Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Submitted by Noeme Timbo (noeme.timbo@metodista.br) on 2017-11-22T17:58:42Z No. of bitstreams: 1 Ana Paula.pdf: 2163250 bytes, checksum: 9224d06f3a657c18defd407f483131cd (MD5) / Made available in DSpace on 2017-11-22T17:58:42Z (GMT). No. of bitstreams: 1 Ana Paula.pdf: 2163250 bytes, checksum: 9224d06f3a657c18defd407f483131cd (MD5) Previous issue date: 2017-06-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The obstetric reality in Brazil has been through significant changes over the past two years. Since 1970, the number of Cesarean sections has constantly increased in the country and worldwide. In 2014, in Brazil, it reached 52% of the deliveries, even though surgical births levels above 15% do not indicate protection for mother and baby, according to the WHO. The literature indicates that children born by Elective C-section without labor are at higher risk of biological development problems, but few studies address the consequences in the psychological aspects. The objective of this study was to compare the psychological development among babies born of elective C-section and normal delivery, considering the few data available in the literature. Considering the exclusion criteria, the sample consisted of 263 children aged between 6 and 42 months. The instruments used were: a sociodemographic questionnaire to be answered by the mother, and the Bayley Scales of Infant Development – 3rd Edition. For this study the scale was standardized and the sample data collected normalized using percentile calculation. These data were collected individually and statistically analyzed through the SPSS - Statistical Package for Social Sciences Version 21. The results pointed out the delivery method and the gestational age at birth as risk factors for child’s psychological development. The correlations among those born by vaginal delivery or elective C-section showed a statistically significant difference (p <0.05). Among the latter, 12% presented inferior performance in relation to sensory processing, and 10 to 19% in adaptive behavior skills. The correlations with gestational age at birth, also revealed a statistically significant difference (p <0.05): 12% of the preterm infants presented lower results in the development of expressive language and 9% in fine motor skills. These results indicate that, in addition to the losses in physical development, widely described in the national and international literature, there is evidence of psychological impairment. Signs of compatibility and divergence between the US and local samples were observed. / A realidade obstétrica no país vem sofrendo alterações significativas nos últimos dois anos. Desde 1970 tem sido crescente o número de cesarianas no país e no mundo. Em 2014, o número de partos cirúrgicos no Brasil chegou a 52%, apesar de índices superiores a 15% de partos cirúrgicos não indicarem proteção à mãe e ao bebê, segundo a Organização Mundial de Saúde. A literatura aponta que crianças nascidas por cesárea eletiva sem trabalho de parto enfrentam maior risco de problemas em seu desenvolvimento orgânico, mas poucos estudos abordam as consequências nos aspectos psicológicos. O objetivo deste estudo foi comparar o desenvolvimento psicológico entre bebês nascidos de cesárea eletiva e de parto normal, uma vez que há poucos dados disponíveis na literatura. Considerando os critérios de exclusão, foi utilizada amostra composta por 263 crianças com idades entre 6 e 42 meses. Os instrumentos utilizados foram: questionário sociodemográfico respondido pela mãe da criança e a Bayley Scales of Infant Development – 3rd Edition. Foi realizada a padronização da escala e a normatização dos dados amostrais através do cálculo de percentil, para uso neste estudo. Estes dados foram coletados individualmente e analisados estatisticamente através do SPSS - Statistical Package for the Social Sciences Version 21. Os resultados apontaram a via de parto e a idade gestacional ao nascer como fatores de risco ao desenvolvimento psicológico da criança. Nas correlações realizadas entre os nascidos por parto vaginal ou cesárea eletiva, foi verificada diferença estatisticamente significativa (p<0,05). Dentre estes últimos, 12% apresentaram desempenho inferior em relação ao processamento sensorial, e 10 a 19% nas habilidades do comportamento adaptativo. Nas correlações com a idade gestacional ao nascer, também se observou diferença estatisticamente significativa (p<0,05): 12% dos nascidos a termo precoce apresentaram resultados inferiores no desenvolvimento da linguagem expressiva e 9% na motricidade fina. Estes resultados indicam que, além dos prejuízos no desenvolvimento físico, amplamente descrito pela literatura nacional e internacional, há indícios de comprometimento psicológico. Observaram-se indícios de compatibilidade e divergências entre as amostras norte-americana e local.

