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The negative impact of war on child mental health has been repeatedly documented. Still, the majority of children exposed to ethnic and political violence show no signs of clinical disorder. In Western countries of exile, these findings have prompted a variety of attempts to evaluate refugee children, in the hope of identifying and offering support to those children “at risk”. This study critically examines one such attempt. The aims are fourfold: 1. to describe the range and pattern of child trauma-stress exposure and mental health reactions as captured on clinician semi-structured interview; 2. to critically compare clinician assessment with independent parent, child and teacher reports; 3. to identify factors of potential risk or protective import for child mental health; 4. to draw clinical implications: from whom and by what means can children at risk be reasonably identified? The target of our study was the entire population of Bosnian-Serbian-Croatian speaking child refugee families assigned to Umeå and surrounding municipalities during 1994-95. Fifty families, containing 90 children aged one month to 20 years, were included in the study. Assessment occurred in two phases. First, a semi-structured interview was conducted that inquired broadly as to the child’s family background, trauma-stress exposure, emotional-behavioral problems, patterns of family functioning, and future hopes. Second, standardized self-report questionnaires were administered, separately to parent and child, to provide alternative appraisal of the child’s war exposure, mental health symptoms, coping strategies, and social network. Teacher evaluation of child cognitive-social functioning as well as emotional-behavioral problems was also obtained. Clinician semi-structured interview revealed the child’s pre-war period as preponderantly good, and provided richly detailed narratives of child exposure during war and resettlement that clustered into a limited number of type-stories. Independent parent assessment captured the same broad strokes of child war exposure; but both approaches – fixed questionnaire and semi-structured interview – showed specific areas of blindness. Teenage self-report offered a disparate but equally rich account of war exposure, while that of primary school child was significantly less detailed. Nearly half of the study children (48%) were identified on clinician interview with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%), followed by posttraumatic reactions (23%) and anxiety-regressiveness (15%). Independent symptom appraisal by parent and primary school child was largely concordant with that of clinician, while teenagers made similar assessment as to who was in distress, but defined the nature of that distress differently. Teacher report stood apart, identifying fewer inward emotional problems and asserting the cognitive-social competence of the vast majority of study children. Trauma-stress exposure during both war and resettlement presented as an unequivocal risk to mental health, but accounted for only part of outcome variance. Additional factors of strong import related broadly to “living in the present”. Parent impairment of daily routines, child dissatisfaction with school and an ongoing quarrelsome relationship presented as risk factors. Protection was associated with parent maintenance of a warm family climate and of concrete physical-emotional caring, child social ties to physically present others, including teacher; and above all, a family sense of hope for the future. Results support the general robustness of our semi-structured approach. Exploring the child’s present well-being in narrative relation to past and future, our assessment captured and gave meaning to the complexity of child exposure and behavior. At the same time, independent parent and child appraisals provided an additional richness to the retelling and evaluation of child experience. Particularly the apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment.

Magister Public Health - MPH / Antiretroviral therapy (ART) improves the quality of lives of people living with HIV/AIDS by suppressing HIV replication and improving the patient’s immunity. An improved immunity will help prevent patients from contracting opportunistic infections. Adherence to ART is vital to obtain good clinical outcome for patients. Defaulting ART leads to increase in viral load, decreased host immunity, development of HIV drug resistant strains, exposure to opportunistic infections and ultimately death. HIV positive patients who are on ART face many challenges in adhering to their medications, these challenges act as barriers to their adherence to treatment. This study explores the barriers that adult patients in a hospital in Eastern Cape of South Africa face while on treatment. These barriers include individual factors, socio-economic factors, health service factors, medical regimen factors.

This bachelor’s thesis is an effort to understand how black women in Sweden experience 'race' and racism in everyday life. The theoretical framework includes a postcolonial theory from Sara Ahmed, with the concept of 'race' as a key element. Additional to that, Judith Butler’s gender performativity theory contributes to a broader understanding of the informants’ situation. The material consisting of interviews with four young black women implies that everyday racism is present in Swedish society to that extent that 'race' is a major aspect of these women’s life. In everyday encounters with the white majority of the society, they often feel different, marginalized, objectified and exotified. Furthermore, the informants experience that their skin color and phenotypic markers are a magnet for white people’s fetish and fantasies, but also an obstacle to obtain legitimacy in interactions with them. To those reasons, the informants are considering migrating to a country where black people are forming a larger minority in society than it is the case in Sweden. That opens up the possibility to interact with more black people who have similar experiences of being exposed to everyday racism.

