Made available in DSpace on 2015-04-11T14:06:35Z (GMT). No. of bitstreams: 1 Zilmar Augusto.pdf: 4619100 bytes, checksum: 3ed6d1b4860a0d8c1efd582bfa9f0b3e (MD5) Previous issue date: 2012-12-11 / The Cerebral Vascular Accident (CVA) is one of the death causes in Brazil. Individuals who survive CVA may remain with some degree of injury become dependent on their family to perform some sort of activity of daily living. This study aimed to investigate at home the experience of families living with a stroke sequel person. It is an exploratory and descriptive study with a qualitative approach, conducted by Calgary Family Assessment Model (CAFM). The instruments used were semi-structured interview, the genogram, the ecomap and direct observation. The research subjects were five families who lived with one of their stroke sequel relative, residents in the area covered by a Basic Health Unit in Manaus city. Data collection was conducted from January to February 2012, after approval by the Ethics Committee of the Universidade Federal do Amazonas. The families were evaluated in three thematic categories of CAFM: structural, assessment development and functional evaluation. In structural evaluation, we found that among the sequel people (59 to 85 years), two had total dependence on family and three had partial dependence. In families, all with more than five members, the care provided was led by women. The dependence of being on the family extrapolated the limits of the internal structure, having need for a social support network, consisting of the extended family, social groups and institutions. In assessing the development, only one family was experiencing the last phase of their life cycle. The other lived more than one life cycle with overlapping tasks. In the functional assessment, the families performed daily activities both technical care like medication, tracheal suction and curative in pressure ulcers, as home care such as food, personal care (bathing), dressing, cleaning and organizing clothes and utensils, and others. This study allowed us to understand the experience of families dealing with a stroke sequel relative contributing to better understanding by the nursing staff of the role of the family in suffering situations due to a chronic disabling / O Acidente Vascular Cerebral (AVC) é uma das principais causas de morte no Brasil. Os indivíduos que sobrevivem ao AVC podem permanecer com algum grau de lesão tornando-se dependentes de sua família para realizar algum tipo de atividade de vida diária. Este estudo teve como objetivo investigar, em domicílio, a experiência das famílias que convivem com um sequelado de AVC. Trata-se de um estudo de caráter exploratório e descritivo, com abordagem qualitativa, conduzido pelo Modelo Calgary de Avaliação da Família (MCAF). Os instrumentos utilizados foram a entrevista semi-estruturada, o genograma, o ecomapa e a observação direta. Os sujeitos da pesquisa foram cinco famílias que convivem com um de seus entes sequelados pelo AVC, residentes na área de abrangência de uma Unidade Básica de Saúde da cidade de Manaus. A coleta de dados foi realizada no período de janeiro a fevereiro de 2012, após aprovação pelo Comitê de Ética em Pesquisa da Universidade Federal do Amazonas. As famílias foram avaliadas nas três categorias temáticas do MCAF: avaliação estrutural, avaliação de desenvolvimento e avaliação funcional. Na avaliação estrutural, verificamos que entre os sequelados (59 a 85 anos), dois apresentaram dependência total da família e três, dependência parcial. Nas famílias, todas com mais de cinco membros, a prestação dos cuidados era liderada pelas mulheres. A dependência do ente em relação à família extrapolava os limites da estrutura interna, havendo necessidade de contar com a rede social de apoio, composta pela família extensa, por grupos sociais e por instituições. Avaliação do desenvolvimento, apenas uma família vivenciava a fase última do ciclo vital. As demais viviam mais de um ciclo vital com superposição de tarefas. Avaliação funcional, as famílias executavam atividades diárias tanto de cuidados técnicos como medicação, aspiração traqueal e curativo em úlcera por pressão, quanto de cuidados domésticos como alimentação, higiene pessoal (banho), ato de vestir, limpeza e organização de roupas e utensílios, entre outros

