Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

OBJECTIVES: To investigate determinants of dental care utilization among low-income African-American women, focusing on psychosocial factors and predictors relevant to this population. METHODS: We used data from Wave I and II of the Detroit Dental Health Project. Participants were selected to represent African-American women caring for young children, and living in Detroit households below 250% of the federal poverty level. Papers I and II are cross-sectional, using baseline data from 969 women. Paper III follows 736 women longitudinally. Our main outcome variable was dental care utilization. The main independent variable in paper I was depression. The role of social support as a moderator was also assessed in that paper. In paper II, the main independent variables were depression, perceived discrimination, and food insufficiency, both individually and in combination. Paper III employs the framework of the Behavioral Model for Vulnerable Populations to assess predisposing, enabling and need factors predicting the incidence of dental visits. RESULTS: Only 41.8% of the women had a dental visit within the past year. Cross-sectional analyses indicated that depressed women had lower odds of having a dental visit within the past year (OR=0.71, 95%CI=0.53-0.94). Emotional social support attenuated the effect of depression on dental visits. Women with high levels of perceived discrimination and those with food insufficiency were less likely to have dental visits in the past year (OR=0.65, 95%CI=0.44-0.95, and OR=0.64, 95%CI=0.44-0.93, respectively). Depression and perceived discrimination were also associated with less preventive visits. When psychosocial stressors were combined, they acted synergistically to lower the odds of having dental visits, including preventive and treatment visits. Longitudinal analyses of the data identified significant interactions between dental insurance and perceived discrimination (P =0.02) and between dental insurance and having a dental home (P =0.04). Experiencing pain in the teeth or gums was also a significant predictor of future dental visits. CONCLUSIONS: Our findings indicate the importance of considering psychosocial factors when studying dental care utilization among low-income African-American women. Our findings also suggest that establishing dental homes, graduating culturally competent dental providers, and providing emotional support resources might improve dental care utilization among these women. / 2019-09-26T00:00:00Z

Immigrant adolescent learners are at risk for loneliness, isolation, rejection, and interpersonal distress from being perceived as outsiders or not belonging to the groups. This may be explained by host country or setting discriminating against them and also the immigrant adolescents' initial tentative engagement of host setting others. This study aimed to determine the relationship between psychosocial factors (psychological factors: emotional regulation, aggressiveness, sympathy, empathy; social support; and cultural differences), and peer interactions through demographic details (gender, age, and grade level) among francophone adolescent learners in the selected high schools in the Western Cape. It further purposed to determine the positive and negative factors that can affect their peer interactions at high schools. This study established the feasibility of recruitment procedures and developed a new model instrument of psychometric properties to measure the psychosocial factors scale and peer interaction scale for francophone adolescent learners in the selected high schools in the Western Cape Province.

A literatura apresenta aspectos psicossociais e familiares como fatores de risco associados ao adoecimento crônico infantil. Considera-se a Doença do Refluxo Gastroesofágico (DRGE), patologia crônica de grande prevalência e incidência na população pediátrica, portanto, tema relevante nas questões e estudos de saúde pública. Este estudo levantou as possíveis associações de alterações psicológicas de cuidadores e de crianças, de 3 a 12 anos, com DRGE. Os instrumentos de coleta de dados foram: Questionário Sócio demográfico, Escala Hospitalar de Ansiedade e Depressão (HAD), Escala de Qualidade da Interação Familiar (EQIF), Inventário de Estilos Parentais, Escala de Comportamento Infantil (ECI-A2 de Rutter) e uma Entrevista Semiestruturada. Foram aplicados nos cuidadores de três grupos, de crianças com sexo e idades equitativas, distribuídos da seguinte forma: Grupo 1 - Experimental: crianças com DRGE primário; Grupo 2 - Controle 1: crianças sem DRGE, porém com constipação