Abstract available through Annals of Epidemiology.

Undersökningar visar att elever med funktionsnedsättning uppger att de trivs sämre i skolan, de upplever ofta högre krav och mer stress från skolarbetet än övriga elever. Arbetsterapi inom skolmiljö riktar sig mot att möjliggöra en stödjande miljö för individen. Syftet med studien var att undersöka och beskriva arbetsterapeuters erfarenheter av arbete i skolan för elever med ADHD och/eller autism. Metoden som författarna använde sig utav var en kvalitativ intervjustudie där deltagarna rekryterades med avsiktligt urval och snöbollsurval. Undersökningen bestod av intervjuer med åtta arbetsterapeuter som arbetar inom skola och habilitering i Sverige. Materialet analyserades enligt kvalitativ innehållsanalys och bygger på arbetsterapeuternas berättelser. Resultatet presenteras i tre kategorier: Utmaningar i skolmiljön, Interventioner samt Skolan som ny arena. Arbetsterapeuterna beskrev utmaningar som målgruppen upplevde i skolmiljö, vilka interventioner som användes samt deras uppfattningar av arbetsterapi i skolan. Slutsatsen är att det finns brist på kunskap om ADHD och autism i omgivningen i skolan. Det finns behov av arbetsterapi i skolan för elever med ADHD och/eller autism. En arbetsterapeut kan med sitt helhetsperspektiv arbeta för att främja aktivitet och delaktighet i skolan. / Studies shows that pupils with disabilities state that they experience a low level of wellbeing in school. Pupils with disabilities often experience higher demands and more stress from school tasks than other pupils. Occupational therapy within school environment is targeted at enabling a supportive environment for the individual. The purpose with this study was to investigate and describe occupational therapist´s experiences of work in school for pupils with ADHD and/or autism. The method that was used by the authors was a qualitative interview study. Participants were recruited by using purposive and snowball sampling. The study consisted of 8 occupational therapists who were working in school and habilitation in Sweden. The material was analyzed by using qualitative content analysis. The results are based on the occupational therapist´s point of view and are presented in three main categories, Challenges in the school environment, Interventions and School as a new arena. The occupational therapists describes challenges in school environment for the pupils, which interventions they were using in their work and their perceptions about occupational therapy in school. The conclusion is that there is a lack of knowledge about ADHD and autism in the surroundings at school. There is a need for occupational therapy in schools for pupils with ADHD and/or autism. An occupational therapist can work with their holistic perspective to promote activity and participation in the school.

As doenças cardiovasculares (DCVs) lideram o ranking de causas de mortes em países desenvolvidos, produzindo custos socioeconômicos elevados. Dentre os fatores de risco para as DCVs, a hipertensão arterial sistêmica (HAS) surge como uma das principais causas para seu desenvolvimento. Estima-se que, no Brasil, a prevalência da HAS em adultos ultrapasse os 30%, o que a torna um grave problema de saúde pública, sendo seu controle uma das áreas prioritárias de atendimento dos Serviços de Atenção Primária à Saúde. Pelo fato da HAS possuir evolução silenciosa e lenta, os pacientes muitas vezes negligenciam sua condição deixando de seguir o tratamento proposto. Além disso, fatores psicológicos como depressão, ansiedade e estresse podem interferir, tanto no surgimento da HAS como na adesão ao tratamento. A falta de adesão à terapêutica, seja ela medicamentosa ou não, torna-se um problema para os profissionais de saúde. Diversos estudos mostram a importância de intervenções psicológicas para a implantação de mudanças e manutenção de comportamentos que interferem no controle da HAS. O objetivo deste trabalho foi avaliar o efeito de uma intervenção cognitivo comportamental sobre a pressão arterial (PA), as variáveis psicológicas, o índice de massa corporal (IMC), o comportamento alimentar e a atividade física de hipertensos atendidos em Serviços de Atenção Primária da cidade de Ribeirão Preto/SP. Participaram