Este estudo teve como objetivo investigar os efeitos da intervenção aquática em crianças com características de Transtorno do Desenvolvimento da Coordenação (TDC). Mais especificamente, investigar estes efeitos no desempenho motor, nas atividades da vida diária (AVD´s) e nas atividades da vida escolar (AVE´s); e compará-los com os efeitos da intervenção terrestre. A amostra foi composta de 66 crianças estudantes do ensino fundamental (27 meninas e 39 meninos), entre 6 e 10 anos de idade. As crianças com características de TDC (N = 47) constituíram os grupos: controle (TDC-C; N=12), de intervenção aquática (TDC-A; N=19) e de intervenção terrestre (TDC-T; N=16). Foi formado também um grupo controle com crianças de desenvolvimento típico (DT-C; N=19). Os grupos experimentais foram submetidos a intervenções específicas (meio terrestre ou meio aquático) durante 4 meses, com três aulas semanais de 60 minutos de duração, totalizando 50 sessões. Ambas as intervenções abordaram três temas: Habilidades de Estabilização, Habilidades de Locomoção e Habilidades de Manipulação. A variável dependente desempenho motor (escore total do MABC2 e escore Z) foi avaliada em quatro pontos no tempo Pré-teste, Pós, 3m-Pós e 6m-Pós - enquanto as variáveis dependentes AVDs e AVEs em três pontos no tempo Pré-teste, Pós e 6m-Pós. Os resultados referentes ao escore total do MABC2 revelaram diferença entre os grupos TDC-T e TDC-C, favorável ao primeiro, e entre o Pré-teste e os demais tempos, sem distinção de grupo. Mas somente para os grupos experimentais (TDC-A e TDC-T) o tamanho dos efeitos entre os tempos foi de grande magnitude, o que confere significância funcional às intervenções. Por sua vez, a análise do escore Z revelou diferença entre o grupo TDC-C e os grupos TDC-A e TDC-T, seis meses após a finalização das intervenções. Este resultado mostra que somente o desempenho motor dos grupos experimentais se aproximou da referência para crianças de desenvolvimento típico. A análise dos escores totais do Questionário de Pais e do Questionário de Professores mostrou que as intervenções aquática e terrestre favoreceram as AVDs e as AVEs. Os resultados revelaram ainda, que não houve diferença significante entre os grupos experimentais (TDC-A e TDC-T) nas variáveis dependentes deste estudo. Estes resultados permitem concluir que: a) a intervenção aquática favorece o desempenho motor, as AVDs e as AVEs de crianças com características de TDC; e, b) esses efeitos favoráveis da intervenção aquática não diferem daqueles da intervenção terrestre. Em suma, pode-se concluir que a intervenção motora, independentemente do meio ambiente em que ocorre, aquático ou terrestre, é altamente recomendada para as crianças com características de TDC, pois possibilita desempenho semelhante ao de crianças com desenvolvimento típico. A partir destes resultados e conclusões, estudos futuros devem ser desenvolvidos com o objetivo, por exemplo, de investigar os efeitos da intervenção aquática em relação às habilidades especificas a cada uma das subseções do teste MABC2 / This study aimed to investigate the effects of the aquatic intervention in children with Developmental Coordination Disorder (DCD) characteristics. More specifically, to investigate these effects in motor performance, daily life activities (DLAs) and school life activities (SLAs), and compare them with terrestrial intervention effects. The sample consisted of 66 elementary school students (27 girls and 39 boys) aged between 6 and 10 years. Children having DCD characteristics (N = 47) constituted the groups: control (DCD-C; N = 12), aquatic intervention (DCD-A; N = 19) and terrestrial intervention (DCD-T; N = 16). A control group of children with typical development (TD-C; N = 19) was also formed. The experimental groups underwent specific intervention programs (terrestrial or aquatic) for four months, with three weekly classes lasting 60 minutes, totalling 50 sessions. Both programs addressed three themes: Stabilization skills, locomotor skills and manipulative skills. The dependent variable motor performance (MABC2 total score and Z score) was assessed at four points in time - Pre-test, Post, 3m-Post and 6m-Post - while the dependent variables DLAs and SLAs at three points in time - Pre-test, post and 6m-post. The results for the total MABC2 score revealed differences between DCD-T and DCD-C, favorable to the former and between the pre test and the other times, irrespective of group. But only for the experimental groups (DCD-A and DCD-T) the effect size between the times was large, which confers interventions functional significance. In turn, the Z-score analysis revealed difference between DCD-C