Made available in DSpace on 2016-04-27T18:47:17Z (GMT). No. of bitstreams: 1 Fernanda Maria Favere Augusto.pdf: 2679215 bytes, checksum: f5334da766dcff0feff9089be71d025e (MD5) Previous issue date: 2015-09-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aims to discuss the effects in the life of a child carer, consequent to quota daily coexistence of mom or dad care elderly. Considering the problem of a family member be bound to assume the role of caregiver of elderly family, when affected by disease that needs assistance to carry out their activities of daily living; whereas a child carer can also be an elderly, most often a woman, this research has as chance that such a situation of dedication to careful Currently, complicated by new factors-if not driven or sustained by external forces as a formal or informal support network-can generate complicated effects to life of the child carer, transforming negatively the Act of caring. This is a qualitative and exploratory research, having as subject of research six children that play role of primary caregiver for over a year; nominated for participation in the study through a network of personal relationships, they are residents of the municipality of São Paulo and Grande São Paulo, residents of the regions: North, South, West and São Caetano do Sul. The method chosen was oral history; thematic oral history, which aims at the articulation of "oral to written sources documentation" (MEIHY; RIBEIRO, 2011, p. 88), by means of a semi-structured interview with the support of a screenplay, composed of closed and open questions in order to verify the effects in the life of the child carer, i.e. the impact associated with the functional and/or behavioral deterioration resulting from the everyday co-existence of care devoted to elderly mother and, one time, assess the shape and quality of care the interviews were recorded and transcribed subsequently. It was found from the lines of children caregivers that the everyday care is overload and absence of sharing among the other family members, in particular the brothers. We analyzed the social support network of the children is still scarce, and there is a need to expand this, given by means of special guidelines for professionals who work with old age / Este estudo tem como objetivo discutir os efeitos na vida de um filho cuidador, consequentes à convivência cotidiana de cuidados dedicados à mãe idosa. Considerando a problemática de um membro familiar obrigar-se a assumir a função de cuidador de familiar idoso, quando acometido por doença que necessite de auxílio para a realização de suas atividades de vida diária; e ainda levando em conta que um filho cuidador também pode ser um idoso, sendo na maior parte das vezes uma mulher, a presente pesquisa tem como hipótese a de que tal situação de dedicação ao cuidado, complicada na atualidade por fatores novos, contingentes - se não orientada ou sustentada por forças externas como uma rede de apoio formal ou informal - pode gerar efeitos complicados à vida do filho cuidador, transformando negativamente o ato de cuidar. Trata-se de uma pesquisa qualitativa e exploratória, tendo como sujeitos de pesquisa seis filhos que desempenham papel de cuidador principal, há mais de um ano; indicados para participação do estudo por meio de uma rede pessoal de relações, os mesmos são residentes no município de São Paulo e Grande São Paulo, nas regiões: norte, sul, oeste, e em São Caetano do Sul. O método escolhido foi o da história oral temática, que tem por finalidade a articulação da documentação oral aos das fontes escritas , por meio da entrevista semiestruturada com o apoio de um roteiro, composto por perguntas fechadas e abertas, com o objetivo de verificar os efeitos na vida do filho cuidador, ou seja, o impacto associado à deterioração funcional e/ou comportamental resultantes da convivência cotidiana de cuidados dedicados à mãe idosa e, a um só tempo, avaliar a forma e a qualidade desses cuidados. As entrevistas foram gravadas, e transcritas posteriormente. Verificou-se a partir das falas dos filhos cuidadores que o cotidiano de cuidados é de sobrecarga, de angústia, pela ausência de compartilhamento com os demais membros familiares, em especial os irmãos. Analisou-se que a rede de suporte social dos filhos ainda é escassa, e há a necessidade de sua ampliação, por meio de relações com vizinhos, amigos e orientações em especial dos profissionais que trabalham com a velhice