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2017-08-07T19:38:21Z No. of bitstreams: 2 Tese - Ana Claudia Antonio Maranhão Sá- 2011.pdf: 3630030 bytes, checksum: 270c12818a43348bdb747081edfc41ac (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-08-08T15:01:34Z (GMT) No. of bitstreams: 2 Tese - Ana Claudia Antonio Maranhão Sá- 2011.pdf: 3630030 bytes, checksum: 270c12818a43348bdb747081edfc41ac (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-08-08T15:01:34Z (GMT). No. of bitstreams: 2 Tese - Ana Claudia Antonio Maranhão Sá- 2011.pdf: 3630030 bytes, checksum: 270c12818a43348bdb747081edfc41ac (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2011-04-29 / Falls in the elderly constitute an important public worldwide health problem, because they are an important cause of morbidity and mortality among elderly. This study aimed to evaluate an intervention program with group physical exercises in the prevention of falls in elderly living at long-term care institutions (LTCI). This is a non-randomized clinical trial, conducted with 20 elderly people of both sexes, residents in two LTCI in Goiânia, Brazil. The interventions were based on previous studies and occurred three times a week for a period of 18 weeks, totaling 40 sessions of group exercises, lasting about two hours each one, in which warm-up exercises were performed, muscle strength, balance, flexibility and relaxation. Standardized measures were used to assess falls (self-reports of participants), balance and gait (Performance - Oriented Mobility Assessment - POMA - Brazil), muscular strength (Hydraulic Hand Dynamometer and 30 second chair stand test), flexibility (Goniometer commuting – Fleximeter and Chair sit-and-reach test), fear of falling (Falls Efficacy Scale - International - FES I - Brazil). After a period of twelve months from the beginning of the intervention the decrease in the number of falls was significant (p = 0.046). Significant differences were observed for POMA-Equilibrium (p = 0.001), POMA-Total (p = 0.007), muscular strength of hand grip (p = 0.001) and lower limbs (p<0.001), flexibility of the bending motion of the shoulders (p = 0.001). The intervention by a physical exercises program proved to be adequate to improve balance, muscle strength of lower and upper limbs, shoulder flexibility, helping to significantly decrease the number of falls among elderly participants, but not enough to improve gait and multiple joint flexibility of spine and hip, as well as to reduce the number of elderly who suffered falls from the beginning of the intervention program. / As quedas em idosos constituem um problema de saúde pública em todo o mundo, pois são importante causa de morbidade e mortalidade entre pessoas dessa faixa etária. Assim, é necessário que os profissionais de saúde desenvolvam intervenções para prevenir essa ocorrência. Este estudo teve como objetivo geral avaliar um programa de intervenção com exercícios físicos em grupo para prevenir quedas em idosos residentes em instituições de longa permanência (ILPI). Trata-se de um ensaio clínico não randomizado realizado com 20 idosos de ambos os sexos, moradores em duas ILPI na cidade de Goiânia, Brasil. As intervenções ocorreram três vezes por semana, por um período de 18 semanas, totalizando 40 sessões de exercícios em grupo, cada uma delas com duração aproximada de 2 horas, nas quais foram realizados exercícios de aquecimento, força muscular, equilíbrio, flexibilidade e relaxamento. Medidas padronizadas foram utilizadas para avaliar quedas (autorrelato dos participantes), equilíbrio e marcha (Performance – Oriented Mobility Assessment – POMA – Brasil), força muscular (Hydraulic Hand Dynamometer e 30 segundos chair stand test), flexibilidade (Goniômetro pendular - Flexímetro e Chair sit-and-reach test) e medo de quedas (Escala de Eficácia de Quedas – Internacional –FES – I – Brasil). A partir do período de doze meses do início da intervenção, houve redução significativa (p = 0,046) no número de quedas. Foram observadas diferenças significantes para POMA-Equilíbrio (p = 0,001), POMA-Total (p = 0,007), força muscular de preensão palmar (p = 0,001) e de membros inferiores (p < 0,001) e flexibilidade do movimento de flexão dos ombros (p = 0,001). A intervenção realizada mediante um programa de exercícios físicos mostrou-se adequada para melhorar equilíbrio, força muscular de membros superiores e inferiores e flexibilidade de ombro, contribuindo para redução significativa do número de quedas entre os idosos participantes do estudo, porém não suficiente para melhorar a marcha e a flexibilidade multiarticular da coluna e quadril, bem como para reduzir o número de idosos que sofreram quedas a partir do início do programa de intervenção.

