Prevalence estimates of child depression are substantial and morbidity leads to an increased risk of recurrence during adolescence and adulthood . Further , early-onset depression is associated with a number of negative outcomes including: poor physical health , social and interpersonal impairments , academic problems , substance abuse , future maladjustment , and suicidal behavior. In light of the prevalence , persistence, and negative outcomes associated with depression in children and adolescents , several treatments ranging from psychosocial to pharmacological interventions have been developed and evaluated. However, the overall efficacy of treatments remains equivocal because the majority of existing reviews of the child and adolescent depression treatment literature are narrative in nature, methodologically flawed , and/or present vague or conflicting conclusions. Although there are a number of good meta-analytic reviews that indicate that psychotherapy is effective with children and adolescents overall, comprehensive meta-analytic reviews focusing on the efficacy of psychological treatments specifically for depressed youth are nonexistent in the published literature. A comprehensive sample of studies on the psychosocial and pharmacological treatment of early-onset depression was located through an extensive literature search. Articles that met the inclusionary criteria were subsequently analyzed. The outcome data from 3 7 outcome studies were extracted and converted into effect sizes. Comparisons of main effects, potential interactions, and other specified variables were conducted. The overall findings of this meta-analysis indicate that several different psychosocial interventions for early-onset depression produce moderate to large treatment gains that are clinically meaningful for many afflicted youth. Further, it appears that psychosocial treatments are, in general, superior to pharmacological regimens in treating depressed children and adolescents. However, there is also recent evidence that selective serotonin reuptake inhibitors such as fluoxetine are efficacious, and they will likely play an increased role in the management of affective illness in youngsters. The clinical implications and limitations of these data are discussed and suggestions for future research are provided.

This study focuses on the ability, or inability, to replicate or compare the design of text-related research from the perspective of the independent or dependent variables employed in such designs. Prior text-related research has used variables that were not clearly described or defined, could not be directly compared from one study or time period to the next, or were applied inappropriately. Measurements of typography-related and substrate-related variables may have absolute or relative values, and confusion can arise if the variables are not clearly identified and defined. The study is an integrative review with mixed methods research design investigating 44 books and two websites (part 1), and 83 journal articles and four theses/dissertations (part 2). The integrative review shows that the sources investigated present neither essential information on typographic and substrate characteristics nor consistent definitions of legibility and readability in order to allow comparable replication from one study to another. Findings are displayed in Chapter 4. Discussion and the related details are presented in Chapter 5. / PHD / This study focuses on the ability, or inability, to replicate or compare the design of text-related research from the perspective of the independent or dependent variables employed in such designs. Previous text-related research has used variables that were not clearly described or defined, could not be directly compared from one study or time period to the next, or were applied inappropriately. Measurements of typography-related and substrate-related variables may have absolute or relative values, and confusion can arise if the variables are not clearly identified and defined. The study is an integrative review with both qualitative and quantitative research design analyzing 44 books and two websites (part 1); and 83 journal articles, one thesis, and three dissertations (part 2). The integrative review shows that the sources investigated do not present essential information on typographic and substrate characteristics, and consistent definitions of legibility and readability to permit comparable replication from one study to another. Findings are displayed in Chapter 4. Discussion and the related details are presented in Chapter 5.

Immigrants, refugees, asylum seekers, internally displaced persons, and stateless persons, collectively known as “persons of concern,” often have unmet mental health and wellness needs as a result of trauma. With a diverse variety of interventions and approaches, the use of music therapy has the potential to meet the needs of persons of concern. In the present study, the researcher conducted an integrative review to examine the use of music therapy with persons of concern. After conducting a hand-search of music therapy journals and an advanced keyword search through internet databases, the researcher found 17 studies that met inclusion criteria. There were ten studies in which participants were immigrants, six studies in which participants were refugees or asylum seekers, and one study in which participants were displaced persons. Refugees’ countries of origin were: Azerbaijan, Cambodia, Chile, Democratic Republic of Congo, Ethiopia, Iran, Liberia, North Korea, Rwanda, Sierra Leone, Sudan, and Vietnam. Immigrants’ countries of origin were: China, Haiti, India, Korea, Latin America, Malaysia, Mexico, Romania, Russia, and Vietnam. Interventions used in the studies were (in order of frequency) singing, songwriting, instrument play, improvisation, lyric analysis, music listening, music imagery, and music-based relaxation. The needs of persons of concern, music therapy interventions, the rigor and quality of music therapy research, and implications for future clinical practice are discussed.