As politicas de apoio a criancas com Transtornos do Neurodesenvolvimento precisam que seus cuidadores sejam responsaveis por prover o ensino especial necessario para o manejo dos problemas de comportamento e evitar que sejam objeto de rejeicao social em funcao de seus deficits comportamentais. Essa carga de trabalho pode acarretar impacto a saude mental e qualidade de vida dos cuidadores e justifica a importancia de estudos voltados para o mapeamento de tais dificuldades, afim de sustentar propostas de prevencao e intervencao destinadas a este publico. Este estudo, de corte transversal, teve como objetivo identificar associacoes entre os problemas de comportamento de criancas com Transtornos do Neurodesenvolvimento e a saude mental e qualidade de seus cuidadores, alem de descrever as praticas parentais educativas utilizadas. A amostra foi composta por 91 diades cuidadorescriancas. Todas as criancas (idade entre 3 e 18 anos) estavam matriculadas em escolas da rede publica do municipio de Barueri-SP como aluno com necessidade educacional especial e apresentavam laudo diagnostico de Deficiencia Intelectual (DI) idiopatica, Transtorno do Espectro Autista ou Sindrome de Down comorbido com DI. Para a avaliacao comportamental infantil foi empregada a Escala de Comportamentos Aberrantes, o Inventario de Problemas de Comportamento e o Inventario dos Comportamentos de Criancas e Adolescentes. Para a avaliacao dos cuidadores, aplicou-se o Inventario de Autoavaliacao para Adultos de 18 a 59 anos, o Instrumento abreviado de avaliacao de qualidade de vida (WHOQOL-Bref) e o World-Safe CORE para as praticas parentais. As analises demonstram nao haver diferenca na saude mental do cuidador em funcao do diagnostico de seu filho. A avaliacao comportamental dos cuidadores evidenciou que suas dificuldades internalizantes foram as areas mais impactadas pelos problemas de comportamento infantis. Entre 3,4% e 20% da variancia dos indicadores de saude mental dos cuidadores foi significativamente explicada pelas queixas externalizantes da crianca, especialmente hiperatividade e agressividade, e as dificuldades internalizantes infantis, principalmente o retraimento. As dificuldades comportamentais infantis nao foram preditores da qualidade de vida total dos cuidadores. Ja a frequencia de comportamento agressivo da crianca foi preditor do Dominio Psicologico do WHOQOLBref. Quanto as praticas parentais, muitos reportaram utilizar metodos coercitivos para tentar controlar o comportamento de seus filhos. As queixas internalizantes dos cuidadores, especialmente Ansiedade/ Depressao e Queixas Somaticas, devem ser alvo de atencao das iniciativas em saude. Assim propostas de intervencao para melhoria da saude mental poderiam ser destinadas a todos os cuidadores independente do diagnostico clinico de seus filhos, dado que muitos reportaram o uso de estrategias coercitivas e que seus problemas de comportamento sao similares / Policies to support children with Neurodevelopmental Disorders need their caregivers to be responsible for providing the special education in order to manage behavioral problems and avoid social rejection due to their child behavioral difficulties. This caregiver\'s workload can impact one\'s mental health and quality of life therefore supporting the importance of studies aimed to investigate this impact in order to support prevention and intervention programs for this specific public. This crosssectional study aimed to identify associations between the behavioral problems of children with Neurodevelopmental Disorders and the mental health and quality of life of their caregivers, as well as to describe their parental practices. The sample consisted of 91 caregiver and child. All children (Aged between 3 and 18 years) were enrolled in public schools in the city of Barueri-SP as students with special educational needs and diagnostic reports of Idiopathic Intellectual Disability (ID), Autism Spectrum Disorder and Down Syndrome comorbid with ID. For the child\'s behavioral assessment, the following questionnaires were used: Aberrant Behavior Checklist, Behavior Problems Inventory and Child Behavior Checklist. For the caregiver\'s evaluation were used the Adult Self-Report, the World Health Organization Quality of Life Instruments (WHOQOL-Bref) and the World-Safe CORE for parental practices. The analysis shows that there is no difference in the caregiver\'s mental health due to their child\'s diagnosis. The caregiver\'s behavioral evaluation demonstrated that their internalizing difficulties are the most impacted area due to their children\'s behavioral