Paper one is a systematic review aimed at improving our understanding of the culturally determined risk factors of postnatal depression (PND) within 'Sub-Saharan Africa', by integrating evidence from quantitative and qualitative studies. A mixed-method systematic review approach was employed, nine quantitative and three qualitative studies were quality assessed, synthesised, and integrated. Stressful life events, adhering to cultural values and traditions, the effects of negative cultural perceptions and difficulties within the African extended family system were found to be risk factors for the development and maintenance of PND in Sub-Saharan Africa. The objective of paper two was to explore the lived experience of postnatal depression in West African mothers living in the UK. A qualitative design using semi-structured interviews with six West African mothers (Nigeria = 3; Ghana = 3) who were experiencing low mood in the postnatal period was undertaken. Participants were recruited from mother and baby groups within the National Health Service. Interpretative Phenomenological Analysis was used to explore and analyse the data. Five overarching themes emerged: (1) conceptualiszing PND, (2) isolation, (3) loss of identity, (4) issues of trust and (5) relationships as a protective factor. Each theme consisted of a number of subthemes. Women exhibited symptoms of PND but did not regard it as an illness, with the name 'depression'. They viewed their emotional distress as a result of social stress, and described feelings of isolation, loss of identity and relationship difficulties. Women's cultural background influenced their help-seeking behaviour; participants often avoided talking about their feelings and kept their distress to themselves. The findings have clinical implications in how services should be designed to meet the needs of African communities. Paper three reflects on the process of developing culturally competent research through the development of the current thesis. Suggestions for future research and reflections on the strengths and limitations of the research process are embedded throughout. Clinical implications are discussed with reference to a community psychology model.

This thesis explores the alcohol consumption practices and experiences of 40 young people, aged 15-24, living in the suburban case study locations of Wythenshawe and Chorlton, Manchester, UK. By paying attention to how young people's drinking practices and experiences are bound up with relationships with friends, family, and diverse spaces, this research enhances understandings of the relational nature of young people's alcohol-related transitions to adulthood. Theoretically, I work at the intersection of multiple more-than-representational conceptual apparatus: 'doing' friendship; mobilities; and atmospheres. I conducted this research with young people, using a flexible suite of methods, which they could 'opt into', including: interviews; peer interviews; drawing elicitation interviews; diaries; mobile phone methods; and participant observation. Young people detail how alcohol assists with the formation of friendships, tensions between friends and strangers, and the development of 'more-than-friendships'. I thus contribute to the children's geographies literature by affording the role of friendship to many young people's everynight lives greater prominence. Second, by engaging with young people's emotional and embodied walking and vehicular mobilities, I show that young people consume alcohol on the move because it is both economically beneficial, and emotionally important. In doing so, I move beyond the typical academic and policy treatment of drinking spaces as bounded terrains. Third, I engage with young people's atmospheric experiences of darkness and lightness. I argue that atmospheres have the ability to shape drinking practices and experiences; young people are not passive to these atmospheres, they actively co-construct them. Whilst traditional harm-reduction messages focus on the individual drinker, I urge policymakers to turn their attention to intra and intergenerational relationships. For instance, by encouraging the practice of being a 'good friend' on nights in/out involving alcohol; and by providing families with advice on how to construct positive affective drinking atmospheres.

