Understanding underlying mechanisms and pathways that lead to chronic homelessness would help develop intervention strategies that could help prevent subsequent episodes of homelessness. Quantitative data for this cross-sectional study was gathered by interviewing individuals who were homeless in the State of Arkansas, using a structured survey between 2007 and 2011. Qualitative data was gathered using semi-structured interviews between 2016 and 2018. Chi-square statistics and a multivariate logistic regression model was used to analyze the quantitative data, while phenomenological methods were used to analyze the qualitative data. Nearly half of the study participants identified themselves as being chronically homeless. Chronically homeless adults in this region were significantly more likely to be older men with no family ties, more likely to be victims of domestic violence, have higher rates of physical health problems, and have alcohol and substance abuse problems. Results from the multivariate nominal regression revealed that individuals who reported themselves as chronically homeless were more likely to be in the 50 years or older age group. In addition, study findings highlighted a dynamic interplay between three biopsychosocial risk factors for homelessness. Fostering development of inclusive sustainable communities, intergenerational relationships, and shared housing practices could help ease such social inequities and prevent problems such as chronic homelessness in older homeless adults.

This study aimed to assess the impact of an Mindfulness-based stress reduction (MBSR) intervention in a program serving women who survived Intimate partner violence (IPV). The biopsychosocial model, formulated by Engel, was the theoretical basis of this study. The impact of the MBSR intervention was assessed by qualitatively evaluating researcher notes and 5 participants' journals and reflections, and quantitatively evaluating 16 participants' self-reported stress, mindfulness, well-being, and optimism before and after the intervention. The themes that emerged from the qualitative data included participants' feelings of relaxation or balance, improved self-awareness, mindfulness exercises becoming easier over time, and improved intentionality. The Kentucky Inventory of Mindfulness Skills (KIMS) self-report inventory was used to assess participants' mindfulness. The KIMS instrument is composed of four subscales: observe, describe, act, and accept. There were significant improvements in the describe and accept dimensions of mindfulness from pretest to posttest, after Bonferroni adjustment. The subscale describe measures how well the participants report being able to describe, identify, or observe mental phenomena in a nonjudgmental manner. There were no significant differences from pre to posttest on stress, well-being, and optimism, a non-equivalent dependent variable not expected to change as a result of the intervention, as optimism is presumed to be a stable personality trait. This study may provide a valuable link to the development of coping and treatment strategies for IPV survivors that can be integrated into therapy programs and individual treatment.

No description available.

Ce travail de thèse trouve son origine dans une intervention menée auprès du collectif d’ergothérapeutes du centre de rééducation François Gallouedec. Il prend pour objet les dilemmes de métier de ces professionnels lorsqu’ils sont confrontés à la question du travail des patients. L’intervention s’est déployée en suivant une méthodologie développementale propre à la clinique de l’activité. Elle a permis aux ergothérapeutes de prendre pour objet d’analyse leur propre travail lors de programmes de restauration fonctionnelle. La littérature sur ces programmes confirme le choix de s’intéresser aux ergothérapeutes comme principaux destinataires des questions professionnelles des patients. Cependant, les recherches dans le domaine tendent à éluder la question du travail des professionnels de santé et à résumer celui des patients au simple retour à l’emploi.C’est justement pourquoi il nous a semblé intéressant de renverser la question en nous intéressant au travail de ceux qui s’intéressent au travail. Nous avons émis l’hypothèse que ce point difficile confrontait les ergothérapeutes du centre François Gallouedec à des dilemmes de métier notamment lors de la réalisation d’un « atelier geste professionnel ». Les résultats de cette recherche montrent toute l’importance de s’intéresser au travail des professionnels de santé, ce qui est fait mais aussi ce qui n’est pas fait ou ce qu’on aurait voulu faire, pour le développement des modèles de prise en charge des patients. Le réel du travail des rééducateurs peut ainsi devenir une ressource dans la mise en place de programmes de rééducation qui souhaitent s’intéresser à la question du travail du patient. / This thesis work originated in an intervention conducted with the collective of occupational therapists of the rehabilitation center François Gallouedec. It focuses on the job dilemmas of these professionals when confronted with the issue of patient’s work.The intervention was deployed following a developmental methodology specific to the clinic of the activity. It allowed occupational therapists to take their own work as an object of analysis during functional restoration programs. The literature on these programs confirms the choice to focus on occupational therapists as the primary addressee for patients' professional issues. However, research in the field tends to evade the question of the work of health professionals and to summarize that of patients simply returning to employment. This is why we felt it necessary to focus on the work of those who are interested in work. We hypothesized that this difficult point confronted the occupational therapists of the François Gallouedec center with job dilemmas, particularly during the realization of a "professional gesture workshop". The results of this research show the importance of taking an interest in the work of health professionals, which is done but also what is not done or what we would have liked to do, for the development of models of patient care. The real work of there educators can thus become a resource in the implementation of rehabilitation programs that wish to be interested in the question of the work of the patient.