problems. Between 3.4% and 20% of the variance on the caregiver\'s assessment were significantly predicted by child\'s externalizing complaints, mainly hyperactivity and aggressiveness, and the child\'s internalizing difficulties, especially social withdrawal. Caregiver\'s overall quality of life were not predicted by child\'s behavioral difficulties, whereas the frequency of child\'s aggressive behavior predicts 4% of variance on the Psychological Domain of WHOQOL-Bref. Regarding parental practices, many caregivers reported the use of coercive methods to try to control their children\'s behavior. Caregiver\'s internalizing problems, especially Anxiety/ Depression and Somatic Complaints, should be addressed by health initiatives. Thus, interventions for improving mental health could be targeted to all caregivers regardless their child\'s clinical diagnosis, given that many of them have reported using coercive measures and the similarity of their behavioral problems

Goda möten och trygga relationer mellan patienter och vårdpersonal är kärnan i all sjukvård.Syftet var att undersöka hur personer med långvarig sjukdom upplever möten med vårdpersonal på hälsocentral. Uppsatsen är genomfördmed kvalitativ design. I denna studie utgick vi från Graneheim och Lundmans metod för kvalitativ innehållsanalys med en manifest ansats.I analysen identifierades fyra kategoriersom är rubriker i resultatet, att inte bli betrodd, att sakna stöd och information om vård och egenvård, att önska få vara delaktig i sin egen vård,att känna tacksamhet över att få vård på rätt nivå. Resultatet visar att patienternahade svårt att bli betrodd av läkareoch att kännedom om dem som patienter var viktigt.I kontakt med hälsocentralen fick de själv efterfråga om hjälpinsatserochstöd saknades för enklare hälsofrågor. God relation och kommunikation med läkare var betydelsefullt i vårdmötet. Patienterna ville vara delaktiga i sin egen vård och ville möta professionell expertis.Erfarenhetsutbytemed andra med samma sjukdom beskrevs betydelsefullt.De negativa fynden visaratt patienter inte blir betrodd av sjukvårdenoch att tillgänglighetenär bristfälligt. Det som skapar trygghet respektive otrygghet finns ett starkt samband mellan hur patienter med långvarig sjukdom upplever besöket och blir bemött av vårdpersonalen på hälsocentralen. Fler studier behövs inom området hur möten med vårdgivare påverkar patienter med långvarig sjukdom

Made available in DSpace on 2014-12-17T15:43:53Z (GMT). No. of bitstreams: 1 PryscilaAG_DISSERT.pdf: 1907578 bytes, checksum: 7adf0d1e03fb28877666c2c5d3840938 (MD5) Previous issue date: 2013-05-28 / The Brazilian Constitution maintains that care for elderly people is a responsibility shared by the state, the family and the society. The politics for the elderly corroborate this understanding and treats home as a privileged place for elderly care taking. This determines the participation of the familiar as a caregiver, but highlights the lack of strategic assistance for the needs of the relative caregiver who feels helplessly and unattended in their responsibility for elderly homecare. In recent years , despite the recently pursuit for health and life quality, there is an increasing incidence of elderly patients with dementia diseases that lead to disability, the most common among then is the Alzheimer?s disease. This disease affects seriously and irreversibly cognition, memory and independence of the elderly, making it dependent on others to perform basic activities of daily life, for all his life. The present study aims to evaluate the perceptions and feelings of family caregivers of elders with Alzheimer on the role of caregiver. This is a qualitative study conducted with family caregivers of seniors with Alzheimer?s, caregivers linked to the group of the Specialized Care Center of the Elderly?s Health, located in Natal / RN. Through semi-structured interview research sought to investigate the perceptions of family caregivers on the role of caregiver, the feelings and the changes in the caregiver?s life since they assumed this role. The data were organized into categories and units of semantic analysis and analyzed using thematic content analysis by Bardin. The reports originated three categories: the perception of the role of caregiver, feelings related to the caregving and consequences of the caregiver role. Perceptions of caregivers of elderly from the requirement of dedication to the care generates losses in personal and professional life for the familiar who assumes this responsibility. The