Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-12-15T12:55:14Z No. of bitstreams: 1 jandersoncleitonaguiar_dissert.pdf: 1129840 bytes, checksum: 9af5fc29da524f1412a397e4e0ed185c (MD5) / Made available in DSpace on 2017-12-15T12:55:14Z (GMT). No. of bitstreams: 1 jandersoncleitonaguiar_dissert.pdf: 1129840 bytes, checksum: 9af5fc29da524f1412a397e4e0ed185c (MD5) Previous issue date: 2017-02-01 / Introduction: The creation of intestinal stomas is a well-defined therapy for intestinal diseases. Objective: To describe sociodemographic and clinical aspects of people with a temporary intestinal ostomy and to identify the factors contributing to the lack of bowel transit reconstruction in those with a temporary intestinal ostomy. Method: This is a quantitative, descriptive-analytical study, with 117 people with a provisional stoma. Data were collected from September to November 2015 through medical chart review and structured interviewing in a Type II Ostomy Care Service. An instrument was used to collect sociodemographic and clinical aspects and the reason for the lack of bowel transit reconstruction after provisional stoma up to the moment of data collection. Results: All enrolled individuals with a temporary stoma participated in the study. Of those, 64 (54.7%) were males, with a mean age of 62.9 years (minimum 23, maximum 95), married (70-59.8%), catholic (87-74.4%), with up to eight years of education (83 - 70.9%). The majority (62 - 52.9%) had a paid work, of which 60 (51.3%) had stopped working, and 52 (44.4%) did not return, with a retirement pension. Of the 57 (48.7%) who had not interrupted their work activities, 39 (33.3%) were retired, 16 (13.6%) were unpaid and two (1.7%) were self-employed without the right to a leave. The majority had a family income up to two minimum wages (79 - 67.5%). Neoplasia prevailed as a cause of stoma production (56 - 47.9%), followed by acute abdomen (37 - 31.6%). Colostomies were the most frequent ostomies (88 - 75.2%), the mean duration of stoma implantation was 5.3 years (median 3 years, minimum 6 months and maximum 25 years). The main reasons for delay in reconstructing bowel traffic were the persistence of the preoperative cause, the presence of comorbidities, postsurgical complications and difficulty accessing exams, appointments and surgery. Age influenced both the pathology (p<0,001)and the reason for delayed reconstruction(p<0,001).Conclusion: Age influences both the cause of stoma construction and the lack of bowel traffic reconstruction. The presence of comorbidities and the persistence of the preoperative cause also have a significant influence on the lack of bowel traffic reconstruction. Neoplasia was the main pathology requiring construction of a stoma, most surgical interventions being urgent. Preventive actions regarding intestinal neoplasias, structuring of network care, with involvement and integration of all services can contribute to the identification of obstacles, and search for solutions, improving the quality of life and reducing costs. / Introducción: La utilización de estomas intestinales es bien definida como medida terapeutica en enfermedades intestinales. Objetivo: Describir los aspectos sociodemográficos y clínicos de personas con estomas intestinales provisionales e identificar los factores que contribuyen para la no reconstrucción de tránsito. Metodología: Es un estudio descriptivo - analítico de carácter cuantitativo, con 117 personas con estoma provisional, la recogida de los datos ocurrió entre septiembre y noviembre de 2015, por medio de revisión de prontuario y entrevista estructurada, en un Servicio de Atención al Ostomizado Tipo II, se utilizó de un instrumento abordando aspectos sociodemográficos, clínicos y motivo de la no reconstrucción del estoma provisional hasta el momento de la recogida de datos. Resultados: 64 (54,7%) era del sexo masculino, con edad mediana de 62,9 años (mínima 23, máxima 95), casados (70 – 59,8%), católicos (87 – 74,4%), con hasta ocho años de estudio (83 – 70,9%). La mayoría (62 – 52,9 %) ejercía actividad laboral remunerada, destes 60 (51,3%) interrumpieron sus actividades laborales y 52 (44,4%) no volvieron, con alejamiento por plan de pensión. De los 57 (48,7%) que