Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

A influência do constragimento posicional da baliza no processo decisional ofensivo no hóquei patins

O presente estudo visa entender e analisar a influência do constrangimento posicional da baliza no processo decisional ofensivo no Hóquei em Patins, efectuada a partir da observação do jogo e visando a optimização do rendimento desportivo. Perante a possibilidade de ocorrência de acções particulares à modalidade em torno da baliza, em permanente dinâmica e interacção com o contexto, procurou-se compreender o comportamento decisional ofensivo do hoquista que actue atrás da baliza, através de uma perspectiva baseada na psicologia ecológica e na teoria dos sistemas dinâmicos. A amostra do estudo foi constituída por 10 jogos do Campeonato Nacional da Primeira Divisão 2007/2008, entre equipas que se classificaram para o play-off de acesso ao título, tendose registado 816 sequências ofensivas, que resultaram num total de 2732 multieventos. Em termos metodológicos, recorreu-se à metodologia observacional, tendo-se efectuado a exploração dos dados fundamentalmente através da análise sequencial, tanto prospectiva como retrospectiva, utilizando o software SDIS-GSEQ. A partir dos resultados obtidos foi possível estimar padrões de conduta relativos ao tipo processo ofensivo analisado, que permitem concluir que: (1) é significativa a probabilidade de um início sem bola de frente activar a ocorrência de acções na área de baliza e de um início com bola de frente activar a ocorrência de acções atrás da baliza; (2) o início com bola no geral e o início com bola de frente em particular, têm uma probabilidade significativa de activar uma acção mais linear. Por outro lado, o início sem bola no geral e o início sem bola com paragem em particular, têm uma probabilidade significativa de activar um comportamento decisional mais aleatório; (3) é significativa a probabilidade de um início sem bola activar uma resposta defensiva pela frente da baliza e de um início com bola activar uma resposta defensiva atrás da baliza; (4) é significativa a probabilidade do modo de comportamento decisional ofensivo no desenvolvimento do processo influenciar a eficiência das acções de finalização, com as acções lineares a potenciarem a ocorrência de acções visando o controlo da bola e as acções não lineares a potenciarem a ocorrência de situações de remate; (5) é significativa a probabilidade do modo de comportamento decisional defensivo no desenvolvimento do processo influenciar a eficácia das acções de finalização, com uma resposta defensiva atrás da baliza a activar uma acção final com eficácia relativa com controlo da bola e uma resposta defensiva pela frente da baliza a activar uma acção final com remate.

A dinâmica decisional no badminton: o acoplamento serviço-recepção nos atletas de singulares homens de elite mundial

O Badminton assume-se como um jogo de confrontação directa, muito dinâmico e complexo, considerado por muitos como o desporto de raquetes mais rápido do mundo. Nesta modalidade, as acções dos jogadores são executadas de forma balística constantemente e onde as jogadas se desenrolam a alta velocidade, obrigando os jogadores a realizarem constantes e rápidos ajustes durante o jogo. Neste contexto de incerteza e constrangimentos constantes, as inúmeras tomadas de decisão dos jogadores acontecem tipicamente sobre uma enorme e constante pressão temporal, durante praticamente todo o jogo. Assim, o presente estudo pretende ser mais um contributo importante para a compreensão dos processos da tomada de decisão no Badminton, segundo uma perspectiva englobada na teoria da psicologia ecológica do desporto, alicerçada na percepção directa, nos sistemas dinâmicos, nos constrangimentos e no processo da tomada de decisão. Pretendeu-se neste estudo analisar o processo da dinâmica decisional do Badminton, mais especificamente, o acoplamento serviço-recepção nos jogadores de singulares homens de elite mundial, através da detecção da estabilidade de padrões de comportamento nas acções dos jogadores ao longo dos jogos. Para a elaboração do estudo recorreu-se à metodologia observacional, onde foi criado e utilizado um instrumento de observação de formato de campo com sistema de categorias, validado através de um questionário aplicado a um grupo de treinadores peritos na modalidade. Posteriormente, efectuou-se a exploração e interpretação dos dados mediante a utilização da análise descritiva e sequencial com transições, de forma prospectiva e retrospectiva. Os resultados do estudo permitiram concluir que, (1); existem padrões de acção dos jogadores quer no serviço, quer na recepção do serviço; (2) A realização do serviço e a recepção do serviço estão associados a zonas específicas do campo; (3) O resultado final do jogo está associado à eficácia dos batimentos na fase de desenvolvimento das jogadas; (4) Os jogadores vencedores dos jogos observados utilizaram uma maior variação nos serviços, nas recepções e nos tipos de batimento no decorrer das jogadas; (5) Os jogadores que foram vencidos nos jogos observados utilizaram uma menor variação nos serviços, nas recepções e nos batimentos durante as jogadas.

