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Många attityder och förutfattade meningar existerar inom vårdkedjan kring patienter med alkoholproblematik. Syftet med denna litteraturstudie är att undersöka sjuksköterskors och läkares attityder gentemot patienter med alkoholproblematik. Dessutom kommer orsaker och effekter till attityderna belysas. Metoden är en systematisk litteraturstudie med tio kvantitativa och två kvalitativa studier. Resultatet innehöll tre av författarna identifierade teman: kunskap & utbildning, interventioner och mötet & stigmatisering. Under temat kunskap & utbildning visade det sig att ökad kunskap och mer utbildning innebar en positiv förändring av hälso- och sjukvårdspersonalens attityder gentemot patienter med alkoholproblematik. Under temat interventioner visades inget entydigt resultat av effekten, men följande områden utgjorde hinder vid genomförandet av interventioner har identifierats; kunskap, utbildning, attityder, arbetsmiljö, tid- och resurser. Temat mötet & stigmatisering visade komplexiteten i mötet, sett ur både patientens och hälso- och sjukvårdspersonalens perspektiv. Författarnas slutkommentarer är att sjuksköterskor är en outnyttjad resurs i vården av patienter med alkoholproblematik och för att öka kunskapen behövs det mer utrymme för ämnet alkohol under sjuksköterskeutbildningen. / Many attitudes and preconceived opinions exist among the health care system, about patients with complex alcoholproblems. The object with this literature study is to examine the attitudes of nurses and doctors towards patients with complex alcoholproblems. The reasons and effects caused by those attitudes will also be illustrated. The method is a systematic literature study with ten quantitative and two qualitative studies. The result includes three by the authors identified themes: knowledge & education, interventions and meeting & stigmatization. In the theme knowledge & education the results demonstrated that increased knowledge and education lead to a positive change of the health personnels attitudes towards patients with complex alcoholproblems. In the theme intervention it didn’t demonstrate any unambiguous result of the effect, but following obstacles have been identified; knowledge, education, attitudes, work environment, time, and resources. The theme meeting and stigmatization showed the complexity in the meeting, from the perspective of both the patient and the health personnel. The writers final comments are that nurses are an unexploited resource in the care of patients with complex alcoholproblems and to increase the knowledge, the need for more space for the subject alcohol is required in nursing education.

Hintergrund: Der Artikel berichtet Ergebnisse einer kontrollierten Studie zu Effekten einer Minimalintervention in der Wartezeit auf Beginn einer ambulanten Psychotherapie. Methoden: 75 Personen, die sich in einer universitären Verhaltenstherapieambulanz aufgrund von Angst- oder depressiven Störungen anmeldeten, wurden parallelisiert nach Alter, Geschlecht und Diagnose zwei Bedingungen zugeordnet. Die Versuchsgruppe (VG) erhielt während der Wartezeit auf den Behandlungsplatz bibliotherapeutische Materialien; die Kontrollgruppe (KG) wartete ohne Intervention. Vor und nach der Wartezeit wurden Einstellungen und Erwartungen zur Behandlung, nach der Wartezeit zusätzlich die Zufriedenheit mit der behandelnden Einrichtung sowie das Hilfesuchverhalten während der Wartezeit erhoben. Ergebnisse: Es konnten keine global positiven Effekte der Wartezeitintervention nachgewiesen werden. Es fanden sich lediglich zwei grundlegende Gruppenunterschiede: Die Teilnehmer der VG beurteilten sich subjektiv als besser vorbereitet auf Wartezeit und Therapie, und ihre Angst vor Stigmatisierung hatte sich signifikant reduziert. Weiterführende Analysen in einzelnen Patientengruppen ergaben zusätzlich Hinweise darauf, dass Angstpatienten und Patienten mit geringem Vorwissen mehr von der Maßnahme profitierten; allerdings traten bei einigen Patienten mit depressiven Störungen auch negative Effekte durch die Minimalintervention auf. Schlussfolgerung: Die Befunde erlauben eine differenziertere Bewertung der Frage, ob und in welcher Form unspezifische minimale Interventionen während der Wartezeit auf Psychotherapie nutzbringend sind. Weiterführende Studien sollten die differenzielle Wirksamkeit spezifischerer Maßnahmen in ausgewählten Patientengruppen