Current UK public health policy and research identifies potential health risks of physical inactivity and high levels of sitting. This is a particularly pertinent issue for office workers, who spend, on average, over two-thirds of the work day sitting. This thesis reports on the design and evaluation of a multicomponent sit-stand desk intervention, delivered within two not-for-profit office-based organisations in London, England. A mixed method study design was employed. A pilot randomised controlled trial examined the efficacy of the intervention on reducing sitting and increasing standing and physical activity, using wearable monitors to measure outcome variables at baseline, and at four additional timepoints up to 12-months following the onset of the intervention. A process evaluation, including in-depth qualitative interviews and participant observation, investigated the processes that influenced the feasibility, acceptability and efficacy of the intervention. Mixed-model ANOVA indicated that the intervention reduced workplace sitting, on average, by 38 minutes, however there was no significant influence on workplace physical activity, or any of the outcome variables across the whole day. The process evaluation revealed that discourses surrounding employee health and organisational effectiveness, and employees' health-focused occupational identities increased the acceptability of sit-stand desk provision, whereas monetary concerns, a centralised organisational structure and incompatibility of the sit-stand desks with the workplace environment negatively influenced implementation feasibility. The sit-stand desk design, expectations and outcomes related to health and productivity, and the organisational culture and interpersonal relationships positively and negatively influenced sit-stand desk experience to differing degrees between participants. Mixed method analyses of outcome and process data illustrated the potential for integrating findings to enhance understanding of 'what works' within behavioural intervention research. Sit-stand desks are not a one-size-fits-all solution to reducing sitting and increasing physical activity, however, they should be available to office-based employees as part of a wider workplace health strategy.

Universidade de Fortaleza / Este estudo teve como objetivo analisar o modo ÃticopolÃtico do cuidado com base nas experiÃncias de trabalhadores em um dispositivo comunitÃrio de saÃde mental localizado na regiÃo Nordeste do Brasil. Para tanto, construiu-se um modelo analÃtico, aqui concebido como uma lente compreensiva do modo ÃticopolÃtico do cuidado, inspirada nos pilares do pensamento complexo, cuja constituiÃÃo aponta para trÃs dimensÃes centrais: acolhimento, entrelaÃado à Ãtica, a relaÃÃes desinteressadas, dialÃgicas e solidÃrias, de circularidade e de experiÃncias voluntÃrias; autonomia, eixo mais polÃtico indissociÃvel de dependÃncia, assunÃÃo, contratualidade, emancipaÃÃo e participaÃÃo; e produÃÃo de vida, assentada na concepÃÃo hermenÃutica crÃtica de saÃde, envolvendo liberdade, projetualidades e cidadania. Em termos metodolÃgicos, trata-se de um estudo qualitativo, alinhado à vertente fenomenolÃgico-hermenÃutica, adotando o procedimento de triangulaÃÃo das tÃcnicas, conjugando entrevistas em profundidade, observaÃÃes e consultas a fontes secundÃrias. Os informantes foram os onze trabalhadores que atuavam nas prÃticas de cuidado desenvolvidas no dispositivo no momento do estudo. A categorizaÃÃo e interpretaÃÃo do material empÃrico evidenciaram quatro eixos temÃticos assim sistematizados: I) OÃsis no Deserto; II) CondiÃÃes de Acolhimento; III) Tramas da Autonomia; e IV) Despertar do Ser. Dentre os achados, destacam-se o histÃrico da estruturaÃÃo do dispositivo, as experiÃncias de trabalhadores em seu percurso terapÃutico no prÃprio dispositivo, o autoconhecimento como elemento central no cuidado de si e do outro e o acolhimento como relaÃÃes de escuta preponderantemente dialÃgicas, ainda que se observe um modo mais interessado na tÃcnica. Outro achado revela significados do voluntariado e o compromisso Ãtico de dar e receber. SÃo tambÃm desvelados diferentes sentidos e significados concernentes à autonomia, implicando distintas formas de lidar com a rede de dependÃncias, ora de forma dÃcil, ora mais crÃtica ante tutelas e o poder mÃdico. No que concerne à pertenÃa e à participaÃÃo, emergiram possibilidades de trabalho mais coletivas, necessidade de um maior engajamento do dispositivo nas lutas comunitÃrias, bem como uma participaÃÃo mais restrita e de diminuta perspectiva decisÃria. Por fim, cabe assinalar a manifestaÃÃo de uma noÃÃo mais ampliada de saÃde, rompendo com amarras diagnÃsticas, bem como possibilidades de despertar do ser e de circulaÃÃo no mundo. Foi possÃvel constatar mediante o estudo realizado junto Ãs experiÃncias dos trabalhadores o emaranhamento de vÃrios fios que ora se aproximam, ora se distanciam do que aqui foi concebido como modo ÃticopolÃtico do cuidado. / This study aims at analyzing the ethical/political way of providing care based on workersâ experiences at a mental health community facility situated in the Brazilian northeast. Therefore, an analytical model was built, conceived here as a comprehensive lens over the ethical/political mode of care, inspired by pillars of complex thought, whose constitutions