Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl'€™s five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs'€™ integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.

Made available in DSpace on 2016-06-02T19:44:00Z (GMT). No. of bitstreams: 1 TeseRFB.pdf: 913534 bytes, checksum: 101c6a0e4213462df968b7bbd6f273d3 (MD5) Previous issue date: 2006-12-08 / Universidade Federal de Sao Carlos / The topic of this study is primary and secondary child sexual abuse (CSA) prevention in the educational area. The study goals involved planning, implementation and assessment of an intervention program in which teachers acted as CSA prevention agents. The first study step was the program planning based on others experiences described in the literature. Secondly, the program was implemented with 101 pre-school teachers in São Carlos, Brazil, 2.918 children (teachers students aged 4-6 years), and 2.732 children s family members. The program was implemented twice, with 52 and 49 teachers in the first and second time, respectively. Each group was divided into three sub-groups in order to receive the intervention. The program involved a theoretical section with teachers and a workshop conducted by teachers with children and family members. The third part involved the program assessment. Indicators of Sexual Abuse (IAS) data was obtained from 101 teachers at three different moments: before to the intervention, in the middle and at the end of the intervention. Teachers Drill on Child Abuse Identification data was obtained before and after the intervention. IAS and Family Members Drill on Child Abuse Identification data was obtained from 101 family members before and after the workshops conducted by teachers. The Drill on Self-Protective Skills Acquisition for Children data was obtained from 96 children before and after workshops conducted by teachers. IAS teachers results showed that they increased their knowledge about CSA specific symptoms. However, no changes in teachers knowledge about CSA nonspecific symptoms were observed. There was an increase in the percentage of appropriate answers from teachers in Teachers Drill on Child Abuse Identification. Family members IAS results showed no changes in their knowledge about CSA specific or non-specific symptoms. After the workshops, there was an increase in the percentage of appropriate answers by family members in Family Members Drill on Child Abuse Identification and children s performance in the Drill on Self-Protective Skills Acquisition for Children. In order to assess the impact of the program in the community, the number of CSA cases notified were identified from 2002 to 2005, in São Carlos. The data obtained showed an increase of CSA cases notified after the program, as well as an increase of reported cases involving young children s victimization. Simultaneously with the program, the teachers received consultation on how to identify CSA suspected cases in their schools. When sexual abuse suspicion was confirmed, the case was reported by teachers. In general, the program s assessment had an important impact in the schools and community as well. The need to plan and assess CSA preventive actions in others sectors of society is discussed. / O tema desse estudo foi a prevenção do abuso sexual infantil na área educacional sob o ponto de vista primário e/ou secundário. Os objetivos do estudo foram elaborar, implementar e avaliar um programa de intervenção para professores no sentido de capacita-los a atuar como agentes de prevenção do abuso sexual infantil. A primeira etapa do estudo envolveu a elaboração do programa a partir de experiências de outros programas desenvolvidos, avaliados e descritos na literatura. Na segunda etapa, o programa elaborado foi realizado contando com a participação de 101 professores de Escolas Municipais Infantis do município de São Carlos, 2.918 crianças de 4 a 6 anos, alunos desses professores e 2.732 familiares das crianças. O programa foi realizado duas vezes em dois momentos distintos, sendo que os professores foram divididos em duas turmas de 52 e 49 profissionais respectivamente. As duas turmas foram subdivididas em três sub-grupos em cada momento da realização do programa. O programa envolveu uma parte teórica com os professores e uma parte prática (oficinas) feita pelos professores com as crianças e os familiares. A terceira etapa foi referente a avaliação do programa realizado. Todos os professores participantes do programa preencheram uma escala - Indicadores de Abuso Sexual IAS, em três momentos distintos, antes, no meio e após o término do programa. Além disso, foi aplicado um Exercício sobre Abuso Sexual antes e depois da intervenção. Os familiares também preencheram o IAS e responderam ao Exercício sobre Abuso Sexual antes e depois das oficinas realizadas pelos professores. As crianças responderam ao Exercício sobre Aquisição de Habilidades de Auto-proteção antes e depois das oficinas realizadas pelos professores. Os resultados obtidos na aplicação do IAS para os professores demonstraram que os mesmos melhoraram seu conhecimento sobre sintomas específicos do abuso sexual, mas mantiveram seu desempenho estável quanto aos sintomas inespecíficos. No Exercício os professores apresentaram um aumento na porcentagem de respostas adequadas após a intervenção. Para os familiares, os resultados obtidos na aplicação do IAS demonstram um desempenho estável tanto em relação a sintomas específicos quanto inespecíficos. Em relação ao Exercício os familiares apresentaram um aumento no percentual de respostas adequadas após as atividades práticas realizadas pelos professores. As crianças apresentaram aumento no percentual de respostas adequadas após as atividades práticas realizadas pelos professores. Como medida de avaliação adicional foi realizado um levantamento dos casos notificados de abuso sexual entre os anos de 2002 e 2005 no município de São Carlos para verificar o impacto do programa na comunidade. Os dados obtidos indicam um aumento no número de denúncias após a realização do programa e o surgimento de denúncias envolvendo crianças mais novas. Simultaneamente ao desenvolvimento do programa, foi realizada uma assessoria aos professores que identificassem suspeita de abuso sexual entre as crianças de sua escola. Dentre os casos em que foi prestada assessoria, todos aqueles em que ficou confirmada a suspeita foram encaminhados para denúncia. De maneira geral, a avaliação do programa verificou um importante impacto da realização do mesmo nas escolas e na comunidade, além de apontar a necessidade de se planejar e avaliar ações preventivas do abuso sexual em outros setores da sociedade.

