Within athletic domains, athletic identity is a cognitive structure guiding and organising how the person processes self-related information (Brewer, Van Raalte, & Linder, 1993). Being one of the domains of the self-concept, athletic identity is the “degree of importance, strength, and exclusivity attached to the athlete role that is maintained by the athletes and influenced by environment” (p. 39; Cieslak, 2005). Previous studies have shown that athletic identity is related to various psychological processes such as identity foreclosure and the emotional reactions of athletes to injuries (Grove, Lavallee, & Gordon, 1997). The Athletic Identity Measurement Scale (AIMS) is a 10-item quantitative inventory measuring the level of athletic identity (Brewer, Van Raalte, & Linder, 1993). Throughout the past decade, researchers have been examining the psychometric properties and factor structures of the AIMS with samples mainly from English-speaking societies (Brewer & Cornelius, 2001; Hale, James, & Stambulova, 1999). This thesis consisted of two studies. The first one investigated the internal consistency and factor structure of the AIMS within a Hong Kong Chinese sample by performing confirmatory factor analyses (CFAs) and Cronbach’s alphas. The author constructed a Chinese version of the AIMS and administered it to 186 Hong Kong athletes. The CFAs showed that multi-dimensional models were better fits than the original unidimenional model. The goodness-of-fit indices of three previously suggested models (and one simplified model) were either above or extremely close to acceptable levels. Considering the possible cultural influences and translation processes, the findings are substantial. In this study, the author also discusses the cultural differences in terms of each factor and overall athletic identity scores. The second study followed up the results of the first study and further explored the construct of athletic identity through qualitative interviews. The author, who was also the interviewer, recruited 13 Hong Kong athletes for in-depth interviews exploring their life experiences of being athletes in Hong Kong. The results revealed that some contributing elements of the participants’ athletic identities seemed well represented by the AIMS items and factors, such as recognition from others (i.e., social identity), sport-related goals, dysphoric emotions associated with injury (i.e., negative affectivity), and perceived importance of sport (i.e., exclusivity). Some themes from the interviews, however, were not represented in the items or factors of the AIMS. For some participants, appearance and accoutrements, such as clothing and equipment, formed part of their overall athletic identities. Also, the author found that the participants’ fantasies about professional athletes were major features of the interviews. These results showed that various cultural characteristics in Hong Kong may influence the development of the participants’ self-identities including athletic identities. The author employed the theory of self-construals (Markus & Kitayama, 1991) and features of Hong Kong culture to explain the results. In the general discussion, the author also discussed the AIMS items, the factor structure, and their connections with Hong Kong athletes’ experiences, based on the qualitative findings. The author recommended some possible items for further development of the AIMS.

A detailed reply paid questionnaire was posted via surface mail to overseeing members of Australian surfboard riding clubs in May 2004. Clubs from Western Australia, Victoria, New South Wales and Queensland partcipated. Further participants were randomly recruited from surfing locations throughout Australia including beaches in Queensland, New South Wales and Victoria. Participants were asked to recall injury details over a retrospective period of two years. Conclusions: Laceration is the most common surfing injury (52%), followed by contusions(36%), muscle strains or tears (4%), fractures (4%), joint sprains (3%), and joint dislocations (1%). Lower limbs are the most commonly injured area, followed by upper limbs, and the head and face. Surfing safety equipment should be designed to protect the limbs from lacerations, and aid in the prevention of serious injuries such as vertebral, facial and skull fractures. Delayed onset muscle soreness is common amongst recreational surfers. Medical doctors are the most commonly consulted health care practitioner by surfers for treatment of surfing related injury, followed by physiotherapists and Osteopaths. This minor thesis was written by post graduate students as part of the requirements of the Master of Health Science (Osteopathy) program.

This study examined the effects of music on physiological and psychological responses in Osteopathic patients who listened to relaxation music. Fifty subjects, twenty-six females and twenty-four males ranging in age from 18-51, were randomly assigned to one of two environmental settings. Participants in the control group were treated in the absence of relaxation music. The participants allocated to the experimental group received their normal osteopathic treatment whilst relaxation music played in the background. The specific music selected was shown in previous research to decrease State anxiety. Pysiological data collected before and after treatment included heart rate, respiration, diastolic blood pressure, and systolic blood pressure. Psychometric data was assessed using a Visual Analogue Scale for self-perceived relaxation. Significant differences (p<.05) were found from pre-test to post-test in the music group for heart rate, blood pressure and respiration. There were no significant differences in self-perceived tension ratings between the two groups. This minor thesis was written by post-graduate students as part of the requirements of the Master of Health Science (Osteopathy) program.