point at three central dimensions: user embracement, interlaced with ethics, and with disinterested relations which can be dialogical and supportive, of circularity and of voluntary experiences; autonomy, most political and indissoluble axis of dependence, assumption, contractuality, emancipation and participation; and life production, centered on the critical hermeneutical conception of health, which involves freedom, projectualities and citizenship. In methodological terms, it is a qualitative study, aligned with the hermeneuticalphenomenological branch. The study employs the technique-triangulation procedure, and combines in-depth interviews, observations and consultations to secondary sources. The providers of information were the eleven workers who were operating in care-taking practices being developed at the moment the study was being produced. The categorization and interpretation of empirical material evidenced four theme axes thus systematized: I) Oasis in the Desert; II) User Embracement Conditions; III) Autonomy Frameworks; and IV) Awakening of a Being. Some of the best discoveries are the records of service structuring, the workersâ experiences in their therapeutic path along the routines of service, self-awareness as a central element when caring for oneself and for others and reception as a relation of predominantly dialogical listening, although a more technique-oriented mode is observed. Another discovery has revealed new meanings in voluntary participation and an ethical commitment towards giving and receiving. Another discovery concerns different meanings and purposes related to autonomy, which implies distinct ways of dealing with a network of dependencies, sometimes in a more docile way, sometimes in a more critical way in the face of tutelage and the medical power. Concerning a sense of belonging and participation, new possibilities of more collective work emerged along with a necessity of greater engagement to their respective units during community struggles, as well as a more restrict participation and small decision-making perspective. At last, it is worth it to point out at a more comprehensive notion of health, which breaks away from diagnostic ties, as well as at possibilities of a beingâs awakening and circulation in the world. It was possible to detect, by means of this study realized with workersâ experiences, the interlacing of several lines which sometimes agree and sometimes disagree with the ethical/political mode of care.

This thesis explores how rally drivers in Scotland perceive environmental issues and the environments through which they drive. The overarching aim behind this is to think about a group of people who may be more hostile towards questions of environmental responsibility, and look at how such stakeholders reason round their behaviours and perceive environmental issues. I argue that due to the potentially farreaching impacts of contemporary environmental challenges, it is crucial to take seriously the viewpoints and values of those who are perhaps not so willing to engage with environmental issues. The work draws on several bodies of literature. First is work in environmental philosophy on the practical contribution of this sub-discipline, in particular environmental pragmatism. Second is thinking in sociology and human geography on responsibility, especially the interface between responsibility and care. Third is recent material in geography on the body and movement, in particular the burgeoning field of automobility. These issues are addressed through a three-fold research design. Ethnographic and participatory techniques are used to foster an understanding of what exactly ‘the environment’ might mean to rally drivers (and indeed other users of the forest with whom rallying may come into conflict) and how it is experienced. In-depth interviews and subsequent narrative analysis seek to delve further into participants’ narratives and life histories in order to get a handle on how rally driving sits in relation to broader life contexts. Finally, two small-scale participatory projects with rally organisers relating to environmentally-responsible practice look at how this all comes together when participants make practical responses to environmental challenges. The key conclusions arising from the empirical data are that environmental problems are experienced through a range of senses, with different groups using different sensory ‘evidence’ to make claims about environmental damage; that in some cases stakeholders’ views of environmental issues are based on perceived conflict with others as opposed to actual conflict; and that the values activities such as motor sport may represent are just as significant as their physical environmental impacts. In terms of the broader applicability of this research, I suggest two things. Firstly, that one of the key challenges in responding to contemporary environmental issues lies in thinking through how publics link up their everyday practices with much bigger discourses on global environmental change. Secondly, that careful and critical reflection on the rich narratives of place and people, and on the range of emotions shaped by embodied experience, can go some way to explaining why people may persist with more environmentally damaging practices in spite of ethical and environmental criticisms.

