Background: While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder. Methods: We designed and implemented a randomized controlled trial (RCT) to determine the effectiveness of integrating pharmacotherapy and behavioral treatments for AUDs into routine medical care for TB in the Tomsk Oblast Tuberculosis Service (TOTBS) in Tomsk, Russia. Eligible patients are diagnosed with alcohol abuse or dependence, are newly diagnosed with TB, and initiating treatment in the TOTBS with Directly Observed Therapy-Short Course (DOTS) for TB. Utilizing a factorial design, the Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients (IMPACT) study randomizes eligible patients who sign informed consent into 1 of 4 study arms: (1) Oral Naltrexone + Brief Behavioral Compliance Enhancement Therapy (BBCET) + treatment as usual (TAU), (2) Brief Counseling Intervention (BCI) + TAU, (3) Naltrexone + BBCET + BCI + TAU, or (4) TAU alone. Results: Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors. Conclusions: The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care settings.

Physical activity is one of the key factors in strengthening health. Yet, in Lithuania as well as in the whole world, the physical activity among youngsters is insufficient. The sudden decrease of physical activity during this period is becoming a huge issue of the society with indisputably harmful consequences (Cairney et al., 2012; Kahn et al., 2008; Bobrova, Grajauskas, 2005); hence the promotion of physical activity of youngsters during this period of their life is becoming one of the most important and urgent issues of the healthcare of the society (Sirard, Barr-Anderson, 2008). Evidently, the period of youngsters is critical; at this time, it is crucial to take extra measures of promotion of physical activity (Schneider, Cooper, 2011). In the activity of physical education, when promoting physical activity of students of senior grades, a new method of educational counseling was brought into practice which is based on Solution focused brief therapy as developed by de Schazer (1985). The pioneer of Lithuanian pedagogical science A.Maceina developed a concept of the agility of a trainee in practice; in the present research, this objective is sought by applying educational counseling. The student is attributed the functions of a trainee, a unique creative and developing personality (Tijūnėlienė, Kavaliauskienė, 2008). Educational counseling also provides presuppositions for the universality of education as an important element of the educational process by developing the... [to full text] / Fizinis aktyvumas yra vienas iš svarbiausių sveikatą stiprinančių veiksnių. Tačiau visame pasaulyje, taip pat ir Lietuvoje, jaunuolių fizinis aktyvumas yra nepakankamas. Labai staigus fizinio aktyvumo mažėjimas tarp vyresniųjų klasių mokinių tampa didžiule visuomenės problema, kurios pasekmės yra žalingos (Cairney et al., 2012; Kahn et al., 2008; Bobrova, Grajauskas, 2005). Todėl vienas svarbiausių ir aktualiausių visuomenės sveikatos priežiūros uždavinių – skatinti jaunuolių fizinį aktyvumą (Sirard, Barr-Anderson, 2008). Akivaizdu, kad vyresniųjų klasių mokinių amžius yra kritinis, taigi šiuo laikotarpiu būtina taikyti papildomas priemones paauglių fiziniam aktyvumui skatinti (Schneider, Cooper, 2011). Išsakytieji teiginiai rodo, kad derėtų ieškoti naujų kūno kultūros pamokų formų. Vykstant ugdymo paradigmų kaitai (Bitinas, 2005), turinčiai įtakos mokyklinei kūno kultūrai, siekiant asmenybės sveikatos ir geros fizinės būklės per visą gyvenimą, ir toliau ieškoma naujų formų bei metodų paauglių fiziniam aktyvumui skatinti. Ugdant vyresniųjų klasių mokinių fizinį aktyvumą, kūno kultūros veikloje pritaikytas naujas tokioje ugdymo praktikoje edukacinio konsultavimo metodas, pagrįstas trumpalaikiu į sprendimus sutelktu konsultavimu (angl. Solution focused brief therapy; de Schazer, 1985). Darbe keliami šie probleminiai klausimai: • Ar ugdytojas, kalbėdamas apie ugdytinio stiprybes ir gerąsias savybes, bet vengdamas analizuoti jo problemą, padeda paaugliui rasti tinkamą fizinio... [toliau žr. visą tekstą]

