The aim of this study is to create a deeper understanding of the disease known as eating disorder. The study is based on four autobiographies written by individuals who themselves have been affected by eating disorders. These stories have been studied using a narrative approach. To achieve the purpose, the study is focused on what participants describe as the factors underlying the onset of the disease, the factors that participants describe maintained their eating disorders, as well as what is described to be the factors responsible for their recovery. By my interpretation of the stories, I have been able to identify common factors that all participants describe to be influential in their disease course. The common factors that have been identified are relationships, expectations and emotions. The result shows that it is possible to see a variation in how these factors have influenced the participants' disease course. The variety of how these factors have influenced suggests that each individual's care is unique. The results have been analyzed by using the theory of social construction.

Studiens syfte är att genom en litteraturstudie undersöka psykosociala riskfaktorer till ungdomsbrottslighet. Riskfaktorer som undersöks är individuella attribut, familjeförhållanden, individens egna psykiska förutsättningar, betydelsen av skolgång samt vänner och grupptillhörighet. Då fokus ligger på individen, kommer studien att analyseras utifrån sociala och utvecklingspsykologiska teorier. Forskare i psykologi och kriminologi förklarar att bakomliggande orsaker till att individen begår brott i ung ålder, måste förstås i ett sammanhang med fler faktorer i beaktande, exempelvis individuella egenskaper, men även villkor och erfarenheter i förhållande till dennes miljö. I annan mening krävs det mer än en riskfaktor för att ett brottsligt beteende ska formas, men de betonar däremot att en enda  riskfaktor även kan härleda till en utveckling av fler. Viktigt att belysa är också att sammansättningen av faktorer inte är identiska för varje individ. Ungdomsbrottsligheten kännetecknas av ett reaktivt kriminellt tänkande, vilket innebär att brott i hög utsträckning begås impulsivt och oplanerat. Andra konstaterade riskfaktorer är  ungdomens familjeförhållanden. Att leva i en dysfunktionell familj, präglad av konflikter mellan syskon, otydlig hierarki mellan barn- och föräldraroll, våld i hemmet samt föräldrar med beroendeproblematik av olika substanser och psykiska bekymmer, ökar sannolikheten med 86% för ungdomar att begå våldsbrott. Vidare har det konstaterats att egenskaper såsom spänningssökande, impulsivitet, svårhanterlig aggression, brist på motivation till studier och ambitioner för livet, utgör en riskfaktor för att falla i kriminaliteten. Att ha en ADHD diagnos har också visat sig vara en sårbarhet och cirka var femte interner i den svenska kriminalvården har diagnosen. Även en hög skolfrånvaro och misslyckande med studier är förknippat med en individs uppvisande av våldsamt och kriminellt beteende. Faktum är ungdomar redan inom 12 månader utan skolgång uppvisar ett normbrytande beteende. Slutligen är influenser från vänner avgörande när barnet når tonåren. Att umgås med någon som begår brott utgör en stor riskfaktor för att själv hamna i ungdomsbrottsligheten. / The aim of this literature study is to research the psychosocial (risk) factors behind juvenile criminality. Researchers in psychological and criminological fields explain that, the underlying factors that lead an adolescent to criminality, need to be analysed through multidimensional lenses, since there are several factors leading to juvenile criminality. Usually, there is more than one factor that leads to juvenile delinquency, nevertheless, researchers claim that a single risk factor can also lead to the development of other factors, hence, leading young people to commit crime. It is also important to highlight that the combination of factors is not identical to every individual. Juvenile criminality is characterised by reactive criminal thinking, therefore, crimes are largely committed impulsively and unplanned. Moreover, other established risk factors are the family circumstances of the adolescent. The probability of adolescents committing crime, increases by 86% when living in an environment that is characterised by a dysfunctional family, dominated by sibling conflicts and unclear hierarchy between parents and children, violence in the home, and parents with drug addictions and psychological instability. Furthermore, it is proven that characteristics, such as, sensation seeking, impulsiveness, aggression, lack of educational motivation and lack of life ambitions, are also risk factors for falling into crime. Additionally, having an ADHD diagnosis has also been shown to be a vulnerability and about every fifth inmate in the Swedish prison system has the diagnosis. Moreover, school absenteeism and failure to study are also associated with an individual's display of violent and criminal behavior. In fact, adolescents who have been 12 months without schooling, show a norm-breaking behavior. Finally, the influence of friends is crucial when the child reaches adolescence. Hence, spending time with someone who commits a crime is a major risk factor for the individual to fall into juvenile delinquency.