This thesis explores the experiences of young people who are survivors of childhood cancer, their parents, health care professionals (HCPs), and case note documentation, of the process of transition from paediatric to adult cancer services. A qualitative, collective case study approach (Stake, 1995), informed by a constructivist-interpretive position, allowed exploration of the multiple realities prioritised in this study. Whilst there is a significant body of literature relating to transition for conditions such as rheumatology and cystic fibrosis, there is little research undertaken into transition in a cancer context, specifically so from an experiences perspective. This study aimed to re-address this issue. The experiences of twelve young people were explored in this study. This resulted in the participation of twelve cases, meaning a total of 35 individual, semi-structured interviews were conducted with young people, parents and HCPs. Young people’s case notes (22 sets) were also reviewed. Data were analysed using matrix-based approaches advocated by Miles and Huberman (1994), at both the within- and between-case level. This generated a multi-dimensional and multiple perspective understanding of the experience of the process of transition. The results of this study clearly identified a central orienting theme: The experience of readiness in the context of transition. Three main themes and six sub-themes were also identified within the data, supporting the explanatory power of the orienting theme. The main themes identified were: The experience of childhood cancer; Planning and preparation: Transition or transfer?; and A process of change. The findings demonstrate that understanding the multi-faceted components of readiness is crucial in understanding people’s experiences of readiness. Readiness should embody people’s illness experiences, the numerous and associated losses intertwined with a move from paediatric to adult care and the simultaneous developmental changes occurring in people’s lives. Only by doing so shall a meaningful understanding of the experience of the process of transition for survivors of childhood cancer, their parents and health care professionals be developed. The thesis concludes by making recommendations for future research and clinical practice.

O manejo de águas pluviais deve contemplar não somente os aspectos quantitativos mas também os aspectos qualitativos. Neste enfoque, o presente trabalho objetivou pesquisar a hipótese da viabilidade da integração, com sinergia no aspecto construtivo e econômico, dos controles da quantidade e da qualidade de água na macrodrenagem urbana, com experimentação em um estudo de caso. O trabalho consistiu em cinco etapas metodológicas: (i) obtenção de dados da área de estudo; (ii) atualização da relação densidade habitacional (DH) x área impermeável (AI), por sua importância como dado de entrada no modelo utilizado para otimização; (iii) estabelecimento do volume de controle qualitativo em função da área impermeável; (iv) definição das restrições das vazões de saída para a bacia de estudo em função das áreas impermeáveis contribuintes e da existência de reservatórios; (v) otimização das soluções. O estudo foi aplicado à bacia do Moinho em Porto Alegre-RS, sub-bacia do arroio Dilúvio, com intensa urbanização. A atualização da relação DH xAI baseou-se em doze bairros com características distintas de ocupação demonstrando uma alteração significativa da taxa de impermeabilização. Após o estabelecimento do volume de controle qualitativo específico, pela regra dos 90%, no intuito de reter e tratar os eventos frequentes de chuva, deu-se início a otimização das soluções utilizando o sistema SSDDrU proposto por Cruz (2004). As simulações contemplaram a manutenção do controle quantitativo para o controle qualitativo e o compartilhamento de volumes pelo somatório dos volumes quantitativo e qualitativo. Os custos obtidos para os cenários otimizados foram atualizados e a situação de apenas restringir a saída pela manutenção do volume quantitativo foi inviabilizada, gerando maiores volumes a jusante e custos exorbitantes para esta configuração. Verificou-se que a situação de compartilhamento de volumes resultou na diminuição de custos em relação à consideração da ampliação total e à condição de manutenção do controle quantitativo. Tal resultado demonstra