We are concerned with addressing the worst-case distributed source coding (DSC) problem in asymmetric and interactive communication scenarios and its application to data-gathering wireless sensor networks in enhancing their lifetime. First, we propose a unified canonical framework, obtained by considering different communication constraints and objectives, to address the variants of DSC problem. Second, as for the worst-case information-theoretic analysis, the notion of information entropy cannot be used, we propose information ambiguity, derive its various properties, and prove that it is a valid information measure. Third, for a few variants of our interest of DSC problem, we provide the communication protocols and prove their optimality. In a typical data-gathering sensor network, the base-station that wants to gather sensor data is often assumed to be much more resourceful with respect to energy, computation, and communication capabilities compared to sensor nodes. Therefore, we argue that in such networks, the base-station should bear the most of the burden of communication and computation in the network. Allowing the base-station and sensor nodes to interactively communicate with each other enables us to carry this out. Our definition of sensor network lifetime allows us to reduce the problem of maximizing the worst-case network lifetime to the problem of minimizing the number of bits communicated by the nodes in the worst-case, which is further reduced to the worst-case DSC problem in asymmetric and interactive communication scenarios, with the assumption that the base-station knows the support-set of sensor data. We demonstrate that the optimal solutions of the energy-oblivious DSC problem variants cannot be directly applied to the data-gathering sensor networks, as those may be inefficient in the energy-constrained sensor networks. We address a few energy-efficient variants of DSC problem and provide optimal communication protocols for the sensor networks, based on those variants. Finally, we combine distributed source coding with two other system level opportunities of channel coding and cooperative nature of the nodes to further enhance the lifetime of the sensor networks. We address various scenarios and demonstrate the dependence of the computational complexity of the network lifetime maximization problem on the complex interplay of above system-level opportunities.

Made available in DSpace on 2016-03-15T19:40:15Z (GMT). No. of bitstreams: 1 Adriana de Fatima Ribeiro.pdf: 1024780 bytes, checksum: d13e14bac4328d6e7a146f7ac32bb833 (MD5) Previous issue date: 2014-02-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Attention Deficit Disorder and Hyperactivity (ADHD) is characterized by a pattern of persistent inattention and/ or hyperactivity that it is more severe than normally observed in individuals with an equivalent level of development. It is a disorder in which the symptoms are varied and may interfere in different degrees according to the environment in which the individual is inserted. The identification of the signs of this disorder must take into consideration an assessment of the neuropsychological functions and of the behavioral indicators, preferably from multiple informants such as parents or guardians, teachers and the adolescent itself. This project aims to identify the main agreements relating to the behaviors of adolescents complaining of symptoms of ADHD observed by multiple informants, and correlate them to their performance on neuropsychological tests. It was used the inventories CBCL/6-18, TRF/6-18 and YSR/11-18 belonging to the Achenbach System of Empirically Based Assessment (ASEBA) and WISC-III, Wisconsin and the Concentrated Attention Test (AC). Twenty adolescents participated in this study aged between 11 and 16 years, divided into two groups, ten with diagnostic (ADHD group) and ten without ADHD (control group). All participants were part of the protocol of neuropsychological, behavioral and clinical assessment to identify signs of inattention and hyperactivity/ impulsivity of the Developmental Disorders Post-Graduation Program at Mackenzie Presbyterian University. The results for the concordance rates in the answers provided by multiple informants in the correlation between CBCL versus