741 resultados para Mental health. Mental health services. Health manpower. Professional role. Politics. Teaching
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Individuals with intellectual disabilities (ID) as a group have been subject to abuse. Individuals with ID need to be made aware of their rights. The 3Rs: Rights, Respect and Responsibility Human Rights Project is promoting rights awareness in individuals with ID, their caregivers and family members. To be effeCtive, abuse prevention must include support from the whole organization and its processes. This research evaluated the impact of the 3Rs initiative on the organization. It focused particularly on descriptions of organizational change perceived by full-time staff and managers in response to the initiation of the 3Rs Project. Behavioural interviews were conducted and a thematic analysis was used to describe changes in the organizational culture and behavioural mechanisms maintaining these changes. Systemic barriers to change were also explored. The results indicate that the Association is effectively implementing and supporting the rights-based philosophy.
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Cette tude de cas vise comparer le modle de soins implant sur le territoire dun centre de sant et des services sociaux (CSSS) de la rgion de Montral aux modles de soins en tapes et examiner linfluence de facteurs contextuels sur limplantation de ce modle. Au total, 13 cliniciens et gestionnaires travaillant linterface entre la premire et la deuxime ligne ont particip une entrevue semi-structure. Les rsultats montrent que le modle de soins hirarchiss implant se compare en plusieurs points aux modles de soins en tapes. Cependant, certains lments de ces derniers sont intgrer afin damliorer lefficience et la qualit des soins, notamment lintroduction de critres dvaluation objectifs et la spcification des interventions dmontres efficaces privilgier. Aussi, plusieurs facteurs influenant limplantation dun modle de soins hirarchiss sont dgags. Parmi ceux-ci, la prsence de concertation et de lieux dapprentissage reprsente un lment cl. Nanmoins, certains lments sont considrer pour favoriser sa russite dont luniformisation des critres et des mcanismes de rfrence, la clarification des rles du guichet daccs en sant mentale et ladhsion des omnipraticiens au modle de soins hirarchiss. En somme, lutilisation des cadres de rfrence et danalyse peut guider les gestionnaires sur les enjeux considrer pour favoriser limplantation dun modle de soins bas sur les donnes probantes, ce qui, long terme, devrait amliorer lefficience des services offerts et leur adquation avec les besoins populationnels.
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Ce mmoire sintresse la centralit des rles via le temps consacr au rle professionnel et au rle familial qui interviennent dans deux principales relations. Premirement, le temps consacr la famille intervient entre le conflit travail famille et la dpression et deuximement le temps consacr au travail simmisce dans la relation prsente entre le conflit famille travail et lpuisement professionnel. Les donnes pour effectuer cette recherche sont celles de lquipe de recherche sur le travail et la sant mentale (ERTSM). Lchantillon est compos de 410 employs du Service de Police de la Ville de Montral (SPVM). Les rsultats des analyses de rgression ont confirm le rle modrateur du temps consacr au rle familial dans la relation entre le conflit travail famille et la dpression. Par contre, le rle modrateur du temps consacr au rle professionnel intervenant entre le conflit famille travail et lpuisement professionnel est infirm. Des analyses complmentaires permettent toutefois de trouver une diffrence entre les hommes et les femmes au niveau de lassociation entre le conflit famille travail et lpuisement professionnel avec le temps consacr au rle professionnel.
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Este artigo pretende fazer um levantamento bibliogrfico sobre a neurose profissional, cujos sintomas so entendidos como a expresso simblica de um conflito psquico que se desenvolve a partir de uma situao organizacional ou profissional determinada. O diagnstico formado a partir das queixas mencionadas, da histria de trabalho e da anlise da situao de trabalho atual. Entende-se que condies estressantes de trabalho, associadas ao contexto social de desemprego e competitividade, contribuem para o aparecimento de doenas mentais como a neurose profissional. As formas de tratamento para essa doena, alm da psicoterapia individual, envolvem a ao integrada de uma equipe multiprofissional capacitada para lidar com o sofrimento psquico do trabalhador e com os aspectos sociais e de interveno nos ambientes de trabalho. Ressalta-se a carncia de literatura sobre o tema estudado e a importncia de se ampliar a discusso sobre os fatores de risco no trabalho, os determinantes psquicos para o desenvolvimento da neurose profissional e o papel do psiclogo no contexto de preveno e promoo da sade mental.