The Czech Republic is numer one in the mortality and morbidity due to cardio-vascular diseases. It is evidence that the incidence of cardio-vascular dieseases can be influenced positively by primary prevention as to the lifestyle of the population and that the secondary prevention can improve the lifequality of patiens, diminish thein mortality and morbidity and reduce the numer of recurrences and complications. The degree work on the subjekt {\clqq}Change in the lifestyle of men after an acute myocardial infarct`` is in its general part concentrated on risk factors connected with cardio-vascular diseases, on a self-contained system of rehabilitation, on prevention (primary, secondary, tertiary) and on the welfare system in the Czech Republic. The risk factors connected with cardio-vascular diseases can be dividend into influenceable ones (nutrition, smoking, lack of physical exercise, alkohol consumption, hypertension, dyslipoproteineme, diabetes mellitus, obesity), into uncontrollable ones, (age, sex, genetic factors) and into behavioural ones, among which count psychosocial and economic factors. The mail aim of the work was to establish the extent as to the occurrence of risk factors in relation to men, who underwent an acute myocardial infarct and to determine the posibility of involving them in an active change in the lifestyle. The research proceeded in the form of questionnaires distributed at cardiological out-patients` departments in the region of Příbram.The data collection was under way from November 2009 to February 2010. The research was quantitative, the questionnaire was anonymous, in printed form, contained 29 questions and the respondents answered in writing. One thousand questionnaire were distributed, where of 231 fully completed questionnaires came back. The return rate of questionnaires were destined only for men, who underwent an acute myocardial infarct (two fundamentals identifications marks). I arrived to two hypotheses. The first was that the education of population played an important role in occurrence of cardio-vascular diseases and in awareness of influence of the lifestyle on reducing the risks connected with the development of these diseases. The second hypothesis was that the secondary prevention of risk factors connected with cardio-vascular diseases was not effetively and regorously applied to men, who underwent myocardial infarct. Both hypothese of mine proved to be right. The doctors and the learned public are doubtless well informed of the prevention and therapy as to the cardio-vascular diseases. The question is how effectively the professional information and recommendations find their way into the subconsciousness of our population. The research results show that an imaginary gap arises between recommended advices relating to the change in the lifestyle and in the positive influencing of influenceable and behaviour risk factors, the doctors give in thein routine practice. It is neccessary to create programmes of intervention in the lifestyle within the scope of a self-contained rehabilitation system. This system is applied on the occasion of spa care in the Czech Republic. The effect of the spa care is shortterm, lasts half a year to one year and there is no direkt further contact of the patient with dietary centres and with specialized physiotherapists. The recommendations concerning the change in the lifestyle should be popularized in the society as a whole in order to find their way into the wide subconsciousness of our population.

Pasaulio sveikatos organizacijos duomenimis, širdies ir kraujagyslių ligos yra dažniausia neįgalumo ir ankstyvos mirties priežastis pasaulyje. Modifikuojant rizikos faktorius galima sumažinti klinikinių atvejų bei ankstyvų mirčių skaičių. Prevenciją būtina taikyti žmonėms, kuriems jau diagnozuota koronarinė širdies liga, ir žmonėms, kuriems nustatyta širdies ir kraujagyslių ligų rizika. Darbo tikslas: Koronarine širdies liga persirgusių pacientų sveikatos priežiūros ir slaugos poreikių tyrimas. Darbo uždaviniai: Įvertinti rizikos veiksnius, veikiančius koronarine širdies liga sergančius pacientus, ir nustatyti pacientų žinias apie rizikos veiksnių modifikavimo būtinumą; Ištirti koronarine širdies liga sergančių pacientų biopsichoemocinę būklę; Išanalizuoti koronarine širdies liga sergančių pacientų fizinį aktyvumą; Ištirti pacientų gyvenimo kokybę, susijusią su sveikatos būkle; Pasiūlyti galimus slaugytojo darbo su pacientais metodus, siekiant įgyvendinti širdies ir kraujagyslių ligų susirgimų prevenciją. Medžiaga ir metodika: Tyrimo objektas – koronarine širdies liga sergančių pacientų žinios, sveikatos priežiūros ir slaugos poreikiai. Tyrimo populiacija - 100 pacientų, sergančių koronarine širdies liga. Tyrimo metodas – koronarine širdies liga sergančių pacientų apklausa (interviu) panaudojant standartizuotus klausimynus, ligos istorijų analizė, fizinių paciento duomenų matavimai. Panaudoti klausimynai: Klausimynas, parengtas Europos kardiologų draugijos, skirtas ES šalių... [toliau žr. visą tekstą] / Following the information by the World Health Organization (WHO) CHD is the leading cause of disability and early death all over the world. Modification of risk factors may reduce the number of clinical records and early deaths. Prevention measures need to be taken for individuals with already diagnosed CHD as well as those with risk factors for CHD. Thesis objective: Investigation of healthcare and nursing needs of patients after CHD. Thesis tasks: Assessment of risk factors affecting patients suffering from CHD and knowledge possessed by patients suffering from CHD about the need for modification of the risk factors; Examination of biopsychoemotional condition of patients suffering from CHD; Analysis of physical activity of patients suffering from CHD; Examination of health condition–related quality of life of patients suffering from CHD; Suggesting possible methods of nursing staff working with the patients aiming at CHD prevention. Material and methodology: Investigation target: Knowledge possessed by patients suffering from CHD; healthcare and nursing needs. Investigation method: interviewed patients suffering from CHD through applying standardized questionnaires; analysis of case records, measurements of physical data of patients. Questionnaires used: Questionnaire developed by the European Society of Cardiology, aimed to assess the level of knowledge on prophylaxis of CHD EU-wide; HADS Questionnaire – Hospital Anxiety and Depression scale; EUROQOL 5D Questionnaire... [to full text]