[Truncated abstract] Despite significant scientific advances in tracking the complex physiological mechanisms that drive the asthma disease process, worldwide trends in childhood asthma continue to rise. This research sought to describe the relationships between psychosocial stress, psychosocial resources, asthma severity, and health-related outcomes from the standpoints of biopsychosocial and developmental theory. The research consisted of three studies based on a prospective study involving 2573 children from a community-based birth cohort. The cohort has been under active follow-up from birth and this thesis draws on data obtained at the 1, 2, 6, 10 and 13 year follow-ups . . . The final study undertook to describe the mediating influence of specific supportive behaviours provided by family members and peers to adolescents with asthma. Ninety-nine adolescents participating in the 13 year follow-up of the community cohort study completed a semi-structured interview adapted from the Diabetes Social Support Interview (La Greca et al., 1995) to assess supportive behaviours and the KINDL (Ravens-Sieberer & Bullinger, 1998) to assess QOL. It was predicted that illness-specific support would mediate the relationship between family dysfunction and quality of life. Qualitative analyses identified parents as important sources of tangible support, peers as important sources of companionship and emotional support, and siblings bridging the two, by providing tangible, companionship and emotional support to the adolescent. Mediator analyses found that specific parent behaviours perceived as unsupportive by the adolescent mediated the relationship between family dysfunction and self-oriented quality of life. Clinical implications support the integration of medical and psychological expertise in the treatment of asthma. Future research directions are also discussed.

Disparities exist in the recognition and treatment of depression among Hispanics in the United States, creating a social, ethical, economic, and public health burden. This study was designed to generate an improved understanding of the causes of and/or contributors to depression within this population. It was specifically designed to 1) assess the prevalence and severity of depression among Hispanic adults in the United States relative to adults of other race/ethnicities in the United States; 2) clarify the inconsistent results in the literature concerning the relationship between acculturation and depression among Hispanic adults in the United States; and 3) fill a gap in the literature by evaluating the potential for inflammation to mediate the relationship between acculturation and depression among Hispanic adults in the United States. The biopsychosocial model was used as a theoretical foundation for this study. Data from the 2009-2010 National Health and Nutrition Examination Survey were analyzed descriptively and via logistic regression. Findings confirmed higher prevalence of depression among Hispanic adults compared with non-Hispanic White adults, and that a lower degree of acculturation was consistently associated with a decreased likelihood of depression among Hispanics. No mediating effect of inflammation on the relationship between acculturation and depression was observed. The findings from this study are intended for use by health care providers, health educators, and public health practitioners to improve depression prevention, diagnosis, and treatment opportunities within this population and to accordingly to affect positive social change.

No description available.

