Made available in DSpace on 2015-03-05T19:35:30Z (GMT). No. of bitstreams: 0 Previous issue date: 14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Investigar o abandono de atendimento psicológico de crianças auxilia na avaliação da qualidade das terapias na clínica da infância. O trabalho com crianças torna mais complexa a situação de tratamento, onde o campo terapêutico constituir-se-á não somente do par analista-paciente, mas de uma tríade analista-paciente-pais. Pesquisar clínicas-escola cria possibilidades de aperfeiçoamento, sendo também uma forma de prevenir e enriquecer esse ambiente de formação, principalmente se possui um número alto de pacientes que não completam o tratamento. O objetivo deste estudo é examinar, entre crianças que estiveram em atendimento psicológico numa clínica-escola, variáveis que possam ter influenciado no abandono de seus processos psicoterápicos. Para realizar este estudo foram analisados protocolos de atendimentos no arquivo de uma clínica-escola, localizada na região metropolitana de Porto Alegre, para examinar os casos de atendimento de crianças de 3 a 12 anos de idade, no período de 1999 a 2006. Os protocolos contêm / To investigate psychology treatment dropout of children helps the evaluation of the quality of therapy in children´s clinic. The work with children makes the treatment situation more complex, where the therapeutic field will constitute not only of the couple patient-analyst, but of a triad analyst-patient-parents. To assess school-clinics creates possibilities of improvement, being also a form to prevent and enrich this training environment, principally if it has a large number of patients that do not complete the treatment. The objetive of this study was to examine, among children who were attending a psychology clinic, variables that might have influenced the abandonment of their psychotherapeutic processes. In order to execute the study the protocols from the archive of the school-clinic located in the metropolitan region of Porto Alegre were analyzed. All children´s cases ages 3 to 12 years old from 1999- 2006 were examined. The protocols contained sociodemographic information, the case evolution, referra

[pt] A psicoterapia com famílias em situações de vulnerabilidade envolve muitas dificuldades, pois inclui a complexidade do trabalho com múltiplos vínculos associada às precariedades inerentes às vivências de desamparo e de violência em diferentes níveis. Visando produzir conhecimentos nesse campo, de modo a consubstanciar a prática clínica com o grupo familiar, o objetivo deste trabalho foi investigar os padrões vinculares predominantes em famílias em situações de vulnerabilidade, buscando pensar alguns dos desafios e limitações da psicoterapia de família. Para tal, foi realizada uma investigação clínicoqualitativa, a partir do método de estudo de casos, ambos interrompidos precocemente pelas famílias. Foi proposta uma análise a partir de algumas das principais contribuições psicanalíticas sobre os vínculos, dentre as quais estão as de Bion e Pichon-Rivière, além das postulações teóricas sobre a noção de duplovínculo da Teoria Sistêmica. Foi observado que os vínculos familiares eram marcados por antiemoções e situações de duplo-vínculo. Identificou-se que, por vezes, uma interrupção precoce do tratamento não significa necessariamente o fracasso da psicoterapia em família. Nos casos pesquisados, foi possível compreender que o tratamento alcançou sua função de escuta e de espaço de reflexão, dadas as limitações das qualidades dos vínculos, específicas de cada família. / [en] Psychotherapy with families in situations of vulnerability involves many difficulties, as it includes the complexity of working with multiple links associated with the precariousness inherent to the experiences of helplessness and violence at different levels. Aiming to produce knowledge in this field, in order to substantiate clinical practice with the family group, the objective of this work was to investigate the linking patterns prevalent in families in situations of vulnerability, developing thoughts about some of the challenges and limitations of family psychotherapy. To this end, a qualitative clinical investigation was carried out, using the case study method, both interrupted early by the families. An analysis was proposed based on some of the main psychoanalytic contributions on the links, among which are those of Bion and Pichon-Rivière, in addition to the theoretical postulations on the notion of double-bind of the Systemic Theory. It was observed that family bonds were marked by anti-emotions and double-bind situations. It was found that sometimes an early interruption of treatment does not necessarily mean the failure of family psychotherapy. In the researched cases, it was possible to understand that the treatment reached its function of listening and space for reflection, given the limitations of the qualities of the links, specific to each family.

