Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2018-08-30T14:21:26Z No. of bitstreams: 1 DISS_2013_ Robson Alves de Paula.pdf: 1323242 bytes, checksum: e1f632f73c89ac37f5fad6446d7a8a43 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2018-10-03T17:10:26Z (GMT) No. of bitstreams: 1 DISS_2013_ Robson Alves de Paula.pdf: 1323242 bytes, checksum: e1f632f73c89ac37f5fad6446d7a8a43 (MD5) / Made available in DSpace on 2018-10-03T17:10:26Z (GMT). No. of bitstreams: 1 DISS_2013_ Robson Alves de Paula.pdf: 1323242 bytes, checksum: e1f632f73c89ac37f5fad6446d7a8a43 (MD5) Previous issue date: 2013-07-17 / Na contemporaneidade, o crack é a droga que mais vem alarmando o Brasil, a ponto de ser tratada epidemiologicamente. Estudos observam que são diferentes os tipos de apresentação dos derivados da cocaína, quais sejam: sal, crack, pasta base, sendo esta ultima, a forma utilizada em Mato Grosso, devido às proximidades fronteiriças com países produtores. A pasta base ou crack tende a ser interpretada simbolicamente, de forma diferenciada em relação às demais substâncias psicoativas, sendo compreendida socialmente como responsável pela maioria dos problemas contemporâneos, tornando secundários os problemas e questões relacionadas às drogas não proibidas e as prescritas com fins medicamentosos, cujos efeitos nocivos causados ou não pelo uso inadequado, acabam sendo invisibilizados nas pautas de discussões do governo. Deste modo, a questão requer análise sob pontos de vista multidimensionais, que sejam capazes de fazer interagir a experiência individual, as biografias, com os enfoques macroestruturais, assim como a organização do trabalho psicossocial, dos saberes e terapias que o acompanham e que se harmonizam com outras alternativas de cuidados, ou com os diversos grupos sociais que fornecem apoio aos adoecidos. Tudo isso um desafio às pesquisas socioantropológicas, sendo aqui neste caso, essencial pensar nos impactos da enfermidade sobre as famílias. Para tanto, valendo-nos do referencial teórico e metodológico da experiência das condições crônicas que acompanham as pessoas em todos os lugares, levando-as a viver com, apesar da enfermidade abordando tanto as ideias que esses familiares detêm sobre as drogas e seus consumidores, como também as formas de gerenciar as consequências desse uso. Foi nessa perspectiva, que se definiu como objeto de estudo a investigação da experiência de familiares que convivem cotidianamente com pessoas usuárias de pasta base de cocaína. Compreender os significados do uso de pasta base de cocaína pelos familiares torna-se pertinente para que abordagens socioculturais venham obter o reconhecimento em prol de um aprimoramento das ações formuladas e implementadas pelo sistema de saúde, dirigidas a esse segmento. Concluiu-se que para os familiares, as drogas não são novidades, entretanto, a descoberta do uso em seu meio surpreende, choca, mobilizando estigmas e sentimentos de impotência. As drogas são normalmente identificadas pela ilicitude, caracterizando forte teor moral sobre a questão, sendo toleradas as medicamentosas. As explicações para o envolvimento com o uso, envolvem vicissitudes e vulnerabilidades das pessoas que as tornaram susceptíveis às más companhias. Faz-se necessário melhor envolvimento de profissionais da saúde com essa questão. / In contemporary times, the crack is the drug that is most alarming Brazil, about to be treated epidemiologically. Studies point out that they are different types of presentation of the cocaine derivatives, which are: salt, crack, home folder, the latter being the form used in Mato Grosso, due to the nearby border with producing countries. Therefore, the base folder or crack tends to be interpreted symbolically differently compared to other psychoactive substances, being understood as socially responsible by most contemporary problems, making secondary problems and issues related to the drugs and not prohibited for purposes prescribed medication whose harmful effects caused by improper use or not, end up being invisible on the agendas of government discussions. Thus, the question requires analysis in multidimensional views, which are capable of interacting individual experience, biographies, with the macro-structural approaches, as well as the psychosocial work organization, knowledge and therapies that accompany and harmonize with other care alternatives, or with the various social groups that provide support to the diseased. All this a challenge to socio-anthropological research, being here in this case, think of the essential impacts of the disease on families. Therefore, availing ourselves of the theoretical and methodological experience chronic conditions that accompany people everywhere, causing them to live with, despite the illness addressing both the ideas that these families have about drugs and their consumers, as well as ways to manage the consequences of that use. It was this perspective that has been defined as an object of study to investigate the experience of family members who live daily with people who use cocaine base paste. Understand the meanings of the use of cocaine base paste by family becomes relevant to sociocultural approaches that will get recognition towards an improvement of actions formulated and implemented by the health system, targeting this segment. It was concluded that for the family, drugs are not new, but the discovery of the use in its midst surprises, shocks, mobilizing stigma and feelings of powerlessness. Drugs are usually identified by the unlawfulness, featuring strong moral content of the question, being tolerated the drug. The explanations for engagement with the use, involve vicissitudes and vulnerabilities of people that made them susceptible to bad company. It is necessary to better involvement of health professionals with this issue.