Contexte : le travail réalisé dans cette thèse s'inscrit dans le projet de prévention précoce CAPEDP qui comprenait une intervention longitudinale adressée à une population de grande vulnérabilité psychosociale. Nos objectifs étaient de tester l'efficacité des interventions à domicile sur la qualité de l'attachement chez l'enfant et de comparer longitudinalement les comportements et les représentations d'attachement avec un groupe témoin qui a reçu les soins usuels. Méthodologie : notre travail est divisé en trois études et temps de mesure : 12, 18 et 48 mois de l'enfant. Les comportements d'attachement ont été évalués à travers la Situation Étrange à 12 mois et l'Attachment Q-sort à 18 mois. A 48 mois, nous avons évalué les représentations d'attachement avec l'Attachment Story Completion Task. Résultats : à 12 mois, les différences en termes de sécurité ne sont pas significatives mais nous remarquons plus d'enfants sécures dans le groupe intervention. A 18 mois, le groupe intervention a des scores de sécurité plus élevés. Nous remarquons aussi une amélioration significative entre 12 et 18 en termes de sécurité dans le groupe intervention. A 48 mois, nous retrouvons une amélioration au niveau des facteurs sociodémographiques et un effet de genre, les filles du groupe intervention étaient significativement plus sécures que celles du groupe contrôle. Discussion : l'intervention CAPEDP a eu un effet positif en augmentant la sécurité de l'attachement entre 12 et 18 mois. Les filles du groupe intervention semblent avoir profité plus de l'intervention CAPEDP. Plusieurs limites de l'étude sont discutées ainsi que les ouvertures de recherche, notamment une intervention conjointe psychologue-assistante sociale pour atténuer l'impact des facteurs de risque sur l'efficacité de l'intervention psychologique. / Context: this PhD research fits into the early prevention CAPEDP project: a home-visiting intervention addressing a high-risk population. Our goals were to test the efficiency of the intervention on infant attachment and to longitudinally compare attachment behaviours and representations with a control group that received only usual care. Method: our work is divided into 3 studies with different times and measures: 12, 18 et 48 months. Attachment behaviour was assessed with the Strange Situation at 12 months and with the Attachment Q-sort at 18 months. Attachment representations were assessed with the Attachment Story Completion Task at 48 months. Results: at 12 months, there are more secure infants in the intervention group although these differences are not statistically significant. At 18 months, the intervention group has higher scores of security. Results also show an improvement in terms of security between 12 and 18 months for the intervention group. At 48 months, results point out an improvement in socio-demographic factors and a gender difference: girls from the intervention group showed significantly higher attachment security than the control group. Discussion: the CAPEDP intervention had a positive effect in enhancing attachment security between 12 and 18 months. Girls seem to have profited the most from our intervention. The limitations and future directions are discussed, particularly the interest of a joint intervention between psychologists and social workers to diminish the socio-economic risk impact on the psychological intervention. / Contexto: este trabalho de tese insere-se no projeto de prevenção precoce CAPDP constituído por uma intervenção longitudinal dirigida a uma população com elevado risco psicossocial. Os objetivos eram testar a eficácia da intervenção a domicílio sobre a qualidade da vinculação na criança e comparar longitudinalmente os comportamentos e as representações de vinculação com um grupo controlo que beneficiou apenas do sistema de cuidados já existente. Metodologia: o nosso trabalho é dividido em três estudos ou tempos: 12, 18 e 48 meses da criança. Os comportamentos de vinculação foram avaliados com a Situação Estranha aos 12 meses e com o Attachment Q-sort aos 18. Aos 48 foram avaliadas as representações de vinculação com o Attachement Story Completion Task. Resultados: aos 12 meses, as diferenças em termos de segurança da vinculação não são significativas, mas constatámos a presença de mais crianças seguras no grupo intervenção. Aos 18 meses, o grupo intervenção verifica scores mais elevados de segurança. De notar também uma melhoria significativa entre os 12 e os 18 meses em termos de segurança da vinculação no grupo intervenção. Aos 48 meses, encontrámos melhorias a nível sociodemográfico e um efeito de género, sendo que as meninas do grupo intervenção apresentam scores de segurança das representações mais elevados comparativamente às do grupo controlo. Discussão: a intervenção CAPEDP teve um efeito positivo aumentando a segurança da vinculação entre 12 e 18 meses. As meninas do grupo intervenção parecem ter beneficiado mais da nossa intervenção. Os limites do estudo são discutidos assim como as aberturas para futuras investigações, nomeadamente para uma intervenção conjunta entre psicólogos e assistentes sociais para diminuir o impacto negativo dos factores de risco sobre a intervenção psicológica.