TRF, CBCL versus YSR and TRF versus YSR, through values of reference (Q corr), according to the ADM program version 7, were high for both groups. In the comparison of the scales of Internalizing, Externalizing and Total Problems in function of the groups and instruments, as much as for the scales of problems of attention and attention deficit disorder and hyperactivity, it was observed in the ADHD group that the parents reported more problems than the teachers and in the control group the teachers reported significantly greater number of problems. In the comparison of the scales of Sluggish Cognitive Tempo in function of the groups and instruments it was verified that the parents also perceive more alterations in the behavior in different instruments constituents of this scale than the teachers. Regarding to correlations of neuropsychological tests and behavioral indicators of problems of behavior in different instruments, no significant differences were observed. It is therefore concluded the need to compose procedures of assessment of people with the complaint of ADHD with different reporting instruments by multiple informants, besides other procedures such as direct observation or neuropsychological testing for the establishment of a cognitive profile as an aid in the process of assessment. / O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) se caracteriza por um padrão de desatenção e/ou hiperatividade persistente e mais grave do que o normalmente observado em indivíduos com nível equivalente de desenvolvimento. Trata-se de um transtorno cujos sintomas são variados e podem interferir em graus diversos conforme o ambiente no qual o indivíduo está inserido. A identificação dos sinais desse transtorno deve levar em consideração uma avaliação das funções neuropsicológicas e de indicadores comportamentais, preferencialmente a partir de múltiplos informantes como pais ou responsáveis, professores e o próprio adolescente. Este projeto tem como objetivo identificar as principais concordâncias referentes aos comportamentos dos adolescentes com queixa dos sintomas de TDAH, observados pelos múltiplos informantes e posteriormente correlacioná-los ao seu desempenho nos testes neuropsicológicos. Foram usados os inventários CBCL/6-18, TRF/6-18 e YSR/11-18 que pertencem ao Sistema de Avaliação Baseado em Evidência do Achenbach (ASEBA) e WISC-III, Wisconsin e Teste de Atenção Concentrada (AC). Participaram desse estudo 20 adolescentes com idades entre 11 a 16 anos, divididos em dois grupos, 10 com diagnóstico (grupo TDAH) e 10 sem TDAH (grupo controle).Todos os participantes fizeram parte do protocolo de avaliação neuropsicológica, comportamental e clínica para identificar sinais de desatenção e hiperatividade/impulsividade do Programa de Pós-Graduação em Distúrbios do Desenvolvimento, da Universidade Presbiteriana Mackenzie. Os resultados para os índices de concordância nas respostas fornecidas pelos múltiplos informantes na correlação entre CBCL versus TRF, CBCL versus YSR e TRF versus YSR, pelo meio dos valores de referência (Q corr), de acordo com o programa ADM versão 7, mostrou-se alta para os dois grupos. Na comparação das escalas de Problemas Internalizantes, Externalizantes e Totais em função dos grupos e instrumentos tanto quanto para as escalas de Problemas de atenção e Problemas de déficit de atenção e hiperatividade, observou-se no grupo TDAH que os pais relataram mais problemas que os professores e no grupo controle os professores é quem relataram um número significativamente maior de problemas. Na comparação das escalas de Ritmo Cognitivo Lento em função dos grupos e instrumentos, verificou-se que os pais também perceberam mais alterações nos comportamentos constituintes dessa escala que os professores. Com relação às correlações dos testes neuropsicológicos e dos indicadores comportamentais de problemas de comportamento nos diferentes instrumentos, não foram observadas diferenças significativas. Conclui-se, assim, a necessidade de compor procedimentos de avalição de pessoas com queixas de TDAH com diferentes instrumentos de relato por múltiplos informantes, além de outros procedimentos como observação direta ou testagem neuropsicológica para o estabelecimento de um perfil cognitivo para auxiliar no processo de avaliação.