Resumo: A hospitalização infantil para realização de cirurgia envolve uma sobrecarga emocional tanto para as crianças quanto para sua família. Sabendo que adultos e crianças são atingidos de modo semelhante pelo stress, este estudo avaliou o nível de stress de acompanhantes e crianças em situação pré-cirúrgica e as estratégias de enfrentamento (coping) das crianças nesta situação. Participaram 63 crianças, com idade entre 7 e 12 anos, hospitalizadas para cirurgias eletivas, e seus acompanhantes. Para verificar as variáveis sociodemográficas e de hospitalização das crianças, um Questionário de Levantamento de Informações, elaborado para este estudo, foi aplicado nos acompanhantes. Para avaliar a presença de stress nas crianças, foi aplicada a Escola de Stress Infantil (ESI) e, nos acompanhantes, o Inventário de Sintomas de Stress para adultos de Lipp (ISSL). Aplicou-se o Instrumento de Avaliação das Estratégias de Enfrentamento da Hospitalização (AEH) para identificar as estratégias de enfrentamento utilizadas pelas crianças para lidar com a hospitalização. Observou-se que cerca de 12,7% das crianças apresentaram stress e 23,8% possibilidade de stress, especialmente para sintomas psicológicos (33%), relacionados às variáveis: idade (sete a oito anos), sexo feminino, não ter experiência anterior com cirurgia e receber pouca informação acerca do período perioperatório. As crianças informadas pelo médico e com informação sobre o procedimento cirúrgico, apresentaram menor nível de stress. A maioria dos acompanhantes (76%) foram diagnosticados como estressados, com prevalência da fase de resistência e sintomas psicológicos principalmente as do sexo feminino. As crianças pontuaram mais comportamentos facilitadores da hospitalização como: tomar medicação, assistir TV e conversar. Meninas, crianças com idade igual ou superior a 11 anos e crianças ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Children's hospitalization for surgery may involve an emotional burden for both, the child and for his family. Knowing that adults and children alike are affected by stress, this study evaluated the stress level of caregivers and children in pre-surgical situation and the coping strategies of children in this situation. Participated in this study 63 children aged between seven and 12 years hospitalized for elective sugery and their carers. To determine the sociodemographic variables and hospitalizationn of children, a questionnaire survey of information prepared for this study was applied in companions. To evaluate the the presence of stress in children, was applied the Escala de Stress Infantil (ESI) and, in accompanying the Inventário de Sintomas de Stress para adultos de Lipp (ISSL). To identify the coping strategies used bu children to cope with hospitalization was applied the Instrumento de Avaliação das Estratégias de Enfrentamento da Hospitalização (AEH). It was observed that approximately 12.7% of children showed stress and 23.8% possibility of stress, especially for psychological psychological symptoms (33%), related to the variables age (seven to eight years), female, have no previous experience with surgery and receive little information about the perioperative period. The children reported by the physician and the surgical procedure had a lower level of stress. The most caregivers (76%) were diagnosed as stressed, with a prevalecence of resistance phase and psychological symptons. The fact that a woman companion and chief caregiver, in addition to being a companion of young children with no previous surgical experience and female was related with higher stress. The children scored more facilitative behaviors of hospitalization as taking medication, watching TV and chatting. Girls, children aged less than 11 years and children ... (Complete abstract click electronic access below) / Orientador: Olga Maria Piazentin Rolim Rodrigues / Coorientador: Gimol Benzaquen Perosa / Banca: Sônia Regina Fiorim Enumo / Banca: Carmen Maria Bueno Neme / Mestre

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-03-27T15:19:04Z No. of bitstreams: 2 Tese - Maria Amélia Dias Pereira - 2014.pdf: 7519480 bytes, checksum: 75f999c1aa69eb2215bb7e7e31872713 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-03-27T15:54:27Z (GMT) No. of bitstreams: 2 Tese - Maria Amélia Dias Pereira - 2014.pdf: 7519480 bytes, checksum: 75f999c1aa69eb2215bb7e7e31872713 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-27T15:54:27Z (GMT). No. of bitstreams: 2 Tese - Maria Amélia Dias Pereira - 2014.pdf: 7519480 bytes, checksum: 75f999c1aa69eb2215bb7e7e31872713 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-10-29 / In this research the object of study was the psychic suffering of the medicine students. The general goal was to discuss stressors e possible abuses or violences of the medical course according to the perception of medicine students from a public university in the center west part of Brazil, analyzing the contributions of an elective course offered in the medical school, in which stress coping strategies were explored. The project is in accordance with