A relação existente entre mudança de percepção da saúde bucal e resiliência é escassa na literatura. O objetivo deste trabalho foi descrever as dinâmicas de mudança de autopercepção relacionada à saúde bucal (melhora e piora) e avaliar os fatores determinantes destas mudanças em idosos do sul do Brasil. Uma amostra representativa de 587 pessoas, com 60 anos ou mais, residentes em Carlos Barbosa, RS, foi avaliada em 2008. O seguimento foi realizado em 2012 e foram avaliados 389 idosos. Este estudo foi aprovado pelo Comitê de Ética da Faculdade de Odontologia da UNICAMP. Os participantes responderam a um questionário sociodemográfico e de saúde geral, a Escala de Resiliência e passaram pelo exame de saúde bucal. A mudança de autopercepção relacionada à saúde bucal foi categorizada em decréscimo, estabilidade e acréscimo entre 2008 e 2012. A fim de analisar os fatores associados com as mudanças na percepção relacionada à saúde bucal em idosos independentes, utilizou-se a regressão multinomial. Os indivíduos apresentaram 21,9% de decréscimo, 48,1% permaneceram estáveis e 30% apresentaram acréscimo na mudança de autopercepção relacionada à saúde bucal. Uso dos serviços odontológicos (OR=3,28,IC=1,05-10,22) e comorbidades (OR=5,43,IC=1,17-25,18) associaram-se com melhora e renda (OR=1,89,IC=1,00-3,57) e resiliência (OR=7,70, IC=0,97-61,02) associaram-se com piora na autopercepção relacionada à saúde bucal. Conclui-se que há uma relação entre as ideias de flexibilidade e de adaptação inseridas no conceito da resiliência e a maneira como um indivíduo vê sua saúde bucal. / The existing relation between change of oral health perception and resilience is insufficient in the literature. The aim of this study was to describe the dynamics of self-perception’s change related to the oral health (improvement and decline) and to evaluate the determinants of these changes in older people of the southern of Brazil. A representative sample of 587 people aged 60 years or more, living in Carlos Barbosa, RS, was evaluated in 2008. The follow-up was made in 2012 and 389 older people were evaluated. This study was approved by the Committee of Ethics of the Faculty of Dentistry of the State University of Campinas. The participants answered an oral health and socio-demographic questionnaire, the Resilience Scale, and took an oral health exam. The change of self-perception related to the oral health was categorized as decrement, stability and increment between 2008 and 2012. In order to analyze the factors associated with the changes in the perception related to the oral health in independent living older people it was used a hierarchical analysis, made through multinomial regression. The individuals experienced 21.9% of decrement, 48.1% remain stable and 30.0% experienced increment in the change of self-perception related to the oral health. Access to the oral services (OR=3.28,CI=1.05-10.22) and co-morbidities (OR=5.43,CI=1.17-25.18) were associated with improvement, income (OR=1.89,CI=1.00-3.57) and resilience (OR=7.70, CI=0.97-61.02) was associated with the decline in the self-perception related to the oral health. It is concluded that there is a relation between the ideas of flexibility and adjustment inserted in the concept of the resilience and the manner how an individual perceives its oral health.