HINTERGRUND: Die Typ-D-Persönlichkeit (von distressed personality) etablierte sich in den letzten Jahren als ein Risikofaktor für den Verlauf kardiovaskulärer Erkrankungen. Die bisherigen Studien waren in den Niederlanden oder Belgien durchgeführt worden. Das Ziel der hier vorliegenden Arbeit war eine unabhängige Überprüfung der Ergebnisse an einer Stichprobe deutscher kardiologischer Patienten. Zusätzlich sollte untersucht werden, ob die Typ-D-Persönlichkeit und ihre Dimensionen der negativen Affektivität (NA) und der sozialen Inhibition (SI) über den Untersuchungszeitraum stabil blieben. METHODEN: Hierzu wurden 1040 stationär oder ambulant kardiologisch behandelte Patienten rekrutiert. Mithilfe der Typ-D-Skala (DS14) und der Hospital Anxiety and Depression Scale (HADS) wurden die Merkmale einer Typ-D-Persönlichkeit sowie Depressivität und Ängstlichkeit erhoben. Zusätzlich wurden klinisch relevante Daten, wie z. B. Geschlecht, Alter und kardiale Vorerkrankungen, erfasst. Endpunkt der Studie war die Gesamtmortalität. Mit Cox-Regressionsanalysen wurde das relative Sterblichkeitsrisiko der Probanden ermittelt. ERGEBNISSE: Hinsichtlich der Stabilität von Typ-D, NA und SI ergaben sich über einen Zeitraum von 5,9 Jahren Re-Test Stabilitäten an der unteren Grenze des Erwarteten. Es gab also eine gewisse Stabilität der Typ-D-Persönlichkeit, diese war aber nicht wesentlich höher als beispielsweise die von Angst und Depressivität, und auf Ebene des individuellen Patienten kam es häufig zu Veränderungen. Der Überlebensstatus ließ sich für 977 Studienteilnehmer ermitteln, hiervon waren 172 im Beobachtungszeitraum verstorben. In univariater und multivariater Analyse waren weder Typ-D noch NA oder SI Prädiktionsfaktoren einer höheren Gesamtmortalität. Im Gegensatz zu anderen Studien wies unsere Stichprobe ein heterogenes kardiales Erkrankungsprofil auf. Eine hierdurch bedingte Verschleierung eines Einflusses des Typ-D-Musters konnten wir durch separate Untersuchung der KHK-Patienten ausschließen. SCHLUSSFOLGERUNG: Zusammenfassend lässt sich sagen, dass unsere Studie zu den größten zählt, die bisher zur Evaluation des Einflusses der Typ-D-Persönlichkeit auf die Gesamtmortalität kardiologischer Patienten durch-geführt worden ist. Nach mehr als 5 Jahren Beobachtungszeit, mit 5764 Menschenjahren und 172 beobachteten Todesfällen hat sie suffiziente Ausdruckskraft, relevante Effekte der Typ-D-Persönlichkeit auf die Mortalität aufzudecken. Die klare Abwesenheit dieses Effektes in univariater und multivariater Analyse legt den Schluss nahe, dass die Typ-D-Persönlichkeit und ihre Dimensionen NA und SI bei deutschen kardiologischen Patienten nicht mit einer erhöhten Mortalität assoziiert sind. Die Diskrepanz zwischen unseren Ergebnissen und den Ergebnissen von Denollet und seiner Arbeitsgruppe macht weitere Forschung an anderen Stichproben nötig. Kulturelle Unterschiede in der Verarbeitung negativer Affekte sind als mögliche Ursache unserer abweichenden Ergebnisse zu diskutieren und sollten in zukünftigen Studien weiter untersucht werden.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-04-09T13:41:31Z No. of bitstreams: 1 ANITA COLLETES BELLODI.pdf: 4974375 bytes, checksum: 3bdee6ea638525af435f08f10b15571b (MD5) / Made available in DSpace on 2018-04-09T13:41:31Z (GMT). No. of bitstreams: 1 ANITA COLLETES BELLODI.pdf: 4974375 bytes, checksum: 3bdee6ea638525af435f08f10b15571b (MD5) Previous issue date: 2018-02-22 / Pontif?cia Universidade Cat?lica de Campinas - PUC - Campinas / Overweight in children and adolescents, which includes obesity and excessive body mass indexes, configure a serious public health problem. Understanding the relationships among some of the modifiable variables involved is the general objective of this Thesis, which was elaborated in three studies. Study 1 presented a systematic review of the literature on psychological and psychosocial variables related to Overweight in childhood and adolescence (three to 18 years old). Were applied descriptors indexed by the American Psychological Association (APA): obesity OR overweight, AND Child Psychology OR Child Characteristics OR Adolescent characteristics OR Adolescent Psychology OR psychosocial development, in the multidisciplinary databases of Academic Search Premier, including empirical studies, reviewed by pairs, published in the last 10 years. Depressive and anxiety symptoms were the most common evaluated. Studies have indicated that these symptoms are more frequent in children and adolescents who are overweight or obese compared to those with normal weight. Other psychological variables were less evaluated, but were shown to be influential, such as temperament. Therefore, it is suggested that child / adolescent overweight studies analyze a greater number of variables, including biological, psychological and social variables, applying more integrative statistical analyzes, such as