Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-03-23T13:09:55Z No. of bitstreams: 2 Tese - Karla Cristina Naves de Carvalho - 2014.pdf: 10516858 bytes, checksum: a4c0d0f6ccce331c7442008dd2a98993 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-03-23T15:39:28Z (GMT) No. of bitstreams: 2 Tese - Karla Cristina Naves de Carvalho - 2014.pdf: 10516858 bytes, checksum: a4c0d0f6ccce331c7442008dd2a98993 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-23T15:39:28Z (GMT). No. of bitstreams: 2 Tese - Karla Cristina Naves de Carvalho - 2014.pdf: 10516858 bytes, checksum: a4c0d0f6ccce331c7442008dd2a98993 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-06-11 / Mental disorders are common in children and adolescents and cause negative impact on their family, school, and social life, often persisting throughout their lives if not detected and treated. This study aimed to assess the existence and estimate the prevalence of mental disorders in children and adolescents living in an isolated rural community of the Kalunga quilombola ethnic group (descendants of African runaway enslaved individuals), located in the northeastern part of the state of Goiás, Brazil. In this cross-sectional, descriptive, quantitative study a sample of 204 Kalunga children and adolescents was evaluated based on the responses of their parents/guardians and teachers to the mental health problems and behavior screening instruments Child Behavior Checklist for ages 6–18 (CBCL/6–18) and Teacher’s Report Form for ages 6–18 (TRF/6–18), respectively. The prevalence of mental health problems in Kalunga children and adolescents was 31.4% using the CBCL/6–18 and 21.1% using the TRF/6–18 (p < 0.01). Differences were found between genders, i.e., girls were more affected by internalizing problems than boys. The prevalence of mental health problems found in the present research was high compared to similar studies around the world. / Os transtornos mentais são bastante comuns em crianças e adolescentes e repercutem negativamente em sua vida familiar, escolar e social, geralmente persistindo por toda a vida desses indivíduos se não forem detectados e tratados. Este estudo teve como objetivos avaliar a existência e estimar a prevalência de transtornos mentais em crianças e adolescentes que vivem em uma comunidade rural isolada do grupo quilombola Kalunga (descendentes de escravos africanos fugitivos), localizada na parte nordeste do estado de Goiás, Brasil. Neste estudo transversal, descritivo e quantitativo, uma amostra de 204 crianças e adolescentes Kalungas foi avaliada com base nas respostas dos pais/responsáveis e professores aos instrumentos de rastreamento de problemas de saúde mental e comportamento denominados Child Behavior Checklist for ages 6–18 (CBCL/6–18) e Teacher’s Report Form for ages 6–18 (TRF/6–18), respectivamente. A prevalência de problemas de saúde mental em crianças e adolescentes Kalunga foi de 31,4% usando o CBCL/6–18 e de 21,1% usando o TRF/6–18 (p < 0,01). Foram encontradas diferenças entre os gêneros, pois as meninas apresentaram mais transtornos internalizantes do que os meninos. A prevalência de problemas de saúde mental encontrada na presente pesquisa foi elevada em comparação com estudos semelhantes em todo o mundo.