intestinal crônica funcional, e Grupo 3 - Controle 2: crianças hígidas. Para a análise dos dados, foi adotado índice de significância p<=0,005 e foram realizadas: análises quantitativas (Teste ?2, Teste Exato de Fisher e ANOVA) e análises qualitativas (Teste ?2, Teste Exato de Fisher) dos dados obtidos. Observou-se fatores de risco psicossociais, nível de ansiedade e depressão do cuidador, qualidade de interação negativa com a criança, e tendência maior ao estilo parental autoritário e menor ao estilo parental participativo, mais frequentes no grupo de crianças com DRGE. Por outro lado, encontrou-se maior frequência de uso/abuso de álcool e/ou drogas, nos cuidadores dos grupos de crianças adoecidas crônicas em relação ao de normais. Na análise final da escala de comportamento infantil, as crianças classificadas como \"com demanda de acompanhamento psicológico ou/e psiquiátrico\", representaram maiores índices no grupo de crianças com DRGE, quando comparado aos outros grupos. Também observou-se diferença significativa nos perfis comportamentais, neurótico e antissocial, das crianças em cada grupo. Na entrevista, observou-se, os cuidadores com percepção limitada em relação às questões afetivas das crianças ou de si mesmos, quando comparadas às dos outros instrumentos. Notou-se, também, diferença da percepção dos cuidadores sobre a relação entre a prática de cuidados exercida por eles e os fatores associados ao adoecimento da criança, quando se comparou o grupo de crianças adoecidas com o grupo de normais. Identificou-se diferenças e peculiaridades entre os grupos de crianças adoecidas e normais, bem como especificidades do grupo de crianças com DRGE, quando comparado aos demais. Dessa forma, sugere-se estudos mais aprofundados nas especificidades encontradas, principalmente, nas crianças com DRGE, visando direcionar a prática clínica interdisciplinar de assistência à saúde desta população. / The literature presents psychosocial and family aspects as risk factors associated with childhood chronic illness. Gastroesophageal Reflux Disease (GERD) is considered a chronic disease of great prevalence and incidence in the pediatric population, therefore, a relevant topic in public health issues and studies. This study raised the possible associations of psychological changes of caregivers and children, from 3 to 12 years old, with GERD. The instruments of data collection were: Demographic Socio Questionnaire, Hospital Anxiety and Depression Scale (HAD), Family Interaction Quality Scale (EQIF), Inventory of Parenting Styles, Infant Behavior Scale (ECI-A2 by Rutter) Semi structured interview. Group 1 - Experimental: children with primary GERD; Group 1 - Experimental: children with primary GERD; Group 2 - Control 1: children without GERD, but with functional chronic intestinal constipation, and Group 3 - Control 2: healthy children. For the data analysis, a significance level of p<=0.005 was adopted and quantitative analyzes (?2 Test, Fisher\'s Exact Test and ANOVA) and qualitative analyzes (?2 Test, Fisher\'s Exact Test) of the data were performed. Psychosocial risk factors, anxiety and depression of the caregiver, quality of negative interaction with the child, and a tendency towards authoritarian parental style and lesser participatory parental style, were more frequent in the group of children with GERD. On the other hand, there was a higher frequency of alcohol/drug use/abuse in the caregivers of the groups of children with chronic illness compared to normal ones. In the final analysis of the children\'s behavior scale, children classified as having \"psychological and/or psychiatric follow-up demand\" represented the highest rates in the group of children with GERD when compared to the other groups. There was also a significant difference in the behavioral, neurotic and antisocial profiles of children in each group. In the interview, it was observed, caregivers with limited perception regarding the affective issues of the children or of themselves, when compared to the other instruments. Differences in caregivers\' perceptions about the relationship between their care practice and the factors associated with the illness of the child were also observed when comparing the group of children who were ill with the normal group. Differences and peculiarities were identified between the groups of sick and normal children, as well as specificities of the group of children with GERD, when compared to the others. Thus, we suggest more in-depth studies on the specificities found, especially in children with GERD, in order to direct the interdisciplinary clinical practice of health care in this population.