network analysis, for a comprehensive and procedural evaluation. Study 2 analyzed data from a cross-sectional study of 3,471 public school students aged three to 13 years from the city of Campinas, SP - Brazil. Measurements of 31 variables were submitted to agglutination, remaining 16 variables, which were applied correlations analyzes, predictions and bivariate correlation network analysis and principal components analysis. We found 33.7% of students with overweight, 17.5% with obesity and 16.2% with excessive body mass. The network analysis showed that under stress these children and adolescents tend to have higher cholesterol levels, followed by a greater use of medications or supplements, and an increase in physical activity, higher ratios for boys and non-white ethnicity. Eating the lunch provided by the school and being female served as a protective factor for cardiovascular risk. It is concluded that stress is impacting the physical health of students, increasing their cardiovascular risk. We suggest actions that verify the sources of stress for this child and youth population and propose policies to manage these conditions. Study 3 analyzed 37 variables: psychosocial (ethnicity, psychosocial risk, city of residence, study in public or private school, influences of advertisements on food), treatment variables (time in treatment, periodicity, comorbidities, medical treatments), family variables (sex, age, body mass index (BMI), physical activity habit, diabetes of the mother, smoking during pregnancy, complications in pregnancy or childbirth, feeding behaviors such as restriction for weight loss, health restrictions, pressure and monitoring, adaptative/non-adaptative coping), child or adolescent variables (gender, age, weight at birth, exclusive breastfeeding, physical activity, hours of physical activity per week, hours of sleep, snacking from home to school, place of meals, screen time, temperament characteristics of effort control, negative affect, extroversion, adaptive and non-adaptive coping) and outcome variables: excessive body mass and obesity. There were 80 participants, 40 patients aged three to 17 years, from a pediatric endocrinology clinic of a university hospital in Campinas, SP - Brazil, and their caregiver (responsible family member), totaling 40 caregivers. Weight and height of participants were measured, and BMI was calculated. Psychosocial Assessment Tool (2.0), Comprehensive Feeding Practices Questionnaire, Motivational Theory of Coping Scale - 12, Children's Behavior Questionnaire, Early Adolescence Temperament Questionnaire - Revised. The network analysis emphasized that overweight begins with impaired maternal health, especially with diabetes mellitus and complications in pregnancy and childbirth, while children / adolescents with a negative temperament affective feature have poor adaptive coping in a context of psychosocial risk. This information should guide prevention strategies in women's health and gestational health, followed by multidisciplinary care programs for the patient and their caregiver, for those already under treatment. With the data from the three studies, it is a general conclusion that treatments for overweight based exclusively on indications of healthy life habits are insufficient. For prevention of overweight in children / adolescents, it is suggested to focus on maternal health and actions to reduce psychosocial risk. To achieve greater success in adherence to treatment, it is necessary to broaden the evaluation of psychological and psychosocial aspects, including stress and stressors evaluation, temperament, coping, in a multidisciplinary and contextualized assessment of the family psychosocial risk, and the economic and social reality of the target population. / El exceso de peso (EP), en ni?os y adolescentes, que incluye el sobrepeso y la obesidad, se presenta como un grave problema de salud p?blica. Comprender las relaciones entre algunas de las variables modificables involucradas es objetivo general de esta Tesis, que fue elaborada en tres estudios. El estudio 1 present? un levantamiento sistem?tico de literatura sobre variables psicol?gicas y psicosociales relacionadas al EP en la infancia y adolescencia (3 a 18 a?os). Se aplic? descriptores indexados por la American Psychological Association (APA): obesity OR overweight, AND Child Psychology OR Child Characteristics OR Adolescent characteristics OR Adolescent Psychology OR psychosocial development, en las bases de datos multidisciplinares de la Academic Search Premier, incluyendo estudios emp?ricos, revisados por pares en idioma ingl?s, publicados entre los a?os 2007 y 2017. Los s?ntomas depresivos y de ansiedad fueron los m?s comunes evaluados. Los estudios indicaron que estos s?ntomas son m?s frecuentes en los ni?os y adolescentes con sobrepeso o obesidad, si se compara con aquellos con peso normal. Otras variables psicol?gicas