SAMMANFATTNING För att möjliggöra öppen hjärtkirurgi används hjärt-lungmaskin som leder blodet i en bana utanför kroppen sammankopplat med kroppscirkulationen. Möjliga komplikationer efter kirurgi med stöd av hjärt-lungmaskin kommer från det centrala nervsystemet och kan ge upphov till kognitiva symtom, dessa komplikationer har ökat sedan 70-talet. Kognitiva nedsättningar kan påverka både patientens livskvalitet och sjukvårdens ekonomi. Risker med att opereras med stöd av hjärt-lungmaskin är embolier, hypoperfusion, anestesi och inflammation. Detaljerad information till patienter som ska genomgå hjärtkirurgi gör dem mer förberedda på eventuella komplikationer. För att som vårdpersonal kunna bemöta och informera dessa patienter krävs kunskap om kognitiva nedsättningar postoperativt. Syftet var att belysa kognitiva förändringar hos patienter som opererats med stöd av hjärt-lungmaskin. Litteraturöversikt genomfördes där alla typer av hjärtkirurgi som utförts med stöd av hjärt-lungmaskin valdes att inkluderas. Originalartiklar på svenska och engelska eftersöktes med åtkomst via "full text", ingen begränsning på publikationsår gjordes. Både kvalitativa och kvantitativa artiklar eftersöktes. Sökord som användes var "cardiopulmonary bypass", "heart-lung machine", "cognition disorders", "neurobehavioral manifestations", "patients", "postoperative" och "experience". Databaser som användes var Cinahl, PsycINFO och PubMed. Slutresultatet blev 15 kvantitativa artiklar som granskades enligt mallar från Sophiahemmets högskola. Ingen artikel exkluderades pga. låg kvalitet, sju stycken bedömdes ha medelkvalitet och åtta bedömdes ha hög kvalitet. Artiklarnas resultat analyserades med studiens syfte som utgångspunkt för att sedan sammanfattas och sammanställas till rubriker. Bedömning gällande artiklarnas etiska ställningstagande har gjorts i samtliga inkluderade artiklar. Resultatet visade att kognitiva nedsättningar var vanligt förekommande. Typer som beskrevs var påverkan på minne, koncentration och visuomotorisk konstruktionsförmåga. Depressiva tillstånd beskrevs och även en koppling till nedsatt minne beskrevs. Det var vanligare att utveckla kognitiva nedsättningar med att opereras med stöd av hjärt-lungmaskin än att opereras utan dess stöd. Kognitiva nedsättningar beskrevs upp till fem år efter operation. Det beskrevs också kognitiv försämring som förvärrades efter ett år till tre år efter operation. Hjärt-lungmaskinen visade sig bidra till utveckling av kognitiva nedsättningar där det också framkom att aortatångtid var associerat med kognitiv nedsättning. Risker för att utveckla kognitiva nedsättningar var hög ålder. Kognitiva nedsättningar utgjorde inte ett hinder för arbete eller vardagliga aktiviteter. Kognitiva nedsättningar är förekommande både på kort och på lång sikt efter att ha genomgått hjärtkirurgi med stöd av hjärt-lungmaskin. Att symtom inte alltid är uppenbara, förutom vid tester ställer krav på att vårdpersonal erbjuder den information som krävs inför operation för att förbereda patienten. Då kognitiva symtom kan debutera senare kan detta tolkas som åldringsprocess och etiologin är inte säkerställd. För att kvalitetssäkra vården kring dessa patienter bör vårdpersonal vara uppmärksamma på kognitiva symtom postoperativt. / ABSTRACT To enable open heart surgery, a heart-lung machine is used which carry blood in a path outside the body coupled to the body circulation. Complications after surgery with support of the heart-lung machine may be derived from the central nervous system and can cause cognitive symptoms, these complications have increased since the 70's. Cognitive impairments can affect both patient quality of life and healthcare economics. Risks of surgery with the support of the heart-lung machine are emboli, hypoperfusion, anesthesia and inflammation. Detailed information for patients about to undergo cardiac surgery makes them more prepared for possible complications. For the nursing staff to respond and inform these patients requires knowledge of cognitive impairment postoperatively. The aim was to illuminate the cognitive changes in patients after undergoing cardiac surgery with the support of the heart-lung machine. Literature review was conducted where all types of heart surgery performed with the support of the heart-lung machine was chosen to be included. Original articles in Swedish and English whereabouts with access via the "full text", no restriction in years of publication was made. Keywords used was "Cardiopulmonary Bypass", "heart-lung machine", "cognition disorders", "neurobehavioral manifestations," "patient," "post-operative" and "experience". Databases used were Cinahl, PsycINFO and PubMed. The end result was 15 quantitative articles which underwent examination according to templates from Sophiahemmet University. No article was excluded due to low quality, seven were considered to have medium quality and eight were judged to be of high quality. Articles results were analyzed by the study's aim as a starting point and then summarized and compiled into headlines. Ethical consideration has been made in all included articles. The results showed that cognitive impairments were common. Cognitive impairments described were the impact on memory, concentration and visuoconstruction. Depressive condition was described and even a link to impaired memory was described. It was more common to develop cognitive impairments after undergoing cardiac surgery with the support of the heart-lung machine than to undergo surgery without its support. Cognitive impairment was described up to five years after surgery. It was also described cognitive decline that worsened after one year to three years after surgery. Heart-lung machine was found to contribute to the development of cognitive impairments, which also revealed that aortic cross-clamp duration was associated with cognitive impairment. Risks of developing cognitive impairment were advanced age. Cognitive impairments did not constitute an obstacle for work or everyday activities. Cognitive impairments are common in both the short and long term after undergoing cardiac surgery with the support of the heart-lung machine. That the symptoms are not always obvious, except when testing requires that health professionals provides the information required before surgery to prepare the patient. Cognitive impairments may have a later debut which can be interpreted as the aging process, and the etiology is not assured. In order to assure the quality of care of these patients, health professionals should be alert to the cognitive symptoms postoperatively.