lack of family and social support, aggravates the burden of care for the dependent elderly. Public health politics for the elderly recognize the importance and needs of family caregivers, but not enough to provide support and meet the needs and assist them in supporting their limitations. The research results show the urgent need to take measures to assist the caregivers of seniors with Alzheimer, recognizing them as an action of promotion quality of life and health of the elderly and protection the health of the caregiver / A Constitui??o Federal Brasileira defende que o cuidado com o idoso ? uma responsabilidade compartilhada entre o Estado, a fam?lia e a sociedade. As Pol?ticas p?blicas voltadas ? pessoa idosa v?m corroborar com esse entendimento e apontam o domic?lio como um espa?o privilegiado para o cuidado do idoso. Isto determina a participa??o do familiar como cuidador, por?m destaca-se a aus?ncia de estrat?gias de assist?ncia voltadas ?s necessidades do cuidador familiar que se sente desamparado e desassistido na sua responsabilidade do cuidado com o idoso no domicilio. Nos ?ltimos anos, apesar da busca incessante pela sa?de e qualidade de vida, observa-se uma crescente incid?ncia de idosos com doen?as demenciais que levam ? incapacidade funcional, dentre elas destaca-se a doen?a de Alzheimer. Essa doen?a compromete de forma grave e irrevers?vel a cogni??o, mem?ria e independ?ncia do idoso, tornando-o dependente de terceiros para executar atividades b?sicas da vida di?ria, por toda sua vida. O presente estudo tem como objetivo conhecer a percep??o e os sentimentos dos cuidadores familiares de idosos com Alzheimer sobre o papel de cuidador. Trata-se de um estudo com abordagem qualitativa, realizado com cuidadores familiares de idosos com Alzheimer, vinculados ao grupo de cuidadores do Centro Especializado de Aten??o em Sa?de do Idoso, localizado em Natal/RN. Por meio de entrevista semiestruturada a pesquisa buscou investigar a percep??o dos cuidadores familiares sobre o papel de cuidador, os sentimentos e as mudan?as ocorridas na vida do cuidador ao assumir esse papel. Os dados foram organizados em categorias e unidades de an?lise sem?ntica e analisados pela t?cnica de an?lise de conte?do tem?tica, segundo Bardin. Os relatos originaram tr?s categorias: a percep??o do papel do cuidador; sentimentos relacionados ao cuidado e consequ?ncias do papel de cuidador. Na percep??o dos cuidadores de idosos a exig?ncia proveniente da dedica??o ao cuidado gera perdas na vida pessoal e profissional do familiar que assume essa responsabilidade. A falta de suporte, familiar e social, acentua a sobrecarga do cuidado ao idoso dependente. As Pol?ticas p?blicas de sa?de do idoso reconhecem a import?ncia e as necessidades dos familiares cuidadores, por?m n?o disponibilizam apoio e suporte suficiente para atender as necessidades e auxili?-los em suas limita??es. Os resultados da pesquisa demonstraram a urg?ncia na tomada de medidas de assist?ncia aos cuidadores de idosos com Alzheimer, reconhecendo-as como uma a??o de promo??o da qualidade de vida e sa?de do idoso e prote??o da sa?de do cuidador

No contexto da Oncologia, define-se recidiva como o reaparecimento do câncer após um período de remissão da doença, o que acarreta menor possibilidade de cura e necessidade de reorganização do paciente e de sua família para lidarem com a situação de tratamento. Considerando o elevado nível de ansiedade associado ao diagnóstico de recidiva e o reduzido número de investigações disponíveis na literatura nacional e internacional sobre seus aspectos psicossociais no âmbito da Oncologia Pediátrica, o presente estudo teve como objetivo compreender as vivências de crianças e de seus cuidadores-familiares diante dessa fase do tratamento. Participaram da pesquisa crianças com idades entre cinco e 12 anos incompletos, em tratamento de recidiva de câncer em um centro de referencia brasileiro para atenção em onco-hematologia infantil, e seus cuidadores principais. Trata-se de um estudo descritivo e exploratório, com enfoque na abordagem clinico-qualitativa. A fim de atender aos objetivos propostos, foi realizada uma entrevista, guiada por um roteiro semiestruturado, com o familiar responsável pelo cuidado do paciente e duas sessões de aplicação do procedimento de Desenhos-Estórias com a criança. As verbalizações foram audiogravadas mediante o consentimento dos participantes. Os relatos extraídos das entrevistas e as narrativas obtidas nas sessões com as crianças foram transcritos na integra e