I studien undersöks individers upplevelse av gruppsykoterapeutisk behandling för komplicerad sorg. Genom halvstrukturerade djupintervjuer och kvalitativa enkätfrågor erhålls beskrivningar från olika livsvärldar utifrån individers olika perspektiv. En tolkningsram har tagits fram innehållande tidigare forskning samt teoretiska utgångspunkter vilken utgör verktyg för analys av erhållna resultat. I resultatavsnittet framhålls den oerhörda och ibland avgörande betydelse behandlingen haft för individernas välbefinnande. Det framkommer också tre aspekter som varit avgörande för det positiva resultatet av behandlingen nämligen relationen till terapeuten, den metod som använts samt gemenskapen i gruppen. Vidare undersöktes gemenskapens betydelse på en djupare nivå. Det resultat som framkom var att förståelse från de andra i gruppen, att individerna insåg att de inte vara unika om sin situation samt att en medvetenhet och insikt uppstod i tankeprocesser och det interpersonella beteendet var det som hade störst betydelse i gemenskapen. Denna upptäckt presenteras som en tentativ modell som kan ligga till grund för framtida forskning. Slutligen diskuteras resultat och analys i relation till syfte och tolkningsram samt presenteras slutsatser och ytterligare förslag till framtida forskning. / The study examines individuals' experience of group psychotherapy for complicated grief treatment. Through semi-structured interviews and qualitative survey questions have descriptions of the various life worlds of individuals from different perspectives been obtained. Previous research and theories are presented which constitute tools for analysis of the obtained results. The results present the tremendous and sometimes vital significance the treatment had on individuals' wellbeing. It also presents three aspects that were decisive for the positive outcome of the treatment. These were the relationship to the therapist, the method used and the community in the group. The meaning of community was further examined on a deeper level. The obtained result of this question shows that understanding from the other group members, the fact that the individuals' realized that they’re not unique about their situation and that awareness and insight in thoughts and interpersonal behavior arose were of greatest meaning. This discovery is presented as a tentative model that could provide a basis for future research. The results are discussed and analyzed in relation to the purpose of the study and previous research. Finally, conclusions and further suggestions for future research are presented.

Made available in DSpace on 2016-04-28T20:40:14Z (GMT). No. of bitstreams: 1 Daniela Reis e Silva.pdf: 3479822 bytes, checksum: 2bd8dd4c462da22cc01284d074772bca (MD5) Previous issue date: 2009-12-11 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Suicide is a complex behavior and is considered as a public health problem. Little attention has been given to the surviving family members. The present research deals with the process of parental bereavement due to a child suicide. The process gathers two variable of potential risk for the development of complicated mourning: the loss of a child and the kind of death involving suicide. The research analyses matters related to the suicide of a child by means of a case study, which is based on a qualitative method, involving a mother who lost her son by suicide one year and three months before the study. A semi-structured interview and the construction of a genogram are used as tools. The thematic analysis reveals a singular bereavement process involving trauma and grief. It presents the son characteristics, the illness history, the suicide, the shock, the guilt, the paralysis, longing feelings, sadness, the ups and downs, the health and the resiliency among other emerging aspects, which seem to be mixed in the participant s verbalization influencing in a recurrent way the mourning process. The author draws the conclusion that religiosity, professional support, social support, art, meaning constructions, the way of sharing among other resources of confrontation can contribute positively, although in a short period of time, for a change in the future expectation. The author considers that the achieved information is only the beginning of recognition of the importance of not labeling negatively the survival family members over suicide, besides the possibility of breaking silence and prejudice involved in it so that they can receive the right support / O suicídio é um ato complexo considerado problema de saúde pública, e pouca atenção tem sido dispensada aos sobreviventes. Este trabalho trata do processo de luto de pais por suicídio de um filho por englobar duas variáveis de potencial risco para o desenvolvimento do luto complicado: a perda de um filho e a morte por suicídio. Examina o processo à luz do paradigma sistêmico. Adota uma metodologia de abordagem qualitativa, mediante um estudo de caso que envolve uma mãe enlutada há um ano e três meses. Utiliza como instrumentos uma entrevista semiestruturada e a construção do genograma familiar. A análise temática revela uma riqueza nos dados obtidos, apesar do trauma e do sofrimento envolvidos, mostrando que as características do filho, a história da doença, o suicídio, o choque, a culpa, a paralisia, a saudade, a tristeza, os altos e baixos, a saúde, a resiliência, entre outros aspectos emergentes que aparecem mesclados no discurso da participante, influenciam de maneira recursiva o processo de luto. Conclui que a religiosidade, o apoio profissional, o apoio social, a arte, a construção de significados, o compartilhar, entre outros recursos de enfrentamento, podem contribuir positivamente, mesmo em pouco tempo, para uma mudança nas expectativas para o futuro. Considera que os dados obtidos são apenas o começo do reconhecimento da importância do cuidado de não se rotular negativamente os sobreviventes ao suicídio, além da possibilidade de romper o silêncio e o preconceito que os envolvem, para que possam receber o acolhimento adequado

