Motivation can foster engagement in the Vocational Rehabilitation (VR) program leading to benefits that can potentially result in sustainable employment. The purpose of this study was to examine the impact of Motivational Interviewing using the Motivation Curriculum for Vocation Rehabilitation Consumers (MCRC) on stages of change, self-determination, functional disability limitations awareness and life satisfaction on minority and non-minority VR clients with disabilities that had open cases with The Florida Division of Vocational Rehabilitation. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Do dying patients have a moral claim to access experimental drugs when all else has failed? This question has been the focus of an active and evolving debate concerning the rights of terminally ill patients, the nature of the drug development process, and the scope of federal regulation, with supporters arguing that seriously ill patients should be able to decide for themselves whether and when to attempt experimental therapies and opponents arguing that the resulting state of affairs would be disastrous for patient safety and for the integrity of the drug development process. This thesis concerns the ethical considerations surrounding the provision of experimental drugs for treatmentoften termed compassionate use or expanded accessand argues that compelling ethical merits on both sides of the debate complicate the formation of satisfactory public policy. Although patient autonomy is often invoked to support liberal access to experimental drugs, the paucity of known information about investigational compounds as well as the unique vulnerability of the terminally ill patient call into question the wisdom of the unfettered exercise of autonomy in this context. Although equitable distribution of experimental drugs is often felt to be a concern, the meaning of equity in this context has not been clearly defined, and in fact several working concepts of equitable access may not be achievable or desirable. Although the financial burden on drug manufacturers is frequently recognized as a barrier to expanded access, the potential for expanded access programs to constitute a marketing strategy should be recognized, and the mixing of profit motives with altruistic ones brought to light. Parsing these and other ethical nuances points to certain ways in which policies governing expanded access can be refined to allow for access while maximizing patient protection and ensuring the generation of scientific knowledge. Physicians, as frequent mediators of requests for experimental drugs, should be knowledgeable of the ethical issues inherent and should help to ensure the judicious use of experimental therapies. Finally, general misconceptions about the benefits of experimental therapy, pervasive in our culture, heighten the contentiousness of this debate. A workable legislative solution should be accompanied by a thoughtful and deliberate effort to educate patients, their advocates, and broader society about the realistic pace of drug development and the limits of modern medicine. This thesis recognizes that individuals who seek expanded access often have valid moral claims to do so, but advocates a cautious attitude toward the dissemination of experimental drugs for treatment and maintains the importance of government and physician participation in adjudicating access.

The study, using a quasi-experimental design, examined the relationship between participation in a comprehensive pulmonary rehabilitation program, locus of control, and the psychological and social concomitants of chronic obstructive pulmonary disease. The study investigated the following questions. To what degree participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component would: (1) generally produce a shift in persons from an external locus of control toward an internal locus of control, (2) specifically decrease the perception of chance, fate, or powerful others to influence and determine personal health; and (3) will result in the lessening of perceived negative effects of the psychological and social concomitants of chronic obstructive pulmonary disease. Two sample groups were evaluated in the study: (1) a group of 35 moderate to severe chronic obstructive pulmonary disease patients enrolled in a 96-hour comprehensive pulmonary rehabilitation program with a 32-hour psychosocial instructional component, and (2) a group of 35 moderate to severe chronic obstructive pulmonary disease patients receiving standard medical care at a Veterans Administration Hospital. Research instruments used for the study were the Multidimensional Health Locus of Control Scale and the Sickness Impact Profile. The research instruments were administered to each study group at approximately 16-week intervals. Results of the study indicated that participation in a comprehensive pulmonary rehabilitation program emphasizing a psychosocial component did not produce a significant shift in program participants from an external locus of control toward an internal locus of control, nor did it produce a significant decrease in the perception of chance, fate, or powerful others to influence and determine personal health. However, the study results indicated that participation in a comprehensive pulmonary rehabilitation program did produce a significant (P < .05) lessening of perceived negative physical and psychosocial effects of chronic obstructive pulmonary disease as measured by the physical scale, psychosocial scale, and total score of the Sickness Impact Profile.