a aplicabilidade da metodologia proposta ao planejamento urbano com ganhos ambientais inexistentes na solução tradicional. Vale ressaltar que pela configuração proposta os custos foram reduzidos em 11,5% com 75,0% de aproveitamento dos reservatórios em relação à configuração inicial caracterizada apenas pelo controle quantitativo. / Stormwater management must consider both quantitative and qualitative aspects. In this context, this study aimed to investigate the feasibility of integrating controls of quantity and quality of water in urban drainage, with synergy between constructive and economic aspects, using experiments on a case study. The work consisted of five methodological steps: (i) data collection from the study area; (ii) update of the relationship between housing density (DH) and impervious area (IA), given their importance as input in the model used for optimization; (iii) establishment of the water quality control according to the impervious area; (iv) definition of constraints of the output flows for the study basin as a function of the impervious areas and the presence of reservoirs; (v) optimization of solutions. The study was applied to the Moinho stream basin in Porto Alegre, Rio Grande do Sul State, sub-basin of the Dilúvio stream, under intense urbanization. The update of the DH/IA ratio was based on twelve neighborhoods with distinctive occupancy characteristics, indicating a significant increase in the impervious area rate. After establishing the specific water quality control volume, by the 90% rule, in order to retain and treat the frequent rainfall events, we started optimizing solutions using the SSDDrU system proposed by Cruz (2004). Simulations included maintaining the quantitative control for the qualitative control and the sharing of volumes by summing quantitative and qualitative volumes. Costs obtained for the optimized backgrounds were updated and the situation of only restricting the output by maintaining the quantitative volume was not feasible, generating larger volumes downstream and huge costs for this setup. The situation of volume sharing resulted in cost reduction in relation to consideration of the total enlargement of stormwater sewers and the condition of maintaining the quantitative control. Such result illustrates the applicability of the proposed methodology to urban planning with environmental gains not found in the traditional solution. It is noteworthy that with the proposed setup, costs were reduced by 11,5% with 75,0% of utilization of reservoirs in relation to the initial setup characterized only by the quantitative control.

Bullying victimization within the context of friendships is a complex phenomenon that is commonly experienced among youth, yet is insufficiently understood. Current psychosocial research examining bullying is often devoid of descriptions of the relationship that exists between those who bullied or are bullied (i.e., are they friends, enemies, former friends?), and there continues to be limited consideration of the underlying social dynamics and negotiations that occur within friendships containing bullying. Furthermore, there is a clear need for bullying research to consider how wider macro-level forces (e.g., social processes, power relations, and cultural discourses) can influence the bullying within friendship experience. Guided by a social-ecological framework, this dissertation reports on the findings from two empirical studies that investigated adolescents' experiences of bullying victimization within friendship. These studies involved interviewing previously victimized adolescents and young women; the analytical approaches were guided by thematic analysis and constructivist grounded theory. The results indicate that friendship victimization is a hurtful relational experience that involves painful emotions and carries significant interpersonal risks for adolescents. Furthermore, participants’ responses to their friend’s bullying behaviours were constrained by a number of barriers, such as depictions of bullying that individualize the problem, discourses of resistance that privilege overt responses, and gender expectations. Finally, the dissertation considers how teacher-student relationships influence peer bullying experiences and reemphasizes how teachers can be influential allies for bullying prevention and intervention.

