La problématique du consentement éclairé en santé mentale demeure au coeur des préoccupations des cliniciens, médecins spécialistes et médecins experts. Le travail auprès des cérébrolésés ou des patients souffrant de troubles mentaux graves, tout comme les questions qui me sont adressées depuis près de 20 ans par les médecins spécialistes, juristes ou résidents en psychiatrie, m’ont amenée à y réfléchir davantage. J’ajouterais que le constat personnel d’une compréhension des comportements, attitudes, motivations et jugements des patients vulnérables qui s’est modifiée au fil des ans, et le constat de l’importance de la notion du consentement vs le flou de sa définition et la fragilité des paramètres établis pour l’évaluer et la définir ont ravivé cette réflexion. La présente étude n’a aucunement pour but d’élaborer quelque règle de conduite que ce soit, ni de définir ce que devrait être le consentement éclairé en psychiatrie, mais plutôt d’explorer les dilemmes éthiques et les questionnements cliniques auxquels sont confrontés les médecins psychiatres afin de raviver une réflexion éthique qui semble s’estomper au profit de procédures juridiques et administratives. / In the mental health field, the topic of informed consent has always been among the most important problems to address for clinicians and psychiatrists. My clinical work with head injured patients and patients with severe mental health disorder, as well as all the questions addressed by physicians, residents or lawyers for the last decade lead me to think about it more deeply. Moreover, the personal observation of cognitively impaired patients and the fact that the concept of informed consent is so present compared to the lack of parameters to assess it has lead me to think about it otherwise. This study does not pretend to lead the actions or clinical behaviour, nor as it pretend to find a better definition of the concept of informed consent. It is only a way to explore some aspects of the complexity and clinical difficulties over the legal and administrative frame in which the medical field is evolving.

<p>Isberg, A. & Lidén, S. (2008). <em>KASAM- livsfrågeformulär som intervention vid psykisk ohälsa. </em>Högskolan i Gävle; Institutionen för pedagogik, didaktik och psykologi.</p><p> </p><p>Tidigare studier visar samband mellan KASAM, Känsla av sammanhang och människors upplevda hälsa. Då psykisk ohälsa tenderar att öka växer behovet av hälsofrämjande åtgärder. I och med detta ville vi studera om KASAM- livsfrågeformulär kunde användas som intervention vid psykisk ohälsa. Studien utgår ifrån en kvalitativ ansats för att få en djupare förståelse för hur deltagarna tänker och känner. Fyra deltagare med psykisk ohälsa har fyllt i KASAM- livsfrågeformulär samt intervjuats med syfte att undersöka om KASAM- livsfrågeformulär inneburit en förändrad förståelse för deltagarnas livssituation. Resultatet visar att deltagarna upplevde att KASAM- livsfrågeformulär inneburit nya reflektioner över sig själv och sin livssituation.</p>

<p>The aim of this study was to identify factors associated with reporting incidents of sexual violence after seventy-two hours at the sexual assault service centre in Newcastle, KwaZulu-Natal. This descriptive study was based on retrospective analysis of 534 medical records of victims of sexual violence at the Newcastle hospital between 2005 and 2009. A data collection sheet was designed to extract information from three sources namely: the victims‟ hospital files, J88 forms and specific hospital forms that were completed for sexual assault victims. The collected data were entered into and processed for analysis using EPI INFO statistical package. Frequencies, means and standard deviations were calculated for the data set. Test of significance was also done using the Chi-square test and presented using odds ratios with 95% CI and p-value of &lt / 0.05. The victims‟ age range was 2-81years (mean= 18.84, &sigma / =13.25). Approximately 87% were female and 59.4% of the victims were aged 0-17 years. One in five victims (19.7%) was HIV positive, and most (74.4%) reported rape with vaginal penetration. Fifty-nine percent reported within 72 hours of being assaulted. The most common reason for delayed reporting (21.5%) was fear of the perpetrator. Most of the sexual assaults were committed by male (96%) and single perpetrator (90%). Nearly a third (32.4%) of the sexual violence occurred within intimate relationships and more than two-thirds (68%) knew the perpetrators. In all, 35% sustained injuries during the assault and a third (34.5%) reported the use of weapons during the assault. Nearly half of the victims (48.7%) were referred to hospital by their relatives who also accompanied them to the facility (42.1%). Of the 198 victims that were offered post-exposure prophylaxis (PEP), 87% collected the full 28-day course.</p>

Isberg, A. &amp; Lidén, S. (2008). KASAM- livsfrågeformulär som intervention vid psykisk ohälsa. Högskolan i Gävle; Institutionen för pedagogik, didaktik och psykologi.   Tidigare studier visar samband mellan KASAM, Känsla av sammanhang och människors upplevda hälsa. Då psykisk ohälsa tenderar att öka växer behovet av hälsofrämjande åtgärder. I och med detta ville vi studera om KASAM- livsfrågeformulär kunde användas som intervention vid psykisk ohälsa. Studien utgår ifrån en kvalitativ ansats för att få en djupare förståelse för hur deltagarna tänker och känner. Fyra deltagare med psykisk ohälsa har fyllt i KASAM- livsfrågeformulär samt intervjuats med syfte att undersöka om KASAM- livsfrågeformulär inneburit en förändrad förståelse för deltagarnas livssituation. Resultatet visar att deltagarna upplevde att KASAM- livsfrågeformulär inneburit nya reflektioner över sig själv och sin livssituation.