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-02-27T13:30:33Z No. of bitstreams: 5 25.pdf: 320576 bytes, checksum: 4781223a193fdf37ff0784eb0c44882b (MD5) license_url: 49 bytes, checksum: fd26723f8d7edacdb29e3f03465c3b03 (MD5) license_text: 20626 bytes, checksum: 7851d446050a985bd0603b7c4cee472d (MD5) license_rdf: 19710 bytes, checksum: aa65da15f424ff71c620a992a187295c (MD5) license.txt: 2109 bytes, checksum: aa477231e840f304454a16eb85a9235f (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-02-27T16:58:53Z (GMT) No. of bitstreams: 5 25.pdf: 320576 bytes, checksum: 4781223a193fdf37ff0784eb0c44882b (MD5) license_url: 49 bytes, checksum: fd26723f8d7edacdb29e3f03465c3b03 (MD5) license_text: 20626 bytes, checksum: 7851d446050a985bd0603b7c4cee472d (MD5) license_rdf: 19710 bytes, checksum: aa65da15f424ff71c620a992a187295c (MD5) license.txt: 2109 bytes, checksum: aa477231e840f304454a16eb85a9235f (MD5) / Made available in DSpace on 2015-02-27T16:58:53Z (GMT). No. of bitstreams: 5 25.pdf: 320576 bytes, checksum: 4781223a193fdf37ff0784eb0c44882b (MD5) license_url: 49 bytes, checksum: fd26723f8d7edacdb29e3f03465c3b03 (MD5) license_text: 20626 bytes, checksum: 7851d446050a985bd0603b7c4cee472d (MD5) license_rdf: 19710 bytes, checksum: aa65da15f424ff71c620a992a187295c (MD5) license.txt: 2109 bytes, checksum: aa477231e840f304454a16eb85a9235f (MD5) Previous issue date: 2008 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (Capes) / O Alto Vale do Jequitinhonha tem apresentado como ascendente p?lo cafeeiro do estado de Minas Gerais. No entanto, pouca import?ncia tem sido dada ao diagn?stico do estado nutricional do cafeeiro que proporcione maior produtividade e, melhor qualidade da bebida.As normas DRIS ainda n?o foram estabelecidas para cafeeiros do Alto Vale do Jequitinhonha,assim, a inexist?ncia dessas impede que o DRIS seja aplicado nesta cultura nessa regi?o. A diagnose foliar, mediante o uso do Sistema Integrado de Diagnose e Recomenda??o (DRIS) e de faixas cr?ticas de nutrientes de refer?ncia, destaca-se dentre as ferramentas potenciais que permitem diagnosticar eficientemente o estado nutricional das plantas. Os objetivos deste trabalho foram (a) estabelecer as normas DRIS, propor faixas adequadas para teores foliares de nutrientes e diagnose nutricional dos cafeeiros (Coffea arabica L.) do Alto Vale do Jequitinhonha; (b) realizar o levantamento da qualidade da bebida do caf? e (c) estabelecer as normas DRIS, propor faixas adequadas de nutrientes e avaliar o estado nutricional dos cafeeiros para maior produtividade. O Alto Vale do Jequitinhonha tem apresentado como ascendente p?lo cafeeiro do estado de Minas Gerais. No entanto, pouca import?ncia tem sido dada ao diagn?stico do estado nutricional do cafeeiro que proporcione maior produtividade e, melhor qualidade da bebida.As normas DRIS ainda n?o foram estabelecidas para cafeeiros do Alto Vale do Jequitinhonha,assim, a inexist?ncia dessas impede que o DRIS seja aplicado nesta cultura nessa regi?o. A diagnose foliar, mediante o uso do Sistema Integrado de Diagnose e Recomenda??o (DRIS) e de faixas cr?ticas de nutrientes de refer?ncia, destaca-se dentre as ferramentas potenciais que permitem diagnosticar eficientemente o estado nutricional das plantas. Os objetivos deste trabalho foram (a) estabelecer as normas DRIS, propor faixas adequadas para teores foliares de nutrientes e diagnose nutricional dos cafeeiros (Coffea arabica L.) do Alto Vale do Jequitinhonha; (b) realizar o levantamento da qualidade da bebida do caf? e (c) estabelecer as normas DRIS, propor faixas adequadas de nutrientes e avaliar o estado nutricional dos cafeeiros para maior produtividade e melhor qualidade da bebida. Pelos resultados obtidos, pode-se concluir: (1) maiores porcentuais de lavouras em desequil?brios nutricionais foram observados para os nutrientes P, K, S, B, Cu, Mn e Zn em defici?ncia, sendo o Mg e Fe os excessivos; (2) as normas DRIS para diagnose nutricional foram estabelecidas para cafeeiros da regi?o do Alto Vale do Jequitinhonha, MG e utilizadas para propor faixas cr?ticas para N (2,25 - 2,79 dag kg-1), P (0,18 - 0,22 dag kg-1), K (1,72 - 2,10 dag kg-1), Ca (1,26 - 1,51 dag kg-1), Mg (0,29 - 0,35 dag kg-1), S (0,13 - 0,32 dag kg-1), B (83,8 - 96,3 mg kg-1), Cu (5,7 ? 