京都大学 / 新制・課程博士 / 博士(医学) / 甲第25182号 / 医博第5068号 / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 西浦 博, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Thesis (M.S.)--University of Missouri--Columbia, 2004. / "May 2004." Typescript. Includes bibliographical references (leaves 27-30). Also available on the Internet.

The thesis is devoted to the issue of involuntary hospitalization in the field of psychiatry. Involuntary psychiatric hospitalization is accompanied by a wide range of ethical issues and practical problems. In the theoretical part of the thesis I describe the involuntary hospitalization from several different points of view. I pay attention to international conventions and documents relating to the issue, reveal the historical roots of involuntary hospitalization, compare the situation in different European countries and mention some important judicial decisions concerning the involuntary admission of a person. Using a comprehensive approach I map all the important aspects of this sensitive area in health care provision. In the research part, using both - the quantitative and the qualitative approach, I offer a more detailed look at two selected aspects surrounding the involuntary hospitalization. The first part of the research is focused on the subjective experiences of involuntarily admitted patients. 88 patients participated in the research. These patients described their perception of coercion, the possibility or impossibility of influencing decisions about hospitalization and subsequent treatment, the level of autonomy and emotional experience. The second part of the research is aimed at...

The thesis is devoted to the issue of involuntary hospitalization in the field of psychiatry. Involuntary psychiatric hospitalization is accompanied by a wide range of ethical issues and practical problems. In the theoretical part of the thesis I describe the involuntary hospitalization from several different points of view. I pay attention to international conventions and documents relating to the issue, reveal the historical roots of involuntary hospitalization, compare the situation in different European countries and mention some important judicial decisions concerning the involuntary admission of a person. Using a comprehensive approach I map all the important aspects of this sensitive area in health care provision. In the research part, using both - the quantitative and the qualitative approach, I offer a more detailed look at two selected aspects surrounding the involuntary hospitalization. The first part of the research is focused on the subjective experiences of involuntarily admitted patients. 88 patients participated in the research. These patients described their perception of coercion, the possibility or impossibility of influencing decisions about hospitalization and subsequent treatment, the level of autonomy and emotional experience. The second part of the research is aimed at...

Thesis (Ph. D.)--RAND Graduate School, 1998. / Includes bibliographical references (p. 241-258).

Thesis (M.S.)--University of Missouri--Columbia, 2004. / Typescript. Includes bibliographical references (leaves 27-30). Also available on the Internet.

My thesis deals with the influence of leisure time activity on psychological state and quality of life of hospitalized child. In theoretical part there is presented historical development of the view of illnes, hospitalization and leisure time, further the theoretical part deals with the concept of quality of life focusing on quality of life of hospitalized. Practical part includes quality research focusing on importance of leisure time activities of hospitalized children, options of leisure time and its influence on psychological state and quality of life of hospitalized child. Analysis of interviews with parents of hospitalized children seeks to answer the research questions:the extent to which leisure time activities are provided on wards and if, or how much are beneficial for hospitalized child, quality of its life and its psychological state.