Made available in DSpace on 2016-08-03T16:34:26Z (GMT). No. of bitstreams: 1 LUANA YEHIA DE LA BARRA.pdf: 647369 bytes, checksum: 5ed787f9c3f80662f9156a0374495f95 (MD5) Previous issue date: 2006-02-08 / The biopsychosocial approach is very important for physical therapists to enabling them to act with human beings, in a global way, not only focusing their attention only on the pathology, but also on the ill person as a whole. The comprehension of the profession and the concepts of health illness, and patient, are also needed for the physical therapists to consider their intervention on a more extended basis than only on the rehabilitation one. The purpose of this study is to investigate the comprehension of the last year´s Physical therapy students from a private University in São Paulo about health illness, patient, Physical therapy and the relationship between physical therapist and their patients, associating the understanding to the existent health models. In order to achieve these objectives it uses authors of the Health Psychology who defend the biopsychosocial approach, and also authors of Physical therapy and Medicine who write about the models for graduation curriculae of health professionals. Ten semi-structured interviews were led with students, asking about the subjects of the study. The results were analyzed qualitatively, using the construction of analysis categories to answer the objectives of the research. In conclusion, the students noticed some phsychological and social aspects of patients, but not in a clear way and in most of the students, this knowledge was adquired outside the University. Eventhough, the topics on humanities are included in their course, but at the time of the graduation, students don´t reach the objectives of a human comprehension of patient, and oscillate between the biomedical and biopsychosocial model / A visão biopsicossocial de homem é de fundamental importância para que os fisioterapeutas sejam capazes de atuar com seus pacientes, de forma global, sem focar a atenção apenas à doença, mas sim à pessoa doente. A compreensão acerca da profissão e dos conceitos de saúde-doença e paciente, também se faz necessária para que esses profissionais possam considerar sua intervenção num âmbito mais amplo do que a reabilitação. O objetivo deste trabalho é investigar a compreensão que os alunos do último ano de Fisioterapia de uma Universidade privada de São Paulo têm sobre saúde-doença, paciente, Fisioterapia e relacionamento fisioterapeuta-paciente e como associam estas compreensões aos modelos de saúde existentes. Para isso toma por base autores da Psicologia da Saúde que defendem uma visão biopsicossocial de homem, assim como autores da Fisioterapia e Medicina que escrevem sobre os modelos adotados nos currículos de formação dos profissionais da saúde. Foram realizadas 10 entrevistas semi-dirigidas com os alunos, apresentando questões a respeito dos temas em questão. Os resultados foram analisados de forma qualitativa através da construção de categorias de análise visando responder aos objetivos da pesquisa. Conclui-se que os alunos percebem alguns aspectos psicológicos e sociais do paciente, mas não de forma clara e, na maioria dos casos, este conhecimento se dá através de conhecimentos que não foram adquiridos na Universidade. Esta, apesar de fornecer os conteúdos para a formação mais humana do fisioterapeuta, não alcança os objetivos ao final do curso, já que os alunos oscilam entre os modelos biomédico e biopsicossocial

Abstract Unemployed are known to be in poorer health and to use less health care services compared to those employed. However, evidence on the work ability of the unemployed remains scarce. The methods of assessing work ability are very divergent, not least because a shared understanding on the concept of work ability is lacking. Furthermore, the aspect of marginalization gives rise to further challenges when assessing work ability among the unemployed. This study explored the work ability of long-term unemployed, their needs for medical care and rehabilitation as well as the methods of assessing work ability. The aims were to find out to which amount and how the work ability was restricted among the unemployed and to clarify the needs for medical care and rehabilitation among them. Additionally, differences between the methods for assessing the disease-oriented and multidimensional work ability, as well as the need for rehabilitation were analysed. Both qualitative and quantitative methods were used in this multi-method research in three different studies. The multidimensional work ability assessments were conducted among long term unemployed individuals in three Labour Force Service Centres (Oulu, Raahe region and Kainuu) and in one municipality (Paltamo). Furthermore, an illustrated case study was conducted to compare the materials and background theories of disease-oriented and multidimensional work ability assessment methods. The work ability was significantly decreased for a great proportion of long term unemployed, mostly because of mental disorders. In one municipality, 27% of the long term unemployed were found disabled for open labour market, in addition 20% of them were considered to need medical care and rehabilitation to enable return to work. By using multidimensional work ability assessment method, restrictions in work ability as well as the needs for rehabilitation appeared to get identified more accurately than by using the disease-oriented method. The latter had missed potential rehabilitation avenues and had led to under-rehabilitation, misrehabilitation and over-rehabilitation. The results indicate that the practices of assessing work ability should be based on biopsychosocial and not only on biomedical approach of health and therefore existing information from the multidisciplinary network concerning the clients’ functioning should be routinely collected and used. The health care services as well as the work ability assessment procedures should be tailored to meet the special needs of the long term unemployed to support their work ability and potential of returning to work. / Tiivistelmä Työttömien terveydentila on heikompi ja he käyttävät vähemmän terveyspalveluja kuin muu samanikäinen väestö. Sen sijaan työttömien työkyvystä ei ole olemassa kattavaa tutkimustietoa. Toisaalta työkyvyn arvioinnin menetelmät ovat epäyhtenäiset, koska työkyvyn käsitteestäkään ei ole yhtenäistä ymmärrystä. Syrjäytymiseen liittyvät ilmiöt aiheuttavat työttömien työkyvyn arviointiin omat erityishaasteensa. Tämän tutkimuksen kohteena olivat pitkäaikaistyöttömien työkyky, sairauksien hoitoon ja kuntoutukseen liittyvät tarpeet sekä työkyvyn arvioinnin menetelmät. Tavoitteena oli selvittää, kuinka suurella osalla ja millä tavoin pitkäaikaistyöttömien työkyky on heikentynyt sekä minkälaista hoidon ja kuntoutuksen tarvetta heillä on. Lisäksi selvitettiin sairauslähtöisen ja monialaisen työkyvyn ja kuntoutustarpeen arvioinnin eroja. Monimenetelmätutkimuksen kolmessa osatutkimuksessa käytettiin sekä laadullisia että määrällisiä menetelmiä. Aineistoina olivat kolmen työvoiman palvelukeskuksen (Oulu, Raahen seutukunta ja Kainuu) ja yhden kunnan (Paltamo) alueella asuville vaikeasti työllistyville henkilöille monialaisesti toteutetut työkyvyn arvioinnit. Lisäksi aineistona analysoitiin sairauslähtöisessä ja monialaisessa työkyvyn arvioinnissa käytettävät tietoaineistot ja tulokset yhdellä esimerkkiasiakkaalla havainnollistaen. Suurella osalla pitkäaikaistyöttömistä työkyky oli merkittävästi heikentynyt, sairausluokista eniten mielenterveyden häiriöiden takia. Yhden kunnan kaikista pitkäaikaistyöttömistä todettiin avoimille työmarkkinoille työkyvyttömiksi 27 % ja näiden lisäksi 20 %:lla todettiin työkykyä kohentavan hoidon ja kuntoutuksen tarvetta. Monialaisen arviointimallin avulla tunnistettiin työkyvyn heikkeneminen ja kuntoutustarve osuvammin kuin perinteisellä sairauslähtöisellä toimintatavalla, joka hukkaa kuntoutuksen potentiaalia ja johtaa alikuntoutukseen, väärinkuntoutukseen tai ylikuntoutukseen. Tulosten perusteella työkyvyn arvioinnin käytännöt tulisi perustaa biopsykososiaaliseen eikä vain biomedikaaliseen terveyskäsitykseen ja niissä tulisi nykyistä enemmän hyödyntää monialaisessa verkostossa olevaa informaatiota tutkittavan toimintakyvystä. Työkyvyn tukemiseksi työttömien terveyspalvelut sekä työkyvyn ja kuntoutustarpeen arvioinnit tulisi aiempaa enemmän suunnitella ja kohdentaa pitkäaikaistyöttömien erityistarpeet huomioiden.

