Abstract Background: Cognitive Behaviour Therapy, (CBT) is well established as an effective treatment for depression. Its applicability in routine public mental health practice is however unknown, as most published studies excluded participants with suicide risk or if co-morbid with other disorders such as schizophrenia or bipolar affective disorder. Clients of public mental health services are characterised by symptom severity, chronic course of illness, treatment resistance and / or co-morbidity. In order to determine whether CBT has utility in routine public mental health practice, it is important to find out whether symptoms of depression (and anxiety) in this client population will respond to a course of CBT provided as part of standard care. Aims and Hypotheses: This effectiveness study aimed to ascertain if CBT is effective in treating depressed and/or anxious symptoms when such symptoms exist within the clinically more complex population found within Community Mental Health Services / Settings, (CMHSs). It was hypothesised that clients receiving CBT would show reliable and clinically significant improvement in symptoms of depression and anxiety but that the amount of improvement would be less than that reported in efficacy studies with less complex client groups. Method: This was a repeated measures, uncontrolled intervention study with results benchmarked against published data. Forty six adult clients of the Inner North Brisbane Mental Health Service (INBMHS) with diagnoses of Depression and / or Anxiety, in isolation or in conjunction with Schizophrenia, Bipolar affective disorder, or a Personality Disorder were treated with an eight (8) session manualised CBT program as part of routine clinical care. Standardised measures of depression, anxiety and stress were taken at time of referral, time of the commencement of treatment, time of treatment completion and at six-month post completion of treatment. Results: Participants showed reliable and statistically significant improvement in self reported symptoms from commencement to completion of treatment. Gains were retained at follow-up. Effect sizes were in the moderate to large range and improvements were clinically significant for approximately one third of the participants. Conclusions: CBT seems to be an effective treatment for depression and anxiety where such symptoms exist within a mental health population. Further research addressing the limitations of this study would add strength to the argument that the mental health population could benefit from the broad availability of such treatment.

Hur preferens påverkar behandlingsutfall är ett ämne som diskuteras och undersöks allt mer. Tidigare forskning indikerar en liten till moderat effekt av preferens på behandlingsutfall. Syftet i den här studien var att undersöka preferens, preferensstyrka och de närliggande begreppen förväntan och trovärdighet i relation till behandlingsutfall för två internetbaserade behandlingar för insomni, kognitiv terapi och beteendeterapi. 112 deltagare randomiserades till en av de två behandlingarna eller till att få välja behandling. Signifikant fler deltagare valde kognitiv terapi. Preferens för typ av behandling påverkade inte behandlingsutfallet. Det fanns heller inget samband mellan preferensstyrka och utfall, men deltagarna skattade det som viktigt att få välja. Det fanns en svag signifikant korrelation mellan förväntans- och trovärdighetsskattningarna och utfall. På grund av små och ojämna grupper är det svårt att dra några vidare slutsatser om hur preferens påverkar behandlingsutfall. / Behandling via Internet av Sömnproblem (BIS)

Purpose: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD), acknowledged repeated or extreme indirect exposure to aversive details of traumatic event(s) in the course of professional duties, can lead to symptoms of PTSD. This has led to discussions around impact and prevalence of vicarious trauma in psychological therapists treating trauma clients. This study considers how therapists delivering trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) make sense of their experiences and protect themselves from any negative effects of the work. Furthermore, it considers if there is a distinction in therapist experience between the two modalities. Methodology/Method: An Interpretative Phenomenological Analysis (IPA) was conducted to explore how trauma-focused CBT and EMDR therapists engaged in trauma work, interpreted and made sense of their experiences; with a view to identifying any protective practice that informed clinical practice and helped ameliorate vicarious trauma. Recorded, semi-structured interviews were conducted with CBT and EMDR therapists (N=11). Before analysis, interviews were transcribed verbatim and sent to individual participants for validation of their authenticity. Data was analysed using descriptive, linguistic and conceptual comments to identify an initial seventy nine emergent themes. When refined, four master themes of ‘Nature of Trauma’, ‘Participant sense of self and managing the process of hearing trauma narrative’, ‘Participant experience of delivering the trauma models’ and ‘Protecting and sustaining the participant sense of self’ were identified to answer the research question and are discussed herein. Findings: This study forms part of the growing body of evidence towards understanding therapist vicarious traumatisation. It both supports and challenges findings of previous studies. It also introduces new concepts in relation to the vicarious trauma phenomenon. Whilst there are clear limitations associated with making generalisations from an IPA study, the findings from the study suggest EMDR may be a protective factor against the negative effects of hearing repeated trauma narrative. Furthermore, certain strategies such as time management, comprehensive trauma training and specific trauma supervision, may also reduce the negative effects of hearing trauma narrative. Finally, regardless of the difficulties faced, therapists enjoy their trauma work and feel a great sense of professional satisfaction. Implications/Recommendations: Indications from the findings of the study are that therapists working within primary care in particular, are becoming increasingly pressurised by cuts to funding within mental health services. Recommendations are that those components of trauma work which promote therapist wellbeing should be supported. In particular, realistic timeframes within which to work, good quality training and supervisors, ideally external to the workplace, who can provide trauma-specific supervision.

