Adoecimento crônico envolve afeto e aproximação entre pacientes e familiares, podendo ser impactados diante da necessidade do cuidado. A rotina e dinâmica do sistema familiar sofrem alterações, apontando a necessidade de clarificar a compreensão sobre os processos familiares e pessoais desencadeados pelo adoecimento crônico que ameaça a continuidade da vida. O objetivo geral desse estudo é avaliar funcionamento familiar e espiritualidade relacionada à qualidade de vida de pessoas com doenças crônicas ameaçadoras a continuidade da vida (DCACV) e seus familiares, verificando possíveis associações destas variáveis com saúde mental e qualidade de vida. Amostra foi composta por grupo de 100 pacientes (GP) portadores de (DCACV), acompanhados em um hospital geral e 100 familiares (GF), pareados com o paciente. Aplicou-se Questionário de informações sociodemográficas e familiares; Escala de Avaliação da Coesão e Adaptabilidade Familiar-versão IV (FACES-IV); Questionário para religiosidade, espiritualidade e crenças pessoais relacionadas à qualidade de vida (WHOQOL-SRPB); Questionário para avaliação de qualidade de vida (WHOQOL-breve); Inventário de Ansiedade de Beck (BAI) e Inventário de Depressão de Beck (BDI-II). Os instrumentos foram aplicados no hospital, quando da consulta ou internação; entrevistados em locais separados, na mesma data. Realizou-se análise estatística descritiva dos resultados, teste t comparando os dois grupos e teste de correlação de Pearson para associações entre variáveis. Amostra predominantemente mulheres (51%-GP e 79%- GF), sem companheiro, residindo com família, católicos, classes B e C. Idade média GP 63,6 anos (+14,85) e GF 48,9 anos (+ 14,25). GP 51% apresentaram sintomas de ansiedade e 31% de depressão, GF 45% ansiedade e 23% depressão. Observou-se diferenças significativas nos grupos em qualidade de vida nos domínios social (t=5,296;p<0,001), ambiental (t=4,038;p<0,001) e resultado global (t=3,919;p<0,001), com melhores resultados para GP. Os grupos se diferenciaram quanto a funcionamento familiar nas subescalas Emaranhada (t=2,357;p=0,019), rígida (t=4,469;p<0,001), com resultados melhores para GF, comunicação (t=2,724;p=0,007) e satisfação (t=3,407;p=0,001), melhor para GP. Espiritualidade, na faceta Admiração (t=2,246;p=0,026), com resultado menor para GP. Observou-se correlações entre ansiedade, depressão e diferentes domínios de qualidade de vida tanto para funcionamento familiar quanto espiritualidade. As correlações entre funcionamento familiar e espiritualidade, no GP foram significativas entre algumas subescalas, porém fracas (r<0,40). As facetas, conexão, força e paz, referentes à espiritualidade, se correlacionaram com todas as subescalas de funcionamento familiar, exceto emaranhada (que não se correlacionou com nenhuma faceta), correlações com caótica foram negativas. A subescala satisfação familiar apresentou correlação positiva com todas facetas de espiritualidade. Resultados apontam que DCACV afeta funcionamento familiar e qualidade de vida, incluindo espiritualidade, e é possível que a doença aproxime as relações familiares, favorecendo ao funcionamento, apesar do processo de adaptação tanto pelo paciente quanto familiar. Quanto à espiritualidade, a presença da DCACV parece afetar a capacidade da pessoa de olhar ao redor buscando inspiração para a vida. Viver torna-se o momento presente, uma vez que o adoecimento pode abreviar a vida. Resultados evidenciaram que maior espiritualidade relacionada à qualidade de vida melhor a funcionalidade familiar, reafirmando que DCACV afeta igualmente paciente e familiar, pois foram observadas mais semelhanças que diferenças entre os dois grupos / Becoming chronically sick involves affection and closeness between patients and family and may be impacted due to the care needed. Routine and family dynamics are changed, pointing to the necessity to understand the personal and family processes triggered by the disease that threatens life. The general goal of this study was to assess family functioning and spirituality relative to quality of life among people with chronical life-threatening diseases (CLTD) and their family and identify possible links between these variables and quality of life and mental health. The sample was composed of 100 patients (GP), all of whom with CLTD, followed up in a hospital, and 100 relatives (GF) paired with the patient. The Sociodemographic and Family Information Questionnaire, Family Adaptability and Cohesion Scale (FACES-IV), Questionnaire on Religiousness, Spirituality and Personal Beliefs Relative to Quality of Life (WHOQOL-SRPB), Quality of life Assessment Questionnaire (WHOQOL-brief), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-II) were all instruments used in the hospital upon visits or admission. Patients were surveyed in separate rooms on the same date. A descriptive statistical analysis of results, t Test comparing both groups, and the Pearson Correlation Test for links between variables were conducted. Predominantly female sample (51%-GP e 79%-GF), without a partner, residing with family, catholic, B and C classes, average age GP 63,6 years (+14,85) and GF 48,9 years (+ 14,25). GP: 51% showed anxiety symptoms and 31% depression symptoms; GF: 45% anxiety and 23% depression. Significant differences were seen between the groups relative to quality of life in the social, environmental and global results realms: (t=5,296; p<0,001), (t=4,038; p<0,001) (t=3,919; p<0,001) respectively, with