literalmente e, posteriormente, submetidos a analise de conteúdo temática, sendo os conjuntos de Desenhos-Estórias analisados de acordo com as recomendações da literatura. Os resultados mostraram que o diagnostico de recidiva remeteu os participantes ao período inicial de investigação e diagnóstico, porém com maior mobilização e intensidade afetiva. Emergiram sentimentos de frustração em relação as expectativas de cura, vivências de ameaça e perda de controle diante do adoecer e do prognóstico, favorecendo o confronto com a possibilidade da morte. Tal situação prejudicou a projeção para a temporalidade da cura, de forma a trazer implicações para a atribuição de sentidos da existência. A necessidade de recomeço do tratamento foi acompanhada pela necessidade de reorganização da dinâmica familiar e pelo fortalecimento afetivo para enfrentamento das vicissitudes do cotidiano terapêutico. Observaram-se relações entre as vivências parental e infantil, abrangendo questões como a comunicação e os significados atribuídos ao adoecer. A religiosidade e a busca de senso de controle foram recursos importantes utilizados pelos cuidadores para o enfrentamento das situações desafiadoras, ao passo que as crianças buscaram manter a proximidade afetiva com os cuidadores e fortalecer o sentimento de segurança. Compreender as vivências da criança e de seu cuidador-familiar pode oferecer subsídios para o planejamento de intervenções psicológicas que favoreçam o enfrentamento das peculiaridades da situação de adoecimento introduzidas pelo diagnóstico de recidiva do câncer infantil, contribuindo para a implementação dos cuidados paliativos. / In the context of Oncology, relapse is defined as the reappearance of cancer after a remission period of the disease, which entails a lesser possibility of cure and the need for patients and families to get reorganized in order to cope with the treatment situation. In view of the high level of anxiety associated with the relapse diagnosis and the limited number of studies available in Brazilian and international literature about its psychosocial aspects in the Pediatric Oncology context, the aim in this research was to understand the experiences of children and their family caregivers in view of this treatment phase. The research participants were children between five and 12 incomplete years of age, undergoing cancer relapse treatment at a Brazilian referral center for childhood onco-hematology, as well as their primary caregivers. A descriptive and exploratory research with a clinical-qualitative approach was carried out. To achieve the objectives, an interview was held with the relative responsible for patient care, guided by a semistructured script, and two application sessions of the Drawing-And-Story Procedure with the child. The interviews were audio-recorded with the participants consent. The reports taken from the interviews and the narratives collected during the sessions with the children were fully and literally transcribed and then submitted to thematic content analysis, while the Drawings-Histories were analyzed in accordance with literature recommendations. The results showed that the relapse diagnosis returned the participants to the initial investigation and diagnosis period, but accompanied by greater mobilization and affective intensity. Feelings of frustration emerged with regard to the cure expectations, feelings of threat and loss of control in view of the disease and prognosis, favoring the confrontation with the possibility of death. This situation negatively affected the projected timing of cure, influencing the attribution of meanings to existence. The need to restart the treatment was accompanied by the need to reorganize the family dynamics and the need for affective strengthening to cope with the vicissitudes of daily treatment. Relations between parents and childrens experiences were observed, comprising issues like communication and the meanings attributed to the disease. Religiosity and the search for a sense of control were important resources the caregivers use to cope with these challenging situations, while the children attempted to maintain their affective proximity with the caregivers and strengthen their feeling of security. Understanding the experiences of the children and their family caregivers can support the planning of psychological interventions that favor coping with the peculiarities of the disease situation introduced by the relapse diagnosis of child cancer, contributing to the implementation of palliative care.