Segundo a Organização Mundial de Saúde a esquizofrenia é um transtorno incapacitante de curso crônico caracterizado pela presença de alucinações e delírios. Alguns trabalhos apontam que o uso de maconha em pessoas com diagnóstico de esquizofrenia pode agravar os sintomas positivos da doença enquanto age positivamente sobre os sintomas negativos. Estudos qualitativos têm surgido na área com o objetivo de compreender os significados que pessoas com diagnóstico de esquizofrenia atribuem ao uso da substância. Esses estudos trazem que essas pessoas possuem uma visão positiva a respeito do uso, que este proporcionaria a elas um estado de relaxamento e alívio de suas tensões, além de relatarem aumento de criatividade e o uso da maconha como forma de atingir um estado espiritual mais elevado, assumindo um caráter de automedicação. Nesse sentido o presente trabalho teve como objetivo conhecer os significados que pessoas com esquizofrenia atribuem ao uso de maconha. Para isso, foi realizado estudo qualitativo, com referencial metodológico clínico-qualitativo. Os participantes foram selecionados em um serviço público de saúde mental especializado em álcool e drogas do interior de São Paulo. Como instrumento de coleta de dados, utilizou-se um roteiro de entrevista semiestruturada. Os critérios de inclusão no estudo foram: estar em atendimento, ou ser oriundo do serviço selecionado; ter diagnóstico de esquizofrenia segundo a CID-10; fazer uso de maconha ou ter feito uso no ano anterior a entrevista; ter mais que 18 anos e não fazer uso de outra droga ilícita, como cocaína ou crack. Foram realizadas um total de 10 entrevistas. Os participantes da pesquisa eram todos do sexo masculino e tinham em média 28 anos de idade. Foram levantadas quatro categorias a partir da análise das entrevistas: a) Percepções a respeito do adoecimento, onde os participantes relatam o preconceito e estigma que envolve o diagnóstico e como alguns sintomas da esquizofrenia os incapacitam para atividades cotidianas; b) Uso de maconha, este iniciado, em sua maioria, na adolescência e sempre na companhia de amigos; c) Esquizofrenia e maconha, onde discursos relacionados sobre aumento de criatividade, capacidade de organizar o pensamento, vivências de espiritualidade e melhora na qualidade do sono se fizeram presentes e d) Tratamento, onde a busca pelo tratamento partia sempre de algum familiar. É importante conhecermos a visão dessas pessoas a respeito do uso de maconha para compreendermos o que sustenta a manutenção deste, além de fornecer novos elementos na construção de um olhar crítico sobre este fenômeno. / According to the World Health Organization schizophrenia is a disabling disorder of chronic course characterized by the presence of hallucinations and delusions. Some studies suggest that the use of marijuana in people diagnosed with schizophrenia may exacerbate the positive symptoms of the disease while it acts positively on the negative symptoms. Qualitative studies have emerged in the area with the goal of understanding the meanings that people diagnosed with schizophrenia attribute to the use of the substance. These studies bring those people have a positive vision regarding the usage, that this would provide them a state of relaxation and relief of the tension, as well as reporting an increase of creativity and the use of marijuana as a way to achieve a spiritual state higher, assuming a character of \"medication\". In this sense, the objective of this study was to understand the meanings that people with schizophrenia attributed to marijuana use. For this reason, a qualitative study was carried out, with a methodological clinical-qualitative. The participants were selected in a public service of mental health who specializes in alcohol and drug use in the interior of São Paulo. As an instrument of data collection, we used a script of semi-structured interview. Inclusion criteria were: being in service, or be from the selected service; have a diagnosis of schizophrenia according to ICD-10; make use of marijuana or having used the year before the interview; have more than 18 years and not make use of other illicit drugs such as cocaine or crack. a total of 10 interviews were conducted. The participants were all male and had an average age of 28. Four categories were raised from the analysis of the interviews: a) Perceptions about the illness, where participants reported prejudice and stigma surrounding the diagnosis and some symptoms of schizophrenia to incapacitate the daily activities; b) Marijuana use, this started, mostly in their teens and always in the company of friends; c) Schizophrenia and cannabis, where speeches related to increased creativity, ability to organize thought, spirituality experiences and improves the quality of sleep were present and d) Treatment, where the search for treatment always started from a family member. It is important to know the vision of these people about marijuana use to understand what supports the maintenance of this, in addition to providing new elements in building a critical look at this phenomenon.

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