group in relation to DCD-A and DCD-T groups six months after the completion of interventions. This result shows that only the experimental groups motor performance approached the typically developing children benchmark. The analysis of the Parent Questionnaire and the Teacher Questionnaire total scores showed that aquatic and terrestrial interventions favored DLAs and SLAs. The results also revealed that there was no significant difference between the experimental groups (DCD-A and DCD-T) in these study dependent variables. These results allow coming to the conclusion that: a) the aquatic intervention favors motor performance, the DLAs and the SLAs of the children with DCD characteristics; and, b) these favorable effects of aquatic intervention did not differ from those of terrestrial intervention. In short, it can be concluded that motor intervention, regardless of the environment in which it occurs, aquatic or terrestrial, is highly recommended for children with DCD characteristics, as it allows similar performance to that of children with typical development. From these results and conclusions, future studies should be developed with the aim, for example, to investigate the effects of aquatic intervention in relation to the specific skills of each of the MABC2 test subsections

Much research has studied cohesiveness within client groups in terms of making therapeutic gains. These studies have defined cohesiveness in terms of a) attraction of the group as perceived by a group member, b) how clearly each member sees his/her role within the group, and c) the effectiveness of one's skills in attaining group goals. Little research has dealt with the role of staff cohesiveness in developing an effective treatment program. Effectiveness, in this study, is defined as the degree to which clients are willing to disclose personal information to the staff. The results show a positive correlation between staff's perceived effectiveness with clients and the clients' willingness to self-disclose. On-hand experience with clients seems important in involving clients in therapy.

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Made available in DSpace on 2018-06-04T19:14:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-08-31 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: As intervenções baseadas em mindfulness podem ser efetivas para tratamento complementar das cefaleias primárias em populações socialmente vulneráveis. Este estudo com mulheres da maior favela do Ceará, no Nordeste do Brasil, verificou os efeitos de uma IBM em mulheres com cefaleia crônica sob risco social. Método: Estudo de eficácia preliminar, exploratório, quasi-experimental, de abordagem mista (quanti e qualitativa), que avaliou o impacto de uma IBM em mulheres usuárias do SUS com relação à incapacidade nas atividades da vida diária (Midas) decorrente da cefaleia crônica (desfecho primário), além de variáveis secundárias como nível de mindfulness, injustiça percebida e autocompaixão. Uma intervenção com acupuntura foi o grupo controle ativo. Resultados: O perfil das participantes foi: (44,5%) casadas; (51,3%) com até 2 filhos; (63,9%) nível fundamental; (53,8%) com renda de 1 a 2 salários-mínimos e (72,21%) com cefaleia crônica, sendo (63,3%) enxaqueca e (8,8%) cefaleia de tensão. A cefaleia está associada à baixa escolaridade, à baixa renda familiar (p<0,05) e a eventos emocionais negativos na vida. Nos autorrelatos, foram categorizados quatro determinantes sociais de saúde causadores de distress psicológico: papel social da mulher na comunidade; busca recorrente aos serviços de saúde; abuso de medicamentos e estratégias de enfrentamento disfuncionais. O distress psicológico estava na base das crises recorrentes de cefaleia. Na comparação dentro dos grupos IBM e acupuntura, IBM promoveu diminuição no nível da incapacidade da cefaleia indicado pelos autorrelatos, mas não por Midas; aumento da autocompaixão (p<0,05); aumento de do nível de mindfulness (p<0,05), enquanto que acupuntura promoveu diminuição apenas em Midas (p<0,05). Houve diminuição da injustiça percebida em ambos os grupos, mas não estatisticamente significante (p>0,05). Na comparação entre grupos, IBM apresentou níveis maiores de autocompaixão e de mindfulness que no grupo acupuntura, com diferença estatisticamente significante (p<0,05). Houve correlações estatisticamente significantes entre Midas e injustiça percebida (p<0,001) e Midas e mindfulness (p<0,05). No modelo de regressão, apenas injustiça percebida influenciou Midas (p<0,001), corroborando os autorrelatos que destacaram esse sentimento negativo na gênese da cefaleia. Considerações finais e Conclusão e: Esse é o