nÃo hà / A Visita DomiciliÃria (VD), tecnologia utilizada na atenÃÃo à saÃde, nÃo à uma prÃtica recente e està presente em todo o contexto de cuidados de saÃde no mundo. A prÃtica baseada em evidÃncia apresenta-se como o referencial teÃrico-metodolÃgico adotado neste estudo, que selecionou a revisÃo integrativa como mÃtodo de pesquisa para utilizar, na atenÃÃo bÃsica e na assistÃncia de enfermagem, os resultados encontrados na prÃtica clÃnica da visita. O objetivo deste estudo à avaliar as produÃÃes cientÃficas disponÃveis na literatura nacional e internacional sobre VD em seus aspectos conceituais, metodolÃgicos, finalidade e situaÃÃes diante do processo saÃde e doenÃa.. Para a seleÃÃo dos artigos foram utilizadas cinco bases de dados, Cinahl, Pubmed, Lilacs, Cochrane e Scielo, e a amostra desta revisÃo constituiu-se de 13 artigos, referentes à VD na atenÃÃo bÃsica. Os resultados evidenciaram que conceituar VD ainda nÃo à uma preocupaÃÃo para aqueles que a estudam, o que se pode inferir que por ser uma tecnologia incorporada na rotina dos serviÃos da atenÃÃo bÃsica, torna-se desnecessÃrio, para alguns autores, a sua conceituaÃÃo. Os artigos avaliaram a tecnologia e sua eficÃcia na prestaÃÃo dos serviÃos de saÃde. Observa-se uma variedade de grupos populacionais que recebem visitas, tais como recÃm-nascidos, crianÃas, adolescentes, idosos e aqueles em situaÃÃes especÃficas: puÃrperas, grÃvidas e diabÃticos. Visualiza-se, porÃm, um predomÃnio das visitas realizadas aos idosos na faixa etÃria de 70 a 84 anos. Quanto aos profissionais que estÃo realizando a visita domiciliÃria, houve diversificaÃÃo, concentrando-se no enfermeiro, seguido pelo agente de saÃde, como executores dessa prÃtica. Diante do processo saÃde-doenÃa a VD està sendo realizada na prestaÃÃo de cuidados centrados ainda na doenÃa, o que satisfaz a prestaÃÃo de serviÃos momentaneamente, desvalorizando o efeito favorÃvel do ambiente familiar para aÃÃes de promoÃÃo à saÃde, prevenÃÃo ou diagnÃstico de doenÃa. Este estudo pretendeu fornecer subsÃdios para a melhoria da prÃtica da VD na atenÃÃo bÃsica, bem como estimular os enfermeiros no desenvolvimento de pesquisas que produzam evidÃncias fortes relativas à elaboraÃÃo de novas metodologias e teorizaÃÃo para a realizaÃÃo da VD a grupos especÃficos na atenÃÃo bÃsica. / Home Visit (HV) is a technology used in health care which, although it is not recent practice, is present in the entire world. Evidence-based practice is the theoretical and methodological framework adopted in this study which selected the integrative review as research method. Results found in the clinical practice of visits will be used in both primary care and nursing care. This study aims at assessing the scientific production about HV and its concept, methodology, purpose as well as situations available in both national and international literature. CINAL, PubMed, Lilacs, Scielo and Cochrane were the five databases used for the selection of articles. The sample of this review consisted of 13 articles concerning HV in primary care. Results showed that the ones who study HV are still not worried about conceptualizing it. Based on these findings it can be inferred that since HV is a technology incorporated into primary care service routine, it is unnecessary, for some authors, the conceptualization of HV. The articles have evaluated this technology and its effectiveness in health care services. It was observed a variety of population groups receiving visits, such as, infants, children, adolescents, the elderly and the ones in specific situations: women in recovery stage, pregnant women and diabetics. However, there is the predominance of visits to the elderly aged between 70 and 84. Concerning the professionals carrying out the visits, there was some variety as well, but nurses, followed by health workers, are the main conductors of such practice. Given the health-disease process, HV has been held in the care focusing on the disease, which fulfills the service temporarily, devaluing the favorable effect of family environment for actions of health promotion, prevention or diagnosis of diseases. This study aimed at providing information to improve the practice of HV in primary care as well as encouraging nurses to develop researches which have as result strong evidences related to the production of new methodologies for HV to specific groups in primary care.

