QUALIDADE DE VIDA E EFIC��CIA ADAPTATIVA DE PESSOAS COM OBESIDADE

A obesidade �� uma doen��a cr��nica que vem acometendo, progressivamente, cada vez mais pessoas no mundo. Por ser uma patologia de dif��cil controle que favorece a eclos��o de outros agravos �� sa��de, �� premente a necessidade de realiza����o de pesquisas que possam contribuir para o aperfei��oamento dos tratamentos, bem como para a melhoria da qualidade de vida e efic��cia adaptativa. Sendo assim, a presente pesquisa visou avaliar a percep����o da qualidade de vida (QV), a efic��cia adaptativa (EDAO) e o funcionamento global (AGF) de pessoas com obesidade, relacionando os resultados obtidos na avalia����o da percep����o da QV com os da efic��cia adaptativa, bem como aos do funcionamento global (AGF). Para tanto, utilizou-se o question��rio WHOQOL-100 vers��o em portugu��s para avalia����o da percep����o de qualidade de vida, a Entrevista Diagn��stica Preventiva Escala Diagn��stica Adaptativa Operacionalizada (EDAO) para a efic��cia adaptativa e a Escala de Avalia����o do Funcionamento Global (AGF) para o funcionamento global. Este estudo contou com a participa����o de trinta mulheres obesas (��ndice de Massa Corporal IMC >=30 kg/m2), com idade m��dia de 52,33 anos, que utilizavam os servi��os de um ambulat��rio situado na regi��o do Grande ABC, estado de SP. A maioria das participantes se encontrava no grau I de obesidade - 46,70%, situava-se no grau II 33,30% e 20,00% no grau III. O aumento de peso da maioria teve in��cio nas gesta����es (43,30%), o segundo per��odo onde ocorreu o in��cio do descontrole do peso corporal foi entre os 40 aos 50 anos (20,00%). Na avalia����o geral da QV, observou-se que no dom��nio VI Aspectos Espirituais/Religi��o/Cren��as Pessoais foi encontrado o maior escore m��dio (16,17 - DP=2,95 [equivalente a 80,83% do escore m��ximo que poderia ser obtido]), comparando-o com os demais dom��nios avaliados. Em oposi����o, o dom��nio I F��sico foi o que apresentou o menor escore m��dio (11,77 - DP=2,78 - 58,83%). Todas as participantes se encontravam em inefic��cia adaptativa: Grupo 2 Ineficaz Leve (26,7%), no Grupo 3 Ineficaz Moderada (33,3%) e no Grupo 4 Ineficaz Severa (30,0%). Quanto �� avalia����o do funcionamento global (AGF), notou-se que 36,67% se situavam no intervalo entre 51-60 pontos. 23,33% das participantes no intervalo entre 31-50 pontos. Apenas 23,33% tiveram pontua����o acima de 70 pontos. Relacionando os resultados das avalia����es, foram encontradas correla����es fortes, positivas e significativas entre a avalia����o da percep����o de qualidade de vida, da efic��cia adaptativa e do funcionamento Global.

Global geriatric evaluation of the Algarve population

The ageing of population challenges communities to adapt and evolve to accommodate the needs of people that live longer (mostly out of work, either healthy, fragile or with chronic disease). Population ageing in the Algarve is higher than in overall Portugal. Studies on health conditions, frailty risk factors and elderly specific needs are undeveloped in Portugal and unknown in the Algarve. Objective To prepare a tool for Global Geriatric Evaluation, to be used in the ���Survey of Health and Ageing in the Region of Algarve - SHARA���, a commitment to ���European Innovation Partnership on Active and Healthy Ageing���. Methods A preliminary version of the screening tool, which includes well-known instruments to measure health condition (EASY-care), risk of fall (Tinetty), physical activity (Baecke���s modified questionnaire), nutritional condition (MNA), cognitive and depressive status (MMSE, Yesavage geriatric depression scale), together with socio-demographic characteristics, was applied to an independent sample of subjects from an elderly community centre - ARPI (���Associa����o de Reformados, Pensionistas e Idosos do Concelho de Faro���), with ages between 55 and 89. Results ARPI is mostly frequented by women, who either have risk of malnutrition or malnutrition incidence, a relevant risk of fall or are physically active. Those who live alone, show a higher risk of fall. Conclusions ARPI members are active, but with risk of malnutrition and fall, suggesting the relevance and importance of future interventions in these areas. The proposed screening tool showed to be adequate for the SHARA study, suitable to provide wider information on frailty.