Abstract Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency towards the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through the use of mobile technologies (mHealth) has grown exponentially in recent years. However, only a fraction of these solutions takes into consideration the views of relevant stakeholders like healthcare professionals or even patients. The use of behavioral change models (BCM) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. This doctoral thesis is framed in Consumer Health Informatics within the field of Medical Informatics and Information Systems. The focus of this work was to discover factors for the design of mHealth solutions for chronic patients; to do so, negotiations between medical knowledge, BCM and gamification were explored through an embedded case study research methodology. The data obtained was thematically analyzed to create the Model for Motivational Mobile-health Design for Chronic conditions (3MD). The 3MD model guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are: 1) Condition specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; 2) Motivation related, which are factors that address how to influence behaviors in an engaging manner; and 3) Technology based, which are factors that are directly connected to the technical capabilities of mobile technologies. 3MD also provides a series of high level illustrative design questions for designers to use and consider during the design process. The work on this thesis addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients. / Tiivistelmä Krooniset sairaudet ovat maailman yleisin kuolinsyy. Akuutissa hoidossa ja diagnostiikassa on tapahtunut merkittäviä parannuksia, ja aikaisemmin kuolemaan johtaneista sairauksista on tullut kroonisia ja ihmisten on opittava hallitsemaan niitä itse. Mobiiliteknologiat tarjoavat mahdollisuuksia sairauksien itsehallintaan, koska teknologiaa on yleisesti saatavilla ja se on kustannustehokasta. Terveyspalvelujen tarjoaminen mobiiliteknologian avulla on lisääntynyt huomattavasti viime vuosina. Kuitenkin vain murto-osa näistä ratkaisuista ottaa huomioon sidosryhmien, kuten terveydenhuollon ammattilaisten ja jopa potilaiden, näkemykset. Käyttäytymismuutosmallit ovat osoittautuneet tärkeiksi kehitettäessä onnistuneita terveysratkaisuja, mutta potilaiden osallistaminen kehittämiseen on yhä vaikeaa. Pelillistäminen on mobiilien terveysratkaisujen suunnittelutrendi, ja pelielementeillä pyritään vaikuttamaan ihmisten käyttäytymiseen ja sitoutumiseen. Mobiilien terveyssovellusten suunnittelijoilla ei ole selkeää näkemystä siitä, mitkä sovellustekijät vaikuttavat merkittävimmin kroonisissa sairauksissa sairastavien potilaiden käyttäytymisen muutokseen. Tämä väitöskirja tarkastelee kuluttajille suunnattua terveysteknologiaa, joka hyödyntää lääketieteellistä informatiikkaa ja tietojärjestelmätieteitä. Työn tavoitteena oli selvittää kroonisia sairauksia sairastaville potilaille tarkoitettujen mobiilien terveyssovellusten suunnitteluun liittyviä tekijöitä. Tämän vuoksi lääketieteen tietämyksen, käyttäytymismuutoksien mallien ja pelillistämisen yhdistämistä tutkittiin sulautetun tapaustutkimuksen avulla. Saatuja tietoja temaattisesti analysoimalla luotiin kroonisia sairauksia varten motivoivan mobiilin terveyssovelluksen suunnittelumalli (3MD = Model for Motivational Mobile-health Design). 3MD-malli ohjaa sairauksien hallintaan tarkoitettujen pelillistettyjen ja käyttäytymismuutoksiin tähtäävien mobiilien terveyssovellusten suunnittelua. Mallin pääkomponentit ovat: 1) Sairautta kuvaavat tekijät, jotka kuvaavat tekijöitä, jotka on mukautettava ja sovitettava kullekin krooniselle sairaudelle. 2) Motivaatioon liittyvät tekijät, jotka vaikuttavat innostavasti käyttäytymiseen. 3) Teknologiaan perustuvat tekijät, jotka liittyvät suoraan mobiiliteknologian teknisiin ominaisuuksiin. 3MD tarjoaa myös havainnollisia suunnittelukysymyksiä, joita suunnittelijat voivat käyttää ja pohtia suunnitteluprosessin aikana. Tämä väitöskirja käsittelee yleisesti tunnistettua puutetta tutkimuksessa ja suunnittelukäytännössä ja esittelee ainutlaatuisen mallin, josta voi olla hyötyä uusien ratkaisujen luomisessa ja kroonisia sairauksia sairastavien potilaiden auttamisessa.