Introdução: A hipertensão arterial é de causa multifatorial, envolvendo hábitos de vida e estilos de vida inadequados como o consumo excessivo de bebida alcoólica que propiciam a elevação dos níveis pressóricos. Além disso, os sintomas relacionados ao transtorno mental comum também podem se associar ao estado de saúde, provocando mais danos ao sujeito com hipertensão arterial. Diante disso, o presente estudo teve como objetivo principal identificar associação entre a ocorrência de hipertensão arterial com o consumo de bebidas alcoólicas e a presença de transtorno mental comum em indígenas das aldeias Muras, residentes em região rural e urbana. Casuística e Métodos: Estudo transversal, de base populacional, com 455 indígenas Mura residentes no município de Autazes, Amazonas, Brasil. Foi aplicada a entrevista semi-estruturada com questões referentes aos dados socioeconômicos e educacionais, hábitos de vida, história clínica, histórico familiar, além dos questionários Alcohol Use Disorders Identification Test (AUDIT) e Self-Reporting Questonnaire (SRQ-20), para avaliar o consumo de álcool e presença de transtorno mental, respectivamente. A pressão arterial foi medida com aparelho automático de braço validado. Foram realizadas três medidas e usada a média das duas últimas medidas. Realizaram-se ainda, medida do peso, altura, circunferência do pescoço, circunferência da cintura, avaliação de bioimpedância; glicemia, triglicérides e colesterol com medida capilar. Na análise bivariada, foi testada a associação entre hipertensos, separadamente, com os dois desfechos: consumo de bebidas alcoólicas e a presença de transtorno mental comum explorando especialmente, os aspectos relacionados à hipertensão arterial. Foi ajustada a regressão de Poisson com variância robusta, para ambos os desfechos, com modelagem em stepwise backward automatizado, tendo como critério de entrada, p<0,20 e de significância no modelo final, p0,05. Utilizou-se como estimativa, as razões de prevalência e respectivos intervalos de confiança de 95%. Resultados: A maioria dos participantes era do sexo feminino (57,8%), com 42,10 (16,74) anos, vivendo com companheiro (74,7%) e cerca de quatro filhos por família, baixo nível de escolaridade Analfabeto/Fundamental incompleto (41,1%) e renda até dois salários mínimos (85,0%). A prevalência de hipertensão arterial foi de 26,6%, tabagismo (20,4%) e ser sedentário/irregularmente ativo (52,8%). O consumo de bebida alcoólica foi de 40,2%, sendo 13,4% classificados como alto risco para dependência alcoólica, e maior na área rural em comparação à urbana (57,3% vs 22,2%) p<0,001. Destacam-se os seguintes aspectos do uso abusivo de álcool: sentimento de culpa/remorso (45,9%); amnésia repentina por não lembrar o ocorrido na noite em que bebeu (31,7%); além de machucar-se ou sentir-se prejudicado por causa da bebida (29,6%); preocupação por parte de parentes, amigos ou profissionais de saúde, que aconselharam o entrevistado a interromper o consumo (51,5%). Não houve associação entre a presença e consumo de bebida alcoólica (23% e 26%). Os indígenas com diagnóstico de hipertensão referida, faziam menos uso de bebida alcoólica (14,2%vs 85,8%, p=0,009), porém nas ocasiões em que bebiam, ingeriam maior quantidade, comparado com os que não referiram hipertensão [55,3(72,2) vs 33,3(62,2) gramas de Etanol