O conceito de resiliência foi adaptado às ciências humanas como a capacidade do indivíduo responder positivamente às adversidades da vida, relacionando-se com a família e a espiritualidade. Considerando a espiritualidade como o que confere significado a existência e o seu potencial em promover a resiliência para o enfrentamento de dificuldades, como as mudanças decorrentes do envelhecimento, desenvolveu-se o presente estudo, cujo objetivo foi: compreender a resiliência e a espiritualidade na reorganização da família frente ao envelhecimento. Procurou-se ainda, conhecer a condição socioeconômica, cultural, a composição familiar, as mudanças que ocorreram na dinâmica familiar e as estratégias de enfrentamento do idoso e sua família, frente ao envelhecimento. Foi realizado um estudo descritivo, prospectivo, sob os pressupostos da pesquisa qualitativa. Em entrevista, aplicou-se um questionário com dados socioeconômico e questões norteadoras para apreender os significados do envelhecimento para o idoso e seu familiar. Foi elaborado um genograma, seguido da aplicação do Mini-Mental, Índex de Katz, Escala de Depressão de Yesavage. Inicialmente foi mapeado 294 idosos residentes no território atendidos por uma equipe de saúde da família de uma Unidade Básica de Saúde do bairro do Teotônio Vilela, município de São Paulo. Dentre estes, foram entrevistados 23 idosos e igual número de familiares, totalizando 46 indivíduos. Os discursos foram analisados com auxílio do programa WebQDA 2.0 e da técnica de análise de conteúdo. Dos idosos entrevistados, 78,3% residiam em domicílio próprio, com pelo menos mais um familiar. A Unidade de saúde é utilizada por 69,6% dos idosos. Dos idosos, 91,3% foram mulheres, 43,5% tinham entre 71 e 80 anos, maioria católicas, aposentadas e com renda entre um a três salários mínimos O Mini-Mental, revelou que 34,8% dos participantes tinham pontuação considerada normal e o aspecto emocional, avaliado pela Escala de Depressão Geriátrica de Yesavage mostrou 26,1% com pontuação sugestiva de depressão. Pelo Índice de Katz, 87,0% dos idosos foram classificados como independentes. Os familiares eram em sua maioria do sexo feminino (82,6%), filhas e acima dos 50 anos. Os discursos revelaram que entre as mudanças individuais decorrentes do envelhecimento, as mudanças cognitivas e físicas impactaram no aumento da dependência e na condição socioeconômica da família. A família, a confiança e os vínculos estabelecidos foram responsáveis por dar sentido à vida dos idosos. A espiritualidade esteve presente significando a existência e em alguns casos, foi expressada através da religiosidade e de sentimentos de felicidade, promovendo a resiliência. Compreendendo a espiritualidade como o que dá sentido a vida e a resiliência como a força advinda da superação das adversidades, conclui-se que não há como ser resiliente sem sentido ou motivo para viver. A enfermagem tem o objetivo de oferecer cuidados holísticos ao ser humano. A família, a comunidade e as relações que o indivíduo estabelece ao longo da vida interferem no modo de viver e encarar as adversidades. Compreender o idoso inserido neste contexto pode potencializar os vínculos estabelecidos entre os pacientes, a família e a equipe de enfermagem, favorecendo a adesão aos tratamentos e a promoção de saúde. / The concept of resilience has been adapted to the human sciences as the ability of an individual to respond positively to the adversities of life, relating with family and spirituality. Considering spirituality as what concedes meaning to the existence and its potencial in promoting resilience to the coping of difficulties such as the changes that result from aging, the present study was developed, which objective has been: to comprehend resilience and spirituality in the family reorganization facing the aging process. It was tried, to know the socio economical and cultural conditions, family composition, the changes that occurred in the family dynamics, and the strategies of coping, of the elder and their family, with the aging process. It was made a descriptive, prospective, study of the assumptions of the qualitative research. In interview, it was applied a questionary with socio economical data, and questions guiding to the apprehension of the meanings of aging to the elder and their family. It was elaborated a genogram, followed by the application of the Mini-Mental, Katz Index, Yesavage Scale of Depression. Initially it was mapped 295 elders residents of the territory attended by a family health team of Basic Health Unit, of Teotonio Vilela neighborhood, in the city of São Paulo. Amongst these, 23 elders were interviewed, and the correspondent number of families, totalizing 46 individuals. The answers were analyzed with the help of WebQDA 2.0, and the technique of content analysis. Of the interviewed elders, 78,3% lived in their own property, with at least one more relative. The health Unit is used by 69,9% of the elders. From the elders, 91,3% were women, 43,5% were between 71 and 80 years old, a majority of catholics, retired and with an income between one and three minimal wages. Mini-Mental revealed that 34,8% of participants had punctuation considered normal, and the emotional aspect, evaluated by Yesavage Geriatric Depression Scale, has