fueron menos evaluadas, pero se mostraron influyentes, tales como el temperamento. Por eso, se sugiere que los estudios del EP del ni?o / adolescente analizan mayor n?mero de variables, incluyendo biol?gicas, psicol?gicas y sociales, aplicando an?lisis estad?sticas m?s integrativas, como el an?lisis de red, para una evaluaci?n amplia y procesal. El estudio 2 analiz? datos de un estudio transversal con 3.471 estudiantes de escuelas p?blicas, de 7 a 13 a?os, de la ciudad de Campinas ? SP, Brasil. Las medidas de 31 variables fueron sometidas a la aglutinaci?n, restando 16 variables, las cuales se aplicaron an?lisis de correlaciones, predicciones y an?lisis de red de correlaci?n bivariada y an?lisis de componentes principales. Se encontr? 33,7% de estudiantes con EP, 17,5% con obesidad y 16,2% con sobrepeso. El an?lisis de red mostr? que, sufriendo estr?s, estos ni?os y adolescentes tienden a presentar niveles de colesterol m?s elevados, seguido por un mayor uso de medicamentos o suplementos, y un aumento de la actividad f?sica, relaciones mayores para ni?os y de etnia no blanca. Alimentarse con la merienda proporcionada por la escuela y ser del sexo femenino actu? como factor de protecci?n para el riesgo cardiovascular. Se concluye que el estr?s est? impactando la salud f?sica de los estudiantes, aumentando su riesgo cardiovascular. Se sugieren acciones que verifiquen las fuentes de estr?s para esta poblaci?n infantojuvenil y que propongan pol?ticas de manejo de esas condiciones. El estudio 3 analiz? 37 variables: psicosociales (etnia, riesgo psicosocial, ciudad de residencia, estudiar en escuela p?blica o particular, influencias de propagandas en la alimentaci?n), variables del tratamiento (tiempo en tratamiento, periodicidad, comorbilidades, especialidades m?dicas), variables familiares (sexo, edad, ?ndice de masa corporal (IMC), h?bito de actividad f?sica, diabetes de la genitora, tabaquismo de la genitora en la gestaci?n, complicaciones en la gestaci?n o parto, comportamientos de alimentaci?n v?a restricci?n para p?rdida de peso, restricci?n para la salud, presi?n y monitoreo, coping adaptativo y mal adaptativo), variables del ni?o o adolescente (sexo, edad, peso al nacer, lactancia materna exclusiva (AME), realizaci?n de actividad f?sica, horas de actividad f?sica por semana, horas de sue?o, h?bito de llevar la merienda de casa para la escuela, lugar de realizaci?n de comidas, tiempo en dispositivos con pantalla, caracter?sticas de temperamento de control con esfuerzo, afecto negativo, extroversi?n, coping adaptativo y el mal adaptativo) y las variables de desenlace: sobrepeso y obesidad (EP). Se tuvo a 80 participantes, siendo 40 pacientes, de 3 a 17 a?os, de un ambulatorio de obesidad infantil de la endocrinolog?a de un hospital universitario de Campinas ? SP, Brasil y su cuidador (familiar responsable), totalizando 40 cuidadores. El peso y la altura de los participantes fueron evaluados y se calcul? el IMC. Se aplic? individualmente instrumentos, de acuerdo con cada edad: Ficha de Caracterizaci?n, Psychosocial Assessment Tool (2.0), Compreensive Feeding Practices Questionnarie, Motivacional Theory of Coping Scale - 12, Children?s Behavior Questionnarie, Early Adolescence Temperament Questionnaire ? Revised. El an?lisis de red destac? que el EP se inicia con la salud materna perjudicada, principalmente con diabetes mellitus y complicaciones en el embarazo y parto, ya los ni?os / adolescentes con caracter?stica de afecto negativo de temperamento, presentan coping mal adaptativo, en contexto de riesgo psicosocial. Estas informaciones deben orientar estrategias de prevenci?n en salud de la mujer y salud gestacional, seguido por programas de atenci?n multidisciplinaria para el paciente y su cuidador, para aquellos ya en tratamiento. Frente a los datos de los tres estudios, se concluye en general que los tratamientos para EP basados exclusivamente en indicaciones de h?bitos de vida saludables son insuficientes. Para la prevenci?n del EP en ni?os / adolescentes, se sugiere foco en salud materna y acciones que disminuyen riesgo psicosocial. Para alcanzar m?s ?xito en la adhesi?n al tratamiento, es necesario ampliar la evaluaci?n de los aspectos psicol?gicos y psicosociales, incluyendo evaluaci?n sobre estr?s y estresores, temperamento, coping, en evaluaci?n multidisciplinaria y contextualizada al riesgo psicosocial familiar, ya la realidad econ?mica y social de la poblaci?n objetivo. / O excesso de peso (EP), em crian?as e adolescentes, que inclui o sobrepeso e a obesidade, apresenta-se como um grave problema de sa?de p?blica. Compreender as rela??es entre algumas das vari?veis modific?veis envolvidas ? objetivo geral desta Tese, que foi elaborada em tr?s estudos. O Estudo 1 apresentou um levantamento sistem?tico de literatura sobre vari?veis psicol?gicas e psicossociais relacionadas ao EP na inf?ncia e adolesc?ncia (tr?s a 18 anos). Aplicou-se