Huntingtons sjukdom (HS) är en ovanligt förekommande sjukdom med komplexa sjukdomsförlopp. Att vara anhörigvårdare till en individ som drabbats av HS kan därför innebära en speciellt utmanande livssituation med många svårigheter liknande andra anhörigvårdare med sjukdomstillstånd som parkinsons sjukdom och alzheimers sjukdom. Det är därför viktigt för sjuksköterskan att att få en förståelse för vad anhörigvårdare går igenom vid vårdandet av en individ med HS för att kunna förstå och ge adekvat stöd. Syftet: med litteraturstudien är att beskriva anhörigas perspektiv av att vara vårdare för en anhörig som är drabbad av huntingtons sjukdom. Metod: för att analysera datan så användes en integrerad analysmetod enligt Whittemore & Knafl (2005). 12 inkluderades (2 kvantitativa, 10 kvalitativa) som samlades från två databaser. Resultat: analysen resulterade i fyra kategorier: Existera i rollen anhörigvårdare, hantera att vara anhörigvårdare, undvikande av sjukdomen, kämpa för att få stöd och förståelse. Resultatet påvisade bland annat hur anhörigvårdares liv förändras samt hur det kan se ut när anhörigvårdare hanterar den nya situationen. Det är viktigt för sjukvården att ha insikt för vad anhörigvårdare går igenom för att kunna ge ett adekvat stöd och bemötande.

Social presence has drawn great attention in the last three decades. A large number of studies attempted to prove that social presence exerted an effect on distance learning through including more interaction. This integrative review provided a comprehensive summary of current studies on social presence, identified problems in measuring social presence, and evaluated the effects of social presence on learning. Data were collected from 189 social presence studies in the area of distance education from 1976 to 2012. Data were analyzed qualitatively followed by a quantitative meta-analysis. This study revealed that social presence was still illusive and difficult to define. Due to its ambiguity, many doubts exist related to the measurement of social presence. The results of this study suggest future researchers should be cautious when advocating the importance of social presence in distance learning. / Ph. D.

Music therapy plays an integral role in end-of-life care, positively impacting emotional, social, physical, cognitive and spiritual health. The purpose of this integrative review was to collect and compile studies (N= 55) between 2000 and 2016 on the topic of music therapy interventions in end-of-life care, in order to provide both music therapy students and therapists access to the most recent and commonly used music therapy interventions and goals. Results of the integrative literature review indicate that the most common intervention for all age groups in end-of-life care is songwriting and composition, with the most common therapeutic goal being emotional expression and catharsis. Details of music therapy interventions, goals and song details are written in tables for readers to refer to as a guide. Further research is needed with each specific age group and setting, in order to provide refined results beyond what is revealed through this review. Additionally, evaluating therapeutic outcomes of the interventions and goals obtained through this integrative review is another step that can be taken for future research.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