Made available in DSpace on 2016-04-28T20:38:46Z (GMT). No. of bitstreams: 1 Mariana Sarkis Braz.pdf: 618893 bytes, checksum: 1611e2369644aad5db2f2d2aad7695b6 (MD5) Previous issue date: 2013-11-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Palliative care seek quality of life based primarily on prevention and relief of suffering of patients who have life threatening diseases, encompassing the areas of physical, psychosocial and spiritual. Furthermore, extending the post-mortem patient, it offers support the family support in the grieving process. The theme provides discussions of education for death and dying process for health care professionals who are educated mostly geared towards the enhancement of technical knowledge at the expense of a humanist education, which removes the theme of death as the focus of learning. This qualitative study aimed to understand and analyze the training of professionals in relation to dying patient and their perception regarding their contributions to the prevention of complicated grief care unit. The Attachment Theory grounded this research theoretically, providing support for the analysis. Health professionals who integrate palliative care teams voluntarily participated in this research . A questionnaire was used to obtain academic and professional data, besides courses taken. A semi-structured interview allowed us to understand the following topics: the choice of working in palliative care, the strategies used (by oneself and by the care unit) on a daily basis to deal with the issue of the dying process and the perception of its contribution to the prevention of complicated grief of patient and family. The results confirmed that the training of professionals in relation to the dying process is scarce. Moreover, it was observed that health professionals working in palliative care have attachment behaviors, identified as natural in this context, and that ends up to make it harder to realize that those are important contributions to prevent grief from becoming complicated in the care unit / Os cuidados paliativos buscam qualidade de vida baseada principalmente na prevenção e no alívio do sofrimento de pacientes que possuem doenças ameaçadoras de vida, englobando as esferas de ordem física, psicossocial e espiritual. Além disso, estende-se ao pós-morte do paciente, oferecendo suporte e apoio à família no processo de luto. O tema proporciona discussões acerca de educação para morte e processo de morrer para os profissionais de saúde, que têm uma formação em sua maioria voltada para a valorização do saber técnico em detrimento de uma formação humanista, o que afasta o tema da morte como foco de aprendizado. Esta pesquisa qualitativa teve como objetivo compreender e analisar a formação dos profissionais em relação ao processo de morrer do paciente e as percepções daqueles em relação às suas contribuições para a prevenção de luto complicado da unidade de cuidado. A Teoria do Apego fundamentou teoricamente esta pesquisa, oferecendo respaldo para a análise. Participaram voluntariamente desta pesquisa profissionais de saúde, que integram formalmente equipes de cuidados paliativos. Foi utilizado um questionário auto-aplicativo para obtenção de dados acadêmicos, profissionais e de cursos realizados e uma entrevista semiestruturada, que permitiu compreender os seguintes tópicos: a escolha de trabalhar em cuidados paliativos; as estratégias utilizadas (para si mesmo e para com a unidade de cuidado) no dia a dia para lidar com a questão do processo de morrer e a percepção sobre a sua contribuição para a prevenção de um luto complicado de paciente e família. Os resultados confirmaram que a formação dos profissionais em relação ao processo de morrer é escassa. Ademais, observou-se que os profissionais de saúde que trabalham em cuidados paliativos possuem comportamentos de apego, os quais são identificados como naturais nesse contexto, o que acaba por dificultar a percepção de que são importantes contribuições para a prevenção de luto complicado da unidade de cuidado

<p>The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use <i>per se</i> and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID.</p><p>The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID.</p><p>There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD.</p><p>IUD use <i>per se</i> was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID.</p><p>An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.</p>

