Colorectal cancer is one of the most common cancers in the United States and confronting its challenges has remained a problem to the United States health sector, especially among outpatient clinics. Guided by health belief model, the purpose of this needs assessment was to identify patients age 50 and older in outpatient clinic located in a large metropolitan city in Texas who should receive information on the need for colorectal cancer screening based on their risk for developing colorectal cancer as outlined by American Cancer Society. A sample of 70 charts of patients age 50-75 years was randomly selected and audited using descriptive statistics. Among the patients aged 50-75 years attending the outpatient clinic, 25.7% were African Americans, 71.4% were Hispanic, and 2.9% were Caucasians; 42.9% were male and 57.1% were female. The rate of colorectal cancer screening was 12.9%, a rate that is lower than the rate for all Texans, which was 54.1% - 59.2%. CRC screening was ordered for 62.9% of all patients; 24.2% of clinic patients were identified as being at high risk for colorectal cancer. The low rate of screening may hamper early detection of colorectal cancer in outpatient clinics setting. It is recommended that the outpatient clinic develop intensive campaign to increase patient awareness about the need for and benefits of colorectal cancer screening, especially for those at high risk for developing colorectal cancer. The findings of this study may raise awareness on the chasm in quality of health care availability and provide insight on colorectal cancer and its prevention.

Darbo tikslas. Išaiškinti pacientų nuomonę apie šeimos klinikos veiklą. Darbo uždaviniai: išaiškinti pacientų nuomonę apie šeimos klinikos medicinos personalo kompetenciją ir bendravimą su pacientais; ištirti pacientų nuomonę apie darbo organizavimą ir šeimos klinikos aplinką; įvertinti veiksnius, lemiančius įstaigos pasirinkimą pagal pacientų socialines demografines charakteristikas, savo sveikatos vertinimą ir pasitenkinimą sveikatos priežiūros paslaugomis. Tyrimo metodika. Anoniminė anketinė šeimos klinikos pacientų apklausa atlikta 2010 m. Išdalintos 369 anketos, iš kurių grįžo 267 (atsako dažnis 72,4 proc.). Statistinė duomenų analizė atlikta naudojant duomenų analizės paketą SPSS 15,0 for Windows. Hipotezės tikrintos naudojant Chi-kvadrato (χ2) kriterijų, porinių dažnių lygybei tikrinti taikytas z kriterijus. Skirtumai tarp požymių laikyti statistiškai reikšmingais, kai p<0,05. Hipotezė apie dviejų nepriklausomų imčių vidurkių lygybę tikrinta naudojant Mann-Whitney kriterijų, o daugiau nei dviem nepriklausomoms imtims taikytas Kruskal-Wallis kriterijus ir vidutiniai rangai. Rezultatai. Šeimos klinikos gydytojų kompetenciją pacientai vertina 4,73 balais, bendruomenės slaugytojų – 4,63, o registratorių – 4,65 balais iš 5. Tyrimo dalyvių nuomone, šeimos klinikos gydytojai yra pakankamai dėmesingi pacientams, išklauso pacientų nuomonę ir skiriant gydymą individualiai atsižvelgia į kiekvieną pacientą. Du trečdaliai pacientų pažymi, kad su jų sveikatos priežiūra susijusius... [toliau žr. visą tekstą] / Aim of the study: To appraise the patients’ attitude towards the practice of the family clinic. Objectives of the study: To clarify patients’ opinion about the competence and communication of medical staff; to examine patients’ views on work organization and environment; to assess factors influencing choice of clinic according to socio-demographical characteristics of the patients; self-assessment of health and satisfaction with services. Material and methods. A survey of patients using an anonymous questionnaire was conducted in 2010. 369 questionnaires were distributed and 267 returned (response rate 72.4%). Statistical data analysis was performed using SPSS 15.0 for Windows statistical software. Associations were tested using chi-square and z-test. Statistical significance level was set at p<0.05. Non-parametric tests of Mann-Whitney for two independent samples and Kruskal-Wallis tests for more than two independent samples were applied. Results. Patients evaluated the work of the family clinic physicians with 4.73 points, the work of community nurses was evaluated with 4.63 points and the work of receptionists 4.65 points out of 5 total points. According to the participants in the survey, the physicians of the family clinic are attentive to their patients; they listen to patients and treat every patient individually while prescribing treatment. Two thirds of patients note that the physician makes decisions regarding their healthcare after discussing it with the... [to full text]