descritores indexados pela American Psychological Association (APA): obesity OR overweight, AND Child Psychology OR Child Characteristics OR Adolescent characteristics OR Adolescent Psychology OR psychosocial development, nas bases de dados multidisciplinares da Academic Search Premier, incluindo estudos emp?ricos, revisados por pares, em idioma ingl?s, publicados entre os anos de 2007 e 2017. Sintomas depressivos e de ansiedade foram os mais comuns avaliados. A revis?o indicou que esses sintomas s?o mais frequentes nas crian?as e adolescentes com sobrepeso ou obesidade, se comparadas ?quelas com peso normal. Outras vari?veis psicol?gicas foram menos avaliadas, mas se mostraram influentes, tais como o temperamento. Por isto, ? sugerido que as pesquisas do EP da crian?a/adolescente analisem maior n?mero de vari?veis, incluindo biol?gicas, psicol?gicas e sociais, aplicando-se an?lises estat?sticas mais integrativas, como a an?lise de rede, para uma avalia??o ampla e processual. O Estudo 2 analisou dados de um estudo transversal com 3.471 estudantes de escolas p?blicas, de sete a 13 anos, da cidade de Campinas ? SP. Medidas de 31 vari?veis foram submetidas ? aglutina??o, restando 16 vari?veis, as quais aplicaram-se an?lises de correla??es, predi??es e an?lise de rede de correla??o bivariada e an?lise de componentes principais. Encontrou-se 33,7% de estudantes com EP, 17,5% com obesidade e 16,2 % com sobrepeso. A an?lise de rede mostrou que, sob estresse, essas crian?as e adolescentes tendem a apresentar n?veis de colesterol mais elevados, seguido por um maior uso de medica??es ou suplementos, e um aumento da atividade f?sica, rela??es maiores para meninos e de etnia n?o branca. Alimentar-se com a merenda fornecida pela escola e ser do sexo feminino atuou como fator de prote??o para o risco cardiovascular. Conclui-se que o estresse est? impactando a sa?de f?sica dos estudantes, aumentando seu risco cardiovascular. Sugerem-se a??es que verifiquem as fontes de estresse para esta popula??o infantojuvenil e que proponham pol?ticas de manejo dessas condi??es. O Estudo 3 analisou 37 vari?veis: psicossociais (etnia, risco psicossocial, cidade de resid?ncia, estudar em escola p?blica ou particular, influ?ncias de propagandas na alimenta??o), vari?veis do tratamento (tempo em tratamento, periodicidade, comorbidades, especialidades m?dicas), vari?veis familiares (sexo, idade, ?ndice de massa corporal (IMC), h?bito de atividade f?sica, diabetes da genitora, tabagismo da genitora na gesta??o, complica??es na gesta??o ou parto, comportamentos de alimentar via restri??o para perda de peso, restri??o para sa?de, press?o e monitoramento, coping adaptativo e mal adaptativo), vari?veis da crian?a ou adolescente (sexo, idade, peso ao nascer, amamenta??o materna exclusiva (AME), realiza??o de atividade f?sica, horas de atividade f?sica por semana, horas de sono, h?bito de levar lanche de casa para a escola, local de realiza??o de refei??es, tempo em dispositivos com tela, caracter?sticas de temperamento de controle com esfor?o, afeto negativo, extrovers?o, coping adaptativo e mal adaptativo) e as vari?veis de desfecho: sobrepeso e obesidade (EP). Teve 80 participantes, sendo 40 pacientes, de tr?s a 17 anos, de um ambulat?rio de obesidade infantil da endocrinologia de um hospital universit?rio de Campinas ? SP e seus cuidadores (familiar respons?vel), totalizando 40 cuidadores. Peso e altura dos participantes foram aferidos e calculou-se o IMC. Aplicou-se individualmente instrumentos, de acordo com cada idade: Ficha de Caracteriza??o, Psychosocial Assessment Tool (2.0), Compreensive Feeding Practices Questionnarie, Motivacional Theory of Coping Scale - 12, Children?s Behavior Questionnarie, Early Adolescence Temperament Questionnaire ? Revised. A an?lise de rede destacou que o EP se inicia com a sa?de materna prejudicada, principalmente com diabetes mellitus e complica??es na gravidez e parto. As crian?as/adolescentes com caracter?stica de afeto negativo de temperamento apresentam coping mal adaptativo, em contexto de risco psicossocial. Essas informa??es devem orientar estrat?gias de preven??o em sa?de da mulher e sa?de gestacional, seguido por programas de atendimento multidisciplinar para o paciente e seu cuidador, para aqueles j? em tratamento. Frente aos dados dos tr?s estudos, conclui-se no geral, que os tratamentos para EP baseados exclusivamente em indica??es de h?bitos de vida saud?veis s?o insuficientes. Para preven??o do EP em crian?as/adolescentes, sugere-se foco em sa?de materna e a??es que diminuam o risco psicossocial. Para atingir mais sucesso na ades?o ao tratamento, ? necess?rio ampliar a avalia??o dos aspectos psicol?gicos e psicossociais, incluindo a avalia??o do estresse e estressores, temperamento, coping, em avalia??o multidisciplinar e contextualizada ao risco psicossocial familiar, e ? realidade econ?mica e social da popula??o-alvo.

