Introdução - A Agência Nacional de Saúde Suplementar determinou, em 2008, que os planos de saúde oferecessem seis consultas anuais com nutricionista. Objetivo - Avaliar os determinantes da demanda por consultas de nutrição em uma operadora de autogestão em saúde entre 2009 e 2011. Métodos - Trata-se de um estudo retrospectivo realizado a partir dos registros administrativos dos beneficiários da Sabesp Previdência. A demanda foi estimada por meio de um modelo tobit para os gastos com consultas de nutricionista. Foram incluídas variáveis demográficas, socioeconômicas, de estado de saúde e de influência familiar. Resultados - A influência familiar, o sexo, o estado civil, a escolaridade e o estado de saúde no período e passado foram os principais determinantes do gasto com consultas de nutrição. A elasticidade renda da demanda, embora estatisticamente significante (p<0,1), foi pequena em relação ao efeito das demais variáveis e a idade não teve impacto significativo. A baixa probabilidade estimada de realizar gastos mostrou que ele é subutilizado. Conclusão - Os resultados evidenciaram a necessidade de estímulo à utilização, numa perspectiva de prevenção de doenças, promoção da saúde e redução dos custos assistenciais no setor de saúde suplementar. / Introduction - The Brazilian private health sector regulatory agency determined, back in 2008, that the insurance plans should offer six nutrition consultations. Objective - To assess the nutrition consultations demand determinants in health insurance plan between 2009 and 2011. Methods - This is retrospective study performed using data from Sabesp Previdência. We used Tobit model to analyze the expenditure on nutritional consultations and tested demographic, socioeconomic, health status and family influence variables. Results - Family influence, sex, marital status, education and health status were the expenditure main. Income elastic of demand, although statistically significant, wasn\'t expressive when compared to other variables effects. Age had no significant impact on individual nutrition consultation expenditure. The low probability of having expends with nutrition consultations showed it is an underutilized service. Conclusion- The results highlighted the need to stimulate the demand for nutrition consultations, in concordance with a disease prevention, health promotion and healthcare care reduction perspective in private health care sector.

Data literacy has become one of the most important competencies for a citizen to exercise in their personal and professional lives. It contributes to more informed decision-making in all aspects of life, and is more frequently being utilized in organizations to drive innovation and change. These skills are especially important for communications professionals, as interpreting and communicating data to various publics is the foundation of information sharing in virtually every industry and sector. Data competencies are typically acquired in post-secondary education; however, existing curricula are lacking robustness, adaptability, and transferability of skills needed in the workplace and in our ever-changing world. Through the results collected from both professors and practitioners in the communications field, this study identifies the gaps in existing curricula, and justifies the importance of communications students acquiring data literacy skills to ensure that they will be equipped for their careers and the world at large. This research highlights that improving data and research skills will better prepare citizens for their professional and personal lives.

Digital consultations in primary care have the advantage of offering equal healthcare for people residing in the countryside. While it is gaining acceptance among young- and middle-aged people, the elderly are reluctant to use it. The aim of this study was hence to identify reasons for non-use among elderly in the countryside and describe perceived possible challenges and opportunities with digital consultations. Semi-structured interviews were conducted with 13 persons over 65 years old residing in the Swedish countryside. There was a mistrust for services offered by private companies and their public funding, a lack of knowledge of available services, and a lack of perceived usefulness. Personal interaction and continuity was more important than time or travel conveniences, although these advantages were recognized. To prevent digital exclusion, caregivers need to offer information, encouragement, or tools for the elderly. Digital primary care also needs to offer familiarity, with continuity and personal connections.