O trabalho proporciona realização pessoal, reconhecimento social e a vita activa, permitindo ao ser humano transformar a si próprio e ao mundo. Pessoas com deficiência, no entanto, têm pouca participação no mercado de trabalho, o que já foi relacionado ao recebimento do Benefício de Prestação Continuada (BPC). O BPC poderia desestimular a participação das pessoas com deficiência no mercado de trabalho porque, caso o beneficiário comece a trabalhar, o benefício deve ser extinto imediatamente. Como o BPC é fundamental para o sustento de seus beneficiários e familiares, poderia estar exercendo uma função ambígua: garantindo a possibilidade da manutenção familiar à custa da manutenção da vulnerabilidade social destas pessoas com deficiência extremamente pobres por seu afastamento do trabalho. O objetivo desta pesquisa foi compreender como o BPC e a deficiência podem interferir na maneira com que as pessoas com deficiência física de locomoção se relacionam e constroem sua vida socialmente, utilizando o trabalho como instância de análise, principalmente na dimensão dos sentidos do trabalho e das possíveis formas de vinculação com o mercado e o mundo do trabalho. Participaram da pesquisa nove pessoas com deficiências físicas músculoesqueléticas com idades entre 19 e 40 anos. A pesquisa foi realizada por meio de entrevistas semi-estruturadas individuais e analisadas a partir da proposta da análise de conteúdo de Bardin. Estabeleceram-se as categorias empíricas: deficiências e desvantagens, trabalho e pessoas com deficiências, e BPC e suas repercussões, as quais tiveram como referencial o quadro teórico de Pierre Bourdieu e Robert Castel. Encontramos uma maioria de participantes com habitus no qual os trabalhos simplificados e precarizados são predominantes. O trabalho foi vinculado à idéia de sofrimento, dignidade e sustento. Encontramos pessoas trabalhando na informalidade e fazendo bicos para aumentar a renda, outras que trabalham sem remuneração, e outras que não trabalham: todos evitando o mercado formal em função do BPC. Reconhecendo a baixa remuneração e especificidade das oportunidades de trabalho disponibilizadas pelo habitus de classe, aliadas à instabilidade do mercado de trabalho formal e a importância do benefício na manutenção financeira familiar, os entrevistados, em sua maioria, optaram por permanecer com o BPC em detrimento do trabalho. O benefício parece atuar como uma alternativa à necessidade de se submeter a estes trabalhos simplificados pela garantia do sustento, oferecendo o tempo livre para que eles pudessem realizar outras atividades. São estas outras atividades de trabalho, por vezes não remuneradas, que proporcionam a realização pessoal, reconhecimento social e a vita activa que esperávamos por meio do trabalho formal. A deficiência, fonte de preconceito para a maior parte dos entrevistados, não parece ter influenciado a vinculação com o trabalho, mas sendo uma diferença reconhecida como diversidade, proporciona a vantagem da proteção social por meio do BPC, reduzindo a vulnerabilidade social e as desvantagens sociais causadas não só pela deficiência, mas principalmente pelo habitus de classe pobre de oportunidades sociais / The work offers personal achievement, social recognition and the vita activa, allowing humans to change itself and the world. However, people with disabilities have small participation in the labor market, which has been linked to the receiving of the Benefit of Continuous Provision (Benefício de Prestação Continuada - BPC), a Brazilian social assistance benefit. BPC may discourage the participation of people with disabilities in the labor market because the benefit must be canceled immediately in the case of the beneficiary get a job. The BPC is fundamental to the support of its beneficiaries and their families, but it could be taking an ambiguous role: at the same time that it has supported these families, it has maintained them at social vulnerability by the distance from work of the beneficiaries. The aim of this research was to understand how the BPC and the disability could interfere in the way people with physical disabilities develop their social lives, using work activity to do this analysis, especially by the understanding of the meaning of work and the main ways of bond to the labor market and the work world. Three empirical categories were established: disabilities and disadvantages, work and people with disabilities, and BPC and its repercussions, which were analyzed by the theoretical framework of Pierre Bourdieu and Robert Castel. It was found that a majority of the participants has a habitus in which precarious and simplified jobs are predominant. The work was linked to the idea of suffering, dignity and supporting. It was found that there are people working in informality to increase income, others working without pay, and others that do not work. All of them avoiding get a regular job to keep the BPC. Acknowledging the low pay and the specificity of job opportunities provided by the class habitus, allied to the instability at the regular labor market and the importance of the benefit to the family financial maintenance, the respondents most opted to stay with the BPC in instead of getting a job. The benefit seems to act as an alternative to the need of undergoing to a simplified work by ensuring sustenance, offering free time to perform other activities. All these other activities of work, often unpaid, that seems to provide personal fulfillment, social recognition and vita activa, what was expected by a regular job. The disability, in spite of being source of prejudice for most of the interviewees, did not seem to have influenced the linking with the work, but at being recognized as diversity, this difference seems to offer the advantage of social protection through the BPC, reducing the social vulnerability and the social disadvantages, not only caused by the disability, but mainly by the class habitus, that is poor of social opportunities

