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Background Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one’s potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their effectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity. Methods We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n = 245) or treatment as usual (n = 320). Results Exploratory and confirmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure’s concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities. Conclusions Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.

The present article first presents a critique about the current status of the community mental health (CMH) field. Second, based on theoretical and empirical literature, it presents a perspective inspired by the inception of community psychology, namely the empowerment and community integration principles to offer a challenging framework to inspire reforms in the CMH field. The article also discusses two promising CMH practices, supported employment and independent housing with support, determinant for the transformation of life conditions for people experiencing mental illness while promoting people’s empowerment and integration in the community. The authors argue that CMH programs and practices focused on integration together with self-representation movements, organisations, or networks aligned with the community psychology acting principles have the potential to inform a renovated partnership within CMH stakeholders and bring about sustainable change focused on the active citizenship for people who experience mental illness. info:eu-repo/semantics/publishedVersion

info:eu-repo/semantics/publishedVersion

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed. info:eu-repo/semantics/publishedVersion

Contains fulltext : 200223.pdf (Publisher’s version ) (Open Access) Background: Most European countries report rising numbers of people experiencing homelessness. For those with mental disorders, interventions are centered on achieving mental health and drug rehabilitation alongside housing readiness, often to the detriment of access to housing. Notwithstanding, more European countries are investing in a new model, Housing First (HF), which postulates immediate access to permanent housing with no initial requirements for treatment. While results of the European HF programs are published on individual-level data, little is known about the opinions of the general population about homelessness and the societal value of the HF model, which can represent barriers to the model's dissemination. Therefore, we present the protocol of a study designed for the following objectives: 1) to explore the knowledge, attitudes, and practices (KAP) about homelessness within the general population of 8 European countries, 2) to assess the valuation of the HF model by European citizens, and 3) to estimate the lifetime prevalence of homelessness in the targeted countries. Methods: A telephone survey was conducted from March to December 2017 among adults selected from opt-in panels from France, Ireland, Italy, the Netherlands, Portugal, Spain, Poland, and Sweden. A total sample of 5600 interviews was expected, with 700 per country. The interviews included three sections: first, the KAP about homelessness; second, the valuation of the HF model by measuring a respondent's willingness-to-pay (WTP) through the contingent valuation method; and third, an assessment of the lifetime prevalence of homelessness among the general population. Descriptive analyses and comparisons between countries will be conducted. KAP indicators will be created and their psychometric properties assessed. Determinants of WTP will be assessed through regression models. Discussion: This survey will highlight Europeans' views of homelessness, especially their level of tolerance towards homelessness, potential misconceptions and the most important barriers for the implementation of the HF model. Additionally, the results on the valuation of the HF model by citizens could be instrumental for key stakeholders in understanding the level of support from the general population. Ethics approval has been obtained from the Aix-Marseille University Ethics Committee (n degrees 2016-01-02-01) for this study, which is part of HOME_EU: Reversing Homelessness in Europe H2O20-SC6-REVINEQUAL-2016/GA726997.

Cardiovascular magnetic resonance imaging (CMR) has become an indispensable clinical tool for the assessment of morphology, function and structure of the heart muscle. By exploiting quantification of the effective transverse relaxation time (T2*) CMR also affords myocardial tissue characterization and probing of cardiac physiology, both being in the focus of ongoing research. These developments are fueled by the move to ultrahigh magnetic field strengths, which permits enhanced sensitivity and spatial resolution that help to overcome limitations of current clinical MR systems with the goal to contribute to a better understanding of myocardial (patho)physiology in vivo. In this context, the aim of this report is to introduce myocardial T2* mapping at ultrahigh magnetic fields as a promising technique to non-invasively assess myocardial (patho)physiology. For this purpose the basic principles of T2* assessment, the biophysical mechanisms determining T2* and (pre)clinical applications of myocardial T2* mapping are presented. Technological challenges and solutions for T2* sensitized CMR at ultrahigh magnetic field strengths are discussed followed by a review of acquisition techniques and post-processing approaches. Preliminary results derived from myocardial T2* mapping in healthy subjects and cardiac patients at 7.0 T are presented. A concluding section discusses remaining questions and challenges and provides an outlook on future developments and potential clinical applications.

