Com o objetivo de avaliar a função metabólica de vacas da raça Holandesa com diferentes graus de catarro genital, foram examinadas 230 vacas e foram colhidas 133 amostras de sangue de fêmeas no puerpério tardio, entre 15 e 42 dias. As amostras foram separadas em quatro grupos de animais, os que apresentaram catarro genital grau I, aqueles com catarro genital grau II, animais com catarro genital grau III e animais saudáveis que formaram o grupo controle, sendo dos grupos G1, G2, G3 e G4 respectivamente. Avaliou-se a função renal a partir da determinação dos teores séricos de uréia e creatinina, a função hepática através da determinação dos teores séricos de proteína total, de albumina, da atividade enzimática da aspartato aminotransferase (AST) e da gamaglutamiltransferase (GGT), o lipidograma foi avaliado por meio da determinação dos teores séricos de colesterol, de triglicérides e dos teores plasmáticos de ácidos graxos não esterificados (NEFA) e do betahidroxibutirato. Além disso foram avaliados os teores plasmáticos de glicose e séricos dos íons cálcio, fósforo e magnésio do soro. A determinação dos teores das variáveis estudadas foram quantificadas em analisador bioquímico automático da marca MAS®, modelo Liasys®. Os teores séricos de uréia foram estatisticamente diferentes entre os grupos 1 e 2. Os teores séricos de creatinina foram estatisticamente maiores nos animais doentes. Não houve diferença estatistica entre os teores de proteína sérica total nos diferentes grupos. Houve diferença estatistica entre os teores séricos de albumina entre os grupos 1 e 3. Houve diferença estatistica entre os teores séricos de AST entre os grupos 1 e 4. Não houve diferença estatistica entre os teores séricos de GGT. Houve diferença estatistica entre os teores séricos de colesterol entre os grupos. Não houve diferença estatistica entre os teores séricos de triglicérides entre os grupos. Não houve diferença estatistica entre os grupos em relação aos teores plasmáticos de NEFA, de β-Hidroxibutirato e de glicose. Houve diferença estatística entre os teores séricos de cálcio entre os grupos 1 e 4. Houve diferença estatística entre os teores séricos de fósforo entre os grupos 1 e 2 e entre os grupos 1 e 4. Houve diferença estatística entre os teores séricos de magnésio entre o grupo 1 e 4. / In order to evaluate the metabolic function of Holstein Friesian cows with different degrees of vaginal catarrh, 230 cows were examined and 133 blood samples were collected from late postpartum females between 15 and 42 days. The blood samples were separated into four experimental groups, animals with vaginal catarrh grade I, animals with vaginal catarrh grade II, animals with vaginal catarrh grade III and healthy animals comprising the control group, being G1, G2, G3 and G4, respectively. We evaluated renal function by determining the levels of serum urea and creatinine, liver function by determining the levels of serum total protein, albumin, the enzymatic activity of aspartate aminotransferase (AST) and gammaglutamyltransferase (GGT), the lipid profile was evaluated by determining the levels of serum cholesterol, triglyceride levels and plasma non-esterified fatty acids (NEFA) and β-hidroxibutyrate. In addition we evaluated the levels of glucose in plasma, calcium, magnesium and phosphorus in serum. The determination of the levels of variables were quantified with the use of automatic biochemical analyzer, AMS® brand, model Liasys®. The serum urea levels were statistically different between groups 1 and 2. The serum creatinine levels were statistically higher in diseased animals. There was no statistical difference between the levels of total serum protein in the different groups. There was statistical difference between serum albumin levels between groups 1 and 3. There was statistical difference between serum AST levels between groups 1 and 4. There was no statistical difference between the serum levels of GGT. There was statistical difference between serum cholesterol levels between the groups. There was no statistical difference between the serum triglyceride levels between the groups. There was no statistical difference between groups in relation to plasma levels of NEFA, β-hydroxybutyrate and glucose. There was statistical difference between the serum calcium levels between groups 1 and 4. There was statistical difference between serum phosphorus levels between groups 1 and 2 and between groups 1 and 4. There was statistical difference between serum magnesium levels between groups 1 and 4.