Estudo observacional quantitativo longitudinal prospectivo em idosos e seus cuidadores, de ambos os sexos, internados na enfermaria de geriatria de um hospital-escola, com coleta de dados no período de agosto de 2013 a março de 2014. Objetivo: Avaliar a condição funcional subjetiva e objetiva de idosos internados em uma enfermaria geriátrica; entre os relatos de desempenho no autocuidado e suas necessidades de ajuda. Método: avaliações subjetivas e objetiva, usando o instrumento Performance test of Activities of Daily Living (PADL), com 16 tarefas associado a três itens da Escala de Atividades Instrumentais de Vida Diária (AIVD). Resultados: o sexo feminino predominou dentre os idosos (32 - 58,2%) e os cuidadores (46 - 83,6%); a idade dos clientes variou entre 64 e 99 (x=80) anos, e dos cuidadores entre 37 e 84 anos (x=58,7a); a escolaridade básica foi mais frequente entre os idosos (36 - 65,4%) e a superior (18 - 32,7%) para os cuidadores; quanto ao parentesco dos cuidadores, 30 (54,4%) eram filhas e 12 (21,5%) esposas. Para comparar as funcionalidades subjetivas e objetiva no desempenho do autocuidado, calculou-se o Índice de Concordância (Ind.Con%), que variou de 62 a 93%, com Kappa oscilando entre 0,20 e 0,59. Tanto os idosos como os cuidadores referiram desempenhar as tarefas sem ou com ajuda, porém, na avaliação objetiva, detectou-se maior necessidade de ajuda ou a incapacidade da realização da tarefa. Saliente-se que os idosos se autoavaliaram um pouco melhor que os seus cuidadores. Discussão: Nas avaliações subjetivas idosos e subjetivas cuidadores, em comparação com a objetiva, as respostas dos idosos para o autocuidado foram confirmadas na avaliação objetiva e com os relatos reportados subjetivamente pelos cuidadores. Verificou que o Nível de funcionalidade nos idosos, na maioria foi o nível 3 (fazer sem ajuda) para as atividades de vida diária PADL e atividades instrumentais AIVD. Os relatos subjetivos idosos em comparação com a avaliação objetiva podem apresentar que alguns idosos fazem as atividades sem ajuda, outros com ajuda e aqueles que não fazem as tarefas sozinhos, e, assim, necessitaram de algum tipo de ajuda. As informações subjetivas reportadas pelos cuidadores foram discordantes em comparações com a avaliação objetiva em alguns itens das escalas. Os idosos tendem a se avaliar melhor que seus cuidadores. Os cuidadores reportam que os idosos conseguem realizar a tarefa, mas, na avaliação objetiva, alguns não fazem. Conclusões: Há importantes diferenças entre as capacidades funcionais relatadas pelo próprio idoso e seus cuidadores quando comparadas com a observação direta destas tarefas pelo enfermeiro, o que indica a necessidade de basear as ações e os cuidados muito mais na avaliação direta do que exclusivamente nos relatos dos clientes e de seus cuidadores / Prospective, longitudinal quantitative study in elderly people and their proxies, of both genders, admitted at a geriatric ward of a school hospital, whose data collection was August 2013 to March 2014. Objective: to evaluate subjective and objective functional condition of elderly people admitted at a geriatric ward; among the reports of self care performance and their needs for help. Method: subjective and objective evaluations using the instrument Performance test of Activities of Daily Living (PADL), with 16 tasks associated to 3 items of Instrumental Activities of Daily Living (IADL). Results: Female gender was predominant among the elderly (32 - 58.2%) and the proxies (46 - 83.6%); clients´ age varied between 64 and 99 (x=80) years old and their proxies between 37 and 84 years old (x=58.7y); basic education was more frequent among the elderly (36 - 65.4%) and higher (18 - 32.7%) for their proxies. Regarding the family connection of proxies, 30 (54.4%) were daughters and 12 (21.5%) wives. In order to compare the subjective and objective functionalities to perform self care, it was calculated the Concordance Index (CI), which varied from 62 to 93%, whose Kappa was between 0.20 and 0.59. Both elderly people and their proxies referred performing tasks with or without help. However, on the objective evaluation it was detected greater need for help or incapability to perform a task. It must be highlighted that elderly people evaluated themselves a little better than their proxies. Discussion: elderly subjective and proxy subjective evaluations in comparison to objective ones, elderly responses for self care were confirmed in objective evaluation and the reports provided subjectively by their proxies. It was verified that the functionality level of elderly people in majority was level 3 (do it without help) for PADL daily life activities and IADL instrumental activities. Elderly subjective reports in comparison to objective evaluation, it can be seen that some elderly people perform their activities without help, others with help and the ones who don´t perform tasks by themselves required some kind of help. Subjective information reported by proxies was discordant in comparison to objective evaluation in some items of the instruments. Elderly people are more prone to evaluate themselves better than their proxies. Proxies reported that elderly people can perform their tasks, but in the objective evaluation it was not observed. Conclusions: there are important differences between the functional capacities reported by elderly themselves and their proxies when compared to the direct observation of these tasks by the nurse, which points to the need of actions and care more focused on the direct evaluation rather than reports by clients and their proxies

