There have been various approaches to the treatment of nonorgasmic women, including psychoanalysis, desensitization, relaxation, masturbation, and group therapy. The present study was conducted to examine the efficacy of group therapy combined with home-based training in the treatment of primary nonorgasmic women. A no-treatment control group was also employed. Treatment consisted of two weekly 1- hour group sessions for 5 weeks. Educative processes were employed, such as detailed information on physiology of female sexual response. Structured homework exercises were also utilized, such as mastubatory techniques, role-playing orgasm, strengthening vaginal muscles, and assertiveness training in sexual and nonsexual situations. Results indicated an 88% success rate in the treatment group and no change in the control group.

The development of palliative care in Indonesia has been slow due to the absence of palliative care guide lines and standards. This results in the limited provision of palliative care where it can only be found available in 14 hospitals in the whole country with a population over 260 million, and the palliative care is basically directed to adult patients. In the paediatric medicine field, the palliative care services in Indonesia is still in its infancy and currently palliative care is served by only one non-profit organization in Jakarta. With around 1,5 million people in Jakarta associated with living in poverty, this organization is focusing on providing free palliative care to children from marginalized communities. The questions that are raised out of these circumstances are how paediatric palliative care is practiced in Jakarta and what the rewarding and challenging parts of the job are. The aim of the study is to describe nurses' perspectives and experiences in giving home-based palliative care to children living with cancer and HIV from marginalized communities in Jakarta. A qualitative study design with content analysis was considered to be the method that fitted the goal of the study best. Semi structured interview was used as data collection method and there were seven nurses who participated in the interviews. The result is described by two main categories; the first category contains different topics that functioned as encouragements to the nurses, and the second category consists of various subjects that contribute to challenges that nurses encounter in their work. Lack of palliative education that lead to certain attitudes in the referral process, misperceptions about pain management and nurses’ stress management are discussed as some challenges encountered in the implementation of palliative care.