prüfen. / The article describes a controlled study that explores effects of a minimal intervention for outpatients waiting for their behavior therapy to start. Methods: Patients applying for psychotherapy for anxiety disorders or depression at an outpatient psychotherapy unit, matched for age, sex and diagnosis, were assigned to either a waiting list as usual (WL) or to an active waiting group (AW) that received bibliotherapeutic materials. Attitudes towards treatment and therapy expectations were assessed before and after waiting time; consumer satisfaction and help-seeking behavior during the waiting time were assessed post waiting. Results: After the waiting time, the two groups differed only in their fear of stigmatization, which had significantly declined in the AW group, and in the subjective preparedness for waiting list and treatment. Additional analyses regarding different patient groups suggested that especially patients with anxiety disorders and patients with little knowledge about psychotherapy benefited from the intervention; on the other hand, some patients with depressive disorders reported negative effects due to the minimal intervention. Conclusions: Findings point out the need for a more sophisticated evaluation of minimal interventions for patients waiting for psychotherapy. Further studies should clarify the differential effectiveness of custom-tailored interventions addressing specific patient populations. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Hintergrund: Der Artikel berichtet Ergebnisse einer kontrollierten Studie zu Effekten einer Minimalintervention in der Wartezeit auf Beginn einer ambulanten Psychotherapie. Methoden: 75 Personen, die sich in einer universitären Verhaltenstherapieambulanz aufgrund von Angst- oder depressiven Störungen anmeldeten, wurden parallelisiert nach Alter, Geschlecht und Diagnose zwei Bedingungen zugeordnet. Die Versuchsgruppe (VG) erhielt während der Wartezeit auf den Behandlungsplatz bibliotherapeutische Materialien; die Kontrollgruppe (KG) wartete ohne Intervention. Vor und nach der Wartezeit wurden Einstellungen und Erwartungen zur Behandlung, nach der Wartezeit zusätzlich die Zufriedenheit mit der behandelnden Einrichtung sowie das Hilfesuchverhalten während der Wartezeit erhoben. Ergebnisse: Es konnten keine global positiven Effekte der Wartezeitintervention nachgewiesen werden. Es fanden sich lediglich zwei grundlegende Gruppenunterschiede: Die Teilnehmer der VG beurteilten sich subjektiv als besser vorbereitet auf Wartezeit und Therapie, und ihre Angst vor Stigmatisierung hatte sich signifikant reduziert. Weiterführende Analysen in einzelnen Patientengruppen ergaben zusätzlich Hinweise darauf, dass Angstpatienten und Patienten mit geringem Vorwissen mehr von der Maßnahme profitierten; allerdings traten bei einigen Patienten mit depressiven Störungen auch negative Effekte durch die Minimalintervention auf. Schlussfolgerung: Die Befunde erlauben eine differenziertere Bewertung der Frage, ob und in welcher Form unspezifische minimale Interventionen während der Wartezeit auf Psychotherapie nutzbringend sind. Weiterführende Studien sollten die differenzielle Wirksamkeit spezifischerer Maßnahmen in ausgewählten Patientengruppen prüfen. / The article describes a controlled study that explores effects of a minimal intervention for outpatients waiting for their behavior therapy to start. Methods: Patients applying for psychotherapy for anxiety disorders or depression at an outpatient psychotherapy unit, matched for age, sex and diagnosis, were assigned to either a waiting list as usual (WL) or to an active waiting group (AW) that received bibliotherapeutic materials. Attitudes towards treatment and therapy expectations were assessed before and after waiting time; consumer satisfaction and help-seeking behavior during the waiting time were assessed post waiting. Results: After the waiting time, the two groups differed only in their fear of stigmatization, which had significantly declined in the AW group, and in the subjective preparedness for waiting list and treatment. Additional analyses regarding different patient groups suggested that especially patients with anxiety disorders and patients with little knowledge about psychotherapy benefited from the intervention; on the other hand, some patients with depressive disorders reported negative effects due to the minimal intervention. Conclusions: Findings point out the need for a more sophisticated evaluation of minimal interventions for patients waiting for psychotherapy. Further studies should clarify the differential effectiveness of custom-tailored interventions addressing specific patient populations. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Este estudo comparou o desempenho clínico de dois métodos minimamente invasivos: químico-mecânico [Carisolv®-MediTeam (MQ-M)] e mecânico [Tratamento Restaurador Atraumático (MM-ART)] no tratamento restaurador da cárie dentária. Os métodos foram testados, aleatoriamente, em 50 pares de lesões cariosas similares de dentes permanentes, usando o modelo de estudo \"boca-dividida\", em 50 gestantes (2º trimestre). As variáveis operatórias avaliadas foram: eficácia e eficiência do grau de remoção do tecido cariado, aceitabilidade das voluntárias e percepção dos operadores. Todos os preparos cavitários foram restaurados com cimento de ionômero de vidro de alta viscosidade (Ketac Molar/3M ESPE), usando a técnica restauradora do ART. As restaurações foram avaliadas por dois examinadores calibrados e independentes, seguindo os critérios do ART, após 1 e 4 anos, sendo o nível de concordância interexaminadores de 0,97 e 0,89, respectivamente. Os dados foram submetidos aos testes estatísticos: correlação linear de Pearson, qui-quadrado, \'t\' Student, Fischer, Wilcoxon e intervalo de confiança (IC)95% (p<0,05). Para eficácia, eficiência e aceitabilidade ambos os métodos não apresentaram diferença estatisticamente significante entre si. Em relação à percepção dos operadores foi observada diferença estatisticamente significante a favor do MQ-M. O grau de sucesso das restaurações no grupo do MM-ART foi de 97,6% (IC=87,4-99,9%) após o 1º ano de avaliação e de 84,2% (IC=66,5-92,5%) após o 4º ano. No grupo do MQ-M, 100% (IC=91,8-100%) e 87,2% (IC=72,6-95,7%) das restaurações foram consideradas sucesso no 1º e 4º anos de avaliação, respectivamente. Quanto ao grau de sucesso das restaurações, diferença estatisticamente significante não foi observada entre os métodos após 1 ano (p=0,49) e 4 anos (p=0,75). Conclui-se que ambos os métodos apresentaram boa eficácia, eficiência e aceitabilidade para o tratamento de gestantes. Operadores reportaram maior facilidade técnica no MQ-M do que no MM-ART. Os dois métodos minimamente invasivos não influenciaram no desempenho clínico das restaurações ionoméricas realizadas pela técnica restauradora do ART após 1 e 4 anos. / This study compared the clinical performance of two minimally invasive restorative treatment methods: chemo-mechanical [Carisolv(TM)-MediTeam (CM)] and mechanical [Atraumatic Restorative Treatment (ART)] for managing dental caries. Using a split-mouth design, the methods were tested randomly in 50 matched pairs of permanent teeth. A total of 50 pregnant women (2nd trimester of pregnancy) were treated. The outcome variables were: efficacy and efficiency of caries removal, acceptability and perception of the methods by pregnant women and operators. In both methods, the cavities were restored using the ART approach with high-viscous glass ionomer cement (Ketac Molar/3M ESPE). The restorations were evaluated by 2 calibrated independent examiners according to ART criteria, after 1 and 4 years. The inter examiner kappa was 0.97 and 0.89, respectively. Pearson correlation, 95% Confidence Interval and Student\'s, Chi-square, Fischer\'s and Wilcoxon tests were used for data analysis (p<0.05). The results showed there were no significant differences for efficacy and efficiency of carious dentin removal, as well as for patients\' acceptability, using both methods. A statistically significant difference regarding the feasibility of techniques in favour of the CM method was observed. In the ART method, 97.6% (CI=87.4-99.9%) of the restorations were judged to be successful at 1 year and 84.2% (IC=66.5-92.5%) at 4 years. The 1 and 4-year success for CM method was 100% (CI=91.8-100%) and 87.1% (CI=72.6-95.7%), respectively. The success rate for both methods was not statistically significant after 1 (p=0.49) and 4 (p=0.75) years. It is concluded from the results that both methods showed good efficacy, efficiency and acceptability in treating of the pregnant women. Operator\'s data revealed the CM method as being a more feasible approach than ART. The two minimal intervention restorative approaches showed similar performance after 1 and 4 years in pregnant women.