primeiro estudo em nível internacional a avaliar os efeitos de uma IBM em população de mulheres com cefaleia crônica e vulneráveis socialmente, comparados com os da acupuntura. As duas intervenções foram efetivas para a redução da incapacidade da cefaleia, sendo que atuando através de mecanismos distintos. Os resultados sugerem que IBM influenciou positivamente a dor através de processos mentais e emocionais (controle atencional, consciência corporal e regulação emocional), o que não ocorreu em relação ao grupo acupuntura. Os efeitos da IBM e da acupuntura na cefaleia crônica das participantes demonstraram preliminar potencial eficácia de práticas mente-corpo em populações vulneráveis socioeconomicamente. / Introduction: Mindfulness-based interventions may be effective for complementary management of primary headaches in socially vulnerable populations. This study with women from the largest favela in Ceará, Northeast Brazil, verified the effects of an IBM in women with chronic headache at social risk. Method: Preliminary, exploratory, quasi-experimental, mixed-approach (quantitative and qualitative) efficacy study evaluating the impact of an IBM on women users of SUS in relation to the disability in daily life activities (Midas) due to chronic headache (Primary outcome), as well as secondary variables such as level of mindfulness, perceived injustice and self-pity. One intervention with acupuncture was the active control group. Results: The participants' profile was: (44.5%) married; (51.3%) with up to 2 children; (63.9%) fundamental level; (53.8%) with income of 1 to 2 minimum wages and (72.21%) with chronic headache, being (63.3%) migraine and (8.8%) tension headache. Headache is associated with low schooling, low family income (p <0.05) and negative emotional events in life. In the self-reports, four social determinants of health that caused psychological distress were categorized: the social role of women in the community; Recurrent search for health services; Drug abuse and dysfunctional coping strategies. Psychological distress was at the basis of recurrent headache crises In the comparison within the IBM groups and acupuncture, IBM promoted a decrease in the level of headache inability indicated by self-reported but not by Midas; Increased self-pity (p <0.05); Increased level of mindfulness (p <0.05), whereas acupuncture promoted a decrease only in Midas (p <0.05). There was a decrease in perceived injustice in both groups, but not statistically significant (p> 0.05). In the comparison between groups, IBM presented higher levels of self-pity and mindfulness than in the acupuncture group, with a statistically significant difference (p <0.05). There were statistically significant correlations between Midas and perceived injustice (p <0.001) and Midas and mindfulness (p <0.05). In the regression model, only perceived injustice influenced Midas (p <0.001), corroborating the self-reports that highlighted this negative feeling in the genesis of headache. Final considerations and conclusions: This is the first international study to evaluate the effects of an IBM on a population of women with chronic and socially vulnerable headache compared to acupuncture. The two interventions were effective in reducing the incapacity of headache, and acting through different mechanisms. The results suggest that IBM positively influenced pain through mental and emotional processes (attention control, body awareness and emotional regulation), which did not occur in relation to the acupuncture group. The effects of IBM and acupuncture on chronic headache of the participants demonstrated preliminary potential efficacy of mind-body practices in socioeconomically vulnerable populations. / BV UNIFESP: Teses e dissertações

La douleur chronique non cancéreuse (DCNC) est un phénomène complexe et des interventions multimodales qui abordent à la fois ses dimensions biologiques et psychosociales sont considérées comme l’approche optimale pour traiter ce type de désordre. La prescription d'opioïdes pour la DCNC a augmenté d’une façon fulgurante au cours des deux dernières décennies, mais les preuves supportant l'efficacité à long terme de ce type de médicament en termes de réduction de la sévérité de la douleur et d’amélioration de la qualité de vie des patients souffrant de DCNC sont manquantes. L'objectif de cette étude était d'investiguer dans un contexte de vraie vie l'efficacité à long terme des opioïdes pour réduire l’intensité et l’impact de la douleur et améliorer la qualité de vie reliée à la santé des patients souffrant de DCNC sur une période d’une année. Méthodes: Les participants à cette étude étaient 1490 patients (âge