Submitted by Camilla Lie Higa null (cah.lie@hotmail.com) on 2018-02-20T01:20:48Z No. of bitstreams: 1 CA_DISSERTACAO.pdf: 7857066 bytes, checksum: 4895fb19d7f08e352d3d3061200b6611 (MD5) / Rejected by Adriana Aparecida Puerta null (dripuerta@rc.unesp.br), reason: Prezada Camilla Lie Higa, O documento "Aconselhamento como estratégia para prevenção do sobrepeso e obesidade na infância: um estudo piloto" enviado para a coleção Instituto de Biociências, Rio Claro foi recusado pelo(s) seguinte(s) motivo(s): - Falta a Folha de aprovação, que deve ser solicitada à Seção de Pós-Graduação e deve ser inserida após a ficha catalográfica. O documento enviado não foi excluído. Para revisá-lo e realizar uma nova tentativa de envio, acesse: https://repositorio.unesp.br/mydspace Em caso de dúvidas entre em contato pelo email repositoriounesp@reitoria.unesp.br. Atenciosamente, Repositório Institucional UNESP https://repositorio.unesp.br on 2018-02-20T13:24:42Z (GMT) / Submitted by Camilla Lie Higa null (cah.lie@hotmail.com) on 2018-02-21T16:32:40Z No. of bitstreams: 1 DISSERTAÇÃO_CAMILLA (2).pdf: 7858232 bytes, checksum: 1b92b6229de595ef7b75ac607246dd31 (MD5) / Approved for entry into archive by Adriana Aparecida Puerta null (dripuerta@rc.unesp.br) on 2018-02-22T13:19:47Z (GMT) No. of bitstreams: 1 higa_cl_me_rcla.pdf: 7470190 bytes, checksum: 09190fa6ec720fa3398c12b37d9f30e5 (MD5) / Made available in DSpace on 2018-02-22T13:19:47Z (GMT). No. of bitstreams: 1 higa_cl_me_rcla.pdf: 7470190 bytes, checksum: 09190fa6ec720fa3398c12b37d9f30e5 (MD5) Previous issue date: 2017-12-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A obesidade infantil vem num crescimento exponencial. Nesse contexto, a família desempenha papel indispensável na construção de hábitos saudáveis, e quando associado à Educação e a Saúde, tal processo passa a ser completo e mais eficaz. O breve aconselhamento parece ser uma boa estratégia para estreitar tais laços, a fim de se realizar um trabalho conjunto e melhorar hábitos das crianças. Objetivo: Verificar os efeitos de uma intervenção de BA, abordando as esferas de atividade física e alimentação saudável à família sobre a criança, com apoio de escolas públicas e a Unidade de Saúde da Família (USF). Métodos: Participaram do estudo 14 pais/responsáveis e 38 crianças entre 6 e 10 anos do EF-I estavam matriculados nas 2 escolas públicas municipais sorteadas no município do interior paulista, com proximidade de 2 USF que auxiliaram nas coletas. As crianças realizaram avaliações antropométricas mensais e responderam ao questionário em três momentos. Os pais receberam BA durante o período de 6 meses, responderam questionários de 2 em 2 meses. E professores e ACS responderam questionário no momento pré e pós. Para os dados estatísticos utilizou-se de média, desvio padrão e porcentagem, ANOVA para medidas repetidas e teste de qui-quadrado com intenção de tratar. As análises foram conduzidas por meio do software SPSS versão 21.0 e Excel 2013, com valor de p≤0,05. Ainda realizou-se análise de conteúdo para os dados qualitativos. Resultados: As crianças atingiram as diretrizes de 60 minutos de atividades moderadas a vigorosas (140,76±114,91; 138,10±114,17; 111,60±121,67) entretanto o tempo despendido em comportamento sedentário aumentou entre as coletas (103,57±136,98; 152,28± 277,38; 185,18±173,99). Os pais não atingiram as recomendações de 150 minutos de AF no lazer por semana nas coletas 2 e 3 (174,28±207,13; 135,00±190,53; 