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The M.A. thesis "The Prevention of hazardous Behaviour" researches the cooperation and interconnectedness of three professional groups and conducts a describes their experience and opinions in the field of child and youth risk-behaviour. The three (target) respondent groups are: primary school prevention methodists, OSPOD social workers and a group of professional lecturers of primary prevention of risk behaviour. The theoretical part introduces definitions and theoretical concepts of hazardous behaviour and types methods of their prevention. In its conclusion, the theoretical part summarizes of selected primary laws. The practical part of the thesis presents a summary and an analysis of data gathered through a survey among the respondent groups.

Bakgrund: Hjärt- och kärlsjukdomar är ett globalt växande folkhälsoproblem som dessutom är en ekonomisk last på samhället. Forskning har uppskattat att majoriteten av dödsfall kommer att bero på hjärt- och kärlsjukdomar vid år 2030. Några riskfaktorer för att utveckla hjärt- och kärlsjukdom är ett högt BMI, rökning och låg fysisk aktivitet. Forskning har visat att primärpreventivt arbete med livsstilsförändringar är något som minskar riskfaktorerna och är kostnadseffektivt för samhället. Syftet: var att beskriva vilka primärpreventiva metoder sjuksköterskan använder för att uppmuntra till livsstilsförändringar hos patienter med risk för  hjärt- och kärlsjukdom samt att beskriva hur dessa primärpreventiva metoder påverkar riskfaktorerna. Syftet var också att beskriva urvalsgrupperna i de valda vetenskapliga artiklarna. Metod: För att besvara syftet och frågeställningarna hade denna litteraturstudie en beskrivande design där tolv vetenskapliga artiklar har analyserats. Databaserna PubMed och CINAHL användes vid sökningen för att finna de vetenskapliga artiklarna. Resultat: Sjuksköterskor använde olika metoder för att uppmuntra till livsstilsförändring hos hjärt- och kärlsjuka patienter. Dessa metoder innebar att sjuksköterskan antingen fungerar som en informationsgivare eller samarbetspartner gentemot patienten. Effekten av metoderna varierade och enligt vissa studier gav de ej gav någon effekt. Slutsats: Utifrån litteraturstudiens resultatet går det ej med säkerhet att säga vilka metoder som är mest effektiva. Sammanfattningsvis kan sjuksköterskan i sitt kliniska arbete ta hänsyn till båda förhållningssätt i mötet med patienterna och anpassa metoden utifrån ett individuellt perspektiv. / Background: Coronary heart disease is a growing health issue from a global perspective. Research has estimated that coronary heart disease will stand for the majority of deaths by the year 2030.  Risk factors include a high BMI, smoking and low level physical activity. Research has also shown that lifestyle change can decrease the risk factors and is cost-effective for the society. Aim: The aim with the litterature study was to describe which primary prevention methods nurses use to encourage lifestyle change for patients at  risk of developing coronary heart disease, and to describe how these methods affect the risk factors. The purpose was also to describe the sample groups in the chosen articles. Method: To answer the study questions, the literature study had a descriptive design where twelve scientific articles were analysed and categorized. The databases PubMed and CINAHL were used to find the scientific articles. Results: Nurses use an array of different methods to encourage life style change in patients with coronary heart disease. These methods include the nurse either acting as a information giver or a collaboration partner towards the patient. The effect of these methods varied and some of the studies didn’t show any effect whatsoever. Conclusion: On the basis of the literature study, the methods nurses use and their effectiveness are inconclusive. In conclusion, the nurse can consider all of the methods in the work place, and decide which method is adequate based on the individual variations of the patients.

