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OBJETIVO: Esta dissertação tem por objetivo apresentar o estudo da associação entre transtornos psiquiátricos pós-parto e fatores demográficos, psicossociais e relacionados à gestação e parto em uma amostra de base populacional de um bairro de Porto Alegre. MÉTODO: O estudo envolveu todas as mães de crianças nascidas em hospital público no bairro Vila Jardim, em Porto Alegre, de novembro de 1998 a dezembro de 1999. As famílias foram estudadas quando os bebês completaram quatro meses de idade. A saúde mental das mães e pais foi avaliada pelo Self Report Questionnaire (SRQ) e por entrevistas semi-estruturadas individuais e do casal. A Escala Avaliação Global do Funcionamento Relacional (GARF) do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV) foi usada para aferir a qualidade do relacionamento do casal, do relacionamento materno com sua família de origem, com a família paterna e com a rede social. Para os outros fatores foram feitas perguntas diretas à mãe e ao pai da criança. RESULTADOS: Segundo a escala SRQ 34,45% das 148 mulheres entrevistadas apresentaram suspeita de transtorno psiquiátrico, sendo que a avaliação clínica feita por dois profissionais de saude mental que avaliavam independentemente utilizando os critérios diagnósticos do DSM-IV indicou um percentual de 54%. Sessenta e dois por cento das mulheres coabitavam com companheiro, sendo que estes também foram entrevistados. Dos 118 pais, 25,4% apresentaram suspeita de transtorno psiquiátrico, segundo a escala SRQ. Nesta população, o fato de coabitar ou não com companheiro não esteve associado com transtorno mental. Nesta pesquisa, na análise de regressão logística estudando a totalidade do grupo de mulheres os fatores que se mostraram relacionados com o desfecho (SRQ igual ou superior a sete ) foram a baixa renda familiar (p=0,017) e a presença de transtorno psiquiátrico materno no passado (p=0,043). Na regressão logística feita exclusivamente com as mulheres que viviam com companheiro, apenas a má qualidade da relação do casal (notas de 1 a 3 pela escala GARF) esteve associada à presença de transtornos psiquiátricos quatro meses após o parto (OR=7,34, p=0,001). CONCLUSÃO: Este estudo reforça a necessidade de verificar a presença de transtornos psiquiátricos da mãe nas consultas de puericultura, introduz dados sobre o pai e, especialmente, sobre a importância de avaliar rotineiramente a relação conjugal. / OBJECTIVE: To study the association between suspicion of psychiatric disorder and demographic, psychosocial factors, as well as those related to pregnancy and delivery, in a population-based sample of women from a circumscribed neighborhood in Porto Alegre. METHOD: This study included the mothers of all the children born in public hospitals in Vila Jardim, a district of Porto Alegre, Brazil, from November 1998 through December 1999. Families were assessed when infants were 4 months of age. Parents’ mental health was assessed using the Self-Report Questionnaire (SRQ) and individual and couple semi-structured interviews. The DSM-IV Global Assessment of Relational Functioning Scale was used to measure quality of couple relationship, of maternal relationship with the mother's family of origin, with paternal family and with social network. As to other factors, direct questions were asked to the child’s parents. RESULTS: According to the SRQ scale, 34.45% of all 148 interviewed women had suspicion of psychiatric disorder. The clinical assessment by two mental health professionals independently using DSM-IV criteria revealed a percentage of 54%. Sixty-two percent of women lived with partners, who were also interviewed. Of the 118 fathers, 25.4% had suspicion of psychiatric disorder, according to the SRQ scale. In this population, the fact of living or not with a partner was not associated with mental disorder. Analysis by logistic regression of the total group of women showed that factors associated with the main outcome (SRQ equal or higher than 7) were low family income (p = 0.017) and presence of previous maternal psychiatric disorder (p = 0.043). Logistic regression including only women living with a partner showed that poor marital relationship was associated with presence of psychiatric disorder, 4 months after delivery (OR = 7.34 p = 0.001). CONCLUSION: This study reinforces the need of investigating presence of maternal psychiatric disorder during childcare, introduces data on the father and especially on the importance of a routine assessment of the marital relationship.