deste estudo 84 pacientes que foram avaliados utilizando-se entrevista semi-estruturada, Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário de Depressão de Beck (BDI) e Inventário de Ansiedade de Beck (BAI). Os pacientes foram submetidos a uma avaliação inicial e uma avaliação final, para que posteriormente os dados das duas avaliações pudessem ser comparados. Entre uma avaliação e outra os pacientes foram divididos em dois grupos: Grupo de Terapia Cognitivo Comportamental (GTCC) e Grupo de Orientação (GO). Vinte e dois pacientes frequentaram os grupos propostos, sendo 11 do GTCC e 11 do GO, enquanto 62 não participaram de quaisquer grupos. Os resultados mostraram que não houve diferença estatística significante entre o GTCC e o GO, o que pode estar relacionado ao baixo número de participantes. Quanto às características sócio demográficas (n=84) observou-se que a maioria era do sexo feminino (76,2%), com idade superior a 50 anos, com companheiro (60,7%), com nível de escolaridade até o ensino fundamental completo (53,6%), sem emprego ou aposentados (60,7%) e com renda familiar superior a três salários mínimos (62,0%). Observou-se ainda que a maioria apresentava IMC acima da taxa de normalidade (75,0%) e não praticava atividade física (64,3%). Tinham sua PA controlada 54,8% dos sujeitos e 94% faziam uso de medicação. Quanto aos fatores psicológicos, 53,6% apresentavam sintomas de estresse, 20,2% obtiveram pontuação do BDI que indicava sintomas de transtorno depressivo e 23,8% apresentavam sintomas ansiosos. Considerando-se a baixa frequência de participação nos grupos buscou-se também avaliar a não adesão ao tratamento proposto. Comparando-se os participantes que aderiram aos grupos (n=22) com aqueles que não aderiram (n=62) observou-se diferença estatística significante quanto ao sexo, estado civil, escolaridade, renda familiar, diabetes melittus, conhecimento da PA, conhecimento da PA tida como normal e presença de estresse. No Grupo Adesão houve predomínio de participantes do sexo feminino (95,5%), sendo que a maioria não possuía companheiro (59,1%), tinha nível de escolaridade elevado (72,7%) e possuía renda familiar superior a três salários mínimos (77,3%). No que se refere ao conhecimento e manejo da HAS, no Grupo Adesão, 100% dos participantes conheciam a sua PA após os encontros grupais. Quanto à presença de estresse, houve diminuição de 59,1% para 31,8% entre aqueles indivíduos que aderiram ao tratamento proposto. Os dados indicaram que as mulheres procuram mais os serviços de saúde e que o nível de escolaridade e a renda familiar elevados podem favorecer a adesão ao tratamento. A análise qualitativa dos motivos para a não adesão mostrou que a \"falta de tempo\" foi o principal motivo que dificultou a presenças dos pacientes nos grupos. De maneira geral, os participantes do estudo acreditaram que o \"desinteresse com a própria saúde\" foi o principal fator que interferiu na adesão aos grupos. As principais sugestões dos pacientes para melhorar a adesão estão relacionadas a mudanças na estrutura dos grupos. Os dados deste estudo podem ter sido comprometidos pelo baixo número de participantes nos grupos; o GTCC não favoreceu mais mudanças comportamentais do que o GO, o que indica que uma intervenção tão elaborada pode não ter uma boa relação custo benefício. Variáveis que não foram controladas podem ter favorecido as mudanças observadas no GO. Como alternativa para aumentar a adesão aos grupos pode-se propor telefonemas semanais aos pacientes, folhetos informativos, atenção da equipe multidisciplinar, auxílio da instituição de saúde na divulgação dos encontros e mudança do nome do grupo. Contudo, para a adequação desta intervenção cognitivo comportamental, novos estudos precisam ser realizados com amostras compostas por um maior número de sujeitos. / Cardiovascular diseases (CVDs) lead the ranking of causes of death in developed countries, producing high socioeconomic costs. Among the risk factors for cardiovascular diseases, hypertension has emerged as a major reason for their development. It is estimated that in Brazil, the prevalence of hypertension in adults exceeds 30% which makes it a serious public health problem, being its control a priority area in Primary Health Care. Because hypertension