A estimulação somatossensitiva através da estimulação repetitiva de nervos da mão parética é uma abordagem promissora na recuperação motora do membro superior de pacientes com acidente vascular cerebral (AVC) na fase crônica e habitualmente é realizada em ambiente hospitalar. A dificuldade de comparecimento frequente de pacientes com AVC ao hospital pode prejudicar a implementação desta estratégia terapêutica em nosso meio. A reabilitação domiciliar pode ser uma alternativa interessante, além de ser menos dispendiosa do que a reabilitação hospitalar. O atual estudo teve como objetivo principal verificar a melhora em desempenho na função do membro superior parético após uma intervenção de estimulação somatossensitiva associada a treino motor, em ambiente domiciliar. Foi realizado um ensaio clínico aleatorizado, com mascaramento duplo e dois tipos de intervenção: ativa ou controle. Os pacientes do grupo ativo foram instruídos a utilizar um dispositivo de estimulação elétrica do nervo mediano, por duas horas. Os pacientes do grupo controle também foram instruídos a usar o dispositivo durante duas horas, porém sem que houvesse estimulação do nervo. Imediatamente após a utilização do dispositivo, todos os pacientes foram orientados a realizar um treino motor baseado no teste de Jebsen-Taylor. O tratamento foi realizado diariamente, ao longo de um mês. O desfecho primário foi o efeito da estimulação somatossensitiva (ativa versus controle) associada a treino motor sobre a melhora da função do membro superior parético avaliada pelo teste de Jebsen-Taylor. Os desfechos secundários foram: 1) melhora na independência funcional, avaliada pela Medida de Independência Funcional (MIF); 2) aderência às intervenções propostas, avaliada através de registros em uma agenda, e de relatos orais dos pacientes; 3) eventos adversos decorrentes dessas intervenções. O desempenho no teste de Jebsen-Taylor e na Medida de Independência Funcional (MIF) foi avaliado antes das intervenções (D0), ao seu término (D30) e quatro meses após o seu término (D150). Para a comparação da melhora em desempenho no teste de Jebsen-Taylor e da melhora em pontuação na MIF no grupo ativo e no grupo controle, foi utilizada análise de variância com medidas repetidas (ANOVAMR) com fatores grupo (ativo e controle) e tempo (D30 e D150). Foi observado um efeito significativo de grupo (F=5,02; p=0,038) na ausência de efeitos significativos de tempo ou interação grupo*tempo (p>0,05) em relação à melhora em desempenho no teste de Jebsen-Taylor. Não houve diferenças estatisticamente significantes entre os grupos em relação à pontuação na MIF após o tratamento. O grupo ativo apresentou maior aderência ao tratamento do que o grupo controle, porém esta conclusão foi baseada em informações fornecidas pelos pacientes, sem observação direta da pesquisadora. Não observamos eventos adversos relevantes. Este estudo é pioneiro por demonstrar efeitos benéficos, em longo prazo, da estimulação somatossensitiva associada a treino motor realizado em ambiente domiciliar, sem a supervisão de um terapeuta. Para a realização de estudos futuros, sugerimos algumas modificações em relação ao protocolo de estimulação somatossensitiva e treino motor, assim como combinações da técnica utilizada a outras técnicas de neuroestimulação / Somatosensory stimulation in the form of peripheral nerve stimulation is a promising strategy to improve motor function of the upper limb in chronic stroke patients and is usually administered in research laboratories. The usual difficulty in commutting to and from the hospital in a regular basis at short intervals of time is an obstacle for implementation of this therapeutic approach in our country. Home-based rehabilitation may be an interesting alternative, in addition to being less expensive than hospital-based rehabilitation. The current study aims to evaluate the improvement in performance of the paretic upper extremity after an experimental intervention consisting of somatosensory stimulation associated with motor training, performed at home. This study is a randomized, double-blind clinical trial, with two different types of interventions: active or control. Patients in the active group were instructed to use a device of electrical stimulation of the median nerve, for two hours. Patients in the control group were also instructed to use the device for two hours, and sham stimulation was administered. Immediately after the use of the device, all patients were instructed to train tasks that are part of the Jebsen-Taylor test. Treatment was performed daily, for one month. The primary outcome was improvement in performance of the paretic hand, evaluated by the Jebsen-Taylor test. Secondary outcomes were: 1) improvement in the Functional Independence Measure (FIM); 2) compliance with the proposed interventions, assessed through a daily written log, and oral reports of the patients; 3) possible adverse events from these interventions. Performance in the Jebsen-Taylor test and FIM scores were assessed before the interventions (D0), immediately after its end (D30) and four months after its end (D150). Analysis was performed with repeated- measures ANOVA (ANOVARM) with factors GROUP (active and control) and TIME (D30 and D150). Regarding Jebsen-Taylor test improvement, there was a significant effect of GROUP (F=5.02; p=0.038) in the absence of significant effects of TIME or interaction GROUP*TIME (p>0.05). There were no significant differences in FIM scores in either group after treatment. Compliance with treatment was greater in the active than in the control group, but conclusions about this finding are limited because data were collected solely based on information provided by patients. No relevant adverse events were observed. This study pioneered home-based somatosensory stimulation combined with motor training, without direct supervision of a therapist. We suggest changes to be made in the protocol in future studies, as well as investigation of effects of somatosensory stimulation combined with other neurostimulation techniques

Esta pesquisa investiga os determinantes e a evolução recente no Brasil do trabalho remunerado feminino exercido no próprio domicílio ou simplesmente trabalho domiciliar. Quase 10% da população feminina ocupada, aproximadamente 4,5 milhões de mulheres, tem esse tipo de ocupação. Constatando a inexistência de estudos sobre o tema com dados quantitativos abrangentes, a presente pesquisa utiliza informações da Pesquisa Nacional por Amostras Domiciliares (PNAD) de 1992 a 2005 para analisar como evoluiu a proporção de trabalhadoras domiciliares no total da população ocupada. As mais importantes hipóteses delineadas na literatura a partir de estudos de caso são discutidas pela confrontação com os dados. Sob a ótica da demanda por essa forma de trabalho, analisa-se os setores que mais fazem uso do trabalho domiciliar feminino e as mudanças nessa composição, bem como sua relação com as transformações no mundo do trabalho decorrentes da reestruturação empresarial. Quanto à oferta por trabalho domiciliar, investiga-se como atributos individuais e familiares afetam as chances da mulher estar nesse tipo de condição de ocupação. É debatido como as transformações na inserção produtiva feminina afetaram a importância relativa do trabalho domiciliar. Constrói-se um modelo Logit Multinomial no Stata a partir dos dados da PNAD para comparar como mudou no tempo o impacto de cada atributo sobre a probabilidade de que uma mulher seja trabalhadora domiciliar. / This research investigates the determinants and recent developments of female home-based work in Brazil. Almost 10% of the occupied female population, approximately 4.5 million women, has this kind of occupation. Noting the lack of studies on the topic with comprehensive quantitative data, the present research uses information from PNAD beginning on 1992 until 2005 to evaluate how the proportion of female home-based workers on occupied population evolved. The most important assumptions outlined in the literature from case studies are discussed by confrontation with the data. From the perspective of demand for this type of work, sectors that intensively use female home-based work are analyzed, as well as its relationship with the changes in the labor market resulting from firms restructuring. On the supply of home-based work, it is investigated how individual and family attributes affect the chances of a woman to be in this work condition. It is discussed how the changes on female\'s productive insertion affected the relative importance of home-based work. A Multinomial Logit model is built on Stata using the data from PNAD to compare how the impacts of each attribute on the probability of a woman being home-based worker changed over time.