138,57±194,25) e também apresentaram níveis altos de comportamento sedentário. Em relação a alimentação saudável os resultados apontam que há uma preocupação com a mesma, entretanto observa-se uma alta ingestão de alimentos ultra processados. A parte qualitativa demonstrou que há a busca da mudança em relação a atividade física e alimentação saudável, melhorando assim a qualidade de vida dos pais e consequentemente das crianças. Na parceria entre Educação e Saúde encontrou-se dificuldades, mas observou-se uma efetividade nos momentos em que participaram. Conclusão: Os dados quantitativos apontam o papel fundamental que a família e escola exercem sobre a criança, e o mesmo é reforçado a partir dos dados qualitativos. A dificuldade na comunicação entre Educação e Saúde foi encontrada, mas nos momentos de participação demonstraram serem importantes e efetivos. Dessa forma, há indícios de que o BA à família sobre a criança, com apoio de escolas públicas e USF, parecem ser efetivas. / Childhood obesity has grown exponentially. In this context, the family plays an indispensable role in the construction of healthy habits, and when associated with Education and Health, this process becomes complete and more effective. Brief advice seems to be a good strategy to strengthen such ties in order to work together and improve children's habits. Objective: To verify the effects of a BA intervention, addressing the spheres of physical activity and healthy diet to the family on the child, with support from public schools and the Family Health Unit (USF). Methods: Participated in the study 14 parents/guardians and 38 children between 6 and 10 years of EF-I were enrolled in the 2 municipal public schools drawn in the city of the interior of São Paulo, with close to 2 USFs that assisted in the collections. The children performed monthly anthropometric assessments and answered the questionnaire in three moments. Parents received BA during the 6-month period, answered questionnaires every 2 months. And teachers and ACS answered questionnaire in the pre and post moments. For statistical data, mean, standard deviation and percentage were used, ANOVA for repeated measurements and chi-square test with intention to treat. The analyzes were conducted using software SPSS version 21.0 and Excel 2013, with a value of p≤0.05. Content analysis was also performed for qualitative data. Results: Children reached the 60-minute guidelines for moderate to vigorous activities (140,76±114,91; 138,10±114,17; 111,60±121,67), however the time spent in sedentary behavior increased among the collections (103,57±136,98; 152,28± 277,38; 185,18±173,99). The parents did not reach the recommendations of 150 minutes of AF at leisure per week in collections 2 and 3 (174,28±207,13; 135,00±190,53; 138,57±194,25), and also showed high levels of sedentary behavior. Regarding healthy eating, the results indicate that there is a concern with it, however, a high intake of ultra-processed foods is observed. The qualitative part showed that there is a search for change in relation to physical activity and healthy eating, thus improving the quality of life of parents and consequently of children. In the partnership between Education and Health there were difficulties, but an effectiveness was observed in the moments in which they participated. Conclusion: The quantitative data point out the fundamental role that the family and school play in the child, and it is reinforced from the qualitative data. The difficulty in the communication between Education and Health was found, but in the moments of participation they demonstrated to be important and effective. Thus, there are indications that the BA to the family on the child, with support from public schools and USF, appear to be effective.