p=0,008]. A prevalência de transtorno mental comum foi de 45,7%, com destaque para os seguintes itens: referência de dores de cabeça frequentes (69,5%), sentir-se nervoso, tenso ou preocupado (66,2%), ter se sentido triste ultimamente (56,0%), dormir mal (55,2%) e ter sensações desagradáveis no estômago (42,9%). Além disso, destaca-se que 7,3% referiram ideia de acabar com a própria vida e 4,2% sentiram-se incapazes de desempenhar papel útil. Após análise ajustada a razão de prevalência após análise ajustada (Razão de prevalência, IC-95%), verificou-se associação positiva entre ingestão de bebida alcoólica e sexo masculino (2,72, IC-2,12-3,48), tabagismo (1,29, IC-1,06-1,56) e morar na zona rural (2,09, IC-1,61-2,72). Porém, a ação foi protetora para idade (0,98, IC-0,98-0,99), consumo de alimentos in natura (0,97, IC-0,95-0,99), e ausência de dislipidemias (0,75, IC-0,62-0,9). Entre os que apresentaram transtorno mental comum, a hipertensão arterial identificada esteve presente em 30,3% e o consumo de álcool uma vez ao mês em 22,1%. Após a análise ajustada (Razão de prevalência, IC-95%) verificou-se associação positiva entre o transtorno mental comum e a zona de moradia urbana (1.25, IC-1,02-1,54), não sabia que tinham antecedentes para diabetes (1.56, IC-1,24-1,96) e a ingestão de bebida alcoólica (1.01, IC-1,00-1,02). Porém, foi ação protetora não ter antecedentes pessoais de cardiopatia (0.59, IC-0,48-0,73). Conclusão: Observou-se que a presença de hipertensão arterial, consumo de bebida alcoólica e de transtorno mental comum foram elevados nos indígenas da etnia Mura. Esses achados podem ser decorrentes da aproximação e convivência entre indígenas e não indígenas favorecendo mudanças culturais, especialmente de hábitos e estilos de vida, com aumento do risco de doenças crônicas não transmissíveis. / Background: The arterial hypertension has a multifactorial disorder, including unappropriated habits and lifestyle as the excessive consumption of alcoholic beverages that may increase the blood pressure. Additionally, the symptoms related to the common mental disorder may be also associated with the health status, producing even more damages to the hypertensive subjects. Thus, this study aimed to identify the association of arterial hypertension occurrence with alcoholic beverages consumption and presence of common mental disorder in Indigenous from Mura villages, who live in rural and urban zones. Casuistic and Methods: Its a cross-sectional investigation, with demographic base, conducted with 455 Mura Indigenous from Autazes, Amazon, Brazil. Through a semi-structured interview, we gathered data about sociodemographic and educational profile, lifestyle, clinical records, family antecedents. In this occasion, the Alcohol Use Disorders Identification Test (AUDIT) and the Self-Reporting Questionnaire (SRQ-20) were applied to assess respectively the alcohol consumption and the presence of common mental disorder. The blood pressure was measured with an arm automatic device, validated for this goal, being three measures taken and, from the two last of them, a mean was obtained. Furthermore, we gathered weight, height, neck circumference, waist circumference, bioimpedance, glycemia, triglycerides and cholesterol, capillary measure for the last ones. In the bivariate analysis, we analyzed the