Made available in DSpace on 2016-04-27T18:12:10Z (GMT). No. of bitstreams: 1 Dissertacao Mauro Domingues Fernandes.pdf: 2243484 bytes, checksum: 6223d4b0b4aaf5b8cbcf5453c1e499ea (MD5) Previous issue date: 2006-03-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work aims at investigating the clinic method in anthroposophic medicine, identifying the contributions of its approach for the comprehension oh hearing and language in phoniatric practice, and identifying possible outcomes in the construction of therapeutic paths on language disorders. The investigation presents a case study design as it is configured by the analysis of a limited set of situations in their several relationships relative to a specific process: a case in which the clinic method in anthroposophic medicine has been applied, having relative requirements for hearing and language disorders, creating the possibility of understanding the diagnostic steps inherent to this methodology, its different integrated qualitative perspectives in dialogue with the quantitative data, and the therapeutic strategies in varied scopes which arise during the conduction of such process, making up a clinic planning. This is one of the challenges that anthroposophic medicine must face in this practice from its epistemologic bases, trying to clasp the mankind in its complexity in physical, animical and spiritual perspective in their sensitivy and super-sensitivy reality, thus, in qualitative-quantitative approach. It was introduced in Brazil in the 1960s, having been reckoned as a medical practice by the Conselho Federal de Medicina in 1993. It has its epistemological foundations in the Anthroposophy, which is a scientic-philosophical movement begun in the early 20th century in Switzerland and Germany by the Austrian epistemological philosopher and educator Rudolf Steiner (1861 1925). Worldwidely, the anthroposophic medicine was begun by the Dutch doctor Ita Wegman in Switzerland between 1920 and 1924, having a progressive spread, initially in Europe, and afterwards, during the 20th century, towards the other continents. The unfoldings of this clinic method have been observed in the phonological practice, deepening the diagnostical possibilities with the enhancement of the therapeutical strategies focused on a binomial phoniatry-phonoaudiology, including other health and education professionals to form a community. The contributions for the health sciences in the present times, before their dilemmas and perspectives, have been observed, including epistemological reflexions, the humanization of procedures, researches, and the deepening in the use of natural therapeutics, including medicinal ones and salutogenical emphasis in its practice / O trabalho tem por objetivo investigar o método clínico na medicina antroposófica, identificar contribuições de sua abordagem para uma compreensão dos fenômenos da audição e linguagem na clínica foniátrica e identificar possíveis desdobramentos na construção de caminhos terapêuticos nos distúrbios da linguagem. O desenho da investigação é o de um estudo de caso, na medida em que se configura pela análise de um conjunto delimitado de situações-em suas várias relações-relativas a um processo específico: um caso em que o método clínico na medicina antroposófica foi utilizado, tendo demandas relativas aos distúrbios de audição e linguagem, gerando a possibilidade de compreensão dos passos diagnósticos inerentes a essa metodologia, suas diferentes perspectivas qualitativas integradas, em diálogo com os dados quantitativos, e as estratégias terapêuticas em diversos âmbitos que surgem na condução dos processos em questão, constituindo- se um planejamento clínico. Esse é um dos desafios que a medicina antroposófica procura enfrentar em sua clínica, a partir de suas bases epistemológicas, buscando-se abarcar o homem em sua complexidade, em uma perspectiva física, anímica e espiritual, em sua realidade sensível e supra-sensível, portanto em uma abordagem quali- quantitativa. Foi introduzida no Brasil na década de 1960, tendo sido reconhecida como prática médica pelo Conselho Federal de Medicina em 1993. Tem como bases epistemológicas a Antroposofia, que é um movimento científico-filosófico iniciado nas primeiras décadas do século XX, na Suíça e Alemanha, pelo filósofo, epistemólogo e educador austríaco Rudolf Steiner (1861-1925). No mundo, a medicina antroposófica teve seu início a partir da médica holandesa Ita Wegman, entre 1920-1924, na Suíça, com a expansão progressiva, inicialmente para a Europa, e posteriormente, durante o século XX, para os demais continentes. Os desdobramentos do método clínico são observados na clínica foniátrica, aprofundando as possibilidades diagnósticas com a ampliação das estratégias terapêuticas, centrada a partir de um binômio foniatria-fonoaudiologia, incluindo-se os demais profissionais da Saúde e Educação, formando-se uma comunidade. Observam-se contribuições para as ciências da saúde na atualidade, diante de seus dilemas e perspectivas, incluindo as reflexões epistemológicas, a humanização do atendimento, as pesquisas e o aprofundamento no uso de terapêuticas naturais, incluindo-se as medicamentosas e uma ênfase salutogênica em sua prática clínica