This research served to explore the client’s experiences of services in a clinic dealing with child sexual abuse and related issues. Addressing the issue of therapeutic interventions in clinics dealing with sexual abuse victims and their caregivers – looking at how the clients experience these treatments and services and how they have made ‘meaning’ of these on their journey to healing, is something that needs to be explored in greater depth. The aim therefore of this research is to gain insight into understanding the clients’ experiences of the therapeutic services. This study will be of specific importance due to the fact that to date no literature has been identified particularly from a South African perspective on how clients make meaning of these therapeutic services at such an agency, making it difficult to compare the findings. Much of the research identified has focused on the interventions in cases of sexual abuse and have thus typically been one-sided in approach, subsequently ignoring the voices of the child victims of sexual abuse and the non-offending caregivers. The client’s experience of the therapeutic interventions will be reviewed within the context of the Teddy Bear Clinic. An interpretive phenomenological approach was used to focus on the understanding of the participant’s subjective experiences and meanings of the therapeutic interventions. The research utilised a qualitative framework which privileged first-person descriptions as the primary sources of subjective meaning. Two case studies in an organisation in Johannesburg were investigated. The case studies comprised the child victim of abuse and the non-offending care-givers that participated with the child in the therapeutic process. Therefore two children and two caregivers were included in each case study. The recruitment of participants was, to a large extent, dependent on the assistance offered by the counsellors at the Teddy Bear Clinic. Therapeutic counsellors at the Teddy Bear Clinic identified a list of clients that had just terminated or were exiting the therapeutic process and not in need of further interventions, and fit the criteria as stipulated by the researcher. Data was gathered through semi-structured interviews of each participant. The analysis was carried out using thematic analysis which revealed the meaning of their experiences. The following themes emerged through the analysis and were used to explore the client’s experience and assignment of meaning to the therapeutic services: (1) background influences. Various sub-themes emerged from this theme: (1a) shame, guilt and fear of punishment (1b) developmental stages, (1c) relationship with stepmother, (1d) legal issues, (1e) marital and parenting difficulties, (1f) outside support structures and (1g) previous relationship with counsellor. The second main theme included; (2) the voices of children and caregivers on the therapeutic experience. The various sub-themes that emerged from this were; (2a) the therapeutic relationship, (2b) the role of the therapist, (2c) being kept in the loop – feedback and introductions, (2d) clarification and support for the caregiver (2e) giving back – peer support groups, and (2f) teddy bears and the therapeutic process. Thus the main findings that emerged from this study involves ‘background influences’, that clients present to the medico-legal clinic for rape or sexual abuse. However, background influences have a profound effect on the therapeutic relationship and the experience of the clinic’s services, as seen in the interrelationships that are interwoven with the presenting problem. A second finding emerging from the voices of the children and caregivers foresee that services could be improved in the following ways. Providing feedback and clarification of the therapeutic process; receiving an introductory brochure which highlights what services the clinic provides and resources available to the clients. Caregiver and peer support groups was another very important element that the clients expressed as a necessary and vital part of the services and interventions that the clinic could offer the clients. Finally, a positive element to the therapeutic interventions which helped the children cope and eased the caregivers anxiety were found to be the handing out of teddy bears which is symbolic of the Teddy Bear Clinic and should continue to be a cornerstone of the therapeutic intervention and introduction to the clinic. The study, while achieving its goal of providing some understanding of how the clients experience these interventions at this medico-legal clinic, highlights the need for further exploration of how clients experience these services and interventions at other clinics dealing with sexual abuse, particularly from a South African perspective. / Dissertation (MA)--University of Pretoria, 2012. / Psychology / unrestricted