Literature suggests that there are a growing number of ‘mental health professionals’ speaking out about their own experiences of using mental health services. Research suggests that these professionals face dilemmas when constructing their identity because they are drawing on two identities that are viewed as fundamentally different, i.e. ‘mental health professionals’ as powerful and ‘mental health service users’ as powerless. This study aimed to explore how ‘mental health professionals’ who are/have been ‘mental health service users’ construct their identity using a social constructionist epistemology, which views identity as fluid and continuously renegotiated in social contexts (Davies & Harré, 1990; Potter & Wetherell, 1987). Ten participants who self-identified as ‘mental health professionals’ who are/have been ‘mental health service users’ volunteered to take part. Interviews were transcribed and analysed using discourse analysis. Participants constructed their identity in a variety of ways, including as separate identities, i.e. a ‘professional identity’ and a ‘patient/mental health service user identity’ constructions, switching between the two in different contexts, therefore developing an ‘un-integrated identity’. Participants also developed an ‘integrated identity’ construction in some professional contexts. These results are discussed and implications for clinical practice and future research are explored.

This Master thesis analyzes how often the specialists of health care, education and law enforcement are facing suicidal behavior, what is their knowledge and attitude toward suicide and its prevention and possibilities to participate at suicide prevention. Aim: to analyze the attitudes, possibilities and readiness of different specialists towards suicide prevention. Objectives: 1. to assess how often the specialists of health care, education and law enforcement are facing suicidal behavior; 2. to evaluate knowledge and attitudes of specialists of health care, education and law enforcement toward suicide and its prevention; 3. to analyze to possibilities of different specialists to participate in suicide prevention; 4. to submit recommendations to regional community authority for community empowerment in suicide prevention. Methodology: Cross-sectional anonymous questionnaires were used for the survey. The questionnaire consists of 27 questions, including the open and closed type questions. The questionnaires were distributed in the institutions and were collected next day. The data was proceeded and analyzed using statistical data analysis batch SPSS 12,0 The research was made in the randomly chosen institutions; medical institutions of all types and police commissariats of the region. Results: the majority of specialists of health care, education and law enforcement of Rokishkis are facing the suicidal behavior of clients and patients at their work. All specialists admit... [to full text]

This is a study of several contentious issues in Canadian health policy involving the interaction of public and private payers and for-profit (FP) and not-for-profit (NFP) providers; the influence of health professionals on market structure; and the role of foreign investment. A case study was used, the Ontario physiotherapy market in 2003-2005, with its complex mix of payers and providers and foreign investment opportunities. Key market features were: fragmented but substantial payer influence, effective though uncoordinated cost control across payers, constrained labour supply, and fragmented patient referral sources. These features increased the complexity of providers’ interactions with patients and payers, reducing standardization and therefore favouring local, professional-owned small business FP providers (FP/s) for ambulatory care. NFP Hospitals’ market share declined. The findings generally confirmed expected behavioural differences between FP and NFP providers but expected differences between investor-owned FP providers (FP/c) and FP/s providers were not generally found. FP/s dominated the market, and FP/c providers appeared to mimic FP/s market behaviours, competing in local sub-markets. With no single or dominant payer, cost control difficulties were expected, but all 11 payer categories (public and private) used various cost control mechanisms, resulting in significant collective but uncoordinated influence. Generally, no payer alone supported a provider’s operations. The dominant labour suppliers, regulated physiotherapists, were scarce and exerted significant pressure, affecting market structure by asserting individual preferences and professional interests. FP/s dominance resulted, supported by the traditional patient referral source, physicians in small practices. Very little foreign investment was found despite little protection for domestic providers under NAFTA. In sum, this study showed FP and NFP provider stereotypes are subject to payer pressure: FP/c organizations can adapt by mimicking FP/s, and payers can modify NFPs’ assumed community orientation. Labour shortages and historical referral patterns can make individual professionals and their preferences more influential than their collective profession without diminishing the importance of professional interests. The degree and structure of payer control can make a market unattractive to foreign investors. Finally, this market – neither a planned or standard market – had a service provision pattern more broadly influenced by professionalism and practitioner interests than policies or prices.