moyen = 52,37 (écart-type = 13,9); femmes = 60,9%) enrôlés dans le Registre Québec Douleur entre octobre 2008 et Avril 2011 et qui ont complété une série de questionnaires avant d'initier un traitement dans un centre multidisciplinaire tertiaire de gestion de la douleur ainsi qu’à 6 et 12 mois plus tard. Selon leur profil d'utilisation d'opioïdes (PUO), les patients ont été classés en 1) non-utilisateurs, 2) utilisateurs non persistants, et 3) utilisateurs persistants. Les données ont été analysées à l'aide du modèle d'équation d'estimation généralisée. Résultats: Chez les utilisateurs d’opioïdes, 52% en ont cessé la prise à un moment ou à un autre pendant la période de suivi. Après ajustement pour l'âge et le sexe, le PUO a prédit d’une manière significative l’intensité de la douleur ressentie en moyenne sur des périodes de 7 jours (p <0,001) ainsi que la qualité de vie physique (pQDV) dans le temps (p <0,001). Comparés aux non-utilisateurs, les utilisateurs persistants avaient des niveaux significativement plus élevés d'intensité de douleur et une moins bonne pQDV. Une interaction significative a été trouvée entre le PUO et le temps dans la prédiction de l’intensité de douleur ressentie à son maximum (p = 0,001), les utilisateurs persistants sont ceux rapportant les scores les plus élevés à travers le temps. Une interaction significative a aussi été observée entre le PUO et le type de douleur dans la prédiction de l'impact de la douleur dans diverses sphères de la vie quotidienne (p = 0,048) et de la mQDV (p = 0,042). Indépendamment du type de douleur, les utilisateurs persistants ont rapporté des scores plus élevés d'interférence de douleur ainsi qu’une moins bonne mQDV par rapport aux non-utilisateurs. Cependant, la magnitude de ces effets était de petite taille (d de Cohen <0,5), une observation qui remet en question la puissance et la signification clinique des différences observées entre ces groupes. Conclusion: Nos résultats contribuent à maintenir les doutes sur l'efficacité d’une thérapie à long terme à base d’opioïdes et remettent ainsi en question le rôle que peut jouer ce type de médicament dans l'arsenal thérapeutique pour la gestion de la DCNC. / Chronic non-cancer pain (CNCP) is a complex phenomenon and multimodal interventions that address both its biological and psychosocial dimensions are considered as the optimal approach for treating this type of disorder. Prescription of opioids for CNCP has dramatically increased over the past two decades but little is known about the long-term effectiveness of this type of medication for reducing pain severity and improving quality of life of CNCP patients. The objective of the present study was to investigate in a real life context the long-term effectiveness of opioids for reducing pain intensity and interference, and improving health-related quality of life in patients with CNCP over a one-year period. Methods: Participants were 1,490 patients (mean age = 52.37 (SD = 13.9); female = 60.9%) enrolled in the Quebec Pain Registry between October 2008 and April 2011 who completed a series of questionnaires before initiating treatment at a tertiary multidisciplinary pain management facility as well as 6 and 12 months thereafter. Based on their opioid use profile (OUP), patients were categorized into 1) non users, 2) non-persistent users, and 3) persistent users. Data were analyzed using generalized estimating equation models. Results: Among the users of opioids, 52% stopped taking them during the follow-up period. After adjusting for age and sex, patients’ OUP significantly predicted pain intensity felt during 7-day periods (p < 0.001) and physical quality of life (pQOL) over time p < 0.001). Compared to non-users, persistent users had significantly higher levels of pain intensity and poorer pQOL. A significant interaction was found between patients’ OUP and time in the prediction of worst pain intensity (p = 0.001) but the persistent users reported the highest pain scores across time. A significant interaction was also observed between patients’ OUP and type of pain in the prediction of pain interference (p = 0.048) and mental quality of life (mQOL) (p = 0.042). Irrespective of the type of pain they suffered, persistent users reported higher pain interference scores and lower mQOL compared to non users. However, all effect sizes were small (Cohen’s d < 0.5), thus questioning the power and clinical significance of these group differences. Conclusion: These results contribute to the debate by adding evidences on the effectiveness of long term opioid therapy and question the role this type of medication should play in the therapeutic arsenal for managing CNCP.