Evaluation of obesity interventions targeting adults in the occupational setting

The study of obesity and its causes has evolved into one of the most important public health issues in the United States (Office of Disease Prevention and Health Promotion, 2007). Obesity is linked to several chronic conditions, such as cardiovascular disease, diabetes and some cancers (National Center for Chronic Disease Prevention and Health Promotion, 2008b) and the public health concern resides in the present morbidity and mortality associated with obesity and related conditions (National Heart, Lung and Blood Institute, 1998). Furthermore, obesity and its related conditions present economic challenges to employers in terms of medical health care, sick leave, short-term disability and long-term disability benefits utilized by employees (��stbye, Dement, and Krause, 2007). Recently, articles covering intervention programs targeting obesity in the occupational setting have surfaced in the body of scientific literature. The increased interest in this area stems from the fact that employees in the United States spend more time in the work environment than many industrialized nations, including Japan and most of Western Europe (Organisation for Economic Co-operation and Development, 2006). Moreover, scientific literature supports the idea of investing in healthy human capital to promote productivity and output from employees (Berger, Howell, Nicholson, & Sharda, 2003). The time spent in the work environment, the business need for healthy employees, and the public health concern create an opportunity for planning, implementation and analysis of interventions for effectiveness. This paper aims to identify those intervention programs that focus on the occupational setting related to obesity, to analyze the overall effect of diet, physical fitness and behavioral change interventions targeting overweight and obesity in the occupational setting, and to evaluate the details and effectiveness of components, such as, intervention setting, target participant group, content, industry and length of follow up. Once strengths and weaknesses of the interventions are evaluated, ideas will be suggested for implementation in the future.^

Autistic and Schizotypal Traits and Global Functioning in Bipolar I Disorder

Objective: To determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar I disorder (BD-I), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD-I. Method: Autistic and positive schizotypal traits were self-assessed in 797 individuals with BD-I recruited by the Bipolar Disorder Research Network. Differences in global functioning (rated using the Global Assessment Scale) during lifetime worst depressive and manic episodes (GASD and GASM respectively) were calculated in groups with high/low autistic and positive schizotypal traits. Regression analyses assessed the interactive effect of autistic and positive schizotypal traits on global functioning. Results: 47.2% (CI=43.7-50.7%) showed clinically significant levels of autistic traits, and 23.22% (95% CI=20.29-26.14) showed clinically significant levels of positive schizotypal traits. In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning compared to the other groups. Individual differences analyses showed that high levels of co-occurring traits were associated with better global functioning in both mood states. Limitations: Autistic and schizotypal traits were assessed using self-rated questionnaires. Conclusions: Expression of autistic and schizotypal traits in adults with BD-I is prevalent, and may be important to predict illness aetiology, prognosis, and diagnostic practices in this population. Future work should focus on replicating these findings in independent samples, and on the biological and/or psychosocial mechanisms underlying better global functioning in those who have high levels of both autistic and positive schizotypal traits.

Autistic and Schizotypal Traits and Global Functioning in Bipolar Disorder

Background and Aims To determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar disorder (BD), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD. Methods Autistic and positive schizotypal traits were assessed in 797 individuals with BD recruited by the Bipolar Disorder Research Network (BDRN), using the Autism-Spectrum Quotient and Kings Schizotypy Questionnaire (KSQ), respectively. Differences in global functioning (rated using the Global Assessment Scale) during lifetime worst depressive and manic episodes (GASD and GASM respectively) were calculated in groups with high/low autistic and positive schizotypal traits. Regression analyses assessed the interactive effect of autistic and positive schizotypal traits on global functioning. Results 47.2% (CI = 43.7���50.7%) showed clinically significant levels of autistic traits. Mean of sample on the KSQ-Positive scale was 11.98 (95% CI: 11.33���12.62). In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning than the low autistic, low positive schizotypal group (mean difference = 3.72, p = 0.004). High levels of co-occurring traits were associated with better global functioning in both mood states in individuals with a history of psychosis (GASM: p < 0.001; GASD: p = 0.055). Conclusions Expression of autistic and schizotypal traits in adults with BD is prevalent, and may be important to predict course of illness, prognosis, and in devising individualised therapies. Future work should focus on replicating these findings in independent samples, and on the biological and/or psychosocial mechanisms underlying better global functioning in those who have high levels of both autistic and positive schizotypal traits.