This study assessed implementation status of collaborative TB/HIV services in Addis Ababa City Administration aiming to promote better implementation strategies. The study employed mixed research methods and was descriptive. The study design used both quantitative and qualitative data using structured questionnaires and semi-structured interview guides, respectively. The study population for the quantitative design included 1,683 TB/HIV patients from 10 conveniently selected health facilities: Zewditu and Menelik Hospitals, health centres of Lideta, Yeka, Kazanchis, NifaSilk-Lafto-No1, Woreda-7, Kality, Bole and Gulele. All the patients who were on their follow-up cares during the data collection period were interviewed. Participants for qualitative design were 1,650 TB/HIV patients for short answered questions; 8 FGDs among patients; interview of 10 TB/HIV care facility coordinators/health workers and one regional TB/HIV care coordinator, all purposively selected. Quantitative data was analysed using SPSS 15.0, while qualitative data were thematically analysed manually. Majority of HIV patients (92.8%) self-reported that they had been screened for TB; of which, 11.2% were diagnosed for active TB during their follow-up cares. Whereas, 87.1% of TB patients had been offered for HIV test; 79.8% tested; 20.2% tested positive. Knowledge on TB and HIV diseases, transmission and prevention was found to be low. However, participants appreciated the support of the healthcare delivery system in improving their health. Collaborative TB/HIV activities brought additional on-the-job training for healthcare workers; improved flow of logistics and re-arrangement of infrastructures of facilities. The study revealed that, implementation of collaborative TB/HIV activities in Addis Ababa need boosting. The study recommends the need for coordinated efforts of all stakeholders for improving implementation of collaborative TB/HIV care services, as identified by this study. The contribution of this study developed pocket-guide for healthcare workers on collaborative TB/HIV care services, which provides guidance in promoting better TB/HIV care / Health Studies / D. Litt. et Phil. (Health Studies)

Submitted by Josiane ribeiro (josiane.caic@gmail.com) on 2015-04-24T13:31:21Z No. of bitstreams: 1 Leonardo_dissertacao_versão_final - Lista de Ilustrações.pdf: 2240391 bytes, checksum: 13f24967fe5b94c8dfc491e4d905802b (MD5) / Approved for entry into archive by Vitor de Carvalho (vitor_carvalho_im@hotmail.com) on 2015-05-19T17:00:28Z (GMT) No. of bitstreams: 1 Leonardo_dissertacao_versão_final - Lista de Ilustrações.pdf: 2240391 bytes, checksum: 13f24967fe5b94c8dfc491e4d905802b (MD5) / Made available in DSpace on 2015-05-19T17:00:28Z (GMT). No. of bitstreams: 1 Leonardo_dissertacao_versão_final - Lista de Ilustrações.pdf: 2240391 bytes, checksum: 13f24967fe5b94c8dfc491e4d905802b (MD5) Previous issue date: 2014 / A presente dissertação tem como questão central investigar como um Consultório na Rua (CnR) tem se relacionado com os moradores de rua frente às atuais discussões sobre as políticas públicas para população em situação de rua no Brasil. Dessa questão principal desdobram-se mais três perguntas de pesquisa:quais clínicas são praticadas pela equipe do CnR?Como tem ocorrido a participação e a in/exclusão dos moradores de rua nos serviços de saúde?De quais formas a sociedade vem lidando com a população em situação de rua na cidade? Para dar conta de responder e problematizar tais questões, realizei uma cartografia inspirada na perspectiva da psicologia social e institucional. Com relação às minhasferramentas teóricas, faço uso de noções tanto do campo da filosofia, a partir de Michel Foucault, Gilles Deleuze e Félix Guattari, quanto do campo da saúde coletiva, com Émerson Merhy, Túlio Franco e Antônio Lancetti. Acompanhei uma equipe de CnR da cidade de Porto Alegre durante cinco meses, participando das abordagens de rua junto a pessoas em situação de rua no município. Sistematizei a minha investigação em quatro partes: na primeira, apresento as Crônicas Urbanas, textos inspirados em uma estética literária, a fim de expor alguns conflitos, tensões, afetos e agenciamentos que vivenciei durante a pesquisa de campo. As crônicas também servem como disparadoras de problematizações da pesquisa. Na segunda parte, trago as opções e os detalhamentos metodológicos (o making of da pesquisa e das crônicas). Na terceira parte, contextualizo de maneira mais detalhada os cenários