has silent and slow evolution, patients often neglect their treatment. In addition, psychological factors like depression, anxiety and stress can interfere with the onset of hypertension and treatment adherence. The nonadherence to drug therapy or other kinds of therapies becomes a problem for health professionals. Several studies shown the importance of psychological interventions for the implementation of changes and maintenance of behaviors that interfere with control of hypertension. The objectives of this study were to evaluate the effect of a cognitive behavioral intervention on blood pressure (BP), psychological variables, body mass index, physical activity and feeding behavior of hypertensive patients in primary care services of the city Ribeirão Preto/SP. The study included 84 patients, which were assessed using a semi-structured interview, Lipp\'s Inventory of Stress Symptoms in Adults (ISSL), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). They were submitted to an initial assessment and a final evaluation so that data from the two moments could be compared. Between assessments the outpatients were divided into two groups: Cognitive Behavioral Therapy Group (CBTG) and Orientation Group (OG), 22 of them adhered to treatment, 11 of the CBTG and 11 of the OG, while 62 did not adhere. The results showed no statistically significant difference between the CBTG and OG which may be related to the low number of participants. With regard to sociodemographic data (n = 84) it was observed that the majority were female (76.2%), older than 50 years, with a partner (60.7%), with an elementary level of education (53.6%), unemployed or retired (60.7%) and family income above three minimum wages (62.0%). It was also observed that the majority had body mass index above the normal rate (75.0%) and physical inactivity (64.3%). They had their blood pressure controlled and 54.8% and 94.0% of the subjects were using medication. As for psychological factors, 53.6% had symptoms of stress, 20.2% had BDI scores indicating symptoms of depressive disorder and 23.8% had anxiety symptoms. Considering the low adherence in groups it was also assessed the nonadherence to the proposed treatment. Comparing the participants who joined the groups (n = 22) with those who did not adhere (n = 62) it were observed significant differences regarding sexgender, marital status, education, family income, diabetes mellitus, knowledge of blood pressure, knowledge of blood pressure regarded as normal and the presence of stress. In the group where adherence treatment was observed, it was verified a predominance of female participants (95.5%), and that most had no partner (59.1%), had higher education (72.7%) and had a family income above three minimum wages (77.3%). With regard to knowledge and management of hypertension in the group that adhered to treatment, 100% of the participants knew their blood pressure after the group meetings. Regarding the presence of stress, it decreased from 59.1% to 31.8% among those individuals who have joined the proposed treatment. The data indicated that more women seek health services and the education level and family income levels may promote adherence to treatment. Qualitative analysis of the reasons for nonadherence showed that \"lack of time\" was the main reason that hindered the participation of patients in groups. Overall, the study participants believed that the \"indifference regarding their own health\" was the main factor that interfered with adherence to the groups. The main suggestions to improve patients\' adherence are related to changes in the structure of the groups. Data from this study may have been compromised by the low number of participants in the groups. The CBTG did not favor more behavioral changes than the OG, which indicates that such elaborated intervention may not have a cost-effective relation. Variables that were not controlled may have favored the changes observed in OG. As an alternative to increasing adherence to groups it can be proposed weeklytelephone calls to patients, newsletters, multidisciplinary care team, assisting of the health institution in order to promote the meetings and group name change. However, for the adequacy of cognitive behavioral intervention, further studies are needed with samples composed of a greater number of subjects.