OBJETIVO: Esta dissertação tem por objetivo apresentar o estudo da associação entre transtornos psiquiátricos pós-parto e fatores demográficos, psicossociais e relacionados à gestação e parto em uma amostra de base populacional de um bairro de Porto Alegre. MÉTODO: O estudo envolveu todas as mães de crianças nascidas em hospital público no bairro Vila Jardim, em Porto Alegre, de novembro de 1998 a dezembro de 1999. As famílias foram estudadas quando os bebês completaram quatro meses de idade. A saúde mental das mães e pais foi avaliada pelo Self Report Questionnaire (SRQ) e por entrevistas semi-estruturadas individuais e do casal. A Escala Avaliação Global do Funcionamento Relacional (GARF) do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV) foi usada para aferir a qualidade do relacionamento do casal, do relacionamento materno com sua família de origem, com a família paterna e com a rede social. Para os outros fatores foram feitas perguntas diretas à mãe e ao pai da criança. RESULTADOS: Segundo a escala SRQ 34,45% das 148 mulheres entrevistadas apresentaram suspeita de transtorno psiquiátrico, sendo que a avaliação clínica feita por dois profissionais de saude mental que avaliavam independentemente utilizando os critérios diagnósticos do DSM-IV indicou um percentual de 54%. Sessenta e dois por cento das mulheres coabitavam com companheiro, sendo que estes também foram entrevistados. Dos 118 pais, 25,4% apresentaram suspeita de transtorno psiquiátrico, segundo a escala SRQ. Nesta população, o fato de coabitar ou não com companheiro não esteve associado com transtorno mental. Nesta pesquisa, na análise de regressão logística estudando a totalidade do grupo de mulheres os fatores que se mostraram relacionados com o desfecho (SRQ igual ou superior a sete ) foram a baixa renda familiar (p=0,017) e a presença de transtorno psiquiátrico materno no passado (p=0,043). Na regressão logística feita exclusivamente com as mulheres que viviam com companheiro, apenas a má qualidade da relação do casal (notas de 1 a 3 pela escala GARF) esteve associada à presença de transtornos psiquiátricos quatro meses após o parto (OR=7,34, p=0,001). CONCLUSÃO: Este estudo reforça a necessidade de verificar a presença de transtornos psiquiátricos da mãe nas consultas de puericultura, introduz dados sobre o pai e, especialmente, sobre a importância de avaliar rotineiramente a relação conjugal. / OBJECTIVE: To study the association between suspicion of psychiatric disorder and demographic, psychosocial factors, as well as those related to pregnancy and delivery, in a population-based sample of women from a circumscribed neighborhood in Porto Alegre. METHOD: This study included the mothers of all the children born in public hospitals in Vila Jardim, a district of Porto Alegre, Brazil, from November 1998 through December 1999. Families were assessed when infants were 4 months of age. Parents’ mental health was assessed using the Self-Report Questionnaire (SRQ) and individual and couple semi-structured interviews. The DSM-IV Global Assessment of Relational Functioning Scale was used to measure quality of couple relationship, of maternal relationship with the mother's family of origin, with paternal family and with social network. As to other factors, direct questions were asked to the child’s parents. RESULTS: According to the SRQ scale, 34.45% of all 148 interviewed women had suspicion of psychiatric disorder. The clinical assessment by two mental health professionals independently using DSM-IV criteria revealed a percentage of 54%. Sixty-two percent of women lived with partners, who were also interviewed. Of the 118 fathers, 25.4% had suspicion of psychiatric disorder, according to the SRQ scale. In this population, the fact of living or not with a partner was not associated with mental disorder. Analysis by logistic regression of the total group of women showed that factors associated with the main outcome (SRQ equal or higher than 7) were low family income (p = 0.017) and presence of previous maternal psychiatric disorder (p = 0.043). Logistic regression including only women living with a partner showed that poor marital relationship was associated with presence of psychiatric disorder, 4 months after delivery (OR = 7.34 p = 0.001). CONCLUSION: This study reinforces the need of investigating presence of maternal psychiatric disorder during childcare, introduces data on the father and especially on the importance of a routine assessment of the marital relationship.