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The perceptions of the Community Health Agent (CHA) referred to ethics in their work have been evaluated in this study. A questionnaire with social and ethical issues was applied in 61 ACS. 90% reported having received information about ethics, and training courses was the most cited source (68.9%). On a scale from 1 (least) to 5 (maximum), 67% claimed to have knowledge about ethics among 4 or 5 and 88.5% reported that this topic has an importance of 5 in their work. Ethical conflicts exposed had an average of 75% of respondents in agreement with the reference sources, and the two items involving information privacy showed the greatest disagreement. Ethics was considered important by the professional performance of subjects who had a good perception about the issue; however the topic about privacy of information generated controversy.
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This case-control study aimed to test the association between voice disorders and job stress among public schoolteachers in Sao Paulo, Brazil. The groups consisted of teachers with (n = 165) and without (n = 105) voice-related complaints. Both groups answered the questionnaires Conditions of Vocal Production and Job Stress Scale. Analysis of cases and controls showed comparable samples, differing only by vocal symptoms. There was a statistically significant difference between cases and controls in relation to job stress involving high strain (OR = 2.1;95%CI: 1.1-3.9), which places high demands combined with low job control. High strain in cases in this study represents the highest risk of physical and mental disorders for teachers. Loss of voice prevents teachers from continuing in their professional role, eliminates their professional identity, and jeopardizes their career.
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Economic and social resources are known to contribute to the unequal distribution of health outcomes. Culture-related factors such as normative beliefs, knowledge and behaviours have also been shown to be associated with health status. The role and function of cultural resources in the unequal distribution of health is addressed. Drawing on the work of French Sociologist Pierre Bourdieu, the concept of cultural capital for its contribution to the current understanding of social inequalities in health is explored. It is suggested that class related cultural resources interact with economic and social capital in the social structuring of people's health chances and choices. It is concluded that cultural capital is a key element in the behavioural transformation of social inequality into health inequality. New directions for empirical research on the interplay between economic, social and cultural capital are outlined.
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Las enfermedades no transmisibles provocan cada ano 38 millones de fallecimientos en el mundo. Entre ellas, tan solo cuatro enfermedades son responsables del 82% de estas muertes: las enfermedades cardiovasculares, las enfermedades crnicas respiratorias, la diabetes, y el cncer. Se prev que estas cifras aumenten en los prximos anos, ya que las tendencias indican que en el ao 2030 las muertes por esta causa ascendern a 53 millones de personas. La Organizacin Mundial de la Salud (OMS) considera importante buscar soluciones para afrontar esta situacin y ha solicitado a los gobiernos del mundo la implementacin de intervenciones para mejorar los hbitos de vida de las personas y reducir as el riesgo de desarrollo de enfermedades no trasmisibles. Cada ao se producen 32 millones de infartos de miocardio y derrames celebrales, de los cuales 12.5 son mortales. En el mundo entre el 40% y 75% de la vctimas de un infarto de miocardio mueren antes de su ingreso en el hospital. En los casos que sobreviven, la adopcin de un estilo de vida saludable puede evitar infartos sucesivo, y supone un ahorro potencial de 6 billones de euros al ao. La rehabilitacin cardiaca es un programa individualizado que aplica un mtodo multidisciplinar para ayudar al paciente a recuperar su condicin fsica, a gestionar la enfermedad cardiovascular y sus comorbilidades, a adoptar hbitos de vida saludables, y a promover su salud mental. La rehabilitacin cardiaca requiere la total involucracin y motivacin del paciente, solo de esta manera se podrn promover hbitos saludables y mejorar la gestin y prevencin de su enfermedad. Aunque la participacin en los programas de rehabilitacin cardiaca es baja, hoy en da existen programas de rehabilitacin cardiaca que el paciente puede realizar en su casa. Estos suponen una solucin prometedora para aumentar la participacin. La rehabilitacin cardiaca se considera una intervencin integral donde los modelos de psicologa de la salud son aplicados para promover un cambio en el estilo de vida de las personas as como para ayudarles a afrontar su propia enfermedad. Existen mtodos para implementar cambios de hbitos y de aptitud, y tambin se considera muy relevante promover no solo el bienestar fsico sino tambin el mental. Existen tecnologas que promueven los cambios de comportamientos en los seres humanos. En concreto, las tecnologas persuasivas y los sistemas de apoyo al cambio de comportamientos modelan las caractersticas, las estrategias