Este estudo comparou o desempenho clínico de dois métodos minimamente invasivos: químico-mecânico [Carisolv®-MediTeam (MQ-M)] e mecânico [Tratamento Restaurador Atraumático (MM-ART)] no tratamento restaurador da cárie dentária. Os métodos foram testados, aleatoriamente, em 50 pares de lesões cariosas similares de dentes permanentes, usando o modelo de estudo \"boca-dividida\", em 50 gestantes (2º trimestre). As variáveis operatórias avaliadas foram: eficácia e eficiência do grau de remoção do tecido cariado, aceitabilidade das voluntárias e percepção dos operadores. Todos os preparos cavitários foram restaurados com cimento de ionômero de vidro de alta viscosidade (Ketac Molar/3M ESPE), usando a técnica restauradora do ART. As restaurações foram avaliadas por dois examinadores calibrados e independentes, seguindo os critérios do ART, após 1 e 4 anos, sendo o nível de concordância interexaminadores de 0,97 e 0,89, respectivamente. Os dados foram submetidos aos testes estatísticos: correlação linear de Pearson, qui-quadrado, \'t\' Student, Fischer, Wilcoxon e intervalo de confiança (IC)95% (p<0,05). Para eficácia, eficiência e aceitabilidade ambos os métodos não apresentaram diferença estatisticamente significante entre si. Em relação à percepção dos operadores foi observada diferença estatisticamente significante a favor do MQ-M. O grau de sucesso das restaurações no grupo do MM-ART foi de 97,6% (IC=87,4-99,9%) após o 1º ano de avaliação e de 84,2% (IC=66,5-92,5%) após o 4º ano. No grupo do MQ-M, 100% (IC=91,8-100%) e 87,2% (IC=72,6-95,7%) das restaurações foram consideradas sucesso no 1º e 4º anos de avaliação, respectivamente. Quanto ao grau de sucesso das restaurações, diferença estatisticamente significante não foi observada entre os métodos após 1 ano (p=0,49) e 4 anos (p=0,75). Conclui-se que ambos os métodos apresentaram boa eficácia, eficiência e aceitabilidade para o tratamento de gestantes. Operadores reportaram maior facilidade técnica no MQ-M do que no MM-ART. Os dois métodos minimamente invasivos não influenciaram no desempenho clínico das restaurações ionoméricas realizadas pela técnica restauradora do ART após 1 e 4 anos. / This study compared the clinical performance of two minimally invasive restorative treatment methods: chemo-mechanical [Carisolv(TM)-MediTeam (CM)] and mechanical [Atraumatic Restorative Treatment (ART)] for managing dental caries. Using a split-mouth design, the methods were tested randomly in 50 matched pairs of permanent teeth. A total of 50 pregnant women (2nd trimester of pregnancy) were treated. The outcome variables were: efficacy and efficiency of caries removal, acceptability and perception of the methods by pregnant women and operators. In both methods, the cavities were restored using the ART approach with high-viscous glass ionomer cement (Ketac Molar/3M ESPE). The restorations were evaluated by 2 calibrated independent examiners according to ART criteria, after 1 and 4 years. The inter examiner kappa was 0.97 and 0.89, respectively. Pearson correlation, 95% Confidence Interval and Student\'s, Chi-square, Fischer\'s and Wilcoxon tests were used for data analysis (p<0.05). The results showed there were no significant differences for efficacy and efficiency of carious dentin removal, as well as for patients\' acceptability, using both methods. A statistically significant difference regarding the feasibility of techniques in favour of the CM method was observed. In the ART method, 97.6% (CI=87.4-99.9%) of the restorations were judged to be successful at 1 year and 84.2% (IC=66.5-92.5%) at 4 years. The 1 and 4-year success for CM method was 100% (CI=91.8-100%) and 87.1% (CI=72.6-95.7%), respectively. The success rate for both methods was not statistically significant after 1 (p=0.49) and 4 (p=0.75) years. It is concluded from the results that both methods showed good efficacy, efficiency and acceptability in treating of the pregnant women. Operator\'s data revealed the CM method as being a more feasible approach than ART. The two minimal intervention restorative approaches showed similar performance after 1 and 4 years in pregnant women.