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-04-26T12:41:31Z No. of bitstreams: 1 arquivo total.pdf: 2682953 bytes, checksum: 52ccc489d26dd8a9c770c60df0b6fa2c (MD5) / Made available in DSpace on 2016-04-26T12:41:31Z (GMT). No. of bitstreams: 1 arquivo total.pdf: 2682953 bytes, checksum: 52ccc489d26dd8a9c770c60df0b6fa2c (MD5) Previous issue date: 2016-01-25 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Currently, the most accepted model in the scientific community to explain the multifactorial origin of the pain is the biopsychosocial model. This model suggests that psychosocial factors also contribute to the onset of pain as well as physical / ergonomic factors. An branch important industrial of the secondary sector, the shoe industry has stood out negatively by the high number of work-related musculoskeletal disorders. Thus, the objective expected is investigate to the relationship between psychosocial factors and the development of musculoskeletal disorders related to work in production sectors of a great shoes industry. To achieve this objective, there was a systematic review in about 150 papers published in international journals with impact factor. We used the Nordic questionnaire to identify the symptoms of pain in the body segments. Psychosocial factors were evaluated by the scores of Job content questionnaire (JCQ) and the Effort-reward imbalance questionnaire (ERI), as well as other modern psychosocial factors, such as bullying, discrimination, job dissatisfaction, sexual harassment and stress. Quadrants were built to evaluate effect of the combination of demands (physical and psychological) with job control; and to evaluate the combination of effort and reward for the onset of pain. Ordinal logistic regression models were built relating the pain reported by employees and psychosocial factors, in order to verify the probability of a given psychosocial factors contribute to the emergence and worsening of pain in the worker's body. All body parts were affected by at least one psychosocial factor. It was observed that some psychosocial factors such as job dissatisfaction affect both sexes, leading to occurrence more frequent of pain in the wrist in men (OR = 2.61; 1.32-5.15) and women (OR = 3.88; 1.33-11.32). Factors such as stress, affect more men, leading to the appearance of more frequent pain (OR = 2.63; 1.26-5.45) and more intense pain (OR = 2.70; 1.32-5.52) in hands. Among women, other factors such as discrimination have impact on the appearance of more frequent pain (OR = 5.10; 1.52-17.13) and more intense pain (OR = 3.43; 1.15-10.23) in the neck. The quadrant that combines the high effort and low reward was the one that presented, for men, more risk for the appearance of frequent pain (OR = 14.35; 3.95-52.18) and intense pain (OR = 17.05; 4.61-63.12) in the neck; and more frequent pain (OR = 9.69; 2.30-40.79) and more intense (OR = 10.81; 2.58-45.23) at the head of women. Thus concluded that psychosocial factors may lead to the onset of pain in the regions of the human body. / Atualmente, o modelo mais aceito na comunidade científica para se explicar a origem multifatorial das dores é o modelo biopsicossocial. Esse modelo sugere que fatores psicossociais contribuem também para o aparecimento de dores, assim como os fatores físicos/ergonômicos. Um importante ramo industrial do setor secundário, a indústria de calçados vem se destacando negativamente pelo elevado número de distúrbios osteomusculares relacionados ao trabalho. Assim, o objetivo desse trabalho é verificar a relação entre os fatores psicossociais e o desenvolvimento de distúrbios osteomusculares relacionados ao trabalho nos setores de produção de uma indústria calçadista de grande porte. Para alcançar esse objetivo, fez-se uma revisão sistemática no entorno de 150 artigos publicados em periódicos internacionais com fator de impacto. Utilizou-se o questionário nórdico para identificar os sintomas de dor nos segmentos corporais. Já os fatores psicossociais foram avaliados pelos escores do Job content questionnaire (JCQ) e do Effort reward-imbalance questionnaire (ERI), além de outros fatores psicossociais modernos, como o bullying, discriminação, insatisfação no trabalho, assédio sexual e estresse. Quadrantes foram construídos para avaliar efeito da combinação de demandas (físicas e psicológicas) com controle sobre o trabalho; e para avaliar a combinação de esforço e recompensa sobre o aparecimento de dores. Construíram-se modelos de regressão logística ordinal relacionando às dores relatadas pelos colaboradores e os fatores psicossociais, no sentido de verificar a probabilidade de um dado fator psicossocial contribuir para o surgimento e agravamento da dor no corpo do trabalhador. Como resultados observou-se que todas as partes do corpo foram afetadas por pelo menos um fator psicossocial. Observou-se que alguns fatores psicossociais, como insatisfação no trabalho afetam ambos os sexos, levando ao aparecimento de dores frequentes no pulso em homens (OR=2,61; 1,32-5,15) e em mulheres (OR=3,88; 1,33-11,32). Fatores como o estresse, afetam mais os homens, levando ao aparecimento de dores mais frequentes (OR=2,63; 1,26-5,45) e intensas (OR=2,70; 1,32-5,52) nas mãos. Entre as mulheres, outros fatores como a discriminação apresentam impacto no aparecimento de dores mais frequentes (OR=5,10; 1,52-17,13) e mais intensas (OR=3,43; 1,15-10,23) na região do pescoço. O quadrante que combina a relação alto esforço e baixa recompensa foi o que apresentou, para os homens, maior risco para o aparecimento de dores frequentes (OR=14,35; 3,95-52,18) e intensas (OR=17,05; 4,61-63,12) no pescoço; e para dores mais frequentes (OR=9,69; 2,30-40,79) e mais intensas (OR=10,81; 2,58-45,23) na cabeça das mulheres. Assim, concluísse que fatores psicossociais podem levar ao aparecimento de dores nas regiões do corpo do humano.