Au Québec, il est connu que l’insécurité alimentaire (IA) touche davantage les immigrants récents que la population québécoise en général, mais il n’existe pas de données spécifiques pour les réfugiés. Les réfugiés, contrairement aux autres immigrants, ont fui leur pays par crainte d’être persécutés et n’ont pas nécessairement choisi d’immigrer au Québec ni même au Canada. Nous savons que la situation vécue par les réfugiés est particulièrement difficile étant donné la nature permanente et forcée de leur migration, mais les facteurs affectant leur sécurité alimentaire, surtout pour ce qui est des aspects culturels, sont peu étudiés. Depuis 2015, plus de 60 000 réfugiés syriens ayant fui la guerre ont été réinstallés au Canada, dont près de 14 000 au Québec, faisant de cette vague le plus important accueil de réfugiés au Canada considérant le nombre d’individus et le court délai. Le but de cette étude est de comprendre comment les facteurs socio-économiques, géographiques et culturels affectent l’insécurité alimentaire des ménages de réfugiés syriens au Québec. Plus spécifiquement, les objectifs sont d’étudier les impacts du lieu de réinstallation, de la catégorie d’immigration et du statut social, entre autres, sur la sécurité alimentaire des réfugiés au Québec, en plus d’explorer les perceptions des informateurs clés et des réfugiés quant aux barrières et aux facteurs contribuant à leur sécurité alimentaire. Pour ce faire, des entrevues semi-dirigées ont été conduites auprès d’informateurs clés (n=9) et une enquête transversale comprenant des questionnaires sociodémographiques et de sécurité alimentaire (Module d’enquête de sécurité alimentaire des ménages, MESAM) a été effectuée auprès de réfugiés syriens réinstallés au Québec (n=49), en plus d’entrevues semi-dirigées chez certains participants (n=34). Les participants ont été recrutés par la méthode boule de neige. Au niveau de la partie qualitative, des analyses de contenu inductives ont été effectuées de façon distincte chez les deux populations à l’étude. Les résultats de l’enquête transversale montrent que 52% des réfugiés syriens de notre échantillon vivent en situation d’IA, ce qui est comparable aux taux obtenus chez d’autres populations de réfugiés au Canada ainsi qu’aux États-Unis et en Australie. À travers les 2 entrevues semi-dirigées, on constate qu’il est important de s’intéresser aux périodes prémigratoire et migratoire en plus de la période postmigratoire puisque ces expériences sont relayées de manière soutenue par les participants. Une fois au Canada, bien que la précarité financière soit l’élément le plus étudié de la vulnérabilité des ménages à l’IA, la qualité des aliments, ce qui inclut le goût de ceux-ci, ainsi que l’accès géographique à des aliments du Moyen-Orient sont des éléments qui ressortent fréquemment des entrevues et apparaissent comme étant des déterminants importants. En conclusion, plusieurs pistes ont été abordées pour expliquer la vulnérabilité à l’IA des réfugiés syriens réinstallés au Québec et cela montre l’importance, pour la prévention de l’insécurité alimentaire chez cette population, de se préoccuper non seulement de l’aspect financier, mais aussi de plusieurs autres aspects, dont ceux culturels. / Food insecurity (FI) is known to affect recent immigrants more than the general population of Quebec, but there are no specific data for refugees. Refugees, unlike other immigrants, fled their country for fear of persecution and did not necessarily choose to immigrate to Quebec or even to Canada. We know that the situation experienced by refugees is particularly difficult given the permanent and forced nature of their migration, but the factors affecting their food security, especially regarding cultural aspects, are little known. Since 2015, more than 60,000 Syrian refugees who fled the war have been resettled in Canada, including almost 14,000 in Quebec, making this wave the most important influx of refugees to Canada, given the number of individuals and the short delay. The purpose of this study is to understand how socio-economic, geographic and cultural factors affect the food security status of Syrian refugee households in Quebec. More specifically, the objectives are to study the impacts of the place of resettlement, the immigration category and social status, among others, on the food security of refugees resettled in Quebec, in addition to exploring the perceptions of key informants and refugees as to the barriers and factors contributing to their food security. To achieve this, semi-structured interviews were conducted with key informants (n = 9) and a cross-sectional survey including socio-demographic and food security questionnaires (Household Food Security Survey Module, HFSSM) was conducted with Syrian refugees resettled in Quebec (n = 49), in addition to semi-structured interviews with some participants (n = 34). Participants were recruited by the snowball method. At the qualitative level, inductive content analyses were carried out separately for the two study populations. Results from the cross-sectional survey show that 52% of the Syrian refugees in our sample are food insecure, which is comparable to the numbers obtained in other refugee populations in Canada as well as in the United States and Australia. In the semi-structured interviews, we note that the pre migratory and migratory periods need to be considered in addition to the post migratory period, which is usually more studied. Once in Canada, although financial insecurity is the most studied element of household vulnerability to food 4 insecurity, the quality of food, which includes its taste, as well as geographic access to Middle-Eastern foods are items that frequently emerge from interviews and seem to be therefore appear to be important determinants. In conclusion, several ways have been explored to explain the vulnerability to food insecurity of Syrian refugees resettled in Quebec, and this shows the importance, for the food insecurity prevention in this population, of being concerned not only with the financial aspect, but also with several other aspects, including the cultural ones.