This study examined the effectiveness of caregiver consultations in caregiver's child's play therapy process through a program evaluation lens. Archival data was used from a counseling clinic located in the central southwestern United States. Quantitative data was collected from caregiver who filled out assessments (PSI-4 and CBCL) about their child's progression through play therapy and both groups frequency of attendance. A regression analysis was used to determine if caregivers perceived changes from the initial session and up to 10 weeks later. Additionally, retention rates over a course of 60 weeks were analyzed. Key findings suggest there is a high dropout rate from play therapy between the initial session before 10 weeks. For those whose therapy extended up to 60 weeks, consultation attritions continued. Due to low attrition numbers the effect of caregiver filled out assessments was unable to be confirmed, but this study did show a need for an intervention focused on caregiver retention to reduce attrition rates. The body of this study shows how to thoroughly conduct a program evaluation based on a specific variable and provides suggestions for explaining evaluation findings to stakeholders.

This research explores parent-teacher consultations in a range of early years settings. Data were collected from eighteen audio-recorded parent-teacher consultations from six different settings and from follow up interviews with parents and teachers. The data related to the consultations and participants’ direct experience of these and revealed the practices of power within these consultations. Using a Foucauldian approach to analysis, the exercise of power and its impact on the parent-teacher relationship was explored. The analysis revealed the ways in which surveillance, normalising judgements and the ‘examination’ of all involved in the reporting process to parents, constitutes an exercise of power. Within the consultation parents, teachers and children are positioned as subjects who are homogenised and judged accordingly. Conversely, the presentation of observations and assessment information leads to the individualisation of children, allowing classifications and comparisons to be made in relation to a particular set of ‘truths’ about what it is to be a child, a parent and a teacher. Throughout the consultations parents and teachers assert and defend their positions and in doing so, attempts at resistance are evident. The findings of the research open up new possibilities for challenging existing modes of practice in parent-teacher consultations. These include implications for initial teacher education and CPD programmes, in order to develop awareness of the way in which power is exercised through parent-teacher interactions and the effects it can have. The need for policy makers to take greater account of the exercise of power when developing policies in relation to partnership with parents, and indeed in evaluating the impact of existing policy is also identified.

The creation of devolved institutions in Scotland and Wales in 1999 provided nationalist parties in both the opportunity to act within an institution solely within their nation’s territorial boundaries. In 2007, they entered government for the first time. In so doing, the Scottish National Party and Plaid Cymru embarked upon public engagement strategies in office which were designed to build support for their constitutional ambitions – namely, independence for Scotland and (in the short-term) full legislative powers for the National Assembly for Wales, as outlined in the Government of Wales Act 2006. This thesis explores the public engagement strategy of both parties, focusing on the respective consultations of the parties in government – A National Conversation and the All Wales Convention¬ – and the following campaign for (in Scotland) and at (in Wales) a referendum intended to deliver their preferred outcome. The aim of this thesis is to consider why public engagement strategies were considered the best vehicle to take forward the respective parties’ constitutional goals and to evaluate the success each party achieved in relation to these objectives. This thesis argues that, while both the SNP and Plaid Cymru have achieved some success with regard to their constitutional objectives, this success can be measured differently depending whether short-term or long-term goals are the defining standard. In Wales, Plaid Cymru’s constitutional consultation found limited engagement with the wider Welsh population, and though the referendum succeeded in securing legislative powers for the National Assembly for Wales, public engagement with the constitutional debate in Wales continues to lack enthusiasm. By contrast, the SNP’s National Conversation saw more enthusiastic engagement, but without a referendum at the end of the process, a clear lack of a tangible short-term outcome. However, the SNP in government did succeed in moving the constitutional debate firmly onto the political agenda, and engagement in this debate is now widespread in Scottish society, particularly in the wake of an agreement to hold an independence referendum in autumn 2014.