OBJETIVO: Esta dissertação tem por objetivo apresentar o estudo da associação entre transtornos psiquiátricos pós-parto e fatores demográficos, psicossociais e relacionados à gestação e parto em uma amostra de base populacional de um bairro de Porto Alegre. MÉTODO: O estudo envolveu todas as mães de crianças nascidas em hospital público no bairro Vila Jardim, em Porto Alegre, de novembro de 1998 a dezembro de 1999. As famílias foram estudadas quando os bebês completaram quatro meses de idade. A saúde mental das mães e pais foi avaliada pelo Self Report Questionnaire (SRQ) e por entrevistas semi-estruturadas individuais e do casal. A Escala Avaliação Global do Funcionamento Relacional (GARF) do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV) foi usada para aferir a qualidade do relacionamento do casal, do relacionamento materno com sua família de origem, com a família paterna e com a rede social. Para os outros fatores foram feitas perguntas diretas à mãe e ao pai da criança. RESULTADOS: Segundo a escala SRQ 34,45% das 148 mulheres entrevistadas apresentaram suspeita de transtorno psiquiátrico, sendo que a avaliação clínica feita por dois profissionais de saude mental que avaliavam independentemente utilizando os critérios diagnósticos do DSM-IV indicou um percentual de 54%. Sessenta e dois por cento das mulheres coabitavam com companheiro, sendo que estes também foram entrevistados. Dos 118 pais, 25,4% apresentaram suspeita de transtorno psiquiátrico, segundo a escala SRQ. Nesta população, o fato de coabitar ou não com companheiro não esteve associado com transtorno mental. Nesta pesquisa, na análise de regressão logística estudando a totalidade do grupo de mulheres os fatores que se mostraram relacionados com o desfecho (SRQ igual ou superior a sete ) foram a baixa renda familiar (p=0,017) e a presença de transtorno psiquiátrico materno no passado (p=0,043). Na regressão logística feita exclusivamente com as mulheres que viviam com companheiro, apenas a má qualidade da relação do casal (notas de 1 a 3 pela escala GARF) esteve associada à presença de transtornos psiquiátricos quatro meses após o parto (OR=7,34, p=0,001). CONCLUSÃO: Este estudo reforça a necessidade de verificar a presença de transtornos psiquiátricos da mãe nas consultas de puericultura, introduz dados sobre o pai e, especialmente, sobre a importância de avaliar rotineiramente a relação conjugal. / OBJECTIVE: To study the association between suspicion of psychiatric disorder and demographic, psychosocial factors, as well as those related to pregnancy and delivery, in a population-based sample of women from a circumscribed neighborhood in Porto Alegre. METHOD: This study included the mothers of all the children born in public hospitals in Vila Jardim, a district of Porto Alegre, Brazil, from November 1998 through December 1999. Families were assessed when infants were 4 months of age. Parents’ mental health was assessed using the Self-Report Questionnaire (SRQ) and individual and couple semi-structured interviews. The DSM-IV Global Assessment of Relational Functioning Scale was used to measure quality of couple relationship, of maternal relationship with the mother's family of origin, with paternal family and with social network. As to other factors, direct questions were asked to the child’s parents. RESULTS: According to the SRQ scale, 34.45% of all 148 interviewed women had suspicion of psychiatric disorder. The clinical assessment by two mental health professionals independently using DSM-IV criteria revealed a percentage of 54%. Sixty-two percent of women lived with partners, who were also interviewed. Of the 118 fathers, 25.4% had suspicion of psychiatric disorder, according to the SRQ scale. In this population, the fact of living or not with a partner was not associated with mental disorder. Analysis by logistic regression of the total group of women showed that factors associated with the main outcome (SRQ equal or higher than 7) were low family income (p = 0.017) and presence of previous maternal psychiatric disorder (p = 0.043). Logistic regression including only women living with a partner showed that poor marital relationship was associated with presence of psychiatric disorder, 4 months after delivery (OR = 7.34 p = 0.001). CONCLUSION: This study reinforces the need of investigating presence of maternal psychiatric disorder during childcare, introduces data on the father and especially on the importance of a routine assessment of the marital relationship.