In this study the phenomenon of persistent physical symptoms (PPS) has been examined by realist evaluation of research and practice. Nimnuan et al., (2001) have shown that up to 35% of patients in primary care and 66% in specialist out-patient clinics have presented with such ‘medically unexplained’ symptoms. The cost in medical investigation to reach diagnosis for PPS is an estimated 10% of the annual UK National Health Service budget (Bermingham et al., 2010) but poor patient outcomes prevail (Dwamena et al., 2009). Currently, PPS is linked to high comorbidity with anxiety and depression (DH 2011b) and Cognitive Behavioural Therapy (CBT) is advised as the evidence based treatment for PPS (IAPT, 2014). However, a shortfall in clinical skills to address PPS is also demonstrated and engagement could be improved (De Lusignan et al., 2014). Moreover, the pragmatic study of alternative therapy modalities and processes for PPS is recommended (Leichsenring, 2005). To obtain a broader knowledge of process for patients with or without co-morbidity, practice based experience suggests that one such alternative is a brief psychodynamic intervention (STPP) for PPS. A Realist Literature Synthesis (Wong et al. 2013) highlights effective psychotherapeutic STPP interventions in real world circumstances in 5 comparison with CBT interventions for heterogenous PPS. STPP for PPS is found at least as effective as CBT, with improved engagement rates. Additionally, common factors were discovered between ‘third generation’ STPP and CBT for effective PPS interventions and these were developed into a preliminary cross-modality theoretical analytical framework. In the realist contextual evaluation (Pawson and Tilley, 1997) of a psychosexual service delivery, the majority of PPS sufferers were found only moderately co-morbid with anxiety and depression. For complete investigative study, clinical tools are developed providing integrative CBT/STPP principles for engagement with PPS for teaching, training and practice. In conclusion, the findings suggest that the reflexive insider position of the realist Therapist-Evaluator facilitates systematically derived Practice-Based Evidence of PPS process, meeting recommendations of Deary et al., (2007) to explore and define process and outcomes with PPS. The findings contribute to development of a conceptual platform to support health professionals in overcoming physical/mental health barriers to addressing PPS and wider patient access to effective care (NHSE, 2014, 2015).

Aims: There is a well-established link between asthma and anxiety, leading to exacerbations for both conditions. National guidelines and policy documents recommend the provision of psychological interventions for this comorbidity, although evidence for their effectiveness is inconclusive. This thesis had two objectives: a) to evaluate cognitive-behavioural therapy (CBT) interventions for reducing anxiety in adults and/or children with asthma, given that CBT has a stronger evidence base for relevant respiratory and mental health conditions, b) to explore the lived experience of the interplay between childhood asthma and anxiety directly from the affected population in order to identify specific thinking and behaviour patterns that may maintain this comorbidity. Method: The first journal article outlined a systematic review. Three major electronic databases and manual searches were used to find relevant published and unpublished research. Trials meeting inclusion criteria, primarily utilising validated anxiety measures and employing both cognitive and behavioural techniques, were evaluated using adapted quality criteria. The second empirical article implemented interpretative phenomenological analysis (IPA) to explore the mechanisms maintaining the interplay between asthma and anxiety as experienced by 11 young people (aged 11-15) living with the comorbidity. Results: Fourteen trials met the inclusion criteria for the systematic review. The reviewed trials showed reasonable preliminary support for the effectiveness of CBT for anxiety in individuals with asthma across the age range. The favourable results were largely maintained long-term. The empirical article revealed three super-ordinate themes: i) ‘the influence of asthma’ by inhibiting valued activities or developmental tasks, triggering catastrophic thinking and leading to a generalisation of asthma coping strategies to managing anxiety; ii) ‘the influence of anxiety’ by affecting appropriate medication use and triggering hyperventilation-induced asthma exacerbations; and iii) ‘the interaction between asthma and anxiety’ by forming an unhelpful positive feedback loop and triggering symptom confusion. Conclusions: The systematic review discussed the moderate overall study quality and called for more methodologically robust research, examining CBT models tailored to this population and utilising clinically representative samples. The empirical article pointed to possible maintaining mechanisms identified, which lend themselves to a cognitive-behavioural framework, potentially including mindfulness-based interventions, and may be used to tailor psychological treatments.