shown that 26,1% had punctuation suggesting depression. By Katz Index, 87% of the elders were classified as independents. The families were in their majority women (82,6%), daughters and above 50 years old. The answers revealed that among the individual changes incurring from the aging process, the cognitive and physical changes affected in the increasing of dependency, and the social economical condition of the family. The family, its confidence and the stablished bonds were responsible for giving meaning to the elders lives. Spirituality has been present, giving meaning to the existence, and in some cases, has been expressed through religiosity and feelings of happiness, promoting resilience. Comprehending spirituality as what gives meaning to life and resilience as the strength arising from overcoming adversities, it has been concluded that there is no possibility of being resilient without a reason or motivation for living. Nursing has the objective of offering holistic care to the human being. Family, community and the relations that an individual satellites throughout life interfere in the way of living and facing adversities. Comprehending the elder in this context may power the bonds stablished among patients, family and the nursing team, favoring the accession to the treatments and health promotion.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23069号 / 医博第4696号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙橋 良輔, 教授 林 康紀, 教授 渡邉 大 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Title: Case study of the training process of couples performing Latin American dances. Objectives: The main objective of this paper is the creation of case studies aimed at developing the sports career of Latin American dance couples. Another objective is to create a training plan for the next dance season based on the information gathered. Methods: The paper used content analysis and critical analysis of expert literature. The research was carried out through case studies, interviews and testing. The research sample consisted of adult Latin American dance couples. The results are presented via text, illustrative graphs and tables. Results: It was found that nowadays the performance of dance couples is most affected by their mental state at individual competitions. Depending on the current level of dancers it is necessary to focus primarily on building up psychological resilience for the next dance season. Another focus point of the preparation will be on practicing expressing the character and experience of the individual dances. Key words: sporting performance, dance technique, physical fitness, psychological resilience, training plan Powered by TCPDF (www.tcpdf.org)

RESUMO: Introdução: Diabetes Mellitus (DM) se constitui em problema de saúde de elevada magnitude por sua prevalência e morbimortalidade e é considerada uma emergência mundial para a saúde do século XXI. Tradicionalmente a pesquisa sobre DM enfatiza a doença e suas complicações. No entanto, nas últimas décadas a atenção ofertada à doença tem se deslocado para dimensões socioculturais e emocionais dos pacientes e aos recursos existentes para enfrentamento do diagnóstico da doença. Resiliência e Qualidade de Vida emergem como construtos que apontam para um novo modelo de compreensão do processo saúde-diabetes-cuidado, pela dimensão da saúde e não somente da doença. Objetivo geral: Identificar a relação entre resiliência e qualidade de vida de pessoas com DM. Método: Estudo descritivo, de abordagem quantitativa, desenvolvido no período de 2014 a 2016, em uma unidade básica de saúde e um ambulatório de especialidades de um centro hospitalar público, no município de Macapá-AP. Amostra de 202 adultos com DM tipo 1 e tipo 2, do tipo probabilístico estratificada, com alocação proporcional e seleção aleatória simples. Os dados foram coletados por meio de entrevista aplicada pela pesquisadora nos locais do estudo. As variáveis investigadas foram as sociodemográficas e clínicas, além da aplicação das escalas de resiliência para adulto-RSA e de qualidade de vidaDiabetes - 39. Para análise estatística descritiva e inferencial, foi utilizado o programa de análise estatística Statistical Package for the Social Sciences (SPSS), versão 22 para Windows. Pesquisa aprovada pelo Comitê de Ética em Pesquisa com seres humanos da Universidade Federal do Amapá, parecer nº 990.066/2015, conforme a Resolução do Conselho Nacional de Saúde 466/2012. Resultados: Foram sistematizados em três manuscritos, a saber: 1. Tecendo interface entre características sociodemográficas, clínicas e de promoção da saúde para pessoas com Diabetes Mellitus: discutem-se as características sociodemográficas mais relevantes da população à luz das propostas da promoção da saúde, sendo estas: etnia parda, faixa etária (53.6±11.8), situação trabalhista ativa, tempo de diagnóstico menos de cinco anos. 2. Resiliência e Qualidade de Vida de pessoas com Diabetes Mellitus à luz da Promoção da Saúde: a população pesquisada apresentou percepção ruim da QV, porém demonstrou resiliência fortalecida. Os resultados revelaram que há relação entre resiliência e qualidade de vida. 3. Relação entre resiliência, qualidade de vida e características sociodemográficas/clínicas de pessoas com Diabetes