Treatment non-adherence in teenage and young adult patients with cancer

Adhering to treatment can be a significant issue for many patients diagnosed with chronic health conditions and this has been reported to be greater during the adolescent years. However, little is known about treatment adherence in teenage and young adult (TYA) patients with cancer. To increase awareness of the adherence challenges faced by these patients, we have reviewed the published work. The available evidence suggests that a substantial proportion of TYA patients with cancer do have difficulties, with reports that up to 63% of patients do not adhere to their treatment regimens. However, with inconsistent findings across studies, the true extent of non-adherence for these young patients is still unclear. Furthermore, it is apparent that there are many components of the cancer treatment regimen that have yet to be assessed in relation to patient adherence. Factors that have been shown to affect treatment adherence in TYA patients include patient emotional functioning (depression and self-esteem), patient health beliefs (perceived illness severity and vulnerability), and family environment (parental support and parent–child concordance). Strategies that foster greater patient adherence are also identified. These strategies are multifactorial, targeting not only the patient, but the health professional, family, and treatment regimen. This review highlights the lack of interventional studies addressing treatment adherence in TYA patients with cancer, with only one such intervention being identified: a video game intervention focusing on behavioural issues related to cancer treatment and care. Methodological issues in measuring adherence are addressed and suggestions for improving the design of future adherence studies highlighted, of which there is a great need.

Öppna arenor och slutna rum : några kommunikationskonsulter i Dalarna ser på opinionsbildning

Syftet med denna uppsats är att ta reda på hur lokala kommunikationskonsulter i Falun/Borlänge-regionen ser på opinionsbildning via professionella konsulter. De centrala begrepp som avhandlas är PR, opinionsbildning och lobbying.Den teoretiska ram som omger undersökningen består av de teoribyggen som skapats av Jürgen Habermas, James E. Grunig och Larsåke Larsson. Habermas ställer sig tveksam till den demokratiska nyttan av professionell opinionsbildning, Grunig är mer positiv och Larsson ser både för- och nackdelar med PR-verksamheten. Larssons undersökning av opinionskonsulter från 2005 refereras också.Undersökningen bygger på intervjuer med ett antal kommunikationskonsulter verksamma i Falun och Borlänge. Den lokala marknaden för opinionsbildande uppdrag diskuteras, men också huruvida politiska uppdrag förser byråerna med politisk färg. Huruvida medarbetarnas engagemang är viktigt och hur hög statusen på opinionsbildande uppdrag är ventileras, samt vilka arbetsmetoder som används. Intervjuerna behandlar också förekomsten av lobbying på lokal nivå. Till slut redogör de intervjuade för sin syn på hur opinionsbildning, PR och lobbying via konsulter påverkar demokratin.Under slutsatser diskuteras resultatet i relation till den teoretiska ramen. Att PR- och reklambranscherna alltmer växer samman och att opinionsbildning är ett vanligt inslag i många projekt är ett faktum som också skymtat fram i den teoretiska ramen. Men reklam- och PR-metoder integreras också i politiken, på gott och ont. Följaktligen växer den gråzon som finns mellan de olika typerna av kommunikation och mellan opinionsbildande och icke-opinionsbildande uppdrag. Det försvårar gränsdragning och tydlighet, men skapar nya kreativa möjligheter.Att den ökade användningen av kommunikationskonsulter kanske kan bidra till en orättvis fördel för resursstarka organisationer diskuteras. Ny teknik, t.ex. Internet, kan dock eventuellt vara den motvikt som gör det möjligt även för resurssvaga grupper att höras i det offentliga samtalet. Kommunikation som maktfaktor tas även upp utifrån termer som lobbying och medias dagordningsfunktion.Några aspekter av den outnyttjade potential som PR har ventileras också. PR som metod är en outnyttjad resurs på det lokala planet, något som kan bero både på okunskap hos de lokala kunderna och ett traditionellt arbetssätt hos byråerna. Utifrån intervjusvaren framkommer att både byråerna, deras kunder och media på landsorten skulle gynnas av ett större samarbete.Resultaten av intervjuerna stöder mycket i den teoretiska ramen, medan somligt förkastas. Som sammanfattning kan sägas att opinionsbildning via konsulter kan användas för både gott och ont. Vilket som blir resultatet handlar som oftast om etik, ansvar, öppenhet och professionalitet.ABSTRACTThe primary target for this report is to find out how communication consultants in the region of Falun and Borlänge views the practice of establishing public opinions by using professional public relations consultants. The concepts in focus are PR, the moulding of public opinion and lobbying.The theoretical framework surrounding this report is the writings by Jürgen Habermas, James E. Grunig and Larsåke Larsson. Habermas has doubts as to the democratic use of professional consultants working with public opinions, Grunig has a somewhat more positive approach and Larsson sees both advantages and disadvantages in a democratic sense with the PR industry. Larssons research concerning consultants working with the moulding of public opinions from 2005 is also reviewed. The research is carried out by interviewing some communication consultants working in the Falun /Borlänge- area. The local market for commissions concerning public opinions is discussed, but also if and how political commissions are forcing a political stamp upon the firms engaging in such commissions. The importance of personal commitment in the consultants and the level of prominence commissions concerning public opinion has in the business is discussed, but also which methods is used and preferred. The interviews also deal with the practice of lobbying in the local arena. Finally the participants state their views on how the moulding of public opinion, PR and lobbying effects the democracy. Conclusively, the result is put in relation to the theories earlier mentioned. The public relations market is merging with the advertising business, that is a fact, and establishing public opinion is a common element in a lot of projects. But methods used for advertising and PR are also integrated in the political sphere, for good and bad. That has made the distinction between different kinds of communication harder, thereby enhancing the difficulties of establishing boundaries and achieving clarity. Yet at the same time it facilitates new creative opportunities.The growing use of communication consultants may contribute to unfair advantages for organisations with large economic resources. New technical development though, such as the Internet for example, may prove to simplify communication for groups with lesser economic power. Communication as an aspect of power is being discussed in terms of lobbying and the agenda setting power of media.Some aspects of the unused potential that lies within PR are also in focus in this report. PR as a method is an unused resource in the local market, which can be due to the local clients lack of knowledge but also to the traditional work carried out by the communication firms. The findings of the interviews show that both communication firms, their clients and the local media would benefit from greater cooperation.The theoretical base in this work is mostly supported by the interviews, though a few of the findings does not agree. The moulding of public opinions by professional consultants can be used for both good and bad. What the result will be is, not surprisingly, a question of ethics, responsibility, openness and professionalism.