Este trabalho se baseia na perspectiva da juventude como construção social, compreendendo a trajetória para a vida adulta como processo não linear resultante dos diferentes modos pelos quais os jovens vivenciam suas experiências. O objetivo é conhecer a percepção de jovens populares urbanos de 18 a 24 anos sobre o processo de construção de sua autonomia e o acesso a oportunidades e direitos sociais, a partir do estudo de suas trajetórias de vida. Por meio da história oral de vida e temática, e da hermenêutica-dialética, são apresentadas narrativas de quatro jovens egressos de Programa de Aprendizagem Profissional e Programas de Medidas Socioeducativas em Meio Aberto - Liberdade Assistida e Prestação de Serviços à Comunidade, do Centro de Orientação ao Adolescente de Campinas - COMEC, partindo das perguntas disparadoras \"Como tem sido a sua trajetória para vida adulta? Como a transição para a vida adulta se relaciona com sua história de vida? Você poderia contar sobre seus caminhos, suas escolhas, suas experiências (escola, trabalho, amigos etc), seus projetos?\". As análises das histórias indicaram quatro eixos temáticos: percursos familiares e de vida, afetos e amizades sob a marca da vulnerabilidade social; a escola e suas (in) visibilidades; trabalho formal, informal, legal e ilegal: fronteiras tênues no acesso ao trabalho; vida, oportunidades sociais, interesses e projetos; apontando para a relevância destes em suas trajetórias para a vida adulta, bem como a necessidade de se pensar alternativas que tragam oportunidades de se alcançar autonomia frente a complexa realidade contemporânea / This study is based on understanding youth as a social construction, taking the trajectory to adulthood as a non linear process as the result from the different ways young people live their experiences. The aim is to study the perceptions of youth from age 18 to 24 years old about the process of autonomy and the access to social opportunities and rights through their life stories. By means of Oral Life History, Thematic Oral History, and Hermeneutic Dialectics methodology, narratives are here presented of four young people who were participants of The Occupational Apprenticeship Program and Social Educational Programs, namely The Assisted Freedom Program and Community Services for youth in conflict with the law from Centro de Orientação ao Adolescente de Campinas - COMEC. The motivating questions were \"How has happened your trajectory to adulthood? How does this transition to adulthood relate to your life story? Can you tell me about your paths, choices projects and experiences (school, work, friends etc)? The analysis of the stories indicated four main themes: family and life paths/affection and friendship under social vulnerability; the the (in) visibility of school; formal, informal, legal and ilegal work: the tenuous line in access to work; social opportunities, interests and projects. They show important features to transition to adulthood, as well as the need of alternatives that bring opportunities to autonomy taking into account the complex contemporary reality

In this study, John Gray&rsquo / s theory of value-pluralism is critically analyzed. Gray&rsquo / s modus vivendi, based on Isaiah Berlin&rsquo / s criticism of monism, is a theory that aims to create the conditions in which peace and diversity in late-modern societies can be protected. Gray argues that a legally pluralistic system where collectives have autonomy is more serving to peace than its liberal alternatives. This study argues that Gray fails to achieve its goal of promoting diversity. This is due to the fact that Gray&rsquo / s theory does not recognize &lsquo / personal autonomy&rsquo / and &lsquo / right of exit&rsquo / as standards for a legitimate regime. It is argued in this study that without &lsquo / personal autonomy&rsquo / and &lsquo / right of exit&rsquo / , legally pluralist systems curb the conditions that makes diversity possible and thereby work at the expense of diversity rather than for diversity.

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 693 pages. Includes vita. Includes bibliographical references.

