L'auteur n'a pas fourni de résumé en français / Individuals do not always enact their intentions into behaviours, which may lead to severe outcomes especially in health-related fields. Self-regulation strategies, like cuedependent plans interventions, have shown efficiency to help to counter the intentionbehaviour gap. Yet, no review has been realised recently to bring a qualitative and quantitative analyses of this effect.Firstly, we carried out a qualitative review to evaluate the effectiveness of cuedependent planning intervention to increase health-related behaviours. We included 329 studies with experimental and prospective designs that measured or evaluated the effect of cue-dependent plans (e.g. implementation intention, action planning, coping planning) on health-related behaviours, among general, clinical and student population. The qualitative analysis revealed for instance that implementation intentions were used in majority, even if the if-then format was not systematically adopted. However, we oticed confusion between the terminologies of the plans and the theories. A quantitative review will be realised to evaluate the effect size and the moderators that could magnify or diminish the effects of cuedependent planning interventions on health-related behaviours. Second, we presented two studies that tested the effectiveness of cue-dependent planning interventions on physical activity, which was the most represented health outcome in cue-dependent planning interventions, according to our review. Motivational (mental simulation) and volitional (implementation intention) interventions were combined to promote physical activity participation. The first study, adopting a cluster randomised controlled trial design among students, did not show any significant effect neither of the mental simulation plus implementation intention intervention, nor of the implementation intention intervention compared to the control condition. The second study adopted a more rigorous methodology with a full-factorial randomised controlled design, with a larger sample and objective measures of physical activity (attendance to gym centre). Nevertheless, the study revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes. Findings were not in line with previous research that showed effects of cue-dependent plans to promote physical activity. This adds to the necessity of identifying the moderators of these interventions in health behaviours.Thirdly, cue-dependent planning interventions are needed in illness behaviours. In chronic disease, non-adherence to medication is a public health problem that can lead to negative health outcomes. Even if the patients want to take their treatment, they may, for instance, forget it and fail to enact the behaviour. We tested the ability of an intervention adopting implementation intention and coping planning to promote medication adherence. In a randomized controlled trial, outpatients with cardiovascular diseases were randomly allocated to either an implementation intention and coping planning condition, or to a noplanning control condition. Findings revealed no significant effect of the intervention on medication adherence. However, post hoc moderator analyses showed that the beliefs moderated the effect of the intervention, which was effective in patients with lower necessity beliefs compared to those with higher necessity beliefs. The design used in the study did not enable to test the direct an interactive effect on medication adherence, so it would be necessary to replicate these findings with a full factorial design among patients with cardiovascular diseases.

Made available in DSpace on 2016-04-29T13:17:56Z (GMT). No. of bitstreams: 1 Rafael Silva Martins Silveira.pdf: 2319571 bytes, checksum: de94e5c8be2a94c1ec163c9a1a6b25c0 (MD5) Previous issue date: 2015-08-21 / In the search for health promotion and prevention of the behaviors that affect the quality of life of the population, telemedicine has been used in Brazil and in the world as a resource to monitor and stimulate the health of people, who have chronic non-transmittable diseases. The aim of the present study was to contribute to telemedicine practice, by building, applying, and analyzing the results of a training program for nurses, who work with distance monitoring of people affected by one or more non-transmittable chronic diseases. Six nurses participated in the study. The training consisted of the following stages: the reading of a handout with information on the behaviors, which are considered relevant and appropriate to the monitoring process; short presentation to the group of participants regarding the central aspects of the handout, following by clarification of their doubts; five individual training sessions, being three of them related solely to the monitoring training, one related to both monitoring training and computer system registration of the main information regarding the monitoring; and a last session focused solely on computer system registration training. During the training sessions, the monitoring practices, which were performed by the nurses and transcribed by the researcher, were discussed using differential reinforcement of the participants responses, removal of the tips, and elaboration of the