Cette thèse a pour objectif d’apporter des résultats pour la connaissance relative au processus d’intervention dans l’organisation en matière de prévention de la santé psychique au travail. Après avoir mis en lien les processus de construction de la santé au travail et pris connaissance des facteurs qui soutiennent la réussite des interventions de prévention primaire, l’analyse permet de questionner la correspondance possible entre ces deux champs de recherche. L’analyse de sept cas d’intervention apporte des éléments pour saisir les conditions qui favorisent la décision de changement de l’organisation. Le processus d’intervention est conçu comme un moyen de produire une dynamique de maturation organisationnelle sur la question de la santé psychique au travail et susceptible d’améliorer la coopération entre acteurs. Enfin, en interrogeant l’interaction entre l’individu et l’organisation, cette thèse analyse les logiques de recours à des formes d’aides pour des salariés en difficulté. Ce détour permet d’interroger les causes du non-recours à des dispositifs organisationnels de prévention et à identifier à quelles conditions ils peuvent être efficaces et utilisés. / We aim to contribute to the study of intervention process in the organization for mental health prevention in the workplace. We begin by linking the different health-building processes in the workplace. We then take into account the factors that support the success of primary prevention interventions. Our analysis then allows for exploration of possible relationship between these two research fields. Our examination of seven cases studies of prevention interventions brings elements of understanding to the conditions that best favour the decision to change an organization. The intervention process is designed as a way to produce a dynamic organizational maturation on the issue of mental health in the workplace, which is likely to improve cooperation between actors. Finally, by questioning interactions between the individual and the organization, this dissertation analyzes the logic behind the non-take-up strategies used by troubled employees. It allows us to examine why arrangements within an organization are not used and to identify under what conditions they can be efficient and well used.

Trata-se de um estudo de revisão integrativa da literatura nacional e internacional, no período de 2000 a 2005, que teve como objetivo evidenciar a contribuição da atividade física na prevenção primária da doença arterial coronariana (DAC). Os artigos foram capturados nas bases de dados PubMed (incluindo MEDLINE) e LILACS, utilizando-se descritores relacionados à intervenção, ao enfoque, à morbidade e aos fatores de risco. Vinte e dois artigos atenderam aos critérios de inclusão deste trabalho e constituíram a amostra. Para a organização dos dados, foi utilizado um instrumento que registrou as informações essenciais dos artigos: título; fonte (dados da revista); número da busca e do resumo; autor(es); país; ano; local do estudo; objetivos; sujeitos e período da pesquisa; método e o que foi analisado; tipo de intervenção e responsável pela mesma; resultados efetivos; conclusões do autor; limitações citadas pelo autor e comentários sobre o estudo. Os resultados foram apresentados em categorias de acordo com o desenho metodológico do artigo, com os objetivos, com a forma de descrição e mensuração da atividade física e com o conteúdo das publicações. Foram notadas semelhanças nestes aspectos entre os artigos de mesmo desenho metodológico. Doze artigos foram categorizados como estudos prospectivos, sete como de corte transversal e três foram os estudos retrospectivos. A maioria dos estudos utilizou questionários do tipo recordatório para avaliar o nível de atividade física realizada no trabalho e no lazer, fazendo correlação entre o nível e o tipo de atividade. Os benefícios das atividades aeróbicas foram os mais descritos, ainda que o exercício resistido tenha sido abordado em dois artigos. Apesar de alguns estudos terem enfocado apenas a mensuração do nível de atividade física, a maioria dos artigos apresentou correlação entre a prática de atividade física e a redução do risco coronariano, contribuindo para prevenir a DAC. Não houve consenso, ainda que a maioria dos estudos tenha abordado o assunto, quanto ao nível e ao tipo de atividade física que promove o melhor efeito preventivo. Consideramos que poderia ter sido utilizado um descritor mais específico do que “atividade física" para buscar os artigos, visando-se a atingir os objetivos propostos. Este estudo evidencia a contribuição benéfica da atividade física na prevenção primária da DAC, atuando nos seus fatores de risco. Além disso, há necessidade de considerar a atividade física como uma prática corporal orientada pelas necessidades individuais e implementada de acordo com as realidades locais, podendo ser uma ferramenta-chave ao lidar com o indivíduo portador de DAC. / This study consists of an integrative review of the national and international literature made between 2000 and 2005 which main purpose is to testify the physical activities’ contributions for the primary prevention of coronary heart disease (CHD) and their risk factors. The articles are based on the PubMed data (including MEDLINE) and LILACS and they make use of descriptors related to the intervention, focus, morbidity and other factors of risk. Twenty two articles attended to the criteria adopted in this research constituting the specific sample presented. To the data organisation it was used an instrument which registered the articles’ essential information such as title, source (the magazine’s data), number of searches and