Tratase de parte do Estudo SABE Saúde, Bem Estar e Envelhecimento, de delineamento longitudinal de base populacional que entrevistou 2143 pessoas de 60 anos e mais em 2000, no município de São Paulo, e reentrevistou 1115 delas em 2006. O objetivo do presente estudo foi avaliar a atenção às condições crônicas, utilizando a Hipertensão Arterial Sistêmica e o Diabetes Mellitus como condições traçadoras. Para isso, identificouse o uso e acesso aos serviços de saúde e as práticas de controle dessas doenças. Além disso, observouse a associação do uso de serviços com a ocorrência de desfechos desfavoráveis e compararamse indicadores de atenção à saúde com relação à posse de plano de saúde ou não. Foram utilizados testes estatísticos de regressão logística múltipla. Observouse uma prevalência de Hipertensão Arterial Sistêmica de 53,1 por cento e de Diabetes Mellitus do tipo 2 de 16,8 por cento em 2000, com incidência de autorreferência acumulada no período, de 30,0 por cento e 8,0 por cento respectivamente. O uso de três ou mais consultas por idosos hipertensos e/ou diabéticos em 2006 foi de 80,0 por cento e identificouse associação com os fatores de necessidade e com posse de plano de saúde, indicando desigualdades de acordo com o modelo de Andersen. A cobertura de planos de saúde entre os hipertensos e/ou diabéticos foi de 48,9 por cento em 2006, mantido no período. Foi referida dificuldade em usar serviços de saúde por 28,6 por cento dos hipertensos e/ou diabéticos em 2006, a maior parte relacionada à qualidade percebida dos serviços. Quem tem plano de saúde mostrou menor dificuldade de acesso, menor tempo de espera para agendamento e para ser atendido no serviço e maior satisfação com o uso. No entanto, o uso de serviços para controle foi maior entre os que não referiram posse de plano de saúde. Houve ampliação do acesso medicamentoso no período para ambas as doenças, em particular no setor público, com 70,5 por cento dos diabéticos e 88,4 por cento dos hipertensos usando medicação específica em 2006. Não se encontrou associação entre uso de serviços ambulatoriais nem com AVC, nem com perda de capacidade funcional sendo que, houve associação de posse de plano de saúde apenas com dificuldades em AIVD. Por outro lado, usar serviços ambulatoriais com maior frequência, mostrouse protetor ao risco de morrer. A taxa de mortalidade foi de 48 por mil para os hipertensos e 59,2 por mil para os diabéticos. Em conclusão, as condições crônicas estudadas têm forte impacto no uso de serviços, mas estes mostram pouca influência nos desfechos e sugerem desigualdades no acesso e na qualidade da atenção / This is part of the SABE Study Health, Welfare and Aging, a longitudinal study, which interviewed 2143 people, aged 60 and older in 2000, in São Paulo, and reinterviewed 1115 people, in 2006. The aim of this study was to evaluate the care for chronic conditions using Hypertension and Diabetes Mellitus as tracer conditions. For this, use of and access to health services and control practices were identified. Furthermore, association between use of health services and the occurrence of unfavorable outcomes was observed and, indicators of health care between public health and health insurance were compared. Logistic regression was used for multivariate analysis. The prevalence of hypertension was 53.1 per cent and type 2 Diabetes Mellitus was 16.8 per cent in 2000 and the incidence of selfreference accumulated in the period was 30.0 per cent and 8.0 per cent respectively. The use of three or more visits by hypertensive and / or diabetics in 2006 was 80.0 per cent. It was possible to identify an association between health services use and the factors of need and health insurance, indicating inequalities, according to the model of Andersen. The percent of the health insurance of hypertension and / or diabetes was 48.9 per cent in 2006. Difficulty in health services use was referred by 28.6 per cent of hypertensive and / or diabetics in 2006 mostly related to quality of services. Those who have health plan haves less difficulty of access, less waiting time for scheduling and to be serviced and increased satisfaction with use. However, the services use for disease control was higher among those who did not have health insurance and the access to drugs was increased, particularly in the public sector, with 70.5 per cent of diabetics and 88.4 per cent of the patients using drugs in 2006. There was no association between health services use and the incidence of stroke and loss of functional capacity, but the last one was associated with health insurance. On the other hand, an increased use of health services is related with a lower risk of death. Mortality rate was 48 per thousand for hypertensive and 59.2 per thousand for diabetics. In conclusion, the chronic conditions studied have a strong impact on the use of services, but they showed little influence on outcomes and suggest inequalities in access and quality of care