association between hypertensive persons and the both outcomes- the alcohol consumption and the presence of common mental disorder, emphasizing the issues hypertension-related issues. The Poison regression, with robust variance, was adjusted for both outcomes, with a modelling in automatized stepwise backward, being p<0,20 the entrance criteria and p<0,05 the significance level for the final model. As estimative, we used the odds ratios and their respective confidence intervals of 95%. Results: Most were females (57,8%), with mean age of 42,2(16,74) years, living with a partner (74,7%), with about four children per family, poor educational level- Illiterate/Incomplete Basic (41,1%) and income of up two minimum wages (85,0%). 26,6% of the sample had hypertension, 20,4% were smokers and 52,8% were sedentary/irregularly active. Alcohol consumption was of 40,2%, with 13,4% showed high risk for alcohol addiction, and the consumption was higher in rural area in comparison with the urban one (57,3% vs 22,2%) p<0,001. We emphasize the following aspects of alcohol abuse: feeling of guilty and remorse (45,9%); abrupt amnesia for not remembering what happened in the night that they had drunk (31,7%); feeling hurt or impaired due to the drink consumption (29,6%); concerns from relatives, friends or healthcare professionals who advised the interviewed to interrupt the consumption (51,5%). There was not association between presence and alcoholic beverages consumption (23% and 26%). Indigenous diagnosed with referred arterial hypertension drank less alcoholic beverages (14,2%vs 85,8% p=0,009), but, when they drank, they had a larger amount than those with referred hypertension [55,3(72,2) vs 33,3(62,2) grams of Ethanol p=0,008]. The common mental disorder was identified in 45,7% of the individuals, being highlighted the following items: reporting of frequent headaches (69,5%), feeling nervous, anxious or worried (66,2%), feeling sad in the last days (56,0%), sleeping badly (55,2%) and having upset stomach (42,9%). Additionally, 7.3% reported the idea of committing suicide, and 4,2% felt themselves unable to play a useful role. We verified positive association between alcoholic beverage consumption and male gender (2.72, CI-2,12-3,48); smoking (1.29, CI-1.06-1.56); and living in rural area (2.09, CI-1.61-2.72). However, the action was protective for the age (0.98, CI-0,98-0,99), intake of natural foods (0.97, CI-0,95-0,99), and absence of dyslipidemias (0.75, CI-0,62-0,9). Among those diagnosed with common mental disorder, the arterial hypertension was found in 30,3% and the alcohol consumption once a month in 22,1%. We observed a positive association of common mental disorder and: living in the urban area (1.25, CI-1,02-1,54); unknowing the antecedents for diabetes (1.56, CI-1,24-1,96); and the alcohol consumption (1.01,CI-1,00-1,02). However, the absence of personal background of heart diseases was not protective (0.59, CI-0,48-0,73). Conclusion: We observed that the presence of arterial hypertension, alcoholic beverages consumption and common mental disorder were high in the Mura ethnicity. This finding may be explained for the approach and interaction among Indigenous and non-Indigenous, which favors cultural changes, especially in habits and lifestyle, increasing the risk of non-transferable chronic diseases.