instructions, to achieve the proposed behavioral objectives. It was observed that, for the majority of the participants, increases in the occurrence of most of the trained behaviors, such as stimulating the patient to discuss about the aggravating factors and health protection, as well as the consequent specific-patient verbalization. For the behaviors of establishing the patients health care goals and complimenting them for their health care at the end of the monitoring practice, more time and different strategies would be needed to observe increase number of these occurrences. It was also observed that by verbalizing which behaviors were adequate, which were inadequate, and pointing out that no longer occurred, did not ensure the occurrence of appropriate behaviors in the subsequent monitoring training nor that inappropriate behavior no longer occurs. Finally, the training described in this work and its results showed that the principles proposed by Behavior Analysis applied to the development of the educational program could help to improve the verbal behaviors of the nurses during monitoring health of people with chronic non-transmittable diseases / Na busca pela promoção de saúde e prevenção de comportamentos que prejudiquem a qualidade de vida da população, tem-se utilizado no Brasil e no mundo a telemedicina como um recurso de monitoramento e incentivo ao cuidado com a saúde de pessoas que possuem doenças crônicas não transmissíveis. O objetivo do presente estudo foi o de contribuir com essa prática construindo, aplicando e analisando os resultados de um programa de capacitação de enfermeiros que trabalham com o monitoramento à distância de pessoas acometidas por uma ou mais doenças crônicas não transmissíveis. Seis enfermeiros participaram do estudo. O treino constituiu-se das seguintes fases: leitura de uma apostila com informações sobre os comportamentos considerados relevantes e adequados no monitoramento; breve apresentação ao grupo de participantes sobre os aspectos centrais da apostila e esclarecimento de suas dúvidas; cinco sessões de treinos individuais com os participantes, sendo três delas relacionadas unicamente ao treino de monitoramento, uma relacionada ao treino de monitoramento e ao treino de registro em sistema das principais informações de saúde dos pacientes colhidas pelos enfermeiros no monitoramento; e uma última sessão voltada unicamente ao treino de registro em sistema. Nas sessões de treino foram discutidos monitoramentos realizados pelos enfermeiros e transcritos pelo experimentador, utilizando-se reforçamento diferencial de respostas dos participantes, remoção de dicas e formulação de instruções para se atingir os objetivos comportamentais propostos. Observou-se que houve, para a maioria dos participantes, um aumento das ocorrências da maior parte dos comportamentos treinados, tais como estimular o paciente ao diálogo sobre fatores agravantes e de proteção a saúde e consequenciar verbalizações específicas do paciente. Para os comportamentos de estabelecer metas de cuidado à saúde com os pacientes e elogiá-los pelos cuidados à saúde no final do monitoramento, haveria a necessidade de mais tempo e diferentes estratégias para que houvesse um aumento no número de ocorrências. Também se observou que levar os enfermeiros a verbalizar quais de seus comportamentos no monitoramento haviam sido adequados, quais haviam sido inadequados e apontar os que deixaram de ocorrer não foi garantia de que comportamentos adequados ocorressem nos monitoramentos subsequentes aos treinos ou que comportamentos inadequados deixassem de ocorrer. Por fim, o treino descrito ao longo deste trabalho e seus resultados demonstram que os princípios propostos pela Análise do Comportamento aplicados na montagem de um programa de ensino podem auxiliar no aperfeiçoamento dos comportamentos verbais emitidos por enfermeiros no monitoramento da saúde de pessoas com doenças crônicas não transmissíveis

Made available in DSpace on 2016-04-28T20:39:54Z (GMT). No. of bitstreams: 1 Joely Helena Roscito Bento.pdf: 3753280 bytes, checksum: 27c604f94eaad69b7d2de703dcf477d4 (MD5) Previous issue date: 2008-11-07 / Home care represents, in the health care setting, a less costly type of medical assistance model than the traditional approach and it holds the promise to alleviate both physical and psychological suffering of the patience and his relatives. However, the crude reality that home care professionals face involves working thru very challenging issues, what can be a stimulus to persevere or a reason to abandon this approach. To shed some light on these issues is the essential task of this study. Always looking from the health professional standpoint, its goal is to clarify certain aspects of the interaction of the multidisciplinary team and the relatives of chronic patients: the relationship that the team establishes with the family, the perceptions of the members of this team of family interactions with the patient and some general aspects of their own work in a home setting. It was verified that home care services had their genesis at the same time of hospitals and scientific medicine and this fact was determinant to establish the physician as the beholder of knowledge and power over the health politics of the XVIII