que permeiam as políticas públicas para usuários de drogas e para pessoas em situação de rua. Por fim, na quarta parte, trago as inquietações e problematizações da pesquisa de campo. Parte dos enunciados e discursividades acerca dos usuários de drogas e dos moradores de rua tem ido na direção de construir a imagem do anormal contemporâneo. Alguns dos efeitos de tal construção são novas formas de manifestação de racismo e a criminalização dos sujeitos que usam drogas e que vivem em situação de rua. Ao analisar as práticas de in/exclusão sob a perspectiva foucaultiana, percebo que tanto as políticas de recolhimento e internação compulsória quanto a política dos Consultórios na Rua fazem parte das estratégias biopolíticas atuais, sendo as primeiras pelo viés da exclusão e a segunda pelo viés da inclusão. No âmbitomicropolítico, do encontro entre trabalhador do CnR e usuário, são possíveis diferentes linhas de fuga, fissuras e resistências à perspectiva biopolítica que deseja instituir-se. A partir das práticas dos trabalhadores do CnR que acompanhei, pude notar diversas tensões e afetos, que culminam, entre outras coisas, em uma clínica pautada pela estratégia de redução de danos e em algo que chamei de uma clínica menor. A clínica menor constitui-se nas práticas de subversão a uma clínica maior, de afirmação de outros modos de existência e dedesterritorialização e possibilidade de produção de novos desenhos e arranjos coletivos, como práticas de resistência e enfrentamento às ações fascistas do campo da saúde. / The current dissertation has as a central issue to investigate how a Clinic in Street – CiS has been related to the homeless, given the current discussions on public policy for the homeless population in Brazil. From this main question, unfolds three more research questions: Which clinics are practiced by the CiS staff? How has occurred the participation and in/exclusion of the homeless in health services? In what ways society has been dealing with the homeless population in the cities? In order to be able to answer these questions and discuss such issues, I created a map inspired on the perspective of social and institucional psychology. With respect to my theoretical affiliation, I use the notions both of the philosophy field, from Michel Foucault, Gilles Deleuze and FélizGuattari, and the field of collective health, with ÉmersonMerhy, Túlio Franco and AntônioLancetti. I accompanied a CiS team from the city of Porto Alegre during five months, taking part in street approaches with homeless people in the city. I systematized my research into four parts: in the first I present the Urban Chronicles, texts inspired by a literary aesthetic, in order to expose some conflits, tensions, affections and assemblages that I have been through during my field research. The Chronicles also serve as triggers of problematizations for the research. In the second part I bring the options and methodologicdetailments (the making of, of the Chronicles and the research). In the third part I contextualize in a more detailed way, the scenarios that permeate the public policies for drug users and for people in street situation. Finally, in the fourth part, I bring the concerns and problems found in field research. Part of the statements and discourses about the drug users and homeless people has been gone towards the direction of building an image of the contemporary abnormal. Some of the effects of such construction are the new ways of racism manifestation and the criminalization of drug using and street living subjects. By analyzing the practices of in/exclusion under the foucauldian perspective, I realize that both, the policies of gathering and compulsory hospitalization, and the policies of Clinics in Street, are part of the current biopolitical strategies, being the first through the point of view of exclusion and the second through the point of view of inclusion. In a micropolitical level, the encounter between the workers and users of the CiS, are possible different lines of flight, fissures and resistance to the biopolitical perspective that has been wanted to be established. From the practices of CiS workers that I have followed, I could notest several tensions and affections, that culminate, among other things, in a clinic based by the strategy of damage reduction and by something that I called minor clinic. The minor clinic constitutes itself on the practices of subversion to a major clinic, of affirmation of other ways of existence and of deterritorialization and the possibility of production of new designs and collective arrangements, as practices of resistance and confrontation of the fascist actions in the field of health.