Introdução: A reforma psiquiátrica e a desinstitucionalização objetivam um tratamento em saúde mental de base territorial. Alinhados a uma proposta de saúde baseada na descentralização, temos no Brasil o Sistema Único de Sáude (SUS) e a Estratégia Saúde da Família (ESF), que tem no Agente Comunitário de Saúde (ACS), o profissional mais próximo do território, casa e rotina destes usuários. Objetivo: identificar aspectos que influenciam o atendimento de pessoas com transtornos mentais pelos Agentes Comunitários de Saúde, a partir de suas experiências. Métodos: Foram realizadas 4 sessões de grupos focais com o total de 27 ACS de 4 Unidade Saúde da Família (USF) diferentes. Um roteiro semi estruturado norteou as discussões que tiveram seus áudios gravados, transcritos, categorizados por temas e analisados através da metodologia de análise de conteúdo, proposta por Bardin. Resultados: Foram identificadas sete categorias temáticas: articulação e construção da rede; acolhimento, acompanhamento e orientação dos pacientes; educação permanente; respaldo, reconhecimento e estrutura; medo; visão antimedicamentosa; e responsabilidade das famílias. Como aspectos que dificultam o atendimento dos casos de transtorno mental, identificamos um processo falho de cadastramento dos casos, o que facilita a desestabilização do quadro; casos em crise que colocam o ACS em situação de risco; falta de apoio matricial e trabalho em rede. Como aspectos que facilitam o atendimento dos casos de transtorno mental, apareceram a visita compartilhada e educação permanente. Como propostas de enfrentamento, no ambiente da ESF foram propostas: reuniões semanais de equipe; vagas para casos de demanda espontânea; e prontuário da casa, mas com cadastro de cada indivíduo. Também enquadramos aspectos referentes à integração com outros equipamentos de saúde, como aumentar o número de visitas compartilhadas e implantar o apoio matricial. E por fim, as propostas relacionadas à reunião de rede intersetorial, que iria ao encontro da educação permanente. Conclusão: Olhar para o contexto das ações, pensar em inserção social através da reabilitação psicossocial e promover tratamento territorial em saúde mental, continua sendo um desafio. Apesar do distanciamento que ainda existe entre as políticas públicas e as práticas no SUS, as propostas de enfrentamento podem colaborar para a efetivação de um SUS com maior qualidade. / Introduction: Psychiatric reform and deinstitutionalization aim at a spatial-based mental health treatment. In line with a health proposal based on decentralization, we have in Brazil the Sistema Único de Saude (SUS) and the Family Health Strategy (ESF), which has in the Community Health Agent (ACS) and routine of these users. Objective: to identify aspects that influence the care of people with mental disorders by the Community Health Agents, based on their experiences. Methods: Four focal group sessions were conducted with a total of 27 ACS from 4 different Family Health Units (FHU). A semi structured script guided the discussions that had their audios recorded, transcribed, categorized by themes and analyzed through the methodology of content analysis, proposed by Bardin. Results: Seven thematic categories were identified: articulation and network construction; patient care, follow-up and orientation; permanent education; support, recognition and structure; fear; anti-drug vision; and family responsibility. As aspects that make difficult the attendance of the cases of mental disorder, we identified a failed process of registration of the cases, which facilitates the destabilization of the picture; cases in crisis that put the ACS at risk; lack of matrix support and networking. As aspects that facilitate the attendance of the cases of mental disorder, appeared the shared visit and permanent education. As proposals for confrontation, in the environment of the ESF were proposed: weekly team meetings; vacancies for cases of spontaneous demand; and records of the house, but with the registration of each individual. We also integrate aspects related to integration with other health equipment, such as increasing the number of shared visits and implementing matrix support. And finally, the proposals related to the intersectoral network meeting, which would meet the permanent education. Conclusion: Looking at the context of actions, thinking about social insertion through psychosocial rehabilitation and promoting territorial treatment in mental health, remains a challenge. Despite the distance that still exists between public policies and practices in SUS, the proposals for coping can contribute to the implementation of a higher quality SUS.

The aim of this work is to enable a person to perceive and understand the specific features of behaviour of girls having Rett syndrome and to offer effective options for activities and effort in the process of education. The substance of the collection of suggestions and proposals for actions and activities as well as tools and equipment sorted according to equipment and objects used at a special needs education primary school. Practical advice, recommendations and suggestions are based on theoretical grounds and basis, particular examples or photo documentation. The work is founded on study cases of two girls with Rett syndrome where there are not only the girls' results and evaluations in the educational process described but also the personal stories of their families and different way of dealing with the tough life situations. The work results enable to discover a suitable attitude not only towards the girls but as well to their parents, siblings or classmates. KEYWORDS rare disease, Rett syndrome, mental disorder, communication, upbringing, education, general regularities, practical activities and actions, case study

(in English): The goal of this thesis is to analyze mainly advantages of iPad use during lectures at special primary schools. In addition, the thesis takes a look at disadvantages of this style of education. The theoretical part includes the first four chapters. The main information source for this part is expert literature. The first step presents the basic terms from the field of education. The next step presents important information about mental retardation and autistic spectrum disorders, including the specific aspects of education of children with such mental disorders. Following are the characteristics of the iPad devices and the history of the device and its manufacturer, the Apple company. This part also includes other information and communication technology used for educational purposes at regular as well as special schools. Last chapter of this part excerpts advantages and disadvantages of iPad listed in used expert literature. The practical part uses the method of qualitative analysis, in the form of semi-structured interview to find out which positive and negative effects can iPad usage have for both parties involved - children and teachers. The analysis builds on the foundation laid in the theoretical part, checking how the answeres of the interviewees correspond to the contemporary...