Submitted by LETICIA APARECIDA CALDERÃO SPOSITO null (sposito.ef@gmail.com) on 2018-02-09T14:42:04Z No. of bitstreams: 1 Dissertação-Leticia Sposito15.pdf: 2848695 bytes, checksum: 8759bd2b383fe1339d20194063d13093 (MD5) / Approved for entry into archive by Ana Paula Santulo Custódio de Medeiros null (asantulo@rc.unesp.br) on 2018-02-09T16:30:43Z (GMT) No. of bitstreams: 1 sposito_lac_me_rcla.pdf: 2205618 bytes, checksum: c606bd13e42313fa52b551e22fa977e2 (MD5) / Made available in DSpace on 2018-02-09T16:30:43Z (GMT). No. of bitstreams: 1 sposito_lac_me_rcla.pdf: 2205618 bytes, checksum: c606bd13e42313fa52b551e22fa977e2 (MD5) Previous issue date: 2017-12-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / No Brasil, 45,1% da população não atingem as recomendações de Atividade Física (AF) sendo um fator de alta relação com às Doenças Crônicas não Transmissíveis. A Atenção Primária atinge cerca de 50% dos brasileiros, tornando-se um local hábil para a promoção de estratégias em AF. O Breve Aconselhamento é um exemplo potencial para aumentar os níveis de AF da população, melhorar a Qualidade de Vida (QdV) e ser econômico. Mas pouco se sabe sobre a efetividade desse tipo de intervenção no Brasil e, um método para verificá-la é por meio da análise econômica de custo-utilidade que fornece o Quality Adjusted Life Years (QALY) ganho. O objetivo do estudo foi comparar o custo-utilidade incremental de uma intervenção de Breve Aconselhamento para a prática de atividade física (BA), de uma estratégia de Indicação para a Prática de Atividade Física supervisionada (IPAF), e de um grupo Controle e, verificar a influência das intervenções sobre o percentual de fisicamente ativos em adultos usuários de unidades do Programa Saúde da Família (PSF) de Rio Claro-SP, durante 12 meses. O estudo é de característica longitudinal, composto por 75 usuários da unidade do PSF de Rio Claro – SP. Para a obtenção dos valores de QALY utilizou-se o questionário SF-36. Para o tempo de AF aplicou-se o questionário International Physical Activity Questionnaire (IPAQ-versão longa) e o Modelo Transteorético (MTT) para verificar mudança de comportamento. Os grupos foram divididos em três pela função aleatória do Excel: (1) BA, com duração média de 20 min, no qual os participantes receberam orientações para aumentar o tempo de AF; (2) IPAF, onde os participantes foram convidados/indicados para participarem do programa de AF no PSF, com frequência de 2 vezes por semana e duração de 60 min/aula, e (3) grupo Controle, não receberam nenhum incentivo para mudança de comportamento. Todos os grupos foram entrevistados na unidade do PSF, em cinco momentos, durante um ano. Para verificar diferenças entre custos e QALYs dos programas fez-se uso da técnica Incremental cost-effectiveness ratio (ICER), e aplicou-se o teste de qui-quadrado para o tempo de AF. Os resultados demonstraram que a intervenção IPAF obteve baixa adesão. Em relação aos valores de QALY o grupo BA apresentou maior média ao fim de 12 meses (0,800). O maior QALY ganho ocorreu entre as intervenções BA vs. Controle, produzindo 0,012/QALY, seguida do grupo BA vs. IPAF com 0,009/QALY e IPAF vs. Controle em 0,003/QALY. O ICER entre a estratégia BA vs. Controle correspondeu a R$ 5.087,50/QALY e BA vs. IPAF com uma economia de R$ - 3.830,00/QALY e IPAF vs. Controle com ICER de R$ 31.840,00/QALY. O BA se apresenta de maneira mais barata quando comparado ao IPAF. Em relação ao tempo de AF, não foram encontradas diferenças significativas para o domínio lazer em nenhuma das intervenções, inversamente ocorre para AF no transporte, identificando-se superioridade significativa no 12º mês do BA vs. grupo Controle de fisicamente ativos. Para o tempo total de AF ocorreu diferença significativa para o BA comparado ao grupo Controle no 9º mês e 12º mês. Sob a perspectiva do MTT observou-se que 38,4% do grupo BA, 16,6% do IPAF e 16,7% do Controle passaram para a fase Ação e Manutenção de AF no lazer no 12º mês. Conclui-se que a estratégia de BA tende a ser efetiva ao ser comparada com o grupo IPAF e Controle, demonstrando resultados moderados para a AF. / In Brazil, 45.1% of the population do not reach the recommendations of Physical Activity (PA) being a factor of high relation with the Noncommunicable Chronic Diseases. Primary Care reaches about 50% of Brazilians, becoming a good place to promote strategies in PA. Brief Counseling is a potential example for increasing the population's PA levels, improving Quality of Life (QoL) and being economical. But little is known about the effectiveness of this type of intervention in Brazil, and one method of verifying it is through the economic cost-utility analysis that provides the Quality Adjusted Life Years (QALY) gain. The objective of the study was to compare the incremental cost-utility of a Brief Counseling intervention for the practice of physical activity (BC), an Indicated Practice for Supervised Physical Activity (IPAF) strategy, and a Control group and, to verify the influence of the interventions on the percentage