A responsabilidade civil ligada aos acidentes de trabalho e às doenças ocupacionais é fonte de constantes preocupações de magistrados, doutrinadores e estudiosos do Direito do Trabalho, em especial após o advento da Emenda Constitucional nº 45/04. Em particular em sua vertente objetiva, que procura estabelecer a responsabilidade pelo risco da atividade, independentemente de culpa do agente. No entanto, há evidente lacuna no estudo da responsabilidade civil relacionada aos acidentes de trabalho e às doenças ocupacionais ligadas aos esportes profissionais. Conquanto os esportes envolvam elementos lúdicos e recreativos, sua prática profissional movimenta elevadas quantias de dinheiro e inúmeros feixes de contratos de trabalho. O alto índice de acidentes, lesões e enfermidades relacionadas ao esporte, que por vezes encerram prematuramente a carreira de atletas que ainda estão muito longe do estrelato, reclama a análise e a proteção jurídica conferidas pelo direito do trabalho, como direito social e fundamental. Este estudo se propõe a analisar os fundamentos jurídicos, doutrinários e jurisprudenciais, que inter-relacionam os campos da responsabilidade civil, do direito do trabalho e do esporte de alto rendimento, praticado profissionalmente. / The liability related to accidents at work and occupational diseases is a source of constant concern of judges, jurists and scholars of labor law, especially after the enactment of Constitutional Amendment No. 45/04. In particular in its objective aspect, which seeks to establish the liability for the risk of the activity, regardless of the agent\'s fault. However, there is an obvious gap in the study of the liability related to accidents at work and occupational diseases linked to professional sports. Although the playful and recreational elements involving sports, their professional practice moves large sums of money and numerous bundles of labor contracts. The high rate of accidents, injuries and illnesses related to sports, which sometimes prematurely terminate the career of athletes who are still far from stardom, claims analysis and legal protection conferred by labor law, as a social and fundamental right. This study aims to analyze the legal grounds, doctrinal and jurisprudential, which interrelate the fields of civil liability, labor law and high performance sport, practiced professionally.

As novas tecnologias têm sido aliadas a uma série de programas que visam melhorar a vida dos idosos. Embora o número de trabalhos que aliem novas tecnologias às intervenções psicoeducacionais seja crescente, a produção ainda é timida e não há registros de estudos que aliem dispositivos móveis com intervenções psicoeducativas visando promover a prevenção de quedas em idosos. Objetivos: Apresentar evidências científicas de uma revisão sistemática da literatura sobre o efeito de intervenções educativas associadas ou não ao treinamento físico no medo de quedas em pessoas idosas. Apresentar o desenvolvimento de uma intervenção educativa e tecnológica para prevenção de quedas em pessoas idosas. Apresentar os resultados do piloto de uma intervenção educativa e tecnológica para prevenção de quedas em pessoas idosas quanto a caracterização da amostra e teste piloto da intervenção psicoeducativa isolada e associada ao treinamento físico. Métodos: Foram convidados a participar do estudo 47 indivíduos participantes da Universidade Aberta a Terceira Idade (UnATI| EACH-USP) matriculados no programa Equilibre-se, com idade igual ou superior a 60 anos, randomizados e divididos em quatro grupos distintos: 1) grupo psicoeducativo; 2) grupo de psicoeducação e exercício físico; 3) grupo exercício e 4) grupo controle. Os participantes do grupo de intervenção psicoeducacional participaram de um encontro semanal de 60 minutos cada, durante 16 semanas e após o término desta intervenção, foram convidados a testar um jogo educativo. Esse procedimento foi realizado após os três últimos encontros com o grupo psicoeducativo. Os participantes do grupo psicoeducacional combinado com exercício realizaram adicionalmente ao grupo psicoeducativo mais 60 minutos de exercício físico, duas vezes na semana, durante 16 semanas. O desenho do presente estudo é multifatorial. A testagem ocorreu de maneira duplo-cega. O grupo controle foi convidado a participar da intervenção ao término da pesquisa. Todos os participantes preencheram o Termo de Consentimento Livre e Esclarecido. Instrumentos: Dados de caracterização e identificação (nome, sexo, idade, escolaridade, estado civil); Questionário sobre doenças autorrelatadas; Questões autorrelatadas sobre quedas; Addenbrooke Cognitive Examination Revised (ACE-R); v Escala de Depressão Geriátrica (EDG); Falls Efficacy Scale-International (FES-I); Falls Risk Awareness Questionnaire (FRAQ); subtestes de Dígitos Diretos e Indiretos da Escala de Inteligência Wechsler para Adultos (WAIS-III); subteste Códigos da WAS-III; Tteste Trilhas, versão A e versão B. Resultados: A revisão de literauta mostrou que embora não exista um consenso sobre o melhor tipo de intervenção para prevenir quedas em idosos, a literatura tem apresentado que intervenções multifatoriais podem gerar