Depuis les années 1990, un nombre grandissant d’accusés sont déclarés non criminellement responsables pour cause de troubles mentaux au Canada (NCRTM). Si certains craignent que ce verdict représente une échappatoire à la punition et libère des individus dangereux en collectivité, d’autres s’interrogent à savoir si cette défense n’occasionnerait pas plus de contrôle qu’une peine dans le système pénal traditionnel. Certains questionnent également la capacité des Commissions d’examen à prendre des décisions qui s’écartent de la rationalité du système punitif. Objectif : Cette étude a pour but de comparer la supervision imposée aux accusés NCRTM à celle des accusés coupables et responsables (CR). Cette comparaison cherche à observer les particularités des trajectoires (durées de supervision et de détention et présence de détention dans le suivi) de ces populations, dans trois provinces canadiennes (Québec, Ontario, Colombie-Britannique) entre 2000 et 2008. Deux sources de données ont été utilisées, soit celle du National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada pour les accusés NCRTM et celle de l’Enquête sur les tribunaux de juridiction criminelle de Statistiques Canada pour ceux déclarés CR. Résultats : Les résultats des régressions de Cox et logistiques indiquent que les accusés NCRTM sont près de trois fois et quatre fois moins susceptibles d’être libérés rapidement de supervision et de détention et sont cinq fois plus susceptibles d’être détenus que les accusés CR. Des différences importantes sont présentes dans les pratiques des provinces, mais de manière significativement plus importante chez les accusés NCRTM. / Since the 1990’s, the number of individuals found not criminally responsible on account of mental disorder has increased in Canada. However, the NCRMD verdict remains controversial. While some fear that the verdict is a loophole and releases dangerous individuals in the community, others suggest that this defense could cause more control than a sentence in the criminal justice system. Some also question the ability of Review Boards to leave aside the punitive rationale in the decision-making process. Objective: This study examines the supervison practices imposed to NCRMD accused by comparing them with those applied to offenders found guilty and responsible (GR). This comparison aims to highlight the specificities these two populations’ trajectories (length of supervision, length of detention and presence of detention in follow-up), in three Canadian provinces (Quebec, Ontario and British Columbia) between 2000 and 2008. Two datasets were used. The first comprises individuals found NCRMD (n = 1794) and comes from the National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. The second comprises GR offenders (n = 320,919) and comes from Statistics Canada's Criminal Court Survey. Results: The Cox and logistic regressions results show that NCRMD individuals are almost three times and four times likely to be released from legal supervision and detention respectively compared to GR offenders, and are five times more likely to be detained during follow-up. Provincial differences were also observed, theses disparities being significantly greater among NCRMD individuals.

Introduction: The study ‘Mental healthcare provision for adults with intellectual disability and a mental disorder’ (MEMENTA) is a cross-sectional epidemiological study carried out in three different regions of Germany. Its main aim is to assess the prevalence of mental disorders in adults with intellectual disability (ID) as well as quality of mental healthcare for this population. Methods and analysis: The target population are persons aged between 18 and 65 years with a mild or moderate ID. The study population will be recruited through service providers. A representative sample is realised by two-stage sampling. First, institutions providing services for people with ID (sheltered workshops) are selected in a stratified cluster sampling, with strata being (1) types of service-providing non-governmental organisations and (2) sizes of their sheltered workshops. Then persons working in selected sheltered workshops are selected by simple random sampling. An estimated number of 600 adults with ID will be included. Information will be obtained from the group leaders in the sheltered workshops, informal carers or staff members in sheltered housing institutions and the person with ID. Besides the main outcome parameter of psychiatric symptomatology and problem behaviour, other outcome parameters such as needs for care, quality of life, caregiver burden, health services utilisation and costs for care are assessed using well-established standardised instruments. If a comorbid mental disorder is diagnosed, quality of mental healthcare will be assessed with open questions to all interview partners and, in addition, problem-focused interviews with a small subgroup. Analyses will be carried out using quantitative and qualitative methods. Ethics and dissemination: Approval of all three local ethics committees was obtained. Research findings will add much needed empirical information in order to improve services provided to this vulnerable group of patients.

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This thesis focuses on the intersection of social entrepreneurship and community gardening. In the middle of both of these initiative is man, his wellbeing and the wellbeing of the whole planet. Both of these social and civil initiatives can potentially become places of social integration of handicapped people. Therefore, this work is paying attention to concepts of social exclusion and inclusion, social entrepreneurship and community gardening. Moreover, it deals with the notions of employment and work of disabled people. This theses also contains a program evaluation of a community garden and a social enterprise, Kokoza,o.p.s, which employs people with a mental disease. Looking at the case of this enterprise we can see that the conjunction of a community garden and a social enterprise can be a fitting solution for all the stakeholders: for the establishing organization, for the employees as well as for the community using the garden. KEY WORDS Social entrepreneurship, Social Economy, Community garden, Urban gardening Social exclusion, Social inclusion, People with mental disorder, Evaluation, Evaluation research