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2018-02-01T21:31:28Z No. of bitstreams: 1 DISSERTA??O - VERS?O DEFINITIVA PARA O MEL - VERS?O ONLINE.pdf: 2274324 bytes, checksum: 1a140e0b84b33cd5944cd6a52881cecf (MD5) / Made available in DSpace on 2018-02-01T21:31:28Z (GMT). No. of bitstreams: 1 DISSERTA??O - VERS?O DEFINITIVA PARA O MEL - VERS?O ONLINE.pdf: 2274324 bytes, checksum: 1a140e0b84b33cd5944cd6a52881cecf (MD5) Previous issue date: 2017-02-17 / Cet ?tude aborde la nature des interventions textuelles-discursives r?sultantes du processus de retextualization d?intervews, ? une interface entre le texte oral et le texte ?crit, en consid?rant les op?rations linguistique-discursives y pr?sentes. L?objetiff est comprendre le niveau d'occurrence de ces interventions, et la fa?on dont ces textes sont modifi?s, ? partir des op?rations de retextualization dans lequel les interf?rences sont plus ou moins intenses. La constitution du corpus est donn?e ? partir d?interviews, accord?es par les candidats pr?sidentiels A?cio Neves et Dilma Rousseff, pendant la campagne ?lectorale en 2014, transform?es en modalit? ?crite, pour les ?l?ves de 3e et 4e ann?e d'enseignement au course Technique Int?gr? de l?Institut F?d?rale d?Education, Science et Technologie de Bahia - IFBA / Campus Ilh?us. Nous croyons que la retextualization n?est-ce pas une libre interpr?tation des textes-bases, mais que des ?l?ments constitutifs de l'?v?nement de l'interaction dont le texte appara?t peuvent influer dans des changements des s?quences textuelles. Le corpus de l'analyse a montr? que les ?tudiants ont pris la perception des interviews en tenant compte des aspects linguistiques et extralinguistiques de l'?v?nement et la pertinence du genre propos? a ?t? satisfaisante. Les interventions ont eu lieu ? travers des op?rations de remplacement, r?ordonnancement et condensation des id?es, en d?crivant des mouvements qui ont chang? des parties du texte, avec la production de nouvelles significations et la projection d'une plus positives ou plus n?gatives des candidats. L'activit? de retextualization, il implique des relations complexes dans un niveau textuel-discursive, et d?pendent de r?seaux d'orientation des individus, elle est soumise ? des changements qui d?passent la relation entre la parole et l'?criture. / Este trabalho, ancorado no aporte te?rico da Lingu?stica Textual, mais especificamente nos estudos de Marcuschi (2003) acerca da Retextualiza??o, versa sobre a natureza das interven??es textuais-discursivas decorrentes do processo de retextualiza??o de entrevistas, numa interface entre texto oral e texto escrito, considerando as opera??es lingu?sticas-discursivas a? envolvidas. O seu prop?sito ? compreender o n?vel de ocorr?ncia dessas interven??es, e como esses textos s?o modificados, considerando as opera??es de retextualiza??o em que h? interfer?ncias mais ou menos acentuadas. A constitui??o do corpus se d? a partir de entrevistas concedidas pelos candidatos ? presid?ncia da Rep?blica A?cio Neves e Dilma Rousseff, na campanha eleitoral de 2014, transformadas para a modalidade escrita da l?ngua, por estudantes de 3? e 4? s?ries do Ensino T?cnico Integrado do Instituto Federal de Educa??o, Ci?ncia e Tecnologia da Bahia ? IFBA/Campus Ilh?us. Acreditamos que, mesmo n?o sendo a retextualiza??o uma livre interpreta??o do texto-base, elementos constitutivos do evento de intera??o do qual o texto emerge poder?o influenciar em altera??es de sequ?ncias dos textos-alvo. A an?lise do corpus demonstrou que os estudantes assumiram a percep??o das entrevistas levando em conta aspectos lingu?sticos e extralingu?sticos do evento e que a adequa??o ao g?nero textual proposto foi satisfat?ria. As interven??es ocorreram por meio de opera??es de substitui??o, reordenamento e condensa??o de ideias, descrevendo movimentos que modificaram partes do texto, produzindo novos sentidos e projetando a imagem dos candidatos positiva ou negativamente. A atividade de retextualiza??o, por envolver complexas rela??es num plano textual-discursivo, e por depender de redes de referencia??o dos sujeitos, ? pass?vel de altera??es que excedem a rela??o entre fala e escrita.