Mellitus: constatou-se que as variáveis sexo, grau de escolaridade, atividade física e glicemia capilar foram preditoras à percepção da qualidade de vida. O grau de escolaridade foi a única característica sociodemográfica que apresentou correlação para resiliência e qualidade vida. A característica de resiliência com maior potencial de influência na qualidade de vida foi a percepção de si mesmo. Conclusão: As pessoas com DM com maior resiliência têm melhor percepção de QV. Os construtos ofereceram possibilidades de apreender as reais necessidades de saúde das pessoas com DM e se apoiam nas bases teóricas da promoção da saúde, possibilitando captar elementos para o cuidado de pessoas com DM. / ABSTRACT: Introduction: Diabetes Mellitus (DM) is a significant health problem due to its prevalence and morbimortality, being considered world health emergency in the 21st century. Traditionally, research on DM stresses the disease and its complications. However, in the past decades, disease attention has been moved towards patients sociocultural and emotional dimensions as well as the existing resources to cope with the disease diagnosis. Resilience and Quality of Life emerge as the constructs which point to a new model of understanding the health-diabetes-care process through the health dimension, not only through the disease dimension. General objective: To identify the relation between resilience and quality of life in people suffering from DM. Method: Quantitative, descriptive study carried out at a primary healthcare unit, and at a specialty outpatient clinic in the municipality of Macapá Amapá State, Brazil, between 2014 and 2016. Probabilistic, multi-staged sampling with quantity-based allocation and simple random selection entailed 202 adults suffering from type 1 and type 2 DM. Data were collected by means of an interview applied by the researcher in the studied settings. Sociodemographic and clinical variables were investigated, besides the application of the RSA (Resilience Scale for Adults) and the Diabetes-39 Assessment Questionnaire for Quality of Life. For the descriptive, inferential statistical analysis, the Statistical Package for the Social Sciences (SPSS), 22.0 for Windows was used. Research was approved by the Ethics Board on research with human beings of the Federal University of Amapá, opinion n. 990.066/2015, according to Resolution 466/2012 of the National Health Council. Results: They were systematized in three manuscripts, as follows: 1. Building an interface between sociodemographic, clinical profile and health promotion for people with Diabetes Mellitus: the most significant sociodemographic features of the population are discussed in light of health promotion proposals: mixed race, age ranging 53.6 ± 11.8 years, working, time of diagnosis of less than five years. 2. Resilience and Quality of Life of people suffering from Diabetes Mellitus in light of Health Promotion: the researched population revealed poor perception of their quality of life, although they showed strengthened resilience. Results evidenced a relationship between resilience and quality of life. 3. Relation between resilience, quality of life and sociodemographic/clinical profile of people with Diabetes Mellitus: it was evidenced that sex, educational level, exercising and CBG variables were predictors to the perception of the quality of life. Educational level was the only sociodemographic feature which evidenced correlation to resilience and quality of life. The resilience feature with the greatest potential to influence quality of life was self-perception. Conclusion: People suffering from DM with higher resilience have better perception of quality of life. The constructs enabled to apprehend the real health needs of people with DM, and are grounded in the theoretical foundations of health promotion, which allows to apprehend elements to care for people with DM.

It is estimated that approximately 30% of individuals worldwide are affected by mental health problems during their lifetime. Currently, Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders and a leading cause of non-lethal disability worldwide. However, despite exposure to known risk factors for MDD, human responses to it vary widely. Whilst some individuals develop MDD, others develop only mild and transient symptoms or no depressive symptomology at all. This ability to 'bounce back' from or 'escape' the development of psychiatric illness is referred to as psychological resilience (Chapter 1). Scientific and clinical interest in resilience has grown exponentially over recent decades, but wide discrepancies are still found in both its definition and measurement. As such, resilience is rarely measured directly, but inferred from the measurement of two specific points of convergence; adversity (its antecedents) and positive adaptation (its consequences). Whilst the study of adversity and positive adaptation has informed our knowledge of resilience it often fails to consider other putative risk factors for MDD (such as genetics), or potential protective factors that may foster resilience despite risk. More recently, examining protective factors have become a focus of research in relation to resilience. This research suggests that numerous protective factors