Made available in DSpace on 2015-03-05T19:37:25Z (GMT). No. of bitstreams: 0 Previous issue date: 5 / Banco Santander / Banespa / Esta dissertação, ‘O dispositivo conto de fadas na clínica com crianças que apresentam déficit de simbolização’ tem como objetivo discutir a utilização dos contos de fadas como possibilidade de intervenção na clínica psicanalítica infantil, especialmente nas situações associadas a falhas no processo de simbolização. Esse déficit está presente em todas aquelas situações onde há a impossibilidade de elaboração dos sentimentos através do pensamento e das palavras, ficando prejudicadas as formas de expressão. Para o entendimento do processo de simbolização, bem como de seu déficit, apoiamo-nos na teoria de desenvolvimento emocional de Winnicott, que considera que a partir da interação mãe-bebê surge a possibilidade de desenvolvimento simbólico. Dessa maneira, na presença de um cuidador atento, interessado e emocionalmente engajado, o bebê pode constituir seu espaço psíquico. Por sua vez, os contos de fadas podem ser considerados como um cenário, onde a criança pode simbolizar seus conflitos e, portanto, nutrir se

Esse é um estudo sobre consultas terapêuticas familiares destinadas a crianças abrigadas e seus pais. Como objetivos desta tese. têm-se: refletir sobre a situação de abngamento e o rompimento da convivência familiar; e favorecer o desenvolvimento de recursos que contribuam para o desenvolvimento emocional de todos os membros da família, preservando-se, ainda, os vínculos familiares na medida do possível. A hipótese do trabalho terapêutico, nesse estudo, refere-se à família que. quando ela mesma é acolhida, pode desenvolver recursos próprios para cuidar de si mesma e dos filhos. Os atendimentos foram realizados no próprio abrigo, uma organização não-governamental, localizado na região do Grande ABC. no Estado de São Paulo. Foi realizada uma análise clínica-quahtativa dos dados obtidos com enfoque psicanalítico. Para a análise foram realizados estudos de caso com a compreensão da situação problema, a qual foi auxiliada por observação documental. No trabalho são apresentados quatro (4) estudos de casos de quatro (4) famílias. A análise do conteiido do procedimento de consultas terapêuticas, na forma individual e familiar, teve por base a livre inspeção de material, que revelou como o fenômeno da ruptura dos laços familiares pode ser melhor compreendido pelos atores familiares envolvidos. Mostramos que a partir de um vértice psicanalítico, seguindo uma abordagem compreensiva, próxima, humana, acolhedora e continente, sendo transmitida caso a caso, é possível promover verdadeiras mudanças. Observamos que tanto as crianças como os pais já apresentavam conflitos antes do abrigamento. o qual pode amenizar a situação de risco, mas pode trazer também muito sofrimento para a criança e a sua família. Identificamos muitas situações de conflito e dor, entretanto observamos que em alguns casos houve possibilidades para a remtegração da criança ao grupo familiar, e que mesmo no caso de pais mais perturbados em suas condições emocionais, com o trabalho das consultas, pôde haver uma evolução. Algumas estratégias utilizadas de modo espontâneo mostraram ser muito úteis no trabalho de consultas psicoterapêuticas, revelando ser o acolhimento fundamental para a elaboração do ódio e da angústia presentes em situações como as descritas nesse estudo. / This is a study of family therapeutic consultations for sheltered children and then parents. The objectives of this thesis are to: reflect on the situation of housing and disruption of family lives, and to encourage the development of the resources that contribute to the emotional development of all members of the family, although sail preserving the family bonds as possible. The idea of therapeutic work, in this study refers to the family that, when harbored, can develop its own resources to take care of itself and its children. The consultations took place in their own shelters, a uon-governniental organization, located in the Great ABC, in the state of Sao Paulo. A clinical-quantitative analysis based on a psychoanalytical approach of the obtained data was made. For the analysis case studies were conducted for the comprehension of the problem, which was helped by documentary observation. Four (4) case studies of four (4) families are presented within this work. The analysis of the content of the therapeutic procedure of consultation, as individual and family, was based on the free inspection of material, which showed how the phenomenon of breaking of family ties can be better understood by the involved family actors. We have shown that from a psychoanalytic point of view, following a comprehensive, close, human, warm and continent approach, which is transmitted case by case, it is possible to promote real changes. We noticed that both children and parents have had conflicts before the shelter, which can alleviate the situation of risk, but can also bring great suffering for the child and its family. We have also identified many situations of conflict and pain, however we have observed that in some cases there were opportunities for the reintegration of the child to the family group, and, even in cases when parents were more disaubed in their emotional conditions, with the work developed diuing the consultations, an evolution was attested. Some strategies used spontaneously proved to be very useful in the study of psychotherapeutic consultations, revealing themselves to be the main key for the development of hatred and anguish in situations such as those described in this study.