Background: During an age of fiscal constraint and increasing pressure to provide timely access to effective, efficient and evidence based care, there is an increased need for research to develop empirically based prevention and intervention strategies for complex psychological difficulties which often present during childhood and adolescence. Child and Adolescent Mental Health Services (CAMHS) are under significant pressure to deliver timely access to services, with demand frequently outstripping capacity to deliver. These challenges have highlighted the need for services to ensure that planning supports continued improvement in quality and delivers the best possible outcomes for service users. Systematic Review: A systematic review of the literature on the efficacy of group based interventions for adolescents with features or a diagnosis of Borderline Personality Disorder (BPD) was conducted. Seven articles met the inclusion criteria and underwent detailed quality analysis. All included studies reported a significant improvement in psychopathology and symptoms of distress as well as an improvement in quality of life for both group based interventions and treatment as usual. Overall, the results hold promise for current work with adolescents with BPD and highlight the importance for future research in this developing area. However, more rigorous research is required to identify the active ingredients of treatments for BPD in adolescents with a view to developing standardised treatment protocols. Empirical Study: A Delphi study was conducted to explore perceptions on the relevance, practicalities, importance and feasibility of implementing nationally agreed CAMHS referral criteria from the perspective of clinicians working in CAMHS in the North of Scotland. In addition, the study aimed to explore and gain consensus on possible factors which support clinicians working in specialist services. A three round electronic Delphi survey, an iterative structured process used to gather information and gain group consensus, was completed by twenty-eight clinicians working in CAMHS. Eight open ended questions in Round 1, were analysed using content analyses resulting in ninety-eight statements to be rated by the same group of clinicians in Round 2 and fifteen statements in Round 3. Of the ninety-eight statements, eighty-four reached consensus. Results indicate that the guidelines are viewed by many clinicians as both acceptable and important, however, implementation of the guidelines can present services with significant challenges and have highlighted the importance of services having the correct infrastructure before it is possible to implement the referral criteria in a consistent and meaningful way.

There is a high prevalence of child sexual abuse (CSA) in India and the UK (Laccino, 2014). However, there is a lack of research on culturally-specific aspects of psychotherapy offered to child and adolescent survivors of CSA in both these countries. Therapeutic interventions with sexually abused children raise complex concerns due to the heterogeneity based on the developmental stage of children; varied impact, presenting difficulties and needs; and characteristics of abuse, age, gender, ethnicity and cultural factors. Numerous therapeutic interventions for CSA have been documented, with varying theoretical constructs, structure, content and outcome (Reavey & Warner, 2001), ranging from cognitive behavioural, psychoanalytic, humanistic and feminist paradigm (Misurell, Springer, & Tryon, 2011). Most of these approaches do not provide sufficient guides to therapy (Reavey & Warner, 2001). Few of these are widely studied and clinically accepted, while most lack empirical evidence. Although existing studies conclude that therapy is better than no treatment, there is lack of consensus on treatment characteristics important in child and adolescent sexual abuse therapy (Hetzel-Riggin, Brausch, & Montgomery, 2007). Further, little is known about culturally-specific holistic and coherent responses to CSA. A Constructivist Grounded Theory (Charmaz, 2006) study was conducted to investigate therapeutic approaches practiced by professionals in India and the UK with child and adolescent survivors of CSA, and to understand the factors that govern the choice of an approach or model adopted. In-depth, semi-structured interviews were undertaken with 32 professionals (16 each in India and the UK) from different settings including statutory, voluntary and private sector. NVIVO 10 was used for data management and analysis of the digitally recorded and transcribed interviews. Although there is a growing emphasis on evidence-based therapies, with most empirical studies focussing on traditional forms of psychotherapy, the actual practice of the professionals interviewed reflected a more fluid, flexible, multi-modal, ecological and integrative approach to CSA-therapy. The findings indicate that the therapeutic interventions progress through four different phases, based on the goals identified by professionals. The goals in turn are influenced by the socio-cultural context, structural factors, and/or trauma understanding of the professionals. Four phases identified in the study are: 1. Social Action Framework, with the goal to identify silenced and invisible children, particularly in a culture of silence and suppression in India; 2. Stabilisation and Resilience Building Framework, found to be practiced in India and the UK, with the goal to ensure safety and build the foundation for ensuing phase of therapy; 3. CSA-Trauma Resolution Framework, where the goal is to uncover the sexual abuse details to facilitate recovery and reintegrate the traumatised child, more visible in therapeutic practice in the UK; and 4. Maintenance and Relapse Prevention Framework, with the goal to prevent relapse and protect from revictimisation and future developmental difficulties. These phases may be mutually exclusive, follow a linear trajectory, or there may be a back and forth movement from one phase to the other. These four phases were integrated to construct a culturally relevant, ecological-based theoretical model of CSA therapy with child and adolescent survivors.