International studies of disasters indicate the risk for developing posttraumatic stress reactions among survivors is high. Modern life implicates increased traveling. During the last decades a large number of Swedish citizens were confronted with disasters taking place outside of their country. The prevalence of trauma reactions in a population that does not  normally  experience natural disasters, but are able to return to a community unaffected by the catastrophe, is not well studied. In addition, the effects of bereavement after traumatic circumstances have not been satisfactorily explored. Longitudinal studies on the effects of natural disasters are underrepresented and there are few studies investigating the course of recovery after traumatic exposure. The aim for this thesis was to examine long-term post-traumatic stress reactions, mental health, and complicated grief after disaster exposure and traumatic bereavement.  Data from returned questionnaires were analysed from bereaved Italian and Swedish relatives 18 months after the Linate airplane disaster 2001, and at 14 months and three years from Swedish travelers returning from Southeast Asia after the 2004 tsunami disaster, and from home staying bereaved relatives within the second year after the tsunami disaster. The main outcome measures were GHQ-12, IES-R and Inventory of Complicated Grief. The findings indicated many survivors were resilient and had ability to recover, but severe exposure to a disaster had considerable impact on psychological distress. Life threat was associated with higher levels of post-traumatic stress reactions, and increased the risk for affected mental health and suicidal ideation. Loss in combination with severe life threat exposure indicated a further increased risk of posttraumatic stress reactions and for complicated grief; this should be considered a substantial risk factor for general mental health. Loss of close relatives, especially loss of children, was associated with higher levels of posttraumatic stress and created a greater risk for complicated grief. Many survivors recovered over time; however, severe exposure and traumatic loss appeared to slow the recovery process. The findings have implications for government and health agencies, regarding the importance of knowledge and awareness of these risks for health, and for organizational structure, training, and accessibility of support and adequate treatment.

The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use per se and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID. The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID. There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD. IUD use per se was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID. An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.

Aortic aneurysm and dissections are potentially life threatening conditions. The advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) has reduced perioperative mortality and morbidity and are now established therapy methods for treatment of aortic disease. Adequate pre- and intraoperative imaging is important for optimal results in endovascular procedures. However, the standard use of CT and angiography may not always be sufficient to provide necessary information required for treatment, and complementary techniques are warranted in selected cases. TEVAR in acute complicated type B aortic dissections is proven effective in several reports, but long-term clinical outcome and aortic remodelling are still not fully evaluated. Intravascular phased array imaging (IPAI) was used in patients undergoing EVAR and TEVAR for aortic aneurysm and dissection. The combined information from IPAI and fluoroscopy allowed exact positioning of the stent graft. The colour Doppler function facilitated detection of blood-flow in relevant arteries during and after the procedures, and it also facilitated control of ceased flow in excluded false lumens or aneurysms. Clinical early and long-term results after TEVAR for acute complicated type B aortic dissection were investigated in all patients treated between 1999 and 2009 at UppsalaUniversityHospital. Results were favourable regarding survival and permanent neurological complications. Long-term follow-up of aortic morphological changes in the same patient group showed overall significant reduction of aortic and false lumen diameters, and an increase of true lumen diameter. Total thrombosis of the false lumen occured more often in patients with DeBakey IIIa aortic dissection, than in IIIb. In conclusion, IPAI may be a complementary tool to traditional imaging modalities in EVAR and TEVAR in selected cases. Long-term clinical outcome is excellent with favourable aortic remodeling after TEVAR in patients with acute complicated type B aortic dissection.