The development and evaluation of a culturally affirmative counselling model for deaf clients in Australia

In Australia, there is only one, newly established, dedicated mental health service catering specifically for the signing *Deaf community. It is staffed by four part-time hearing professionals and based in Brisbane. There are currently no Deaf psychologists or psychiatrists and there is no valid or reliable empirical evidence on outcomes for Deaf people accessing specialised or mainstream mental health services. Further compounding these issues, is the fact that there are no sign language versions of the most common standardised mental health or psychological instruments available to clinicians in Australia. Contemporary counselling literature is acknowledging the role of the therapeutic alliance and the impact of 'common factors' on therapeutic outcomes. However, these issues are complicated by the relationship between the Deaf client and the hearing therapist being a cross-cultural exchange. The disability model of deafness is contentious and few professionals in Australia have the requisite knowledge and understanding of deafness from a cultural perspective to attend to the therapeutic relationship with this in mind. Consequently, Deaf people are severely disadvantaged by the current lack of services, resources and skilled professionals in the field of deafness and psychology in this country. The primary aim of the following program of research has been to propose a model for culturally affirmative service delivery and to provide clinicians with tools to evaluate the effect of their therapeutic work with Deaf people seeking mental health treatment. The research document is presented as a thesis by publication and comprises four specific objectives formulated in response to the lack of existing services and resources. The first objective was to explore the use of social constructionist counselling techniques and a reflecting team with Deaf clients, hearing therapists and an interpreter. Following the establishment of a pilot counselling clinic, indepth semi-structured interviews were conducted with two long-term clients following the one year pilot of this service. These interviews generated recommendations for the development of a new 'enriched' model of counselling to be implemented and evaluated in later stages of the research program. The second objective was to identify appropriate psychometric measures that could be translated into Australian Sign Language (Auslan) for research into efficacy, effectiveness and counselling outcomes. Two instruments were identified as potentially suitable; the Outcome Rating Scale (ORS), a measure of global functioning, and the Session Rating Scale (SRS), a measure of therapeutic alliance. A specialised team of bi-lingual and bi-cultural interpreters, native signers and the primary researcher for this thesis, produced the ORS-Auslan and the SRS-Auslan in DVD format, using the translation and back-translation process. The third objective was to establish the validity and reliability of these new Auslan measures based on normative data from the Deaf community. Data from the ORS-Auslan was collected from one clinical and one non-clinical sample of Deaf people. Statistical analyses revealed that the ORS-Auslan is reliable, valid and adequately distinguishes between clinical and non-clinical presentations. Furthermore, construct validity has been established using a yet to be validated sign language version of the Depression, Anxiety and Stress Scale-21 items (DASS-21), providing a platform for further research using the DASS-21 with Deaf people. The fourth objective was to evaluate counselling outcomes following the implementation of an enriched counselling service, based on the findings generated by the first objective, and using the newly translated Auslan measures. A second university counselling clinic was established and implemented over the course of one year. Practice-based evidence guided the research and the ORS-Auslan and the SRS-Auslan were administered at every session and provided outcome data on Deaf clients' global functioning. Data from six clients over the course of ten months indicated that this culturally affirmative model was an effective approach for these six clients. This is the first time that outcome data have been collected in Australia using valid and reliable Auslan measures to establish preliminary evidence for the effectiveness of any therapeutic intervention for clinical work with adult, signing Deaf clients. The research generated by this thesis contributes theoretical knowledge, professional development and practical resources that can be used by a variety of mental health clinicians in the context of mental health service delivery to Deaf clients in Australia.