Made available in DSpace on 2016-07-27T14:19:50Z (GMT). No. of bitstreams: 1 Ana Paula Rocha de Siqueira Zaconeta.pdf: 205671 bytes, checksum: 3d448b36f05ae5d491e6fd4d57c99b24 (MD5) Previous issue date: 2005-04-28 / The neonatal pain is present in the Neonatal Intensive Care Unit NICU, in the term as well as in the pre-term babies. Even though health professionals have the knowledge that the newborn feels pain, most of them don t know how to identify its occurrence and mainly, don t know how to prevent it during the routine procedures of blood withdraw. The objective of the present study was to identify responses indicative of pain in premature babies during procedures of blood withdraw carried on in the NICU. Five premature neonates participated of the study. The observations of the responses indicative of pain were done in the NICU setting with application of the Neonatal Facial Code System NFCS and the Neonatal Infant Pain Scale NIPS. Physiological measures were also taken: Heart Rate (HR) and Oxygen Saturation (SatO2) two minutes before, during the blood withdraw and two minutes after the procedure. Experimental Control was obtained using a Reversal Design of the ABA type for three of the five participants. A multiple Elements Design combined with a Reversal Design was used with two participants. The proposed interventions for the reduction of pain responses were the Administration of Glucose, Non-nutritive Suction, and Manual Contention. The observations registered in the NIPS and NFCS scales suggest the presence of pain during the routine procedure of blood withdraw as well as its reduction with the non-pharmacological interventions proposed. The analysis of the physiological measures of pain revealed that both the Heart Rate as well as the Oxygen Saturation did not show a direct relation with the observations of pain in the premature baby. These measures did not present clinical relevance for all variations were considered normal physiological responses. It can be concluded that all the non-pharmacological interventions tested were effective in reducing the responses indicative of pain in the premature baby. / A dor neonatal está presente na Unidade de Terapia Intensiva Neonatal - UTIN tanto nos bebês a termo quanto nos pré-termo. Apesar dos profissionais de saúde terem o conhecimento de que o recém-nascido sente dor, a maioria deles não sabe como identificar sua ocorrência e principalmente não sabem como evitá-la durante os procedimentos rotineiros de coleta de sangue. O objetivo do presente estudo foi identificar e reduzir as respostas indicadoras de dor dos bebês prematuros durante o procedimento de coleta de sangue realizados na UTIN. Cinco neonatos prematuros participaram do estudo. As observações das respostas indicadoras de dor foram feitas no ambiente de UTIN com a aplicação do Sistema de Codificação da Atividade Facial (NFCS) de Grunau e Craig (1987) e da Escala de Avaliação de Dor para o Recém-Nascido (Neonatal Infant Pain Scale- NIPS). Também foram obtidas medidas fisiológicas: Freqüência Cardíaca (FC) e Saturação de Oxigênio (SatO2) dois minutos antes, durante a coleta de sangue e dois minutos após o procedimento. O Controle Experimental foi obtido utilizando o Delineamento de Reversão do tipo ABA para três dos participantes. Um Delineamento de Múltiplos Elementos combinado com Delineamento de Reversão foi utilizado em dois participantes. As intervenções propostas para a redução de respostas de dor foram a Administração de Glicose, Sucção Nãonutritiva e Contenção Manual. As observações registradas nas escalas NIPS e NFCS sugerem a presença de dor durante o rotineiro procedimento de coleta de sangue assim como a sua redução com as intervenções não-farmacológicas propostas. A análise das medidas fisiológicas da dor revelou que tanto a Freqüência Cardíaca quanto a Saturação de Oxigênio não mostraram uma relação direta com a observação de dor do bebê prematuro. Essas medidas também não apresentam relevância clínica, pois as variações foram consideradas respostas fisiológicas normais. Concluiu-se que todas as intervenções não-farmacológicas testadas foram efetivas na redução das respostas indicadoras de dor no bebê prematuro.