y los mtodos de diseo para promover cambios usando la tecnologa. Pero estos modelos tienen algunas limitaciones: todava no se ha definido que rol tienen las emociones en el cambio de comportamientos y como traducir los mtodos de la psicologa de la salud en la tecnologa. Esta tesis se centra en tres elementos que tienen un rol clave en los cambios de hbitos y actitud: el estado fsico, el estado mental, y la tecnologa. -Estado de salud: un estado de salud critico puede modificar la actitud del ser humano respecto al cambio. A la vez un buen estado de salud hace que la necesidad del cambio sea menos percibida. -Estado emocional: la actitud tiene un componente afectivo. Los estados emocionales negativos pueden reducir la habilidad de una persona para adoptar nuevos comportamientos. La salud mental es la situacin ideal donde los individuos tienen predisposicin a los cambios. La tecnologa puede ayudar a las personas a adoptar nuevos hbitos, as como a mantener una salud fsica y mental. Este trabajo de investigacin se centra en el diseo de tecnologas para la mejora del estado fsico y emocional de las personas. Se ha propuesto un marco de diseo llamado Well.Be.Sign. El marco se basa en tres aspectos: El marco terico: representa los elementos que se tienen que definir para disear tecnologas para promover el bienestar de las personas. -El diagrama de influencia: presenta las fuerzas de persuasin en el contexto de la salud. El rol de las tecnologas persuasivas ha sido contextualizado en una dimensin donde otros elementos influencian el usuario. El proceso de diseo: describe el proceso de diseo utilizando una metodologa iterativa e incremental que aplica una combinacin de mtodos de diseo existentes (Diseo Orientado a Objetivos, Diseo de Sistemas Persuasivos) as como elementos originales de este trabajo de investigacin. Los mtodos se han aplicados para disear un sistema que ofrezca un programa de tele-rehabilitacin cardiaca. Inicialmente se ha diseado un prototipo de acuerdo con las necesidades del usuario. En segundo lugar, el prototipo se ha extendido especificando la intervencin requerida para al programa de rehabilitacin cardiaca. Finalmente el sistema se ha desarrollado y validado en un ensayo clnico con grupo control, donde se observaron las variaciones del estado cardiovascular, el nivel de conocimiento acerca de la enfermedad, la percepcin de la enfermedad, la persistencia de hbitos saludables, y la aceptabilidad del sistema. Los resultados muestran que el grupo de intervencin tiene una superior capacidad cardiovascular, mejor conocimiento acerca de la enfermedad, y ms percepcin de control de la enfermedad. Asimismo, en algunos casos se ha registrado persistencia de los hbitos de ejercicios 6 meses despus del uso del sistema. Otros dos estudios se han presentado para demonstrar la relevancia del estado emocional del usuario en el diseo de aplicaciones para la promocin del bienestar. En personas con una grave enfermedad crnica como la insuficiencia cardiaca, donde se ha presentado las conexiones entre estado de salud y estado emocional. En el estudio se ensena la relaciones que tienen los sntomas y las emociones negativas y como un estado negativo emocional puede empeorar la condicin fsica del paciente. -Personas con trastornos del humor: el estudio muestra como las emociones pueden tener un impacto en la percepcin de la tecnologa por parte del usuario. ABSTRACT Noncommunicable diseases (NCDs) cause the death of 38 million people every year. Four major NCDs are responsible for 82% of these deaths: cardio vascular disease, chronic respiratory disease, diabetes and cancer. These pandemic numbers are projected to raise to 53 million deaths in 2030, and for this reason the assembly of the World Health Organization (WHO) considers communicable diseases as an urgent need to be addressed. It is also a trend to advocate the adoption of mobile technology to deliver health services and to promote healthy behaviours among citizens, but adopting healthS promoting lifestyle is still a difficult task facing human tendencies. Within this context, there is a promising opportunity: persuasive technologies. These technologies are intentionally designed to change a persons attitudes or behaviours; when applied in this context, than can be used to change health-related attitudes, beliefs, and behaviours. Each year there are 32 million heart attacks and strokes globally, of which about 12.5 million are fatal. Worldwide between 40 and 75% of all heart-attack victims die before reaching hospital. Avoiding a second heart attack by improving adherence to lifestyle and medication regimens has a cost saving potential of around 6 billion per year. In most of the cases the cardiovascular event has been provoked by unhealthy lifestyle. Furthermore, after an MI event the patient's decision to adopt or not healthier behaviour will influence the progress of the disease. Cardio-rehabilitation is an individualized program that follows a multidisciplinary approach to support the user to recover from the Myocardial Infarction, manage the Cardio Vascular Disease and the comorbidities, adopt healthy habits, and cope with any emotional distress. Cardio- rehabilitation requires patient participation and willingness to perform behavioral modifications and change the attitude toward the