Fitness and fatness in childhood obesity : implications of physical activity

Overweight and obesity are a significant cause of poor health worldwide, particularly in conjunction with low levels of physical activity (PA). PA is health-protective and essential for the physical growth and development of children, promoting physical and psychological health while simultaneously increasing the probability of remaining active as an adult. However, many obese children and adolescents have a unique set of physiological, biomechanical, and neuromuscular barriers to PA that they must overcome. It is essential to understand the influence of these barriers on an obese child's motivation in order to exercise and tailor exercise programs to the special needs of this population. Chapter Outline ��� Introduction ��� Defining Physical Activity, Exercise, and Physical Fitness ��� Physical Activity, Physical Fitness, And Motor Competence In Obese Children ��� Physical Activity and Obesity in Children ��� Physical Fitness in Obese Children ��� Balance and Gait in Obese Children ��� Motor Competence in Obese Children ��� Physical Activity Guidelines for Obese Children ��� Clinical Assessment of the Obese Child ��� Physical Activity Characteristics: Mode ��� Physical Activity Characteristics: Intensity ��� Physical Activity Characteristics: Frequency ��� Physical Activity Characteristics: Duration ��� Conclusion

Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia

BACKGROUND/OBJECTIVES: This paper reports on the evaluation of the Smart Choices healthy food and drink supply strategy for Queensland schools (Smart Choices) implementation across the whole school environment in state government primary and secondary schools in Queensland, Australia. SUBJECTS/METHODS: Three concurrent surveys using different methods for each group of stakeholders that targeted all 1275 school Principals, all 1258 Parent and Citizens��� Associations (P&Cs) and a random sample of 526 tuckshop convenors throughout Queensland. Nine hundred and seventy-three Principals, 598 P&Cs and 513 tuckshop convenors participated with response rates of 78%, 48% and 98%, respectively. RESULTS: Nearly all Principals (97%), P&Cs (99%) and tuckshop convenors (97%) reported that their school tuckshop had implemented Smart Choices. The majority of Principals and P&Cs reported implementation, respectively, in: school breakfast programs (98 and 92%); vending machine stock (94 and 83%); vending machine advertising (85 and 84%); school events (87 and 88%); school sporting events (81 and 80%); sponsorship and advertising (93 and 84%); fundraising events (80 and 84%); and sporting clubs (73 and 75%). Implementation in curriculum activities, classroom rewards and class parties was reported, respectively, by 97%, 86% and 75% of Principals. Respondents also reported very high levels of understanding of Smart Choices and engagement of the school community. CONCLUSIONS: The results demonstrated that food supply interventions to promote nutrition across all domains of the school environment can be implemented successfully.

Evaluation of an ambulatory nutrition support service for malnourished patients post hospital discharge

Introduction Malnutrition is common among hospitalised patients, with poor follow-up of nutrition support post-discharge. Published studies on the efficacy of ambulatory nutrition support (ANS) for malnourished patients post-discharge are scarce. The aims of this study were to evaluate the rate of dietetics follow-up of malnourished patients post-discharge, before (2008) and after (2010) implementation of a new ANS service, and to evaluate nutritional outcomes post-implementation. Materials and Methods Consecutive samples of 261 (2008) and 163 (2010) adult inpatients referred to dietetics and assessed as malnourished using Subjective Global Assessment (SGA) were enrolled. All subjects received inpatient nutrition intervention and dietetic outpatient clinic follow-up appointments. For the 2010 cohort, ANS was initiated to provide telephone follow-up and home visits for patients who failed to attend the outpatient clinic. Subjective Global Assessment, body weight, quality of life (EQ-5D VAS) and handgrip strength were measured at baseline and five months post-discharge. Paired t-test was used to compare pre- and post-intervention results. Results In 2008, only 15% of patients returned for follow-up with a dietitian within four months post-discharge. After implementation of ANS in 2010, the follow-up rate was 100%. Mean weight improved from 44.0 �� 8.5kg to 46.3 �� 9.6kg, EQ-5D VAS from 61.2 �� 19.8 to 71.6 �� 17.4 and handgrip strength from 15.1 �� 7.1 kg force to 17.5 �� 8.5 kg force; p<0.001 for all. Seventy-four percent of patients improved in SGA score. Conclusion Ambulatory nutrition support resulted in significant improvements in follow-up rate, nutritional status and quality of life of malnourished patients post-discharge.

