Esta dissertação trata de analisar, de um modo geral, os processos de trabalho dos trabalhadores em Saúde Mental e, de modo específico, como os trabalhadores de Educação Física se incorporam (ou são incorporados) no cotidiano de trabalho nos Centros de Atenção Psicossocial (Caps). A temática é tratada nesta dissertação com base nas formulações teóricas produzidas a partir do movimento antimanicomial e da Reforma Sanitária Brasileira. A metodologia adotada foi o estudo de caso qualitativo em um Caps especializado na atenção a usuários de álcool e outras drogas, localizado na região metropolitana de Porto Alegre. Por meio de um roteiro de entrevista semiestruturada, principal instrumento de produção dos dados empíricos, oito trabalhadores de diversos núcleos profissionais da equipe colaboraram com a pesquisa. Do material levantado, três categorias de análise emergiram: 1) a tensão entre público e privado na organização dos processos coletivos de trabalho para a produção do cuidado em serviços de Saúde Mental; 2) as expectativas e demandas da equipe relativa ao trabalho da Educação Física em um Caps AD; e 3) a produção de saberes sem fronteiras disciplinares/profissionais em meio aos afazeres que se misturam na composição do trabalho em Saúde Mental. A análise resultante desta categorização levou às seguintes considerações: a terceirização dos serviços e a precarização dos vínculos empregatícios interfere na organização de processos coletivos de trabalho e na efetiva integração das equipes em Saúde Mental; o trabalho da Educação Física em um Caps Ad transita tanto entre as expectativas de tarefas clássicas do núcleo quanto à composição do trabalho coletivo voltado para as demandas do campo; as equipes multiprofissionais de Saúde Mental que funcionam de forma efetivamente integrada rasuram as fronteiras dos saberes dos núcleos e convocam os trabalhadores a desenvolverem projetos terapêuticos pautados, sobretudo, na produção de vida. / This dissertation is to examine, in general, the working processes of professionals involved in Mental Health and, specifically, how the professionals of Physical Education incorporate (or are embedded) in the daily work at the Centers for Psychosocial Care (CAPS). The topic is treated in this dissertation based on theoretical formulations produced from anti-asylum movement and from Brazilian Sanitary Reform. The adopted methodology was a qualitative case study based on CAPS, who is specialized in caring for users of alcohol and other drugs, located in the metropolitan area of Porto Alegre. Through a guide of semi-structured interviews, the main instrument of production of empirical data, eight professionals from the multidisciplinary core team collaborated with the research. From the collected material, three categories of analysis emerged: 1) the tension between public and private in the organization of the collective bargaining process for the production of care in mental health services, 2) the expectations and demands of the team concerned the Physical Education in a Caps, and 3) the production of knowledge without borders disciplinary/professionals during their duties that mixtures in the composition of the work in Mental Health. The resulting analysis of this categorization led to the following considerations: the outsourcing of services and the casualization of employment relationships interfere in the organization of collective bargaining processes and the effective integration of the Mental Health teams, the duty of Physical Education in a Caps transitions even between expectations from classical tasks of the core team about the composition of the collective work facing the demands on the field, than the multidisciplinary teams of Mental Health that works effectively integrated erasure the frontiers of knowledge of the core teams and summon professionals to develop therapeutic projects guided mainly in the production of life. / Esta tesis intenta analizar, de modo general, los procesos de trabajo de los trabajadores en Salud Mental y, de modo puntual, como los trabajadores de Educación Física se adhieren (o son adheridos) en el cotidiano laboral de los Centros de Atención Psicosocial (Caps). La temática es abordada en esta tesis con base las diferentes formulaciones teóricas generadas a partir del movimiento Antimanicomial y la Reforma Sanitaria Brasilera. La metodología empleada fue el estudio de caso cualitativo en un Caps especializado en la atención a los usuarios de alcohol e drogas , ubicado en la región metropolitana de la ciudad de Porto Alegre. A partir de una entrevista semi-estructurada, principal instrumento de producción de datos empíricos, ocho trabajadores de diferentes equipos profesionales colaboraron con la investigación. En el material recogido surgieron tres categorías de análisis: 1) la tensión entre lo público y privado en la organización de procesos colectivos de trabajo para la atención en los servicios de Salud Mental. 2) las expectativas y exigencias del trabajo de la Educación Física en un Caps Ad, y 3) la producción de conocimiento sin barreras disciplinarias/profesionales en medio a los quehaceres que se mezclan en la configuración del trabajo en Salud Mental. El análisis resultante de esta clasificación llevó a las siguientes consideraciones: la tercerización de los servicios y la precarización de los vínculos laborales interfieren en la organización de los procesos de trabajo colectivo y en la integración efectiva de los equipos de trabajadores en Salud Mental; el trabajo de la Educación Física en un Caps Ad transita tanto en la expectativas de las tareas clásicas del núcleo como en la composición del trabajo colectivo dirigido a las demandas del campo; los equipos multiprofesionales de Salud Mental que funcionan de forma efectivamente integrada, rasuran las fronteras de los saberes de los núcleos y convocan a los trabajadores a desarrollar proyectos terapéuticos pautados, sobre todo en la producción de la vida. El análisis resultante de esta clasificación llevó a las siguientes consideraciones: el trabajo de Educación Física en un CAPS Ad ambas transiciones entre expectativas de las tareas clásicas del núcleo y la composición de la obra colectiva frente a las demandas del campo, los equipos multidisciplinarios de Salud Mental que trabajan rasuram efectivamente integrada de las fronteras del conocimiento de los núcleos y convocan a los trabajadores a desarrollar proyectos terapéuticos guiados principalmente en la producción de la vida.