This study is aimed at exploring the impact of secondary trauma on the child. A shortcoming has been identified in practice because of the lack of trained social workers and therapists in the field of secondary trauma and children and applying effective therapeutic intervention. The goal of this study was to explore and determine the impact of trauma on the child as the secondary victim in the emergency room of the hospital. In order to reach the required goal, a number of objectives were set. By means of a literature study and consultation with experts in the field of trauma, a theoretical framework was set up with regard to the following: secondary trauma as phenomenon; the child in the middle childhood as part of life; trauma debriefing and the child. An empirical study where semi-structured interviews and participatory observation were used as the methods of data collection was undertaken, to assess the impact of trauma on the child, as the secondary victim in the emergency room of the hospital. The following aspects were handled specifically: 1. the experience of trauma by the child 2. fears and anxiety 3. re-experiencing the event through thoughts 4. sensation, communication and play 5. increase in sensitivity through sight, noises and smell 6. avoidance of memories, thoughts and feelings towards the trauma and then the search for closure Individual semi-structured interviews were used with ten respondents. Applied research was undertaken as the researcher aimed at establishing solutions for problems that occur in the emergency room of the hospital. The researcher used a qualitative research approach. Considering that in this study a relatively unknown field was researched, a phenomenological strategy within an exploratory study was used to explore, understand and interpret the research question, which is not well known. The research question formulated for this study was: “What is the effect of trauma on the child as the secondary victim?” Empirical data, which was obtained by using a semi-structured interview schedule and participatory observation, revealed the following: 1. The secondary traumatized child is the individual that’s been exposed to the trauma by either witnessing the event or through the relationship with the victim. 2. The following phases of trauma were identified through the study of the secondary traumatized child: i. PHASE 1 : Biological impact phase ii. PHASE 2 : Reaction phase iii. PHASE 3 : Avoidance phase iv. PHASE 4 : Reintegration and recovery of homeostasis 3. Role of social support systems for the adaptation of the psycho-social functioning of the victim. 4. External factors that might influence the traumatized child. The study revealed information on the child as the secondary traumatized victim in the emergency room of the hospital, which holds further research possibilities. The desired information was acquired and can be used in further studies and the development of a trauma-debriefing programme. / Dissertation (MSW (Social Health Care))--University of Pretoria, 2006. / Social Work and Criminology / MSW (Social Health Care) / Unrestricted