9,3 mg kg-1), Fe (67,5 - 116,2 mg kg-1), Mn (219 - 422 mg kg 1) e Zn (17,4 - 30,0 mg kg 1); (3) pelo levantamento da qualidade da bebida do caf? verificou-se que a maior parte das lavouras avaliadas da regi?o apresentou qualidade da bebida classificada como ?dura?, por?m a regi?o apresenta aptid?o para produzir caf?s de melhor qualidade (bebida ?mole?, ?apenas mole? e ?estritamente mole?); (4) as normas DRIS para o estado nutricional juntamente com a qualidade da bebida do caf? foram estabelecidas para cafeeiros da regi?o do Alto Vale do Jequitinhonha, MG e a partir destas normas, foram propostas as faixas cr?ticas de nutrientes N (2,20 - 2,48 dag kg-1), P (0,20 - 0,24 dag kg-1), K (1,49 - 1,79 dag kg-1), Ca (1,30 - 1,61 dag kg-1), Mg (0,32 - 0,38 dag kg-1), S (0,10 - 0,13 dag kg-1), B (77,3 - 89,1 mg kg-1), Cu (3,1 ? 3,8 mg kg-1), Fe (174,0 - 242,4 mg kg-1), Mn (197,5 - 341,8 mg kg-1) e Zn (19,8 - 31,0 mg kg-1) e (5) a manuten??o do equil?brio do estado nutricional das lavouras cafeeiras proporciona elevada produtividade e qualidade da bebida do caf?. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Produ??o Vegetal, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2008. / ABSTRACT The High Jequitinhonha Valley has presented as coffee upward pole of the state of Minas Gerais. However, little attention has been given the diagnosis of the nutritional status of coffee that provides greater productivity and, together with productivity, improved quality of the drink. The DRIS standards have not yet been set for the coffee yield in Valley do Jequitinhonha, thus the absence of such rules prevent the DRIS is applied in that region's coffee culture. The diagnosis leaf, using the Integrated System Diagnosis and Recommendation (DRIS) and tracks critical of reference, stands out among the potential tools that allow efficiently diagnose the nutritional status of the plants. The objectives of this study were (a) establish the rules DRIS, propose suitable for tracks levels of nutrients and leaf diagnose nutritional of coffee (Coffea arabica L.) of the High Jequitinhonha Valley; (b) carry out lifting the quality of the coffee drink and (c) set the standards DRIS, propose appropriate tracks of nutrients and assess the nutritional status of coffee for higher productivity and better quality of the drink. Those results, we can conclude: (1) higher percentage of crops in nutritional imbalances were observed for nutrients P, S, B, Cu, Zn Mn and in disability, and the Mg and the excessive Fe; (2) The DRIS to diagnose nutritional standards were established for coffee in the region of the High Jequitinhonha Valley, MG and tracks used to propose critical for N (2.25 - 2.79 dag kg-1), P (0.18 - 0, 22 dag kg-1), K (1.72 - 2.10 dag kg-1), Ca (1.26 - 1.51 dag kg-1), Mg (0.29 - 0.35 dag kg-1 ), S (0.13 - 0.32 dag kg-1), B (83.8 - 96.3 mg kg-1), Cu (5.7 - 9.3 mg kg-1), Fe (67 , 5 to 116.2 mg kg-1), Mn (219 - 422 mg kg 1) and Zn (17.4 - 30.0 mg kg 1); (3) by lifting the quality of the coffee drink there was that most of the crops in the region had assessed quality of the drink classified as "hard", but the region presents ability to produce higher quality coffee (drink "soft", "just soft" and "strictly soft"); (4) DRIS standards for the nutritional status along with the quality of the drink of coffee were down for coffee in the region of the High Jequitinhonha Valley, MG and from these standards, the tracks were proposed critical nutrients N (2.20 - 2.48 dag kg-1), P (0.20 - 0.24 dag kg-1), K (1.49 - 1.79 dag kg-1), Ca (1.30 - 1.61 dag kg-1), Mg (0.32 - 0.38 dag kg-1), S (0.10 - 0.13 dag kg-1), B (77.3 - 89.1 mg kg-1), Cu (3.1 - 3.8 mg kg-1), Fe (174.0 - 242.4 mg kg-1), Mn (197.5 - 341.8 mg kg-1) and Zn (19.8 - 31.0 mg kg-1) as tracks appropriate for the better nutritional status and quality of the coffee beverage for the region of Minas; (5) for the diagnosis of the nutritional quality of coffee to drink noted that maintaining the balance of the nutritional status of crop, provides high productivity and quality of the coffee beverage.