of physically active in adult users of units of the Family Health Program (PSF) of Rio Claro-SP, for 12 months. The study is a longitudinal feature, composed of 75 users of the PSF unit of Rio Claro - SP. To obtain the QALY values, the SF-36 questionnaire was used. For the PA time, the International Physical Activity Questionnaire (IPAQ-long version) and the Transtheoric Model (MTT) were applied to verify behavior change. The groups were divided into three groups by the random function of Excel: (1) BC, with an average duration of 20 min, in which the participants received guidelines to increase the PA time; (2) IPAF, where participants were invited/nominated to participate in the FHP program, with frequency of 2 times a week and duration of 60 min / lesson, and (3) Control group, received no incentive to change behavior. All groups were interviewed at the PSF unit, in five moments, during a year. To verify differences between costs and QALYs of the programs, the Incremental cost-effectiveness ratio (ICER) technique was used, and the chi-square test for the AF time was applied. The results demonstrated that the IPAF intervention obtained low adhesion. Regarding the QALY values, the BC group presented the highest mean at the end of 12 months (0.800). The highest QALY gain occurred between the interventions BC vs. Control, producing 0.012/QALY, followed by group BC vs. IPAF with 0.009/QALY and IPAF vs. Control at 0.003/QALY. The ICER between the strategy BC vs. Control corresponded to R $ 5,087.50/QALY and BC vs. IPAF with a saving of R$-3,830.00/QALY and IPAF vs. Control with ICER of R $ 31,840.00/QALY. BC is less expensive when compared to IPAF. In relation to the time of PA, no significant differences were found for the leisure domain in any of the interventions, inversely for PA in the transport, identifying significant superiority in the 12th month of BC vs. Control group of physically active. For the total PA time, there was a significant difference for the BC compared to the Control group in the 9th month and 12 months. From the perspective of the MTT, it was observed that 38.4% of the BC group, 16.6% of the IPAF and 16.7% of the Control moved to the Action and Maintenance phase of leisure PA in the 12th month. It is concluded that the BC strategy tends to be effective when compared to the IPAF and Control group, showing moderate results for PA.

This study examined the perceptions of elementary school counselors regarding their experience in using solution-focused brief counseling for meeting the demanding responsibilities of their job and the particular needs of the students they serve. Specifically, the four research questions addressed the school counselors' perceptions regarding: (1) use and importance of particular solution-focused techniques; (2) effectiveness of solution-focused strategies in addressing specific student issues; (3) training in solution-focused brief counseling; and (4) use of this approach in settings other than the counseling office. The data for this study were collected from elementary school counselors in Virginia who had previously received training in solution-focused brief counseling. This training was provided by their school systems as inservice and was conducted by the same workshop leader in all instances. The school counselors were sent a questionnaire that was developed by the researcher. The survey contained a selection of Likert-style scale questions, yes/no items, rank-order items, and open-ended questions. The final section contained questions designed to obtain demographic information about the respondent and the school and students they served. The researcher conducted a follow-up interview with several school counselors to supplement the survey data. The data analysis was descriptive and relational in nature. The findings of the study indicate that elementary school counselors who have received training in solution-focused brief counseling philosophies and techniques find it important and useful for working with children. The majority of the school counselors indicated that they use all of the solution-focused techniques listed in the survey to at least some degree. Their responses to the survey indicated the perception that this approach is effective with various student issues. The school counselors reported the perception that they have some proficiency with solution focused brief counseling and that they have interest in pursuing more training. The school counselors also indicated that they were able to use solution-focused brief counseling philosophies in school settings other than the counseling office. In summary, school counselors appear to have a relatively positive perception of solution-focused brief counseling as an approach for working with elementary age school students. Recommendations for practice and future research are presented. / Ph. D.

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

Magister Public Health - MPH / Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care. / South Africa