The Community Mental Health Act of 1963 launched the deinstitutionalization movement, whereby individuals with serious mental illnesses were released from psychiatric hospitals and began living and receiving mental health care in the community (Carling, 1995). However, these actions have not necessarily integrated those individuals into all aspects of community life (Dewees, Pulice, & McCormick, 1996). This is unfortunate because people with serious mental illnesses frequently report that community integration is not only important to them, but that it also aids in reducing symptoms and promoting recovery (Townley, 2015). Although past research suggests that receiving mental health care in the community has a positive impact on symptom management, the influence of other community factors (e.g., sense of community, community participation) has yet to be fully explored (Segal, Silverman, & Temkin, 2010). Furthermore, there is lack of understanding as to how these community factors influence other aspects of recovery, such as mental and physical health. As such, the goal of the current study is to better understand the association between community participation and recovery by investigating sense of community as a potential mediating factor between community participation, psychological distress, mental health, and physical health. Data were collected from 300 adults with serious mental illnesses utilizing community mental health services in the United States. Results indicated that sense of community partially mediated the association between community participation and mental health, as well as psychological distress, and fully mediated the association between community participation and physical health. Implications include contributing to the current knowledge base about the role of community factors in recovery and informing future interventions aimed at promoting community integration of adults with serious mental illnesses.

Although 1 in 5 Americans will experience a mental illness at some point, each year people with mental illnesses continue to face high levels of stigmatization and discrimination at work. Recognizing this, many organizational researchers and practitioners have sought to improve workplaces for employees with mental illness through a variety of organizational interventions. Unfortunately, few interventions are thoroughly evaluated. One barrier to evaluating such interventions is the lack of a theoretically meaningful measure of workplace mental illness stigma. In this dissertation, I proposed to develop and evaluate such a measure (the W-MISS) based on Jones, Farina, Hastorf, Markus, Miller, and Scott's (1984) six-dimension stigma framework (i.e., concealability, course, disruptiveness, aesthetics, origin, and peril). To do so, I used Hinkin's (1998) approach: Phase 1) item generation was completed by 8 subject matter experts; Phase 2) content validity evidence was provided by 47 adults with management experience and 7 subject matter experts; Phase 3) exploratory factor analysis was conducted based on responses from 300 adults with management experience; Phase 4) confirmatory factor analysis was conducted based on responses from 200 adults with management experience; Phase 5) convergent and discriminant validity evidence was provided by 101 adults with management experience; and Phase 6) predictive validity evidence with regard to hiring discrimination was provided by 365 adults with management experience. Overall, the results supported the hypothesized factorial structure, convergent and discriminant validity, and predictive utility of the W-MISS. Findings provide empirical support for Jones et al.'s (1984) theoretical stigma framework in a workplace context for mental illness and represent the first comprehensive measure development drawing on these dimensions for any stigmatized identity in a workplace context. Further, results demonstrate the potential for scholarly and practical utility of such a measure.

Cette thèse visait à contribuer aux connaissances sur les différenciations sociales des comportements de santé en France et à une meilleure compréhension des mécanismes sous-jacents à ces différenciations. Nous nous sommes plus particulièrement intéressés au rôle de certains facteurs sociocognitifs (perceptions, croyances…) inspirés de théories issues de la sociologie du risque et de la déviance. En utilisant les données des enquêtes Baromètre cancer 2010 et Baromètre santé 2016, nos travaux ont porté sur des comportements relatifs à la prévention primaire de certains cancers (consommation d’alcool et protection solaire) et des maladies infectieuses (vaccinations infantiles). Un faible statut socio-économique était associé à une relativisation accrue du risque de cancer lié à la consommation d’alcool et à des connaissances et croyances vis-à-vis du risque solaire plus éloignées du « savoir expert ». Ces derniers facteurs expliquaient en partie la moindre utilisation des moyens de protection solaire chez les personnes ayant un faible statut socio-économique. Dans le domaine de la vaccination, nous avons constaté une prévalence plus élevée de l’hésitation vaccinale chez les parents ayant un niveau de diplôme supérieur ou égal au baccalauréat. Cette association s’expliquait en partie par le fait que les parents diplômés avaient un moindre niveau de confiance dans les autorités et la médecine conventionnelle et un degré d’implication dans les décisions de santé accru. Ces résultats fournissent des pistes pour conduire des actions de promotion de la santé tenant compte du contexte social dans lequel sont inscrits les comportements des individus, plus efficaces et équitables. / This thesis aimed to contribute to current scientific knowledge about the social differentiation of health behaviours in France and to a better understanding of the mechanisms underlying this differentiation. We focused on the role of specific sociocognitive factors (perceptions and beliefs) based on theories derived from the sociology of risk and the sociology of deviance. This work used data from the 2010 Baromètre cancer survey and the 2016 Baromètre santé survey to examine health behaviours related to primary prevention of some cancers (alcohol consumption and sun protection) and infectious diseases (childhood vaccinations). People of low socioeconomic status were more prone to relativize the alcohol-related risks of cancer and to have substantially less knowledge about sun health and more “false beliefs” about sun protection than people of high socioeconomic status. This knowledge and these false beliefs were significant mediators of the positive association between socioeconomic status and sun-protection behaviours. In the field of vaccination, we found a higher prevalence of vaccine hesitancy among parents who had at least passed the “bac”. This association was partly explained by their lower level of trust in health authorities and mainstream medicine than among the least educated group and by their greater commitment to making “good” health-related decisions. From a public health perspective, these results furnish avenues for designing health promotion interventions that take into account the social context in which people’s health behaviours are embedded to improve both effectiveness and equity.