Background and Objectives: Alterations in the habitual sleep/wake patterns of women with breast cancer and their informal caregivers may be concurrently exacerbated and co-vary during the patient’s treatment. The current study set out to longitudinally ex-plore sleep-wake patterns of patient-caregiver dyads in the context of adjuvant chemotherapy (CTh) for breast cancer. Taking into consideration the complexity of mechanisms interfering with a care dyad’s sleep, diverse sleep-impairing factors were also investigated. Design and Methods: Descriptive, observational, repeated-measures dyadic study. Forty eight newly diagnosed women receiving outpatient adjuvant CTh for early stage breast cancer (stage I-IIIA) and their nominated primary informal caregiver completed self-reported sleep measures at pre-treatment (week prior to CTh), post-CTh cycle 1, post-CThC4, and approximately 30 days after the end of CTh (total of =6 cycles received). Additional data on the dyads’ sleep hygiene practices (SH), patient physical burden, caregiving burden (CRACB), psychological burden (PSYCH), nocturnal sleep disturbances (SDSTRB), and maladaptive coping strategies were collected at each assessment point. Results: Prior to CTh, 65% of dyads consisted of at least one poor sleeper, a rate further increasing to approximately 88% at CThC4. Multivariate hierarchical linear modelling revealed curvilinear trajectories for most dyads’ sleep/wake parameters that nevertheless reached significance (p<.05) for patients only. In both groups, sleep/wake impairment reached its peak at mid-treatment (CThC4); yet, patients consistently reported significantly more sleep problems than their carers. Partial convergence also emerged as suggested by positive correlations and no between-groups differences in daily disturbance, daytime napping duration, total sleep time, and overall sleep/wake impairment at pre-treatment. At CThC4, rates of change in sleep latency and daytime napping duration were also similar. In exploratory analyses, increased CRACB, poor SH, and SDSTRB consistently predicted poorer outcomes in the dyad members’ own sleep-wake patterns. Cross-partner effects most frequently emerged with regard to the dyads’ PSYCH, as well as for CRACB. Among the most interesting findings, increased patient PSYCH adversely affected caregiver perceived sleep quality and daytime napping. Reversely, increased CRACB was related to worse patient sleep quality, reduced sleep time, and difficulty to fall asleep. Some links might be suggested for own poor sleep hygiene and worse partner outcomes on daytime functioning, sleep efficiency, or wake after sleep onset. Conclusions and Future Implications: This is one of the first studies to show that a dyadic approach in the assessment of sleep/wake patterns in patients with breast cancer and their informal carers is a promising method to enhance exploration of potentially concurrent sleep/wake-impairment and associations with sleep-impairing factors that may co-vary in dyad members. Replication of the current findings in future dyadic sleep research is warranted. Meanwhile, clinicians will need to engage in concurrent systematic and ongoing sleep assessments that synthesise and contrast data to establish a care dyad’s level of sleep quality.

A doença de Alzheimer, doença neurodegenerativa, em que a dificuldade de encontrar palavras é um dos déficits mais presentes, mesmo em estágios iniciais já ocorrem alterações focalmente no hipocampo e giros parahipocampais. Com o avanço da doença, a dificuldade de encontrar palavras e o uso de itens lexicais efetivos ficam muitas vezes mais comprometidos sugerindo distribuição difusa da doença no encéfalo. A dificuldade em encontrar palavras ou anomia se deve consensualmente à deterioração do processamento semântico e ao déficit da memória operacional. Ainda, mesmo nesses estágios iniciais da doença, muitos pacientes relatam dificuldades em encontrar os itens lexicais adequados para seguir uma conversação, o que os constrange causando isolamento e falta de interações comunicativas verbais. Esse relato indica que eles têm consciência dessa perda cognitiva. Nas conversações ou interações sociais entre pacientes e cuidadores, muitas vezes a dificuldade de encontrar os itens lexicais não é claramente percebida. Entretanto, com o progresso da doença essa incompreensão se acentua, gerando situações estressantes e de sobrecarga, especialmente para o cuidador. A presente pesquisa objetivou analisar os itens lexicais no discurso oral dos pacientes com doença de Alzheimer, verificar aquelas palavras mais preservadas, que visem à elaboração de estratégias linguísticas adequadas e que permitam o desenvolvimento de mecanismos discursivos, a fim de identificar estratégias que possam melhorar a interação entre cuidadores e pacientes. Neste estudo avaliaram-se os itens lexicais verbos e substantivos, hápax e as oito outras categorias gramaticais da língua portuguesa de 23 pacientes com doença de Alzheimer e 23 idosos controles sadios. Os itens selecionados foram extraídos de conversações livres por no máximo 20 