summary, author(s), country, year, study place, goals, subjects and research period, method and what has been analysed, sort of intervention and its responsible, effective results, author’s conclusion, limitations quoted by the author as well as comments about the study. The results have been compiled into categories according to the methodological drawing of the article, its purposes, descriptive manners, the physical activities’ measurement and the publications’ content. It has also been noticed some similarities towards these aspects and methodological drawings of other articles. Twelve articles has been categorised as prospective studies, seven as transversal cut and three as retrospective studies. In great part of them some questionnaires of the recording type have been used in order to evaluate the physical activities’ level involved at work and leisure time establishing, this way, a correlation between the level and the sort of exercise done. It is important to say that the benefits of aerobic activities were the most described, even though resisted exercises were also mentioned in two of the articles. Despite the fact that some studies have focused only on the measurement of the physical activity, the majority of them has established a correlation between the practice of such activities and the decrease of coronary risks, therefore contributing considerably for the CHD prevention. There has not been a consensus, though almost all studies mentioned this matter, about the level and sort of physical exercises that promote the best preventive effects. Moreover, we have taken into account the fact that a more specific descriptor could have been used instead of only “physical activity" with the intention of achieving the proposed objectives. Above all, this research shows the beneficial contributions of physical activities in the primary prevention of CHD as well as its possible risks. Not only that, but there is a necessity of considering physical activity as a corporal practice based on the individual demands and directed to a specific reality, aiming to be a useful way of dealing with an individual with CHD.

OBJETIVO: Este estudo tem como objetivo elaborar um protocolo eficiente para triagem do desenvolvimento de linguagem em crianças da população brasileira, analisar se existem diferenças nas habilidades de linguagem das crianças com e sem fissura labiopalatina (FLP) e verificar se há diferenças no perfil do desenvolvimento de linguagem entre crianças com FLP, com e sem otite média. MODELO: Prospectivo e amostra aleatória. LOCAL: Setor de Fonoaudiologia e Ambulatório de Saúde Pública - HRAC- USP. PARTICIPANTES: Foram avaliadas 163 crianças, sendo 102 com FLP (50 sem e 52 com otite média) e 61 sem FLP, na faixa etária de 22 a 24 meses e de 34 a 36 meses, por ordem de agendamento no HRAC - USP. INTERVENÇÕES: Aplicação do Protocolo de triagem do desenvolvimento de linguagem em crianças até 3 anos de idade, composto dos Testes REEL-2, ELM e LDS e avaliação fonoaudiológica, possibilitando a detecção precoce de crianças de risco para o atraso no desenvolvimento da linguagem. RESULTADOS: Constatou-se, com diferença estatisticamente significante, atraso no desenvolvimento da linguagem receptiva pelo Teste REEL-2, em crianças com 3 anos de idade, sendo mais baixo o desempenho naquelas com FLP. A Escala ELM mostrou diferença estatisticamente significante para a linguagem expressiva com 3 anos de idade, destacando-se o grupo de crianças sem FLP. No Teste LDS os dados foram significativos para crianças com 3 anos, do grupo sem FLP. Todos esses dados foram confirmados pela avaliação fonoaudiológica. CONCLUSÃO: O protocolo proposto mostrou eficácia, principalmente quando acentua as diferenças existentes em crianças com e sem FLP. Com esses dados, a implantação do protocolo é de alto benefício aos pacientes de risco nesta condição. / Objective: The goals of the present work are: to generale a protocol screening to evaluate the development of language in Brazilian children; to analise differences existing in language skills in children with/without cleft lip/palate, and to verify differences existing in the profile of language development between children with clefting, with/ without median otitis. Model: Prospective study based in randomized sampling Setting: Speech Pathology Section, Public Health Ambulatory, HRAC-USP Participants: 163 children composed this sample, where 102 presented cleft lip/palate (52 with otitis media and 50 without) and 61 normal children. The age ranged between 22 to 24 months and from 34 to 36 months, according the routine agenda. Intervention: The Protocol was applied to all children having less than 36 months. It includes the following scales: REEL-2, ELM and LDS, as well as the speech language evaluation, concerning early identification of children at risk for developmental language delay. Results: Through the Protocol screening we showed that there was significant standard deviation in receptive developmental language delay detected through the REEL-2 Scale, mainly for children with CL/P at age 36 months. The ELM and LDS scales showed significant standard deviation for expressive language delay, mainly in children without clefting at age 36 months. These data were confirmed through speech-language evaluation. Conclusions: The studied Protocol was efficient in all circumstances, mainly when we take into account the differences existing between children with cleft lip/palate with and without otitis media, and when we also consider the groups with and without CL/P. We suggest that this Protocol should be established as a routine procedure in the evaluation of at risk patients, no matter where they are.