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease that attacks the motor system and contributes to a range of cognitive and behavioral impairments (e.g., behavioral and emotional disinhibition, planning and problem solving difficulties, impulsivity, attention, and personality change). This executive dysfunction may contribute to selfregulatory impairment across several domains, including cognitive skills, thought processes, emotion regulation, interpersonal skills, and physiology, that may be crucial to the quality of life (QOL), or well being, of patients and their caregivers. Given the relentless course and prognosis of ALS, palliative treatments for ALS should target the full range of self-regulatory deficits. Thirty-seven patient-caregiver pairs completed questionnaires regarding the patients’ ability to regulate emotions, social behavior, and thought patterns. Patients also completed neuropsychological measures of executive functions and provided measures of glycosylated hemoglobin (A1c) and heart rate variability (HRV). Results suggest that SR and EF deficits exist on a continuum in ALS, such that some patients evidence adequate or superior ability to self-regulate while others evidence deficits. Patient- caregiver agreement about patients’ selfregulatory capacity across domains was generally weak to moderate. Patients perceived themselves to have less capacity for global regulation than caregivers perceived them to have, patients perceived less dyadic cohesion than caregivers, and patients perceived themselves to ruminate more than caregivers indicated. Overall, caregivers tended to perceive a more pervasive pattern of deficits compared to patients. Additionally, measures of SR and EF were not strongly inter-correlated in general, challenging the idea that SR in different domains depends on a common resource. Accordingly, correlations among measures of theoretically similar constructs (i.e., EF and SR) were small to moderate in magnitude and non-significant. With regard to physiological functioning, when patients had better regulated glucose (A1c), patients and caregivers perceived better global regulation. A similar pattern emerged with patient ratings, with higher baseline HRV linked to less emotional lability. Last, mixed results were obtained when predicting patient and caregiver QOL. Less rumination, less dyadic cohesion and more social anxiety were associated with higher QOL for patients. Caregivers’ QOL was not significantly related to their perceptions of patients’ self-regulatory capacity in any area.

<p> Coping with chronic illness often takes place within the context of the marital relationship. Among married couples, collaborative efforts to cope with one partner's chronic health condition have been linked to a range of positive outcomes, including better disease management among patients and greater emotional and interpersonal adjustment among patients and their spouses. Theory suggests that dyadic forms of coping with disease, such as collaboration, may be more beneficial when they are consistent with, or match, partners' appraisal of who is responsible (couple vs. patient) for managing the patient's disease. Very few studies, however, have examined this possibility. The current study of couples coping with one partner's diabetes addressed this research gap by investigating whether disease-related collaboration was more strongly related to better adjustment among partners who view diabetes management as their shared responsibility compared to those who view diabetes management as the patient's responsibility alone. Three major areas of adjustment were examined: 1) patients' disease management; 2) patients' and spouses' emotional well-being; and 3) patients' and spouses' relationship quality. Participants were 126 married couples in which one partner (the patient) was at least 55 years old and had been diagnosed with type 2 diabetes for at least one year and the other partner (the spouse) did not have diabetes. Patients and spouses separately completed a baseline interview and 24-day electronic daily diary. Predictor variables were derived from interviews; outcome variables were derived from daily diary records, and daily assessments of outcomes were aggregated across the entire diary period. Study hypotheses were tested using regression analysis and dyadic multilevel modeling. Results indicated that disease-related collaboration was linked to more positive psychosocial outcomes among patients in "shared responsibility" couples compared to patients "patient responsibility" couples. In contrast, collaboration had mixed associations with spouses' psychosocial outcomes, and none of these associations depended on partners' appraisal of responsibility for diabetes management. Overall, findings suggest that match between partners' collaborative efforts to cope with diabetes and their appraisal of disease management is important for the daily psychosocial adjustment of patients, but not for that of spouses. Implications for theory and intervention are discussed.</p>