As Doenças Cardiovasculares (DCV) são importantes causas de morte, morbidade e incapacidade e têm etiologia complexa e multifatorial. Estão relacionadas a fatores de riscos como estilo de vida e padrões de comportamentos. Entre as terapêuticas está a Reabilitação Cardiovascular (RCV), caracterizada por programas de treinamento físico supervisionado, visando diminuir a mortalidade por DCV e garantir melhores condições físicas, mental e social. O sucesso da RCV depende da adesão do paciente, o que se constitui num desafio para as equipes multidisciplinares de saúde. O presente estudo objetivou definir características sóciodemográficas e psicológicas de pacientes de um programa de RCV e avaliar fatores sociais, clínicos e psicológicos que poderiam influenciar na adesão à reabilitação. Participaram do estudo 72 pacientes, entre fevereiro de 2008 a agosto de 2009. Os participantes foram avaliados ao ingressarem na RCV e quando abandonavam ou completavam seis meses de tratamento. Considerou-se adesão participar do programa por um período de seis meses. Foram utilizadas entrevistas estruturadas, Inventário de Sintomas de Stress para Adultos de Lipp, Inventário Beck de Depressão e Questionário de Avaliação de Qualidade de vida (SF-36). Para a análise dos dados foi utilizado o método de Regressão Logística. Verificou-se que 50% dos participantes abandonaram a RCV. O cálculo do Odds Ratio mostrou que pacientes que estavam trabalhando/em atividade apresentaram 7,2 vezes maior risco de abandono à reabilitação do que participantes que estavam afastados/recebendo auxílio doença (OR 7,2; IC95%; 1,4-38,3). Com o ajustamento entre as variáveis sóciodemográficas, observou-se que participantes que tinham de oito a 10 anos de estudo mostraram menor chance de abandono em relação aos que tinham até sete anos de estudo (ORaj 0,04; IC95%; 0,01-0,56) e pacientes que residiam entre 50km e 100km do local de tratamento apresentaram menor chance de abandono em relação aos que residiam no local de tratamento ou até 50km do mesmo (ORaj 0,2; IC95%; 0,0-0,09). Não foram verificadas associações entre as variáveis clínicas e abandono à RCV. Ter expectativas negativas ou incertezas quanto aos benefícios do exercício físico mostrou associação com abandono, ao ingressar na RCV (OR 3,5; IC95%; 1,3-9,7). O conhecimento insuficiente sobre o motivo do tratamento (OR 4,4; IC95%; 1,4-13,5) e a atribuição de causalidade da doença a fatores não modificáveis (OR 3,8; IC95%; 1,2-11,8) foram associados com abandono, ao longo do tempo. Pacientes que não percebiam o suporte social recebido em relação à prática do exercício físico apresentaram 3,3 vezes maior risco de abandono em relação aos que percebiam esse suporte, ao ingressar na RCV (OR 3,3; IC95%, 1,2-9,5) e os participantes que não aumentaram contatos sociais durante a RCV apresentaram maior risco de abandono em relação aos que aumentaram (OR 5,2; IC95%. 1,8-15,0). Pacientes que apresentavam sintomas cognitivos/afetivos de depressão mostraram 3,9 vezes maior risco de abandono em relação aos que não apresentavam esses sintomas (OR 3,9; IC95%; 1,4-10,9). Não foi identificada associação entre sintomas de estresse e abandono à RCV. Verificou-se que participantes que aderiram apresentaram melhores 8 escores nos domínios Aspectos Físicos e Saúde Mental quando comparados com os que abandonaram a reabilitação. Pacientes que apresentavam história de sedentarismo demonstraram 3,6 vezes maior risco de abandono que pacientes que já praticavam exercícios ao ingressar na RCV (OR 3,6; IC95%; 1,1-11,4). Os resultados obtidos neste estudo podem ser utilizados para aumentar a adesão em programas de RCV. / Cardiovascular Diseases (CVD) are major causes of death, morbidity and disability, whose etiology is multifactorial and complex. They are related to risk factors such as lifestyle and behavior patterns. Among the treatments is the Cardiovascular Rehabilitation (CR), characterized by programs of supervised physical training in order to reduce CVD mortality and ensure better physical, mental and social conditions. The success of the CR depends on the patient\'s adherence, which constitutes a challenge for multidisciplinary health teams. This study aimed to describe sociodemographic and psychological characteristics of patients in a CR program and evaluate social, clinical and psychological factors that might influence adherence to rehabilitation. The study included 72 patients between February 2008 and August 2009. Participants were evaluated at entry to the CR and when abandoned or completed six months of treatment. It was considered adherence patient´s participation in the program for a six months period. Structured interviews, Lipp\'s Inventário de Sintomas de Stress para Adultos, Beck Depression Inventory and Medical Outcomes Study 36-Item, Short Form Survey (SF-36) were used. For the data analysis it was used the logistic regression method. It was found that 50% of participants dropped out of CR. Odds Ratio calculation showed that patients who were working/active had 7.2 greater risk of dropping out of rehabilitation than participants who were in health license/receiving financial health support (OR 7.2, CI 95%, 1.4 - 38.3). Analyses were adjusted for sociodemographic variables. It was found that participants who had eight to 10 years of study were less likely to drop out than those who had up to seven years of education (OR 0.04, CI 95%, 0.01 - 0.56) and patients who lived between 50km and 100km from the place of treatment were less likely to drop out than those who lived in the place of treatment or up to 50km away from it (OR 0.2, CI 95%, 0.0 - 0.09). It was not found relation between clinical variables and dropping out the CR. Negative expectations and uncertainties about the benefits of physical exercise when starting CR were associated with dropping out (OR 3.5, CI 95%, 1.3 - 9.7). Insufficient knowledge about the reason for treatment (OR 4.4, CI 95%, 1.4 - 13.5) and causal attribution of disease to non-modifiable factors (OR 3.8, CI 95%, 1.2 - 11.8) were associated with abandonment, over time. Patients who did not perceive the social support received regarding physical exercise had 3.3 times greater risk of dropping out than those who perceived this support by joining the CR (OR 3.3, CI 95%, 1.2 - 9.5) and participants who did not increase social contacts during the CR had a higher risk of dropping out than those who increased their social contacts (OR 5.2, CI 95%, 1.8 - 15.0). Patients with cognitive/affective depression symptoms showed 3.9 times greater risk of dropping out compared to those without these symptoms (OR 3.9, CI 95%, 1.4 - 10.9). No association was found between stress symptoms and CR abandonment. It was found that participants who joined the program had better scores for Role Physical and Mental Health compared to those leaving rehabilitation. Patients who had 10 a history of physical inactivity when starting CR showed 3.6 times greater risk of dropout than patients who already practiced exercises (OR 3.6, CI 95%,1.1 - 11.4). The results of this study may be used to increase adherence to CR programs.