bons resultados. O Equilibre-se também apresentou bons resultados e aponta que a psicoeducação combinada a tecnologia pode ser utilizada em programas de prevenção de quedas em idosos. O piloto de usabilidade do jogo apresentou bons resultados, sugerindo que o jogo pode ser uma boa ferramenta tecnológica a ser empregada em programas de prevenção de quedas / The new technologies have been combined with a series of programs aimed at improving the lives of the elderly. Although the number of works that combine new technologies with psychoeducational interventions is increasing, production is still timid and there are no records of studies that include mobile devices with psychoeducational interventions aimed at promoting the prevention of falls in the elderly. Objectives: To present scientific evidence of a systematic review of the literature on the effect of educational interventions associated or not with physical training on fear of falls in the elderly. To present the development of an educational and technological intervention to prevent falls in the elderly. To present the results of the pilot of an educational and technological intervention to prevent falls in the elderly regarding the characterization of the sample and pilot test of the psychoeducational intervention isolated and associated to the physical training. Methods: Participants were enrolled in Equilibre-se program, aged 60 years or older, randomly divided into four groups: (1) psychoeducational group; 2) psychoeducation and physical exercise group; 3) group exercise and 4) control group. Participants in the psychoeducational intervention group participated in a weekly meeting of 60 minutes each, during 16 weeks and after the end of this intervention, were invited to test an educational game. This procedure was performed after the last three meetings with the psychoeducational group. Participants of the psychoeducational group combined with exercise performed the psychoeducational group plus 60 minutes of physical exercise, twice a week, for 16 weeks. The design of the present study is multifactorial. Testing occurred in a double-blind fashion. The control group was invited to participate in the intervention at the end of the research. All participants completed the Free and Informed Consent Form. Instruments: Characterization and identification data (name, sex, age, schooling, marital status); Questionnaire on self-reported diseases; Self-reported fall issues; Addenbrooke Cognitive Examination Revised (ACE-R); Geriatric Depression Scale (EDG); Falls Efficacy Scale-International (FES-I); Falls Risk Awareness Questionnaire (FRAQ); Direct and Indirect Digits subtests of the Wechsler Intelligence Scale for Adults (WAIS-III); subtest WAS-III codes; The literature review has shown that although there is no consensus on the best type of intervention to prevent falls in the vii elderly, the literature has shown that multifactorial interventions can generate good results. Equilibre-se has also presented good results and points out that psychoeducation combined technology can be used in programs to prevent falls in the elderly. The game\'s usability pilot has yielded good results, suggesting that the game may be a good technological tool to be employed in fall prevention programs

O Brasil é um país em que o número de idosos tem crescido vertiginosamente e com isso ocorrem mudanças no perfil demográfico, socioeconômico e epidemiológico. As doenças crônicas assumem posição de destaque, dentre elas o Acidente Vascular Cerebral - AVC. O objetivo foi determinar a incidência de sintomas depressivos em idosos que foram hospitalizados por AVC, após a alta hospitalar. Trata-se de um estudo observacional e prospectivo com abordagem quantitativa. Foram entrevistados 48 idosos (60 anos ou mais) residentes na comunidade de cidades do interior paulista, que sofreram AVC e foram internados em um hospital terciário. A coleta dos dados foi realizada através de visitas domiciliares em duas etapas (após três e seis meses do AVC), no período de maio de 2010 a março de 2011. O instrumento de coleta de dados foi composto por dados demográficos e socioeconômicos, Mini-Exame do Estado Mental (MEEM), Atividades Instrumentais da Vida Diária (AIVD), Medida de Independência Funcional (MIF), presença de comorbidades e Escala de Depressão Geriátrica (GDS). A média de idade foi de 72,4 (±7,5) anos, com predominância do sexo masculino (56,2%). A maioria era composta por idosos casados, com média de 3,4 anos de estudo, 75% tinham renda familiar maior que um salário mínimo, 89,6% moravam acompanhados e 56,3% possuíam cinco ou mais morbidades. O tipo de AVC mais prevalente foi o isquêmico (81,2%), com maior comprometimento do lado esquerdo do cérebro. Com relação à Capacidade Funcional (CF), houve um aumento da média da MIF do terceiro para o sexto mês, ou seja, os idosos se tornaram mais independentes nesse quesito. Com as AIVD ocorre o contrário, os idosos se tornam mais dependentes na segunda avaliação. Os idosos do sexo masculino se tornaram menos depressivos, enquanto as idosas sofreram mais desses sintomas após seis meses do AVC. Embora o AVC seja a primeira causa de morte