A new Home, far from Home : The assimilation process of women involved in intercultural marriages based on Internet meeting

The internet has revolutionized the way we socialize, and as a consequence the way to love. The new communication technologies have facilitated intercultural relationships. Nowadays family relations are one of the major factors in immigration to European countries. Family relations means persons who arrive as family dependents and in accordance with laws regulating family reunification. This thesis aims to apply the classical assimilation theory stated by Milton Gordon (1964), which formulates a series of assimilation stages through which an individual must pass in order to be completely assimilated. In accordance with this theory, marriage is the final phase for a newcomer to fully incorporate into the host society. Thus, based on this presumption and other contemporary theories, the present study has analysed how women who get involved in intercultural marriages based on internet meeting experience these assimilation stages and evaluated the resources used by respondents to incorporate themselves into Swedish society.The main goal of the study was to determine if jumping to the last stage of assimilation does assure the incorporation in the social or/and labour spheres and the findings demonstrate that even though husbands are a valuable resource for assimilation, several cultural issues in Swedish society make it difficult to assure success for the newcomers.On the other hand, Sweden is a country with a strong national sentiment and the assimilation of immigrants still is an important issue to deal with. The Swedish Integration Board has disappeared and major projects for integration have been left in the hands of the municipalities or the Migration Board, institutions that still do not know how to deal with this dilemma.

"Ungerska för rötternas skull" : Språkval och identitet bland andragenerationens ungrare i Sverige och Finland