no interrumpieron las actividades laborales 39 (33,3%) eran jubilados, 16 (13,6%) ejercía actividad no remunerada y 02 (1,7%) eran trabajadores autónomos sin derechos a alejamiento con pensión. con renta familiar hasta 2 sueldos mínimos (79 – 67,5%). Neoplasia predominó como causa de confeccíon del estoma (56 – 47,9%), seguida pelo abdome agudo (37 – 31,6%). Las colostomías fueron más frecuentes (88 – 75,2%), la permanencia del estoma fue en media de 5,3 años (mediana 3 años, tiempo mínimo 6 meses y máximo 25 años). Los principales motivos de demora para reconstrucción de tránsito fueron la persistencia de la causa pre-quirúrgica, la presencia de comorbilidades, complicaciones pos-quirúrgicas y dificultad de acceso a exámenes, consultas y plaza de quirurgía. La edad influenció en la patología(p<0,001) y en el motivo de la demora en la reconstrucción(p<0,001). Conclusión: La edad influye en la causa de construcción del estoma y en su no reconstrucción. La presencia de comorbilidades y la persistencia de la causa pre- quirúrgica tambien influêncian significativamente para la no reconstrucción de tránsito. La neoplasía fue la patología que más desencadenó la necesidad de estoma, con la mayoría de las intervenciones quirúrgicas de urgencia. Acciones preventivas en cuanto a neoplasías intestinales, estructuración del cuidado en red, con involucramiento e integración de todos los servicios pueden contribuir para identificación de obstáculos y búsqueda de solucciones, mejorando la calidad de vida, reduciendo costes. / Introdução: A utilização de estomas intestinais é bem definida como medida terapêutica em doenças intestinais. Objetivo: Descrever os aspectos sociodemográficos e clínicos de pessoas com estomas intestinais provisórios e identificar os fatores que contribuem para a não reconstrução de trânsito em pessoas com estoma intestinal provisório. Metodologia: Trata-se de um estudo descritivo - analítico de caráter quantitativo, com 117 pessoas com estoma provisório, a coleta dos dados ocorreu no período entre setembro e novembro de 2015, por meio de análise de prontuário e entrevista estruturada, em um Serviço de Atenção ao Estomizado, utilizou-se de instrumento abordando aspectos sociodemográficos, clínicos e motivo da não reconstrução do estoma provisório até o momento da coleta dos dados. Resultados: Todas as pessoas com estoma provisório cadastradas participaram do estudo. Destes 64 (54,7%) eram do sexo masculino, com média de idade 62,9 anos (mínima 23, máxima 95), casados (70 – 59,8%), católicos (87 – 74.4%), com até oito anos de estudo (83 – 70,9%). A maioria (62 – 52,9 %) exercia atividade laboral remunerada, destes 60 (51,3%) interromperam suas atividades laborais, e 52 (44,4%) não retornaram, com afastamento pela previdência. Dos 57 (48,7%) que não interromperam as atividades laborais 39 (33,3%) eram aposentados, 16 (13,6%) exerciam atividade não remunerada e 02 (1,7%) eram autônomos sem direito a afastamento. e renda familiar até dois salários mínimos (79 – 67,5%). A neoplasia predominou como causa de confecção do estoma (56 – 47,9%), seguida pelo abdome agudo (37 – 31,6%). As colostomias foram mais frequentes (88 – 75,2%), a permanência do estoma foi em média de 5,3 anos (mediana 3 anos, tempo mínimo 6 meses e máximo 25 anos).Os principais motivos de demora para reconstrução de trânsito foram a persistência da causa pré cirúrgica, a presença de comorbidades, complicações pós cirúrgicas e dificuldade de acesso a exames, consultas e vaga de cirurgia. A idade exerceu influência tanto na patologia(p<0,001),como no motivo da demora na reconstrução(p<0,001). Conclusão: A idade influênciou tanto na causa de construção do estoma como na reconstrução. A presença de comorbidades e a persistência da causa pré cirúrgica também exerceram influência significativa para a não reconstrução de trânsito. A neoplasia foi à patologia que mais desencadeou a necessidade de estoma, com a maioria das intervenções cirúrgicas de urgência. Ações preventivas quanto a neoplasias intestinais, estruturação do cuidado em rede, com envolvimento e integração de todos os serviços podem contribuir para identificação de obstáculos, e busca de soluções, melhorando a qualidade de vida, reduzindo custos.