Syfte: Undersöka huruvida föräldrar med och utan barn med kroniska tillstånd skiljer sig åt gällande: psykologisk flexibilitet (generell och föräldraspecifik), utbrändhet, psykologiskt lidande och subjektiv livskvalitet. Samt undersöka om prediktorerna: huruvida föräldrarna har barn med kroniska tillstånd, nivåer av psykologisk flexibilitet (generell och föräldraspecifik), samt nivåer av medveten närvaro och kognitiv defusion förklarar föräldrars utbrändhetssymtom, psykologiska lidande och subjektiva livskvalitet. Metod: Oberoende ttest och Mann-Whitney U test genomfördes i syfte att undersöka medelvärdes skillnader mellan föräldrar till barn med kroniska tillstånd (N=51) och föräldrar till barn utan kroniska tillstånd (N= 28) gällande psykologisk flexibilitet, utbrändhet, psykologiskt lidande och subjektiv livskvalitet. Hierarkiska multipla regressionsanalyser (HRA) (N=79) genomfördes i syfte att undersöka möjliga förklaringar till föräldrars utbrändhetssymtom, psykologiska lidande och livskvalitet. Resultat: Oberoende t-test och Mann- Whitney U-test indikerade enbart signifikanta skillnader mellan föräldrar till barn med kroniska tillstånd och föräldrar till barn utan kroniska tillstånd avseende generell psykologisk flexibilitet, utbrändhet och psykologiskt lidande. Således ingen signifikant skillnad mellan de två föräldragrupperna avseende föräldraspecifik psykologisk flexibilitet och subjektiv livskvalitet. HRA indikerade att generell (inte föräldraspecifik) psykologisk flexibilitet var en signifikant prediktor beträffande föräldrars utbrändhetssymtom, psykologiska lidande och subjektiva livskvalitet. Att ha barn med eller utan kroniska tillstånd predicerade enbart föräldrars utbrändhet. Medveten närvaro och kognitiv defusion predicerade utöver generell psykologisk flexibilitet, föräldrarnas subjektiva livskvalitet. Slutsats: Psykologisk flexibilitet som enhetlig modell för mänskligt fungerande, antas vara användbar i framtida forskning gällande föräldrar till barn med kroniska tillstånd samt till föräldrar över lag som har lägre grad av psykologisk flexibilitet. Mer forskning om specifika psykologiska flexibilitets relaterade processerna behövs, samt studier som inkluderar bakgrundsinformation om föräldrarna såsom kön och ålder. / Objective: Whether parents with or without children having chronic conditions differ in regard to; Psychological flexibility (global and parent-specific), burnout symptoms, psychological distress and subjective quality of life. As well as to investigate whether following predictors; having a child with a chronic conditions or not, levels of psychological flexibility (global and parentspecific) and levels of mindfulness and cognitive defusion explain parents burnout symptoms, psychological distress and subjective quality of life. Method: Independent samples T-tests and Mann-Whitney U-tests were used in order to investigate mean differences between parents to children with chronic conditions (N=51) and parents to children without chronic conditions (N=28) regarding psychological flexibility, burnout symptoms, psychological distress and subjective quality of life. Hierarchical multiple regression analyses (HRA) (N=79) were conducted in order to investige possible explanaitions to parents burnout symptoms, psychological distress and subjective quality of life. Results: Independent samples T-tests and Mann- Whitney U tests indicated sicnificant mean differences regarding global psychological flexibility, burnout and psychological distress. No significant differences were found between the two groups in regard to parent-specific psychological flexibility and subjective quality of life. HRA indicated that global (and not parents-specific) psychological flexibility was a significant predictor in explaining parents burnout symptoms, psychological distress and subjective quality of life. Having a child with or without a chronic condition, only predicted parents burnout symptoms. Mindfulness and cognitive defusion predicted over and beyond global psychological flexibility, parents subjective quality of life. Conclusion: Psychological flexibility as a unified model of human functioning, is presumed to be useful in future research in regard to parents having children with chronic conditions, as well as to parents of children without chronic conditions and parents who has lower level of psychological flexibility. There is a need for further research regarding psychological flexibility related processes and future studies that include background information of parents such as gender and age.

This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour. / Psychology / M.A. (Psychology)