<p>The aim of this study was to identify factors associated with reporting incidents of sexual violence after seventy-two hours at the sexual assault service centre in Newcastle, KwaZulu-Natal. This descriptive study was based on retrospective analysis of 534 medical records of victims of sexual violence at the Newcastle hospital between 2005 and 2009. A data collection sheet was designed to extract information from three sources namely: the victims‟ hospital files, J88 forms and specific hospital forms that were completed for sexual assault victims. The collected data were entered into and processed for analysis using EPI INFO statistical package. Frequencies, means and standard deviations were calculated for the data set. Test of significance was also done using the Chi-square test and presented using odds ratios with 95% CI and p-value of &lt / 0.05. The victims‟ age range was 2-81years (mean= 18.84, &sigma / =13.25). Approximately 87% were female and 59.4% of the victims were aged 0-17 years. One in five victims (19.7%) was HIV positive, and most (74.4%) reported rape with vaginal penetration. Fifty-nine percent reported within 72 hours of being assaulted. The most common reason for delayed reporting (21.5%) was fear of the perpetrator. Most of the sexual assaults were committed by male (96%) and single perpetrator (90%). Nearly a third (32.4%) of the sexual violence occurred within intimate relationships and more than two-thirds (68%) knew the perpetrators. In all, 35% sustained injuries during the assault and a third (34.5%) reported the use of weapons during the assault. Nearly half of the victims (48.7%) were referred to hospital by their relatives who also accompanied them to the facility (42.1%). Of the 198 victims that were offered post-exposure prophylaxis (PEP), 87% collected the full 28-day course.</p>

La problématique du consentement éclairé en santé mentale demeure au coeur des préoccupations des cliniciens, médecins spécialistes et médecins experts. Le travail auprès des cérébrolésés ou des patients souffrant de troubles mentaux graves, tout comme les questions qui me sont adressées depuis près de 20 ans par les médecins spécialistes, juristes ou résidents en psychiatrie, m’ont amenée à y réfléchir davantage. J’ajouterais que le constat personnel d’une compréhension des comportements, attitudes, motivations et jugements des patients vulnérables qui s’est modifiée au fil des ans, et le constat de l’importance de la notion du consentement vs le flou de sa définition et la fragilité des paramètres établis pour l’évaluer et la définir ont ravivé cette réflexion. La présente étude n’a aucunement pour but d’élaborer quelque règle de conduite que ce soit, ni de définir ce que devrait être le consentement éclairé en psychiatrie, mais plutôt d’explorer les dilemmes éthiques et les questionnements cliniques auxquels sont confrontés les médecins psychiatres afin de raviver une réflexion éthique qui semble s’estomper au profit de procédures juridiques et administratives. / In the mental health field, the topic of informed consent has always been among the most important problems to address for clinicians and psychiatrists. My clinical work with head injured patients and patients with severe mental health disorder, as well as all the questions addressed by physicians, residents or lawyers for the last decade lead me to think about it more deeply. Moreover, the personal observation of cognitively impaired patients and the fact that the concept of informed consent is so present compared to the lack of parameters to assess it has lead me to think about it otherwise. This study does not pretend to lead the actions or clinical behaviour, nor as it pretend to find a better definition of the concept of informed consent. It is only a way to explore some aspects of the complexity and clinical difficulties over the legal and administrative frame in which the medical field is evolving.