The event of breaking bad news is a subject that no one present in the practical setting could choose to avoid. It is a subject that the practitioners comes in touch with during a daily basis. Traditionally the role as the breaker of bad news has been settled by the physician, but at the time being, disagreements occur in the clinical setting about who should break bad news to familys and patients. Aim: The aim of this study was to explore the nurses’ experiences of breaking bad news. What are the nurses’ role in the event of breaking bad news, and are there any barriers that can affect the way the bad news is given to the patients and family members? These were two questions of issue that were looked into. Method: The integrative review method based out of Whittemore and Knafl (2005) was used for this review. A systematic search resulted in twelve articles that were deemed fitting for the purpose of this study. Results: This integrative review resulted in five identified roles carried out by the nurse in the event of breaking bad news. Further on, nine factors were identified as being of significance in how the bad news were delivered by nurses and received by patients and the patient’s family members. Nurses expressed a desire and a wish for some kind of education or training in how to break bad news. Conclusion:  This article contributes with five roles experienced by nurses, along with nine different factors to have in mind when carrying out difficult news. The SPIKE model and Gibbs reflective model were discussed to have a great importance in the clinical setting.

Este estudo consiste de uma revisão integrativa da literatura nacional e internacional sobre a Assistência de Enfermagem Hospitalar ao Estomizado Intestinal, publicada no período de 2002 a 2006. Para realização deste estudo foram utilizadas as fases propostas por Ganong (1987): seleção das hipóteses ou questões para a revisão; estabelecimento de critérios para seleção da amostra; apresentação das características da pesquisa primária; analisar os dados; interpretação dos resultados e apresentação da revisão. Realizou-se a busca on-line dos trabalhos científicos no site Bireme e no sistema Dedalus (USP). Estabelecemos como critérios de inclusão de trabalhos: abordagem da assistência de enfermagem ao estomizado intestinal hospitalizado, realizados com seres humanos, publicados em inglês, espanhol e português e localizados na íntegra; e como critérios de exclusão trabalhos que abordavam outros tipos de estomas (não intestinais), os experimentais com animais, trabalhos direcionados à clientela infantil e trabalhos publicados em outros idiomas que não o inglês, o espanhol ou o português. Obteve-se uma amostra de 22 artigos para análise. Os temas abordados foram categorizados em Cuidados de Enfermagem com 14 (63,6%) trabalhos científicos; Autocuidado com 4 (18,2%), e Complicações com 4(18,2%). A análise dos temas de pesquisa possibilitou identificar a necessidade de realização de pesquisas futuras abordando aspectos específicos como intervenções de enfermagem e estratégias de ensino, em todas as etapas do atendimento hospitalar, assim como a organização e dinâmica de atendimento da equipe de saúde hospitalar. Quanto aos delineamentos das pesquisas, evidenciou-se a necessidade de investimentos nos aspectos metodológicos como uma condição para produção de conhecimento científico que consolida a prática clínica. / The purpose of this dissertation is to present a national and international review about the Hospital Nursing Care to the Intestinal Ostomized from the period of 2002 to 2006. In order to realize this study, the stages proposed by Ganong (1987) were applied: selection of hypothesis or questions to the review, establishment of criteria for the sample selection, presentation of the primary research characteristics, data analysis, interpretation of the results and the review presentation. A research of the scientific works was made on the Bireme website and in the Dedalus (USP) system. The criteria established for the inclusion of the works were: mention of the nursing care approaches to the hospitalized intestinal ostomized, experiments performed on humans\' beings, publication of the work in English, Spanish and Portuguese of which the verbatim could be found. And the criteria for exclusion of the works were: works which referred to other types of ostomates (nonintestinal), to the experiments on animals, works aimed to the juvenile public and last, those works published in other languages apart from English, Spanish or Portuguese. Twentytwo sample works were obtained for analysis. The topics were classified in: Nursing Care with 14 (63, 6%) scientific works; Self-care with 4 (18, 2%) scientific works; and Complications with 4 (18, 2%) scientific works. The analysis of the research topics revealed the necessity of future researches on specific aspects, such as nursing interventions and teaching strategies in the different stages of the hospitalar service as well as in the dynamism and organization of the staff\'s service. Concerning to the delineation of the research, it became evident that there is also the necessity of investment in methodological aspects as a main condition to the acquisition of scientific knowledge to consolidate the clinic practice.