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No. of bitstreams: 1 dissertacao_LFerreira Final Ficha Aprovação 01062016.pdf: 2009019 bytes, checksum: 64380d068659809b6ebe280b45cf37d6 (MD5) Previous issue date: 2015-12-23 / From 2012, the State Government of Rio de Janeiro through the State Health Department began to adopt the management model based on Health Social Organizations (OSS) in order to improve the services provided by health units under their responsibility, ie, extend the service coverage, improve performance and reduce costs. Since June 2014, 80% of State Health Units were already managed by social organizations. The OSS model was created in order to publicize services of public relevance, previously provided by the state, but which are now considered not unique to it, in order to achieve greater efficiency. In this context, the present study aims to analyze the performance of the services provided through the OSS contracted by the State of Rio de Janeiro (RJ). For such a contextualization about the process of implementation and monitoring of management contracts in the State Department of Health of Rio de Janeiro was carried out and documentary research to the study of quantitative and qualitative indicators agreed and the cost of resources used, resulting in the preparation of technical specifications of all management contracts. The analyzes have focused on the development of quantitative indicators of management contracts in 2012 to the 1st half of 2015 as well as the performance measured by the correlation of productivity results based on quantitative indicators. The results show that 80% of Emergency Hospitals management contracts, 75% of the Specialized Hospitals and 92% of the Emergency Care Units meet or exceed the level of performance expected by SES for compliance of the Hospital Production in the year 2015, with increasing the supply of specialized services based on OS. As for the performance indicator Auxiliary Diagnosis and Therapy Services Production results are 60% for Emergency Hospitals and 25% for Specialized Hospitals. One of the possible conclusions and it is for the SES / RJ, improve its regulatory function with the effective utilization of the historical series of information for the construction of indicators compatible with the profile of their units. As a suggestion for future studies, points to the possibility of performing the measurement of the efficiency of the ERJ management contracts using data envelopment technical data that correlates a larger number of qualitative indicators for verification efficiency. / A partir de 2012, o Governo Estadual do Rio de Janeiro através da Secretaria de Estado de Saúde passou a adotar o modelo de gestão com base em Organizações Sociais de Saúde (OSS), a fim de melhorar os serviços prestados pelas Unidades de Saúde sob sua responsabilidade, ou seja, ampliar a cobertura de atendimento, melhorar o desempenho e reduzir custos. Desde junho de 2014, 80% das Unidades Estaduais de Saúde já eram gerenciadas por Organizações Sociais. O modelo de OSS foi criado com o intuito de publicizar serviços de relevância pública, até então prestados pelo Estado, mas que passaram a ser considerados não exclusivos do mesmo, a fim de alcançar maior eficiência. Nesse contexto, a presente pesquisa tem o objetivo de analisar o desempenho dos serviços prestados através das OSS contratualizadas pelo Estado do Rio de Janeiro (ERJ). Para tanto foi realizada uma contextualização sobre o processo de implementação e acompanhamento dos contratos de gestão na Secretaria de Estado de Saúde do Rio de Janeiro, bem como uma pesquisa documental com o levantamento dos indicadores quantitativos e qualitativos pactuados e os recursos de custeio utilizados, resultando na elaboração de ficha técnica de todos os contratos de gestão. As análises tiveram como foco a evolução dos indicadores quantitativos dos contratos de gestão no ano de 2012 até o 1º semestre de 2015, bem como o desempenho medido pela correlação de resultados de produtividade obtidos com base em indicadores quantitativos. Os resultados encontrados mostram que 80 % dos contratos de gestão de Hospitais Emergência, 75 % dos Hospitais Especializados e 92 % das Unidades de Pronto Atendimento atingem ou superam o grau de desempenho esperado pela SES quanto ao cumprimento do indicador Produção Hospitalar no ano de 2015, com ampliação da oferta de serviços especializados através das OS. Já para o cumprimento do indicador Produção Serviços Auxiliares de Diagnose e Terapia os resultados são 60 % para Hospitais Emergência e 25 % para Hospitais Especializados. Uma das conclusões possíveis e que cabe à SES/RJ, aprimorar sua função regulatória com a efetiva utilização da serie histórica de informações para a construção de indicadores compatíveis com o perfil das suas Unidades. Como sugestão para futuros estudos, aponta-se a possibilidade de realizar a mensuração da eficiência dos contratos de gestão do ERJ através da técnica envoltória de dados que correlaciona um número maior de indicadores qualitativos para verificação da eficiência.