minutos com os temas: cidade, família, educação, alimentação, saúde e religião. Foi utilizado o programa Stablex que efetua o tratamento computacional de itens lexicais e confecções de léxico para identificar os itens lexicais mais frequentes e com maior peso ou valor. Os resultados indicam que os pacientes têm maior dificuldade em nomear substantivos, especialmente seres vivos, p<0,05. Ainda, esses pacientes apresentam maior preservação de itens lexicais concretos em relação aos itens lexicais abstratos. Além disso, foi observada maior preservação de verbos do que de substantivos, hápax fica preservado nos pacientes com doença de Alzheimer, p<0.001. Os adjetivos, p<0,001, interjeições, p<0,001,artigos e preposições p<0,001, também são significantes na doença. Conclui-se, assim, que embora os pacientes tenham perda lexical progressiva, suas habilidades comunicativas, semântico-pragmáticas não estão muito alteradas e que os pacientes ao serem estimulados com frases curtas, com aquelas palavras mais preservadas no seu léxico ainda podem se comunicar e interagir oralmente. Portanto, as análises de itens lexicais nos discursos orais dos pacientes com doença de Alzheimer não só contribuirão para o entendimento dos déficits de linguagem, mas também oferecerão formas de melhorar a comunicação entre pacientes e cuidadores / Alzheimer\'s disease, neurodegenerative disease, wherein the word-finding difficulty is one of the most common deficits, even at early stages alterations occur focally in the hippocampus and parahippocampal gyri. With disease progression, the word-finding difficulty and effective use of lexical items are often more affected suggesting diffuse distribution of the disease in the brain. The word-finding difficulty or anomie is consensually to the deterioration of semantic processing or the occurrence of impaired connection between the lexical and semantic level as well as the working memory impairment. Yet, even in these early stages of the disease, many patients report difficulties in finding suitable lexical items to follow a conversation, therefore the patients get constrained, causing isolation and lack of verbal communicative interactions. This indicates that they are aware of this cognitive loss. In conversations or social interactions between patients and caregivers, often the difficulty of finding lexical items is not clearly perceived. These caregivers often help the patient to complete the words and sentences inferring meanings thereby masking the stage of disease. However, with the progress of the disease misunderstanding increases, causing overload and stressful situations, especially for the caregiver. The current study aimed at analyzing the lexical items in oral discourse of patients with Alzheimer\'s disease, to verify the most retained words in order to develop appropriate linguistic strategies enabling the development of discursive mechanisms to identify strategies to improve the interaction between caregivers and patients. This study evaluated the lexical items, verbs, nouns hápax and the other eight grammatical categories of Portuguese language of 23 patients with Alzheimer\'s disease and 23 healthy elderly controls. The selected items were drawn from free conversations of at least 20 minutes with the themes: city, family, education, food, health and religion. We used Stablex program that performs the computational treatment of lexical items and creates lexicons to identify more frequently lexical items and with their weight or value. The results indicate patients have greater difficulty in naming living things, p<0.05. Also, these patients have higher retention of concrete lexical items in relation to abstract lexical items. Moreover, hapax is retained in Alzheimers disease, p<0.001. It is attributed to the greater number of nouns in the languages compared to verbs or because, perhaps, the frontal areas of the brain where the verbs are represented are affected later. Also, it was observed that the lexical item hapax is significant in patients with Alzheimer\'s disease. Adjectives, p<0,001, interjections, p<0,001, articles and prepositions, p<0,001, are also significant during the disease, We conclude, therefore, that although patients have progressive lexical loss, their communication and semantic-pragmatic skills are not much changed, and when patients are stimulated with short sentences with words that are more retained in their lexicons they can still communicate and interact verbally. Therefore, the analysis of lexical items in oral discourse of patients with Alzheimers disease not only contributes to the understanding of language deficits, but also it will offer ways to improve communication between patients and caregivers