Cette recherche concerne le management du bien-être au travail à l'aide des espaces de discussion. En effet, la perspective pathogénique semble largement dominante aussi bien dans la littérature que dans les pratiques des professionnels – prévention des risques psycho-sociaux, du stress, du burnout, de la souffrance au travail…- pour aborder cette question de la santé au travail. Dès lors, l'enjeu de cette recherche est de proposer une vision plus appréciative de cette question à travers le concept de bien-être au travail. En s'appuyant sur la définition de la santé au travail de l'OMS (2007) qui définit la santé comme « un état de complet bien-être physique, mental et social », et non pas seulement comme l'absence de pathologies, cette recherche vise à tracer les contours d'une perspective salutogénique du travail à travers trois recherches-interventions. La thèse défendue est que la construction et l'animation d'espaces de discussion par la DRH et le management constituent un puissant levier de préservation des ressources (compétences, règles de métier, capacités, pouvoir d'agir, identité professionnelle…) et conséquemment un facteur de bien-être - et de qualité - au travail. La confiance entre acteurs et la possibilité de dire et d'entendre une parole sur l'activité réelle et l'organisation effective du travail sont à la base de la construction de tels espaces de discussion, sans lesquels aucun bien-être durable n'est possible. Pour ce faire, une approche constructiviste aménagée articule trois recherches-interventions sur différents terrains –un Conseil Général, un service technique de mairie et une banque privée – mêlant étude qualitative et quantitative. Les résultats mettent en évidence l'importance des espaces de discussion centrés sur le travail pour préserver bien-être et santé au travail, à condition qu'ils n'empêchent pas de travailler et ne soient pas polluer par un climat de violence psychologique. L'apport principal de cette recherche est la présentation d'un modèle du management durable du bien-être au travail, à travers les espaces de discussion. / This research deals with well-being management at work by means of discussion areas. Indeed, pathogenic perspective seems to be largely prevailing as well in literature as in professional practices – psychosocial risks, stress, burnout and suffering at work prevention – to address the issue of health at work. This considered, the challenge treated by this research is to propose a more appreciative picture of this issue by means of the concept of wellbeing at work. On the basis of the definition of health at work by the WHO (2007) which defines health as « A state of complete physical mental and social wellbeing», and not only as the absence of pathosis, this research aims at drawing the outline of a salutogenic perspective of work using three action researches .This communication aims to define that the setting up and the animation of discussion areas by the HRD and managers are a powerful lever to preserve resources (skills, working rules, capabilities, power to act, professional identity…) and consequently a factor of well-being – and quality – at work .Trust between actors, and the possibility to say and hear words on the activity and the effective organization of work as they really are, are the basis of the setting up of such discussion areas without which sustainable well-being is not possible .Within a constructivist framework we conducted three action researches on various public and private French organizations, using qualitative and quantitative studies. The results highlight how important work discussions areas are to preserve well-being and health at work, provided that users still work, and are not being polluted by psychological violence. The essential added value of this research is the presentation of a pattern on sustainable well-being management at work by means of discussion areas. Key words: Psycho social risks prevention; well-being at work; salutogenic management; sustainable management; action research; discussion areas.