Considerando que estamos vivendo em São Paulo e em todos os Estados do Brasil, um brutal estado de insegurança pública, vemos o crime de seqüestro (tanto na sua modalidade clássica de manter a vítima em cativeiro por período de tempo variável até o pagamento de resgate, quanto à modalidade conhecida como \"seqüestro-relâmpago\", no qual a vítima fica em poder dos criminosos por poucas horas, enquanto eles agem sobre caixas eletrônicos de bancos e as ameaçam de várias maneiras) atingir um grande número de pessoas com conseqüências graves para o desempenho de suas funções existenciais pós-seqüestro. Este trabalho mostra, através de Entrevistas Estruturadas e Escalas de Avaliação, que o grau de magnitude do Transtorno de Estresse Pós-Traumático que acomete vítimas de ambos os tipos de seqüestro atinge picos suficientemente elevados e que devem receber maior atenção tanto em nível de Saúde Pública quanto Segurança Pública. / Considering that we are living in Sao Paulo and all others States of Brazil, a brutal state of public unsafeness, we see the kidnapping crime (not only in its classical modality of keeping the victim in captivity for a variable period of time until the rescue payment, but also in the modality known as \"lightning-kidnapping\", in which the victim remains under the criminal´ s arrest for few hours, while they act on cash machines and threaten the victims) reaching a great number of people with serious consequences for the performance of their post-sequestration existential functions. This work shows that the magnitude level of the Post-Traumatic Stress Disorder that attacks kidnapping victims reaches sufficiently high peaks, that must receive more attention, not only in terms of Public Health but also Public Security.

Unemployment is a major issue in South Africa and if not properly addressed, will have devastating effects in the near future. The challenges facing the South African government is poverty, inequality and unemployment. When carefully examined, all these problems are interrelated. Studies have shown the causes of structural unemployment in South Africa, because despite the high statistical figures, unemployment is highly concentrated on specific racial groups and age cohorts. The purpose of this study was to investigate the experiences of youth unemployment in two selected townships. The motivation for the selection of the research participants for this research was because persons in the same age cohorts are likely to share many characteristics that might influence their labour market experiences and outcomes. A qualitative study was undertaken in two locations in 2016, using two research instruments namely; the In-Depth Interviews (IDI’s) and the Focus Group Discussion (FGD’s). In both locations selected for the study, four FGD’s were conducted with both males and females, each with 8 participants and the IDI’s had 10 per site, 5 for males and 5 for females respectively. The data was analysed using the Nvivo computer software. The findings revealed that where the participants have solid family support, the experience of living with unemployment is severe because their potential to contribute in society goes untapped. However, the experience of living with unemployment is cushioned by the support they receive in their families. However, in households where the participants lack family support life becomes difficult for the unemployed. On the other note, the family support also makes the research respondents not to be serious when looking for employment opportunities. It renders them redundant. Another finding concerns the social grant provided by government. Participants in households that receive social grants are shielded from abject poverty. Many participants reported that it is not easy to get into the EPWP while others are not interested in it at all. Finally, none of the research participants have participated in the EPWP programs before, with some being aware of their existence while others are not. The research has shown that young people will not take up any job opportunity that is available for them. / Sociology / M.A. (Sociology)