Made available in DSpace on 2015-05-14T12:47:19Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3698853 bytes, checksum: 2aef64808c364d9731b5fd0d369cfa20 (MD5) Previous issue date: 2015-02-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study aimed to analyzing the potential of serious games as a pedagogical tool in the qualification of health professionals in the approach to domestic violence against women. Recognized as a universal problem and important epidemiological dimension, violence against women is a phenomenon based on gender, and its confrontation requires multidisciplinary interventions. To develop and evaluate the serious game presented in this research, the work included simultaneous adoption and complement of two methodological approaches: the qualitative and quantitative. The quality plan was used for defining the pedagogical dimension of the game, i.e. to identifying the themes that led to construction of the conceptual map categories (MC). Such categories and themes subsidized game implementation guiding the definition and creation of game elements: plot, challenges, images/scenes and method of evaluation. The theoretical dimension of the game and its pedagogical character are based on the Constructivist perspective based on the Freiriana methodology of problematization of reality. Pandora's box is a narrative about the life of a woman in a situation of domestic violence using public health services.The graphic design of the game and the method of evaluation were designed to work with concepts that guide professional practice by considering the knowledge and worldviews of the professionals are constituted as instruments of the health working process. In this approach, the game elements (illustrations, reflective dialogues, musical tracks and the method of valuation of the player, which acts as the intelligence of the game) were designed to awaken the motivations for reflection and awareness of the player. From the quantitative research, the game has been validated on the 85 professionals from family health teams. The results of this validation enabled verify the capability of the game for deserting the motivations towards learning about the issue, mobilizing new knowledge and enabling the production of new concepts by the players. The results showed that the game also proved powerful to steer changes of conceptions regarding the problem. Pandora's box was well accepted by health professionals as a pedagogical resource and training, having positive evaluation of more than 90% of the players. That way, the argument championed in this study that the serious games are capable of arousing motivation for learning and changing conceptions of the domestic violence committed against women. In particular, Pandora's box has the potential to working the theme of domestic violence in public health services and to contributing to a change of paradigmatic assistance on women's health. / Este estudo objetivou analisar as potencialidades dos serious games como uma ferramenta pedagógica na qualificação de profissionais de saúde na abordagem à violência doméstica contra a mulher. Reconhecida como um problema universal e de importante dimensão epidemiológica, a violência contra as mulheres é um fenômeno baseado no gênero e o seu enfrentamento requer intervenções multidisciplinares. Para desenvolver e avaliar o serious game apresentado nessa pesquisa, o trabalho comportou a adoção simultânea e complementar de duas abordagens metodológicas: a qualitativa e a quantitativa. O plano qualitativo foi utilizado para a definição da dimensão pedagógica do jogo, ou seja, para a identificação dos temas que conduziram a construção das categorias do Mapa Conceitual (MC). Tais categorias e temas subsidiaram a implementação do game orientando a definição e criação dos elementos do jogo: enredo, desafios, imagens/cenas e método de avaliação. A dimensão teórica do jogo e o seu caráter pedagógico fundamentam-se na perspectiva Construtivista com base na metodologia Freiriana de problematização da realidade. Caixa de Pandora trata de uma narrativa sobre a vida de uma mulher em situação de violência doméstica que recorre aos serviços públicos de saúde. O design gráfico do jogo e o método de avaliação foram projetados para trabalhar com concepções que orientam práticas profissionais por considerar que os saberes e as visões de mundo dos profissionais se constituem como instrumentos do processo de trabalho em saúde. Nesse enfoque, os elementos do jogo (ilustrações, diálogos reflexivos, trilhas musicais e o método de avaliação do jogador, que atua como a Inteligência do jogo) foram elaborados para despertar as motivações para a reflexão e a tomada de consciência do jogador. A partir da pesquisa quantitativa, o jogo foi validado por 85 profissionais de equipes de Saúde da Família. Os resultados dessa validação permitiram verificar a potencialidade do jogo para desertar as motivações no sentido da aprendizagem sobre o tema, mobilizando novos saberes e permitindo a produção de novos conceitos pelos jogadores. Os resultados evidenciaram também que o jogo se mostrou potente para orientar mudanças de concepções a respeito do problema. Caixa de Pandora foi bem aceito pelos profissionais de saúde como um recurso pedagógico e de treinamento, tendo avaliação positiva de mais de 90% dos jogadores. Dessa maneira, confirma-se o argumento defendido neste estudo de que os serious games são capazes de despertar motivações para o aprendizado e mudança de concepções sobre a violência doméstica cometida contra mulheres. Em especial, Caixa de Pandora apresenta potencialidades para trabalhar o tema da violência doméstica nos serviços públicos de saúde e contribuir para uma mudança paradigmática da assistência na saúde da mulher.