Le continuel développement des outils statistiques permet aujourd’hui la modélisation de nombreux phénomènes, toujours plus complexes. En combinant l’approche offerte par des modèles statistiques spécifiques, dit "multiniveaux", et leurs applications à différentes problématiques médicales, cette thèse s’inscrit à la croisée de divers domaines : celui des statistiques, de par la méthodologie sur laquelle reposent les résultats ; mais aussi, celui de l’économie de la santé et de la santé publique en général, au travers des applications présentées.La première partie de cette thèse s’intéresse aux aspects théoriques, et plus particulièrement à l’évolution des méthodologies, du modèle de régression linéaire simple aux modèles multiniveaux pour des liens non nécessairement linéaires. Le déroulé historique de la modélisation mais également les hypothèses, le principe, la stratégie d'analyse et enfin les limites y sont abordés.La seconde partie s’articule autour de deux applications multiniveaux distinctes. La première concerne les déterminants de l'observance et des interruptions de traitement, chez les personnes infectées par le virus du VIH/Sida suivant un traitement par antirétroviraux, dans le contexte du Cameroun. La seconde, quant à elle, s'intéresse au recours aux soins dentaires chez les personnes âgées de 60 ans et plus et vivant en domicile ordinaire. Ces deux applications sont comparables dans leurs méthodologies puisqu’il s’agit de déterminer les comportements étudiés par des variables individuelles habituellement retenues, mais aussi des variables de "contexte" (caractéristiques de l’offre de soins).La troisième partie est consacrée aux applications sur le panel de médecins généralistes et traite deux études autonomes. La première expose les réticences des médecins, et le rôle de leurs aprioris, face aux Recommandations de Bonnes Pratiques (RBP). Elle nous permet de déboucher sur quelques pistes pour améliorer l’usage des RBP en médecine de ville. La seconde analyse la similarité – ou parfois la dissimilarité – entre le cycle d’activité des médecins généralistes et la saisonnalité des épidémies, dans le but d’identifier les facteurs favorisant l’ajustement des médecins généralistes aux variations saisonnières des besoins des patients. Cette étude pourrait permettre, notamment, d’anticiper et de mieux gérer des situations de crise sanitaire, avec l’appui effectif de la médecine de ville. / The continual development of statistical tools allows the modelling of numerous phenomena, including the complex ones. Using a set of statistical techniques and applications, based on the so-called “multilevel” modelling, this thesis deals with different aspects related to the statistical methodology and applications as per health economics and public health.The first part reconsiders the evolution of methodology, starting from the simple linear regression techniques to the more complex multilevel modelling as applied to both the linear and non-linear relations. It addresses issues related to the historical development, the hypotheses, the strategy of analysis, and the scope of applications. The second part presents two distinct multilevel studies. The first concerns the determinants of observance and interruptions of treatment for persons infected by the HIV/AIDS and treated with antiretroviral in Cameroon. The second one focuses on the use of dental services for the elderly. The two studies are methodologically comparable in that, besides integrating the usually retained individual variables, the analyses examine health seeking behaviours, particularly, the utilisation of health care services, while accounting for contextual determinants such as the characteristics of health supply (clinic, department or region).The third part is dedicated to the applications on GPs' panel and contains two different studies. The first one explains the GPs’ behaviours and the role of their aprioris vis-à-vis Clinical Practice Guidelines (CPG), and suggests solutions to overcome their negative attitudes. The second study analyses the similarity – sometimes the differences – between the cycle of GPs’ activity and the seasonality of epidemics with the aim of better understanding determinants favouring the adjustment of the GP in the seasonal variations of the patients needs. This study helps anticipate and manage situations of sanitary crisis, with the effective support of general practitioners.