Trata-se de uma pesquisa qualitativa descritiva que teve como objeto de estudo as estratégias de enfrentamento dos pais com o nascimento de uma criança com anomalia craniofacial. Objetivou identificar o impacto causado nos pais frente ao nascimento de um filho portador de anomalia craniofacial; descrever as estratégias de enfrentamento que os pais utilizam para estabelecer vinculação com o filho que apresenta malformação. Utilizou o método Narrativa de Vida, através da entrevista gravada com 15 mães e sete pais de crianças com malformação craniofacial. O estudo foi aprovado pelo Comitê de Ética da Universidade do Estado do Rio de Janeiro. A coleta de dados foi realizada entre junho e agosto de 2014. As narrativas apontaram para a emergência de três categorias: Ter um filho com anomalia craniofacial: situação impactante; Estratégias de enfrentamento utilizadas por pais de crianças com malformação craniofacial; Pais e profissionais da equipe de saúde: uma relação conturbada. As categorias puderam explicitar que a notícia da malformação gera impacto e crise na vida dos pais e no seio familiar. A grande expectativa na gravidez pelo bebê perfeito se transforma em frustração, choque e culpa. Diante dessa adversidade, as famílias começam a desenvolver estratégias de enfrentamento que auxiliam vinculação com seu filho malformado. Essa capacidade de desenvolver forças e habilidades para se adaptar à nova realidade, minimizando os efeitos negativos, é chamada de resiliência. As narrativas apontam a experiência religiosa e a rede de apoio como as principais estratégias de enfrentamento utilizadas pelos participantes. A equipe de saúde é chamada a apoiar os pais ao longo do processo de adaptação com o filho malformado. Os profissionais de saúde podem auxiliar no suporte e adaptação destes pais, diante da nova condição, sendo agentes promotores da escuta terapêutica. Compreender o que há por detrás de cada história desvelada, traz subsídios para potencializar a resiliência no acolhimento institucional dos pais e sua família. / This paper is a qualitative descriptive research that studies the parents' confrontation strategies when in the birth of a child with a craniofacial anomaly. It targeted to identify the impact on parents of a birth of a child with craniofacial anomaly; to describe the parents' confrontation strategies to create a bounding with their ill-formed child. This paper used the Life's Narrative method through an interview with fifteen mothers and seven fathers of children with craniofacial anomaly. This study was approved by the Rio de Janeiro State University Ethics Committee. The data gathering took place between June and August 2014. The narratives pointed to the emerging of three categories: having a child with craniofacial anomaly: impacting situation; Confrontation strategies used by the parents of children with craniofacial anomaly; Parents and healthcare workers: a disturbed relationship. The categories were able to clarify that the ill-formation's news generate an impact and a crisis in the parents' life and in the family unity. The pregnancy's big anticipation for a perfect baby turns into frustration, shock and guilt. In face of this adversity, the families start to develop confrontation's strategies that assist the bounding with the ill-formed child. This capacity to develop forces and abilities to adapt to this new reality, minimizing its negative effects, is called resilience. The narratives point to the religious experience and the support system as the main confrontation strategies used by the participants. The healthcare team is called to support the parents through the adapting process to an ill-formed child. The healthcare professionals can auxiliate on supporting those parents through adaptation to this new condition being promoting agents of the therapeutical listening. Understanding what is behind each unveiled history brings aids to strengthen the resilience in the institutional reception of the parents and their family.