Primärprävention hat sich insbesondere im Bereich der infektiösen Erkrankungen als erfolgreich erwiesen. Auch für die chronischen Krankheitsbilder gilt es, effektive Präventionsmaßnahmen zu entwickeln. Obwohl es zahlreiche Hinweise aus der wissenschaftlichen Literatur gibt, dass bestimmte Verhaltensweisen, z.B. das Ernährungsverhalten oder die körperliche Aktivität, einen beträchtlichen Anteil an der Entstehung von Krankheitsbildern wie Herz-Kreislauf-Erkrankungen oder Krebs haben, ist das darin vorhandene präventive Potential bislang nur wenig ausgeschöpft worden. Ein Grund hierfür könnte in der mangelnden wissenschaftlichen Glaubwürdigkeit der postulierten Maßnahmen liegen. Die vorliegende Arbeit befasst sich mit den Forschungsschritten, die notwendig sind, um zu belastbaren, wissenschaftlich fundierten Aussagen zu kommen, aus denen sich Empfehlungen zum Ernährungsverhalten ableiten lassen. Dazu wurden drei Komponenten dieses Prozesses beleuchtet: 1. Methodische Aspekte Einleitend wird auf methodische Vorrausetzungen eingegangen, die zur Gewinnung valider Daten notwendig sind, angefangen bei Erhebungsinstrumenten bis hin zur Anwendung adäquater Studiendesigns. Beispielhaft werden methodische Arbeiten vorgestellt, die im Rahmen der EPIC-Potsdam Studie entstanden sind und sich auf die Validierung von Ernährungserhebungsinstrumenten und Blutdruckmessungen beziehen. 2. Ergebnisse epidemiologischer Studien Grundvoraussetzung zur Entwicklung primärpräventiv wirksamer Empfehlungen ist die Generierung epidemiologischer Daten, die einen Zusammenhang zwischen Ernährungs-verhalten und dem Auftreten der untersuchten Erkrankung aufzeigen. Als Beispiel werden analytisch-epidemiologische Studienergebnisse aus dem Bereich des metabolischen Syndroms präsentiert und diskutiert. 3. Konzeptionelle Überlegungen Abschließend werden Aspekte der Interpretation einzelner Studienergebnisse sowie der zusammenfassenden Interpretation aller zu einem Thema vorliegenden Daten diskutiert. Die Synthese von Evidenz wird insbesondere auf dem Hintergrund der Konzepte des sog. evidenz-basierten Vorgehens betrachtet. Zusammenfassend lässt sich feststellen, dass der aufgezeigte Prozess hin zu evidenz-basierten Ernährungsempfehlungen begonnen hat und in den nächsten Jahren erste Erkenntnissen zu erwarten sind, die eine fundierte Einschätzung der Ernährung im Rahmen der Primärprävention erlauben. / Primary prevention has been proven to be a successful approach, especially in the area of infectious diseases. Nowadays the challenge is to develop effective preventive measures for chronic disease prevention. However, despite numerous signs from the scientific literature that life-style factors such as dietary behaviour or physical activity levels contribute substantially to the development of diseases like cardio-vascular disease or cancer, the preventive potential has not been fully exploited so far. One reason for that might be the lack of credibility of the postulated measures. This thesis deals with the necessary research steps needed for the development of scientifically based dietary recommendations. Three aspects of this process were highlighted: 1. Methodological aspects The introductory part points out the prerequisites for obtaining valid data, beginning with the assessments instruments and ending with the appropriate study design. As an example, validation studies on dietary assessment and blood pressure measurement that were undertaken for the EPIC-Potsdam study are presented. 2. Results from epidemiological studies Basic requirement for the development of primary prevention measures are epidemiological data demonstrating an association between dietary behaviour and disease occurrence. To exemplify this, analytical epidemiological study results obtained from studies on the metabolic syndrome are presented and discussed. 3. Conceptual considerations Finally, aspects of interpretation of single study results as well as of summarizing all data on a certain topic are discussed. Background of the considerations on the synthesis of evidence is the so-called evidence based approach. In summary, the outlined process leading towards evidence based dietary recommendations has begun, and during the upcoming years first results from this process are to be expected. These will then allow to derive a sound appraisal of the role of nutrition for primary prevention.