This study aims to understand the traumatic situation of domestic violence in order to investigate the elements of its arrangement and bonding settings. Psychoanalysis of Bonding Configurations emphasizes the constitution of the subject from each encounter, repositioning the impossibility of the subject to be without a social place that composes his/her history. In this sense, trauma will produce different effects as a social and bonding register. The methodology used in this study was the construction of a case of a family being assisted by the psychoanalytic method. The Family Clinic facilitated the writing of the clinical case, a story of pain and suffering that portrays human bonding and entanglements with narratives that reveal repetition of violent scenes. In this perspective, I dare to build an analysis path as trauma possibly unfolding this bonding that enables the outburst of violence. Recollections upon the case accentuate the tone of the family organization, pointing to the binding mesh encompassed by violence. In fitting telescoping family, there are no boundaries to organize the links, but there is a setting that denotes the confusion and disruption of family membership. In households where violence and aggression reign, functions are blurred and trauma acquire transgenerational contours. The body, marked by violence, is the traumatic exposure in the family history and is a place that inhabits all excesses and transgenerational breaks. The family-subject of this study experiences time in alternation. The analytic space reveals the time for each \"thing\" to appear and disappear; the critical time of mourning and the subjectivity of its buildings; setting time as an ally to deal with the traumatic. The family telescoping is accessed in chronological time and becomes emblematic of the violent structuring bonds that tack on redoing the senses acquired in fantasy and appointment of traumatic content. The meanings of the losses will be recovered and a new subjectivity can be drawn in the transference field. The traumatic event points to the intransitive existence of a past that can perpetuate the experience; however, there is a direct correspondence between the size of the painful event and its alienating effect. The trauma interrupts the narrative, but also launches a new story from new subscriptions. From the traumatic event, re-accommodations of borders and the meaning of belonging to the set of characters may come about with effects and resonances that affect the group in various configurations. Traumatic thus could even be the element that feeds the emotional fabric of the family. The subject in the family is balanced between the traumatic event that marks its history and the creative possibilities of reinventing the narrative. / A presente pesquisa tem como objetivo compreender o traumático na situação de violência intrafamiliar, buscando investigar os elementos do arranjo e das configurações vinculares. A Psicanálise das Configurações Vinculares enfatiza a constituição do sujeito a partir de cada encontro, reposicionando a impossibilidade de se fazer sujeito sem um espaço social que componha sua história. Neste sentido, o trauma produzirá diferentes efeitos como inscrição social e vincular. A metodologia utilizada envolveu a construção do caso clínico de um atendimento familiar, ancorada no método psicanalítico. A Clínica de Família viabilizou a escrita do caso clínico, uma história de dor e sofrimento que retrata o vínculo humano, com enredamentos e narrativas que revelam repetições de cenas violentas. Nesta perspectiva, ouso construir como caminho de análise o traumático como possível desdobramento deste campo vinculativo que possibilita a irrupção da violência. As rememorações sobre o caso vão acentuando o tom da organização familiar, apontando para a malhagem vinculativa em torno da violência. No encaixe da telescopagem familiar não há fronteiras que organizem os vínculos, mas há uma configuração que denota a confusão e a ruptura da filiação. Nos núcleos familiares, onde impera a violência e a agressão, as funções se constituem borradas e os traumas adquirem contornos transgeracionais. O corpo, marcado pela violência, é a exposição do traumático na história familiar como lugar que habita todos os excessos e rupturas transgeracionais. A família-sujeito desta pesquisa vivencia o tempo em alternância. O espaço analítico vai revelando o tempo para cada coisa aparecer e desaparecer; o tempo fundamental dos lutos e a subjetividade de suas construções; estabelecendo o tempo como aliado na elaboração do traumático. A telescopagem familiar é acessada no tempo cronológico e se torna emblemática dos vínculos violentos estruturantes que vão se refazendo no alinhavo dos sentidos adquiridos na fantasia e na nomeação dos conteúdos traumáticos. Os sentidos das perdas vão sendo recuperados e uma nova subjetividade pode ser desenhada no campo transferencial. O acontecimento traumático aponta para a existência intransitiva de um passado que pode se perpetuar na experiência; entretanto, não há uma correspondência direta entre a dimensão dolorosa do acontecimento e seu efeito alienante. O trauma interrompe a narrativa, mas também inaugura uma nova história a partir de novas inscrições. A partir do fato traumático podem haver reacomodações das fronteiras e do significado de pertencimento dos personagens do conjunto, com efeitos e ressonâncias que afetam o conjunto em configurações diversas. O traumático, assim, pode, inclusive, ser o elemento que alimenta condição constitutiva do tecido afetivo da família. O sujeito na família equilibra-se entre o acontecimento traumático que marca sua história e as possibilidades criativas de reinventar a narrativa. / Mestre em Psicologia Aplicada

The objective of the present research was to analyze the links of families crossed by a psychotic crisis and the outcome of such crisis in the institutional care at CAPS (Centers of Psychosocial Attention), having the linkage clinic as focus. The framework proposed is the family clinic, apprehending the family as a founder of the subjectivity of the subject, a mediator between the subject and society, essential in the work with psychosis and consonant with the practices of care in the psychosocial attention in mental health. The methodology used was study of a clinical case based on the psychoanalytic method of investigation. From the analysis of the case presented, the family links and the family care were discussed. We have noticed that the group of family members was an important care asset for the family, from the listening of their suffering. Just as family therapy allows, in a unique way, the event and the intervention on the link configuration typical of the family, we believe that family therapy at CAPS, with the focus on link configurations, is essential to orient the practice of mental health care. / A presente pesquisa teve como objetivo analisar os vínculos de famílias atravessadas por uma crise psicótica e o que advém desta crise no atendimento institucional em CAPS, tendo como enfoque a clínica vincular. O recorte proposto é a clínica de família por apreender a família como fundante da subjetividade do sujeito, mediadora entre o sujeito e a sociedade, essencial no trabalho com a psicose e consonante com as práticas de cuidado na atenção psicossocial em saúde mental. A metodologia utilizada foi o estudo do caso clínico, baseada no método psicanalítico de investigação. A partir da análise do caso apresentado, discutiu-se os vínculos familiares e o atendimento da família. Percebemos que o grupo de familiares, foi um importante dispositivo de cuidado para a família, a partir da escuta de seu sofrimento. Assim como a terapia familiar possibilita, de modo singular, o acontecimento e a intervenção sobre a configuração vincular própria da família, acreditamos que a terapia familiar no CAPS, com enfoque nas configurações vinculares, é fundamental para orientar a prática de cuidados em saúde mental. / Mestre em Psicologia Aplicada