no país e também o grande responsável pelas incapacidades (físicas e emocionais) e internações hospitalares, estudos sobre a morbidade ainda é escasso. O intuito desse trabalho é o de apresentar essas consequências e os sintomas depressivos, os quais podem ser prevenidos com avaliação e intervenção de equipe interdisciplinar. / Brazil is a country in which the number of elderly people has displayed a steep growth, entailing changes in the demographic, socioeconomic and epidemiological profile. Chronic conditions stand out, including Cerebrovascular Accident - CVA. The aim was to determine the incidence of depressive symptoms in elderly people hospitalized due to CVA, after discharge from hospital. An observational and prospective study with a quantitative approach was carried out. Forty-eight elderly people (aged 60 years or older) were interviewed who lived in the community in interior cities in São Paulo State, had been victims of a CVA and were hospitalized at a tertiary-care hospital. Data were collected through home visits in two phases (three and six months after the CVA), between May 2010 and March 2011. The data collection instrument comprises demographic and socioeconomic data, the Mini-Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL), Functional Independent Measure (FIM), presence of co-morbidities and the Geriatric Depression Scale (GDS). The mean age was 72.4 (±7.5) years and the male gender predominated (56.2%). Most elderly were married, the mean education time was 3.4 years, 75% gained a family income of more than one minimum wage, 89.6% lived with another person and 56.3% suffered from five or more co-morbidities. The most prevalent type of CVA was ischemic (81,2%), which more strongly affects the left side of the brain. Regarding Functional Capacity (FC), the mean FIM score increased between the third and sixth month, that is, the elderly became more independent in this regard. The opposite occurred with the IADL, as the elderly become increasingly dependent on the second assessment. Male elderly became less depressed, while these symptoms were more present among female elderly six months after the CVA. Although CVA is the first cause of death in the country and also the main responsible for (physical and emotional) disabilities and hospitalizations, studies on this morbidity remain scarce. This research aims to present these consequences and depressive symptoms, which can be prevented through multidisciplinary team assessment and intervention.

Orientador: José Roberto Montes Heloani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-20T20:12:52Z (GMT). No. of bitstreams: 1 Hass_Sergio_M.pdf: 766970 bytes, checksum: aa10e3ae00263a98149eb2ac4612cd35 (MD5) Previous issue date: 2012 / Resumo: A presente pesquisa visa investigar a atuação do técnico de segurança do trabalho nos ambientes das organizações que contratam, por força de lei, este profissional prevencionista e por extensão, identificar os obstáculos por ele encontrados nas ações inerentes à profissão. Os referenciais teóricos que se utilizou são encontrados na literatura de autores que analisaram as relações de trabalho com ênfase nos transtornos mentais e sua estreita ligação com a organização do trabalho. Autores como Dejours, Dubar, Ciampa, Bourdieu, Pagès, Goffman, Heloani e, ainda outros, debruçaram-se exaustivamente nos estudos para melhor compreender a construção da identidade de uma pessoa e as patologias nele desenvolvidas pelo sofrimento diário devido ao trabalho. A estratégia metodológica buscou reunir os elementos coletados em categorias temáticas que identificam óbices de profissionais cuja prevenção contra acidentes seria o elemento fundamental da atividade do trabalho do técnico de segurança. Para buscar essa categorização, utilizou-se a técnica de análise temática a partir da fala de dezoito entrevistados, todos técnicos de segurança do trabalho, a maioria em atividade em empresas da região metropolitana de Florianópolis. Os resultados constatados evidenciam claramente a questão do custo econômico como perturbador das ações de prevenção de acidentes; revelou a priorização da produção em detrimento da capacitação e, com muita preocupação, trouxe à tona a questão da fragilização da identidade que pode trazer sérias consequências à saúde mental desses profissionais. / Abstract: This research aims to investigate the performance of technical work safety in environments of organizations that contract, by law, this professional prevention and by extension, identify the obstacles he found in the actions in her profession. The theorical frameworks that are used in the literature of authors who studied labor relations with emphasis on mental disorders and their close connection with the organization of work. Authors such as Dejours, Dubar, Ciampa, Bourdieu, Pagès, Goffman, Heloani and still others, pored extensively in studies to better understand the formation of the identity of a person and the conditions it developed by daily suffering because of word. The strategy sought to gather the information collected in thematic categories that identify obstacles of professionals which occupational accidents prevention should be the main element of the work activity of this technician. To seek this categorization, we used the analysis technique based on speech eighteen respondents, all technical security work, mostly in business activity in the metropolitan region of Florianópolis. The observed results clearly show the question of economic cost as disruptive of prevention of accidents; reveled the prioritization of production at the expense of training and, with great concern, raised the question of the fragility of identity that can have serious health consequences mental of these professionals. / Mestrado / Politicas, Administração e Sistemas Educacionais / Mestre em Educação