Šiame moksliniame tyrime nagrinėjamas teisėtų lūkesčių principo turinio įgyvendinimas valstybės tarnyboje. Siekiant atskleisti temą, analizuojami Valstybės tarnybos įstatymas, valstybės ekonominę būklę apibūdinantys teisės aktai, teismų praktika bei Lietuvos ir užsienio mokslinė literatūra. Pirmoje dalyje aptariama teisėtų lūkesčių principo kilmės istorija bei samprata. Analizuojant teisės šaltinius, atskleidžiama, kada asmuo gali įgyti teisėtus lūkesčius bei valstybės pareiga gerbti asmens teises. Tuo pačiu nurodoma, jog teisėtų lūkesčių principas nėra absoliutus bei atskleidžiamos aplinkybės, kurioms egzistuojant, viešoji valdžia gali keisti teisinį reglamentavimą. Antroje mokslinio tyrimo dalyje pabrėžiamas valstybės tarnautojų vaidmuo valstybės valdyme bei valstybės pareiga paisyti šių asmenų teisėtų lūkesčių. Nagrinėjami teisės aktai, reglamentuojantys valstybės tarnautojų darbo užmokesčio dydį bei socialines garantijas, ir atskleidžiami konkretūs aukščiausių valstybės institucijų priimti sprendimai, kurie pažeidžia valstybės tarnautojų teisėtus lūkesčius ir kelia nepasitikėjimą valstybe. Trečioje mokslinio tyrimo dalyje yra apžvelgiama naujausia Europos Teisingumo Teismo praktika, kurioje nagrinėjamas Europos Sąjungos pareigūnų darbo užmokesčio ir socialinių garantijų didinimo ribojimo klausimas. Tuo pačiu, atsižvelgiant į antrojoje dalyje identifikuotas problemas, yra analizuojama Konstitucinio Teismo jurisprudencija bei suformuojamos pagrindinės sąlygos, kurias... [toliau žr. visą tekstą] / In this scientific research the implementation of substance of principle of legitimate expectations in the public service is analyzed. In order to reveal the point of this subject, the Public service Act, act’s revealing complicated economical and financial situation of state, Court practice and scientific literature of Lithuania as well as foreign countries are analyzed. Firstly, we discuss historical development and conception of principle of legitimate expectations. Analyzing sources of law we reveal when person is able to gain legitimate expectations and duty of state to respect person’s rights. Herewith, it is said that principle of legitimate expectations is not undeniable and circumstances when public authority is able to chance it legal acts are revealed. In Part two we reveal the importance of officials in administration of state and the duty of state to respect officials’ legitimate expectations. Herewith, legal acts related with officials’ salary and social securities are analyzed and problems that arise: decisions which were made by authority of state and which can infringe officials’ legitimate expectations and trust in state. In Part three the point of practice of European Court of Justice of the European Union realated with officials’ salaries and social securities restraint is revealed. Herewith, readers attention is paid to situation in Lithuania: we recall problems identified in Part two and analyze practice of Constitutional Court in order to set main... [to full text]

Computed tomography is one of the most evolving fields of modern radiology. The current CT applications permit among other things angiography, 3D image reconstructions, material decomposition and tissue characterization. CT is an important tool in the assessment of specific patient populations prior to an invasive or surgical procedure. The aim of this dissertation was to demonstrate the decisive role of CT with 3D-image reconstructions in haemodialysis patients scheduled to undergo fistulography, in patients undergoing surgical breast reconstructions with a perforator flap and in patients with complicated renal calculi scheduled to undergo percutaneous nephrolithotomy. CT Angiography with 3D image reconstructions was performed in 31 patients with failing arteriovenous fistulas and grafts, illustrating the vascular anatomy in a comprehensive manner in 93.5% of the evaluated segments and demonstrating a sensitivity of 95% compared to fistulography. In 59 mastectomy patients scheduled to undergo reconstructive breast surgery with a deep inferior epigastric perforator flap, the preoperative planning with CT Angiography with 3D image reconstructions of the anterior abdominal wall providing details of its vascular supply, reduced surgery time significantly (p&lt; 0.001) and resulted in fewer complications. Dual Energy CT Urography with advanced image reconstructions in 31 patients with complicated renal calculi scheduled to undergo PNL, resulted in a new method of material characterisation (depicting renal calculi within excreted contrast) and in the possibility of reducing radiation dose by 28% by omitting the nonenhanced scanning phase. Detailed analysis of the changes renal calculi undergo when virtually reconstructed was performed and a comparison of renal calculi number, volume, height and attenuation between virtual nonenhanced and true nonenhanced images was undertaken. All parameters were significantly underestimated in the virtual nonenhanced images. CT with 3D-reconstructions is more than just “flashy images”. It is crucial in preoperative planning, optimizes various procedures and can reduce radiation dose.

In this study we are verifying aplicability of the tool BNAT for the target group of people with severe, multiple disability and autism in social residential facilities. Next we comment the tool. The research has been conducted by means of interviewing primary care workers. Based on the results of qualitative analysis of interviews we had commented BNAT tool and suggested adjustments, leading towards usability in residential facility conditions, considering target group. The contribution of the study is based on verifying of practicality of the tool that is mapping the needs of users in the moment of loss. The significance is foremost for workers who lead individuals with intellectual disability through the loss of the loved one.