The aim of this diploma thesis is to deal with the issue of both mental and social health in relation to the circadian rhythm. This work was created at the same time as a project GAJU no. 101/2011/S. "The Psychosocial and Somatic Indicators in Comparison to the Circadian Rhythm". In the theoretic part of this work the issue of the mental and social health is solved as well as the definition and characterization of the pubescent period is given here. The matter of the circadian and diurnal rhythms is explicated here as well. In the experimental part there is a questionnaire research involving 250 pubescents (125 girls, 125 boys). The age of the pubescents ranged from 11 up to 13 years. The average age for both of the sexes was 13 years. The data capture was proceeding from May 2011 till February 2012. For this purpose the method of two standardized questionnaires was used. The questions from the social sphere originated from the questionnaire called The Quality of Life, Cummins (1997) ComQol S5. The questions solving the issue of the circadian rhythms were chosen from the questionnaire called The Circadian Typology CIT, Harada, Krejčí (2012). The gained data were evaluated by the means of the basic statistic methods and reciprocal correlation. On the basis of results I concluded that some data are correlated with social and mental health, strongly affecting the concept and the importance of sleeping. At the beginning of this work 5 hypothesis were provided. Three of them were confirmed by data analyze.

According to Wilkinson and Marmot (2003), the area of ten social health determinants constitutes probably the most comprehensive approach to analysis to the individual's health condition. The goal of the dissertation consisted in assessing the social health determinants in the area of social support, stress, childhood and transportation. The quantitative investigation method of the research subject was implemented through questioning. The research set consisted of legally settled immigrants, living in the Czech Republic for more than one year, in age category of 18-65 years, of Vietnamese, Mongolian and Ukrainian nationality. The respondents lived in selected localities: capital of Prague, South Bohemian Region and Vysočina Region. 246 respondents in total were questioned. The investigation results show that Ukrainians perceive the Czech Republic as their home state more frequently than the Vietnamese and Mongolians. Relationship between selected characteristics of social support, subjective assessment of health, presence of depression and stress symptoms of psychic and physical origin was proved. The ability to communicate in Czech language was shown to be very important in the area of social support. One tenth of the respondents is daily exposed to effect of stress. The Mongolians reported most frequent exposure to stress situations, while the Ukrainians reported least frequent exposure. The most respondents have signs of depression. The respondents who have medium, serious or extreme depression assessed their health with higher statistically significant frequency as mediocre. More exacting movement activities are performed with higher statistically significant frequency by men, university graduates and intellectually working respondents. The immigrants who have reported to perform regular walking and movement activities assess their health as good and report absence of signs of depression. During pregnancy, the female respondents observed regular examinations and the course of their pregnancy was predominantly physiological. A high percentage of female respondents worked 9 and more hours during pregnancy. The health condition of the respondents' youngest children is good; most of them have suffered only common children's diseases. More than one tenth of the respondents' children have no health insurance and vaccination. The immigrants often find themselves in adverse social situation, and it is therefore important to adopt measures to eliminate its impacts. The crucial measures include for example social programs focused on immigrants, preventive programs focused on foreigners' children and increasing language knowledge of the immigrants.