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-13T18:36:38Z No. of bitstreams: 1 carolinaferreiraguarniericandido.pdf: 1306757 bytes, checksum: f424cb742d750709fa80cc252dfb911f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-27T21:21:08Z (GMT) No. of bitstreams: 1 carolinaferreiraguarniericandido.pdf: 1306757 bytes, checksum: f424cb742d750709fa80cc252dfb911f (MD5) / Made available in DSpace on 2016-06-27T21:21:08Z (GMT). No. of bitstreams: 1 carolinaferreiraguarniericandido.pdf: 1306757 bytes, checksum: f424cb742d750709fa80cc252dfb911f (MD5) Previous issue date: 2015-02-10 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: A cirurgia bariátrica é um tratamento legítimo da obesidade na atualidade e para sua eficácia é indispensável a aderência às modificações alimentares, comportamentais e de estilo de vida, a qual pode estar também associada a fatores psicossociais. Objetivo: Avaliar a aderência ao tratamento de pacientes submetidos à cirurgia bariátrica e sua associação com aspectos psicossociais (resiliência, auto-eficácia, suporte social). Métodos: Estudo transversal, realizado com 39 pacientes do Serviço de Controle da Hipertensão, Obesidade e Diabetes da cidade de Juiz de Fora, submetidos à cirurgia bariátrica, através de quatro instrumentos validados e entrevista. Resultados: A auto-eficácia e a resiliência se mostraram variáveis importantes frente ao estilo comportamental necessário para o sucesso do tratamento, para a adequação alimentar e aderência à atividade física. A atividade física ganha destaque frente às várias correlações obtidas, com variáveis clínicas, psicossociais e comportamentais. A atividade física e a alta auto-eficácia mostraram-se fatores de proteção em relação a um quadro depressivo. Conclusão: Faz-se necessário o acompanhamento de qualidade a longo prazo, assim como o desenvolvimento de mediadores importantes na manutenção dessas mudanças comportamentais, tais como a resiliência e a auto-eficácia. / Introduction: Nowadays, bariatric surgery is a legitimate obesity treatment and for real effectiveness is essential the adherence to dietary changes, behavioral changes and lifestyle, which can be associated with psychosocial factors. Objective: To evaluate the adherence to treatment of patients undergoing bariatric surgery and its association with psychosocial factors (resilience, self-efficacy, social support). Methods: Cross-sectional study with 39 patients, from Serviço de Controle da Hipertensão, Diabetes e Obesidade of Juiz de Fora, who are going through the process of bariatric surgery. For the study, four validated instruments were applied and the patients were interviewed. Results: Self-efficacy and resilience were important variables in the behavioral style for a successful treatment along with appropriate diet and adherence to physical activity. Physical activity is highlighted across the various correlations obtained with clinical, psychosocial and behavioral variables. Physical activity and high self-efficacy proved to be preventive factors to depression. Conclusion: It is necessary to make a quality monitoring in the long-term and also the development of important mediators in the maintenance of these behavioral changes, such as resilience and self-efficacy.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-03-28T10:43:38Z No. of bitstreams: 1 laislagedecarvalho.pdf: 1112714 bytes, checksum: aa0ba981df3de07f2ac45bb0df0dba63 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-04-09T19:22:53Z (GMT) No. of bitstreams: 1 laislagedecarvalho.pdf: 1112714 bytes, checksum: aa0ba981df3de07f2ac45bb0df0dba63 (MD5) / Made available in DSpace on 2018-04-09T19:22:53Z (GMT). No. of bitstreams: 1 laislagedecarvalho.pdf: 1112714 bytes, checksum: aa0ba981df3de07f2ac45bb0df0dba63 (MD5) Previous issue date: 2018-02-20 / A gestação de alto risco é caracterizada por ser um momento em que a vida ou a saúde da mãe e/ou do feto e/ou do recém-nascido está submetida a maiores riscos que a média da população considerada. O presente estudo objetivou apresentar dados sobre o perfil de gestantes de alto risco, determinar os aspectos psicossociais ligados à gravidez de risco, bem como identificar graus de vulnerabilidade nos períodos de gestação, no que diz respeito às comorbidades associadas. Trata-se de um estudo quantitativo, transversal, de caráter exploratório, cuja amostragem foi composta por 74 gestantes enquadradas no perfil de risco em um hospitalmaternidade do município de Juiz de Fora/MG. Os instrumentos utilizados foram: Questionário de Saúde Geral do Paciente - PHQ-2, Escala de Percepção de Suporte Social - EPSS, Inventário de Ansiedade Traço-Estado – IDATE, Alcohol, Smoking and Substance Involvement Screening Test – ASSIST e um questionário contendo dados sociodemográficos e clínicos. Observou-se