Made available in DSpace on 2014-12-17T14:46:53Z (GMT). No. of bitstreams: 1 JaquelineMBS_DISSERT.pdf: 1765859 bytes, checksum: 6d288bdaf8d4615845eb0265dedead22 (MD5) Previous issue date: 2011-12-13 / The counseling on HIV/Aids consists in a prevention strategy that contributes to increase the diagnosis of HIV and start earlier the treatment. The counseling has as pillars the emotional and educational support, risks evaluation that aim at the adoption of safe practices and the individual s responsibility for his own health. To accomplish these results, it is necessary that health workers understand counseling as a unique educational moment that stimulates the user s critical-reflection when it comes to his role as an active subject in this process. This study aimed to analyze the counseling on HIV/Aids conducted by the professionals of the Testing and Counseling Center (CTA), based on the educational perspective of Paulo Freire . This is a descriptive qualitative study with a critical reflexive design based on the principles of Action-Science. All the professionals acting as counselors in the Joao Pessoa, PB CTA, eight in total, took part in the study. Data were collected during the month of March, 2011, through non participative observation and semi-structured interviews with a critical-reflexive focus, analyzed according to the tenets of the critical-reflexive methodology, and discussed taking into consideration the Paulo Freire s pedagogy and pertinent literature. It was observed that most of the professionals expressed the work philosophy of CTA as the diagnosis and prevention of the disease, associated with the utilization and demonstration of condoms. However, upon observation of their counseling sessions, these ideas were not converted in actions. Educational themes were not covered and the condom wasn t offered at any time. The counseling actions focused on the provision of information and filling out the paper forms which are necessary for attendance. The sessions were conducted with brief dialogues and little opportunity for the users to expose or complement their thoughts and needs. The professionals mentioned as facilitating conditions for counseling, the team interaction and physical structure. The difficulties focused on the users low cognition, the large demand for attendance, aspects related to the service organization, and the counselors absences and delays. After reflecting about the actions observed in the counseling, the majority of professionals admitted the need to modify their practice in the incorporation of educational principles for the achievement of a broader prevention, and seemed to be willing to work in this perspective. In conclusion, although the counselors show ideas consistent with the purposes of CTA, these ideas are limited when it comes to the understanding of the meaning of prevention in HIV/Aids. Taking into consideration that they express a certain comprehension and act differently during the counseling, they demonstrate a lack of bond between the theories in use and the proposed ones, in accordance with the contribution of the action-science theory. The counseling, as an educative practice, doesn t materialize in the counseling itself and the orientation for reflection is not given during the attendance. These findings suggest the need to include the process of reflection in the execution of the actions of counseling, so that these practices are guided by reflexive practice, aiming at transforming the way of thinking and acting into a more educational perspective toward a more democratic and holistic assistance. / O aconselhamento em HIV/Aids consiste numa estrat?gia de preven??o pela qual ? poss?vel aumentar o diagn?stico do HIV e iniciar o mais precoce o tratamento. Os pilares que sustentam a estrat?gia s?o o apoio emocional e educativo, e a avalia??o de riscos, que visam ? ado??o de pr?ticas seguras e responsabilidade do sujeito como agente da sua sa?de. Para o alcance dos resultados, torna-se necess?rio que os profissionais de sa?de compreendam o aconselhamento como um momento educativo ?mpar, por estimular a reflex?o cr?tica do usu?rio no tocante ao seu papel como sujeito ativo nesse processo. Este estudo teve como objetivo analisar o aconselhamento em HIV/Aids realizado pelos profissionais do Centro de Testagem e Aconselhamento (CTA), na perspectiva educacional de Paulo Freire. Realizou-se um estudo descritivo com abordagem qualitativa e delineamento de investiga??o cr?tico-reflexiva, com base nos princ?pios da Ci?ncia-A??o. Participaram desta pesquisa todos os profissionais, totalizando oito, que atuam no aconselhamento no CTA de Jo?o Pessoa/PB. Os dados foram coletados no m?s de mar?o de 2011, por meio da observa??o n?o participativa e entrevista semiestruturada, com enfoque cr?tico-reflexivo, e analisados segundo os aportes da metodologia cr?tico-reflexiva e discutidos ? luz da pedagogia de Paulo Freire e autores pertinentes. Observou-se que a maioria dos profissionais compreende a filosofia de trabalho do CTA como sendo o diagn?stico e a preven??o associada ? utiliza??o e demonstra??o do preservativo. Contudo, ao observar as suas a??es durante os aconselhamentos, essas ideias se concretizam parcialmente. Temas educativos n?o foram abordados e o preservativo n?o foi