Introduktion: WHO betonar vikten av att integrera traditionell- och komplementärmedicin i nationella hälsovårdssystem. I Sverige förekommer integrativ medicin med antroposofisk inriktning på Vidarkliniken i Järna. Syfte: Att studera förändringar av självskattat hälsotillstånd hos patienter som erhållit antroposofisk vård på Vidarklinikens öppenvårdsmottagning i Norrköping. Metod: En kvantitativ metod med enkäter till 26 patienter på Vidarklinikens öppenvårdsmottagning i Norrköping, konsekutiv datainsamling. Hälsorelaterad livskvalitet skattades med hjälp av EQ-5D (rörlighet, hygien, aktivitet, smärta och oro) och EQ-VAS (totalt hälsotillstånd) samt två enkäter, konstruerade för denna studie, med VAS-skalor för sömnkvalitet, fysiskt tillstånd, psykiskt tillstånd och förutsättningar att hantera sin livssituation, samt patienternas beskrivning av måluppfyllelse. Därutöver undersöktes patienternas sjukskrivningsgrad och läkemedelsförbrukning. Resultat: Patienterna hade mycket varierande diagnoser och ofta sammansatt problematik. Vanligast var utmattning, fibromyalgi och smärta. Resultaten varierade mellan diagnosgrupperna. Huvuddelen av patienterna rapporterade stor tillfredsställelse med vård, behandling och bemötandet från personal, till hög grad uppnådda förväntningar och mål, samt att överlag ha fått bättre förutsättningar att hantera sin livssituation. Det fanns ingen signifikant skillnad i medelvärdet för EQ-5D index eller EQ-VAS, men trend till signifikant förbättring vad gäller sömnkvalitet och psykiskt tillstånd, samt signifikant förbättring av självskattat fysiskt tillstånd (p=0.021). Vid delanalys av de enskilda dimensionerna (EQ-5D) fann man förbättrat tillstånd i någon/några av dimensionerna hos 36 % av patienterna, oftast vad gäller rörlighet och minst vanligt vad gäller smärta. Slutsats: I denna grupp med omfattande och varierande och ofta mycket långvarig problematik påvisades stor uppskattning av vården, trender till förbättrade resultat vid sömnkvalitet och psykiskt tillstånd, samt signifikant förbättrade resultat vid självskattat fysiskt tillstånd. / Introduction: WHO stresses the importance of integrating traditional and complementary medicine into national health systems. In Sweden, integrative medicine with an anthroposophical focus is practised at Vidar Clinic in Järna. Purpose: To study changes in the self-rated health status of patients receiving anthroposophic care at Vidar Clinic outpatient facility in Norrköping. Method: A quantitative method using questionnaires to 26 patients at the Vidar Clinic outpatient facility in Norrköping, [using] consecutive data collection. Health-related quality of life was estimated using EQ-5D (mobility, hygiene, activity, pain and anxiety) and EQ-VAS (overall health status) along with two questionnaires specially designed for this study, with VAS scales for sleep quality, physical condition, mental condition and the ability to manage their lives, as well as the patients’ description of whether or not they felt fulfilled in their lives. In addition, the patients’ sickness absence rates and drug consumption were analysed. Results: The patients had extremely varying diagnoses and often complex problems. The most common were fatigue, fibromyalgia and pain. The results varied between the diagnostic groups. The majority of the patients reported great satisfaction with their care and treatment and how they were being cared for by the staff; to a large extent they felt that their expectations and goals had been achieved, and that in general they had been given better capabilities to manage their lives. There was no significant difference in the mean value for the EQ-5D index or EQ-VAS, but a tendency to significant improvement in sleep quality and mental condition, and a significant improvement in self-estimated physical condition (p=0.021). When a partial analysis was conducted of the individual dimensions (EQ-5D), improved conditions were found in one/some of the dimensions in 36 per cent of the patients, usually in terms of mobility and least common with regard to pain. Conclusion: In this group, with extensive and varied and often very long-term problems, great appreciation of the care was shown, there were tendencies to improved results in sleep quality and mental condition, and significantly improved results in self-estimated physical condition.