This thesis is a comparative sociolinguistic study which describes and compares language choice among people with Hungarian background in Sweden and Finland and studies their views on the importance of the Hungarian language and Hungarian cultural heritage for identity. The future prospects of language maintenance and language shift and differences between the Swedish-Hungarians and the Finnish-Hungarians are discussed. A survey was completed among 50 Swedish-Hungarian informants and 38 Finnish-Hungarian informants during 2006. The survey was supplemented by in-depth interviews with 15 informants during 2007. The majority language, either Swedish or Finnish, is much more active in the second-generation Hungarians’ lives than Hungarian is. Hungarian is mostly used in the domain of family relations. The language choices made today are dependent on the informant’s situation during childhood, particularly the parents’ usage of the language and the ability to learn and use Hungarian, chiefly gained through contact with the parents’ mother country and other Hungarian speakers. For some informants, having Hungarian roots forms the sole foundation for belonging, while for others it is this heritage combined with the culture, the ability to use the language or specific character traits. The Hungarian background is most often seen as a treasure offering diversity in life. Finnish-Hungarians are generally more positive about their Hungarian background, have better competence in the language and a greater awareness of the culture than Swedish-Hungarians. The Hungarian language plays a central though often symbolic role. The most important conditions for minority language preservation are language competence together with the desire and opportunity to use it; whereof the largest deficit among second-generation Hungarians is knowledge of the Hungarian language. Only one-fourth of the informants have all of the conditions necessary to be able to maintain the language, which means that Hungarian is an endangered minority language in Sweden and Finland.

Método mãe-canguru: vivência de mães no alojamento conjunto

DAVIM, Rejane Marie Barbosa;ENDERS, Bertha Cruz; DANTAS, Janmilli da Costa; SILVA, Richardson Augusto Rosendo da; NÓBREGA, Edualeide Jeane Pereira Bulhões da. Método mãe-canguru: vivência de mães no alojamento conjunto. Revista da Rede de Enfermagem do Nordeste, Fortaleza, v. 10, n. 1, p. 37-44, jan./mar.2009.

O processo de cuidar em Unidade de Terapia Intensiva

The environment of Intensive Care Unit (ICU) is commonly referred to as a place where caring is inextricably linked to high technology. The care in ICU often changes the patient into a taxpayer being left apart from its complexity and sometimes seen through a reductionist perspective. Thus, studies circa the care process are needed oriented from a historical ransom, raising the prospect of a more centralized human care. Hence, this study aimed to analyze the care process in a nursing intensive care unit from the perspective of the professional, family and patients. The study is characterized from a qualitative, descriptive and exploratory methodological approach. The actors were participating nursing professionals, patients and family members of an intensive care unit of Mossoró / RN. Data were collected in the period of May-June 2011, through interviews and observation of activities performed by nursing professionals, and their records in the chart. Data analysis was divided into topics and subtopics representing the phases and shapes that formed the collection. The analysis and discussion of the interviews were based on Bardin's proposal, when we created categories from a process of sorting and grouping criteria adequately defined. The observation of nursing records intended to observe the emphasis which is described in those notes as well as their consistency with practice of FCN and resolution 358/2009. The analysis showed that the nursing staff also performs work focused on mechanized activities and technical-bureaucratic institution that seem to override the needs of patients. In an overview, the care provided by professionals occurs either fragmented or insipient, however there is a service that involves other aspects beyond technical-curative practice, considering that major attention is given to the family and patient, focused on the concern of Nursing guiding their actions in not only the performance of procedures. However, the process of humanizing not always ends with an engagement between professional and patient, which mischaracterizes the true meaning of human care. The records also showed a tendency to focus on caring in a positivist line, where, in most cases, the factors of the disease and the obligation to meet the productivity have overshadowed other relevant aspects to a holistic understanding of caring. Regarding FCN Resolution No. 358/2009, which guides a systematization of nursing care, it is confirmed a technical view, a fragmented and superficial view of the patient, as well as a weakness of care, caused by ignorance and unpreparedness of the entire team. The perspective of caring demonstrates a reality with dialectic between what is proposed in a humane nursing and what happens in this performance space. Besides, it was shown a daily full of important considerations that arise in professional practice, in their views and also those people who were participants in the process

Giving up reporting the aggressor: reports of female victims of domestic violence

The goal of this study is to describe the experience of female victims of domestic violence, who forfeited the lawsuits against their aggressors. The interviews were oriented by the question: What was your experience of forfeiting the denunciation of your aggressor? Three themes emerged from the convergence of the testimonies: time passed from the aggression to the denunciation and then to the forfeiting; the partner, the family, the women's precinct; reflecting about the experience, which described the studied phenomenon. The women expressed ambiguous feelings for their aggressor: affection, anger, humiliation and fear. They recognize that they are dominated and humiliated, but notions of justice and equality between spouses do not appear in the testimonies. Forfeiting can be understood in the context of the reproduction of the traditional family structure, conditioned to economic and social factors. Results highlight implications about the role of the Women's Precinct and the healthcare institutions in the care for women who were victims of domestic violence.