century. This study shows the implications of these past facts in the present relationship between the physician and other multidisciplinary professionals and the chronic patient families. Several existing concepts of home care and the way this service functions in health institutions were also analyzed, highlighting the important influence of the symbolic meanings of getting sick in the relationship of the health professionals with the patient family, besides other particularities of this close contact that can be verified when the chronic character of the sickness is established and at the time of the death of the patient. This study refers to a qualitative survey conducted on a home care provider. Two questionnaires with open questions were answered by a multidisciplinary team in the beginning and the end of a home assignment. This team also participated on group sessions. The conclusion was that the way the professional gives meaning to the sickness and its context and, in this task, the individual and the cultural dimensions interpenetrate themselves defines the quality of his/her interaction with the rest of the home care agents / O atendimento domiciliário representa, no cenário da saúde, um modelo de assistência hospitalar menos dispendioso que o tradicional e com a promessa de amenizar o sofrimento físico e psíquico do paciente e seus familiares. Porém, a realidade com a qual o profissional da saúde se depara demanda enfrentar desafios de tal modo impactantes, que podem tanto reforçar a sua decisão de permanecer nesse contexto quanto motivar o seu abandono. Lançar luz sobre esses desafios é a tarefa essencial deste estudo. Ele se propõe, sempre pela perspectiva do profissional da saúde, a esclarecer os seguintes aspectos da interação entre equipes multidisciplinares e familiares de doentes crônicos: a relação que essas equipes estabelecem com as famílias, a percepção dos integrantes dessas equipes sobre a relação da família com o doente e sobre aspectos gerais do próprio trabalho realizado no domicílio. Verificou-se historicamente que o serviço de atendimento domiciliário deriva do surgimento do hospital e da medicina científica e que esta foi determinante para que o médico se instituísse como detentor do saber e do poder sobre as decisões relacionadas às políticas de saúde do século XVIII. Este estudo aponta as implicações destes fatos do passado na relação atual do médico com outros profissionais de equipes multidisciplinares e com as famílias de doentes crônicos. Os vários conceitos existentes de assistência domiciliária e o modo de funcionamento deste serviço em instituições de saúde são também analisados, ressaltando-se ainda a importante influência dos significados simbólicos do adoecimento na relação dos profissionais com os familiares do doente, além de outras particularidades dessa convivência quando se estabelece a cronicidade da doença e quando ocorre a morte do paciente. Este estudo foi realizado por meio de uma pesquisa qualitativa em uma instituição provedora de assistência domiciliária. Dois questionários com perguntas abertas foram respondidos no início e no final do trabalho por uma equipe de profissionais, que participou, ainda, de sessões de grupo operativo. Concluiu-se que a maneira de o profissional da saúde significar a doença e o seu contexto e nessa tarefa, as dimensões do individual e do cultural se interpenetram define a qualidade de sua interação com todos os demais agentes do atendimento domiciliário

Thesis (M.A. Education (Community and Continuing Education)) -- University of Limpopo, 2015 / This report describes the research conducted at Kgotlelelang Basadi Home-based Care centre, in the Capricorn District Limpopo Province of South Africa. The centre serves four villages: Ngwanamago, Makata, Matobole and Thaba. Statement of the problem It seems the home-based caregivers of chronic patients at Kgotlelelang Basadi HBC centre do not have the necessary qualifications, knowledge, skills, and health care and protective resources such as gloves, thermometers and masks. It looks like the homebased caregivers are not adequately and continuously trained as there are always new discoveries and developments with regard to the treatment of diseases. It apprears they perform their duties without sufficient support by relevant institutions like clinics and hospitals. Furthermore, it appears the home-based caregivers are not recognised, and are also undermined. The aim of the study is to explore the educational needs and assets of home-based caregivers for homebound chronic patients at Kgotlelelang Basadi Home-based Care centre. After establishing the educational needs and assets of home-based caregivers I recommended the formulation of possible relevant educational programmes. In an attempt to achieve the said aims, the following research questions were formulated and put forward in chapter 1. Objectives  To establish the existing qualifications of home-based caregivers for home-bound chronic patients at Kgotlelelang Basadi HBC Centre.  To determine the relevancy of the existing educational programmes of home-based caregivers for home-bound chronic patients.  To contribute towards formulating relevant educational programmes of home-based caregivers for home-bound chronic patients.