Orientador: Cléa Adas Saliba Garbin / Banca: Renato Moreira Arcieri / Banca: Eduardo Daruge Junior / Resumo: O trabalho executado pelos profissionais auxiliares da odontologia constitui uma ferramenta diferenciada para se obter um aumento de produtividade, principalmente no que se refere ao serviço público de saúde. Para o cirurgião-dentista alcançar a produtividade máxima, os auxiliares precisam ter conhecimento de suas funções segundo as legislações vigentes. Esses conhecimentos abrangem a parte técnica e as posturas éticas desses profissionais, buscando uma humanização dos serviços na odontologia e a promoção dos direitos dos pacientes. Sendo assim, o consentimento informado e o sigilo profissional devem ser respeitados na prática odontológica, não apenas como uma doutrina legal, mas como um direito moral dos pacientes e que gera obrigações morais para os Cirurgiões- Dentistas e pessoal auxiliar. O objetivo foi avaliar o conhecimento dos Técnicos em Saúde Bucal (TSB) e Auxiliar de Saúde Bucal (ASB) quanto à realização de suas funções regulamentadas pela Lei Nº 11.889, de 24 de dezembro de 2008, assim como a formação destes e capacitação recebida antes de exercerem suas funções no sistema publico de saúde; avaliar também o conhecimento destes em relação aos conceitos bioéticos, no que diz respeito ao consentimento informado e sigilo profissional, aprendidos durante os cursos de formação ou prática profissional dentro do sistema público de saúde. A população alvo do presente estudo foram os TSB e ASB (N=76) que atuam no sistema público de 5 municípios da área de abrangência do DRS II-SP. A coleta dos dados foi realizada através de questionários semiestruturados e auto-administrados, com questões abertas e fechadas. A taxa resposta foi de 90,79% (n= 69). Os resultados mostraram que a maioria dos profissionais conhece parte de suas funções (56%). Quase metade dos profissionais tem curso de formação (47,8%). Quanto às ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The work made by dental auxiliaries is a different tool to obtain an increase of productivity, principally about public health service. It's necessary that auxiliaries have knowledge about their role according current Law, and so, dental surgeon get the maximum productivity. This knowledge involves techniques and ethical postures of them, aiming humanization on dental services and promotion of patient's rights. So, informed consent and professional secrecy should be respected on dental practice, not only like a legal doctrine, but like a moral right of patients and that cause moral duties for dental surgeons and dental auxiliaries. The aim of this study was to evaluate the knowledge of hygienists (TSB) and dental auxiliaries (ASB) about performance of their roles regulated by Law number 11.889, December 24th, 2008, evaluate the formation of them and capacitating received before they had executed their roles on Public Health System; to evaluate the knowledge of them about bioethical means, in relation to informed consent and professional secrecy, learned during courses of formation or professional practice into public health system. The target population of this study were TSB and ASB (N=76) that work on public health system from 5 cities belong to DRS II-SP. Data collection was performed through semi-structured questionnaire and self-applied, with opened and closed questions. The answer rate was 90,79% (n=69). The results showed that the majority of professionals know part of their roles (56%). Near half of them has formation course (47,8%). About received information during current course, 80% affirmed had received all information that are necessary for their formation, however, 84% affirmed feel necessity of actualization of their knowledge to develop their works. 58% of researched professionals said that they didn't receive capacitating after ... (Complete abstract click electronic access below) / Mestre

Estudo observacional quantitativo longitudinal prospectivo em idosos e seus cuidadores, de ambos os sexos, internados na enfermaria de geriatria de um hospital-escola, com coleta de dados no período de agosto de 2013 a março de 2014. Objetivo: Avaliar a condição funcional subjetiva e objetiva de idosos internados em uma enfermaria geriátrica; entre os relatos de desempenho no autocuidado e suas necessidades de ajuda. Método: avaliações subjetivas e objetiva, usando o instrumento Performance test of Activities of Daily Living (PADL), com 16 tarefas associado a três itens da Escala de Atividades Instrumentais de Vida Diária (AIVD). Resultados: o sexo feminino predominou dentre os idosos (32 - 58,2%) e os cuidadores (46 - 83,6%); a idade dos clientes variou entre 64 e 99 (x=80) anos, e dos cuidadores entre 37 e 84 anos (x=58,7a); a escolaridade básica foi mais frequente entre os