Esta pesquisa visou investigar as representações sociais de transtornos mentais e conflitos psicossociais, que constituem-se enquanto determinantes simbólicos de condutas de promoção ou não de saúde mental em núcleos do Programa de Saúde da Família. A investigação esteve referenciada no método de análise das representações sociais, proposto por Moscovici (1978), que se baseia na análise das práticas discursivas dos profissionais envolvidos na dinâmica institucional dos núcleos do PSF. Enquanto procedimento foi realizado 7 entrevistas individuais em profundidade, com a equipe de um núcleo do PSF em Ribeirão Preto. Com intuito de conhecer as formas pelas quais a doença mental é simbolizada no PSF, neste sentido, percebeu-se que existem relevantes dificuldades e necessidades da equipe em seus vários segmentos profissionais, as quais influenciam no tratamento das famílias e nas estratégias de promoção de saúde mental. / The aim of this survey was investigate the social representation of mental disorders and psychosocial disturbs. The social representation is a health mental promotion symbolic determinant in Family Health Program Centers (PSF). The investigation was based on social representation analysis method proposed by Moscovici (1978). The method is due to the professional discursive practice analyses involved on institutional PSF Centers. Seven individual interviews were made by PSF Centers group on Ribeirão Preto. The objectives was knowing the ways witch the mental disease are symbolized at PSF. We realized that the several professional segment groups had important difficulties and needing witch influences on family treatments and health mental promotion strategies.

Introdução: O primeiro episódio psicótico na adolescência é um indicador de possível ocorrência de esquizofrenia. Infelizmente, pessoas vivenciando os sintomas iniciais de psicose raramente buscam tratamento, ficando esta responsabilidade principalmente para seus familiares. Objetivo: Analisar os significados atribuídos ao adoecimento mental, no contexto da adolescência, pelos familiares de jovens que vivenciaram o primeiro episódio psicótico. Referencial Teórico-Metodológico: Adotou-se o Interacionismo Simbólico e a Narrativa Eles se articulam pois ambos focalizam as relações familiares, permitindo analisar os dados a partir desta perspectiva. Método: Optou-se por entrevistar famílias de jovens que passaram pela primeira internação psiquiátrica, em decorrência do primeiro episódio psicótico. As famílias foram recrutadas a partir de dois serviços de internação psiquiátrica. Foram entrevistados 13 familiares de 11 jovens. Resultados: Com relação aos participantes do estudo, pôde-se observar um predomínio de mães nas entrevistas, o uso de drogas antes da primeira internação por oito dos 11 jovens adoecidos, a dificuldade dos jovens em seguirem a escola e o tratamento e a presença de algum transtorno mental na família atual ou estendida. As mudanças de comportamento que antecedem a instalação do primeiro episódio psicótico ocorreram dentro do contexto de vida familiar. As famílias explicaram as mudanças de comportamento observadas em seus jovens por meio da história de vida da família e do adoecido. Não pensaram em adoecimento. Os significados foram construídos de acordo com as crenças familiares sobre o impacto de eventos, que ocorreram na família, na vida no jovem adoecido. Discussão: Ao explicar as mudanças de comportamento do jovem adoecido por meio de sua história inscrita no contexto familiar as famílias tornaram-se mais flexíveis e inclusivas. A construção desses significados reforça o papel de cuidadora da família possibilitando que ela enfrente o contexto de mudança de comportamento. Porém, por outro lado, o papel cuidador pode retardar a procura por ajuda especializada. A literatura aponta que a família é uma variável importante no tempo de demora para procurar tratamento. Porém ainda se conhece pouco sobre esta influência. Esta pesquisa apontou que a significação das alterações de comportamento do jovem por meio de sua história de vida pode implicar em demora para buscar tratamento. Assim como outras pesquisas este estudo mostrou que inicialmente as famílias não perceberam as mudanças de comportamento de seu