The aim of this study is to describe and explain how five women with a non-European background find the expression of everyday racism in today’s Swedish society, how everyday racism can affect their mental health and how they experience that the Swedish majority population handle and respond to everyday racism. The study is qualitative and was made with semi-structured interviews. The theories used are the theory of everyday racism, "we" and "the Others" and Goffman’s stigma. The results indicate that everyday racism is manifested through the population's ignorance and silence, comments, prejudices and stereotypes and is mainly expressed in arenas where there are many people at the same time. According to the women, the school and the labor market are the two most common arenas for the expression of everyday racism. They witness that the Swedish majority population rarely deal with the occurrence of everyday racism. Their mental health is negatively affected by everyday racism and can lower the individual's self-esteem. The study’s three theories that include everyday racism, “we” and “the Others” and stigma can be applied to the women's stories about their experiences and feelings about everyday racism in the Swedish society.

本研究以城鄉差異觀點，評估台灣鄉村型社區心理衛生中心之服務需求，具體目的有(1)分析台灣縣市及雲林縣鄉鎮與心理衛生有關之各項社會指標，以驗證社區心理衛生相關問題的城鄉差異性；(2)瞭解雲林縣及其鄉鎮關鍵訊息提供者對高度農業地區各項社區心理衛生問題嚴重程度、問題型式、地理分佈與相關在地服務資源之看法；(3)瞭解雲林縣高度農業人口鄉鎮社區居民對其村落各項相關心理衛生問題嚴重程度、問題型式、社區壓力源、因應方式與求助情形之看法；(4)由社區居民調查結果，抽取鄉村心理衛生相關問題之共同因素，並歸納諸項調查研究與指標分析結果，初步擬定出一「台灣鄉村心理衛生指標系統目錄」。 研究方法採用多方法評估策略。社會指標分析方面，共計分析台灣地區23個縣市24項及雲林縣20個鄉鎮市16項心理衛生相關問題，以比較不同農業人口分群其發生率或盛行率之差異。關鍵訊息提供者調查方面，使用自編問卷分別調查雲林縣30位與二崙與水林兩鄉69位政府單位、民間機構或專業個人等。社區居民調查方面，二崙與水林兩鄉共發出2049份問卷，回收1074份(52.4%)，有效問卷為967份(41村、97.6%)。統計方法有描述統計、集群分析、t考驗、單因子變異數分析、皮爾森積差相關分析、因素分析等。 研究主要發現如下：(1)高度農業人口地區之老年、低教育程度、喪偶、外籍配偶、身心障礙、意外事故死亡、醫事人員平均服務人口數等比例明顯較高，離婚、全般刑案、竊盜、強盜搶奪、暴力犯罪、強制性交等比例則較低。(2)台灣縣市心理衛生相關嚴重問題社會指標之地理分佈概況不明顯，但雲林縣心理衛生相關嚴重問題比例則以高度農業人口的二崙與麥寮兩鄉明顯較高。(3)雲林縣與二崙、水林兩鄉關鍵訊息提供者皆認為人口外移與老化、老人問題(獨居、貧窮、安養等)、電話詐騙等問題比例較高。雲林縣關鍵訊息提供者主觀覺得口湖、台西與四湖為最亟需心理衛生服務的農業鄉鎮。二崙鄉關鍵訊息提供者主觀覺得大庄、楊賢與港後為該鄉最亟需心理衛生服務的村落。水林鄉關鍵訊息提供者主觀覺得水北、塭底與大山為該鄉最亟需心理衛生服務的村落。(4)二崙與水林兩鄉社區居民認為電話詐騙、人口外移、農產經營影響、人口老化、家庭經濟壓力等問題比例較高，青少女母親(含未婚懷孕)、家庭人數眾多、親友與鄰居死亡頻傳、自殺、性侵害、精神疾病、家庭暴力、家庭虐待等比例較低。(5)二崙與水林兩鄉居民認為「社區孤立與無望感」來自人口老化、多孤獨貧窮老人、人口外流嚴重、生活無聊、缺乏休閒娛樂等因素較多，「犯罪被害擔憂與恐懼」來自竊盜、詐騙、嗑藥吸毒等問題較多，「社區憂鬱現象」來自個人與家庭經濟壓力、失業、農業損害或收益等因素較多。(6)二崙與水林兩鄉居民認為其感受社會壓力源以治安惡化為主，農業壓力源以農產收益與自然災害為主，社區壓力源以治安不佳、衛生環境不良、缺乏休閒娛樂等較多，學校壓力源以城鄉差距大、教育與學習資源不足、課業或升學壓力、教育政策多變等較多，家庭壓力源以經濟收入與子女教養為主，個人壓力源以經濟收入、身體健康、工作壓力等較多。(7)二崙與水林兩鄉居民指出習慣(或主要)抒解或因應壓力方法，以「找人聊天」居首，只有6.5%曾求助於親友之外的專業人員。(8)雲林縣現有7個單位或機構(衛生局─社區心理衛生中心與長期照護管理示範中心、社會局─各課、家庭教育中心、台大醫院雲林分院精神科、雲林區心理衛生諮詢服務中心與生命線協會)共提供37個鄉村心理衛生相關服務項目。 本研究由社區居民調查結果，共抽取出七個因素構面並分別命名為「一般社區心理衛生問題」、「農業社區心理衛生問題」、「環境污染」、「經濟壓力」、「居住生活風險」、「犯罪」與「家庭婚姻特性」，並歸納諸項調查研究與指標分析結果，初步擬定出一「台灣鄉村心理衛生指標系統目錄」(5大指標向度，14個指標項目)。 