Trata-se de uma pesquisa qualitativa descritiva que teve como objeto de estudo as estratégias de enfrentamento dos pais com o nascimento de uma criança com anomalia craniofacial. Objetivou identificar o impacto causado nos pais frente ao nascimento de um filho portador de anomalia craniofacial; descrever as estratégias de enfrentamento que os pais utilizam para estabelecer vinculação com o filho que apresenta malformação. Utilizou o método Narrativa de Vida, através da entrevista gravada com 15 mães e sete pais de crianças com malformação craniofacial. O estudo foi aprovado pelo Comitê de Ética da Universidade do Estado do Rio de Janeiro. A coleta de dados foi realizada entre junho e agosto de 2014. As narrativas apontaram para a emergência de três categorias: Ter um filho com anomalia craniofacial: situação impactante; Estratégias de enfrentamento utilizadas por pais de crianças com malformação craniofacial; Pais e profissionais da equipe de saúde: uma relação conturbada. As categorias puderam explicitar que a notícia da malformação gera impacto e crise na vida dos pais e no seio familiar. A grande expectativa na gravidez pelo bebê perfeito se transforma em frustração, choque e culpa. Diante dessa adversidade, as famílias começam a desenvolver estratégias de enfrentamento que auxiliam vinculação com seu filho malformado. Essa capacidade de desenvolver forças e habilidades para se adaptar à nova realidade, minimizando os efeitos negativos, é chamada de resiliência. As narrativas apontam a experiência religiosa e a rede de apoio como as principais estratégias de enfrentamento utilizadas pelos participantes. A equipe de saúde é chamada a apoiar os pais ao longo do processo de adaptação com o filho malformado. Os profissionais de saúde podem auxiliar no suporte e adaptação destes pais, diante da nova condição, sendo agentes promotores da escuta terapêutica. Compreender o que há por detrás de cada história desvelada, traz subsídios para potencializar a resiliência no acolhimento institucional dos pais e sua família. / This paper is a qualitative descriptive research that studies the parents' confrontation strategies when in the birth of a child with a craniofacial anomaly. It targeted to identify the impact on parents of a birth of a child with craniofacial anomaly; to describe the parents' confrontation strategies to create a bounding with their ill-formed child. This paper used the Life's Narrative method through an interview with fifteen mothers and seven fathers of children with craniofacial anomaly. This study was approved by the Rio de Janeiro State University Ethics Committee. The data gathering took place between June and August 2014. The narratives pointed to the emerging of three categories: having a child with craniofacial anomaly: impacting situation; Confrontation strategies used by the parents of children with craniofacial anomaly; Parents and healthcare workers: a disturbed relationship. The categories were able to clarify that the ill-formation's news generate an impact and a crisis in the parents' life and in the family unity. The pregnancy's big anticipation for a perfect baby turns into frustration, shock and guilt. In face of this adversity, the families start to develop confrontation's strategies that assist the bounding with the ill-formed child. This capacity to develop forces and abilities to adapt to this new reality, minimizing its negative effects, is called resilience. The narratives point to the religious experience and the support system as the main confrontation strategies used by the participants. The healthcare team is called to support the parents through the adapting process to an ill-formed child. The healthcare professionals can auxiliate on supporting those parents through adaptation to this new condition being promoting agents of the therapeutical listening. Understanding what is behind each unveiled history brings aids to strengthen the resilience in the institutional reception of the parents and their family.