oferecido em nenhum dos atendimentos. As a??es centraram-se no acolhimento de informa??es e no preenchimento dos formul?rios necess?rios ao atendimento, com di?logo breve e com pouca abertura para o usu?rio expor, ou completar, os seus pensamentos e necessidades. Os profissionais citaram as condi??es facilitadoras para o aconselhamento, a intera??o da equipe e estrutura f?sica. Focalizaram as dificuldades do baixo grau de cogni??o dos usu?rios, a demanda de atendimentos e outros aspectos da organiza??o de servi?o, e o descompromisso dos aconselhadores quanto ?s faltas e atrasos. Ao refletir sobre as a??es observadas nos aconselhamentos, a maioria dos profissionais reconheceu que precisa modificar algumas a??es do atendimento para incorpora??o dos princ?pios educativos na realiza??o de uma preven??o mais ampla, e se mostraram dispostos a trabalhar nessa perspectiva. Conclui-se que, embora os profissionais expressem ideias condizentes com os prop?sitos do CTA, estas s?o limitadas como apropria??o do significado de preven??o em HIV/Aids. Na medida em que expressam uma compreens?o e agem de forma diferente na realiza??o das a??es durante o aconselhamento, demonstram a desarticula??o entre as teorias em uso e as teorias propostas, conforme os aportes da teoria da ci?ncia-a??o. O aconselhamento como pr?tica educativa se concretiza parcialmente nos atendimentos e a orienta??o para uma reflex?o ? pouco oportunizada no atendimento. Esses achados sugerem a necessidade de inserir o processo de reflex?o na realiza??o das a??es de aconselhamento, de forma que estas sejam pautadas na pr?tica reflexiva, objetivando a transforma??o do seu modo de pensar e agir para uma perspectiva educacional com vistas a uma assist?ncia mais democr?tica e integral.

Bakgrund: När en patient vårdas palliativt innebär det att sjukdomen inte längre går att bota och vårdarbetet inriktas mot symtomlindring. Det finns lagar och föreskrifter som tydliggör hur information ska delges till närstående inom hälsooch sjukvårdsorganisationen så närstående ska få det stöd de behöver. Litteraturöversiktens teoretiska referensram förklarar hur stöd och information till närstående är en viktig del av den palliativa vården. Under den tiden som patienten vårdas palliativt är det viktigt att patientens närstående blir informerade om vad som sker med patienten. Syfte: Att belysa närståendes upplevelser av information kring den palliativa omvårdnaden av vuxna patienter. Metod: Studien har genomförts som en litteraturöversikt och baseras på tolv artiklar skrivna mellan år 2006-2016. Resultat: Resultatet visar olika faktorer som påverkar närståendes upplevelser av information vid palliativ omvårdnad av vuxna patienter. Det framkom i flera studier att närstående hade behov av att få information om patientens vård. Informationen skulle vara tydlig och enkel att förstå så närstående kunde känna sig förberedda och införstådda vad som skulle ske med patienten. Slutsats: Flera av faktorerna som är presenterade i litteraturöversiktens resultat är påverkansbara. Vårdpersonal behöver mer kunskap om utlämnande av information och dess betydelse för närstående till palliativa patienter. Denna kunskap bör spridas till alla vårdavdelningar inom hälso- och sjukvårdsorganisationen. Kunskapen om delgivning av information är viktig för att kunna ge närstående det stöd och den information som de har rätt till. Det kan leda till att närstående upplever att de kan hantera den svåra situation som de befinner sig i trots omständigheterna. / Background: When a patient is treated palliatively, it means that the disease can no longer be cured, and the care job focuses instead on symptom relief. There are laws and regulations that clarify how information is to be communicated to related people within the health care organization so relatives will get the support they need. The theoretical frame of reference in this study explains how support and information to close relatives is an important part of palliative care. During the time the patient is treated palliative, it is important that the relatives are informed of what happens to the patient. Aim: To highlight relatives experiences of the information concerning the palliative care of adult patients. Method: The study has been carried out as a literature review and is based on twelve articles written between 2006-2016. Results: The results of the study show various factors that affect the relatives experience of information on palliative care of adult patients. It appeared in several studies that relatives had the need to receive information about the patient's care. The information would be clear and easy to understand so that the close relatives could feel well prepared and understood what would happen to the patient. Conclusion: Several of the factors presented in the literature review result are influential. Healthcare professionals need more knowledge about the disclosure of information and its importance to relatives of palliative patients, and this knowledge should be spread to all healthcare organizations. Knowledge of information is important in order to provide the patients family support and information they are entitled to. This can lead to relatives experiencing that they can handle the difficult situation they are in despite the circumstances.

