11,739 research outputs found

    Implementing screening and brief Interventions for excessive alcohol consumption in primary health care

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    O consumo de bebidas alcoólicas é um dos principais fatores de risco da morbilidade e mortalidade prematura a nível mundial. As pessoas que consomem este género de bebidas têm um risco aumentado de vir a desenvolver mais de 200 problemas de saúde diferentes. A maioria do impacto do consumo de álcool na saúde humana é determinado por duas dimensões: o volume total de álcool consumido e o padrão de consumo. Existem várias medidas com comprovada eficácia que podem ser empregues para reduzir o risco associado ao consumo de álcool, entre as quais se encontra a deteção precoce e intervenção breve ao nível dos Cuidados de Saúde Primários. A maioria dos profissionais de saúde neste nível de cuidados considera o consumo de álcool como um importante problema de saúde e manifesta o seu apoio a medidas que visem reduzir o seu impacto. No entanto, poucos são os profissionais dos Cuidados de Saúde Primários que de forma sistemática identificam e aconselham os seus doentes relativamente aos seus hábitos etílicos. Como tal, o objetivo geral desta tese foi investigar como implementar a deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. Foi realizada uma revisão sistemática das barreiras e facilitadores à implementação da deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. As barreiras e facilitadores identificados nesta revisão foram analisados à luz da teoria de modificação comportamental para compreender a ligação destes fatores aos determinantes da mudança de comportamento, e para identificar as estratégias conceptualmente mais eficazes para abordar as barreiras e facilitadores à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no sentido de aumentar as taxas de deteção precoce e intervenção breve no consumo excessivo de álcool. Esta metodologia foi utilizada para desenhar um programa de implementação com base em pressupostos teóricos que foi testado num estudo experimental randomizado e controlado em clusters. Esta tese identificou diversas barreiras à implementação, ligadas a todos os domínios teóricos da mudança comportamental. As barreiras mais frequentemente mencionadas pelos profissionais foram: preocupação sobre as suas competências e eficácia para realizar a deteção precoce e intervenção breve; falta de conhecimento específico sobre o consumo de álcool; falta de tempo; falta de materiais; falta de apoio; e atitudes para com o doente com consumos excessivos de álcool. Esta tese mostrou também a existência de dois grupos distintos de médicos de família com base nas suas atitudes para com estes doentes, um com atitudes mais positivas, o outro com atitudes mais negativas. Esta tese mostrou ainda que um programa de implementação da deteção precoce e intervenção breve, desenhado com base em pressupostos teóricos de modificação comportamental, adaptado às barreiras e facilitadores da implementação, aumenta de forma significativa as taxas de identificação precoce dos consumos de álcool. Esta tese contribui para aumentar o conhecimento atual no sentido em que põe à disposição dos investigadores evidência prática sobre como abordar os fatores com influência na implementação da identificação precoce e intervenção breve para o consumo de álcool ao nível dos Cuidados de Saúde Primários. Esta tese contribui também para um melhor entendimento dos mecanismos subjacentes à resistência e à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no que respeita à implementação da deteção precoce e intervenção breve do consumo de álcool. Os resultados desta tese poderão ser usados por investigadores e decisores políticos para desenhar novos programas de implementação tendo como objetivo modificar esta prática clínica ao nível dos Cuidados de Saúde Primários.Alcohol use is among the leading risk factors for the global burden of disease and premature death. People who drink alcoholic beverages are at risk of developing more than 200 diseases and injury conditions. Most of the impact of alcohol consumption on human health and well-being is determined by two dimensions of drinking: the total volume of alcohol consumed and the pattern of drinking. Several effective strategies exist to reduce the harmful use of alcohol, which includes screening and brief interventions for excessive alcohol use in primary health care. The majority of primary health care providers agree that the excessive consumption of alcohol is an important health issue and express their support to policies for reducing the impact of alcohol on the health of their patients. Notwithstanding, implementation of screening and brief interventions is low at the primary health care level. Therefore, the overall aim of this thesis is to investigate how to implement screening and brief interventions for excessive alcohol consumption in primary health care. This thesis reviewed the barriers of, and facilitators for, the implementation of alcohol screening and brief interventions in primary health care. Behaviour change theory was used to understand how these factors linked to the determinants of behaviour change and how they could be addressed in order to change primary health care providers’ behaviour, i.e. to increase the delivery of alcohol screening and brief interventions. A comprehensive theory-based implementation programme was designed and tested in a cluster randomized controlled trial. This thesis identified several barriers to implementation which were mapped to all the theoretical domains of behaviour change. Primary health care providers concerns about their ability to deliver alcohol screening and brief interventions and to help patients to cut down, lack of alcohol-related knowledge, lack of time, lack of materials and support, and providers’ attitudes towards at-risk drinkers were among the most commonly cited barriers. This thesis found evidence that the attitudes of family physicians could be used to divide practitioners into two distinct groups, one with more positive and the other with more negative attitudes towards at-risk drinkers. This thesis also found that a behaviour change theory-based programme, tailored to the barriers for, and facilitators of, the implementation of screening and brief intervention in primary health care is effective in increasing alcohol screening rates. This thesis contributed to the evidence base by providing researchers with practical evidence on how to address the factors influencing the implementation of screening and brief interventions in primary health care. This thesis also provides researchers with insight into the behavioural mechanisms mediating primary health care providers’ decision to deliver alcohol screening and brief interventions. The results of this thesis could be used by researchers and policymakers to inform the design of novel theory-oriented interventions to support the implementation of alcohol screening and brief interventions in primary health care