No cuidado cotidiano a crianças portadoras de cardiopatias congênitas percebe-se que os pais têm dificuldade para lidar, no domicílio, com as situações decorrentes da própria situação clínica, tais como cianose, prevenção da endocardite infecciosa, administração dos fármacos, etc. Com a finalidade de conhecer melhor os determinantes e possíveis soluções para tais situações, buscou-se identificar trabalhos científicos que abordassem as necessidades de informação e suporte a pais de criança cardiopatas, de 0 a 12 anos de idade, quanto à sete pontos: cardiopatia congênita propriamente dita; como lidar com a cianose; promoção de atividade física; promoção da alimentação; promoção da saúde bucal; prevenção da endocardite infecciosa e administração de fármacos. A busca foi realizada nas bases de dados MEDLINE, Cochrane, CINAHL, LILACS e Scielo, tendo-se limitado o período entre janeiro de 1997 e abril de 2007. Foram identificados 17 estudos, nos quais foi utilizada a análise temática de conteúdo como referencial metodológico. As categorias de análise foram os sete pontos previamente determinados. Os resultados mostraram que há categorias pouco exploradas, como, cuidados por ocasião de crise de cianose, promoção de atividade física e administração de fármacos. As outras concentram a maior parte dos estudos. São elas: conhecimento dos pais sobre a cardiopatia, promoção de alimentação (compreendendo aleitamento natural), promoção da saúde bucal e prevenção da endocardite infecciosa. Na análise geral percebe-se que o conhecimento dos pais, como um todo, é incompleto e fragmentado, tanto em países desenvolvidos, quanto nos em desenvolvimento. São descritos cuidados prestados por enfermeiros, dentistas e médicos, entre outros. Programas de capacitação de pais são poucos e apenas um é descrito como tendo êxito. Tais resultados apontam para a necessidade de mudanças, tanto em termos da relação direta com os pais, quanto em termos de re-organização dos serviços com vistas a abarcar de modo mais completo a necessidade de informação e suporte a estes / In the daily care regarding to children bearing congenital heart disease one can realize that parents have difficulties to deal, at home, with situations coming from the clinical situation itself, such as cyanosis, prevention of the infective endocarditis, administration of medicines, etc. In order to know better the main causes and possible solutions to such situations, one has sought to identify scientifical studies which approach the necessities of information and support to the parents of congenital heart disease from 0 up to 12 years old concerning seven points: congenital heart disease in the very sense of the problem; how to deal with cyanosis; promotion of physical activity; promotion of feeding; promotion of mouth and teeth hygiene; prevention of infective endocarditis and administration of medicines. The search was done in the bases of data MEDLINE, Cochrane, CINAHL, LILACS and Scielo, in the period between 1997 January to 2007 April. Seventeen studies were identified and the tematic analyses of content was used as methodological reference. The categories to analyse were the 7 points previously determinate. The results showed that there are categories with few reaserches carried out, as, for example, the care in situations of cyanosis crisis, promotion of physical activity and administration of medicines. The other ones concentrate the most of the studies. They are: parents\' knowledge about heart disease, promotion of feeding (including breast-feeding), promotion of mouth and teeth hygiene and prevention of infective endocarditis. The general analyses demonstrates that the parents\' knowledge, as a whole, is incomplete and fragmented both in developed world\'s countries and in the developing world ones. Cares rendered by nursery, odontological and medical staff are described along other sort of cares. Programs to capacitate parents are few and only one is describeb as succesful. Such results point to the need of changing.concerning the straight relation with parents and concerning the re-organization of the service as well, in order to embrace in a more complete way the necessity of information and support to parents

Orientador: Heitor Moreno Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T09:51:17Z (GMT). No. of bitstreams: 1 Souza_WalneiaAparecidade_D.pdf: 8636548 bytes, checksum: c4e5dc584dbab0a2abcce8dceb2db584 (MD5) Previous issue date: 2008 / Resumo: Introdução: O diagnóstico de hipertensão arterial resistente requer cuidadosa avaliação da adesão ao tratamento prescrito. Objetivos: Analisar a adesão ao tratamento dos pacientes com hipertensão arterial de difícil controle, referenciados ao Ambulatório de Farmacologia Cardiovascular do Hospital das Clínicas da Universidade Estadual de Campinas, a fim de identificar os hipertensos resistentes ao tratamento farmacológico. Avaliar também os resultados clínicos e humanísticos durante o seguimento farmacoterapêutico. Método. Realizou-se um estudo prospectivo de 44 pacientes acompanhados por um período de 12 meses. Durante o seguimento farmacoterapêutico, utilizaram-se os seguintes instrumentos: Teste de Morisky et al. e contagem de comprimidos para análise da adesão ao tratamento; teste do conhecimento em relação à doença e ao tratamento anti-hipertensivo; análise da pressão arterial (PA) ambulatorial e através da Monitorização