Desistindo da denúncia ao agressor: relato de mulheres vítimas de violência doméstica

O objetivo do estudo é descrever a experiência de mulheres, vítimas da violência doméstica, que desistiram do processo contra seu agressor. As entrevistas foram orientadas pela questão: Como foi sua experiência de desistir da denúncia contra seu agressor? Das convergências dos depoimentos emergiram três temas: o tempo vivido da agressão até a denúncia e desistência; o companheiro, a família, a delegacia da mulher; refletindo sobre a experiência vivida, que descrevem o fenômeno estudado. As participantes expressam sentimentos ambíguos em relação ao agressor: afetividade, raiva, humilhação e medo. Reconhecem que são dominadas e humilhadas. Porém, noções de justiça e igualdade entre os cônjuges não aparecem nos depoimentos. A desistência do processo pode ser compreendida na concepção da reprodução da estrutura familiar, condicionada a fatores econômicos e sociais. Os resultados remetem à reflexão sobre o papel da Delegacia da Mulher e das instituições de saúde na assistência à mulher vítima da violência doméstica.

As implicações sociais da deficiência auditiva adquirida em adultos

O objetivo deste estudo foi analisar as implicações da surdez adquirida em adultos, na vida familiar, social e no trabalho, com uma abordagem qualitativa. Foram selecionadas 27 pessoas residentes em Bauru-SP, com diagnóstico de perda auditiva de manifestação súbita na faixa etária de 18 a 60 anos, matriculados no Hospital de Reabilitação de Anomalias Craniofaciais (HRAC/USP) entre janeiro de 2000 e fevereiro de 2005, sendo entrevistados 16. Utilizaram-se a entrevista e a análise de conteúdo. Constatou-se: a perda auditiva ocorreu entre os 40 e 44 anos, 37,5%; 62,5% dos que perderam a audição eram do sexo masculino, 62,5% não tinham o ensino fundamental; 62,5% eram da classe Baixa Superior; 75% apresentaram perda auditiva bilateral, 18,75% de grau moderado/profundo. Dos 13 que estavam trabalhando quando perderam a audição, 30,77% pararam de trabalhar e 15,38% mudaram de profissão. Foram relatadas situações como: afastamento do trabalho, demissão a pedido e demissão pelo empregador, dificuldade de aceitação, cobranças, falta de esclarecimentos e desconhecimento dos próprios profissionais de saúde. Os dados sugerem a necessidade dos recursos de reabilitação, de apoio terapêutico, respeito e alternativas de conhecimentos.

Encontrando-se em casa: uma proposta de atendimento domiciliar para famílias de idosos dependentes

OBJETIVO: Este estudo qualitativo teve por objetivo descrever como um sistema familiar reage perante a situação de dependência em um membro idoso, quais recursos utiliza para manter sua estabilidade e a assistência de enfermagem disponibilizada neste contexto. MÉTODOS: Utilizou-se como referencial teórico a abordagem dos sistemas familiares e como método a pesquisa-ação. Os dados foram colhidos de novembro de 2004 a janeiro de 2005, utilizando-se o genograma, o ecomapa e o levantamento de problemas. RESULTADOS: Principais demandas familiares: luto antecipado, sobrecarga do papel de cuidador, falta de conhecimento sobre a doença e desajustamento familiar perante a crise. Principais intervenções: incentivar a narrativa da enfermidade, oferecer sugestões e informações, elogiar as forças familiares e assegurar pronto atendimento. CONCLUSÕES: Com o atendimento à família sob o enfoque sistêmico foi possível propor as intervenções de ajuda para a melhoria da qualidade de vida familiar, de maneira que ela também vislumbrasse suas próprias soluções para o enfrentamento das adversidades.