The family is a miniature society, where a child is afforded the opportunity to develop, form relationships and create his/her own identity. The child's development does not always take place without certain challenges. Different internal and external factors influence a child's development. Certain external factors, for instance a child with disabilities, can have a negative or positive influence on the child. The aim of this study is to determine the influence of the child with Cerebral Palsy on the social and emotional development of siblings. The research will be done using the idiographic method. The results show that the child with Cerebral Palsy does have an influence on the emotional and social development of siblings. / Educational Studies / M.Ed. (Inclusive Education)

As a result of the Zimbabwean socio-economic and political crisis many have joined the Diaspora leaving their children behind in the care of others. Qualitative research in the form of in-depth semi-structured interviews carried out with seventeen adolescent Zimbabwean Diaspora orphans evidenced a number of emerging themes that illuminate how these adolescents view their situation, such as symptomology of depression, feelings of abandonment and rejection, conflicting feelings, lack of social support, the importance of communication, role changes and additions, materialism, challenges presented by relationships with caregivers, and vulnerability to sexual abuse and molestation. Most of the themes do not appear to be country specific but are shared by adolescent Diaspora orphans world-wide. Defence and coping mechanisms employed by these adolescents to cope with parental absence were also identified. Recommendations aimed at optimising their integration in society and suggestions for further research in this field conclude this study. / Psychology / M.A. (Psychology)

Made available in DSpace on 2014-08-20T13:46:35Z (GMT). No. of bitstreams: 1 Tiago_Neuenfeld_Munhoz_Dissertacao.pdf: 1064238 bytes, checksum: e083c184510e3f2cd9e106ae5e97daef (MD5) Previous issue date: 2012-07-06 / During the last decades, the mental health field has been going through important theoretical, technical and legal modifications, impacting on healthcare users. Thus, this study intends to understand and analyze, through the Oral History methodology, how these alterations affect the routines of two users of Centers of Psychosocial Care (CAPS). It also has the objective of understanding life experiences related to psychological distress. Life stories were analyzed in accordance with structural categories, based on their narratives. The psychological or physical abuses these women underwent at some point in the lives are important factors in relation to their present state of mental health. These oral histories reveal similar problems to those found in other studies with mental health healthcare users in Brazil. According to the narratives, the CAPS s play an important therapeutic role, however, public policies in the sector still don t make up to deficits related to low educational and socioeconomic levels of many users, as well as to their inclusion in the labor market. Further studies addressing gender and mental health could provide important information for the comprehension of these gaps / Durante as últimas décadas, o campo da saúde mental passa por modificações teóricas, técnicas e legislativas importantes, com impacto sobre os usuários do sistema de saúde. Dessa forma, este trabalho procura entender e analisar, através da metodologia da história oral de vida, como estas transformações afetam o cotidiano de duas usuárias dos Centros de Atenção Psicossocial (CAPS). Também objetiva compreender as experiências de vida relacionadas com o sofrimento psíquico. Foram analisadas as histórias de vida de acordo com categorias estruturais, segundo as suas narrativas. As violências psicológica ou física sofrida em algum momento da vida são importantes fatores relacionados com a atual situação de saúde mental destas mulheres. Estas histórias de vida refletem problemáticas similares a aquelas encontradas em outros estudos com usuários dos serviços de saúde mental no Brasil. Segundo as narrativas, os CAPS exercem um papel terapêutico importante, contudo, as políticas públicas do setor ainda não suprem carências em relação ao baixo nível educacional e socioeconômico de muitos usuários, bem como a inclusão no mercado de trabalho. Novos estudos abordando as relações de gênero e saúde mental podem fornecer informações importantes para compreensão destas lacunas.