Ambulatorial da Pressão Arterial (MAPA); para qualidade de vida, utilizou-se o instrumento genérico como o SF-36 e instrumento específico (perfil de sintomas físicos); também utilizaram-se os facilitadores de cuidados à saúde (urgência hipertensiva e internação hospitalar). Resultados: Com relação à adesão ao tratamento pelo método contagem de comprimidos, 63,6% dos pacientes foram aderentes no início e, 95,4%, no final do estudo. Pelo Teste de Morisky et al., a adesão foi de 36,4%, no início e, 68,2%, no final. Os hipertensos apresentaram altos níveis de conhecimento em relação à doença e ao tratamento, porém não houve relação com o controle da pressão arterial. Houve redução significativa da pressão arterial (p<0,05) pela MAPA e ambulatorial, mas 59% dos pacientes não controlaram a PA. Quase todos os domínios do SF-36 não sofreram alteração durante o estudo. Mas, para o instrumento específico (perfil de sintomas físicos), houve uma redução significativa nos sintomas moderados e graves (p=0,005). Houve também uma redução significativa no número de urgências hipertensivas (p=0,0001) e de internação hospitalar (p=0,0006). Conclusões: O seguimento farmacoterapêutico foi efetivo na redução da pressão arterial, de sintomas físicos, de urgência hipertensiva e de internação hospitalar; mas não foi sensitivo o suficiente para detectar mudanças nos domínios do SF-36. Apesar dos elevados níveis de adesão ao tratamento, a maioria dos pacientes não controlou a PA. Portanto, outros fatores devem ser investigados, a fim de se caracterizar esses pacientes como resistentes ao tratamento / Abstract: Introduction: The diagnosis of resistant arterial hypertension requires careful evaluation of the adherence to the therapies prescribed. Objectives: Study of the adherence to therapy for patients with difficult-to-control hypertension referred to the Cardiovascular Pharmacology Out-Patient Clinic at the University Hospital of the State University of Campinas (UNICAMP), in Campinas, SP Brazil, in order to identify hypertensive patients with a resistance to pharmacological therapy. The humanistic and clinical results during the pharmacotherapeutic follow-up were also assessed. Method: A prospective survey of 44 patients was conducted where each patient was monitored for a 12-month period. During the pharmacotherapeutic used the following instruments: the test prepared by Morisky et al., and pill count to assess adherence to the treatment; a test to gauge the knowledge of the disease and of the anti-hypertension treatment; analysis made at the office blood pressure, and through Ambulatory Blood Pressure Monitoring (ABPM); the SF-36 (Short Form) questionnaire and a specific instrument (physical symptoms profile) were used to assess the Health-Related Quality of Life (HRQOL); and was also used the health care facilitators (hypertension urgent care and hospital admissions). Results: In relation to the adherence to therapy via the pill count method, 63.6% of the patients were adherent from the start, and 95,4% at the end of the survey. Through the Morisky et al. Test, the adherence to the therapy at the baseline was of 36.4%, and of 68.2% at the end. Hypertensive patients displayed significant knowledge about hypertension and therapy but no relation was found between that and the control of blood pressure. There was a significant blood pressure reduction (p<0.05) via the MAPA and in the office blood pressure, but 59% of the patients did not control their BP. Nearly all domains of the HRQOL assessed by SF-36 remained unchanged during the follow-up. But for the specific instrument there was a significant reduction in the moderate and severe physical symptoms (p=0.005). There were also significant reductions in the number of urgent care visits (p=0.0001) and hospital admissions (p=0.006). Conclusions: The pharmacotherapeutic follow-up was effective in reducing blood pressure, physical symptoms, and urgent care visit and hospital admission numbers; but it was not sensitive enough to detect changes in the domains of the SF-36. In spite of the high adherence levels to the therapy, most of the patients failed to control their BP. Therefore, other factors should be investigated in order to characterize these patients as resistant to treatment / Doutorado / Doutor em Farmacologia

Les Soins de Support sont apparus en France dans les années 90. Héritiers du mouvement des Soins Palliatifs et de la médecine des maladies chroniques, ils occupent une place singulière dans les services de cancérologie. La définition des Soins de Support n’est pourtant pas harmonisée au sein des études, des pratiques et des discours. L’enjeu de ce travail est de poser ce constat, d’en analyser les causes puis de proposer des perspectives menant à un positionnement commun dans le paysage médical contemporain.Il s’agira ainsi de démontrer qu’une définition des Soins de Support est souhaitable et qu’un socle de convictions propres la permet. Méthodes : Une revue de littérature par mots clés a été menée afin de décrire l’utilisation de la définition de Soins de Support dans les études les concernant. Des axes récurrents ont, ensuite, été dégagés. Les Soins de Support sont définis en tant qu’amélioration de la qualité de vie, prise en charge des effets secondaires, modèle d’organisation des soins ou bien à partir de la durée de prise en charge. Cette revue de littérature donne lieu