the ethics aspects of Resolution 466/12. It is a descriptive-exploratory using the qualitative approach characterized as case study. The sample was 33 medicine students in 2011 and 76 in 2013. The data collection was made through focus groups, semi-structured questionnaires and notes from the teachers during the time spent with the students. The data was registered, organized and analyzed with the use of a software that support qualitative analysis called WebQDA. The analysis of the content was based on the methodology of Bardin. The results were presented in articles about the stress factors with the following categories: curriculum, evaluations, relation with teachers, support structure, interpersonal relations, professional perspectives, personal expectations, fear and insecurity, the coping strategies divided in distractions and relief or comprehension and resolution; the way the students deal with pain were characterized as negation and escape or reflexive and the violence and abuse during the medical course were seen as abuse of power or institutional fragilities; the perceptions about the changes after doing the elective about the coping strategies include more self-reflection, improvement in assertiveness and communication. It was concluded that among other stressors is the excessive work load, too much content to be learned, exams, seminars and numerous group works, big responsibilities, insecurity and fear of failing, competitive environment, verbal abuse, violence in the freshmen’s hazing. As examples of the coping strategies there are: going out with friends, searching support from religion, physical activities, doing other things apart from university, support from family/friends, sharing the difficulties. Many react to pain by denying it. After doing the elective course the majority of the students reported less stress symptoms than in the begging of the semester, more use of coping strategies, considering the course as an useful moment to learn new techniques with a higher self-reflection and they realized positive changes in their own life. The elective discipline meant theoretical and practical learning, brought benefits from the class itself, moments of reflection and psychic and emotional changes. / Na presente investigação o objeto de estudo foi o sofrimento psíquico dos estudantes de Medicina. O objetivo geral foi discutir a percepção dos acadêmicos de Medicina de uma Universidade Pública na região Centro-Oeste do Brasil quanto a fatores estressores e possíveis abusos ou violências do curso médico e sua forma de enfrentamento, analisando as contribuições de uma disciplina eletiva oferecida no curso de Medicina, na qual são discutidas estratégias de enfrentamento do estresse. O projeto está de acordo com os aspectos éticos recomendados pela Resolução 466/12. Estudo do tipo descritivo-exploratório utilizando abordagem qualitativa caracterizada como estudo de caso. A amostra constituiu-se de 33 acadêmicos de medicina em 2011 e 76 em 2013. A coleta de dados ocorreu por meio da utilização de grupo focal, questionários semiestruturados e anotações da pesquisadora nos momentos presenciais com os alunos. Os dados foram registrados, organizados e analisados por meio do Software de Apoio à Análise Qualitativa denominado WebQDA. A análise do conteúdo seguiu a metodologia sugerida por Bardin. Os resultados foram apresentados em artigos abordando fatores de estresse com as categorias currículo, avaliação, relação com os professores, estrutura de apoio, falta de tempo, relações interpessoais, perspectivas profissionais, cobrança, medo e insegurança; as estratégias de enfrentamento divididas em distrações e alivio ou compreensão e resolução; a forma como os estudantes lidam com a dor estão nas categorias negação e fuga ou reflexiva e as violências e abusos no curso médico são percebidas pelos alunos como abuso de poder ou fragilidades institucionais; as percepções quanto às mudanças após cursar a disciplina eletiva sobre estratégias de enfrentamento do estresse curso de graduação incluem maior autorreflexão, melhora na assertividade e comunicação. Concluiu-se que os fatores de estresse são a carga horária excessiva, muito conteúdo a ser aprendido, provas, seminários e trabalhos numerosos, grande responsabilidade, insegurança e medo do fracasso, ambiente competitivo, abuso verbal, violência dos trotes ao recepcionar os calouros. Entre as estratégias de enfrentamento estão o ato de sair para se distrair com amigos, buscar apoio da religião, atividades físicas, investir em assuntos alheios à faculdade, receber apoio dos pais/familiares, compartilhar suas dificuldades. Muitos reagem à dor, negando-a. Após a disciplina, a maioria dos alunos relatou menos sintomas de estresse do que no início do semestre, utilizam mais estratégias de enfrentamento, consideraram que foi um momento útil onde aprenderam novas técnicas e aumentaram a autorreflexão e perceberam mudanças positivas na própria vida. A disciplina significou aprendizado teórico e prático, trouxe benefícios da aula em si, mudanças psíquicas e emocionais; e momento de reflexão.