In this dissertation, the author provides an account of his therapeutic interaction and experience, as an intern clinical psychologist, in working with a patient in psychotherapy who was eventually diagnosed with a “factitious disorder”. This study descriptively addresses how the therapeutic interaction impacted upon the therapist’s thinking of the process both diagnostically and in terms of therapeutic goals. This study consists of a single case, qualitative research design. It concerns the interactions and experiences of the therapist with a specific patient (diagnosed with a factitious disorder) in the context of a multidisciplinary academic hospital setting. The study aims to be predominantly descriptive of this therapy, and as such employs the psychological phenomenological method of Giorgi (1985) in order to provide a specific description of the situated structure of the therapy. As such, this study is able to contribute to the sparse psychological and therapeutic information available on factitious disorders. There are few detailed accounts of actual therapeutic interactions – specifically from a psychological perspective – for patients diagnosed with factitious disorders. The specific description of the situated structure of the therapy is also compared to the available literature on factitious disorders. Although the aim of this study was not evaluative in nature, the author does provide some tentative comments on the aetiology and therapeutic considerations for factitious disorders – with regards to this particular case. The author suggests a strong link to personality and character deficits underlying factitious behaviour. The author further suggests the importance of acknowledging the “sick role”; allowing for “face-saving” strategies; providing consistency (on behalf of the therapist); and the setting of rigid, overt, therapeutic boundaries in the psychotherapeutic treatment of factitious disorders. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Some children with severe to profound hearing loss are implanted with a cochlear implant on the hypothesis that short-term outcomes in auditory receptive skills can be utilized into greater social independence and quality of life. In order to measure the outcomes and progress achieved from cochlear implants, effective assessment protocols are vital. The purpose of assessment after cochlear implantation, is to monitor an individual child’s rate of progress in speech and language acquisition, with reference to other cochlear implant users; to collect data on the range of linguistic benefits observed against cochlear implant users over time and to investigate and amend unforeseen difficulties. Furthermore, the outcome measures provide concrete information to the multidisciplinary team, and parents, and for collection of prevalence data for further research, which is crucial for funding purposes. The dynamic and natural approach to assessment has been recommended as the most effective, to ensure a holistic assessment in young children with cochlear implants. The aim of the current study was to determine the relevance of an assessment protocol proposed by the Pretoria Cochlear Implant Programme. The protocol was administered on eight children in the transitional stage of spoken language development, within an inclusive educational setting. A descriptive research design was selected in order to describe the qualitative results obtained during the study. The following assessments were included in the protocol: A questionnaire on background information, an aided audiogram (with cochlear implants and hearing aids), speech discrimination, Speech in Noise Test; Developmental Assessment Schema (Auditory Communication), Developmental Assessment Schema (General Development), Rossetti Infant-Toddler Language Scale, Reynell Developmental Language Scales III (Verbal Comprehension), Speech Intelligibility Rating, Voice Skills Assessment, Preschool Literacy Assessment, Mother Infant Communication Scale, Caregiver-Child Interaction, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale and Profile of Actual Linguistic Skills. The results indicated that all the vital areas of assessment are included in the protocol, and under-evaluation is not a concern. Some of the areas of assessment overlap in the protocol, ensuring that the cross-check principle is being applied. The information gained from the assessment protocol can be used effectively for future intervention planning and adaptations can be made where necessary. Moreover, it was concluded that the administration and interpretation of the assessment protocol is time efficient and can be used effectively within a clinical setting. Cultural barriers did not have an effect on the administration and interpretation of the assessment protocol, however, linguistic barriers can influence the outcome of the results obtained. In summary, the assessment protocol has been found to be innovative, time effective, user-friendly, informative and relevant for the assessment of young cochlear implant users in the transitional stage of verbal linguistic development. Recommended changes for the assessment protocol were suggested, as well as recommendations for the educational setting. It was suggested that the questionnaires be available in all South African languages and that some of the protocols only be used if age-appropriate. Another recommendation was that the Listening Progress (LiP) and a pragmatic profile should be included in the protocol. Furthermore, it was suggested that an assistant audiologist could be involved to ensure more accurate and quicker hearing assessments. / Thesis (M Communication Pathology)--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / unrestricted