que determinadas características sociodemográficas e clínicas, como situação conjugal, escolaridade, renda, idade e tempo gestacional estão correlacionadas às mudanças nos padrões psicossociais dessas mulheres. Além disso, foi possível identificar a prevalência de sintomatologias depressivas, ansiosas, prejuízos no suporte social e uso inadequado de substâncias nessa população. Os resultados demonstram a relevância de se conhecer o perfil dessas mulheres para melhora na elaboração de estratégias de suporte direcionadas ao enfrentamento de possíveis fatores que possam interferir no bom andamento da gestação. / The high-risk pregnancy is characterized for being a moment that the life or health of the mother and/or fetus and/or newborn is submitted to higher risks than the mean population. The current study aimed to present data concerned about the profile of high risks pregnancy, determine psychosocial aspects about high-risk pregnancy as well as identify vulnerability during pregnancy, regarding the associated comorbidities. It is a quantitative, cross-sectional, exploratory study with a sampling composed by 74 pregnant women identified as high tisk pregnant in a maternity hospital located in of Juiz de Fora/MG, Brazil. The instruments applied were: Patient's General Health Questionnaire - PHQ-2, Perceived Social Support Scale – EPSS, Trait Anxiety Inventory-State – STAI, Alcohol, Smoking and Substance Involvement Screening Test – ASSIST and a survey containing sociodemographic and clinical characteristics, such as marital status, education level, incomes, age and gestational time are correlated to changes in the psychosocial patterns of these women. Furthermore, it was possible to identify prevalence of symptoms of depressive, anxiety, social support loss and inappropriate substances use in this population. The results demonstrate the relevance of knowing the profile of these women in order to improve supportive strategies formulation directed to confront possible factors that may interfere with the good progress of gestation.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-28T17:06:10Z No. of bitstreams: 1 hilamartinscamposfaria.pdf: 1380339 bytes, checksum: b19bba2d42034c9faa4862256ad3867f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-29T11:01:38Z (GMT) No. of bitstreams: 1 hilamartinscamposfaria.pdf: 1380339 bytes, checksum: b19bba2d42034c9faa4862256ad3867f (MD5) / Made available in DSpace on 2016-01-29T11:01:38Z (GMT). No. of bitstreams: 1 hilamartinscamposfaria.pdf: 1380339 bytes, checksum: b19bba2d42034c9faa4862256ad3867f (MD5) Previous issue date: 2014-02-20 / O diagnóstico de câncer de mama geralmente acarreta impacto emocional pelo temor das alterações corporais, pelo medo da morte ou pelas múltiplas perdas nas esferas emocional, social e material. Devido à relevância da doença faz-se necessário um conjunto de cuidados junto às pacientes que lhes permita situarem-se em sua nova condição. A proposta desta pesquisa é avaliar o impacto do Grupo de Suporte sobre as repercussões psicossociais do adoecimento de mulheres com câncer de mama. Método: o estudo é qualitativo e longitudinal. Nove mulheres com diagnóstico de câncer de mama receberam assistência, semanal, no Grupo de Suporte, por 4 meses, no Hospital Universitário. Antes e depois da intervenção grupal foram realizadas entrevistas com roteiro semiestruturado com o intuito de comparar possíveis mudanças pré- e pós-grupo. A análise do material levou em conta dois níveis de focalização: o individual e o grupal. A Análise de Discurso, a clínica psicanalítica e as práticas de grupo sustentam as interpretações deste material. Resultados: os resultados encontrados apontaram que o medo e os fantasmas associados à doença e à morte foram amenizados; as angústias e sentimentos depressivos se evidenciaram, sobretudo pela perda dos cabelos e pelo medo da recidiva e da morte; por fim, o trabalho possibilitou o afrouxamento de certas defesas psíquicas, dificultadoras do trabalho de elaboração. / Breast cancer diagnosis generally leads to emotional impact due to fear of bodily changes, fear of death or due to multiple losses in the emotional, social and material spheres. Given the relevance of the disease there is the need of a set of care measures to be taken with the patients which allows them to be situated in their new condition. The purpose of this research is to assess the impact of the Support Group on the psychosocial repercussions of the breast cancer diagnosis. Method: nine women with a breast cancer diagnosis received weekly assistance at the Support Group, for 4 months, at the University Hospital. The study is qualitative and longitudinal. Before and after the group intervention there were interviews following a semi-structured script aiming to compare the possible changes pre and post group. The analysis of the material took into consideration two focus levels: individual and group. The Discourse Analysis, the psychoanalytical clinic and the group practices are the basis of the interpretation. Results: the results found that the fear and ghosts associated with the disease and with death were lightened; the anguish and depressive feelings were shown, mainly by the hair loss and by the fear of recurrence and of death; finally, the work made it possible to lighten certain psychological defenses, which make the elaboration work more difficult.