idosos (36 - 65,4%) e a superior (18 - 32,7%) para os cuidadores; quanto ao parentesco dos cuidadores, 30 (54,4%) eram filhas e 12 (21,5%) esposas. Para comparar as funcionalidades subjetivas e objetiva no desempenho do autocuidado, calculou-se o Índice de Concordância (Ind.Con%), que variou de 62 a 93%, com Kappa oscilando entre 0,20 e 0,59. Tanto os idosos como os cuidadores referiram desempenhar as tarefas sem ou com ajuda, porém, na avaliação objetiva, detectou-se maior necessidade de ajuda ou a incapacidade da realização da tarefa. Saliente-se que os idosos se autoavaliaram um pouco melhor que os seus cuidadores. Discussão: Nas avaliações subjetivas idosos e subjetivas cuidadores, em comparação com a objetiva, as respostas dos idosos para o autocuidado foram confirmadas na avaliação objetiva e com os relatos reportados subjetivamente pelos cuidadores. Verificou que o Nível de funcionalidade nos idosos, na maioria foi o nível 3 (fazer sem ajuda) para as atividades de vida diária PADL e atividades instrumentais AIVD. Os relatos subjetivos idosos em comparação com a avaliação objetiva podem apresentar que alguns idosos fazem as atividades sem ajuda, outros com ajuda e aqueles que não fazem as tarefas sozinhos, e, assim, necessitaram de algum tipo de ajuda. As informações subjetivas reportadas pelos cuidadores foram discordantes em comparações com a avaliação objetiva em alguns itens das escalas. Os idosos tendem a se avaliar melhor que seus cuidadores. Os cuidadores reportam que os idosos conseguem realizar a tarefa, mas, na avaliação objetiva, alguns não fazem. Conclusões: Há importantes diferenças entre as capacidades funcionais relatadas pelo próprio idoso e seus cuidadores quando comparadas com a observação direta destas tarefas pelo enfermeiro, o que indica a necessidade de basear as ações e os cuidados muito mais na avaliação direta do que exclusivamente nos relatos dos clientes e de seus cuidadores / Prospective, longitudinal quantitative study in elderly people and their proxies, of both genders, admitted at a geriatric ward of a school hospital, whose data collection was August 2013 to March 2014. Objective: to evaluate subjective and objective functional condition of elderly people admitted at a geriatric ward; among the reports of self care performance and their needs for help. Method: subjective and objective evaluations using the instrument Performance test of Activities of Daily Living (PADL), with 16 tasks associated to 3 items of Instrumental Activities of Daily Living (IADL). Results: Female gender was predominant among the elderly (32 - 58.2%) and the proxies (46 - 83.6%); clients´ age varied between 64 and 99 (x=80) years old and their proxies between 37 and 84 years old (x=58.7y); basic education was more frequent among the elderly (36 - 65.4%) and higher (18 - 32.7%) for their proxies. Regarding the family connection of proxies, 30 (54.4%) were daughters and 12 (21.5%) wives. In order to compare the subjective and objective functionalities to perform self care, it was calculated the Concordance Index (CI), which varied from 62 to 93%, whose Kappa was between 0.20 and 0.59. Both elderly people and their proxies referred performing tasks with or without help. However, on the objective evaluation it was detected greater need for help or incapability to perform a task. It must be highlighted that elderly people evaluated themselves a little better than their proxies. Discussion: elderly subjective and proxy subjective evaluations in comparison to objective ones, elderly responses for self care were confirmed in objective evaluation and the reports provided subjectively by their proxies. It was verified that the functionality level of elderly people in majority was level 3 (do it without help) for PADL daily life activities and IADL instrumental activities. Elderly subjective reports in comparison to objective evaluation, it can be seen that some elderly people perform their activities without help, others with help and the ones who don´t perform tasks by themselves required some kind of help. Subjective information reported by proxies was discordant in comparison to objective evaluation in some items of the instruments. Elderly people are more prone to evaluate themselves better than their proxies. Proxies reported that elderly people can perform their tasks, but in the objective evaluation it was not observed. Conclusions: there are important differences between the functional capacities reported by elderly themselves and their proxies when compared to the direct observation of these tasks by the nurse, which points to the need of actions and care more focused on the direct evaluation rather than reports by clients and their proxies