Il presente lavoro di tesi è stato condotto in ambito psicocardiologico, e riguarda l’indagine delle determinanti psicosociali potenzialmente coinvolte nell’eziopatogenesi, digressione e prognosi delle malattie cardiache. Più studi preliminari sono stati condotti a fini esplorativi, e solo le varabili risultate caratteristiche del campione mantenute in indagini successive. Dopo aver indagato il ruolo del benessere psicologico nell’influenzare la Capacità Funzionale dei pazienti, uno degli indicatori di esito di maggiore importanza in Riabilitazione Cardiologica (RC) (studio 1), si è proceduto a verificare quali tra le variabili cognitive e psicologiche tradizionalmente associate alle malattie cardiache caratterizzasse lo specifico campione, condizionandone Qualità della Vita (QdV) e benessere psicologico (studio 2). Esclusa l’influenza delle variabili cognitive sullo stato emotivo dei soggetti, si è, poi, approfondito il ruolo delle variabili psicologiche nel determinarne la QdV percepita dei degenti (studio 3). Obiettivo del quarto studio è, infine, valutare efficacia ed efficienza dell’aggiunta di tecniche e principi propri del Colloquio Motivazionale (CM) al trattamento psicologico standard (Terapia Breve Strategica, TBS), al di la del solo trattamento breve strategico, nell’incrementare autoefficacia percepita, disponibilità al cambiamento ed aderenza al trattamento riabilitativo nel malati di cuore. Un esempio dell’uso di tale stile comunicativo viene, inoltre, proposto mediante caso clinico (studio 5). / The general aim of this thesis is to seek evidence on how to achieve long-term maintenance of lifestyle changes in a sample of obese inpatients with heart diseases referred to Cardiac Rehabilitation by investigating the influence of selected variables on their physical and psychological status, as well as by examining the efficacy and effectiveness of a motivational-based intervention. Study 1 is aimed at evaluating whether psychological well-being represents an independent predictor of Exercise Capacity. Study 2 focuses on investigating the influence of cognitive abilities and established psychosocial risk factors on the sample’s subjective Quality of life (QoL) and well-being. Since no effect of different levels of cognitive impairments on the expression of psychological distress among the study participants has been identified, in study 3 the effect of emotional impairments on QoL has been further explored. To conclude, the MOTIV-HEART study (study 4) is aimed at testing the incremental efficacy of a brief strategic treatment including motivational components (BST + MI) in improving physical and psychological outcomes over and beyond the stand-alone brief strategic treatment (BST) and whether results will be maintained/increased at 3-month follow-up. An example of this style of communication is also presented through a case study (study 5).

Acute myocardial infarction (AMI), caused by ischaemic heart disease (IHD), is a leading cause of death in both men and women in the western society. Hypertension, diabetes, and smoking are examples of well-known risk factors of IHD, but also there are psychosocial factors, such as stress, vital exhaustion (unusual fatigue, irritability, and demoralization) and depression that have been associated with an increased risk in both genders. After an AMI, however, women are more likely than men to be psychosocially impaired resulting in suffering and a presumed increase in the risk of recurrent cardiac events. Psychosocial factors may be targeted in secondary prevention, complementary to drug treatment and conventional lifestyle advice. There is some evidence of beneficial effects on both psychosocial well-being and cardiac outcomes by psychosocial interventions in men. Far fewer women have been studied and the results have been inconsistent. It is not clear how psychosocial factors convey the increased risk of cardiac events, but many possible psychopathological mechanisms, including biochemical and physiological links, have been suggested. In the Women’s Hearts study we have, in a randomised controlled trial, evaluated a one-year cognitive-behavioural stress management programme designed specifically for women with IHD. We included 198 women with IHD, with a mean age of 61 years and from the county of Västerbotten in Northern Sweden, who were randomised to either conventional treatment and follow-up, or to stress management in addition to conventional care. Extensive questionnaires, blood samplings, and biomedical and physiologic data were obtained before randomisation, as well as at follow-ups approximately one and two years after randomisation. Two groups of healthy controls were included for comparisons with women with IHD. Compared to women without IHD, women with IHD reported more stress behaviour and vital exhaustion. Women with IHD also had a lower heart rate variability (HRV) than the healthy controls, possibly reflecting a dysfunctional autonomic nervous regulation of the heart. Reduced HRV has been shown to increase the risk of cardiac arrhythmias and sudden death. At the first follow-up, performed at the end of the one-year stress management programme, women who had participated in the programme had reduced the stress behaviour and vital exhaustion, compared to the women in the conventional care group. We could not find any evidence of a direct cause-effect relationship between stress management and biological cardiovascular risk indicators, or HRV; the intervention and control groups did not differ in insulin resistance, inflammatory, haemostatic and fibrinolytic factors, or HRV. At second follow-up one year later, several additional psychosocial domains were studied. The stress management programme had accelerated psychosocial recovery at the first follow-up over and above that observed in the control group. At the second follow-up, there was further marked improvement in the control group, so the differences in psychosocial variables between the intervention and control groups were no longer significant. In conclusion, a cognitive-behavioural stress management programme could accelerate psychosocial improvement in women with IHD, and thus reduce the amount of psychological and psychosocial suffering. We could not find any evidence that the stress management programme was associated with a concomitant improvement in biological cardiovascular risk indicators, or HRV. Our results suggest that the women with the greatest psychosocial burden should be identified and targeted in new clinical trials of cognitive-behavioural interventions in women with IHD. Future studies within the Women’s Hearts project will evaluate the psychosocial effects at a five-year follow-up, as well as investigations of other possible pathways by which psychosocial interventions might mediate beneficial effects on cardiac events.