L'accès aux thérapeutiques de reperfusion (thrombolyse/thrombectomie) dans les délais recommandés constitue l'enjeu principal de la prise en charge de l'accident vasculaire cérébral (AVC) à la phase aiguë. Actuellement, seuls 20% des patients éligibles en bénéficient, en raison de difficultés à identifier l'AVC et de délais de prise en charge prolongés. La filière de soins optimale pour l'AVC à la phase aiguë comprend l'appel au 15 dès la survenue des symptômes et un transfert direct du patient en unité neurovasculaire (UNV). Cependant, une 1ère étude menée dans le Rhône en 2006-2007 (AVC 69) avait objectivé que la filière de soins passait par les urgences dans 80% des cas et que seuls 10% des patients éligibles étaient thrombolysés. Les principaux retards identifiés dans la prise en charge concernaient au niveau préhospitalier, l'identification de l'AVC et l'appel au 15 par le patient ou les témoins, et au niveau intrahospitalier, le parcours de soins dans les services d'urgences, l'obtention de l'imagerie cérébrale et le transfert en UNV. Pour répondre à ces problématiques, nous avons mis en place un programme visant à améliorer la prise en charge de l'AVC en région Rhône-Alpes. Notre travail de thèse rapporte 3 projets menés au sein de ce programme : Le premier projet ciblait la phase préhospitalière. Il a permis d'évaluer la perception de l'AVC au sein de la population générale, afin de proposer une campagne d'information pertinente. Nous avons étudié l'impact de cette campagne dans le Rhône sur l'appel au 15 et les connaissances de la population sur l'AVC. Le second projet a évalué une intervention multifacettes de formation des professionnels des services d'urgences dont l'objectif était de diminuer les délais de prise en charge intrahospitaliers et améliorer l'accès à la thrombolyse. Le troisième projet a porté sur l'étude de la validité des bases de données médico-administratives hospitalières pour identifier les AVC, en vue de l'utilisation de ces bases à des fins épidémiologiques ou pour la construction d'indicateurs de suivi de la performance. Les interventions déployées au sein du programme ont permis d'améliorer le recours à l'appel au 15 et le taux de thrombolyse, néanmoins l'ampleur des effets observés reste limitée et aucun effet sur les délais n'a pu être mis en évidence. Un approfondissement des mécanismes d'action des interventions est nécessaire pour pouvoir proposer des interventions plus efficaces / The main issue in the management of acute stroke is access to reperfusion strategies (ie thrombolysis or thrombectomy) within the recommended time window. Currently, fewer than 1 in 2 eligible patients are receiving this treatment, partly because of difficulties in stoke identification and extended treatment delays. The optimal care pathway for acute stroke includes immediately calling emergency medical services (EMS) at symptoms onset followed by a direct transfer to the stroke unit (SU). However, a previous study carried out in 2006-2007 in the Rhône region (AVC69) pointed out that 80% of patients were managed in the emergency unit and only 10% of eligible patients were thrombolysed. Delays in management were identified at different stages: at the prehospital level, for stroke identification and the EMS call, and at the inhospital level with inefficicent processes in emergency units, delays in cerebral imaging obtaining and for SU transfert. To address these problems, we have set up a program to improve stroke management in the Rhône-Alpes region. Our work reports 3 projects carried out within this program: The first project identified stroke representations in the general population in order to design a relevant information campaign. Then, we studied the impact of this campaign on the number of EMS call for stroke suspicion and on population's knowledge about stroke. In the second project, we developed and evaluated a multifaceted training intervention for emergency units professionals aimed at reducing inhospital management times and improving access to thrombolysis. The third project analyzed the validity of hospital medico-administrative databases to identify strokes, in anticipation of the use of these databases for epidemiological studies or for the construction of performance indicators. Interventions within the program improved the EMS call and thrombolysis rate, but the magnitude of observed effects remained limited and no effect on management times could be observed. A deeper understanding of the mechanisms of intervention is needed to further design more effective interventions