better results for GP. Groups also showed differences regarding family functioning in the Enmeshed (t=2,357;p=0,019), and Rigid (t=4,469;p<0,001) subscales, with better results for GF; communication (t=2,724;p=0,007) and satisfaction (t=3,407;p=0,001),with better results for GP; Spirituality, in the Admiration facet, (t=2,246;p=0,026), with lower results for GP. There were correlations between anxiety, depression and different domains of quality of life both for Family functioning and spirituality. Correlations between family functioning and spirituality in GP were significant between some subscales, though weak (r<0,40). The facets, connection, strength, and peace, regarding spirituality correlated with all subscales of family functioning, except Enmeshed, which did not correlate with any facet. Correlations with Chaotic were negative. Subscale Family Satisfaction showed positive correlation with all facets of spirituality. Results showed that CLTD\'s affect family functioning and quality of life, including spirituality, possibly making family relationships closer and improving family functioning, in spite of the adaptation process. Regarding spirituality, existing CLTD\'s seemed to affect one\'s ability to look around seeking inspiration to live. Living becomes the present moment, since becoming sick may shorten life span. Results evidenced that the higher spirituality related to quality of life was, the better were family functioning, emphasizing that CLTD\'s affect patients and family equally, since more similarities than differences were identified between the groups

Adoecimento crônico envolve afeto e aproximação entre pacientes e familiares, podendo ser impactados diante da necessidade do cuidado. A rotina e dinâmica do sistema familiar sofrem alterações, apontando a necessidade de clarificar a compreensão sobre os processos familiares e pessoais desencadeados pelo adoecimento crônico que ameaça a continuidade da vida. O objetivo geral desse estudo é avaliar funcionamento familiar e espiritualidade relacionada à qualidade de vida de pessoas com doenças crônicas ameaçadoras a continuidade da vida (DCACV) e seus familiares, verificando possíveis associações destas variáveis com saúde mental e qualidade de vida. Amostra foi composta por grupo de 100 pacientes (GP) portadores de (DCACV), acompanhados em um hospital geral e 100 familiares (GF), pareados com o paciente. Aplicou-se Questionário de informações sociodemográficas e familiares; Escala de Avaliação da Coesão e Adaptabilidade Familiar-versão IV (FACES-IV); Questionário para religiosidade, espiritualidade e crenças pessoais relacionadas à qualidade de vida (WHOQOL-SRPB); Questionário para avaliação de qualidade de vida (WHOQOL-breve); Inventário de Ansiedade de Beck (BAI) e Inventário de Depressão de Beck (BDI-II). Os instrumentos foram aplicados no hospital, quando da consulta ou internação; entrevistados em locais separados, na mesma data. Realizou-se análise estatística descritiva dos resultados, teste t comparando os dois grupos e teste de correlação de Pearson para associações entre variáveis. Amostra predominantemente mulheres (51%-GP e 79%- GF), sem companheiro, residindo com família, católicos, classes B e C. Idade média GP 63,6 anos (+14,85) e GF 48,9 anos (+ 14,25). GP 51% apresentaram sintomas de ansiedade e 31% de depressão, GF 45% ansiedade e 23% depressão. Observou-se diferenças significativas nos grupos em qualidade de vida nos domínios social (t=5,296;p<0,001), ambiental (t=4,038;p<0,001) e resultado global (t=3,919;p<0,001), com melhores resultados para GP. Os grupos se diferenciaram quanto a funcionamento familiar nas subescalas Emaranhada (t=2,357;p=0,019), rígida (t=4,469;p<0,001), com resultados melhores para GF, comunicação (t=2,724;p=0,007) e satisfação (t=3,407;p=0,001), melhor para GP. Espiritualidade, na faceta Admiração (t=2,246;p=0,026), com resultado menor para GP. Observou-se correlações entre ansiedade, depressão e diferentes domínios de qualidade de vida tanto para funcionamento familiar quanto espiritualidade. As correlações entre funcionamento familiar e espiritualidade, no GP foram significativas entre algumas subescalas, porém fracas (r<0,40). As facetas, conexão, força e paz, referentes à espiritualidade, se correlacionaram com todas as subescalas de funcionamento familiar, exceto emaranhada (que não se correlacionou com nenhuma faceta), correlações com caótica foram negativas. A subescala satisfação familiar apresentou correlação positiva com todas facetas de espiritualidade. Resultados apontam que DCACV afeta funcionamento familiar e qualidade de vida, incluindo espiritualidade, e é possível que a doença aproxime as relações familiares, favorecendo ao funcionamento, apesar do processo de adaptação tanto pelo paciente quanto familiar. Quanto à espiritualidade, a presença da DCACV parece afetar a capacidade da pessoa de olhar ao redor buscando inspiração para a vida. Viver torna-se o momento presente, uma vez que o adoecimento pode abreviar a vida. Resultados evidenciaram que maior espiritualidade relacionada à qualidade de vida melhor a funcionalidade familiar, reafirmando que DCACV afeta igualmente paciente e familiar, pois foram observadas mais semelhanças que diferenças entre os dois grupos / Becoming chronically sick involves affection and closeness between patients and family and may be impacted due to the care needed. Routine and