The problem of this study concerns the effects of a parent group counseling procedure and an individual consultation procedure upon (1) the attitude of the parents, (2) the school-related behavior of the children, (3) the academic grades of the children, (4) the peer relations of the children, and (5) self-concept of the children. The results of this investigation indicated no significant differences in procedures for affecting behavior changes on the variables examined. Generally, parent group counseling appeared to generate more pervasive changes affecting multiple behaviors in their children than individual consultation with the parents.

Background: Nurse practitioners are increasingly conducting consultations with patients on the same basis as medical doctors. However little is known about communication within nurse practitioner consultations. Research on communication in nurse practitioner consultations has identified nurse practitioners communicate with patients in a hybrid style, combining biomedical information with the discussion of subjective information from everyday life. Research has not fully explained why this hybrid style occurs in nurse practitioner consultations, nor determined its links to consultation duration, patient expectations, satisfaction, and enablement. This study was developed to address these gaps in research of communication in nurse practitioner consultations. Aim: This study aims to advance understanding of the discrete nature of the communication processes and social interactions occurring in the nurse practitioner consultation, including explicating the reasons for the occurrence of the particular communication processes and interaction styles observed in those consultations. Methods: The study was conducted in a nurse-led primary care clinic providing general practice care. Within a case study research approach mixed methods were utilised, combining structured analysis of video recorded observations of nurse practitioner consultations, questionnaire-based measures of patient expectations, satisfaction, and enablement, and interviews with some of the participants of the consultations. The sample for video recording comprised three nurse practitioners employed at the clinic, and 30 patients registered at the clinic. Questionnaire responses were provided by 71 patients, including 26 whose consultations had been video recorded. All three nurse practitioners participated in post-consultation individual interviews, and 11 patient / carers participated in post-consultation individual interviews. The video recorded consultations were analysed with the Roter Interaction Analysis System (RIAS), a method of quantified interactions frequency analysis. The questionnaire responses were analysed with descriptive statistics. Transcripts of the interviews were analysed using computerised qualitative data analysis with NVivo. Findings: A significant majority of observed social interaction in the consultations used patient-centred communication styles (p=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse ii practitioners guided the sequence of consultation interaction phases, but patients and carers participated through asking questions and involvement in negotiations for care planning. Patient / carers were highly satisfied with their consultations, and significantly higher general satisfaction was noted when participants expected the nurse practitioners to be able to diagnose their presenting problem (p=0.043). Patient / carers expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (p=0.003). The mean consultation time length of 10.97 minutes is comparable with studies of general practitioners. The participants’ perceptions of nurse practitioner consultation communication processes and social interactions were represented through six themes; Consulting style of nurse practitioners; Nurse practitioner – GP comparisons; Lifeworld content or lifeworld style issues; Nurse practitioner role ambiguity; Creating the impression of time; and Expectations for safety netting. Contribution to knowledge: This study reveals nurse practitioner consultations comprise collaborative openness to peoples’ agendas and questions, expressions of everyday lifeworld experiences, expanded impressions of time, clear explanations augmented by integrated clinical reasoning, and participatory negotiations. These communicative features arise from a combination of social, ideological, and epistemological factors, prompting nurse practitioners to privilege how they interact with patients and carers, and to adopt a hybrid patient-centred style combining the nursing ideology of holism and their knowledge of biomedicine. This form of communication has been characterised as a stylistic exemplar for good consultation communication practice, which potentially facilitates shared decision-making. This research has resulted in new knowledge of the communication processes and social interactions used in nurse practitioner consultations, which demonstrates the importance of clinicians giving precedence to how they communicate and interact with patients so as to optimise their therapeutic outcomes without compromising the duration of consultations.