Made available in DSpace on 2015-07-22T20:50:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-09-28 / A seleção de mutações de resistência aos medicamentos antirretrovirais pós-falha terapêutica representam um grande desafio para a tomada de decisão de novos esquemas de tratamento na pandemia global. A elevada variabilidade genética do HIV-1 e a seleção de mutações de resistência transmitida a pacientes infectados cronicamente, sem que tenham participado de qualquer esquema terapêutico, tem sido objeto de vários estudos no mundo. Os padrões de resistência são estudados principalmente em países da Europa e Estados Unidos, que apresentam prevalência majoritária do subtipo B. Contudo, estudos que direcionam a seleção de mutações transmitidas aos medicamentos antirretrovirais e em subtipos não-B, assim como em suas formas recombinantes, tem aumentado significativamente em várias regiões do mundo. No Brasil, esses estudos são realizados esporadicamente e em regiões distintas do país e, principalmente, em pacientes recém-infectados. A alta variabilidade genética do HIV-1 no nosso país é representada de forma diversificada, com a presença do subtipo B, seguida do F, e especificamente na região Sul a importante prevalência do subtipo C. O objetivo principal deste estudo está embasado nas características de mutações de resistência transmitida aos medicamentos antirretrovirais pelo HIV-1 no gene pol, frações da transcriptase reversa e protease, com análise do perfil mutacional por grupos populacionais de pacientes cronicamente infectados pelo HIV-1 e não tratados, porém com indicação de início imediato de tratamento. Foram avaliados os pacientes representados nas regiões demográficas do Brasil. A prevalência nacional, resultou em 12,1% de mutações de resistência transmitida aos antirretrovirais pelo HIV-1 (grau intermediário de 5 a 15%) e 70,8% de subtipo B; 15,5% C; 6,4% F; 4,0% BF e 3,0% BC na classificação dos subtipos do HIV-1. Além disso, foram classificadas as prevalências de mutações transmitidas, dos subtipos do HIV-1 e características sociodemográficas, laboratoriais e os dados comportamentais na população HIV positiva pré-terapia por cidade nas cinco regiões brasileiras. / The selection of resistance mutations to antiretroviral drugs after failure of antiretroviral therapy represents a major challenge for decision-making of new therapeutic regimens in the global pandemic. The high genetic variability of HIV- 1and the selection of resistance mutations trasmitted to patients chronically infected without having participated in the regimen has been the subject of several studies in the world. Resistance patterns are studied mainly in European countries and the United States, wich have majority prevalence of subtype B. However, studies that guide the selection of transmitted mutants to antiretroviral drugs and non-B subtypes, and in their recombinant forms, has increased significantly in the several regions of the world. In Brazil, these studies are conducted sporadically and in different regions of the country and specially in newly infected patients. The high genetic variability of HIV-1 is represented in our country so diverse, with the presence of subtype B, followed by F, and specifically in the South region, the prevalence of subtype C. In addition, coexist the prevalence of recombinant forms, where the principal is the subtype BF, followed by BC. The main objective of this study estimate the characteristics of transmitted resistance mutations to antiretroviral drugs in HIV-1 ol gene, fractions of reverse transcriptase and protease, with mutational analysis of the profile by a population patients chronically infected with HIV-1 and not treated, but with indication of immediate initiation of treatment. We evaluated the patients represented in the demographic regions of Brazil. The national prevalence resulted in 12.1% of transmitted resistance mutations to antiretroviral (intermediate grade 5% to 15%) and 70.8%, 15.5% C, 6.4% F, 4.0% BF and 3.0% BC in the classification of subtypes of HIV-1. In addition, the prevalence of transmitted mutations, the subtypes of HIV-1 and sociodemographic characteristics, laboratory parameters and behavior data in population HIV-1 positive pre-treatment were classified by the cities in five Brazilian regions. / TEDE / BV UNIFESP: Teses e dissertações