    Viral infections and complications in inflammatory bowel disease

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    UNCOVERING THE MENTAL WORLD OF CHILDREN: ATTACHMENT QUALITY, MENTALIZATION, AND CHILDREN’S DRAWINGS

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    Although we have long been aware of the widespread benefits of drawing for children (Goodenough, 1926), there is much to learn from a clinical perspective about children’s attachment patterns and mentalization capacities in analyzing their drawings. The present study utilized archival data to uncover trends associated with children’s drawing characteristics, attachment qualities, and mentalization capacities. This study further explored the extent to which mentalization mediates the relationship between attachment quality and Formal Elements (FE) scores as well as the relationship between attachment quality and Content scores of children’s drawings. Two samples of 5–12-year-old children and their caregivers were recruited: one child sample from a public elementary school in White Plains, NY (n = 54), and the other child sample recruited consecutively following admission to a child psychiatric inpatient unit in White Plains, NY (n = 45). Each of the 99 children, including both the inpatient and nonpatient samples, completed three drawings: a drawing of family, primary caregiver, and self, totaling 297 drawings. These drawings were coded using the Formal Elements and Content rating scales (Tuman, 1998, 1999a). Attachment quality and mentalization data for these samples were obtained from previous studies, using the Attachment Story-Completion Task (ASCT) and Children’s Apperception Test (CAT). Attachment quality was found to have a significant positive relationship with the Content scores of family drawings within the inpatient sample. Attachment quality was also found to have a significant positive relationship with mentalization in both the nonpatient and inpatient samples. Mentalization was found to have a significant positive relationship with the Content and FE scores of children’s drawings. This relationship held true for Content scores of caregiver drawings and FE scores of family drawings within the nonpatient sample, and for both the Content and FE scores of family drawings within the inpatient sample. In general, drawings appear to hold promise as tools to access both psychiatrically compromised and nonpatient children’s internal working models and mental states. Gender differences and clinical implications are discussed

    WHY DO REGIONAL SOCIAL POLICIES FAIL? Gendered Institutions and the Maputo Plan of Action