Objective: Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not).Method: Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data.Results: Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment.Conclusions: Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

Made available in DSpace on 2017-07-10T19:07:24Z (GMT). No. of bitstreams: 1 Dissertacao Teresa Cristina Duarte2.pdf: 1829449 bytes, checksum: 419957adc9e2fc6e56bc77a39c2d786b (MD5) Previous issue date: 2014-02-20 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior The biomedical model institutionally assumed in Healthcare today has been unable to achieve comprehensiveness regarding individual care. The conflict this sector is facing has required a deeper understanding of the human being, whos meaning is found in the context. Among the many challenges facing health professionals embedded in a context of borders, there is the understanding of aspects involving cultural differences and social representations, which motivated the proposition of this very research. In order to investigate how health professionals in the plurilcultural border scenario build their discursive practices, representations of health and desease, three research questions were developed: a) How the (re) meaning of the concept of health and disease and the role of interdisciplinarity in the current context representations of health and desease, three research questions were developed has been made? b) How the representations of cultural differences influence their professional practice? c) What representations are formed by health professionals on health and disease? To answer these questions a qualitative / interpretive methodological approach was followed. The generation of data for the analysis was conducted through audio-recorded semi-structured interviews with 10 participants. A field diary was also used. As categories emerged from the formulated representations regarding cultural differences and their influences in professional practices we have: cultural plural due to differences present in all relationships, the presence of practices flexibility adopted by health professionals facing the individual‟s cultural needs and the paradox between recognizing the importance of culture and the lack of it‟s effective application, indicated primarily by the biomedical model of health. The representations of health and desease by health professionals allowed to observe the acceptance of this concept as a dynamic process that is individually established with an overview divided into three categories: the relation with well-being; the dynamic process; the individual perceptions. Through the analysis it was evident that contact with people from other cultures leads to changes which, in most cases, were positive in the sense that the professional has become more open, flexible and attentive to the other, a factor that contributes to health and disease representation to be conditioned by external factors and determined by the individual. O modelo biomédico institucionalmente assumido na Saúde, hoje, tem se apresentado incapaz de alcançar a integralidade no atendimento ao sujeito. O conflito pelo qual esse setor tem passado revela que o trabalho nesta área tem exigido conhecimentos mais profundos do ser humano, que encontra sentido no contexto. Entre os muitos desafios colocados aos profissionais da área da Saúde, inseridos em um contexto de fronteiras, há o de compreender aspectos que envolvem as diferenças culturais e suas representações sociais, o que motivou a proposição da presente pesquisa. Com o objetivo de investigar como os profissionais da Saúde no cenário pluricultural de fronteira constroem, em suas práticas discursivas, representações sobre saúde-doença, foram elaboradas três perguntas de pesquisa: a) Como foi sendo (re)significado o conceito de saúde e doença e qual o papel da interdisciplinaridade no contexto atual?; b) Como as representações sobre diferenças culturais influenciam em suas práticas profissionais? e c) Quais representações são construídas pelos profissionais da Saúde sobre a saúde e a doença? Para responder às perguntas, foi seguida a abordagem metodológica qualitativa/interpretativista. A geração de dados para a análise foi realizada por meio de entrevistas semiestruturadas realizadas com dez participantes, gravadas em áudio. Também foi utilizado diário de campo. Surgiram como categorias das representações formuladas sobre as diferenças culturais e a influência delas nas práticas profissionais: as culturas plurais que apareceram devido às diferenças presentes em todas as relações, a presença da flexibilidade das práticas adotadas pelos profissionais da Saúde diante da necessidade cultural do indivíduo e o paradoxo entre reconhecer a importância da cultura e a falta de aplicação prática, apontados principalmente pelo modelo biomédico vigente de Saúde. As representações de saúde e de doença pelos profissionais da Saúde permitiram observar a aceitação deste conceito como sendo um processo dinâmico que se estabelece individualmente, ideia geral dividida em três categorias: a relação com o bem-estar; o processo dinâmico; as percepções individuais. Ficou evidente, pelas análises, que o contato com pessoas de outras culturas provoca mudanças, que, em sua maioria, mostraram-se positivas no sentido de que o profissional apresenta-se mais aberto, flexível e atento ao outro, fator que contribui para representar que saúde e doença são condicionadas por fatores externos e determinadas pelo indivíduo.