This study assessed the feasibility of the newly manualized Prevent Teach Reinforce for Families (PTR-F) for use with Hispanic families of young children with autism spectrum disorders (ASD) who have difficulty adjusting to family routine. The study involved three families of children with ASD ages 3 to 6 years old who participated in the 5-step PTR-F process and who implemented the PTR intervention plan during naturally occurring family routines. A multiple-baseline across participants design was employed to examine the preliminary evidence of efficacy of using the PTR-F for children with ASD. The results indicated that Hispanic parents successfully implemented intervention strategies with the help of a facilitator using the PTR-F manual. All children’s alternate desirable behavior increased and problem behavior reduced a significant amount when the PTR-F intervention was implemented by the parents. The parents reported high social validity when implementing the PTR-F intervention.

Research Doctorate - Doctor of Philosophy (PhD) / Families with serious and/or chronic child protection risks often have complex personal and social issues. Statutory child protection services must manage escalating child protection reports with limited resources. Addressing families at immediate risk often takes precedence over comprehensive family assessment and planned intervention, so the child protection issues in the lower priority families persist, and child protection reports continue. The Montrose Home-Based Family Assessment Program assesses Department of Community Services registered families who are at risk of child removal because of chronic and/or severe child protection issues. Using an ecological perspective, the Montrose team conducts a five day comprehensive assessment in the family's home and community, and develops a caseplan to address child protection risks and family support needs. The assessment is voluntary, and the family is encouraged to participate in identifying the child protection issues and developing solutions. The primary goal of this study is to compare child protection outcomes, three years after referral, for 100 families who participated in a Montrose Assessment, and 100 Comparison Group families. The research questions also explore the relationship between demographic, family, parent, child and child protection service factors and child protection outcome. Outcome is measured by Family Outcome, Children's Outcome, Legal Status, Children's Placement, subsequent Child Protection Reports and Substantiated Child Protection Reports, and Type of Abuse. The results suggest that home-based family assessment is a cost-effective model that can measurably reduce the likelihood of further abuse, court intervention and out of home care even for complex, high risk families. The study also identifies specific child, parent and child protection service related variables that are significantly associated with child protection outcome. These findings have major relevance for current child protection policy and practice, and also for broader social policy that impacts on high risk families.

<p>The increase of women’s labor force participation, the diversity of family constellations, many men’s increased participation in childcare, and the development of flexible working arrangements have stimulated research on the relationship between work and non-work. In this thesis, the interaction between work and non-work is examined in the case of home-based telework, an example of flexible working arrangement. Because of the disappearance or blurring of the traditional boundaries in time and space, the consequences of these working conditions for individuals need to be analyzed. The overall aim of this thesis is to study the interaction between work and non-work in home-based telework and to analyze the following issues:</p><p>- conflict versus facilitation as related to the segmentation and integration of work/non-work domains</p><p>- the nature and role of boundaries</p><p>- the physical and mental aspects of work activities within the domains</p><p>The thesis is based on quantitative as well as qualitative data. In general, the results show that the domains of work and non-work do interact with each other in various ways and dimensions. The employees reported some degree of overlap spatially, temporally, and mentally, and limited overlap was preferred by the majority. The results show the importance of boundaries, as they are needed in order to bring structure and legitimacy to the work (carried out in the home/private domain) and to detach from work. The teleworking women reported less effective restoration than the non-teleworking women, while the teleworking men reported slightly more effective restoration than the non-teleworking men. Generally, the results showed that work tended to intrude more on family and non-work than vice versa. Individuals who experienced conflict between the domains of work and non-work also reported a lower degree of life satisfaction. Significant associations were found between facilitation (positive spillover) and life satisfaction and recovery.</p>