family dynamics are changed, pointing to the necessity to understand the personal and family processes triggered by the disease that threatens life. The general goal of this study was to assess family functioning and spirituality relative to quality of life among people with chronical life-threatening diseases (CLTD) and their family and identify possible links between these variables and quality of life and mental health. The sample was composed of 100 patients (GP), all of whom with CLTD, followed up in a hospital, and 100 relatives (GF) paired with the patient. The Sociodemographic and Family Information Questionnaire, Family Adaptability and Cohesion Scale (FACES-IV), Questionnaire on Religiousness, Spirituality and Personal Beliefs Relative to Quality of Life (WHOQOL-SRPB), Quality of life Assessment Questionnaire (WHOQOL-brief), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-II) were all instruments used in the hospital upon visits or admission. Patients were surveyed in separate rooms on the same date. A descriptive statistical analysis of results, t Test comparing both groups, and the Pearson Correlation Test for links between variables were conducted. Predominantly female sample (51%-GP e 79%-GF), without a partner, residing with family, catholic, B and C classes, average age GP 63,6 years (+14,85) and GF 48,9 years (+ 14,25). GP: 51% showed anxiety symptoms and 31% depression symptoms; GF: 45% anxiety and 23% depression. Significant differences were seen between the groups relative to quality of life in the social, environmental and global results realms: (t=5,296; p<0,001), (t=4,038; p<0,001) (t=3,919; p<0,001) respectively, with better results for GP. Groups also showed differences regarding family functioning in the Enmeshed (t=2,357;p=0,019), and Rigid (t=4,469;p<0,001) subscales, with better results for GF; communication (t=2,724;p=0,007) and satisfaction (t=3,407;p=0,001),with better results for GP; Spirituality, in the Admiration facet, (t=2,246;p=0,026), with lower results for GP. There were correlations between anxiety, depression and different domains of quality of life both for Family functioning and spirituality. Correlations between family functioning and spirituality in GP were significant between some subscales, though weak (r<0,40). The facets, connection, strength, and peace, regarding spirituality correlated with all subscales of family functioning, except Enmeshed, which did not correlate with any facet. Correlations with Chaotic were negative. Subscale Family Satisfaction showed positive correlation with all facets of spirituality. Results showed that CLTD\'s affect family functioning and quality of life, including spirituality, possibly making family relationships closer and improving family functioning, in spite of the adaptation process. Regarding spirituality, existing CLTD\'s seemed to affect one\'s ability to look around seeking inspiration to live. Living becomes the present moment, since becoming sick may shorten life span. Results evidenced that the higher spirituality related to quality of life was, the better were family functioning, emphasizing that CLTD\'s affect patients and family equally, since more similarities than differences were identified between the groups

D.Ed. / The goal of this research was to generate and describe an acquiescent approach for the educational psychologist to utilise with a family with a terminally ill child. It appears that family units with a terminally ill child have a tendency to withdraw and this isolation leads to problems in mental health. Their mental health is, amongst others, characterised by anger, frustration, unrest and depression. A tendency with psychologists, clergy and helpers from other professions is to act as ideal experts on the lives of saddened people. From painful personal experience this does not seem to enable acquiescence. In their efforts to provide consultation to the grief stricken families, these professionals often overlook the family's real needs and forge their own views upon them. In this way they only further damage their mental condition. This led me to ask the following questions: • What does the world of the family with a terminally ill child comprise of? • Which approach could be described in order to lead the family with a terminally ill child to acquiescence? A qualitative, explorative, descriptive and contextual research design was followed. v The research was conducted in two phases as follows : The experiences of four families with terminally ill children were explored and described in phase one. This was done using phenomenological, unstructured, in-depth interviews. In phase two, a description for educational psychologists for families with a terminally ill child was done, which is based on the results from phase one. After data was gathered in phase one, I came to the conclusion that the family with a terminally ill child goes through a painful process which could last for years. As they go through the process they gain insight into certain life-skills. The aim of the support was then to facilitate a context for the family with a terminally ill child in order for them to internalise these lifeskills. The central statement of this research was thus supported and can be read as follows: An understanding of the world of the family with a terminally ill child will provide the educational psychologist with the data to describe a acquiescent approach.