Este estudo trata da relação de afinidade entre a religião, a família e a escola e suas influências no desempenho escolar de alunos provenientes das chamadas \"classes populares\". Com base em entrevistas, realizadas em uma escola pública da periferia da cidade de São Paulo, investiga-se o estilo de vida de famílias de alunos protestantes, que apresentaram um rendimento escolar favorável no ensino fundamental. Para tanto, utiliza-se, como referência, o consumo, considerado em termos de práticas culturais relacionadas às demandas escolares. Analisa-se a articulação entre as práticas socializadoras da religião protestante, da escola e das famílias protestantes entrevistadas, a partir das afinidades eletivas entre elas, com o objetivo específico de determinar disposições de habitus que contribuem para que o aluno apresente um rendimento escolar favorável. Demonstra-se, por meio de evidências empíricas, baseadas nas observações de campo e no discurso dos informantes, que o êxito escolar de alunos protestantes apresenta-se associado a um feixe de situações socializadoras, uma vez que tal êxito não se deve apenas ao fato da pertença religiosa protestante, mas ao modo como as famílias se relacionam com a religião. Dessa forma, focaliza-se o êxito no rendimento escolar dos alunos investigados enquanto relacionado a uma coerência nos projetos das instâncias de socialização aos quais esses alunos estão sujeitos - família, escola e religião. / This research is about the relation linking religion, family and school, and their influences on the schooling development on students who belong to layers named \"popular classes\". Based on interviews made within a public school in São Paulo City suburbia, it\'s surveyed the sort of life Protestants students\' families take due to their better shown schooling development at the elementary school. For this survey to happen it\'s searched the purchasing habits considered in term of cultured practices in relation to the schooling demands. It\'s analyzed the articulation between the Protestant religion socializing practices of schools and families from the interviewed ones, with the specific aim to determine the dispositions of habitués that contribute to the student with a better schooling development. It\'s shown, by the usage of empirics evidences, based on field observations and on informing speeches that the schooling improvement of Protestant students is linked to socializing situations, once this improvement doesn\'t happen just due to the fact of the Protestant religion presence, but to the way families relate to religion. Through this the schooling improvement is spotlighted within the surveyed students along with coherence on the socialization to which these students are subjected - family, school and religion.