Magister Public Health - MPH / The aim of this study was to identify factors associated with reporting incidents of sexual violence after seventy-two hours at the sexual assault service centre in Newcastle, KwaZulu-Natal. This descriptive study was based on retrospective analysis of 534 medical records of victims of sexual violence at the Newcastle hospital between 2005 and 2009. A data collection sheet was designed to extract information from three sources namely: the victims' hospital files, J88 forms and specific hospital forms that were completed for sexual assault victims. The collected data were entered into and processed for analysis using EPI INFO statistical package. Frequencies, means and standard deviations were calculated for the data set. Test of significance was also done using the Chi-square test and presented using odds ratios with 95% CI and p-value of <0.05. The victims' age range was 2-81years (mean= 18.84, σ=13.25). Approximately 87% were female and 59.4% of the victims were aged 0-17 years. One in five victims (19.7%) was HIV positive, and most (74.4%) reported rape with vaginal penetration. Fifty-nine percent reported within 72 hours of being assaulted. The most common reason for delayed reporting (21.5%) was fear of the perpetrator. Most of the sexual assaults were committed by male (96%) and single perpetrator (90%). Nearly a third (32.4%) of the sexual violence occurred within intimate relationships and more than two-thirds (68%) knew the perpetrators. In all, 35% sustained injuries during the assault and a third (34.5%) reported the use of weapons during the assault. Nearly half of the victims (48.7%) were referred to hospital by their relatives who also accompanied them to the facility (42.1%). Of the 198 victims that were offered post-exposure prophylaxis (PEP), 87% collected the full 28-day course. / South Africa

Made available in DSpace on 2018-06-04T19:14:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-05-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivo: Descrever os caminhos percorridos pelo portador da Síndrome do Olho Seco em busca da atenção integral do cuidado na saúde pelo Sistema Único de Saúde. O objeto de estudo foi construído a partir da contextualização do agravo no cenário mundial, inclusive no Brasil, do entendimento da doença como problema de saúde pública, bem como sob o ponto de vista da integralidade sistêmica, passando pelas políticas públicas, e da atenção integral do cuidado individual na saúde, incluindo os aspectos psicossociais. Método: Trata-se de uma pesquisa com abordagem qualitativa e de caráter exploratório que envolveu duas etapas: a teórico-conceitual e a empírica. Na primeira, foram utilizados trabalhos que abordam a temática deste estudo, incluindo uma pesquisa bibliográfica correspondente ao período de 2011-2015. Na segunda etapa, as ferramentas utilizadas foram: a realização de grupos focais e entrevistas semiestruturadas, e como suporte, o diário de campo. Os grupos focais, com a participação de usuários do Ambulatório de Doenças Externas e Córnea, portadores da Síndrome do Olho Seco, no intuito de conhecer os caminhos percorridos na busca por um cuidado integral. A “amostra” final para a análise constituiu-se de 14 participantes. As entrevistas semiestruturadas com gestores do Departamento de Oftalmologia para conhecer a dinâmica de funcionamento dos serviços, incluindo a da assistência psicossocial, e o médico oftalmologista, no que tange a assistência ao portador da Síndrome do Olho Seco pelo serviço estudado. O diário de campo foi o instrumento utilizado para o registro sobre o reconhecimento do cenário da pesquisa, bem como outros acontecimentos no decorrer do estudo, inclusive durante os grupos focais e entrevistas semiestruturadas. Este estudo foi realizado num serviço universitário ligado ao Departamento de Oftalmologia de uma Escola Médica vinculada a uma Universidade Federal. Resultados: quanto à análise da empiria, pode-se afirmar que o cuidado em saúde ao portador da Síndrome do Olho Seco está aquém do princípio da integralidade. Tanto na gestão, quanto no cuidado, o Sistema Único de Saúde apresenta lacunas que incidem sobre a qualidade de vida do portador do agravo. Considerações: Por fim, este estudo propõe algumas ações que visam tornar o SUS mais acessível ao portador da Síndrome do Olho Seco, inclusive sugerindo a aproximação do Departamento de Oftalmologia com a rede básica, a integração entre os serviços de psicologia/psicoterapia, de assistência social e de oftalmologia clínico-cirúrgica, e, no serviço estudado, o incentivo para a formação de grupo de apoio com portadores do agravo em parceria com a Associação dos Portadores de Olho Seco, entidade tida como porta-voz dos portadores desse agravo para a população brasileira, por meio de ações que realiza. / Objective: Describing the paths covered by the Dry Eye Syndrome patient in search of the integral attention of health care by the Unified Health System (SUS). The object of study was constructed from the contextualization of the disease in the world scenario, including in Brazil, the understanding of the disease as a public health problem, as well as from the point of view of systemic integrality, through public policies, and the integral attention of individual health care, including psychosocial aspects. Method: This is a research with a qualitative and exploratory approach that involved two stages: the theoretical-conceptual and the empirical. In the first one, papers which approach the theme of this study were used, including a bibliographical research corresponding to the period of 2011-2015. In the second stage, the tools used were the observance of focal groups and semi-structured interviews, and as support, the field diary. The focal groups, with the participation of users of the Outpatient Clinic of External Diseases and Cornea, with Dry Eye Syndrome, in order to know the paths covered in the search for integral care. The final sample for the analysis consisted of 14 participants. The semi-structured interviews with managers of the Department of Ophthalmology to know the dynamics of the functioning of the services, including psychosocial assistance, and the ophthalmologist, regarding the assistance to the bearer of Dry Eye Syndrome by the service studied. The field diary was the instrument used to register the recognition of the research scenario, as well as other events during the study, including during focus groups and semi-structured interviews. This study was carried out in a university service linked to the Department of Ophthalmology of a Medical School linked to a Federal University. Results: Regarding the empirical analysis, it can be affirmed that health care for patients with Dry Eye Syndrome falls short of the principle of integrality. In both management and care, the Unified Health System has gaps that affect the quality of life of people suffering from the disease. Considerations: Finally, this study proposes some actions aiming at making the SUS more accessible to the bearer of Dry Eye Syndrome, including suggesting the approach of the Department of Ophthalmology with the basic network, the integration between psychology / psychotherapy services, social care and clinical-surgical ophthalmology, and, in the service studied, the stimulus for the formation of a support group with patients with the disease in partnership with the Association of Carriers of Dry Eye, an entity considered as the spokesperson for those who suffer from this disease to the Brazilian population, through its actions. / BV UNIFESP: Teses e dissertações