à une restitution par thématiques. Un travail de terrain, fondé sur l’observation et des entretiens auprès de 32 professionnels, patients, proches et associations a été réalisé au sein de quatre établissements de soin : l’Institut Curie, l’Institut Curie Saint Cloud, l’Hôpital Kremlin Bicêtre, l’hôpital Henri Mondor. Il a permis de tester les axes issus de la revue de littérature et d’en mettre en lumière de nouveaux. Le temps, les projets, le corps et la notion de collectif se sont révélés au cœur des discours des acteurs des Soins de Support.Ce travail est qualitatif et non représentatif. Analyse et discussion : Un premier temps dévoile les références auxquelles se rattachent les Soins de Support et les tensions qu’elles produisent les unes par rapport aux autres. Les Soins de Support sont partagés entre des philosophies de l’action définissant la maladie comme réduction des capacités, et des philosophies du soin refoulant les notions telles que l’autonomie en étudiant la relation à l’autre. Un second temps permet de condenser en trois axes unanimes le positionnement des Soins de Support. Tout d’abord, les Soins de Support appuient leurs actions sur une compréhension du temps comme épaisseur vécue. Il s’agit d’accompagner le patient dans un cheminement propre, et d’inscrire le temps des horloges, des techniques et de la physiologie dans le temps de celui qui vit l’événement de la maladie. Ensuite, les Soins de Support mettent en œuvre une compréhension du soin en tant qu’acte collectif. L’équipe de soin se constitue avec le malade au cours de sa maladie. Elle comprend des professionnels soignants et non soignants, ainsi que des membres de la société civile. Elle se forme aux grés des besoins et en fonction des enjeux qui jalonnent le parcours du patient. Enfin, les Soins de Support brisent le monopole médical du savoir sur la maladie. Chaque situation exige la construction collective de la compréhension de la maladie. Il s’agit de comprendre la maladie en tant que carrefour des connaissances médicales, techniques, sociales, culturelles, psychologiques, mais aussi comme questionnement existentiel et affectif. La conviction profonde des Soins de Support est que la pluralité des approches et des regards permet par l’échange de tracer avec le patient ses possibilités et de l’y aider. / Description : Support Cares appeared in France in the 90s. Heirs of Palliative Care Mouvement and chronic diseases medicine take a singular place in cancer departments. Nevertheless, the definition of Support Cares is not harmonized within studies, practices and speeches.The stake in this work is to put this report, to analyze the causes then to propose perspectives leading to a common positioning in the contemporary medical landscape. It will so be a question of demonstrating that a definition of Support Cares is advisable and that a base of appropriate convictions allows it. Methods : A literature review by keywords was led to describe the use of Support Cares definition in the studies concerning them. Then, Recurring axes were cleared. The Support cares are defined as the quality of life improvement, treating the side effects, the care organization model or from the care duration. This literature review gives rise to a return by themes.A field work, based on the observation and interviews with 32 professionals, patients, relatives and associations was conducted within four Care establishments : Curie institute, Saint Cloud Curie Institue, Kremlin Bicêtre Institute, Henri Mondor Hospital. It allowed to test axes stemming from the literature review and to highlight new ones. Time, projects, body and notion of collective proved to be in the heart of the Care Actors speeches.This work is qualitative and not representative.Analysis and discussion : A first time reveals the references with which Support Cares are connected and the tensions they produce in relation to each other. The Support Cares are shared between philosophies of the action defining the disease as reduction of capacities, and Care philosophies repressing notions such as autonomy by studying the relationship. A second time allows to condense in three unanimous axes the Support cares positioning. First of all, Support Cares opress their actions an understanding time as real-life thickness. It is a question of accompanying the patient in a unique path progress, and registering the time of clocks, techniques and physiology in the time of the one who lives the disease event. Then, the Support Cares implement an understanding of the care as a collective act. The Care team establishes with the ill person during his disease. It understands nursing and not nursing professionals, as well as members of the civil society. It forms in the wills of needs and according to the stakes which mark out the route of the patient. Finally, the Support Cares break the knowledge medical monopoly on the disease. Every situation requires the collective construction of the desease understanding. It is a question of understanding the disease as crossroads of medical, technical, social, cultural, pasychological knowledge, but also as existential and emotional questioning.The deep conviction of the Support Cares is that the plurality of the approaches and the looks enable by exchanging to draw with the patient his possibilities and to bring that about.

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