O objetivo desta pesquisa é, a partir do referencial junguiano, ampliar a compreensão de como está se dando a experiência de paternidade atualmente, com foco na subjetividade masculina: qual o impacto que a experiência de se tornar pai vem causando no processo de desenvolvimento psicológico do homem - seu processo de individuação. Em busca de maior compreensão do significado atual da paternidade para os próprios homens na condição de pais, procura-se observar como o arquétipo paterno está se constelando na sociedade atual, de acordo com os novos modos de sentir e de se comportar, tendo em vista uma atitude mais favorável à alteridade e às relações democráticas. A partir de uma contextualização histórico-social, reconstitui-se um cenário marcado pelas reformulações nas concepções de masculino e feminino que vêm ocorrendo nas últimas décadas, e que interferem coletivamente nas identidades de gênero, portanto na subjetividade masculina, com desdobramentos nas expectativas que recaem sobre a figura do pai. Trata-se de uma pesquisa qualitativa que tem como principal instrumento a entrevista individual, com base em um roteiro de temas e questões abordados de forma semi-dirigida. A partir dos depoimentos, observa-se a representação e a vivência de paternidade em transformação através de manifestações da paternidade distintas do padrão patriarcal dominante, caracterizado pelo afastamento afetivo no comportamento masculino. Verifica-se uma crescente expectativa por parte dos homens de maior participação na gravidez, parto e cuidados junto ao filho, acompanhada de envolvimento emocional expresso. Destacam-se na análise os temas do \'desejo de ser pai\' e \'modelos de pai\', que se articulam em torno da afetividade masculina e paterna em transformação. Constata-se a coexistência de múltiplas referências e a valorização dessa pluralidade expressa em comportamentos e valores, o que contrasta com antigos modelos até então tidos como hegemônicos. Trabalha-se com a hipótese de que a crise vivenciada nesse âmbito, em função da instabilidade gerada pelo período de transição que desorganiza tanto a estrutura emocional quanto as estruturas familiares, promove, a médio e longo prazo, crescimento tanto para o indivíduo como para a sociedade. / The purpose of this research is to broaden the understanding of how the experience of fatherhood is taking place at the present time, using a Jungian perspective: to find out what the impact of the experience of becoming a father is causing on men\'s developmental process and process of individuation. As a better understanding about the meaning of fatherhood nowadays for men themselves as fathers is searched, we analyse how the paternal archetype is being constellated in contemporary society, according to new modes of feeling and behaviour, aiming at a more favorable approach towards alterity and democratic relationships. After a sociohistoric contextualization, emerges a scenario marked by reformulation in the conceptions of masculine and feminine over the last decades, which interferes on the aggregate level in gender identities and, therefore, on male subjectivity as well, with consequences for the expectations towards the father figure. This is a qualitative research based on individual interviews supported by a semi-directed script of issues and questions. Based on these statements, we observe the representation and the experience of fatherhood in transformation throughout manifestations of fatherhood that differ from the dominant pattern (patriarchal) and characterized by emotional aloofness as a common male trait. Men\'s growing expectation towards greater participation over pregnancy, childbirth and day-to-day care has been identified, as well as explicit emotional involvement. \'Willingness to be a father\' and \'models of father\' were emphasized issues, involving male and paternal affection in transformation. The coexistence of multiple frames of reference along with such diversity, as expressed in behaviours and values, have been demonstrated. This contrasts with old models considered, until now, to be hegemonic. We worked with the hypothesis that the crisis in this area, due to instability generated by this transitory period that disorganizes both emotional and family structures, generates, over medium and long range, development for the individual as well as for society.