Abstract The prevalence of memory disorders is increasing worldwide due to an aging population. The condition affects not only those with the disorder, but also their families and the wider social network. Establishing services that meet the needs of patients and their families is a topical issue and requires knowledge produced from service user viewpoints. However there remains limited knowledge of how families manage their lives when there is a memory disorder. This study produces a substantive theory that describes the processes of managing life after disclosure of a progressive memory disorder from the viewpoint of individuals with that diagnosis and their family caregivers. A qualitative longitudinal research design informed by grounded theory methodology was undertaken. Research data were gathered for 2006–2009 using in-depth interviews (n=40) from those with the memory disorder (n=8) and their family caregivers (n=8). The data were analyzed using a constant comparative analysis. A core category ‘Accepting memory disorder as part of family life’ with related categories and subcategories was formulated from the gathered data. Family illness trajectory begins when patients or close relatives recognize the symptoms. Diagnosis of memory disorder is a turning point in that trajectory. It changes the course of lives for both individuals and their whole family and leads families to seek a new equilibrium. Altering life challenges people with the diagnosis and their family caregivers to restructure their roles and identities. Adjusting to altering self and adapting to the new role of caregiver are intertwined processes. Families strive to manage these changes by acknowledging available qualities and resources, seeking meaningful social support and living for today. Managing life with a memory disorder produces mutual processes in families that contain both positive and negative factors. Accepting memory disorder as part of family life represents a hope-fostering adjustment. The findings confirm and supplement the knowledge base in nursing science of family experiences and the means families use for managing life after diagnosis of a progressive memory disorder. These findings can be well utilized by professionals working with patients and their families who are living with newly diagnosed memory disorder while also advancing nursing education. / Tiivistelmä Väestön ikääntymisen vuoksi muistisairauksien esiintyvyys on kasvussa koko maailmassa. Etenevä muistisairaus vaikuttaa sekä sairastuneiden että perheiden elämään, ja heidän tarpeisiinsa vastaavien palvelujen kehittäminen on ajankohtaista. Perheiden selviytymistä koskevaa tutkimustietoa palvelujen kehittämiseksi on kuitenkin rajallisesti. Tutkimuksen tarkoituksena oli kehittää aineistolähtöinen teoria, joka kuvaa muistisairaiden ja omaishoitajien elämänhallinnan prosesseja muistisairausdiagnoosin varmistumisen jälkeen. Tutkimus oli laadullinen pitkittäistutkimus, jossa aineisto kerättiin vuosina 2006–2009 syvähaastattelemalla (n=40) sekä sairastuneita (n=8) että heidän omaisiaan (n=8). Aineisto analysoitiin grounded theory -metodologian jatkuvan vertailun analyysimenetelmällä. Tutkimuksessa tuotetun aineistolähtöisen teorian ydinkategoriaksi muodostui ’Muistisairauden hyväksyminen osaksi perheen elämää’. Ydinkategoriaan olivat yhteydessä pää- ja alakategoriat, jotka kuvasivat vastavuoroisia elämänhallinnan prosesseja perheessä. Perheiden kehityskulku muistisairauden kanssa käynnistyi ennen diagnoosin varmistumista, kun sairastunut itse tai hänen läheisensä kiinnittivät huomiota oireisiin. Muistisairausdiagnoosi oli käännekohta, joka muutti perheiden elämänkulun suuntaa ja johti etsimään uutta tasapainoa elämässä. Muuttuva elämäntilanne haastoi sairastuneet ja heidän omaisensa rakentamaan uudelleen käsitystä itsestään ja sosiaalisista rooleistaan. Sairastuneiden kokemuksena tämä tarkoitti sopeutumista muuttuvaan itseen ja omaisten kokemuksena mukautumista uuteen omaishoitajan rooliin. Nämä kehityshaasteet kytkeytyivät toisiinsa. Perheet pyrkivät selviytymään muuttuvassa elämäntilanteessaan huomioimalla käytettävissä olevat voimavarat, hyödyntämällä merkityksellistä sosiaalista tukea ja tavoittelemalla elämää tässä ja nyt. Muistisairaiden ja omaishoitajien vastavuoroiset elämänhallinnan prosessit sisälsivät sekä myönteisiä että kielteisiä tekijöitä. Muistisairauden hyväksyminen osaksi perheen elämää merkitsi toivoa vahvistavaa sopeutumista. Tutkimustulokset täydentävät hoitotieteen tietoperustaa perheiden kokemuksista ja elämänhallinnan keinoista muistisairausdiagnoosin varmistumisen jälkeen. Tutkimustuloksia voidaan hyödyntää sekä käytännön hoitotyössä tuettaessa muistisairaita ja heidän perheitään diagnoosin jälkeen että hoitotyön koulutuksessa.