The purpose of this PhD was to explore the psycho-social health (PSH) and well-being (WB) of Great Britain's (GB) Wheelchair Basketball (WhB) players over time, starting from when they became disabled and culminating in the London 2012 Paralympic Games. The sample comprised 16 players (8 male, 8 female) and 4 coaches. They were interviewed on three occasions - 2 years before, within a year of and a year after London. Observations spanned this period, whilst data was also collected via two visual methods: auto-photography (AP) and timelining. All data was analysed using a thematic analytical approach. First the challenges to PSH and WB of being disabled are discussed, with the diversity of experience highlighted. Secondly in exploring the role of spinal units and story-tellers in initiating players into sport, a lottery which risked their PSH and WB is exposed. Whilst copious benefits of recreational disability sport are described, being a GB WhB player is revealed as an extreme health rollercoaster. Just as being a Paralympian offers perks and privileges, so too does it risk players becoming obsessed. Performance and health are shown to be uniquely related and yet not always simultaneously achievable. Finally, from the pride of wearing the jersey and competing at a home Paralympics, to shattered dreams and unfulfilled ambitions, London 2012 is relived. The research concludes that creating a 'Healthy Paralympian' is a challenging task and yet winning formula. Recommendations are made to realise this aim, whilst those which have already been adopted by GB WhB are also shared.

Made available in DSpace on 2014-06-11T19:29:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-03-11Bitstream added on 2014-06-13T20:18:49Z : No. of bitstreams: 1 devera_d_me_assis.pdf: 483753 bytes, checksum: 32b688498419268d6582212515b28515 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A história da construção da Reforma Psiquiátrica no Brasil elucida o processo de implantação dos serviços extra-hospitalares, substitutivos ao modelo hospitalocêntrico. A presente pesquisa realizou um levantamento de iniciativas das gestões municipais e estadual no interior do Estado de São Paulo, objetivando visualizar a implantação e construção dos programas de Saúde Mental, propiciando dados que permitem analisar a matiz das possíveis mudanças paradigmáticas, levando em conta também que este lócus necessitava de uma leitura sistematizada de suas transformações e possíveis contribuições à Reforma Psiquiátrica no Brasil. O estudo teve como balizador as diretrizes preconizadas nas Conferências Nacionais de Saúde Mental e portarias ministeriais refletidas nas experiências e práticas do interior do Estado de São Paulo, analisadas em referência aos paradigmas Psiquiátricos e Psicossocial (Amarante, 1966 e Costa-Rosa, 2000). Foi possível verificar que a Reforma Psiquiátrica encontrada, tanto nos discursos dos gestores municipais quanto nos dados quantitativos, referentes à natureza dos dispositivos implantados, evidencia uma compreensão do processo de transformação, num sentido amplo do termo Reforma, mais próximo do modelo preventivo-comunitário, do que do ponto de vista de um movimento substitutivo das práticas hospitalocêntricas, quando consideramos como parâmetro de análise o Paradigma Psicossocial. O banco de dados possibilitará o desenvolvimento de futuras pesquisas sobre as mudanças do setor de Saúde Mental no interior do Estado de São Paulo, bem como a análise de outras vicissitudes presentes no processo de construção das práticas substitutivas ao Paradigma Psiquiátrico (hospitalocêntrico e asilar), neste contexto. / In Brazil, the process of implementation of out-of-hospital services is explained by the evolvement of the Psychiatric Reform that replaced the hospital-centered model. This study surveyed the actions of municipal and state governments in the area of mental health in the countryside of Sao Paulo State, Brazil. This paper aims at pointing out the implementation and the planning process of such Mental Health Programs while providing data to allow a deeper analysis of the generating factors of changes and pinpointing contributing factors to the Psychiatric Reform in Brazil. This study took into account the guidelines proposed by the National Conferences on Mental Health and government decrees reflecting the practices and experience in the countryside of Sao Paulo State analyzed from the psychiatric and psychosocial paradigm standpoint (Amarante, 1966 & Costa Rosa 2000). It was possible to conclude that the headways of the Psychiatric Reform in Brazil found in municipal managing policies and confirmed by quantitative data shows a better understanding of the transformation process leading to the proposal of a model which is closer to community prevention rather than a replacement for the hospital-centered practice. The databank may allow both further research work on the changes occurred in the area of Mental Health in the countryside of Sao Paulo State and further analysis of other issues involved in the process of constructing of new practices to replace the Psychiatric Paradigm (hospital-centered or asylum)