Orientador: Rosana Onocko Campos / Tese (Doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T20:10:44Z (GMT). No. of bitstreams: 1 Goncalves_LauraLamasMartins_D.pdf: 2375907 bytes, checksum: 3048b5843c3d5fa2b26b62d5c1ac1734 (MD5) Previous issue date: 2013 / Resumo: Esta pesquisa insere-se no contexto de uma pesquisa multicêntrica realizada em Centros de Atenção Psicossocial (CAPS) de três cidades brasileiras, nos anos de 2009 e 2010, com o objetivo de traduzir, adaptar e testar um instrumento produzido no Canadá, o Guia pessoal da gestão autônoma da medicação (Guia GAM). Tal instrumento foi criado a partir do reconhecimento de uma utilização pouco crítica dos medicamentos nos tratamentos em saúde mental e também do reconhecimento do valor simbólico da medicação na vida dos usuários. O Guia parte do reconhecimento do direito ao consentimento livre e esclarecido para a utilização da medicação e da necessidade de compartilhar as decisões entre profissionais e usuários e tem como um de seus objetivos tornarem disponíveis informações sobre as medicações (efeitos colaterais, doses terapêuticas, etc.). Propusemos o uso do Guia através de um Grupo de Intervenção com sete usuários de serviços de saúde mental do município de Campinas, com transtorno mental grave e com história de participação política no campo da saúde com o objetivo de avaliar os efeitos da experimentação do Guia na relação desses usuários com seus tratamentos e nas suas ações de militância. Nossa pesquisa incluiu a realização de encontros quinzenais, grupos focais e entrevistas em profundidade. Transformamos as transcrições em narrativas por extração de seus núcleos argumentais e identificamos uma mudança no julgamento crítico dos usuários, sobretudo, acerca do uso da medicação, dos seus direitos. Os usuários demonstraram maior conhecimento sobre o que tomam e para quê e passaram a reconhecer uma autoridade em si própria, e não apenas nos médicos, embora mantivessem a percepção de que os profissionais seriam superiores e possuiriam o poder de decisão sobre o tratamento. Problematizaram mais o modo como são atendidos e houve usuários que, mobilizados pelas discussões nos grupos, buscaram conversar com seus médicos, visando ajustes no uso de algum medicamento. Também fortaleceram suas participações enquanto militantes da saúde mental, ampliando espaços de atuação e/ou ampliando as próprias ações enquanto usuários sujeito- político de direito, que debate o tratamento e a instituição de que participa / Abstract: This research falls within the context of a multicenter study conducted in Centers for Psychosocial Care (CAPS) in three Brazilian cities, in the years 2009 and 2010, aiming to translate and adapt to the Brazilian culture the personal Guide for the Autonomous Medication Management (GAM), beyond testing this instrument developed in Canada. This instrument was drawn on the recognition of an uncritical use of medicines in mental health treatments, as well as the acceptance of the symbolic value of such medicines in the lives of the users of mental health services. The Guide recognizes the right to informed consent prior to the use of the medication and asserts the need of shared decisions between professionals and service users; therefore one of its goals is to provide information about medications (side effects, therapeutic doses, etc.). To evaluate its effects over the service users in relation with their treatment and their militant actions, the research proposed the utilization of this Guide through an Intervention Group composed of seven users of mental health services in Campinas, all of them with diagnostic of severe mental disorder and a personal history of political participation in the field of health. Our research included conducting fortnightly meetings, focus groups and in-depth interviews, whose transcripts were transformed in narratives by extracting their argumentation nuclei. As a result, a change was identified in the critical judgment of these users, especially regarding the use of medication and the recognition of their rights as such. These users demonstrated improved knowledge about the medicines they take and why they do so, assimilating an authority in themselves, not just in their doctors, although keeping their perception that professionals would have superiority and the power to make decisions about treatment. The users questioned over how they are treated at the health services and some of them, driven by the group discussions, sought to talk to their doctors aiming adjustments in the use of particular medications. They also strengthened their holdings while militants in the mental health field, increasing the scope of intervention and / or expanding their own actions as 'users - political subjects' which discuss the treatment and the institution in which they participate / Doutorado / Política, Gestão e Planejamento / Doutora em Saúde Coletiva