management and prevention of the disease. Participation in the Cardio Rehabilitation program is not high; the home-based rehabilitation program is a promising solution to increase participation. Nowadays cardio rehabilitation is considered a comprehensive intervention in which models of health psychology are applied to promote the behaviour change of the individuals. Relevant methods that have been successfully applied to foster healthy habits include the Health Belief Model and the Trans Theoretical Model. Studies also demonstrate the importance to promote not only the physical but also the mental well being of the individuals. The idea of also promoting behaviour change using technologies has been defined by the literature as persuasive technologies or behaviour change support systems, in which the features, the strategies and the design method have been modelled to foster the behaviour change using technology. Limitations have been found in this model: there is still research to be done on the role of the emotions and how psychological health intervention can be translated into computer methods. This research focuses on three elements that could foster behaviour change in individuals: the physical and emotional status of the person, and the technology. Every component can influence the user's attitude and behaviour in the following ways: ' Physical status: bad physical status could change human attitude toward the necessity to adopt health behaviours; at the same time, good health status reduces the need to adopt healthy habits. ' Emotional status: the attitude has an affective component, negative emotional state can reduce the ability of a person to adopt new behaviours, and mental well being is the ideal situation in which individuals have a predisposition to adopt healthy behaviours. ' Technology: it can help users to adopt new behaviours and can also be support to promote physical and emotional status. Following this approach the idea driven in this research is that technology that is designed to improve the physical status and the emotional status of the individual could better foster behaviour change. According to this principle, the Well.Be.Sign framework has been proposed. The framework is based on three views: ' The theoretical framework: it represents the patterns that have to be defined to design the technologies to promote well being. ' The influence diagram: it shows the persuasive forces in the context of health care. The role of the persuasive technologies is contextualized in a wider universe where other factors and persuasive forces influence a patient. ' The design process: it shows the process of design using an iterative, incremental methodology that applies a combination of existing methodologies (Goal Directed Design and Persuasive System Design) and others that are original to this research. The methods have been applied to design a system to deliver cardio rehabilitation at home: first a prototype has been defined according to the users needs, then it has been extended with the specific intervention required for the cardiorehabilitation, finally the system has been developed and validated in a controlled clinical study in which the cardiovascular fitness, the level of knowledge, the perception of the illness, the persistence of healthy habits and the system acceptance (only the intervention group) were measured. The results show that the intervention group increased cardiovascular capacity, knowledge, feeling of control of illness and perceived benefits of exercise at the end of the study. After six months of the study, a followSup of the exercise habits was performed. Some individuals of the intervention group continued to be engaged in the running exercise sessions promoted in the designed system. Two other cases have been presented to demonstrate the foundations of the Well.Be.Signs approach to promote both physical and emotional status: ' People affected by Heart Failure, in which a bidirectional connection between health status and emotions has been discussed with patients. Two correlations were demonstrated: the relationship between symptoms and negative emotional response, and that negative emotional status is correlated with worsening of chronic conditions. ' People with mood disorders: the study shows that emotions could also impact how the user perceives the technology.
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A transformao nos modos de organizar e produzir ateno em sade exige a inveno de dispositivos com potncia para proporcionar espaos coletivos de anlise acerca da produo da gesto e do cuidado. O apoio tecido por mltiplas relaes, interesses, projetos e agenciamentos. Fabricado no encontro, um intercessor que pode favorecer reflexes sobre a micropoltica do trabalho, sobre os encontros entre trabalhadores e usurios, entre trabalhadores e entre trabalhadores e gesto, agenciando possibilidades de anlise do cotidiano e interferncias sobre os modos de cuidar e de gerir. As interrogaes sobre o cuidado podem abrir zonas de visibilidade aos processos de trabalho, discursos, prticas e relaes de poder. A pesquisa procurou analisar o processo de fabricao do apoio na rede de ateno sade no municpio de So Bernardo do Campo e seus efeitos. O municpio organizou nove ncleos territoriais em sade, cada qual com