Evaluation of public transportation as a risk factor for active tuberculosis in Lima, Peru

Thesis (Master's)--University of Washington, 2012

Estudo sobre o insight em pessoas com psicose

Para al��m das vari��veis cl��nicas e sociodemogr��ficas existem concerteza importantes componentes individuais que desempenham um contributo importante no n��vel de insight apresentado por cada pessoa doente, por exemplo, o n��vel de intelig��ncia, personalidade, cultura, experi��ncias passadas, mem��ria, etc. A natureza cl��nica, emocional e/ou intelectual do termo ajuda-nos a compreender a complexidade da dificuldade que existe na sua tradu����o e, inclusive, na sua compreens��o. Da�� que as defini����es atribu��das ao conceito sejam muito distintas e variem consoante a forma����o te��rica do autor/investigador. Pretende-se, a partir dessa identifica����o/compreens��o, promover a qualidade de vida destas pessoas atrav��s do desenvolvimento de novas aprendizagens que possibilitem uma coopera����o activa. �� igualmente fundamental ir ao encontro das capacidade intactas de maneira a possibilitar a aquisi����o de novos(s) comportamento(s) que tenham um impacte positivo nas queixas, sinais, sintomas, incapacidade e disfuncionalidade apresentados pelo/a utente. Uma vez que a pr��pria conceptualiza����o do termo traduzir�� aquilo que se pretende avaliar,ser�� efectuada uma reflex��o detalhada acerca dos instrumentos e defini����es que t��m sido mais utilizadas para explorar o insight nas psicoses.Procurei, no meu trabalho de investiga����o, real��ar e promover a import��ncia que cada sujeito, alvo de interven����o, desempenha ao longo do seu processo de recupera����o e na preven����o de reca��das. No seguimento dos objectivos acima descritos, para al��m da revis��o te��rica efectuada ao fen��meno em termos de conceptualiza����o e estudos desenvolvidos na ��rea de investiga����o, foi,neste estudo, realizada a contribui����o para a valida����o do instrumento ���Assessment of Insight in Psychosis: a re-standartization of a New Scale��� de Markov�� & Berrios (2003).O fen��meno de insight escolhido pela Insight Scale, relata menos as mudan��as vividas em rela����o �� doen��a mental, e mais a actual consci��ncia e articula����o de tais mudan��as. Tendo como base uma abordagem psicopedag��gica, o fen��meno do insight aqui explorado assentou numa perspectiva reabilitativa, actual e multidimensional, que fosse para al��m das dimens��es cl��nicas tradicionais. Neste sentido �� apresentada uma escala original, intitulada ���Escala de Avalia����o do Insight e Identifica����o das Necessidades em Pessoas com Psicose���, bem como um modelo de interven����o psicopedag��gico breve, assente nos pressupostos descritos ao longo do trabalho.-----------------------------------------ABSTRACT: The importance of insight in people with mental illnesses was first studied in psychiatry, in the first decades of the 20th century, by people as important as Lewis (1934) and Jaspers (1959). However, this field of investigation was left unexplored for many years. Only in the last decade has this phenomenon become the object of numerous scientific investigations, having been given special attention by its investigators. For this reason a significant number of instruments for evalauting insight in psychotic disorders were developed. Since then many papers have been published, which has allowed for a more in depth knowledge on the subject. Therefore, in recent years, the concept of insight has been developed in an attempt to clarify its compexity. A once dichotomic phenomenon, described in terms of presence or absence, became considered multidimensional, which made the identification of different levels of insight and different dimensions possible. Current concepts categorize insight into five dimensions: the awareness of the patient in relation to his/her mental illness, the awareness of the patient in relation to the social consequences of his/her illness, the awareness of the need for treatment, the awareness of the symptoms and the explanation of those symptoms in relation to the illness. The lack of insight in psychiatry, in general terms, and as this phenomenon has been described, the lack of awareness of having a mental illness, represents one of the most common symptoms of schizophrenia and affects a big part of the population that suffer from this illness. It is estimated that bewteen 50 and 80 per cent of patients with schizophrenia do not believe that they are ill, which, consequently has a big impact in the process of adherence to treatment. It is still not possible, however, to identify all the factors that determine the lack of insight in schizophrenics. There are psychological, social and cultural influences that almost certainly play their role in the lack of insight registered in this pathology.Since the impact of scizophrenia is felt in many aspects of the individual���s life, its effective treatment should be directed at various levels, including the improvement of insight. One of the objectives of this study is to explore the relationship between the level of insight in psychosis and the clinical and sociodemographic variables, the psychopathology and its global functioning. As well as the clinical and sociodemographic variables, there are of course important individual components that contribute to the level of insight seen in each patient, for example, their level of inteligence, personality, culture, past experiences, memory, etc. The clinical, emotional and/or intelectual nature of the term helps us understand the difficulty that lies in its interpretation as well as in its comprehension. Therefore, the definitions attributed to the term are very different and vary according to the theoretical training of the investigator. It is intended, from this identification/understanding, to promote the quality of life of these people through the development of new findings that might enable an active cooperation. It is equally fundamental to observe their unimpaired capacities in order to enable the acquisition of new behaviour(s) that have a positive impact on the complaints, signs, symptoms, incapacity and disfunctioning seen in the patient.As the actual comprehension of the term explains what we intend to evaluate, a detailed reflection is made on the instruments and definitions that have been used the most to explore insight in psychosis.In this investigation I tried to underline and promote the importance that each subject, undergoing medical intervention, plays during his/her process of recovery and prevention of relapses. Considering the above mentioned objectives, as well as a theoretical review of the phenomenon in terms of conceptualization and investigative studies developed, this study contributed to the validation of the instrument.The insight phenomenon chosen by the ���Insight Scale���, records less changes experienced in relation to the mental illness and more actual awareness and articulation of these changes. Based on a psychopedagogical approach, the insight phenomenon explored here settled on a rehabilitation, current and multidimensional perspective that would go beyond the traditional clinical dimensions. For this reason an original scale entitled ���Insight Evaluation Scale and Need Identification in Psychosis Patients��� is presented, as well as a psychopedagogical intervention model soon to be used with admitted patients based on the presuppositions described in this study.