I Sverige lever cirka 800 000 personer med astma, vilket gör att sjukdomen klassas som en folksjukdom. Astma är en kronisk inflammatorisk luftvägssjukdom med olika svårighetsgrader som medför konsekvenser i det vardagliga livet. Syfte: Att belysa vuxna personer upplevelser av att leva med astma. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Samtliga artiklar har sökts fram i Cinahl, pubmed och PsycInfo. Resultat: Resultatet baserades på tio kvalitativa vetenskapliga artiklar. Utifrån meningsbärande enheter framkom tre huvudkategorier: Begränsningar i vardagen, Att förhålla sig till sjukdomen och Behov av kunskap och stöd. Under Begränsningar i vardagen framkom subkategorierna: Fysiska begränsningar, Sociala begränsningar och Emotionella begränsningar. Under Att förhålla sig till sjukdomen framkom subkategorierna: Inte kunna acceptera sjukdomen och Lära sig leva med sjukdomen. Under Behov av kunskap och stöd framkom subkategorierna: Information och stöd från hälso- och sjukvårdspersonal och Socialt stöd. Slutsats. Svårigheter att andas medförde känslor som oro, rädsla, nedstämdhet och frustration hos personer med astma. Vardagslivet påverkades negativt i form av att undvika sociala tillställningar och ledde till en stor påverkan emotionellt. Personer med astma upplevde brist på information och därmed avsaknad av kunskap om sin sjukdom. Det fanns svårigheter att acceptera sin astma vilket ledde till att personerna förnekade att de var sjuka och skämdes när symtomen uppkom oförutsägbart. För att få kontroll över sin sjukdom och att lära sig leva med astma krävdes det acceptans och att lära känna sina symtom samt begränsningar. / In Sweden there are approximately 800 000 people living with asthma, which classifies it as a public disease. Asthma is a chronic inflammatory airway disease with varying degrees of difficulty that have consequences in everyday life. Aim: To illustrate adult asthmatic persons experiences of the disease. Method: The study was conducted as a general literature study with inductive approach. All articles have been searched in Cinahl, pubmed and PsycInfo. Result: The result was based on ten qualitative scientific articles. After coding the material three main categories emerged: Limitations in everyday life, Relating to the disease, The need for knowledge and support. Under Limitations in everyday life the associated subcategories are: Physical limitations, Social limitation and Emotional limitation. Under Relating to the disease are the associated subcategories: Not being able to accept the disease and Learning to live with the disease. Under Need for knowledge and support are the associated subcategories: Information and support from healthcare professionals and Social support. Conclusion: Breathing difficulties causes feelings such as anxiety, fear, depression and frustration. That everyday life is adversely affected in the form of avoiding social situations leads to a large impact emotionally. Several people with asthma experienced a lack of information and lack of knowledge of the disease. There are difficulties in accepting there asthma, which leads to the persons denying that they were sick and they felt ashamed when the symptoms appeared an predictable. In order to gain control of their disease and learn to live with asthma required acceptant and to get to know their symptoms and limitations.