um grupo de at cinco apoiadores constitudo por trabalhadores com formaes variadas. Ademais, conta com uma dupla de facilitadores de educao permanente, ligados gesto nos diferentes departamentos da Secretaria de Sade e orientadores de educao permanente que tem a funo de dar suporte aos apoiadores e facilitar os processos de educao permanente nos territrios. No desenho de So Bernardo, o apoio uma ferramenta estratgica para a construo do cuidado em rede e para a anlise das prticas de sade. H uma forte aposta da gesto na criao de espaos coletivos e dispositivos de conexo entre os departamentos, servios, gestores e trabalhadores na inteno de suscitar transversalidade e combater a estrutura vertical de sua organizao. O municpio vive uma intensa criao de dispositivos mobilizadores de encontros, propostos para a construo de redes e de gesto compartilhada do cuidado. Por meio de andanas com os apoiadores em variados territrios, conversas, afeces, registros em dirio de campo, narrativas e documentos, tecemos uma cartografia: composio de cenrios, de perspectivas e de analisadores, sentidos abertos, mltiplos e conectveis. A abordagem cartogrfica acompanha processos, persegue rastros e traados, se movimenta entre linhas, sustenta problemticas; nela, somos pesquisadores in-mundos, nos infectamos, nos misturamos, sempre implicados e em produo com os mundos pesquisados. Mesmo sendo uma aposta de governo, tensionamentos e conflitos acontecem no cotidiano, relacionados a diferentes prioridades, agendas, quebra de acordos, interrupo de projetos. As produes do apoio vm fomentando conexes entre os servios, contribuindo com o matriciamento de sade mental e de outras especialidades na ateno bsica e entre os trabalhadores da ateno especializada, fortalecendo redes, estimulando anlises coletivas sobre o cuidado, criando estratgias e ferramentas, transformaes em fluxos e na regulao. O apoio no funo somente do apoiador, pode ser agenciado por variados atores. Por fim, a auto-anlise, quando acontece, potencializa o apoio como dispositivo, provisrio, ativador de processos e de protagonismo coletivo.
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The aims of the current study were to describe presence and clinical role over time of Streptococcus pluranimalium isolated in milk samples of Mediterranean buffalo (MB). Two hundred composite milk samples originating from 40 primiparous MB were collected at 10, 30, 60, 90, and 150d in milk (DIM) and from 20 pluriparous MB at 77 to 120 DIM. Milk samples were used for analysis of somatic cell counts, bacteriological cultures, and identification (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). Nine of 200 (4.5%) samples of primiparous MB and 3 of 20 (15%) samples of pluriparous MB were positive for Strep. pluranimalium. The prevalence of the bacterium in primipari was 0% (0/40) at 10, 30, and 150 DIM, whereas it was 5 (2/40) and 17.5% (7/40) at 60 and 90 DIM, respectively. Eight primipari were positive only once, whereas 1 was positive at 2 different samplings. Mono-infection was not detected in any of the age categories or udder health status. Infections were transient in primipari. Clinical mastitis was observed in primipari once at 90 DIM, subclinical mastitis detected twice in the same animals at 60 and 90 DIM, and intramammary infections were diagnosed 1 and 5 times at 60 and 90 DIM in primipari, respectively, whereas 3 infections were diagnosed in pluripari. The clinical reflections demonstrate for the first time the presence of Strep. pluranimalium in MB and its association with different udder health status. Nevertheless, it cannot be excluded that the bacterium may simply follow a pattern of commensal or opportunistic behavior, taking advantage of a preexisting bacterial udder infection.
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A adeso teraputica medicamentosa por idosos um fenmeno dependente de fatores diversificados. Defende-se como tese: A adeso aos medicamentos prescritos em idosos em atendimento ambulatorial apresenta-se relacionada aos fatores referentes s caractersticas: demogrficas, socioeconmicas; dos servios de sade, dos profissionais de sade; das condies de sade; da teraputica medicamentosa; comportamentais. Esses fatores esto relacionados aos principais motivos referidos pelos idosos para aderirem ou no aos medicamentos prescritos. Foram objetivos: identificar na literatura brasileira e estrangeira a prevalncia de adeso teraputica medicamentosa e os fatores relacionados em idosos; caracterizar os idosos em atendimento ambulatorial em um hospital universitrio no Rio Grande/RS, Brasil, quanto s caractersticas demogrficas, socioeconmicas, condies de sade e uso de medicamentos; identificar os motivos referidos por estes idosos que levavam adeso/no adeso teraputica medicamentosa; verificar a prevalncia de adeso teraputica medicamentosa nestes idosos; verificar se h associao entre adeso teraputica medicamentosa e fatores demogrficos, socioeconmicos, condies de sade, teraputica medicamentosa e fatores comportamentais destes idosos. Pesquisa realizada por meio de uma reviso integrativa da literatura e de um estudo quantitativo. Na reviso integrativa selecionaram-se 49 artigos e os fatores identificados foram organizados nas categorias: demogrficas e socioeconmicas; sistema e profissionais de