coalesce to contribute to resilient outcomes which give rise to a dynamic resilience process that varies contextually and temporally. Although investigating resilience may be expected to reveal similar findings to studying MDD itself, it does represent a new facet to scientific and clinical research. Specifically, resilience focuses on intervention long before the development of MDD when effects on subsequent suffering may be ameliorated. For this reason, it is imperative to address the concept of resilience, concentrating on the core components of adversity, positive adaptation and protective factors, to move beyond description towards an understanding of individual differences in resilience (Chapter 2). In this thesis, three studies will be presented which aim to examine psychological resilience from multiple perspectives to further delineate the concept. In Chapter 3, the associations and interactions between neuroticism and general intelligence (g) on MDD, and psychological distress were examined in GS:SFHS (Generation Scotland: Scottish Family Health Study) to investigate whether g mitigates the detrimental effects of neuroticism on mental health, as such an association has previously been identified for physical health and mortality. A larger replication was also performed in UK Biobank using a self-reported measure of depression. Across two large samples it was found that intelligence provides protection against psychological distress and self-reported depression in individuals high in neuroticism, but intelligence confers no such protection against clinical MDD in those high in neuroticism. In Chapter 4, a new dataset is presented which was designed to investigate psychological resilience and mental health. Specifically, the STRADL (Stratifying Resilience and Depression Longitudinally) dataset aimed to re-contact existing GS:SFHS participants to obtain repeat measures of MDD and psychological distress in addition to obtaining data on resilience, coping style and adverse life experiences. This dataset has the potential to identify mechanisms and pathways to resilience but also elucidate causal mechanisms and pathways of depression sub-types. Chapter 5 investigated whether neuroticism and resilience are downstream mediators of genetic risk for depression, and whether they contribute independently to such risk. Specifically, the moderating and mediating relationships between polygenic risk scores (PRS) for depression, neuroticism, resilience, and both clinical and self-reported MDD were examined in STRADL. Regression analyses indicated that neuroticism and PRS for depression independently associated with increased risk for both clinical and self-reported MDD, whereas resilience associated with reduced risk. Structural equation modelling suggested that polygenic risk for depression associates with vulnerability for both clinical and self-reported MDD through two partially independent mediating mechanisms in which neuroticism increases vulnerability and resilience reduces it. In Chapter 6, the proportion of phenotypic variance that is attributable to genetic and shared-familial environment was estimated for resilience and three main coping styles; task-, emotion-, and avoidance-oriented coping. Bivariate analyses were conducted to estimate the genetic correlations between these traits and neuroticism. Our results indicate that common genetics affect both resilience and coping style. However, in addition, early shared-environmental effects from the nuclear family influence resilience whereas recent shared-environment effects from a spouse influence coping style. Furthermore, strong genetic overlap between resilience, emotion-oriented coping, and neuroticism suggests a relationship whereby genetic factors that increase negative emotionality lead to decreased resilience. These studies highlight the necessity for complementary multivariate techniques in resilience research to elucidate tractable methodologies to potentially identify mechanisms and modifiable risk factors to protect against psychiatric illness (Chapter 7).

RESUMO: Introdução: Diabetes Mellitus (DM) se constitui em problema de saúde de elevada magnitude por sua prevalência e morbimortalidade e é considerada uma emergência mundial para a saúde do século XXI. Tradicionalmente a pesquisa sobre DM enfatiza a doença e suas complicações. No entanto, nas últimas décadas a atenção ofertada à doença tem se deslocado para dimensões socioculturais e emocionais dos pacientes e aos recursos existentes para enfrentamento do diagnóstico da doença. Resiliência e Qualidade de Vida emergem como construtos que apontam para um novo modelo de compreensão do processo saúde-diabetes-cuidado, pela dimensão da saúde e não somente da doença. Objetivo geral: Identificar a relação entre resiliência e qualidade de vida de pessoas com DM. Método: Estudo descritivo, de abordagem quantitativa, desenvolvido no período de 2014 a 2016, em uma unidade básica de saúde e um ambulatório de especialidades de um centro hospitalar público, no município de Macapá-AP. Amostra de 202 adultos com DM tipo 1 e tipo 2, do tipo probabilístico estratificada, com alocação proporcional e seleção aleatória simples. Os dados foram coletados por meio de entrevista aplicada pela pesquisadora