Introduction : Le diagnostic de cancer du sein, les symptômes et les effets secondaires des traitements, entraînent de multiples déficits physiques et psychologiques qui peuvent avoir des effets sur la vie professionnelle. En effet, avec un âge médian de 63 ans au moment du diagnostic de cancer du sein, la moitié des femmes sont encore en âge de travailler. Pourtant, après le diagnostic, toutes les femmes ne retournent pas au travail. Afin d’expliquer ce phénomène, de nombreuses études se sont intéressées aux déterminants sociodémographiques, professionnels et médicaux impactant le retour à l’emploi des patientes ; or ces seuls facteurs ne suffisent pas à expliquer le non-retour à l’emploi des femmes. Il semble qu’un certain nombre de facteurs psychosociaux puissent également rendre compte du retour à l’emploi.Objectifs : L’objectif principal de cette étude est d’identifier les principaux déterminants psychosociaux du retour à l’emploi des femmes ayant un cancer du sein durant l’année suivant le début de leurs traitements adjuvants. Un objectif secondaire consiste à appréhender l’impact des variations de ces déterminants psychosociaux sur le retour à l’emploi des patientes.Méthode : Nous avons réalisé une étude longitudinale et prospective auprès de 68 patientes d’âge moyen 46,97 (ET = 6,92), en emploi au moment du diagnostic de cancer du sein, recrutées au Montpellier Institut du Sein (MIS). Les femmes ont été rencontrées lors d’un premier temps de mesure, par entretien interindividuel, en début de traitements adjuvants (T0). Par la suite, elles ont été suivies par voie téléphonique à 3, 6 et 12 mois après T0 (T1, T2 et T3, respectivement). Les données sociodémographiques, professionnelles, médicales, la précarité (score EPICES), le névrosisme (Néo-PI r), la qualité de vie (QLQ-C30), la fatigue (MFI 20), le développement post traumatique (PTGI), la détresse sociale (SDI) et le soutien social perçu (QSSSC) ont été évalués à T0. À T1, T2 et T3 nous avons relevé : le fait d’être en couple, de subvenir ou non aux études des enfants, le recueil de toxicités liées au traitement médical et le retour à l’emploi. À T2 et T3 nous avons également évalué : la qualité de vie, le développement post-traumatique, la fatigue, la détresse sociale et le soutien social perçu.Résultats : À T1, 50,0% des patientes sont de retour à l’emploi ; à T2, 60,7% sont de retour à l’emploi ; à T3, 74,5% d’entre elles sont de retour à l’emploi. Les résultats des analyses de régression logistique indiquent qu’une forte perception de soutien négatif à T0, OR = 0,74 [0,56 – 0,97] et à T3, OR = 0,59 [0,39 – 0,90], une forte sensation de fatigue physique à T3, OR = 0,55 [0,36 – 0,80] et une précarité élevée, OR = 0,94 [0,89 – 0,99], sont des freins au retour à l’emploi à T3. En revanche, un bon état physique à T0, OR = 1,17 [1,02 – 1,33] et un bon état cognitif à T2, OR = 1,06 [1,01 – 1,11] sont des leviers du retour à l’emploi à T3. Par ailleurs, nous observons qu’une bonne santé globale, OR = 1,10 [1,001 – 1,20] ainsi qu’un bon état cognitif, OR = 1,08 [1,02 – 1,15], à T2, sont des leviers du retour à l’emploi à ce même moment, alors qu’une augmentation de la fatigue mentale, entre T0 et T2, diminue les chances de retour à l’emploi à T2, OR = 0,13 [0,02 – 0,80]. Enfin, les résultats de notre étude montrent qu’une bonne santé globale à T0 est un levier du retour à l’emploi à T1, OR = 1,05 [1,01 – 1,10].Conclusion : Les déterminants psychosociaux, notamment le soutien social, la précarité, la qualité de vie et la fatigue, peuvent jouer un rôle important pour prédire le retour à l’emploi des femmes ayant un cancer du sein. Cela justifie l’intérêt d’une prise en charge pluridisciplinaire du cancer et encourage l’émergence d’un modèle théorique du maintien en emploi, tenant compte à la fois des caractéristiques sociodémographiques, professionnelles, médicales, sociales, physiques et psychologiques des patientes. / Introduction : The breast cancer diagnosis, the symptoms and the side effects of the treatments, lead to multiple physical and psychological deficits that can have effects on the professional life. Indeed, with a median age of 63 years at the time of diagnosis, half of the women are still of working age. However, after the diagnosis, all women do not return to work. In order to explain this phenomenon, numerous studies have addressed the sociodemographic, occupational and medical determinants that impact the patients’ return to work ; but these factors alone are not sufficient to explain women's non-return to work. It appears that a number of psychosocial factors may also account for the return to work.Aims : The main objective of this study is to identify the main psychosocial determinants of the return to work of women with breast cancer during the year following the start of their adjuvant treatments. A secondary objective is to understand the impact of changes in these psychosocial determinants on the return to work.Method : We performed a longitudinal and prospective study of 68 patients with a mean age of 46.97 (SD = 6.92), employed at the time of diagnosis of breast cancer, recruited at the Montpellier Institut du Sein (MIS). The women were encountered during an initial measurement, by interindividual maintenance, at the beginning of adjuvant treatments (T0). Subsequently, they were followed by telephone at 3, 6 and 