The increase of women’s labor force participation, the diversity of family constellations, many men’s increased participation in childcare, and the development of flexible working arrangements have stimulated research on the relationship between work and non-work. In this thesis, the interaction between work and non-work is examined in the case of home-based telework, an example of flexible working arrangement. Because of the disappearance or blurring of the traditional boundaries in time and space, the consequences of these working conditions for individuals need to be analyzed. The overall aim of this thesis is to study the interaction between work and non-work in home-based telework and to analyze the following issues: - conflict versus facilitation as related to the segmentation and integration of work/non-work domains - the nature and role of boundaries - the physical and mental aspects of work activities within the domains The thesis is based on quantitative as well as qualitative data. In general, the results show that the domains of work and non-work do interact with each other in various ways and dimensions. The employees reported some degree of overlap spatially, temporally, and mentally, and limited overlap was preferred by the majority. The results show the importance of boundaries, as they are needed in order to bring structure and legitimacy to the work (carried out in the home/private domain) and to detach from work. The teleworking women reported less effective restoration than the non-teleworking women, while the teleworking men reported slightly more effective restoration than the non-teleworking men. Generally, the results showed that work tended to intrude more on family and non-work than vice versa. Individuals who experienced conflict between the domains of work and non-work also reported a lower degree of life satisfaction. Significant associations were found between facilitation (positive spillover) and life satisfaction and recovery.

<p>In many developing countries including South Africa, there is an overwhelming number of people infected with HIV/AIDS in the hospitals, which the health care workers are unable to cope with. Therefore, an urgent need to develop alternative community based activities such as support groups, home based care programs and placement of&nbsp / orphans, for the provision of social health care services to the HIV client, arises. However, a deeper understanding of the challenges facing community organizations when&nbsp / providing home based care is crucial and necessary in order to formulate effective and relevant care services. The aim of the study was to explore the challenges faced by Umtha&nbsp / elanga Community Organization (UWCO) in the provision of HIV/AIDS home based care. The objectives of the study were to assess the current home based care of the UWCO and to explore the challenges that community based organizations have to face when providing care services to people being infected and affected by HIV/AIDS. The research design undertaken was the case study of UWCO. The qualitative approach with in-depth interviews with the&nbsp / management staff and home based caregivers was utilized. Data analysis began immediately after the interviews by transcribing and translating the audio-taped data. Thematic analysis was used in which data was coded and categorized. The findings of the research&nbsp / indicated that the home based care programme assists PLWHA clients in their natural home setting. All home based carers work voluntary and get supported by the organization as&nbsp / ell as by the department of social development and health such as the social workers. Finances appear to be, both for the organization and the home based carers, a huge&nbsp / hindrance. Research indicated that the organization experiences various challenges to provide the service to their community. It is recommended that Government must ensure that&nbsp / home based care workers get recognition, credit and support for their valuable contribution. Training for HBC employers needs to be extended to expose and add more skills. This&nbsp / will ensure that they are equipped for their tasks. Home based care workers must become registered and paid better salaries by the government.</p>

Syftet med denna uppsats var att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelse av mötet med kunderna utifrån aspekterna kvalitet, tid och makt. Vi har genomfört en kvalitativ intervjustudie med sex personer som arbetar inom hemtjänstverksamheten. Studiens resultat har analyserats och tolkats utifrån teorierna socialkonstruktionism och roll­teori samt begreppet relationell makt. Resultaten visar att tiden är central i mötet mellan hem­tjänstpersonal och kunder då den inverkar på när och hur länge insatserna ska utföras. Lyhörd­het och att utgå från kundens behov och önskemål definieras som god omsorgskvalitet medan maktförhållandet växlar mellan hemtjänstpersonal och kund utifrån varje unikt om­sorgs­möte. För att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelser av mötet med kunderna behöver aspekterna kvalitet, tid och makt belysas och analyseras i en och samma kontext. Resultaten visar att de tre aspekterna samverkar i mötet och analysen med­verkar till att nå en djupare förståelse för hemtjänstpersonalens upplevelser. / The purpose of this study was to gain a deeper understanding and knowledge of home based care giver´s experiences of the encounter with clients from three perspectives: quality, time and power. We conducted a qualitative interview study with six people working in home based care. Our results have been analyzed and interpreted by the theories social construc­tionism and role theory and the concept of relational power. The results of the study demon­strate that time is central for the encounter between home care giver´s and clients affecting both when and how long the care should be performed. Responsiveness and putting the client´s needs in focus are defined as good quality of care, while the power relationship between home care givers and clients changes between each unique encounter. To get a deeper understanding and knowledge of home care givers experiences of the encounter with clients the three aspects: quality, time and power, needs to be highlighted and studied in the same context. The results demonstrate that the three aspects interact in the encounter and analyzing these together creates a deeper understanding of home care giver´s experience of the encounter.