sade; condies de sade; teraputica medicamentosa; comportamentais. O estudo quantitativo foi exploratrio, descritivo, transversal, realizado em um servio ambulatorial de um hospital universitrio no Rio Grande/RS, Brasil. Participaram 107 idosos que responderam ao instrumento para caracterizao do idoso e dos fatores relacionados adeso teraputica medicamentosa; ao Miniexame do Estado Mental; Escala de Medida de Adeso aos Tratamentos. A coleta de dados foi realizada em novembro de 2013. Realizou-se anlise estatstica descritiva e inferencial. Verificaram-se mais idosos do sexo feminino, na faixa etria entre 60-69 anos. A doena mais prevalente foi a Hipertenso Arterial e a mdia de uso de medicamentos por dia foi de 4,8. Querer sentir-se bem/manter a sade e querer controlar a doena e os sintomas foram os motivos para aderir teraputica medicamentosa prescrita. A ocorrncia de reao adversa e falta de condies financeiras foram os motivos para no aderir. A prevalncia de adeso teraputica medicamentosa foi de 86,9%. Houve associao entre a adeso e receber orientaes do mdico sobre como tomar os medicamentos, ter reao adversa, acreditar que os medicamentos so importantes para manuteno da sade e ter vontade de no tomar os medicamentos. A tese confirmada em parte: a adeso aos medicamentos prescritos em idosos em atendimento ambulatorial apresenta-se relacionada aos fatores referentes s caractersticas: dos profissionais de sade; das condies de sade; da teraputica medicamentosa; comportamentais. Esses fatores estiveram relacionados aos principais motivos referidos pelos idosos para aderirem ou no aos medicamentos prescritos. Por outro lado, a adeso no apresentou relao com os fatores demogrficos e socioeconmicos, embora as condies financeiras tenham sido referidas pelos idosos como um motivo que leva no adeso.
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O presente relatrio descreve as atividades de estgio desenvolvidas no mbito do Ramo de Aprofundamento de Competncias Profissionais (RACP) do mestrado em Reabilitao Psicomotora da Faculdade de Motricidade Humana. O estgio profissionalizante realizou-se no servio de psiquiatria do Hospital Prof. Doutor Fernando Fonseca, e contou com sesses de observao participada e interveno psicomotora na equipa de pedopsiquiatria e de psiquiatria de adultos. O relatrio inclui um enquadramento terico com uma reviso legal da sade mental e o enquadramento profissional do psicomotricista, da prtica psicomotora em sade mental e uma reviso de literatura das psicopatologias mais prevalentes, destacando os principais objetivos da psicomotricidade em cada uma delas. Inclui tambm o enquadramento da prtica profissional, no qual se descreve a organizao das atividades de estgio, a caracterizao dos utentes acompanhados e do processo teraputico com dois estudos-caso. Este estgio permitiu a participao da aluna numa equipa multidisciplinar, e contribuiu positivamente para a sua formao profissional e pessoal, no mbito dos objetivos definidos pelo RACP no contexto da prtica em sade mental. Considerando as evolues observadas nos diferentes utentes acompanhados conclui-se que a interveno psicomotora realizada foi pertinente quer no contexto pedopsiquitrico, quer no contexto psiquitrico.
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The issue of health professionals facing criminal charges of manslaughter or criminal negligence causing death or grievous bodily harm as a result of alleged negligence in their professional practice was thrown into stark relief by the recent acquittal of four physicians accused of mismanaging Canadas blood system in the early 1980s. Stories like these, as well as international reports detailing an increase in the numbers of physicians being charged with (and in some cases convicted of) serious criminal offences as the result of alleged negligence in their professional practice, have resulted in some anxiety about the apparent increase in the incidence of such charges and their appropriateness in the healthcare context. Whilst research has focused on the incidence, nature and appropriateness of criminal charges against health professionals, particularly physicians, for alleged negligence in their professional practice in the United Kingdom, the United States, Japan, and New Zealand, the Canadian context has yet to be examined. This article examines the Canadian context and how the criminal law is used to regulate the negligent acts or omissions of a health care professional in the course of their professional practice. It also assesses the appropriateness of such use. It is important at this point to state that the analysis in this article does not focus on those, fortunately few, cases where a health professional has intentionally killed his or her patients but rather when patients deaths or grievous injuries were allegedly as a result of that health professionals negligent acts or omissions when providing health services to that patient.
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Background Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. Methods/design Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke; 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or; 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. Discussion This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions.