Abstract Fertility declines with advancing age and the number of couples seeking infertility treatment at an older age is constantly increasing. A top quality embryo is believed to have the highest potential for implantation and development into a child. A better understanding of the relative importance of patient and treatment characteristics and of embryo quality could help to optimise the existing therapeutic schemes and the safety of in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI). In this work, databases of five Finnish infertility clinics were studied retrospectively. Data on treatments performed in the years 1994–2005 were collected. A total of 19,000 treatment cycles were analysed. Special attention was paid to the relative significance of the transfer of top quality embryos with regards to pregnancy, miscarriage, live birth and cost of treatment in the general IVF/ICSI patient population and in groups with expected poor outcome. The results showed that the transfer of a top quality embryo is associated with a better chance of pregnancy and live birth. However, it does not diminish the probability of miscarriage. Both low and high BMI increase the miscarriage rate. Advancing age and a positive history of previous miscarriages are also associated with a higher probability of miscarriage. In addition, the need for hormonal substitution in cases of frozen-embryo transfer is a risk factor of miscarriage, probably because of suboptimal endometrial function. Since the transfer of several embryos leads to multiple pregnancies, which are associated with a high risk of maternal and fetal complications, elective single embryo transfer (eSET) of a top quality embryo allows all additional good quality embryos to be frozen and transferred later in frozen-thawed embryo transfer cycles. The present work demonstrates that eSET is a safe treatment strategy at least until the age of 40. However, it might not be performed in women with fewer than four collected oocytes, since the prognosis might remain poor even if the response is improved in a following cycle. When eSET is applied routinely and on a large scale, it diminishes treatment costs while increasing the number of deliveries occurring at term, making IVF/ICSI at the same time safer and more affordable even to patients without access to reimbursed IVF treatment.

Bakgrund: Kejsarsnitt har blivit vanligare, orsaken kan vara medicinska indikationer, men också förlossningsrädsla. Att kvinnor som föder barn vaginalt får en bättre upplevelse om de får stöd av en medmänniska är välkänt. Studier av kvinnor som föder barn med planerade kejsarsnitt visar att de också behöver stöd. Detta stöd ges framför allt av anestesisjuksköterskor eftersom barnmorskan är sterilklädd. Syfte: Syftet var att beskriva hur anestesisjuksköterskan ger stöd till den födande kvinnan vid planerat kejsarsnitt i spinalanestesi. Metod: En empirisk, deskriptiv studie med kvalitativ ansats genomfördes. Fem anestesisjuksköterskor intervjuades. Deras berättelser analyserades med kvalitativ innehållsanalys. Resultat: I resultatet framkom fem olika teman och tio subkategorier. Resultatet visar hur anestesisjuksköterskorna ger stöd. Temana var främja delaktighet (kommunicera, involvera närstående), värna integritet (stå bakom, dela födelsen), inge trygghet (vara närvarande, utstråla kompetens, teamarbete) och skapa relation (emotionellt engagemang, använda personligheten, känna in den unika patienten). Det femte temat produktionskrav beskriver de tidspressade förhållanden som gäller där anestesisjuksköterskorna ger stödet. Slutsats: Att ge stöd vid kejsarsnitt innebär att anestesisjuksköterskorna pendlar mellan närhet och distans till patienten, utifrån den unika patientens behov. Målet för stödet var att den blivande modern skulle kunna föda sitt barn lugn och trygg, tillsammans med sin närstående. Arbetsmiljö med flera kejsarsnitt per dag påverkar anestesisjuksköterskornas möjligheter att ge stöd. Klinisk betydelse: Denna studie avser att öka kunskapen om anestesisjuksköterskans stöd vid planerade kejsarsnitt. Detta är en pilotstudie som det kan vara värdefullt att reflektera kring som kliniskt verksam anestesisjuksköterska. / Background: Caesarean section has become more common, the cause may be medical indications, but also fear of childbirth. It is well known that women who give birth vaginally have a better experience if they are supported by a fellow human being. Studies of women who give birth with planned caesarean section shows that they also need support. The purpose was to describe how the nurse anesthetist provides support to the woman in labor at elective caesarean section in spinal anesthesia. Method: An empirical, descriptive study with qualitative approach was conducted. Five nurse anesthetists were interviewed. Their stories were analyzed using qualitative content analysis. Results: The results revealed five different themes and ten subcategories. The results show how a nurse anesthetist provides support. Nurse anesthetists provide support by promoting participation, protect integrity, provide safety and build relationships. The fifth theme, which is called the production requirements, describes the time-strained circumstances of the place where nurse anesthetists provide support. Conclusion: Nurse anesthetists were prepared to provide support so that the mother could give birth to the baby while feeling safe and calm. Working environment with multiple caesarean sections per day affects nurse anesthetist capacity to provide support. Clinical significance: This study intends to increase awareness of the nurse anesthetist support for this form of childbirth. This is a pilot study that it may be useful for the clinically active nurse anesthetist to reflect on.