Assessment of groundwater contamination in an agricultural peri-urban area (NW Portugal): an integrated approach

The excessive use of pesticides and fertilisers in agriculture has generated a decrease in groundwater and surface water quality in many regions of the EU, constituting a hazard for human health and the environment. Besides, on-site sewage disposal is an important source of groundwater contamination in urban and peri-urban areas. The assessment of groundwater vulnerability to contamination is an important tool to fulfil the demands of EU Directives. The purpose of this study is to assess the groundwater vulnerability to contamination related mainly to agricultural activities in a peri-urban area (Vila do Conde, NW Portugal). The hydrogeological framework is characterised mainly by fissured granitic basement and sedimentary cover. Water samples were collected and analysed for temperature, pH, electrical conductivity, chloride, phosphate, nitrate and nitrite. An evaluation of groundwater vulnerability to contamination was applied (GOD-S, Pesticide DRASTIC-Fm, SINTACS and SI) and the potential nitrate contamination risk was assessed, both on a hydrogeological GIS-based mapping. A principal component analysis was performed to characterised patterns of relationship among groundwater contamination, vulnerability, and the hydrogeological setting assessed. Levels of nitrate above legislation limits were detected in 75 % of the samples analysed. Alluvia units showed the highest nitrate concentrations and also the highest vulnerability and risk. Nitrate contamination is a serious problem affecting groundwater, particularly shallow aquifers, especially due to agriculture activities, livestock and cesspools. GIS-based cartography provided an accurate way to improve knowledge on water circulation models and global functioning of local aquifer systems. Finally, this study highlights the adequacy of an integrated approach, combining hydrogeochemical data, vulnerability assessments and multivariate analysis, to understand groundwater processes in peri-urban areas.