Der Tagungsband enthält das Programm und die Abstracts des 26. Symposiums der Fachgruppe Klinische Psychologie und Psychotherapie der Deutschen Gesellschaft für Psychologie, veranstaltet an der Universität Potsdam vom 1. bis 3. Mai 2008. Etwa 450 Kongressteilnehmer präsentieren den aktuellen Forschungs- und Wissensstand der Klinischen Psychologie und Psychotherapie in Deutschland. Grußworte halten die brandenburgische Ministerin für Arbeit, Soziales, Gesundheit und Familie, Dagmar Ziegler, die Präsidentin der Universität Potsdam, Prof. Dr.-Ing. Dr. Sabine Kunst, sowie Prof. Dr. Michael Linden als Vertreter der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN). Zu den Themenschwerpunkten des Kongresses gehören Einflussfaktoren auf die psychische Gesundheit Älterer, Impulsivität, Schlaf- und Traumforschung in der Klinischen Psychologie, Behandlung von Essstörungen, Wirksamkeitsstudien psychischer Störungen des Kindes- und Jugendalters, Angst und Depression, Behandlung von Kriegs- und Folteropfern, Risiko- und Schutzfaktoren der Kindesentwicklung sowie Adipositas im Kindes- und Jugendalter. Außer den Vorträgen gibt es eine Präsentation von etwa 150 Postern. Zum Programm der Tagung gehört ebenso die Verleihung des Klaus-Grawe-Awards for the Advancement of Innovative Research in Clinical Psychology and Psychotherapy an Prof. Dr. Timothy J. Strauman von der Duke University (USA), die Verleihung der Nachwuchswissenschaftler- und Posterpreise sowie ein Pre-conference Workshop für Doktorandinnen und Doktoranden der Klinischen Psychologie zum Thema "Verhaltens- und Molekulargenetik".

Background: Adverse birth outcomes present a difficult and chronic challenge in Ontario, in Canada and in developed countries in general. Increasing proportions of preterm births, significant regional disparities and the high cost of treating all adverse birth outcomes have focused attention on explaining them and developing effective treatments. Methods: Birth outcomes and maternal characteristics for approximately 626,000 births, about 90% of births in 2005–2009, were linked to small geographic areas throughout Ontario. For each of four adverse outcomes: late preterm, moderate to very preterm, small for gestation age and still births, proportions of total births were calculated for the full province and for each small geographic area. Geographic hotspots of elevated rates were identified for each of the different adverse birth outcomes using the local Moran’s I statistic. Data for nine known ecologic and individual risk factors were then linked to the areas. Hierarchical regression analysis was used to model each of the outcomes for the full province and for dispersed local areas. The resulting models for the different outcomes were contrasted. Results: Significant geographic hotspots exist for each of the four outcomes. Hotspots for the different outcomes were found to be largely spatially exclusive. For like outcomes, predictive models differed markedly between local areas (i.e. local groups of hotspots) as well as between full-province and local areas. Ecologic level variables played a strong role in all models; the influence of individual level risk factors was consistently modified by ecologic risk factors except for small for gestational births. Conclusions: The finding of significant hotspots for different adverse birth outcomes indicates that certain geographic areas have aetiologies or patterns of predictors sufficient to create significantly elevated levels of particular outcomes. The finding that hotspots for the different adverse outcomes are largely exclusive implies that the aetiologies are specific; i.e., those that are sufficient to create significantly higher levels for one outcome do not also create significantly higher levels of others. The consistently strong role of ecologic level risk factors in modifying individual level risk factors implies that contextual characteristics are an important part of the aetiology of adverse birth outcomes. Differences in local area models suggest the existence of location-specific (rather than universal) aetiologies. The findings support the need for more careful attention to local context when explaining birth outcomes.