Saturação em CO2 e regulação metabólica do bacterioplancton em ecossistemas aquáticos de baixa latitude

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Annual profile of fecal androgen and glucocorticoid levels in free-living male American kestrels from southern mid-latitude areas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Morphometric variations in the housefly, Musca domestica (L.) with latitude

Morphologic analysis of geographic strains of Musca domestica carried out on natural and laboratory experiments starting with 400 and 800 eggs showed phenotypic variations related with latitude. Females of the natural populations showed clines for several morphological traits of the wing, whereas male flies showed a reduction in the dispersion measures (s2 and CV) of wing width and length. The same reduction was obtained for males, females and total number of flies of the natural populations in dispersion of the number of bristles on the fourth abdominal sternite. A significant negative correlation was observed for the head width of females and for the total number of flies emerged in the laboratory experiments started with 400 eggs. All flies produced by the experiments starting with 800 eggs showed a reduction in variability of dispersion of the bristles on the fourth abdominal sternite in the strains obtained from locations south of the area analyzed. Evolutionary aspects of these correlation coefficients between morphometric traits and latitude are discussed.

Low latitude scintillations: A comparison of modeling and observations within the CIGALA project

Ionospheric scintillations can seriously jeopardize the reliability of the GNSS signals and consequently can cause significant error or outage on precise positioning applications. The threat is most acute at low latitudes where ionospheric irregularities are more likely to occur resulting in L-band signal scintillations. This paper describes the effort made to model the ionospheric scintillations over the Latin American region in the frame of the CIGALA project funded by the European GNSS Supervisory Authority within the 7th Framework Programme of the European Commission. Comparisons between the low-latitude model of scintillations and observations are here presented and discussed within the project perspectives. © 2011 IEEE.

Diagnostics of equatorial and low latitude ionosphere by TEC mapping over Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Macroecology of Caribbean Bats: Effects of Area, Elevation, Latitude, and Hurricane-Induced Disturbance

Understanding the geographic and environmental characteristics of islands that affect aspects of biodiversity is a major theme in ecology (Begon et al. 2006; Krebs 2001) and biogeography (Cox and Moore 2000; Drakare et al. 2006; Lomolino et al. 2006). Such understanding has become particularly relevant over the past century because human activities on continents have fragmented natural landscapes, often creating islands of isolated habitat dispersed within a sea of land uses that include agriculture, forestry, and various degrees of urban and suburban development. The increasingly fragmented or islandlike structure of mainland habitats has critical ramifications to conservation biology, as it provides insights regarding the mechanisms leading to species persistence and loss. Consequently, the study of patterns and mechanisms associated with island biodiversity is of interest in its own right (Whittaker 1998; Williamson 1981), and may provide critical insights into mainland phenomena that otherwise could not be studied because of ethical, financial, or logistical considerations involved with the execution of large-scale manipulative experiments.

Abrupt changes in high-latitude nutrient supply to the Atlantic during the last glacial cycle

The supply of nutrients to the low-latitude thermocline is largely controlled by intermediate-depth waters formed at the surface in the high southern latitudes. Silicic acid is an essential macronutrient for diatoms, which are responsible for a significant portion of marine carbon export production. Changes in ocean circulation, such as those observed during the last deglaciation, would influence the nutrient composition of the thermocline and, therefore, the relative abundance of diatoms in the low latitudes. Here we present the first record of the silicic acid content of the Atlantic over the last glacial cycle. Our results show that at intermediate depths of the South Atlantic, the silicic acid concentration was the same at the Last Glacial Maximum (LGM) as it is today, overprinted by high silicic acid pulses that coincided with abrupt changes in ocean and atmospheric circulation during Heinrich Stadials and the Younger Dryas. We suggest these pulses were caused by changes in intermediate water formation resulting from shifts in the subpolar hydrological cycle, with fundamental implications for the nutrient supply to the Atlantic.

A new snowfall detection algorithm for high latitude regions based on a combination of active and passive sensors

Precipitation retrieval over high latitudes, particularly snowfall retrieval over ice and snow, using satellite-based passive microwave spectrometers, is currently an unsolved problem. The challenge results from the large variability of microwave emissivity spectra for snow and ice surfaces, which can mimic, to some degree, the spectral characteristics of snowfall. This work focuses on the investigation of a new snowfall detection algorithm specific for high latitude regions, based on a combination of active and passive sensors able to discriminate between snowing and non snowing areas. The space-borne Cloud Profiling Radar (on CloudSat), the Advanced Microwave Sensor units A and B (on NOAA-16) and the infrared spectrometer MODIS (on AQUA) have been co-located for 365 days, from October 1st 2006 to September 30th, 2007. CloudSat products have been used as truth to calibrate and validate all the proposed algorithms. The methodological approach followed can be summarised into two different steps. In a first step, an empirical search for a threshold, aimed at discriminating the case of no snow, was performed, following Kongoli et al. [2003]. This single-channel approach has not produced appropriate results, a more statistically sound approach was attempted. Two different techniques, which allow to compute the probability above and below a Brightness Temperature (BT) threshold, have been used on the available data. The first technique is based upon a Logistic Distribution to represent the probability of Snow given the predictors. The second technique, defined Bayesian Multivariate Binary Predictor (BMBP), is a fully Bayesian technique not requiring any hypothesis on the shape of the probabilistic model (such as for instance the Logistic), which only requires the estimation of the BT thresholds. The results obtained show that both methods proposed are able to discriminate snowing and non snowing condition over the Polar regions with a probability of correct detection larger than 0.5, highlighting the importance of a multispectral approach.