It is widely accepted that Higher Education should provide students with a challenging experience. Research on threshold concepts provides a framework for exploring challenging content within a discipline and has contributed to understanding how to support students with conceptual difficulties. However, less is known about how individual students experience challenge and difficulty in their academic studies, in particular how they respond and feel when they become stuck. This study explores students’ experience of challenge, difficulty and stuckness, how they responded and managed challenges and any associated feelings. The study, carried out in a university in the Southwest of England, used a Qualitative Longitudinal Research design to follow 16 students through the second year of a degree for Allied Health Professionals. Data were collected using the semi-structured and email interview methods. Data were analysed longitudinally and cross-sectionally using a constant comparison process. The findings and discussion are presented using a ‘natural’ style which aims to capture the student journey over the academic year. The study found that some form of challenge, difficulty or stuckness was commonplace in the students’ educational experience. The value of challenges which create uncertainty in education is recognised, particularly where students are grappling with boundaries around knowledge. Variation in students’ experiences was partly explained by their ‘spiky profiles’ (influencing factors such as prior education and work experience) and partly by differences in factors relating to strategy use. The students were creative and resourceful in developing a range of specific and generic strategies in several areas: the use of time and space; the management of expectations and acceptance of feelings; and monitoring and reflection. The study adds to current understanding of stuckness through an examination of the liminal spaces students encountered. The discussion argues for a more nuanced and holistic approach to understanding students’ engagement with a complex cycle of challenges and strategy use, which creates a range of expectations, tensions, feelings and opportunities. It identifies implications for Higher Education practice and calls for an understanding of the impact and interconnectedness of factors influencing students. It stresses the importance of providing structures for students to explore how they learn and develop their academic practice, in addition to discipline specific knowledge and skills.

Submitted by Socorro Pontes (socorrop@ufersa.edu.br) on 2017-01-30T13:39:15Z No. of bitstreams: 1 GiselleSCO_DISSERT.pdf: 1058104 bytes, checksum: 89fd1032b2b20bfc50ba7056a41faafa (MD5) / Made available in DSpace on 2017-01-30T13:39:15Z (GMT). No. of bitstreams: 1 GiselleSCO_DISSERT.pdf: 1058104 bytes, checksum: 89fd1032b2b20bfc50ba7056a41faafa (MD5) Previous issue date: 2016-01-15 / The visceral leishmaniasis (VL) is an infectious disease and a zoonosis. It is still considered a public health challenge, due to the frequency and mortality caused on the population. The overall objective is to develop an instrument for prevention of Visceral Leishmaniasis in the context of the Family Health Strategy, analyzing the knowledge of health professionals. The specific objectives are characterizing the profile of health professionals on the Family Health Strategy Program; developing an instrument to assess the interest of Health Professionals in the Family Health Strategy Program (FHS) on measures to prevent visceral leishmaniasis in their community; identifying the influencing factors which come into play when those professionals take actions to prevent visceral leishmaniasis; identifying areas of greatest prevalence of visceral leishmaniasis in Mossoró and evaluating the influence of health professionals’ knowledge on the prevalence of visceral leishmaniasis. It is an exploratory, descriptive and quantitative research which was carried out in 30 Basic Health Centers (BHC) of the Family Health Strategy Program in the urban area in the town of Mossoró-RN. The population were health professionals from the FHSP, and the sample composed by 227 elements. Two questionnaires have been administered, one related to knowledge on VL and the other one for identifying the factors that guide health professionals. Data were expressed on standard average and deviation, minimum, maximum, simple frequencies and percentages obtained through the software Statistical Package for Social Science (SPSS) version 20.0. The instrument was developed and submitted to content validation with application of Kappa Index and Content Validity Index. Then, the instrument was applied to health