文末，研究者並根據研究結果與國內外相關文獻，分別提出鄉村居民心理健康政策、鄉村心理衛生指標系統、農業危機服務、老人心理衛生、社區孤立與無望感、犯罪被害恐懼、環境污染心理影響、鄉村性別與族群心理議題、鄉村學校之預防功能、鄉村心理衛生服務模式等10項建議。 / The purposes of this thesis were: (1) to analyze the differences of some social indicators related to mental health of Taiwan (23 cities/counties) and Yunlin county (20 townships). (2) to understand the opinions of the key informants about community mental health problems. (3) to survey community residents of agricultural areas about the subjective perceptions of their mental health. (4) to set up a summative index of Taiwan Rural Mental Health indicators System. This research used a multi-method strategy. Data collected in the spring of 2005 included 24 social indicators of 23 cities/counties in Taiwan, and 16 social indicators of 20 cities/township in Yunlin, and questionnaires of 99 key informants and 967 community members of Erh-lun and Shui-lin Township of Yunlin County. Major findings of this study were as follows: (1)Significant differences were found in the social indicators about the numbers of older population, the lower educational status, the widowed, the foreign spouse, and the disabled, the accidental injury-related deaths in agricultural counties. In contrast, urbanized areas had higher rates of the divorced, all criminal case, larceny, robbery and forceful taking, violent crime, rape, and the average number of people serviced by per medical personnel . (2)The geographic analysis in terms of the mental health status and service needs of residents revealed no significant differences among 23 cities/counties, but significant differences among 20 cities/township (Yunlin County), Erh-lun and Mailiao had much more problems. (3)Yunlin County’s key informants indicated that the areas of Kou-hu, Tai-si and Sih-hu have high needs for mental health services. Erh-lun’s key informants indicated that 3 villages have high needs for mental health services. Shui-lin’s key informants indicated that 3 villages have high needs for mental health services. (4)Most respondents of resident sample ranked the following mental health problems as serious: fraudulent telephone calls, out-migrant, farm crisis, being elderly, and family economic hardship. (5)Most respondents of resident sample employed “chatting with others” as stress-relieving or coping method. Besides “family and friends”, only about 6.5% of respondents reported that they sought help from mental health professionals or specialists. (6)To set up the initial rural mental health indicator systems of Taiwan: a summative index consists of 14 items and is divided into five dimensions The recommendations for rural mental health policies, indicator systems, program strategies and rural mental health service delivery issues were also suggested.