nos locais do estudo. As variáveis investigadas foram as sociodemográficas e clínicas, além da aplicação das escalas de resiliência para adulto-RSA e de qualidade de vidaDiabetes - 39. Para análise estatística descritiva e inferencial, foi utilizado o programa de análise estatística Statistical Package for the Social Sciences (SPSS), versão 22 para Windows. Pesquisa aprovada pelo Comitê de Ética em Pesquisa com seres humanos da Universidade Federal do Amapá, parecer nº 990.066/2015, conforme a Resolução do Conselho Nacional de Saúde 466/2012. Resultados: Foram sistematizados em três manuscritos, a saber: 1. Tecendo interface entre características sociodemográficas, clínicas e de promoção da saúde para pessoas com Diabetes Mellitus: discutem-se as características sociodemográficas mais relevantes da população à luz das propostas da promoção da saúde, sendo estas: etnia parda, faixa etária (53.6±11.8), situação trabalhista ativa, tempo de diagnóstico menos de cinco anos. 2. Resiliência e Qualidade de Vida de pessoas com Diabetes Mellitus à luz da Promoção da Saúde: a população pesquisada apresentou percepção ruim da QV, porém demonstrou resiliência fortalecida. Os resultados revelaram que há relação entre resiliência e qualidade de vida. 3. Relação entre resiliência, qualidade de vida e características sociodemográficas/clínicas de pessoas com Diabetes Mellitus: constatou-se que as variáveis sexo, grau de escolaridade, atividade física e glicemia capilar foram preditoras à percepção da qualidade de vida. O grau de escolaridade foi a única característica sociodemográfica que apresentou correlação para resiliência e qualidade vida. A característica de resiliência com maior potencial de influência na qualidade de vida foi a percepção de si mesmo. Conclusão: As pessoas com DM com maior resiliência têm melhor percepção de QV. Os construtos ofereceram possibilidades de apreender as reais necessidades de saúde das pessoas com DM e se apoiam nas bases teóricas da promoção da saúde, possibilitando captar elementos para o cuidado de pessoas com DM. / ABSTRACT: Introduction: Diabetes Mellitus (DM) is a significant health problem due to its prevalence and morbimortality, being considered world health emergency in the 21st century. Traditionally, research on DM stresses the disease and its complications. However, in the past decades, disease attention has been moved towards patients sociocultural and emotional dimensions as well as the existing resources to cope with the disease diagnosis. Resilience and Quality of Life emerge as the constructs which point to a new model of understanding the health-diabetes-care process through the health dimension, not only through the disease dimension. General objective: To identify the relation between resilience and quality of life in people suffering from DM. Method: Quantitative, descriptive study carried out at a primary healthcare unit, and at a specialty outpatient clinic in the municipality of Macapá Amapá State, Brazil, between 2014 and 2016. Probabilistic, multi-staged sampling with quantity-based allocation and simple random selection entailed 202 adults suffering from type 1 and type 2 DM. Data were collected by means of an interview applied by the researcher in the studied settings. Sociodemographic and clinical variables were investigated, besides the application of the RSA (Resilience Scale for Adults) and the Diabetes-39 Assessment Questionnaire for Quality of Life. For the descriptive, inferential statistical analysis, the Statistical Package for the Social Sciences (SPSS), 22.0 for Windows was used. Research was approved by the Ethics Board on research with human beings of the Federal University of Amapá, opinion n. 990.066/2015, according to Resolution 466/2012 of the National Health Council. Results: They were systematized in three manuscripts, as follows: 1. Building an interface between sociodemographic, clinical profile and health promotion for people with Diabetes Mellitus: the most significant sociodemographic features of the population are discussed in light of health promotion proposals: mixed race, age ranging 53.6 ± 11.8 years, working, time of diagnosis of less than five years. 2. Resilience and Quality of Life of people suffering from Diabetes Mellitus in light of Health Promotion: the researched population revealed poor perception of their quality of life, although they showed strengthened resilience. Results evidenced a relationship between resilience and quality of life. 3. Relation between resilience, quality of life and sociodemographic/clinical profile of people with Diabetes Mellitus: it was evidenced that sex, educational level, exercising and CBG variables were predictors to the perception of the quality of life. Educational level was the only sociodemographic feature which evidenced correlation to resilience and quality of life. The resilience feature with the greatest potential to influence quality of life was self-perception. Conclusion: People suffering from DM with higher resilience have better perception of quality of life. The constructs enabled to apprehend the real health needs of people with DM, and are grounded in the theoretical foundations of health promotion, which allows to apprehend elements to care for people with DM.