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    In 2005, the African Union (AU) developed a regional policy on sexual reproductive health (SRH) and rights aimed at improving member states’ SRH delivery, the Maputo Plan of Action (MPoA). It initially ran from 2006 to 2015 and was then extended to 2016 to 2030. However, the MPoA’s implementation has been slow and largely ineffective. This thesis explores the factors behind this ineffectiveness despite the apparent commitment to improving SRH delivery on the part of the AU member states as demonstrated by their collective development and adoption of the policy. The thesis addresses reproductive health policy from a social policy perspective and begins its investigation by exploring existing regionalism literature that provides insights into why regionally integrated social policies oftentimes fail. The thesis finds that existing literature highlights specific institutional structures and path dependencies as factors that undermine regionalism’s efforts in social policy. In this thesis, I argue that these explanations, while relevant, offer only part of the story, because they do not consider the gendered character of regional organisations and the impact of this on policy formulation and implementation processes. I address this gap by exploring the role of gendered institutions in the design and delivery of regional social policies using the MPoA as a case study. To develop this analysis, I use Feminist Institutionalism (FI) to study the gendered factors behind the ineffectiveness of the MPoA. Overall, I argue that the design, development and implementation processes of the MPoA are shaped by the gendered institutions of its host organisation, the AU, which undermine its priority setting, strategy development and resource allocation processes by undervaluing and trivialising the needs of women and girls, contributing to weak delivery. These gendered institutions are indicated by the exclusion of women in the AU structure, gendered sharing of roles and responsibilities and unequal opportunities to participate and influence AU processes. The thesis therefore concludes that the MPoA fails to deliver on SRH for women and girls due to the underlying gendered institutions of the AU that shaped the policy and drives in implementation in gendered ways. More broadly, the thesis concludes that regionally integrated social policies oftentimes fail because of the gendered character of regional organisations, which undermines policy formulation and implementation processes

    Vitalism and Its Legacy in Twentieth Century Life Sciences and Philosophy

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    This Open Access book combines philosophical and historical analysis of various forms of alternatives to mechanism and mechanistic explanation, focusing on the 19th century to the present. It addresses vitalism, organicism and responses to materialism and its relevance to current biological science. In doing so, it promotes dialogue and discussion about the historical and philosophical importance of vitalism and other non-mechanistic conceptions of life. It points towards the integration of genomic science into the broader history of biology. It details a broad engagement with a variety of nineteenth, twentieth and twenty-first century vitalisms and conceptions of life. In addition, it discusses important threads in the history of concepts in the United States and Europe, including charting new reception histories in eastern and south-eastern Europe. While vitalism, organicism and similar epistemologies are often the concern of specialists in the history and philosophy of biology and of historians of ideas, the range of the contributions as well as the geographical and temporal scope of the volume allows for it to appeal to the historian of science and the historian of biology generally

    Preliminary study of perceived cardiovascular disease risk and risk status of adults in small rural and urban locations in Ibadan, Nigeria

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    The burden of cardiovascular disease (CVD) has been on the rise in developing countries like Nigeria recently. Studies on perceived CVD risk and the risk status of adults in Ibadan are not readily available, hence this study. A mixed-method design involving a cross-sectional survey and an exploratory qualitative study was utilized. Convenience sampling was used to recruit 418 participants (209 from rural and 209 from urban) for the cross-sectional survey, while purposive sampling was used to recruit 14 participants for the qualitative aspect. The INTERHEART risk score and the Perception of Risk of Heart Disease Scale were used to investigate participants' CVD risk status and perceived risk, respectively. The data from the cross-sectional survey were summarized by using descriptive statistics, and the data were then analyzed by using the chi-square test of association and a multiple logistic regression model, while content thematic analysis was used to analyze the qualitative data. In the rural and urban areas, respectively, 39.7% and 52.2% had a positive perception of CVD risk. In the rural and urban areas, 44% and 41.6% of individuals respectively had moderate-to-high risk of CVD. Participants with at least secondary school education [2.66 (0.61–11.53)] and participants in the urban area [2.62 (0.78–7.08)] had twice higher odds of positive CVD risk perception. Males [3.91 (1.58–9.68)], adults aged 40 and above [1.59 (0.63–4.00)] and urban dwellers [1.21 (0.33–4.39)] had higher odds of a high CVD risk status. The qualitative aspect of the study corroborated the findings from the survey, as many participants did not perceive themselves as being at risk of CVD. The majority of the participants in this study were found to have a moderate-to-high risk of CVD, and many had a negative perception of their risk. Health education and CVD prevention programs are required to curb the burden of CVD