Context: Tobacco use among medical students is of public health concern, given their role as future role models for healthy lifestyles. This study sought to determine the prevalence and determinants of tobacco use and nicotine dependence in medical students in Pretoria. In particular, this study explored the role of sense of coherence – a measure of stress-coping ability – on tobacco use patterns among medical students. Furthermore, we examined the students’ knowledge of smoking cessation approaches, their perceptions with regard to the availability and adequacy of tobacco control curricula, and their perception of their role as ”role models” for their patients. Methods: This cross-sectional analytical study, involving undergraduate medical students in their 2nd and 6th year of study at the universities of Pretoria and Limpopo (MEDUNSA), was conducted during August and September 2008. Consenting participants completed a self-administered questionnaire (N=722). Information obtained included: demographic characteristics of respondents, alcohol use, past and current use of various tobacco products, perception of availability and adequacy of training in tobacco control (TC), support for various TC legislation and perception of the role of doctors in smoking cessation. A six-item Antonovsky’s sense of coherence scale (SOC) was also included to measure respondents’ ability to cope with stress. Nicotine dependence was measured using the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). Data analysis included chi-square statistics, t-test and multiple logistic regression analysis. Level of significance was set at p<0.05. Results: Prevalence of cigarette smoking in medical students was 17.3%. Cigarette smoking was significantly higher among the 6th (21.5%) than among the 2nd year (14.1%) students and was also significantly higher among males (20.4%) than among females (14.4%). In a bivariate analysis, problem drinkers were more likely to be smokers (37.5%) as compared to non-problem drinkers (13%). Compared to non-smokes, smokers were more likely to have a lower SOC [Mean(sd); 26.8 (8.8) vs 28.8 (7.4); p=0.019] and were less likely to attach importance to being seen as a role model by patients. Only 21.9% felt their training curriculum contained TC issues and of these a little over half felt the TC content was inadequate. After controlling for potential confounders, the factors that were independently associated with the current smoking status were, having lower support for TC legislation (OR=0.49; 95% CI= (0.41-0.59) and attaching less importance to being seen as a role model by patients (0.62; 0.41-0.91). Other factors associated with cigarette use included: being a 6th year student (OR=2.17; 95% CI; 1.32-3.58), having a drinking problem (2.17; 1.28-3.68), reporting exposure to others smoking at home (3.29; 1.91-5.66) and having received previous formal training in cessation (0.55; 0.32-0.95). Younger age (0.86; 0.77- 0.97), lower SOC (0.94; 0.90-0.99), and lower level of support for TC legislation (0.56; 0.40-0.79) were independently associated with nicotine dependence. Conclusions: This study’s findings suggest that tobacco use is prevalent among medical students and tobacco use is strongly associated with alcohol abuse. In addition to offering tobacco cessation services to these students, these findings highlight the need to institute a curriculum on tobacco control that includes not only teaching cessation counselling skills to medical students, but that also encourages them to become advocates for TC legislation and to recognise themselves as important role models in the society. Copyright / Dissertation (MMed)--University of Pretoria, 2009. / School of Health Systems and Public Health (SHSPH) / MMed / Unrestricted

The diploma thesis deals with psychosocial risks and stress in work. The theoretical part of the work is devoted to the definition and characteristics of psychosocial risks and stress. Furthermore, the legislative entrenchment of psychosocial risks in the Czech Republic and the European Union is described. The theoretical assumptions are concluded by the definition of psychosocial risk management. The methodological part is devoted to the quantitative survey, which is focused on the psychosocial risks of bank advisers of the company. Based on the results of the questionnaire survey, appropriate recommendations are made to reduce psychosocial risks in the company.