Submitted by Automação e Estatística (sst@bczm.ufrn.br) on 2018-07-03T11:30:10Z No. of bitstreams: 1 JoadilzaDaSilvaBezerra_DISSERT.pdf: 2697659 bytes, checksum: efa321461185d3e73686b477cb6967cc (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-07-09T14:29:38Z (GMT) No. of bitstreams: 1 JoadilzaDaSilvaBezerra_DISSERT.pdf: 2697659 bytes, checksum: efa321461185d3e73686b477cb6967cc (MD5) / Made available in DSpace on 2018-07-09T14:29:38Z (GMT). No. of bitstreams: 1 JoadilzaDaSilvaBezerra_DISSERT.pdf: 2697659 bytes, checksum: efa321461185d3e73686b477cb6967cc (MD5) Previous issue date: 2018-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A contagem de células somáticas (CCS) aumentada no leite acarreta mudanças nos componentes, pelo incremento na atividade proteolítica e lipolítica do leite, influenciando diretamente no rendimento, qualidade sensorial e vida de prateleira dos derivados lácteos. Diante disso, esta pesquisa teve como principal objetivo avaliar o efeito da contagem de células somáticas sobre a qualidade do leite bovino coletado em tanques, baseado nos parâmetros de composição química, e efeitos nas características sensoriais do leite e do queijo coalho. A pesquisa foi desenvolvida na Associação de Pequenos Agropecuaristas do Sertão de Angicos (APASA), no município de Angicos, estado do Rio Grande do Norte, Brasil. Foram coletadas amostras de leite cru de 21 tanques de expansão, durante os meses de abril de 2016 a abril de 2017. Durante as coletas registraram-se as informações referentes ao tipo de ordenha e foi feito o monitoramento da temperatura e tempo de armazenamento do leite nos tanques. As amostras foram coletadas em frascos apropriados, conservadas refrigeradas (4 a 7°C) e, em seguida, enviadas a um laboratório credenciado à Rede Brasileira de Controle de Qualidade do Leite para análise de composição, contagem de células somáticas e contagem bacteriana total. Para relacionar os níveis de CCS com a composição química, foi feito um escalonamento da CCS originando três categorias: Baixa - CCS < 200.000 céls.mL-1 ; Média CCS – 201.000 <CCS< 400.000 céls.mL-1 ; Alta CCS: CCS>400.000 céls.mL-1 . A matéria-prima para elaboração dos derivados foi selecionada com base nos valores médios de CCS obtidos do leite cru oriundo dos tanques, obtendo-se duas categorias: Baixa CCS – inferior a 100.000 céls.mL1 ; alta CCS entre 400.000 e 500.000 céls.mL-1 . As categorias selecionadas foram submetidas à pasteurização e, posteriormente, elaborado o queijo coalho. A análise sensorial foi realizada no leite pasteurizado e no queijo coalho, ambos com dois níveis de CCS, sendo executada por 100 julgadores não treinados, utilizando-se o teste triangular, escala hedônica e teste de intenção de consumo. Os dados foram submetidos ao método estatístico de análise descritiva, para obtenção de média, desvio-padrão e coeficiente de variação. Foi aplicado o teste Tukey (P<0,05) para comparação das médias. Em relação ao tipo de ordenha, a contagem bacteriana total foi menor para o leite obtido através de ordenha mecânica. As condições de armazenamento demonstraram que a temperatura teve mais variação nos tanques individuais e observou-se correlação positiva entre o tempo de armazenamento e a CBT do leite. Não houve diferença estatística entre os níveis de CCS e os componentes