professionals. Being validated with 20 items, divided into five factors such as the work process, environment, socio-personal difficulties, financing, prevention and control. The instrument is suitable and can be used for research in primary health care regarding to prevention and control of visceral leishmaniasis, particularly in endemic areas. Regarding to the knowledge on VL, it was identified that health professionals know the animals that may be affected, enabling an increase in the identification of cases of this disease (OR: 2.74; IC95%=1.17 – 6.41). Knowing the symptoms of the disease in animals is the key to realize its existence (OR: 2.75; IC95%=1.09 – 6.89). In addition, the fact of knowing prevention is a contributing factor to detect the disease in the regions (OR: 2.38; IC95%=1.07 – 5.31). Regarding the transmission times of the disease, it was most relevant to a greater detection of VL cases (OR: 2.75; IC95%=1.24 – 6.05). In conducting an active search for HVL and Canine Visceral Leishmaniasis (CVL), there is a greater risk of finding positive cases of the disease (OR: 2.57; IC95%=1.13 – 5.61). After the crude analysis of the O.R., the adjusted data revealed that these variables are more important. The health professionals have a limited knowledge about the VL, there are still gaps to be considered, especially on the prevention and control of disease in the researched areas. Thus, requiring an ongoing training and implementation of incisive governmental actions / A Leishmaniose Visceral (LV) é uma doença infecciosa e uma zoonose. Considerada um desafio à saúde pública pela frequência e morbimortalidade ocasionada. Objetiva-se desenvolver um instrumento para prevenção da Leishmaniose Visceral no âmbito da Estratégia de Saúde da Família, analisando o conhecimento dos profissionais de saúde. Mais especificamente, caracterizar o perfil dos Profissionais de Saúde da Estratégia de Saúde da Família; elaborar um instrumento que avalie o interesse dos Profissionais de Saúde da Estratégia de Saúde da Família (ESF) sobre as ações de prevenção da Leishmaniose Visceral da sua comunidade; identificar os fatores influenciadores dos Profissionais de Saúde da Estratégia de Saúde da Família (ESF) sobre as ações de prevenção da Leishmaniose Visceral; avaliar a influência do conhecimento dos Profissionais de Saúde da Estratégia de Saúde da Família (ESF) sobre a prevalência de Leishmaniose Visceral; realizar um levantamento das áreas de maior prevalência da Leishmaniose Visceral em Mossoró, Rio Grande do Norte. Trata-se de uma pesquisa exploratória, descritiva e quantitativa. Foi realizada em 30 Unidades Básicas de Saúde (UBS) da ESF na zona urbana, no Município de Mossoró-RN. A população foi composta pelos profissionais de saúde das ESF, sendo a amostra composta por 227 elementos. Foram aplicados dois questionários, um relacionado ao conhecimento sobre LV e outro para identificação de fatores que norteiam os profissionais de saúde. Os dados foram expressos em média e desvio padrão, valores mínimos, máximos, frequência simples e porcentagem obtidos através do programa (SPSS) versão 20.0. O instrumento foi desenvolvido, sendo submetido à validação de conteúdo com aplicação do Índice Kappa e Índice de Validade de Conteúdo. Em seguida, foi aplicado o instrumento aos profissionais de saúde. Ficando validado com 20 itens, subdividido em cinco fatores caracterizados em processo de trabalho, ambiente, dificuldades sócios pessoais, financiamento, prevenção e controle. O instrumento encontra-se adequado, podendo ser utilizado em pesquisas na atenção primária de saúde em relação à prevenção e controle da Leishmaniose visceral, principalmente em áreas endêmicas. Em relação ao conhecimento da LV, foi identificado que os profissionais de saúde conhecem os animais que podem ser acometidos, possibilitando um aumento na identificação de casos da doença (OR: 2,74; IC95%=1,17 – 6,41). O conhecimento da sintomatologia da doença no animal é um determinante para perceber a sua existência (OR: 2,75; IC95%=1,09 – 6,89). Além disso, o fato de conhecer a prevenção é um fator que contribui para detectar a doença nas regiões. (OR: 2,38; IC95%=1,07 – 5,31). Em relação aos horários de transmissão da doença foi relevante para uma maior detecção de casos de LV (OR: 2,75; IC 95%1,24 – 6,05). Na realização de busca ativa de LVH e Leishmaniose Visceral Canina (LVC), existe um maior risco de encontrar casos positivos da doença (OR: 2,57; IC95%=1,13 – 5,61). Após a análise bruta do OR, o ajustado revelou que essas variáveis são mais importantes. Os profissionais de saúde possuem um conhecimento restrito acerca da LV, existindo ainda lacunas a serem consideradas, principalmente sobre a prevenção e controle da doença nas áreas estudadas, necessitando assim, de capacitação continuada por parte das ações governamentais contudentes / 2017-01-27