Why public officials complicit in corruption? It is absolutely a nagging and antiquated question. This thesis examines the corruption on a micro-scale from those convicted in corruption cases in Central Java Province, Indonesia, more specifically by taking the personal views and experiences of the imprisoned actors into account. Broadly speaking, the problem of corruption is a tantalizing daily issue around Indonesia. Despite the government is highly committed to overcome corruption, it is argued that national corruption eradication efforts have not simply failed to diminish the number of corruption cases, but they - at least until 2019 – failed to impede the deployment of corruption from central to local government levels. Empirically, this study explores corruption from leadership theories to build its own analytical framework of corruption, namely administrative and political corruption. Using narrative analysis methods, this study analyses nine interviews with elective public officials at district and village levels, combined with several secondary techniques. In drawing its conclusions, this study highlights three major findings to understand the failure of government in addressing corruption, each of which is related to 1) critical role of public legitimacy built upon informal norms; 2) strict bureaucratic function built upon formal norms; 3) cleavages between formal and informal norms that encourage public officials to enact one or both types of corruption. Above all, the idea of ‘private gain’ as the central element of corruption cannot be found in this study. Ultimately, this study provides some direction for future research that would suggest academia and policymakers to better understand the corruption in the public sector by taking informal norms into consideration.

Bakgrund: Preoperativ förberdelse möjliggör barns trygghet och förhindrar oro och rädsla inför elektiv kirurgi. Barn har rätt till information och bör få den anpassad efter ålder och mognad. Föräldrars involvering i förberedelsen är avgörande för barns delaktighet. Som teoretisk referensram för studien användes Känsla av sammanhang-KASAM.  Syfte: Syftet var att belysa föräldrars upplevelser av möjligheterna för barns delaktighet i den proeperativa förberedelsen inför elektiv kirurgi. Metod: Studien genomfördes med kvalitativ ansats och utfördes genom enskilda intervjuer. Analysen utfördes enligt Graneheim och Lundmans modell för kvalitativ innehållsanalys. Resultat: Föräldrarnas upplevelser resulterade i tre kategorier; Behovet av den preoperativa informationen, Strategier för att förbereda och skapa delaktighet samt HInder för att skapa delaktighet, med sex tillhörande underkategorier.  Slutsats: Preoperativ information och förberedelse skiljs åt utifrån vilken information och förutsättningar barn och föräldrar får. Informationen bör vara barnanpassad med möjlighet för barnet att begripa, hantera och uppleva en meningsfullhet med förberedelsen. Genom tydligare grundläggande information i ett tidigt skede kan förutsättningarna för barns delaktighet öka. / Bakground: Preoperative preparation enables children´s sense of security and prevents from anxiety and fear prior to elective surgery. Children have the right to information and ought to get it adjusted to thier age and maturity. Parents´ participation in preparation is crusial for children´s involvement. As theoretical framework for the study Sence of coherence-SOC was used. Aim: Elucidate parents´ experiences of the possibilities of involving children in the preoperative preparation prior to elective surgery. Method: The study was performed with a qualitative approach and was conducted through individual interviews. The analysis was conducted according to Graneheim and Lundmans model for qualitative content analysis. Result: The parents´ experiences resulted in three categories; The need of the preoperative information, Strategies to prepare and create involvement along with Obstacles to create involvement. Conclusion: Preoperative information and preparation differs based on what kind of information and circumstances parents and children have. The information ought to be child adjusted with an opportunity for the child´s comprehensibility, manageability and experience a meaning with the preparation. By stronger foundational information in an early stage the conditions for children´s involvement can be enhanced.

This research is an archival case study examining Helen B. Landgarten’s art therapy practice as observed in a videotaped, early stage, art therapy session with a child with elective mutism. This art therapy session is transcribed, analyzed, and given context by research questions drawn from Landgarten’s 32 journal articles published between 1973 and 2001. These journal articles are chronologically presented in the literature review in a manner resembling an annotative bibliography, familiarizing the reader with Landgarten’s writings and art therapy practice as she progressed through stages in her professional life.