Having a newborn can be a big change for families, especially for first-time parents. At hospital discharge, parents are often provided with a lot of information, which can be difficult to retain. Due to shortened postnatal lengths of stay, nurses typically have less time to educate parents, which often results in families feeling overwhelmed. After hospital discharge, it is recommended for families to see a health care provider (i.e., physician, nurse practitioner, or registered midwife) within 72 hours for a follow-up appointment. This follow-up appointment is meant to assess both the mother and newborn to ensure they are both in good health and to provide any needed support. Unfortunately, completing the appointment within this timeframe may not be possible for every family or they may not be aware of its importance. Depending on the family’s model of care, completing the follow-up appointment within 72 hours after hospital discharge can be challenging. Families that have a physician as their health care provider may experience delays in scheduling the follow-up appointment. This can be due to the physician’s lack of availability, as there is a physician shortage in most communities. Furthermore, some families do not have access to a health care provider and, therefore, do not see a care provider after hospital discharge. Completing the follow-up appointment later than when it is recommended, or not at all, can result in negative health consequences for the mother and newborn and can also increase re-admission hospital rates and related costs (Cargill et al., 2007). At the moment, postnatal lengths of stay are shortening but the service delivery has not changed to accommodate this trend (Lemyre et al., 2018). This means that the services typically provided to families in the hospital now need to be provided in the community. The follow-up appointment after hospital discharge is an opportunity to provide these services; however, timely access to a health care provider, specifically a physician, can be challenging. Thus, this thesis explores the development of a general design methodology for a postpartum nurse practitioner-led clinic. The aim of the clinic is to provide timely access to any family that needs to complete the necessary postpartum services after hospital discharge within a community. An analytical model was developed to explore the characteristics of a postpartum nurse practitioner-led clinic and how it would operate (i.e., what services would be offered, the amount of time needed for these services, what is needed to offer these services, etc.). The model conducts a simulation of the appointment scheduling process based on the input values entered into it and evaluates a number of performance metrics (e.g., number of diversions, patient wait times, resource idle time, clinic overtime, number of appointments provided within 72 hours and number of appointments provided beyond 72 hours). The findings from the model can support the potential implementation of a postpartum nurse practitioner-led clinic in any community. Implementing such clinics could increase awareness, further educate parents and increase access to postpartum services.

This study assessed implementation status of collaborative TB/HIV services in Addis Ababa City Administration aiming to promote better implementation strategies. The study employed mixed research methods and was descriptive. The study design used both quantitative and qualitative data using structured questionnaires and semi-structured interview guides, respectively. The study population for the quantitative design included 1,683 TB/HIV patients from 10 conveniently selected health facilities: Zewditu and Menelik Hospitals, health centres of Lideta, Yeka, Kazanchis, NifaSilk-Lafto-No1, Woreda-7, Kality, Bole and Gulele. All the patients who were on their follow-up cares during the data collection period were interviewed. Participants for qualitative design were 1,650 TB/HIV patients for short answered questions; 8 FGDs among patients; interview of 10 TB/HIV care facility coordinators/health workers and one regional TB/HIV care coordinator, all purposively selected. Quantitative data was analysed using SPSS 15.0, while qualitative data were thematically analysed manually. Majority of HIV patients (92.8%) self-reported that they had been screened for TB; of which, 11.2% were diagnosed for active TB during their follow-up cares. Whereas, 87.1% of TB patients had been offered for HIV test; 79.8% tested; 20.2% tested positive. Knowledge on TB and HIV diseases, transmission and prevention was found to be low. However, participants appreciated the support of the healthcare delivery system in improving their health. Collaborative TB/HIV activities brought additional on-the-job training for healthcare workers; improved flow of logistics and re-arrangement of infrastructures of facilities. The study revealed that, implementation of collaborative TB/HIV activities in Addis Ababa need boosting. The study recommends the need for coordinated efforts of all stakeholders for improving implementation of collaborative TB/HIV care services, as identified by this study. The contribution of this study developed pocket-guide for healthcare workers on collaborative TB/HIV care services, which provides guidance in promoting better TB/HIV care / Health Studies / D. Litt. et Phil. (Health Studies)

No description available.