In this dissertation the author provides an account of the emotional experience of one clinical psychology intern whose client had committed suicide. This study describes the impact on the intern both as an individual and as a professional in the field of psychology. The impact on the intern as an individual is studied in terms of the coping mechanisms used as well as the changes that occurred in her views of death and suicide. The impact on the intern as a professional is studied in terms of her interactions with patients, how she addresses the topic of suicide within therapy, and the eventual changes that she experienced as therapist. The study uses a single case qualitative research design. It concerns the experiences of a specific intern clinical psychologist within the context of a multidisciplinary academic hospital setting. The study is predominantly descriptive in nature, and as such employs the phenomenological method of Giorgi (1985) to provide a specific description of the experiences of the intern psychologist. Through this, the study aims to add to the limited descriptive and qualitative information available on the experiences of therapists whose clients commit suicide. The information available on this topic is mostly quantative in nature, providing statistical data on the emotions and experiences of therapists. The description of the experiences is also compared to the existing information on the topic. As the aim of this study is descriptive in nature, it will not provide any fixed theory on the subject. It does illustrate the experiences of one intern and actively studies the correlation of these experiences with existing data. Conclusions drawn at the end of this study are purely speculative in nature and their validity is left to judge for readers to judge for themselves. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Submitted thesis occupies with the process of formation of multidisciplinary team, which becomes an instrument of care to services dealing with mental illness treatment in the case of transformation of psychiatric care from institutional to sphere of community services. In psychiatrical community-based services as we know them today, multidisciplinatory cooperation should provide more complex and effective help for people with mental illness. The theoretical part of the thesis consists of informative overview, stating the basic terms from fields of mental disorders and community psychiatry and discription of contemporaneous state care about mentally ill and it also brings new information about prepared reforms in area of providing psychiatric services. The empiric part maps the process of putting the multidisciplinary team together in newly established Centre of mental health, which is the new low-threshold pillar of transformation of psychiatric services. In addition, it shows views of all the professionals from the team on the problematics of creating a team, mutual cooperation, bringing a peer worker in and it also points on the bariers keeping multidisciplinary cooperation from optimal functioning.

This thesis deals with multidisciplinary cooperation in residential facilities for the elderly (so- called MTD). I'm going to focus on retirement houses. The theoretical part deals with old age, fundamental documents defining social rights and basic values in the care of the elderly. It also deals with cooperation team composition in retirement houses for the elderly, development phases, principles and barriers to the functioning of a multidisciplinary team. In the empirical part I deal with the description of the data collecting and analysing the results of questionnaire survey and interviews. The aim of my thesis is to find out with what barriers of multidisciplinary cooperation retirement houses deals with. In the practical part, I looked for obstacles affecting their functioning and also what would contribute to the creation of a team in a retirement house. Keywords cooperation multidisciplinary team seniors care residential facilities self-sufficiency

Abstract Introduction: Obesity amongst children is a major health problem. At the outpatient paediatric clinic at Södertälje hospital in Region Stockholm, there is a large and well-established treatment model against childhood obesity. During spring 2020 all elective care in Region Stockholm, including visits to the obesity team, was cancelled for 3 months due to relocation of health care professionals because of the Covid-19 pandemic. Aim: To investigate whether the first wave of the Covid-19 pandemic affected the outcome of childhood obesity treatment at one outpatient paediatric clinic in Region Stockholm. Methods: A retrospective controlled cohort study comparing two groups regarding results of first year of obesity treatment for children. One group had their first year of treatment during the first wave of the Covid-19 pandemic and the control group before the pandemic. Data was retrieved from BORIS and complemented by a review of medical records. Results: Mean change in BMI SDS after one year of treatment in the Covid group was -0.10 units and in the control group -0.11 (ns). In the Covid group more patients quit the treatment programme and had a smaller number of visits to a nurse compared to controls. Conclusion: This study showed no difference in outcome regarding change in BMI SDS. However, it seems that the cancellation of visits might have affected the number of children lost to follow-up. Therefore, clinics should consider “digi-physical” care (e.g., via telephone, videocalls or other media) to secure the child and parents motivation and participation in the obesity treatment programme.

