's perspective. METHOD: Participants were recruited in a hospital whilst they waited for PICC insertion. A purposeful sampling approach was used to select participants based on diagnosis types. Semi-structured telephone interviews were conducted November 2012-August 2013. Transcripts of the interviews were analysed using thematic analysis. FINDINGS: Ten participants were interviewed. Four themes were identified: (i) apprehension/adaptation/acceptance, (ii) impact of treatment, (iii) asking questions (trusting doctors) and (iv) freedom. Although initially apprehensive, participants adapted to the PICC and came to accept that the device allowed convenient access for treatment. This allowed them the freedom to receive treatment at home. The use of the dominant or non-dominant arm for PICC insertion had marginal impact on activities of daily living for participants. Auxiliary factors such as the infusion pump had a significant impact for those who received outpatient treatment. For those participants who did not understand the procedure, many did not seek clarification and trusted medical and nursing staff to make decisions for them. CONCLUSION: Nurses should involve consumers in clinical decision-making and provide individualised information and support that facilitates adaptation for patients living with a PICC.

FASD: From isolation to inclusion in Australian schools.

This research investigated pedagogical approaches required for the successful inclusion of children and young people living with Fetal Alcohol Spectrum Disorders. The research applied an Indigenist constructivist qualitative method working with one school community. The development of a National Framework for Achieving Inclusion for Australian Students with FASD demands urgent policy and support for educators to meet the complex learning needs of students with FASD.

Protect your body, your temple : Know the Facts about HIV

These bookmarks state: Blacks account for more than 11,000 people living with HIV and AIDS in the state of South Carolina. Blacks account for 27% of the state’s population and 73% of new HIV infections. Among Blacks, men account for 67% of new HIV infections and women account for 33%. The rate of HIV infection for Blacks is more than 7 times as high as the rate among Whites, and more than three times that of Hispanics.