[pt] Catástrofe e continuidade de ser: o trabalho psíquico da criança na pandemia de Covid-19. Este trabalho consiste numa pesquisa teórico-clínica acerca dos atravessamentos e produções específicas da clínica psicanalítica online com crianças durante a pandemia de Covid-19. Na primeira parte, estabelecemos o entendimento do contexto pandêmico a partir do conceito de catástrofe de Sandor Ferenczi, marcando distinções e relações com o traumático, de modo a considerar as mobilizações psíquicas do par analítico e as consequentes necessidades de elasticidade da técnica e de adaptação do setting por meio de vinheta. Em seguida, apresentamos o conceito de privação em Winnicott como fundamento de uma experiência psíquica de luto para a criança em confinamento, por vezes vivenciada de forma ambígua e imprecisa, e traçamos articulações com o fenômeno da evacuação de crianças de zonas urbanas no Reino Unido durante a Segunda Guerra para situar um referencial sobre possíveis efeitos psíquicos de grandes rupturas conjunturais no processo de constituição subjetiva. Relacionamos tais questões com a processualidade da constituição psíquica pela ótica de Ferenczi no tocante à gradual introjeção da realidade e ao papel do ambiente no acolhimento do sofrimento da criança. Por fim, exploramos através de vinhetas clínicas a especificidade do atendimento remoto na sua dimensão de setting audiovisual a partir do conceito de câmera subjetiva, relacionando-o com a teoria do brincar de Winnicott, mormente o conceito de uso do objeto, para refletir sobre o processo de construção de uma possibilidade de relação sofisticada com o mundo externo mesmo em circunstâncias de profundas restrições. / [en] The present research consists in an exploration of the challenges and specific productions of the psychoanalytical clinic with children during the Covid-19 pandemic. First, we establish the concept of catastrophe according to Sandor Ferenczi as a means to understand the psychological impacts on the analytic pair and the necessary adaptations of technique. Then, we present the notion of deprivation from Donald Winnicott to better explore the psychological experience of the child in confinement, articulating such experience with the evacuation of children in the United Kingdom during the Second World War. We articulate these issues to the process of subjective constitution through Ferenczi’s concepts of gradual introjection of the reality and the role of the environment in the psychological suffering of children. Lastly, we present clinical excerpts to discuss the specificities of the online setting, whilst articulating the findings with the concept of subjective camera and Winnicott’s theory of play.

No description available.

Bakgrund: Hjärtsvikt är ett vanligt och allvarligt tillstånd med hög dödlighet, sjuklighet och försämrad livskvalité. Det beräknas att omkring en kvarts miljon personer i Sverige har kronisk hjärtsvikt. Inrättandet av specialistsjuksköterskeledda hjärtsviktsmottagningar med läkarstöd har förbättrat behandlingen av patienter med hjärtsvikt. Syfte: Syftet med denna studie var att undersöka patienters upplevelser av vilka faktorer som har betydelse i vården på specialistsjuksköterskeledda hjärtsviktsmottagningar. Metod: En intervjustudie med semistrukturerade frågor har använts. En kvalitativ manifest innehållsanalys användes för att analysera det material som framkom vid intervjuerna. Informanterna valdes ut genom ett strategiskt urval. Resultat: Resultatet visade att en fungerande vårdrelation med sjukvården som representerades av specialistsjuksköterska på hjärtsviktsmottagningen samt information för att klara av sin egenvård var av betydelse för informanterna. En god vårdrelation beskrivs av informanterna i studien att den innehåller kontinuitet, tillit till specialistsjuksköterska, samarbete med vårdpersonal, ett bekräftande bemötande samt tillgänglighet vid behov. Konklusion: Vården på specialistsjuksköterskeledda hjärtsviktsmottagningar är betydelsefull för patienters trygghet. Det förefaller viktigt att få veta vem hjärtsviktspatienterna ska kontakta vid behov av stöd och hjälp för att hantera sin situation. Möjligheten att kontakta specialistsjuksköterska när behovet fanns upplevdes betydelsefull. Information om egenvård uppfattades av informanterna som viktigt och som ett stöd i det dagliga livet. / Background: Heart failure is a common and serious condition with high mortality rate, morbidity and impaired quality of life. It is estimated that about a quarter of a million Swedish people have chronic heart failure. The creation of a specialist nurse-led heart failure clinic with medical assistance has improved the treatment of patients with heart failure. Aim: The aim of this study was to examine patients’ perceptions of the factors that are important in the care on specialist nurse-led heart failure clinics. Method: Interviews with semi- structured questions were used. A qualitative manifest content analysis was used to analyze the material found during the interviews. The informants were selected through a strategic selection. Results: The result showed that a functional relationship between patient and specially trained nurses at the heart failure clinic, and sufficient information to manage their own care, was of the most importance to the patients. A good healthcare relationship are described by the patients as containing continuity, trust to the nurse, friendly treatment, cooperation’s with healthcare staff and availability as needed. Conclusion: The care of a specialist nurse-led heart failure clinics are important for patient safety. It seems important to know whom heart failure patients should contact if necessary help and support to deal with their situation. To have the ability to contact a nurse when needed was very meaningful. The informants found the information on how to handling their own care as important and as a support in their daily life.