(1) Background: Although most clinicians involved in the treatment of cleft patients agree upon the major importance of interdisciplinary cooperation and many protocols and concepts have been discussed in the literature, there is little evidence of the relevance of continuous interdisciplinary care. We aimed to objectify the type and number of therapeutic decisions resulting from an annual multidisciplinary follow-up. (2) Methods: We retrospectively analyzed the data of all 1126 patients followed up in the weekly consultation hours for cleft patients at university clinics in Leipzig for the years 2005–2020. We assessed the clinical data of every patient and specifically evaluated the treatment decisions taken at different points in time by the participating experts of different specialties. (3) Results: In total, 3470 consultations were included in the evaluation, and in 70% of those, a therapeutic recommendation was given. Each specialty showed certain time frames with intense treatment demand, which partially overlapped. Nearly all therapy recommendations were statistically attached to a certain age (p < 0.001). (4) Conclusions: There is an exceptionally high need for the interdisciplinary assessment of patients with cleft formation. Some developmental phases are of particular importance with regard to regular follow-up and initiation of different treatment protocols. The therapy and checkup of cleft patients should be concentrated in specialized centers.

Bakgrund: Undernäring förekommer hos uppemot 30 % av äldre personer på särskilda boenden (SÄBO). Det är ett av distriktssköterskans ansvarsområden att upprätthålla en god nutritionsvård. Syfte: Syftet var att undersöka förekomst av undernäring bland äldre personer (65 år och äldre) på särskilt boende samt relationer mellan undernäring och fallrisk, risk för trycksår respektive nedsatt munhälsa. Vidare var syftet att undersöka vilka preventiva åtgärder distriktssköterskan erbjöd för att förbygga alternativt behandla undernäring hos äldre personer. Metod: Studien hade en kvantitativ ansats. Antalet studiedeltagare var 436 personer som bodde på SÄBO. Gruppjämförelser gjordes mellan tre oberoende grupper (ej risk för undernäring, risk för undernäring och undernärd) avseende fallrisk, risk för trycksår samt nedsatt munhälsa. Vidare gjordes logistisk regressionsanalys för att undersöka relationen mellan risk för undernäring/undernärd och fallrisk, risk för trycksår samt nedsatt munhälsa. Deskriptiv statistik användes för att beskriva preventiva och behandlande åtgärder. Resultat: Undernäring relaterar starkt till risk för trycksår. Relation kunde inte påvisas mellan undernäring och fallrisk samt munhälsa. Preventiva åtgärder användes i låg utsträckning. Slutsats: Nutritionsomvårdnad är ett komplext område vilket kräver att distriktssköterskan arbetar i ett multidisciplinärt team med riskbedömningar, utredningar, åtgärder och uppföljningar. Nutritionsåtgärder bör erbjudas i högre utsträckning till personer med risk för undernäring eller som är undernärda. / Background: Undernutrition occurs in up to 30 % of older people in special accommodation (SA). It is one of the district nurse's responsibility areas to maintain good nutritional care. Purpose: The purpose was to investigate the prevalence of undernutrition among older people (65 years and older) in special accommodation and relationships between undernutrition and fall risk, risk of pressure ulcers and impaired oral health. A further aim was to investigate the preventive measures district nurse’s offered to prevent alternatively treat undernutrition in older people. Method: The study had a quantitative approach. The number of study participants was 436 people who lived in SA. Group comparisons were made between three independent groups (not at risk of undernutrition, risk of undernutrition and undernourished) regarding fall risk, risk of pressure ulcers and impaired oral health. Furthermore, logistic regression analysis was conducted to examine the relationship between risk of undernutrition/undernourished and fall risk, risk of pressure ulcers and impaired oral health. Descriptive statistics were used to describe the preventive and treatment measures. Results: Undernutrition relate strongly to the risk of pressure ulcers. No relationship was detected between undernutrition and risk of falling and impaired oral health. Preventive measures was used to a low extent. Conclusion: Nutritional care is a complex area that requires that the district nurse work in a multidisciplinary team with risk assessments, investigations, actions and follow up. Nutritional measures should be offered to a greater extent to persons at risk of undernutrition or with manifest undernutrition.