do leite (gordura, proteína total, caseína, lactose, extrato seco total, extrato seco), os quais estavam de acordo com a legislação. Porém, das amostras de leite analisadas, 42,7% continham alta contagem de CCS e a média da CBT exibiu valores acima do preconizado. Na análise sensorial, o leite pasteurizado e o queijo coalho oriundos de leite com baixa CCS obtiveram maior aceitação sensorial. / Increased somatic cell count (SCC) in milk leads to changes in the components, by the increase in the proteolytic and lipolytic activity of milk, directly influencing the yield, sensory quality and shelf life of dairy products. The objective of this research was to evaluate the effect of somatic cell counts on the quality of bovine milk collected in tanks, based on chemical composition parameters and effects on the sensorial characteristics of milk and coalho cheese. The research was developed in the Associação de Pequenos Agropecuaristas do Sertão de Angicos (APASA), in the municipality of Angicos, state of Rio Grande do Norte, Brazil. Samples of raw milk were collected from 21 expansion tanks during the months of April 2016 to April 2017. During the collection the information regarding the type of milking was recorded and the temperature and storage time of the milk in the tanks. The samples were collected in appropriate bottles, stored refrigerated (4 to 7 ° C) and then sent to a laboratory accredited to the Rede Brasileira de Controle de Qualidade do Leite for analysis of composition, somatic cell count and total bacterial count . In order to relate CCS levels to chemical composition, SCC was scaled to three categories: Low - SCC <200.000 cells.mL-1 ; Average SCC – 201.000 <SCC <400.000 cells.mL-1 ; High SCC: SCC> 400.000 cells.mL-1 . The raw material for the elaboration of the derivatives was selected based on the average values of CCS obtained from the raw milk from the tanks, obtaining two categories: Lower SCC - less than 100.000 cells.mL-1 ; high SCC between 400.000 and 500.000 cells.mL-1 . The selected categories were submitted to pasteurization and, subsequently, the rennet cheese was produced. Sensory analysis was performed on pasteurized milk and rennet cheese, both with two SCC levels, performed by 100 untrained judges, using the triangular test, hedonic scale and consumption intention test. The data were submitted to the statistical method of descriptive analysis, to obtain mean, standard deviation and coefficient of variation. The Tukey test (P <0.05) was used to compare the mean. Regarding the type of milking, the total bacterial count was lower for the milk obtained through mechanical milking. The storage conditions showed that the temperature had more variation in the individual tanks and a positive correlation was observed between the storage time and the total bacterial count (TBC) of the milk. There was no statistical difference between the levels of SCC and the components of milk (fat, total protein, casein, lactose, total dry extract, dry extract), which were in accordance with the legislation. However, of the analyzed milk samples, 42.7% contained a high SCC count and the mean of the TBC showed values above that recommended. In the sensorial analysis, the pasteurized milk and the coalho cheese from low SCC milk obtained greater sensorial acceptance.