The aim of this study was to examine how three newspapers covered the question of guilt while reporting about the bus accident in Sveg where three school children died. The questions examined were: How does the local newspaper Borås Tidning and Barometern and the evening newspaper Aftonbladet report about the question of responsibility of the bus accident in Sveg? What are the differences and similarities between the three newspapers? We made a discourse analysis of 23 news articles from three different newspapers. The result shows that the newspapers reported about possible reasons that caused the disaster. If the society had taken responsibility and maintained the road then maybe the bus had not crashed. The passengers are described as guilty because of their lack of using seat belts. Simultaneously the bus driver is represented as irresponsible who could have prevented the misfortune by not driving so recklessly. Another aspect of the question of responsibility produce the bus company as the scapegoat of the tragical incident because of the miserable working conditions. We discovered that the newspapers are driven by figuring out the question of guilt in order to give answers to the readers about the tragedy in Sveg. Conclusions drawn from this study are that the media coverage are influenced by news values like their proximity to the persons involved.

The aim of this study is to compare the cause of the, to date, three onlycommercial nuclear power plant accidents. These are very complex incidents,which have dire impact on society and the environment and therefore benefitfrom further investigation, if there lays a possibility of identifying factors thatcould prevent further accidents in the future. In order to investigate this theactions and decisions that lead up to each nuclear meltdown was identified andcompared.The investigation was based on a qualitative study on three cases of nuclearmeltdown accidents. They are based on text analysis of official reports anddocumentaries on the subject. The theoretical background for this study wasKajtazi’s (2011) work on Information Inadequacy. The study was limited to theevents leading up to the accidents and do not include activities afterwards.The study shows that each case had different underlying reasons. It alsoshows that we seem to have learned something from our previous mistakes, andacted on them accordingly. From the Fukushima Daiichi accident we canrecommend that organizations in charge should take early warnings seriouslyand act upon them as soon as they are presented.

Injuries related to snowmobiles, motorcycles and moose-car collisions have increased. The aim of the present thesis was to analyse mechanisms and consequences in fatal and non-fatal accidents of these types, and to penetrate possible preventive measures. Snowmobiles The median age of the injured was 30 and of the killed 32, males pre­dominating. A majority of the accidents occurred during weekends, and especially the fatal accidents occurred after dark. The extremities were the most commonly injured parts of the body, however, drowning, crushed chest and cranial injuries caused most of the fatalities. Among the fatalities, four out of five were under the influence of alcohol. The present Swedish laws regarding snowmobiles seem well motivated. "Built-in" safety measures in the construction of the snowmobiles, pro­perly designed snowmobile tracks and functional search and rescue sys­tems could reduce the injuries. Motorcycles The median age was 19 years for both the traffic injured and the kil­led. Half of the traffic accidents were collisions with other motor ve­hicles. In the fatally injured group, also collisions with fixed road­side objects were common. Of the fatally injured, more than every fifth person died in an accident where alcohol was an influential factor. In the injured group, lower extremity injuries (especially in off-road riding) were common and among the fatalities most riders died from injuries to the head or chest. Out of one thousand motorcycle riders interviewed, 45% reported wobbling experiences (8% reported severe wobbling). Possible injury reducing measures include increasing the licensing age, more discriminating driving test, "built-in" restriction of the motorcycle's top speed, elimination of motorcycles prone to wobbling, and a more intensive traffic supervision (speeding, alco­hol). Moose-car collisitions The median age of the drivers was 38 years. Most collisions happened at dusk or when dark (3/4). The median collision speed was 70 km/h. The damage to the car was typical, the roof and the windshield pillars were deformed downwards and backwards. The broken windshield was often pressed into the passenger compartment. Most of the injured car occu­pants suffered cuts predominantly to the head and upper extremities. Nearly all the fatally injured died of head and neck injuries. The injuries may be reduced by strengthening the roof and the windshield pillars, and by introducing anti 1 acerati ve windshields. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1985</p> / digitalisering@umu