Made available in DSpace on 2015-07-22T20:50:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-24 / Este estudo teve por objetivo explorar como a resiliência e alguns de seus aspectos se relacionam aos diferentes padrões de uso de drogas por adolescentes. Foi composta uma amostra representativa de estudantes de escolas particulares de São Paulo (Brasil), selecionada por estratos e conglomerados. Os dados foram coletados através de questionário de auto-preenchimento aplicado em sala de aula. Para mensurar o uso no mês de álcool, binge de álcool, tabaco e outras drogas (maconha, inalantes, ansiolíticos, estimulantes, cocaína, ecstasy e crack) foi utilizado um questionário proposto pela OMS. Para avaliar resiliência, foi aplicada a Escala de Resiliência. O principal fator da escala, encontrado na validação brasileira, foi nomeado “resolução de ações e valores”. As classes econômicas foram mensuradas pela escala da ABEP. Os dados foram analisados por estatística descritiva, bivariada (GLM), análise de cluster e regressão logística. O nível de significância adotado foi de 5%. Os 2691 estudantes que participaram da amostra apresentaram média de 16 anos (IC=15,9-16,1) e 95,5% eram de classes mais favorecidas (A e B). A droga mais consumida foi o álcool (50,2%), seguida do tabaco (14,1%) e outras drogas (11,6%). O consumo binge de álcool foi relatado por 31,8%. A análise de cluster definiu quatro grupos quanto ao uso de drogas no mês: não usou drogas, álcool, álcool/binge/tabaco, álcool/binge/tabaco/outras drogas. A resiliência não se relacionou aos padrões de uso de drogas avaliados nessa população. Apesar disso, o fator de “resolução de ações e valores”, que avaliou auto-estima, determinação, disciplina, bom humor, prontidão para ajuda e adaptabilidade, contribuiu para uma menor chance de uso de álcool, binge, uso de tabaco e de outras drogas. Para esse padrão de uso, os principais aspectos protetores foram a disciplina e a determinação. A disciplina também diminuiu as chances do uso de álcool, associado a episódios de binge e uso de tabaco. Esses resultados ressaltam a relevância de aspectos relacionados a ações e valores, especialmente disciplina e determinação, para prevenção ao uso de drogas na adolescência, cuja prática tem sido um grande desafio. / The aim was assess how resilience and its factors are related to different drug use patterns in adolescents. Private school students from São Paulo (Brazil) were selected by a representative, stratified and cluster sample. It was applied a self-report questionnaire proposed by WHO measuring alcohol, binge drinking, tobacco and other drugs (marijuana, inhalants, tranquilizers, stimulants, cocaine, ecstasy and crack) 30-day use. The resilience was assessed by Resilience Scale, which in Brazilian validation the main factor was named “capacity to act based on ones values”. The economic class was measured by ABEP scale. Weighted data were analyzed by descriptive, bivariate (GLM), cluster analysis and logistic regression statistics. Significance level was set at 5%. The sample was comprised of 2691 students with mean age 16 (CI=15.9-16.1), 52% were female and 95.5% were from upper economic classes. The most prevalent drug consumption was alcohol (50.2%), followed by tobacco (14.1%) and other drugs (11.6%). Binge drinking was related by 31.8%.Cluster analysis identified four groups according to 30-day drug use: do not use drugs, alcohol, alcohol/ binge drinking/ tobacco, alcohol/ binge drinking/ tobacco/ other drugs. The resilience was not associated with different drug use patterns in this population. However, the factor “capacity to act based on ones values” that evaluate self-steam, determination, self-discipline, good mood, readiness to help and adaptability, contribute to decrease the odds of alcohol use, binge drinking and other drug use. The main protect factors for this drug use pattern was self-discipline and determination. Self-discipline also decreased the odds of alcohol associated with binge drinking and tobacco use. These results highlight the relevance of aspects related to “capacity to act based on ones values”, especially self-discipline and determination, to drug use prevention in adolescence. / TEDE / BV UNIFESP: Teses e dissertações

Albert Bandura’s construct of moral disengagement has been recognized as theoretically useful for the study of self-destructive behaviors and moral disengagement, and to provide a unique criterion for empirical investigation of United States combat veterans returning from the wars in Iraq and Afghanistan. The purpose of this project is to better understand predictors related to the disengagement of moral self-sanctions in order that self-destructive behaviors related to Post Traumatic Stress Disorder, such as drug and alcohol abuse, and the ultimate self-destructive behavior of suicide, might be mitigated. Charles Snyder’s hope construct, Harold Koenig and Arndt Büssing’s concept of intrinsic religiosity and Corey Keyes’ notion of psychological flourishing are chosen as viable predictor variables. Hope and intrinsic religiosity are found to be significant and to be correlated with moral disengagement. Inferences regarding the results are postulated and suggestions are made for research regarding other possible predictors of moral disengagement. Agentive moral reinforcement is discussed and proposals offered related to increasing psychological resilience and decreasing the agent’s risk associated with moral disengagement.