12 months after T0 (T1, T2 and T3, respectively). Socio-demographic, occupational and medical data, precariousness (EPICES score), neuroticism (Neo-PI r), quality of life (QLQ-C30), fatigue (MFI 20), post traumatic development social distress (SDI) and perceived social support (SSHSC) were assessed at T0. At T1, T2 and T3 we observed : being in a couple, providing or not supporting children's studies, collecting toxicities related to medical treatment and returning to work. At T2 and T3 we also assessed : quality of life, post-traumatic development, fatigue, social distress and perceived social support.Results : At T1, 50.0% of patients returned to work ; at T2, 60.7% were back to work ; at T3, 74.5% of them were back to work. Results of logistic regression analyzes indicate that a strong perception of negative support at T0, OR = 0.74 [0.56 - 0.97] and at T3, OR = 0.59 [0.39-0.90], a high sensation of physical fatigue at T3, OR = 0.55 [0.36 - 0.80] and high precariousness, OR = 0.94 [0.89 - 0.99] brake the return to work at T3. On the other hand, a good physical state at T0, OR = 1.17 [1.02 - 1.33] and a good cognitive state at T2, OR = 1.06 [1.01 - 1.11] are levers for returning to work at T3. Otherwise, we observed that overall good health, OR = 1.10 [1.001 - 1.20] and good cognitive status, OR = 1.08 [1.02 - 1.15] at T2, are levers for returning to work at the same time, while an increase in mental fatigue between T0 and T2 decreases the chances of returning to work at T2, OR = 0.13 [0.02 - 0.80]. Finally, the results of our study show that good overall health at T0 is a return to employment lever at T1, OR = 1.05 [1.01 - 1.10].Conclusion : Psychosocial determinants, including social support, precariousness, quality of life and fatigue, can play an important role in predicting the return to work of women with breast cancer. This confirms the interest of a multidisciplinary care of cancer and encourages the emergence of a theoretical model of the job retention, taking into account the socio-demographic, professional, medical, social, physical and psychological characteristics of the patients.

This dissertation focuses on 2 parts: 1) Whether evidence-based guidelines are recognized and integrated into clinical practice in primary care and 2) Whether a university course aimed at teaching physical therapists to identify and address evidence-based psychosocial factors in primary care might change practice behaviour and patient outcome. To this end practising clinicians were surveyed and a course for physical therapists was developed.Concerning the first part, we showed that a relatively large proportion of clinicians in primary care were unfamiliar with the content of evidence-based guidelines and/or with the concept of “Red flags”. Yet, concerning the self-reported practice behaviour, the majority indicated they followed the key points in the guidelines. To enhance the impact of guidelines, interventions or tactics for teaching and implementing guidelines should include interactive education,discussion, feedback, and reminders which in research have shown to enhance knowledge,skills and change behaviour. Furthermore, the clinical applicability of the guidelines needs to be further developed. We could also show that psychosocial factors were integrated up to a certain point and that physical therapists in primary care were well aware of the importance of psychosocial risk factors, but it seemed physical therapists lack specificity about which factors are important. Physical therapists may have heard about risk factors but probably did not have a clear model or structure about how these factors work.Concerning the second part, the results showed that we, by means of a university course, managed to change attitudes and beliefs, increase knowledge, skills and competencies towards a more biopsychosocial standpoint. But despite these changes, the results did not show a behavioural change on behalf of the physical therapists or a better outcome for patients at risk of longterm pain and disability. Several possible explanations for this are discussed. First, the content of the course should be changed so it focuses more on behavioural change on behalf of the physical therapists. This would facilitate implementation of new behaviour in clinical practice and increase the likelihood that the new behaviour is maintained and thereby the possibility of improved patient outcome. Second, treating patients at risk for long-term pain and disability may also be too difficult for a single physical therapist in a clinical setting. This would imply large changes in the way patients are directed through the health care system compared to now. The main tasks of the physical therapists in primary care would then be to select patients at risk for long-term pain and disability. They would then treat the patients not at risk and refer the patients at risk for long-term pain and disability to more suitable treatment, for example CBT treatment delivered by a psychologist or multimodal treatment delivered by a team of experts.Since risk patients experience most suffering and are the most costly for the health care system, it is important they get the appropriate treatment at the earliest possible opportunity.In summary, this dissertation shows that integrating psychosocial factors in physical therapy is not an easy task.