É possível rir da ciência? Qual seria a relação entre o cômico e a ciência? Onde está o humor na ciência? No âmbito do ensino, os alunos riem das piadas com física? É preciso entender ou saber conceitos de física para entender a piada? É pensando nestas questões que articulamos a presente pesquisa, que visa estudar a relação entre o humor e a ciência e suas implicações didáticas. Para tanto, iniciamos nossa pesquisa a partir de um estudo das teorias sobre o humor e sua evolução ao longo da história, seguida de um levantamento de obras, tais como: O Guia do Mochileiro das Galáxias de Douglas Adams, As cosmicômicas de Italo Calvino, tiras e charges, entre outras, nas quais enxergamos uma aproximação entre ciência e humor. Com a base teórica, investigamos os resultados de intervenções didáticas nas quais foram utilizados materiais midiáticos pesquisados. Para a elaboração e realização das atividades e da pesquisa, nós nos apoiamos em uma metodologia que engloba três etapas: análise, formulação e aplicação/intervenção. Em que na primeira, o material é estudado, em seguida é realizada a produção de uma proposta de atividades, que, por fim, é realizada em um espaço educacional, seja ele formal ou não. No presente trabalho, a investigação foi realizada em dois momentos distintos. O primeiro envolvendo estudantes do ensino superior, tanto da Escola de Artes Ciências e Humanidades da Universidade de São Paulo, quanto da Universidade Júlio de Mesquita Filho - UNESP, Campus Rio Claro, e no segundo com alunos do ensino fundamental II, no âmbito do projeto Banca da Ciência na Escola. Como resultado, concluímos que, no geral, a relação entre humor e ciência se encontra fora da ciência, e relacionada com outros conteúdos. Pudemos observar que, de fato, há uma estreita relação entre o riso e a compreensão de um conteúdo científico, e, que o humor, devido a sua aproximação com o lúdico, possibilita, e necessita, um espaço dinâmico para a sua utilização. Portanto, o humor apresenta um papel importante tanto no processo de ensino-aprendizagem quanto no engajamento à ciência. / Is it possible to laugh from Science? What would it be the relationship between something funny and science? Where is the humor on science? On the scope of teaching, do the students laugh from physics puns? Is it necessary to understand or to know physics concepts to \"get\" the joke? It is thinking on these questions that we have articulated this current research, that aims to study the relationship between humor and science, and its didactical implications. To do so, we started this research studying the humors theories and its evolution trough history, followed by a study of media works, such as Douglas Adams\' Hitchhiker\'s Guide to the Galaxy, Italo Calvino\'s Cosmicomics, comic stripes, among others, on which we saw an approximation of science and humor. With this theoretical background, we have investigated the outcomes of didactical interventions on which the works researched were used. For the elaboration and realization of the activities and the research, we supported a methodology that can be divided in three steps, analysis, elaboration and intervention. On the first step, the work its studied, on the second step one intervention its elaborated, and, on the third step, the intervention takes place on an education environment, be it formal or nonformal. On the current work, the investigation was performed on two different moments. The first involving students from undergraduate courses, such as Escola de Artes, Ciências e Humanidades da Universidade de São Paulo, and, Universidade Júlio de Mesquita Filho - UNESP, Campus Rio Claro, and on the second moment, with students from secondary education on the project Science stand at school. As results, we have concluded that, in general, the relation between humor and science can be found outside the science, and related with others subjects. We could also observe that, indeed, there is a strait relationship among laugh and the comprehension of a scientific content, and, that the humor, due its proximity with ludic activities, allows, and requires, a dynamical space for its use. Therefore, the humor has an important role in teaching and learning process an in the engagement of science

Bakgrund: En del patienter kan uppleva smärta och obehag inför moment som inkluderar kanyler och nålar vilket kan omnämnas som stickrädsla. En del patienter kan till följd av rädsla undvika vaccinationsprogram, operationer och övrig medicinsk hjälp vilket kan få allvarliga konsekvenser för hälsan. Sjuksköterskan arbetar dagligen med att administrera injektioner, infusioner och att ta blodprover, det är därför angeläget att sjuksköterskan har kunskaper och färdigheter kring betydelsefulla omvårdnadsåtgärder i mötet med stickrädda patienter. Syfte: Syftet var att beskriva vilka omvårdnadsåtgärder sjuksköterskan kan vidta hos vuxna patienter med stickrädsla för att reducera smärta och obehag. Metod: En litteraturöversikt baserat på 15 vetenskapliga artiklar från databaserna PubMed, Chinal och psycINFO. Resultat: För att reducera smärta och obehag bör sjuksköterskan välja att använda tunnare kanyler, använda en långsammare injektionsteknik, erbjuda