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Agradecemos a compreensão. on 2016-07-04T17:30:07Z (GMT) / Submitted by LEANDRO TEMER JAMAS null (leandrotemer@gmail.com) on 2016-07-04T19:35:38Z No. of bitstreams: 1 DISSERTAÇÃO MESTRADO 4-7-2016.pdf: 836958 bytes, checksum: 551116afc1da02b0877b65ce444cf9c0 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-07-06T16:14:14Z (GMT) No. of bitstreams: 1 jamas_lt_me_bot.pdf: 836958 bytes, checksum: 551116afc1da02b0877b65ce444cf9c0 (MD5) / Made available in DSpace on 2016-07-06T16:14:14Z (GMT). No. of bitstreams: 1 jamas_lt_me_bot.pdf: 836958 bytes, checksum: 551116afc1da02b0877b65ce444cf9c0 (MD5) Previous issue date: 2016-06-02 / Propriedades da agricultura familiar tem contribuído para aumentar a produção leiteira, sendo um importante seguimento da cadeia produtiva do leite. A higiene no processo produtivo deve ser o foco principal para garantir maior produção e qualidade do leite. Monitorou-se a qualidade do leite de vacas, em propriedades da agricultura familiar, no município de Bofete/SP, antes e após medidas de controle. Avaliou-se 21 propriedades, selecionadas por conveniência. Após período inicial de 13 coletas para avaliação de CCS e CBT, os proprietários dos dois grupos (G1 e G2) receberam orientações técnicas sobre mastite e qualidade do leite, em atividade de dia de campo. Os proprietários do G1 receberam intervenção no manejo utilizado, com visita técnica, e orientações individuais quanto à maneira adequada de ordenha e obtenção higiênica do leite. Os proprietários do G2 (grupo controle) não receberam orientação nem intervenção do manejo. Em seguida novas coletas quinzenais (n=12) foram realizadas, de amostras de leite de conjunto de cada propriedade nos dois grupos, bem como do tanque comunitário. As propriedades tinham em média 29 hectares, variando de 3,5 hectares a 120 hectares. A produção média de leite diária, era de 40 litros/dia propriedade, sendo a menor produção de 10 litros e a maior de 100 litros/dia. Observou-se uma variação dos resultados de cada coleta tanto para CCS/mL de leite quanto para CBT/mL de leite, nos dois períodos. Quanto a CCS no G1 houve uma diminuição significativa (P < 0,02), enquanto que para CBT houve um ligeiro aumento, bem menor, quando comparado ao valor mediano foi de 381x103 UFC/mL de leite do grupo G2. Os resultados medianos de CCS/mL de leite e de CBT/mL de leite do tanque comunitário, foram mais elevados nas duas fases, entretanto muito superior para CBT. A análise das variáveis climáticas evidenciou aumento das medianas de precipitação, temperatura e umidade relativa do ar. No entanto, a correlação entre as variáveis climáticas e qualidade do leite, não mostrou diferenças para o Log10 da CCS e CBT. Os resultados obtidos sugerem a higiene precária no manejo de ordenha. Recomenda-se adoção de políticas públicas voltadas aos pequenos produtores de leite, fixando-os nas propriedades, estimulando-os para incrementar a produção de leite, com melhor qualidade, oferecendo-se condições de sobrevivência em função das atividades que desenvolvem. / Family farming properties has contributed to increase milk production is an important follow-up milk production chain .Hygiene in the production process must be the major focus to ensure higher milk quality and production. The quality of milk from cows in a family farm, in the city of Bofete/SP, was monitored before and after control measures. The evaluation included 21 farms, selected for convenience. Following the initial period of 13 collections for SCC and TBC evaluation, farmers of the two groups (G1 and G2) received technical guidance about mastitis and milk quality in field activity. G1 farmers received intervention in the adopted management by means of technical visit and individual guidance as to the adequate milking manner and hygienic milk production. G2 farmers (control group) did not receive guidance or management intervention. Then, new collections (n=12) of milk samples were performed fortnightly from each farm in the two groups, as well as from the community tank. The farms had on average 29 hectares, varying from 3.5 hectares to 120 hectares. The daily average milk production was 40 liters/day farm, and the lowest production was 10 liters while the largest production was 100 liters/day. Results of each collection varied for both SCC/mL milk and TBC/mL milk in the two periods. As to SCC in G1, there was a statistically significant decrease (P < 0.02), whereas for TBC there was a slight increase, much lower, compared to the median value of 381x103 CFU/mL milk of group G2. The median results of SCC/mL milk and TBC/mL milk from the community tank were higher in the two phases, but even superior for TBC. Analysis of climate variables evidenced an increase in the medians of rainfall, temperature and relative humidity. However, the correlation between climate variables and milk quality did not show differences for Log10 of SCC and TBC. The obtained results suggest precarious hygiene in the milking management. Adoption of public policies directed to small dairy farmers is recommended, establishing them in the farms and stimulating them to increase milk production with higher quality, offering survival conditions according to the activities they develop.