Background: Improved clinical effectiveness and therefore positive modification of multiple sclerosis (MS) with basic therapy can be achieved by long-term regular intake of drugs as prescribed but investigations have shown that a high percentage of patients do not take their medications as prescribed. Objectives: We assessed the satisfaction and adherence of patients with MS with their current disease-modifying treatment under clinical practice conditions. We compared different facets of satisfaction as well as their internal relationship and identified predictors in an exploratory manner. Methods: Therapy satisfaction in patients with relapsing–remitting multiple sclerosis (THEPAMS) was a noninterventional, prospective cross-sectional study performed throughout Germany in 2013 and 2014, and included patients with clinically isolated syndrome or relapsing–remitting MS. We applied a standardized approach to document satisfaction and adherence by patient-reported outcomes (Treatment Satisfaction Questionnaire for Medication) as well as by physician ratings. Results: Of 3312 patients with a mean age of 43.7 years, 73.3% were women and the mean level of disability according to the Expanded Disability Status Scale was 2.29; 13.3% did not receive any medication at the time of documentation, 21.3% received interferon β1a intramuscularly, 20.7% had interferon β1a subcutaneously, 17.0% had interferon β1b subcutaneously and 23.7% had glatiramer acetate. Adherence rates varied between 60% (lifetime) and 96.5% (current medication). Differences between current medications were found for side effects and convenience scores but not for effectiveness, satisfaction and adherence. Higher global satisfaction and effectiveness were associated with fewer relapses, longer duration of medication, lower disability score and the absence of several side effects. Conclusion: In a connected model of patient satisfaction, effectiveness, side effects, convenience and adherence, patients’ individual needs and concerns have to be addressed. Most differences were found with respect to side effects and convenience of treatment. Therefore, an improvement in these two domains seems to be the most promising proximate approach to elevate adherence levels.

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The objectives of this study were to provide a detailed biopsychosocial description of the characteristics of a sample of 100 individuals screened and referred by the National Responsible Gaming Programme helpline for their outpatient treatment programme over an eighteen month period, and, importantly, to measure the success of this specific treatment programme at set intervals, up to a one year follow-up period. While 80% of the sample did not relapse during the six-week treatment programme, the number of treatment seekers without any gambling relapses during each follow-up period declined, and those falling back into gambling increased as time went on. After one year 47% of treatment seekers managed not to revert back to gambling &#8211; total abstinence. A further 28% reported having relapsed once or twice or that their gambling was controlled. 25% of treatment seekers reported that they reverted back to gambling fulltime which leaves the success rate of the treatment at 75%. Treatment seekers reported an overall reduction in gambling participation, debt and expenditure and an overall improvement in social and vocational functioning. There is evidence in this study to support the perspective that pathological gambling is a multidimensional disorder and that certain sub-groups of gamblers have distinct gambling behaviour. / Psychology / M.Soc.Sc.

The objectives of this study were to provide a detailed biopsychosocial description of the characteristics of a sample of 100 individuals screened and referred by the National Responsible Gaming Programme helpline for their outpatient treatment programme over an eighteen month period, and, importantly, to measure the success of this specific treatment programme at set intervals, up to a one year follow-up period. While 80% of the sample did not relapse during the six-week treatment programme, the number of treatment seekers without any gambling relapses during each follow-up period declined, and those falling back into gambling increased as time went on. After one year 47% of treatment seekers managed not to revert back to gambling &#8211; total abstinence. A further 28% reported having relapsed once or twice or that their gambling was controlled. 25% of treatment seekers reported that they reverted back to gambling fulltime which leaves the success rate of the treatment at 75%. Treatment seekers reported an overall reduction in gambling participation, debt and expenditure and an overall improvement in social and vocational functioning. There is evidence in this study to support the perspective that pathological gambling is a multidimensional disorder and that certain sub-groups of gamblers have distinct gambling behaviour. / Psychology / M.Soc.Sc.

The purpose of this study was to compare and measure the long term effectiveness of the rehabilitative day treatment program at San Bernardino County's Department of Mental Health. This current study was completed in 2005 and is a follow up study tracking the long term effectiveness of the program.