Un vécu traumatique de l’accouchement et ses conséquences représentent un problème majeur souvent sous-estimé pour la santé de la femme (Ayers, 2004). Certaines femmes peuvent développer après leur accouchement un état de stress post-traumatique (ESPT). Une prévalence moyenne de 2% de femmes qui manifestent un ESPT postpartum est reconnu et un tiers des femmes présentent des symptômes cliniquement significatifs d’un ESPT (revue de la littérature Olde et al., 2006 ; Denis & Callahan, 2009). Partie 1 : une étude longitudinale quantitative avec quatre temps d’évaluation (fin de grossesse et 2, 6, 12 mois postpartum) a été menée auprès de 400 femmes. A deux mois postpartum 163 femmes ont répondu aux questionnaires, 32 femmes (19,6%) présentent des symptômes d’un ESPT suite à l’accouchement. A six mois postpartum, 97 femmes ont poursuivi l’étude et 11 présentent des symptômes d’ESPT (11,5%). L’analyse longitudinale et multifactorielle a montré des différences significatives entre le groupe des femmes « ESPT postpartum » et le groupe témoin concernant le sentiment d’auto-efficacité, les stratégies de coping et la qualité de vie. A douze mois postpartum, 80 femmes ont répondu aux questionnaires, 13 d’entre elles (16,5%) présentent des symptômes d’un ESPT postpartum. Une analyse de régression linéaire indique que les antécédents obstétricaux-gynécologiques, la présence d’affects dépressifs en prépartum et l’utilisation de la stratégie de coping d’auto-blâme ainsi que la difficulté à réinterpréter les situations de manière positive en postpartum (T2) prédisent l’apparition de symptômes d’ESPT postpartum à un an. Les résultats de l’analyse de médiation montrent un effet de la stratégie de coping auto-blâme (T2) sur la relation entre la perception du soutien à l’autonomie par l’équipe soignante à T2 et le score d’ESPT à un an postpartum (T4). Partie 2 : une étude qualitative a été menée afin de connaître les représentations des soignants sur le développement d’un état de stress post-traumatique suite à l’accouchement à l’aide une étude par entretiens. Indépendamment, un protocole de prise en charge des femmes présentant un ESPT consécutif à l’accouchement a été élaboré afin d’évaluer l’effet d’une prise en charge psychothérapeutique (thérapie EMDR) chez ces femmes en souffrance. Conclusion : les résultats de cette étude confirment la présence d’un ESPT postpartum chez un certain nombre de femmes. A partir de ces résultats, une réflexion clinique est proposée sur les améliorations possibles de la prise en charge des femmes souffrant d’un ESPT suite à l’accouchement / A traumatic birth experience and its consequences are representing a major health issue in women, much too often underestimated (Ayers, 2004). However some women develop posttraumatic stress disorder (PTSD) following childbirth. Prevalence is estimated about 2% of women presenting postpartum PTSD, one third present clinically significant symptoms of PTSD (2 reviews: Olde et al., 2006; Denis & Callahan, 2009). Part 1: A quantitative longitudinal study was carried out within 400 women and with four times of evaluation (late pregnancy and 2, 6, 12 month postpartum. At 2 month postpartum, 163 women answered the questionnaire, 32 women (19.6%) presented symptoms of PTSD postpartum. At six month postpartum, 97 women were followed and 11 presented symptoms of PTSD (16.5%). Multifactor and longitudinal analysis showed significant differences between women within “PTSD group” or “control group” in relation to self-efficacy, coping and quality of life. At twelve month postpartum, 80 women answered questionnaire, 11 presented symptoms of PTSD (11.5%). Regression analysis indicates gynecological or obstetrical history, presence of prepartum depression and coping strategies such as blame and difficulties in positive re-interpretation of a given situation as predicting postpartum PTSD symptoms. The effect of perception of support for autonomy provided by health professionals on the score of PTSD at one year following birth is mediated by using coping strategy “blame” at T2. Part 2: Our qualitative study was implemented in order to understand health professionals perception of the postpartum PTSD development. Qualitative interviews were conducted. Furthermore, a research protocol was elaborated for a treatment of women presenting PTSD following childbirth and for evaluating the effects of psychotherapy (EMDR treatment). Conclusion: These results confirm the presence of postpartum PTSD in some women. Following these results, clinical implications are offered to improve the provided health care