Interface cerveau-machine pour compenser les déficits moteurs chez des patients ayant des troubles moteurs, avec des implantations chroniques d'électrodes corticales. Etude expérimentale sur animaux. Une interface cerveau-machine (ICM) est définie comme un système de communication qui permet à l'activité cérébrale seule de contrôler des effecteurs externes. L'objectif immédiat des ICM est de fournir des capacités de communication aux personnes gravement handicapées qui sont totalement paralysées par des troubles neuromusculaires, tels que la sclérose latérale amyotrophique, l'accident vasculaire cérébral ou une lésion de la moelle épinière. Des résultats prometteurs (des patients pilotent un joystick grâce à la modulation de leur activité corticale) permettre d'accroître l'espoir dans de futures applications d'ICM avec une matrice de microélectrodes implantées chroniquement à la surface du cortex. Des expériences récentes ont démontré la capacité d'un tétraplégique à contrôler un bras robotisé. Ce travail de thèse contribue aux études précliniques, réalisées en parallèle du développement technique afin de fournir la validation du protocole expérimental chez l'homme par étapes successives. Il permet de développer un dispositif d'enregistrement ElectroCorticoGramme (ECoG) chez des rats, pour l'implanter chez ces animaux et enregistrer leur activité ECoG lors d'expériences comportementales pour contrôler un effecteur externe. Deux types d'études en ligne ont été effectués: le contrôle du distributeur directement par l'activité corticale ou par la combinaison de la tâche motrice (appuyer sur la pédale) et la détection de la signature. Dans les études de contrôle direct par la détection, la Performance Générale (PG) de notre ICM a été de 21,01% ± 4,33 (10 animaux 69 expériences), mais le nombre d'appuis par minute est tombé à 0,57±0,47 rendant plus difficile l'interprétation de ces résultats. C'est pourquoi les expériences, plus complexes, nécessitant l'activation du levier et la détection de signature ont été réalisés. La PG, dans ce cas, est de 37,76% ± 9,64 avec un nombre d'appuis qui a augmenté à 3,24 ± 0,7. La comparaison avec une détection aléatoire nous a permis d'être sûr que ces résultats ne sont pas aléatoires (environ 25-30 fois plus que l'analyse aléatoire). L'une des caractéristiques la plus intéressante de ces expériences est que la zone qui semble en évidence concernée par l'exécution de la tâche motrice est la région du cervelet et non la zone motrice et sensori-motrice, zones qui étaient attendues, comme pour les humains. Un aspect de notre étude sur la neuroplasticité a été de démontrer que la signature, une fois identifiée sur le cervelet, peut être détectée en temps réel dans d'autres régions du cerveau. Nos résultats ont montré une PG de 15,16% ± 3,75 dans 97 expériences faites sur 8 rats. Ces résultats ont montré que l'activité cérébrale en corrélation avec la tâche comportementale, identifiée en premier lieu dans le cervelet, peut être détectée dans une zone différente du cerveau. La caractéristique principale de ce travail de thèse est la démonstration que l'activité neuronale enregistrée en continu au niveau d'une électrode corticale unique peut être efficacement utilisée pour piloter un effecteur avec un degré de liberté, au cours d'expériences longue durant jusqu'à une heure, avec un animal libre de ses mouvements capable de prendre des décisions de manière aléatoire sans indication. Ce travail est une étape déterminante, un premier pas, vers un programme plus vaste visant à fournir un certain niveau de mobilité pour des jeunes patients tétraplégiques. / Brain computer interface with chronic cortical electrode arrays for motor deficit compensation in motor disabled patients. Experimental study in rodents. A brain-computer interface (BCI) is currently defined as a hardware and software communication system that permits cerebral activity alone to control external devices. The immediate goal of BCI research is to provide communication capabilities to severely disabled people who are totally paralyzed or ‘locked in' by neuromuscular disorders, such as amyotrophic lateral sclerosis, brain stem stroke, or spinal cord injury. Promising results (patients piloting a joystick through modulation of their cortical activity) increase the hope of BCI with an array of microelectrodes chronically implanted at the cortex's surface, which doesn't exist yet. Recent experiments demonstrated the capacity for a tetraplegic to control a robotic arm. This PhD work contributes to preclinical studies, performed in parallel of technical development to provide validation of the human experimental protocol in successive steps. It contributes to develop ECoG recording device for rats, to implant them in the corresponding animals and record their ECoG activity during freely moving behavioural experiments to control an external effector. Two kinds of on-line studies have been done: the control of the dispenser directly by cortical activity or by the combination of motor task (push the lever) and detection of the signature. In studies of direct control by the detection the Overall Performance (OP) was 21,01%±4,33 (10 animals 69 experiments) but the number of push per minute fell to 0,57±0,47 making more difficult the interpretation of these results. That's why the experiments, more complicated, requiring both lever activation and signature detection have been realized. The OP, in this case, is 37,76%±9,64 with a number of push which increased back to 3,24±0,7. The comparison with random detection permitted us to be sure that these results are not random (around 25-30 fold more than random analysis). One of the most intriguing features of these experiments is that the area which seems prominently concerned by the execution of the motor task is the cerebellar area and not the central, motor and sensorimotor, areas which would be expected, as in human beings. An aspect of our neuroplasticity study has been to demonstrate that the signature, once identified on cerebellum, can be detected in real-time in other areas of the brain. Our results showed an OP of 15,16%±3,75 in 97 experiments done on 8 rats. These results showed that brain activities correlated with behavioural task identified firstly in cerebellum can be detected in a different area of the brain. The main feature of this report is the demonstration that neural activity continuously recorded at the level of one single cortical electrode can be efficiently used to pilot an effector with one degree of freedom, during experiments up to 1 hour, in a freely moving individual making decisions in a random unsupervised manner. This work is a determining first step towards a larger program aiming at providing a certain level of mobility to young cervical spinal-cord injured patients with tetraplegia.