Made available in DSpace on 2016-12-23T14:38:01Z (GMT). No. of bitstreams: 1 Dissertacao.pdf: 1242933 bytes, checksum: 6176e371eb60d735f23132dcf866d4fa (MD5) Previous issue date: 2007-09-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Child hospitalization may bring about psychological problems, such as depression and stress due to routine changes and invasive procedures. It is worth, then, identifying the hospitalization coping strategies, emphasizing the playing as a facilitator of the child adjustment to the hospital setting. The psychological assessment in the hospital environment implies in controlling several variables; and it is made easier by means of IT based resources. This research analyzed the hospitalization coping strategies and playful activities by means of IT instruments. Twenty-eight (28) children (20 boys; aged 6-12) admitted to a public hospital in the city of Vila Velha/ES and their parents were subjects of this research. They answered the Child Behavior Checklist (CBCL, aged 6-18) as well as provided data about the routine of their children who in turn answered Hospitalization Coping IT Based Instruments (AEHcomp), with 20 facilitating and non-facilitating hospitalization scenarios, in addition to the IT Based Assessment of Playing Activities in the Hospital (ABHcomp), with 20 playful activities. Data about pathologies and hospital admissions was gathered. Seventeen (17) children were referred to in the CBCL. The plays chosen most often (ABHcomp) were: watching TV (average = 3,4) and playing minigame (average = 3,0), supported by nonexplanatory answers (50,2%) or by the play context (19,6%). The AEHcomp, presented more facilitating answers to the hospitalization (average = 1,8), such as talking (100%) and taking medicine (100%), than non-facilitating (average = 0,9), as being sad (71,4%) and crying (75%). Among 13 coping strategies, rumination (28,6%) and distraction (20,1%) were the most common. There were no correlations between behavioral problems prior to the hospitalization and nonfacilitating behaviors. There was a significant correlation of facilitating behaviors only related to age and routine changes. This assessment may provide subsidies in intervention towards children, thus preventing emotional damages caused by the hospital setting. / A hospitalização infantil pode desencadear problemas psicológicos, como depressão e stress, por mudanças acentuadas na rotina e exposição a procedimentos invasivos. É relevante, então, identificar as estratégias de enfrentamento da hospitalização, com ênfase no brincar como facilitador da adaptação da criança. A avaliação psicológica no hospital implica controlar diversas variáveis, sendo facilitada pela informática. Esta pesquisa analisou as estratégias de enfrentamento da hospitalização e atividades lúdicas preferidas, por instrumentos informatizados. Participaram 28 crianças (20 meninos; 6-12 anos) internadas em hospital público de Vila Velha/ES e seus pais. Estes responderam o Child Behavior Checklist (CBCL 6-18 anos) e dados da rotina das crianças, que responderam instrumentos de Avaliação Informatizada do Enfrentamento da Hospitalização (AEHcomp), com 20 cenas facilitadoras e nãofacilitadoras da hospitalização, e Avaliação Informatizada do Brincar no Hospital (ABHcomp), com 20 atividades lúdicas. Obtiveram-se dados sobre patologias e internações. Foram referidas como clínicas 17 crianças na Escala de Síndromes do CBCL. As brincadeiras mais escolhidas (ABHcomp) foram: assistir TV (média = 3,4) e minigame (média = 3,0), justificadas por respostas não-explicativas (50,2%) ou pelo contexto da brincadeira (19,6%). No AEHcomp, houveram mais respostas 17 facilitadoras à hospitalização (média = 1,8), como conversar (100%) e tomar remédio (100%), do que não-facilitadoras (média = 0,9), como ficar triste (71,4%) e chorar (75%). Entre 13 estratégias de enfrentamento, ruminação (28,6%) e distração (20,1%) foram mais freqüentes. Não houve correlações entre problemas de comportamento anteriores à hospitalização e comportamentos nãofacilitadores. Houve correlação significativa dos comportamentos facilitadores somente com a idade e com as mudanças na rotina. Esta avaliação pode subsidiar intervenções com crianças, prevenindo danos emocionais gerados pela hospitalização.

This dissertation involved linking a clinical cystic fibrosis (CF) data registry with administrative databases to evaluate clinical, demographic, and geographical predictors of hospitalization in CF patients living in Ontario over a 10 year period. In addition, this work assessed the ability of administrative data to identify individuals with CF using the clinical registry as the reference standard. Sex was an independent predictor of hospitalization rates for individuals with CF. Females had a significantly higher hospitalization rate compared to males even after adjusting for important clinical factors suggesting that this finding is not simply due to worse CF disease. In those between 7 and 19 years of age, the adjusted hospitalization rate was 38% higher in females (rate ratio[RR] 1.38, 95% confidence interval [CI] 1.11-1.73). Similarly in those over the age of 19, females had a 30% higher hospitalization rate compared to males (RR 1.30, 95% CI 1.06-1.59). Other significant predictors associated with higher hospitalization rates in both age groups were lower lung function, worse nutritional status, pancreatic insufficiency, and the presence of CF-related diabetes. The presence of Burkholderia cepacia complex in the sputum was a significant predictor in those over the age of 19 years (RR 1.54, 95% CI 1.26-1.89). Distance to CF centre, community size and socioeconomic status were not significant predictors of hospitalization rates in either age group. There was no significant trend in hospitalization rates over time once rates were adjusted for markers of disease severity (p=0.08). Comparing administrative data with the CF registry data, administrative data captured hospitalizations more comprehensively. Despite CF being a specific diagnosis, health administrative databases alone were insufficient to reliably and accurately identify individuals with CF unless they had been hospitalized. The reason for the gender disparity seen within this dissertation is likely multifactorial. There may be differences in outpatient management between the sexes, hormonal influences may modulate disease severity causing higher hospitalization rates, and patient and provider-level influences may affect the decision to hospitalize a patient. Further research is needed in this area to elucidate the factors contributing to this gender gap.

The purpose of the present study was to assess patient improvement in a specific freestanding partial hospital. Improvement was assessed in two specific areas: 1) symptom reduction as measured by the Symptom Check List-90-Revised (SCL-90-R) and 2) social adjustment as measured by the Social Adjustment Scale Self-Report (SAS-SR) at admission, discharge and three month follow-up. In addition, improvement was assessed from two perspectives: 1) patient evaluation and 2) therapist evaluation. Results indicated that there was statistically significant improvement from admission to discharge on the SCL-90-R and the SAS-SR. This improvement was maintained from discharge to three month follow-up. Findings also revealed statistically significant improvement when analyzed from both the patient perspective and the therapist perspective.