lokal smärtlindring och/eller premedicinering med lugnande inför nålproceduren. Sjuksköterskan bör låta patienten ha kontroll över situationen och respektera individuella behov och önskemål. Likaså bör sjuksköterskan lyssna och vara tillmötesgående för att kunna anpassa nålproceduren i samverkan med patienten. Sjuksköterskan bör tillämpa fiktiva visualiseringsmetoder och distraktion för att reducera rädsla och obehag under momentet. I de fall det finns en uttalad nålfobi bör sjuksköterskan samordna patienten en vårdkontakt till terapeut eller psykolog. Slutsats: Resultatet i denna litteraturöversikt visar att det finns omvårdnadsåtgärder som sjuksköterskan kan tillämpa för att minska smärta och obehag hos vuxna patienter med stickrädsla. För de patienter som lider av stickrädsla bör sjuksköterskan planera nålproceduren i samverkan med patienten med utgångspunkt i en personcentrerad vård med hänsyn till enskilda behov och önskemål. Genom att sjuksköterskan tar sig tid att lyssna till patientens berättelse, visar empati och ger patienten möjlighet till delaktighet och självbestämmande i samband med nålproceduren kan smärta och obehag minska. / Background: Some patients can experience pain and discomfort for moments that include cannula and needles which can be mentioned as needle fear. Some patients can as a sequence of the fear refuse vaccinations programs, operations and other medicinal help which can have severe consequences for the health. Nurses works daily with administering injections, infusions and taking blood samples, therefore it is desirable that the nurse have the knowledge and skill regarding significant nursing actions with needle fearing patients. Aim: The purpose was to describe which nursing actions a nurse can use with adult patients with needle fear to reduce pain and discomfort. Method: This is a literature review based on 15 scientific articles from the databases PubMed, Chinal and psycINFO. Results: To reduce pain and discomfort the nurse should opt to use the thinner needles, and use a slower injection technique, offer local pain relief/ or premedication with sedative before the needle procedure. The nurse should let the patient have control over the situation and respect the individual needs and request. As well should the nurse listen and be accommodating for adapting the needle procedure in collaboration with the patient. The nurse should apply fictitious visualization methods and distraction to reduce fear and discomfort during the moment. In cases when there is a recorded needle phobia the nurse should coordinate a nursing contact to a therapist or a psychologist for the patient. Conclusion: The result in this literature review shows nursing interventions that the nurse can use to reduce pain and discomfort at adult patients with needle fear. For the patients who suffers from needle fear should the nurse plan the needle procedure in conjunction with the patient based on a person-centered care in consideration to the individual needs and wishes. Because the nurse takes the time to listen to the patient’s story, show empathy and gives the patient participation and self-determination regarding the needle procedure, pain and discomfort can be reduced.

Image guided therapy procedures under MRI guidance has been a focused research area over past decade. Also, over the last decade, various MRI guided robotic devices have been developed and used clinically for percutaneous interventions, such as prostate biopsy, brachytherapy, and tissue ablation. Though MRI provides better soft tissue contrast compared to Computed Tomography and Ultrasound, it poses various challenges like constrained space, less ergonomic patient access and limited material choices due to its high magnetic field. Even after, advancements in MRI compatible actuation methods and robotic devices using them, most MRI guided interventions are still open-loop in nature and relies on preoperative or intraoperative images. In this thesis, an intraoperative MRI guided robotic system for prostate biopsy comprising of an MRI compatible 4-DOF robotic manipulator, robot controller and control application with Clinical User Interface (CUI) and surgical planning applications (3DSlicer and RadVision) is presented. This system utilizes intraoperative images acquired after each full or partial needle insertion for needle tip localization. Presented system was approved by Institutional Review Board at Brigham and Women's Hospital(BWH) and has been used in 30 patient trials. Successful translation of such a system utilizing intraoperative MR images motivated towards the development of a system architecture for close-loop, real-time MRI guided percutaneous interventions. Robot assisted, close-loop intervention could help in accurate positioning and localization of the therapy delivery instrument, improve physician and patient comfort and allow real-time therapy monitoring. Also, utilizing real-time MR images could allow correction of surgical instrument trajectory and controlled therapy delivery. Two of the applications validating the presented architecture; closed-loop needle steering and MRI guided brain tumor ablation are demonstrated under real-time MRI guidance.