The project follows two previous semesters when the analysis of river Svitavy in Brno was elaborated together with colleagues Lenka Gulačovou and Zdeňka Sedláková. It dealt with the river's values and potential problems and subsequent recovery. Important aspect of the thesis is that it does not have the traditional form of urban study. The project extends into the theoretical plane, which is dedicated to the waterfront, the river in an urban environment and in particular to the issues of brownfields, that are substantial for the area of Svitava river. For this work I chose a site located close to the northern edge of the city (Obřany, Maloměřice, Husovice). Three sites are selected, their central motifs are islands and brownfields. Both of these phenomena have their values, problems, but also large potential. At selected locations (Obřany, Maloměřice, Husovice) I try to illustrate the options that are presented in the form of interventions. Selected locations continually follow each other and are connected by a series of interventions that improve the quality of the space.

Made available in DSpace on 2016-04-26T20:21:04Z (GMT). No. of bitstreams: 1 Glaucio Roberto Brittes de Araujo.pdf: 993084 bytes, checksum: 6295e6d1a3544f78c9d40729765efd96 (MD5) Previous issue date: 2012-07-01 / This area, are exposed some misconceptions of the legislature in relation to parental bids, as inflation punitive scattered through legislation, rather than simple point releases enough of the Penal Code, such as the advance of the barriers of penal intervention, with the characterization of negligible preparatory acts and conduct abstract and remotely related to the possibility of injury to the interest protected at the expense of the principles of minimum intervention and injury; as the equivalence between an attempt and completion, to the detriment of the principles of culpability and proportionality, as the autonomous classification conduct that would configure as an attempt to more serious crimes or who were under the Penal Code, as over crimes of abstract danger and formal, as the adoption of open standards and penal rules too criminal blank inadequate to achieve the principle of legality, in the form of legal reserve and taxativity; as the pain of penalties for similar infractions of gravity substantially different in relation to injury to the legal and housed, without due attention to the principle of proportionality, and as the criminalization of conduct that could be curbed by Administrative Law sanctioning or intervention, reserving and prestige to the application of prison sentences, depending on the primary functions assigned to it in our times, serious injury or threat to the relevant legal right under the constitutional prism, without yielding to the temptation of building a Symbolic Criminal Law. Eventually, assuming a minimum functionalism, considers it is appropriate to outline the contours of the criminal action, as ultima ratio, but effective, in the area of bid and contract administration in a model of itself guarantees the democratic rule of law, in its dual meaning, ie, the guarantor of both fundamental human rights, as an efficient protection of legal interests relevant to all citizens, in the terms that had been sheltered by the Constitution / Nesta sede, são expostos alguns equívocos do legislador pátrio em relação às licitações, como a inflação punitiva, mediante legislação esparsa, ao invés de simples e suficientes atualizações pontuais do Código Penal; como o adiantamento das barreiras da intervenção penal, com a tipificação despicienda de atos preparatórios e de condutas abstrata e remotamente relacionadas à possibilidade de lesão do interesse tutelado, em detrimento dos princípios da intervenção mínima e da lesividade; como a equiparação entre tentativa e consumação, em prejuízo dos princípios da culpabilidade e da proporcionalidade; como a tipificação autônoma de condutas que já configurariam tentativa de delitos mais graves ou que estariam previstas no Código Penal; como o excesso de crimes de perigo abstrato e formais; como a adoção de tipos demasiadamente abertos e normas penais em branco, inadequada à concretização do princípio da legalidade, na forma de reserva legal e taxatividade; como a cominação de sanções semelhantes para infrações de gravidade substancialmente distinta, em relação à lesão ao bem jurídico albergado, sem a devida atenção ao princípio da proporcionalidade; e como a criminalização de condutas que poderiam ser coibidas pelo Direito Administrativo Sancionador ou de Intervenção, reservando e prestigiando a aplicação de penas privativas de liberdade, consoante as funções primordiais que lhe são atribuídas hodiernamente, para graves lesões ou ameaças a bem jurídicos relevantes, sob o prisma constitucional, sem ceder à tentação da construção de um Direito Penal Simbólico. Por fim, assumindo um funcionalismo mínimo, reputa-se conveniente esboçar os contornos da intervenção penal, como ultima ratio, mas eficaz, na seara de licitações e contratos administrativos, em um modelo de garantias próprio do Estado Democrático de Direito, na sua dúplice acepção, ou seja, garantidor tanto dos direitos fundamentais da pessoa humana, como de uma proteção eficiente dos bens jurídicos relevantes para todos os cidadãos, nos termos em que foram albergados pela Constituição Federal