jovem como adoecimento. Esta pesquisa revelou que os significados foram construídos a partir da história de vida familiar. Este resultado difere dos resultados de outros estudos que indicam explicações relacionadas à fase de adolescência, uso de droga, depressão ou estresse. Conclusão: Ao adotar a pesquisa interpretativa para analisar os significados atribuídos ao adoecimento mental, no contexto da adolescência, pelos familiares de jovens que vivenciaram o primeiro episódio psicótico esta pesquisa contribui com o conhecimento indicando o papel da história de vida na construção de crenças e significados adotados pela família para enfrentar o adoecimento. Este processo de significação pode influenciar no tempo de demora para procurar iniciar o tratamento / Introduction: The first psychotic episode during adolescence is a indicative of possible occurrence of schizophrenia. Unfortunately, people that experience the first symptoms of phychosis seldom look for treatment, what turns the responsabilty towards the others family members. Purpose: Analyze the signification associated to mental illness, in the context of adolescence, by the family members of the adolescent that suffered the first psycothic episode. Referencial Theoretical-Methodological: It was used the symbolic interactionism and the narrative. They combine with each other once both of them focus on the familes\' relations, allowing to analyze the data from this perspective. Method: It was chosen the process of interviewing the families of the adolescents that suffered the first psychiatric hospitalization, as a consequence of the first psycothic episode. The families were recruited from the two services of psychiatric hospitalization. 13 family members of 11 adolescents were interviewed. Results: Regarding the participants of the study, it was possible to observe the predominance of moms participating in the interviews; the use of drugs before the first hospitalization by eight of the 11 sick adolescents; the difficulty of the latter in continuing to follow the school and the treatment, besides the presence of certain mental disorder at the current family. The behavior changes that preceded the occurrence of the first psychotic episode took place inside the family life context. Those families explained the behavior changes of their adolescents through the families\' - and the ill adolescent\'s - life story. They did not considerate the illness itself. The signification was constructed taking into consideration the families\' beliefs of the impact of the events that took place among them, in the life of the sick adolescent. Discussion: When explaining the behavior changes of the ill adolescent via their story enrolled in the family context, those families became more flexible and inclusive. The construction of those meanings reinforces the role of the mom as the family leader, allowing her to go through the context of behavior changing. On the other hand, however, the leader role can delay the demand for specialized help. The literature says that the family is an important variable on determining how long it takes to look for treatment. Nevertheless, few is known by this so-called influence. This study showed that the meaning of the alterations at the adolescent\'s behavior changing, taking into consideration their life story, can imply a delay when looking for treatment. As in other researches, this study showed that originally the families did not perceived the behavior changes of the ill adolescent as illness. This study revealed that the signification was constructed from the family\'s life story. This result differs from the others that use as explanation for the disease the youth period, use of drugs, depression or stress. Conclusion: By adopting the interpretative study to analyze the signification attributed to mental illness, in the context of adolescence, by the adolescents\' family members that experienced the first psychotic episode, this study contributed with knowledge, indicating the role of the family\'s story of life in the construction of beliefs and meanings adopted by that family when facing the illness. This process of signification can influence on the delay of looking and initiating the proper treatment