��valuation d���un programme novateur de r��adaptation par les arts de la sc��ne pour des jeunes pr��sentant un trouble psychiatrique stabilis�� : le programme Espace de Transition

L���objectif de cette th��se ��tait d�����valuer Espace de Transition (ET), un programme novateur d���intervention par les arts de la sc��ne visant �� favoriser la r��adaptation psychosociale d���adolescents et de jeunes adultes pr��sentant des troubles mentaux stabilis��s et �� diminuer la stigmatisation des individus aux prises avec des probl��mes de sant�� mentale. Ce programme a ��t�� con��u par une ��quipe de cliniciens du d��partement de psychiatrie du Centre hospitalier universitaire Ste-Justine, en collaboration avec des artistes professionnels, et est livr�� depuis le printemps 2009. L�����valuation du programme ET a ��t�� conduite de mani��re ind��pendante, selon des approches collaborative et naturaliste et en usant de m��thodes mixtes. Les donn��es de recherche ont ��t�� recueillies avant pendant et apr��s le programme aupr��s de l���ensemble des participants �� deux sessions distinctes (N = 24), de m��me qu���aupr��s des deux artistes instructeurs, de la psycho��ducatrice responsable du soutien clinique, ainsi que des psychiatres et autres intervenants ayant r��f��r�� des participants (N=11). Des entrevues semi-structur��es individuelles et de groupe, des observations directes et des questionnaires ont servi �� recueillir les donn��es n��cessaires �� l�����valuation. Des analyses quantitatives de variance, ainsi que des analyses qualitatives th��matiques ont ��t�� r��alis��es et leurs r��sultats ont ��t�� interpr��t��s de mani��re int��gr��e. Le premier chapitre empirique de la th��se relate l�����valuation de la mise en ��uvre du programme ET. Cette ��tude a permis de constater que le programme avait rejoint des participants correspondant de pr��s �� la population vis��e et que ceux-ci pr��sentaient globalement des niveaux ��lev��s d���assiduit��, d���engagement et d���appr��ciation du programme. L�����valuation de la mise en ��uvre a en outre permis de conclure que la plupart des composantes du programme identifi��es a priori comme ses param��tres essentiels ont ��t�� livr��es tel que pr��vu par les concepteurs et que la plupart d���entre elles ont ��t�� largement appr��ci��es et jug��es pertinentes par les participants et les autres r��pondants consult��s. Le second chapitre empirique consiste en un article portant sur l�����valuation des effets du programme ET relativement �� l���atteinte de trois de ses objectifs interm��diaires, soient l���am��lioration 1) du fonctionnement global, 2) du confort relationnel et des comp��tences sociales, ainsi que 3) de la perception de soi des participants pr��sentant des troubles mentaux. Les r��sultats de cette ��tude ont r��v��l�� des changements significatifs et positifs dans le fonctionnement global des participants suite au programme, tel qu�����valu�� par les cliniciens r��f��rents et partiellement corrobor�� par les participants eux-m��mes. Des am��liorations en ce qui concerne le confort relationnel, les comp��tences sociales et la perception de soi ont ��galement ��t�� objectiv��es chez une proportion substantielle de participants, bien que celles-ci ne se soient pas traduites en des diff��rences significatives d��cel��es par les analyses quantitatives de groupe. Le troisi��me et dernier chapitre empirique de la th��se relate une ��tude exploratoire des m��canismes sous-tendant les effets du programme ET ayant conduit �� l�����laboration inductive d���une th��orie d���action de ce programme. Cette investigation qualitative a r��v��l�� quatre cat��gories de m��canismes, soient des processus de 1) gain d���exp��rience et de gratification sociales, 2) de d��sensibilisation par exposition graduelle, 3) de succ��s et de valorisation, et 4) de normalisation. Cette ��tude a ��galement permis de sugg��rer les caract��ristiques et composantes du programme qui favorisent la mise en place ou l���impact de ces m��canismes, tels l���environnement et l���animation non cliniques du programme, la composition h��t��rog��ne des groupes de participants, le recours aux arts de la sc��ne, ainsi que la poursuite d���une r��alisation collective et son partage avec un public ext��rieur au programme. Globalement, les ��tudes pr��sent��es dans la th��se appuient la pertinence et le caract��re prometteur du programme ET, tout en sugg��rant des pistes d���am��lioration potentielle pour ses versions ult��rieures. Par extension, la th��se soutient l���efficacit�� potentielle d���interventions r��adaptatives mettant en ��uvre des composantes apparent��es �� celles du programme ET pour soutenir le r��tablissement des jeunes aux prises avec des troubles mentaux.