Communication that values patient autonomy is associated with satisfaction with care: a systematic review

Question: Which communication factors used by clinicians during patient-clinician interactions are associated with satisfaction with care? Design: Systematic review with meta-analysis of studies investigating the association of verbal or nonverbal factors or interaction styles used by clinicians with patient satisfaction during an encounter between clinician and patient. Participants: Clinicians interacting with patients in primary care or rehabilitation settings. Results: Twenty-seven studies investigated 129 verbal, nonverbal, and interaction style factors. of these, 38 factors were consistently associated with satisfaction. Verbal factors concerning clinicians involving, facilitating, and supporting patients were associated with satisfaction with care. Most communication factors presented a fair correlation (r >= 0.21 but < 0.41) with satisfaction with care. Nonverbal factors such as time spent discussing prevention and time spent reading patient charts had a fair association with satisfaction with care (correlations range from 0.21 to 0.40). A moderate association was found between interaction styles such as caring (pooled r = 0.51, 95% CI 0.42 to 0.60) and satisfaction with care. Over half (58%) of the 129 identified factors never associated with satisfaction with care and the remainder associated inconsistently. Conclusion: The number of potential modifiable communication factors associated with satisfaction with care and the magnitude of their association partially support interventions to train clinicians in communication skills that value patient autonomy. [Oliveira VC, Refshauge KM, Ferreira ML, Pinto RZ, Beckenkamp PR, Negrao Filho RF, Ferreira PH (2012) Communication that values patient autonomy is associated with satisfaction with care: a systematic review. Journal of Physiotherapy 58: 215-229]

Interferentes eritrocitários e ambientais na anemia falciforme

Erythrocytes and environmental interferences on sickle cell anaemia Sickle cell anaemia runs na extremely variable clinical course At one end of spectrum, it is characterized by a crippling haemolitic anaemia, interspersed with severe exacerbations, or crises, yet it may be an extremely mild disorder, which is found only by chance on rotine haematological examination. The reasons are only partly understood for these remarkable differences in phenotypic expression of what appears to be the same genetic defect: they include the level of Hb Fetal, coinheritance of the alpha thalassaemia and of other genetic variantsthat has influence as genetic modulation in sickle cell anaemia. However, other genetics abnormalities of erythrocytes: G-6PD deficiency, spherocytosis and deficiencies of anti-oxidant enzymes(SOD, GPx and Catalase) probably interfereon the clinical course of sickle cell anaemia. The haplotypes of the chromosome (Bantu, Benin, Camaroon and Arab-Indian) bearing the sickle gene is associated with assorted haematological and clinical features that are likely, at least in part, to be mediated throgh effects on Hb Fetal concentration. Beyond these factors characterizes as erythrocytes interferents, there are the environmental interferents. Between environmental interferents become detached the socio-economic and cultural situation of each patient. These aspects have influence on the life of affected individuals including social interactions, family relations, peer interaction, intimate relationships, education, enployment, violence, spiritual attitudes and navigating complexities of the health care system, providers and their ancillary functions. As a result of this article it is proposed a protocol of laboratorial management of sickle cell syndrome with detach to sickle cell anaemia.

Psychosocial impact on anophthalmic patients wearing ocular prosthesis

The aim of this study was to assess the improvement in psychosocial awareness of anophthalmic patients wearing ocular prostheses and its relationship with demographic characteristics, factors of loss/treatment, social activity, and relationship between professional and patient. Surveys including a form for evaluation of psychosocial pattern were conducted with 40 anophthalmic patients rehabilitated with ocular prosthesis at the Center of Oral Oncology in the authors' dental school from January 1998 to November 2010. The improvement in psychosocial awareness was assessed by comparing the perception of some feelings reported in the period of eye loss and currently. Wilcoxon tests were applied for comparison of patients' perception between the periods. χ2 tests were used to assess the relationship between the improvement in psychosocial awareness and the variables of the study. In addition, the logistic regression model measured this relationship with the measure of odds ratio. The feelings of shame, shyness, preoccupation with hiding it, sadness, insecurity and fear were significant for improvement in psychosocial awareness. It was concluded that the anophthalmic patients wearing an ocular prosthesis has significant improvement in psychosocial awareness after rehabilitation. © 2012 International Association of Oral and Maxillofacial Surgeons.

Escola e família: relações possíveis em projetos de educação moral em escolas públicas

Pós-graduação em Educação - FCT

Avaliação do conhecimento dos cirurgiões dentistas que realizam curso de especialização na Universidade Estadual Paulista-UNESP, sobre aspectos bioéticos, éticos e legais do tratamento odontológico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)