    Self-processing in coma, unresponsive wakefulness syndrome and minimally conscious state

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    IntroductionBehavioral and cerebral dissociation has been now clearly established in some patients with acquired disorders of consciousness (DoC). Altogether, these studies mainly focused on the preservation of high-level cognitive markers in prolonged DoC, but did not specifically investigate lower but key-cognitive functions to consciousness emergence, such as the ability to take a first-person perspective, notably at the acute stage of coma. We made the hypothesis that the preservation of self-recognition (i) is independent of the behavioral impairment of consciousness, and (ii) can reflect the ability to recover consciousness.MethodsHence, using bedside Electroencephalography (EEG) recordings, we acquired, in a large cohort of 129 severely brain damaged patients, the brain response to the passive listening of the subject’s own name (SON) and unfamiliar other first names (OFN). One hundred and twelve of them (mean age ± SD = 46 ± 18.3 years, sex ratio M/F: 71/41) could be analyzed for the detection of an individual and significant discriminative P3 event-related brain response to the SON as compared to OFN (‘SON effect’, primary endpoint assessed by temporal clustering permutation tests).ResultsPatients were either coma (n = 38), unresponsive wakefulness syndrome (UWS, n = 30) or minimally conscious state (MCS, n = 44), according to the revised version of the Coma Recovery Scale (CRS-R). Overall, 33 DoC patients (29%) evoked a ‘SON effect’. This electrophysiological index was similar between coma (29%), MCS (23%) and UWS (34%) patients (p = 0.61). MCS patients at the time of enrolment were more likely to emerged from MCS (EMCS) at 6 months than coma and UWS patients (p = 0.013 for comparison between groups). Among the 72 survivors’ patients with event-related responses recorded within 3 months after brain injury, 75% of the 16 patients with a SON effect were EMCS at 6 months, while 59% of the 56 patients without a SON effect evolved to this favorable behavioral outcome.DiscussionAbout 30% of severely brain-damaged patients suffering from DoC are capable to process salient self-referential auditory stimuli, even in case of absence of behavioral detection of self-conscious processing. We suggest that self-recognition covert brain ability could be an index of consciousness recovery, and thus could help to predict good outcome

    The dual-path hypothesis for the emergence of anosognosia in Alzheimer's disease

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    Although neurocognitive models have been proposed to explain anosognosia in Alzheimer's disease (AD), the neural cascade responsible for its origin in the human brain remains unknown. Here, we build on a mechanistic dual-path hypothesis that brings error-monitoring and emotional processing systems as key elements for self-awareness, with distinct impacts on the emergence of anosognosia in AD. Proceeding from the notion of anosognosia as a dimensional syndrome, ranging from the lack of concern about one's own deficits (i.e., anosodiaphoria) to the complete lack of awareness of deficits, our hypothesis states that (i) unawareness of deficits would result from a failure in the error-monitoring system, whereas (ii) anosodiaphoria would more likely result from an imbalance between emotional processing and error-monitoring systems. In the first case, a synaptic failure in the error-monitoring system, in which the cingulate cortex plays a major role, would have a negative impact on error (or deficits) awareness, preventing patients from becoming aware of their condition. In the second case, an impairment in the emotional processing system, in which the amygdala and orbitofrontal cortex play a major role, would prevent patients from monitoring the internal milieu for relevant errors (or deficits) and assigning appropriate value to them, thus biasing their impact on the error-monitoring system. Our hypothesis stems from two scientific premises. One comes from preliminary results in AD patients showing a synaptic failure in the error-monitoring system and decline of awareness at the time of diagnosis. Another comes from the somatic marker hypothesis, which proposes that emotional signals are critical to adaptive behavior. Further exploration will be of great interest to illuminate the foundations of self-awareness and improve our understanding of the underlying mechanisms of anosognosia in AD
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