This study examined the delivery of information and services offered to grandparents who had become the primary caregivers of pre-k through third grade students to determine if the information and services were effective in decreasing chronic early absence as defined by Chang and Romero (2008). This mixed-method, multi-case study focused on the perceived needs of custodial grandparents and examined if the school system was meeting their needs through delivery of information and services. The researcher sought participation from 5 custodial grandparents who had grandchildren in pre-k, kindergarten, first, second, or third grades in a Northeast Tennessee school system and whose grandchildren had accumulated absences that met the definition of chronic early absenteeism (10% or more absences) as defined by Chang and Romero (2008). Skyward Database provided a list of families who met the aforementioned criteria. The average age of this group of grandparents was 51.8 with a range of ages from 48 to 54.The comparison group, also retrieved from the Skyward Database, included 4 custodial grandparents whose grandchildren had the highest attendance rates (top 5%). The average age of this group was 53 with a range of ages from 48 to 59. Researcher-developed questionnaires and interviews were used to determine outcomes and major findings. [a1] Major findings included 1) A Chi Squared Test determined that children in grandparent-led households were significantly more likely to meet the criteria of chronic early absence than children from parent/other guardian-led households; 2) 100% of grandparents in both groups had not heard of chronic early absence, 33% of teachers had not heard of chronic early absence, and 50% of Family Resource Center Staff had not heard of chronic early absence; 3) 47% of grandparent-led households met the criteria of chronic early absence while only 18% of parent/other guardian-led households met criteria of chronic early absence; 4) 0% of the parents were involved in the child’s life or education in the grandparent-led households while 50% of the parents were involved in the child’s life or education in parent/other guardian-led households; 5) 20% of children in grandparent-led households with chronic early absence had disciplinary actions while 100% of children in grandparent-led households with high attendance had significant disciplinary actions; and 6) Sickness was the primary reason for absences in grandparent-led families with chronic early absence; 7) A majority of grandparents in both groups used verbal communication with teachers and school staff, but written communication was preferred by each group.

Functional analyses (FAs) are a common tool used in the assessment and treatment of severe problem behaviors and often occur in the context of clinical settings with unfamiliar, trained staff. Previous research suggests that inconsistent outcomes can emerge when caregivers with an existing history of seeing their child’s challenging behavior are trained to implement the assessment in place of clinical staff. The purpose of the current study was to expand on existing literature by comparing FA implemented by clinical staff and caregivers in the context of a clinical setting. Results demonstrate that efficient identification of function and differentiated rates of problem behavior given the inclusion of caregivers during assessment may vary based on the child’s existing history of responding with those caregivers. Implications of results for researchers and practitioners are discussed.

Psychosocial support from family is important in outpatient treatment programs for individuals with depressive disorder. The purpose of this phenomenological study was to explore the lived experiences and perceptions of parents of patients with depressive disorder regarding intensive outpatient treatment. The research question was what are the experiences and perceptions of parents of patients with depression regarding their role as caretakers in intensive outpatient treatment? The conceptual framework was a biopsychosocial framework and family systems theory. Content analysis was used to analyze data provided from interviews with parent participants (n = 8). Many participants reported high levels of involvement with various forms of support. They maintained positive relations with professionals, were involved in patient socialization, and facilitated adherence to patients' treatment plans. The results of this study indicated that family caregivers experienced ambivalent emotions toward their roles and patients. Findings also indicated experiences of exhaustion, strong emotions about the burden of having to support the patient, and concern for their own and the rest of the family's well-being. Future researchers should study these aspects further. Researchers, clinical practitioners, and policy makers must increase efforts to support those who help family members suffering from depression to intensify the search for effective ways to reduce the toll on those caregivers. Because of these findings, researchers could expand literature to illuminate the decisions and practices of psychotherapists, leading to improvements in intensive treatment programs for both patients and their caretakers. This study impacts social change by providing insights to aid policy makers in ensuring that outpatients receive the best treatment program available and that their primary caretakers are psychologically prepared and healthy.