Introdução: a cirurgia bariátrica destaca-se como o método mais eficaz no tratamento da obesidade em longo prazo, acarretando remissão significativa das enfermidades associadas ao excesso de peso. Ocorre que os resultados da cirurgia nem sempre são duradouros. Estima-se que 20% a 30% das pessoas que são submetidas ao procedimento bariátrico irão apresentar reganho de peso passados os dois primeiros anos. Objetivo: compreender a experiência de reganho de peso para as pessoas que foram submetidas à cirurgia bariátrica. Método: pesquisa qualitativa de abordagem fenomenológica, realizada em um hospital público de São Paulo. A Amostra foi composta de 17 participantes que apresentaram reganho de peso após a cirurgia bariátrica. Para obtenção dos dados, utilizou-se a entrevista aberta com as seguintes questões norteadoras: Como é para você se perceber ganhando peso novamente? O que você acredita que esteja contribuindo para o seu ganho de peso? Como você lida com o reganho de peso? Como você se vê daqui a alguns anos em relação ao seu peso corporal? A organização e a análise dos depoimentos foram realizadas seguindo os passos preconizados por estudiosos da fenomenologia social de Alfred Schütz. Resultados: o típico da ação vivida pela pessoa que apresenta recidiva de peso após a cirurgia bariátrica mostrou-se como aquela que: atribui o reganho de peso à instabilidade emocional, que a leva a dificuldades no controle do comportamento alimentar; afirma que o estresse, a ansiedade e a solidão contribuem para o reganho de peso; associa a recidiva de peso a alterações anatômicas relacionadas à cirurgia; expressa sentimentos como derrota, culpa e tristeza; refere consequências físicas, psíquicas e sociais advindas da recuperação de peso, medo de engordar demais e ficar sem saída; relata consumo excessivo de álcool; tem como expectativa controlar o peso com vistas a impactar positivamente sua qualidade de vida, para tanto, necessita suporte multidisciplinar para as questões físicas e emocionais envolvidas no reganho de peso; almeja se submeter a uma nova cirurgia bariátrica e a cirurgia plástica para melhorar a autoestima. Conclusões: os achados ilustram o quanto o fenômeno reganho de peso é complexo em seus aspectos biopsicoemocionais e necessita uma escuta individualizada e qualificada, acolhendo as questões subjetivas vividas por aqueles que foram submetidos à cirurgia bariátrica e estão passando pela situação de recuperação de peso. Acredita-se que a discussão proporcionada por esta investigação reforce a necessidade de as equipes de saúde investirem nos encontros com o paciente bariátrico, pautados na relação intersubjetiva que respeite e considere o outro, compartilhando decisões e contribuindo para que os pacientes se tornem ativos na produção de sua saúde e corresponsáveis pelo êxito no alcance e manutenção do peso desejado. / Introduction: bariatric surgery stands out as the most effective method in the long-term treatment of obesity, leading to significant remission of diseases associated with overweight. However, the results of the surgery are not always long lasting. It is estimated that 20% to 30% of the people who undergo the bariatric surgery will regain weight after the first two years. Aim: to understand the experience of weight regain to people who were subjected to bariatric surgery. Method: qualitative research with a phenomenological approach, conducted in a public hospital of Sao Paulo. The sample was composed of 17 participants who presented weight regain after bariatric surgery. To collect the data, an open interview was used with the following guiding questions: How is it to you, to notice yourself gaining weight again? What do you believe is contributing to your weight gain? How do you deal with the weight regain? How do you see yourself in a few years, in relation to your body weight? The organization and analysis of the interviews were conducted following the steps recommended by scholars of the social phenomenology of Alfred Schütz. Results: the typical action experienced by people with weight regain after bariatric surgery showed up as one that: assigns the weight regain to an emotional instability that leads them to difficulties in the control of eating behaviour; states that stress, anxiety and loneliness contributes to weight regain; associates the recurrence of overweight to anatomical changes related to the surgery; expresses feelings of defeat, guilt and sadness; points out physical and mental consequences arising from the weight regain; fears gaining too much weight and losing control; report excessive alcohol consumption; has the expectation of controlling the weight gain in order to positively impact the quality of life, thus, requires multidisciplinary support for issues regarding weight regain; intend to undergo another bariatric surgery and a plastic surgery to improve self-esteem. Conclusions: the findings illustrate how the phenomenon of weight regain is complex in its bio-psycho-emotional aspects and requires an individualized and qualified attention, welcoming of the subjective issues experienced by those who were submitted to a bariatric surgery and are going through a situation of weight regain. It is believed that the discussion on this research reinforces the need of the healthcare teams to invest on a follow-up of bariatric patients, based on an intersubjective relationship that respects and considers the other, sharing decisions and contributing to the patients becoming active in the production of their health and partners in the success of reaching and maintaining their desired weight.