Orientador: Hélio Langoni / Resumo: Propriedades da agricultura familiar tem contribuído para aumentar a produção leiteira, sendo um importante seguimento da cadeia produtiva do leite. A higiene no processo produtivo deve ser o foco principal para garantir maior produção e qualidade do leite. Monitorou-se a qualidade do leite de vacas, em propriedades da agricultura familiar, no município de Bofete/SP, antes e após medidas de controle. Avaliou-se 21 propriedades, selecionadas por conveniência. Após período inicial de 13 coletas para avaliação de CCS e CBT, os proprietários dos dois grupos (G1 e G2) receberam orientações técnicas sobre mastite e qualidade do leite, em atividade de dia de campo. Os proprietários do G1 receberam intervenção no manejo utilizado, com visita técnica, e orientações individuais quanto à maneira adequada de ordenha e obtenção higiênica do leite. Os proprietários do G2 (grupo controle) não receberam orientação nem intervenção do manejo. Em seguida novas coletas quinzenais (n=12) foram realizadas, de amostras de leite de conjunto de cada propriedade nos dois grupos, bem como do tanque comunitário. As propriedades tinham em média 29 hectares, variando de 3,5 hectares a 120 hectares. A produção média de leite diária, era de 40 litros/dia propriedade, sendo a menor produção de 10 litros e a maior de 100 litros/dia. Observou-se uma variação dos resultados de cada coleta tanto para CCS/mL de leite quanto para CBT/mL de leite, nos dois períodos. Quanto a CCS no G1 houve uma diminuição significa... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Family farming properties has contributed to increase milk production is an important follow-up milk production chain .Hygiene in the production process must be the major focus to ensure higher milk quality and production. The quality of milk from cows in a family farm, in the city of Bofete/SP, was monitored before and after control measures. The evaluation included 21 farms, selected for convenience. Following the initial period of 13 collections for SCC and TBC evaluation, farmers of the two groups (G1 and G2) received technical guidance about mastitis and milk quality in field activity. G1 farmers received intervention in the adopted management by means of technical visit and individual guidance as to the adequate milking manner and hygienic milk production. G2 farmers (control group) did not receive guidance or management intervention. Then, new collections (n=12) of milk samples were performed fortnightly from each farm in the two groups, as well as from the community tank. The farms had on average 29 hectares, varying from 3.5 hectares to 120 hectares. The daily average milk production was 40 liters/day farm, and the lowest production was 10 liters while the largest production was 100 liters/day. Results of each collection varied for both SCC/mL milk and TBC/mL milk in the two periods. As to SCC in G1, there was a statistically significant decrease (P < 0.02), whereas for TBC there was a slight increase, much lower, compared to the median value of 381x103 CFU/mL milk o... (Complete abstract click electronic access below) / Mestre

nÃo hà / A regiÃo nordeste do Brasil tem grande potencial para a produÃÃo de leite de cabra, e a qualidade do leite produzido à importante para garantir a oferta de um alimento seguro do ponto de vista nutricional e higiÃnico sanitÃrio aos consumidores. O leite de cabra tem alto valor nutricional e possui grande aceitaÃÃo, especialmente em comunidades carentes, uma vez que constitui importante fonte proteica de alta qualidade na dieta dessas pessoas. A distribuiÃÃo gratuita e diÃria do leite de cabra, por meio de programas governamentais, tem o objetivo de reduzir deficiÃncias nutricionais com prioridade para as crianÃas, as gestantes e as nutrizes. O Kit Embrapa de Ordenha Manual foi desenvolvido com o propÃsito de contribuir para a produÃÃo segura do leite, atravÃs de uma tecnologia de baixo custo, ao alcance dos produtores familiares, os quais sÃo responsÃveis por grande parte da produÃÃo de leite de cabra no Brasil. O objetivo deste trabalho foi avaliar o efeito do Kit Embrapa de Ordenha Manual para caprinos leiteiros em propriedades de agricultura familiar, localizadas em trÃs regiÃes do nordeste Brasileiro. Durante o perÃodo de maio de 2010 a fevereiro de 2011, foram colhidas amostras de leite de cabra provenientes de rebanhos dos Estados do CearÃ, ParaÃba e Rio Grande do Norte para determinaÃÃo da composiÃÃo, contagem de cÃlulas somÃticas (CCS) e contagem bacteriana total (CTB). Avaliou-se tambÃm os impactos ambientais e sociais do Kit atravÃs do Sistema Ambitec-Agro. ApÃs a implantaÃÃo do Kit nas propriedades estudadas, observou-se uma diminuiÃÃo mÃdia de 72,1% da CTB e preservaÃÃo das caracterÃsticas de composiÃÃo do leite. A avaliaÃÃo do efeito da CCS sobre os componentes mostrou que houve um decrÃscimo da porcentagem de lactose do leite conforme aumentou a CCS. Dentre as amostras analisadas, 64% apresentavam