M.A. (Psychology) / Please refer to full text to view abstract

D.Cur. / The purpose of this study was to generate an interpersonal communication skills approach for adolescents. Through this approach adolescents will be given an opportunity to formulate new stories on their interpersonal communication skills in the form of stories about constructive communication skills. This will enable adolescents to maintain their important interpersonal relationships. Adolescence is a period characterised by the occurance of many adjustments and changes. Continually higher demands are made from adolescents in terms of career choices, the choice of friends, release from parents and parental homes, development of autonomy and the successful completion of the adolescent developmental phase. The climate of reconciliation in the post apartheid South Africa pressurise adolescents even more. Sources of support is consequently of great importance to adolescents during this phase of change. Sources of support for example the families of adolescents, members of the community and especially the peer group plays a significant role. interpersonal relationships with the aforementioned groups of persons and individuals must be maintained in order to ensure continued support during and in order to successfully complete the developmental phase of adolesence. This requires constructive interpersonal communication skills. It is however evident that adolescents do not posess all of the required constructive communication skills which would enable them to maintain these important interpersonal relationships. The abovementioned lead to the following questions which were addressed in phase one, -two and -three of this research: Over which interpersonal communication skills do adolescents posess? Which specific interpersonal communication skills needs to be addressed in the interpersonal communication skills approach in order to maximise adolescent's ability to communicate interpersonally with a view to improve, maintain and restore their mental health? Which guidelines can be given for the operationalising of the interpersonal communication skills approach for adolescents? A qualitative, investigative, descriptive and contextual design was followed. The research was conducted in three phases with a pre-phase which preceeded phase one of the research. A topical scenario to be utilised in the course of the research was established in the pre-phase of the research through group interviews with adolescents. In phase one of the research role play was conducted and written dialogue was obtained based on the scenarios identified in the pre-phase. An interpersonal communication skills approach was generated in phase two of the research. In phase three of the research certain guidelines were described for the operationalising of the approach. The researcher concluded from the results obtained in phase one of the research that the interpersonal communication of adolescents included in this research were characterised by an entanglement within four repetative circular interpersonalcommunication patterns. These four repetative circular interpersonal communication patterns are initiated and maintained by certain feelings, thoughts and behaviour. The four repetative circular interpersonal communication patterns are the following: Recurrent circular interpersonal patterns of defocusing and externalizing the topic under discussion; Recurrent circular interpersonal patterns of struggling for power between the adolescent and the other conversationist; Recurrent circular interpersonal patterns of not listening to the other conversationist; and Recurrent circular interpersonal patterns of not focusing on feelings while conversating.

M.A. / Little is known about how police officers who are exposed to daily traumatic stressors in their working environment cope with these experiences, or how the coping strategies that they utilize mediate the levels of psychological distress and possible development of Posttraumatic Stress Disorder (PTSD). Focusing on 109 Brixton Flying Squad members of the South African Police Service, this exploratory study assessed the coping strategies and levels of psychological distress reported by these officers following traumatic exposure. The study examined the relative frequency of using eight ways of coping (as assessed by the Ways of Coping Checklist-Revised) with traumatic policing experiences and the association between the use of those coping strategies and subsequent development of symptomatologies and PTSD. Consistent with previous studies with combat veterans, police officers predominantly used emotion-focused coping strategies to cope with traumatic stressors. Nearly a third of the police officers met psychometric criteria for a positive screening diagnosis for PTSD. Results indicated that PTSD positive subjects tended to use relatively more escape –avoidance in coping with trauma, as opposed to PTSD negative subjects. Significantly higher levels of psychological distress, especially depression were also found for PTSD positive subjects, and the use of emotion-focused strategies was positively related to greater PTSD symptom severity and elevated levels of psychological distress. Findings demonstrated the mediating role of coping strategies that have the potential to become either adaptive or maladaptive to occupational and psychological functioning. These preliminary findings are discussed in-relation to methodologic and clinical issues.