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Aterosklerozė, kaip arterijas pažeidžianti liga, žinoma jau daugelį metų. Periferinių arterijų okliuzinės ligos (PAOL) simptomus jaučia apie 27 milijonai žmonių Šiaurės Amerikoje ir Europoje. Nežiūrint gerėjančios PAOL diagnostikos, chirurginio, endovaskulinio ir medikamentinio gydymo, jos paplitimas toliau didėja. Ši liga ypač neigiamai veikia gyvenimo kokybę ir išgyvenamumą. Populiacijai senstant, 2040 metais žmonių, sergančių PAOL, skaičius padidės iki 22 proc.. Taigi, akivaizdžiai galime pastebėti, kad žmonėms senstant, daugėja PAOL sergančiųjų ir ši liga progresuoja, blogina žmonių gyvenimo kokybę bei didina mirštamumą ar sunkina gretutinių susirgimų eigą. Ilgėjant žmonių amžiui, jie turi daug gretutinių susirgimų. Todėl PAOL operacinis gydymas gali būti gyvybei pavojingas, nes sukelia gretutinių ligų pasunkėjimą. Šiuo metu šią problemą bandoma spręsti pritaikant endovaskulinius arterijų užakimo koregavimo metodus, kurie yra mažai invazyvūs, atliekami vietinėje nejautroje ir sąlyginai pigūs. Darbo tikslas: palyginti subintiminės angioplastikos (SA), arterijų šuntavimo operacijų ir perkutaninės transliuminalinės angioplastikos (PTA) gydymo rezultatus, esant paviršinės šlaunies arterijos lėtiniam užakimui bei įvertinti subintiminės angioplastikos rizikos veiksnius. Darbo uždaviniai: 1. Įvertinti subintiminės ir perkutaninės transliuminalinės angioplastikų bei arterijų šuntavimo operacijos ypatumus, gydant lėtinį paviršinės šlaunies arterijos užakimą. 2. Įvertinti... [toliau žr. visą tekstą] / The Aim The aim of this study is to compare the results of subintimal angioplasty (SA), the bypass surgery and percutaneus transluminal angioplasty (PTA) in treatment of the chronic occlusion of superficial femoral artery (SFA) and determine risk factors of subintimal angioplasty. The objectives: 1. To evaluate peculiarity of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 2. To evaluate the primary results of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 3. To evaluate the early results of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 4. To determine risk factors predicting the primary and the early results of chronic superficial femoral artery occlusion treatment by means of subintimal and percutaneus transluminal angioplasty and the arterial bypass surgery. 2.1. Patients The prospective clinical study is being performed at the Department of Vascular Surgery of the Clinic of Cardiac, Thoracic and Vascular Surgery of Kaunas University of Medicine. The study was started in November 2002 and ended on December 2006. We had 255 patients admitted to the clinic during this period of time due to the occlusion of SFA, which matched the criteria of the study. The patients were... [to full text]

Submitted by Claudia Rocha (claudia.rocha@udesc.br) on 2017-12-15T16:09:02Z No. of bitstreams: 1 PGEF17MA084.pdf: 119371 bytes, checksum: 801be2ea2b2097b46bd080a6ed243a0d (MD5) / Made available in DSpace on 2017-12-15T16:09:02Z (GMT). No. of bitstreams: 1 PGEF17MA084.pdf: 119371 bytes, checksum: 801be2ea2b2097b46bd080a6ed243a0d (MD5) Previous issue date: 2017-06-23 / FUMDES / The present dissertationaimed to investigate the tree component dynamics in different forest remnants in “Planalto Sul Catarinense Region”. In particular, I seek to understand how edaphoclimatic variables, anthropogenic chronic disturbances, landscape and forest structure could influence the regional scale spatial variation of tree species demographics rates. This information is essential for a better comprehension of forest ecosystems functioning ina contemporary context, marked by frequent chronical anthropogenic disturbances. Thus, I obtained data from permanent plots tree component monitoring and environmental conditions (edaphoclimatic, altitude, landscape and cattle presence) of nine forest remnants in the municipalities of Capão Alto, São José do Cerrito, Lages, Painel, Urubici and Bom Jardim da Serra, in Santa Catarina State. Principal Components Analysis (PCAs) were performed in order to identify regional scale tree component dynamics pattern and ecological gradients. The influence of explicative variables on dynamics patterns was verified by Regression Tree. In the first and second inventory a mean tree density of 1,583 e 1,546 ind.ha-1 were observed, representing a mean net change rate of -0.61%.year-1. For basal area, values of 34.74 m2.ha-1and 35.79 m2.ha-1were observed, represent a mean net change rate of 0.79%.year-1.In regional scale, the Araucaria Forest dynamics varied, mostly, in mortality and basal area loss rates. In general, mortality and basal area loss rates were smaller in well-structured (greater values of basal area) larger fragments with smaller proportion of edge areas. Therefore, I conclude that, in regional scale, anthropogenic fragmentation impacted significantly the tree component dynamics in the study Araucaria Forest areas / A presente dissertação teve como objetivo geral investigar a dinâmica do componente arbóreo em diferentes remanescentes florestais na região do Planalto Sul Catarinense. Em particular, buscou-se compreender a influência de variáveis edafoclimáticas, de perturbações antropogênicas crônicas, da paisagem e estruturação da floresta sobre a variação espacial das taxas demográficas de espécies arbóreas em escala regional. Informações desta natureza são fundamentais para a compreensão do funcionamento dos ecossistemas florestais no contexto da época em que vivemos, caracterizada pela presença marcante de impactos crônicos causados por atividades de origem antrópica. Desta forma, foram obtidos dados de monitoramento de parcelas permanentes do componente arbóreo e de condições ambientais (altitude, variáveis edafoclimáticas, da paisagem e presença de gado) de nove remanescentes de Floresta Ombrófila Mista, situados nos municípios de Capão Alto, São José do Cerrito, Lages, Painel, Urubici e Bom Jardim da Serra, no Estado de Santa Catarina. Visando identificar os padrões de dinâmica do componente arbóreo e gradientes ecológicos em escala regional, foi utilizado uma abordagem multivariada através da Análise de Componentes Principais (PCA). A influência das variáveis explicativas sobre o padrão de dinâmica foi avaliada por meio de Árvore de Regressão. Entre o primeiro e o segundo inventário foram observados, respectivamente, uma densidade média de 1.583 e 1.546 ind.ha-1, o que representou uma taxa de mudança líquida média de -0,61%.ano-1. Para área basal, os valores foram de 34,74 m2.ha-1 e 35,79 m2.ha-1, com mudança líquida de 0,79%ano-1. Em escala regional, a dinâmica das áreas de Floresta com Araucária variou, principalmente, no que se refere as taxas de mortalidade e perda em área basal. De forma geral, fragmentos maiores, com menor proporção de bordas e mais bem estruturados (maior área basal) apresentaram menores taxas de mortalidade e perda em área basal. Assim, conclui-se que, em escala regional, a fragmentação antrópica impactou de forma significativa os padrões de dinâmica observados nas áreas de Floresta Ombrófila Mista

Irritable Bowel Syndrome är en vanlig kronisk mag-tarmsjukdom som medför konsekvenser i det vardagliga livet för den som lever med sjukdomen. Än idag är orsaken till sjukdomen okänd, likväl finns inga tydliga riktlinjer för hur den ska behandlas. Syfte: Att belysa upplevelsen av att leva med Irritable Bowel Syndrome. Metod: Studien genomfördes som en systematisk litteraturstudie med induktiv ansats. Resultat: Resultatet baserades på nio kvalitativa vetenskapliga artiklar. Utifrån meningsenheter framkom tre huvudkategorier; Ett begränsat liv, Emotionell påverkan och Behov av förståelse och stöd med tillhörande sex underkategorier; Social isolering, Brist på energi, Rädsla och oro, Frustration, Att inte bli tagen på allvar av hälso- och sjukvårdspersonal och Att förstå och acceptera sin sjukdom. Slutsats: Att leva med Irritable Bowel Syndrome medförde begränsningar i det vardagliga livet. Det handlade både om professionella och privata områden. Att leva med den kroniska sjukdomen påverkade de drabbade individerna emotionellt eftersom de uttryckte att de inte kunde leva ett ”normalt” liv på grund av de oförutsägbara och genanta symtomen. I möten med hälso- och sjukvårdspersonal var det viktigt att ett personcentrerat förhållningssätt användes. Resultatet visade att individer med IBS uttryckte frustration över att inte få information och kunskap om deras sjukdom samt brist på evidensbaserad behandling. Därför behöver forskning bedrivas inom området. / Irritable Bowel Syndrome is a common chronic gastroinestinal disease that has consequenses in the everyday life for persons living with the condition. Still the cause of the disease is unknown, yet there