contagens superiores a 1.000.000 CCS/mL, antes da adoÃÃo do Kit, o que evidenciou a necessidade da implantaÃÃo das Boas PrÃticas de ordenha nas propriedades avaliadas. A avaliaÃÃo de impacto social e ambiental foi positiva, apresentando valores mÃdios de 1,07 e 0,9 na avaliaÃÃo ex-post para os Ãndices de impacto Ambiental e Social, respectivamente, mostrando o potencial desta tecnologia como parte de um conjunto de atitudes capazes de melhorar a qualidade do leite de cabra produzido no Brasil, assim como proporcionar ganhos aos produtores. / The northeastern region of Brazil has great potential for the production of goat milk, and the quality of the milk produced is important to ensure consumers a safe food supply from the nutritional and hygienic-sanitary standpoint. Goat milk has high nutritional value and has a wide acceptance, especially in poor communities, since it is an important protein source in the diet of these people. The free and daily distribution of the goat milk, through government programs, aims to reduce nutritional deficiencies with priority given to children, pregnant women and nursing mothers. The goal of this study was to evaluate the effect of the Kit Embrapa de Ordenha Manual for dairy goats in family farming, located in three regions of northeastern Brazil. This effect was evaluated in samples of goat milk on the composition, somatic cell count (SCC) and total bacterial count (TBC), and also the effect of SCC on the components, by correlation of the data. In parallel, we assessed the environmental and social impacts of the Kit through Sistema Ambitec-Agro. The Kit Embrapa de Ordenha Manual was developed with the purpose of safe milk production through a low-cost technology that is available to family farmers, who are responsible for much of the production of goat milk in Brazil. Its validation in properties of Paraiba, Rio Grande do Norte and Cearà brought positive results, as the average of TBC decreased 72% and the characteristics of milk composition were preserved. The evaluation of SCC effect on the milk components showed that there was a decrease in the percentage of lactose in milk as SCC increased. Among the samples analyzed, 64% had counts exceeding 1.000.000 CCS/mL. This highlights the need for the implementation of hygiene practices on the milking properties evaluated. The social and environmental impact was also positive, with average values of 1.07 and 0.9 in the ex post evaluation indexes for Environmental and Social Impact, respectively, showing the potential of this technology as part of a set of attitudes capable of improving the quality of goat milk produced in Brazil, as well as of providing gains to producers.

Cognitive behaviour therapy (CBT) is a therapeutic modality which is commonly argued to be oriented to a medical model, and so to diverge significantly in theory and practice from the traditional relational and humanistic roots of counselling psychology. A large body of literature and research exists which examines counselling psychologists’ professional identity in medical settings, but there appears to be a significant gap in the extant literature relating to how counselling psychologists experience professional identity specifically in the practice of CBT, a therapeutic modality which presently provides a considerable amount of employment for counselling psychologists. To address this gap, the present study sought to explore qualitatively whether counselling psychologists’ experience of their professional identity is affected by the inclusion of CBT in their practice. A sample of eight counselling psychologists who worked with CBT and had been qualified for at least five years were interviewed. Data gathered from the semistructured interviews were transcribed and analysed using interpretative phenomenological analysis (IPA), a method selected because it is concerned with the detailed examination of personal lived experience and the meaning of experience to participants. The methodology was approached within the contextual constructionist epistemological framework. Three superordinate themes, each containing four subordinate themes, emerged from participants’ accounts: (i) components of professional identity; (ii) the contribution of CBT to the professional self; and (iii) how CBT compromises the professional self. The findings are discussed in relation to the relevant literature, and lines of enquiry that have emerged have been located in current postmodern literature, arguments and debates. One main conclusion of the present study is that feeling comfortable with CBT can CBT, Counselling Psychology and Professional Identity 3 depend upon practitioners’ initial training, personal experience, cultural background, personal characteristics and personal beliefs – that is, the professional self as emerging from the personal self. Clinical implications, methodological limitations, directions for future research and reflections upon the researcher’s reflexivity are presented.