is no clear guidelines how to treat it. Aim: To highlight the experience of living with Irritable Bowel Syndrome. Method: The study was conducted as a systematic literature study with inductive approach. Result: The result was based on nine qualitative scientific articles. Based on meaningful extracts three main categories were formed; A limited life, Emotional impact and The need for understanding and support. Six related subcategories were formed; Social isolation, Lack of energy, Fear and worry, Frustration, Not to be taken seriously by healthcare professionals and To understand and accept the disease. Conclusion: Living with Irritable Bowel Syndrome caused limitations in everyday life. It limited both the professional life and the private life. To live with a chronic disease affected the individuals emotionally because they expressed that they could not live a ”normal” life because of the unpredicable and embarrassing symptoms. In the meeting with healthcare it was important that a person-centered approach was used. The results showed that individuals living with IBS expressed frustration about not getting information and knowledge about their disease and treatment options. Because of this research needs to be conducted about the chronic condition and potential treatments.

Bakgrund: Antalet fall av kardiovaskulära sjukdomar, där hypertoni ingår, ökar världen över och är de mest dödliga icke smittsamma sjukdomarna. Hälften av alla som är drabbade av högt blodtryck vet inte om att de är det. Behandlingen består bland annat av egenvårdsåtgärder, vilket innefattar farmakologisk behandling och livsstilsförändringar. Det finns ett behov av att beskriva patienters erfarenheter av egenvård vid hypertoni för att öka kunskap och förståelse hos sjuksköterskor. Syfte: Att beskriva patienters erfarenheter av egenvård vid hypertonibehandling.Metod: En litteraturöversikt med kvalitativ metod och induktiv ansats. Litteratursökning gjordes i databaserna CINAHL och PubMed vilket genererade 13 resultatartiklar. Dataanalys av artiklarna genomfördes enligt Fribergs fem steg (2017).  Resultat: Patienter erfor både förutsättningar och begränsningar till att utföra egenvård. Det framkom att få stöd, besitta kunskap och känna motivation var förutsättningar för följsamhet till egenvård. Begränsningar bestod av otillräcklig kunskap, lågt socialt stöd, uppfattade barriärer och låg självförmåga.   Slutsats: Patienter med hypertonidiagnoser erfar hinder att utföra egenvård och behöver stöd från omgivningen eller från vården. Med hjälp av kunskap om sin sjukdom och individuella medel som exempelvis mobilapplikationer blir egenvården mer lätthanterlig. Sjuksköterskan möter dagligen patienter med hypertoni och därför är det viktigt att förstå patienters erfarenheter av behandlingen för att kunna ge en god vård. / Backround: The number of people living with cardiovascular diseases, including hypertension, is increasing worldwide and is the most deadly non communicable disease. Half of the world's population with hypertension is unaware of their condition. Treatments can consist of self-care measures which include both lifestyle changes and medical treatment. To understand and encounter hypertensive patients from a nurse’s perspective, it is important to determine patients’ experiences of self-care.Aim: To describe patients’ experiences of self-care in hypertension treatment.Method: A literature review with a qualitive design and inductive approach was conducted. The databases CINAHL and PubMed were searched to find literature and 13 articles were found. The articles were analysed using Friberg’s five steps (2017).Results: Patients experience both prerequisites and limitations when managing self-care. The results show that receiving support, possessing knowledge, and feeling motivated were prerequisites for compliance to self-care. Limitations were insufficient knowledge, low social support, perceived barriers, and low self-efficacy.  Conclusion: Patients with hypertension experience difficulties in performing self-care and need support from family or healthcare. With the help of individual means such as mobile applications, and knowledge of illness, self-care becomes more manageable. Nurses meet patients with hypertension on daily basis and it is, therefore, important to understand patients' experiences of the treatment to provide good nursing care.