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Distal radius fracture (DRF) is one of the most common fall-related osteoporotic (OP) fracture and is an early predictor of subsequent falls and OP fractures among people with DRF. The majority of older people with DRF present with low bone mineral density (BMD) and there is often transition to reduced muscle strength, poor balance, fear of falling and physically inactive lifestyle after fall-related DRF. This thesis consists of three manuscripts which are aimed to explore the recovery patterns and the role of modifiable risk factors in predicting subsequent falls, OP fractures and BMD in patients with DRF. The first manuscript explores the recovery patterns in modifiable risk factors for falls and OP fractures over four years in patients with DRF. Our study findings showed that patients with DRF experienced both short-term (6 months) and long-term (4 years) improvement in fracture specific pain/disability, physical activity, fear of falling, BMD and general health status; although the majority of the recovery was achieved at six months after DRF. The second manuscript is a cross-sectional study identifying modifiable risk factors for BMD in patients with DRF. The unaffected hand grip strength was identified as the independent predictor of BMD explaining 17% and 12% of total variability in the BMD-femoral neck and BMD-total hip, respectively. Among age-stratified women with DRF, balance and unaffected hand grip strength were identified as independent determinants of BMD explaining 10% and 32% of the total variability in BMD-femoral neck among 50-64 year and 65-80 year old, respectively. The third manuscript is a longitudinal study identifying modifiable risk factors for subsequent falls and OP fractures at four years after DRF. The results suggest that nearly 24% of patients reported one or more subsequent falls (in the last six months) and 19% of patients experienced at least one subsequent OP fracture after DRF. Patients with poor balance, low BMD, fracture specific pain/disability of >81 points on patient-rated wrist evaluation questionnaire and presence of a prior history of multiple falls (≥2) had three times higher odds of subsequent falls. When adjusted for BMD, age and gender, only prior falls was identified as a significant independent predictor of subsequent falls. We were not fully powered to explore association of various modifiable and non-modifiable risk factors with subsequent fractures. However, we found that patients with osteopenia or osteoporosis had clinically four times higher odds of subsequent OP fractures than patients with normal BMD. / Thesis / Doctor of Philosophy (PhD) / Wrist fractures are the most common fall-related fragility fractures and often an early indicator of future falls and fractures. This thesis project described recovery patterns in various risk-factors at 4-years after wrist fracture and explored their association with bone mineral density (BMD) and subsequent falls and fractures. We found that the majority of recovery in fracture-specific pain/disability, fear of falling and health-status takes place within six months, although small changes were also noted between 6 months-4 years. People with low unaffected hand grip-strength might have low BMD. Furthermore, people with poor balance, greater fracture-specific pain/disability, osteopenia or osteoporosis and a prior history of multiple falls (≥2) had nearly 3 times higher odds of secondary falls and those with osteopenia or osteoporosis had 4 times higher odds of a secondary fracture. We believe this information will help therapists/clinicians to identify people at risk of future falls/fractures and offer preventive services.

The diploma thesis is focused on the marketing strategy of QMI's Health prevention center. The aim of the study is to make a situation analysis, through its own research to assess consumer attitudes to health and health care, evaluate opportunities and threats arising from the marketing environment and to define on the basis of the results achieved for the development strategy of health prevention centers. The theoretical part deals with theoretical background of strategic marketing, its specifics in the health care, marketing environmental analysis, market and consumer decision-making motives. It describes the legislative framework and the importance of health prevention in public health care. The practical part presents the concept and mission of the QMI's Health prevention center. It deals with the survey of consumer attitudes, application of theoretical knowledge in situation analysis and attempts to explain the current strengths, weaknesses, opportunities and threats arising from the marketing environment. The main contribution of the thesis is a detailed situation analysis, application of knowledge gained from research and defining the marketing strategy for the development of Health prevention center.

Neoplastic diseases are considered as one of the most frequented reasons of death among the world population. A prophylaxis of these diseases should be a part of life of each one human. A theoretical part of this work deals with classification of particular types of prevention in the way of how to divide the prevention into primary, secondary, thertiary and quarteriary prevention. An empiric part of the work addresses two aims: To find how the Czech population is informed about the prevention of cancer diseases and to research how nurses advise their patients on the prophylaxis of those diseases. There was used a combination of a qualitative and a quantitative survey for the dissertation. The quantitative form of survey was based on an inquiry of sample of Czech Republic's population. This surge was aimed for finding out the knowledge about a prevention of cancer diseases among this population. There, in this part of th survey, was used an originally created questionnaire. The qualitative survey aimed for founding out how nurses provide the information about a prophylaxis of neoplastic diseases. Results of this inquiry have displayed that the majority of nurses strive to provide their patients with the complex information, either on their own or in the collaboration with a physician. Next, there was proved that nurses consider the most important form of a patient's education is a verbal communication with the patient; under the terms of this kind of education is the patient provided by appropriate information. Results of the inquiry display among others that the public awareness of a neoplastic-diseases' prevention is relatively high, nonetheless, there is still a space for an improvement in this way. A contribution of this work is characterized through its output an article. The article involves a summary of knowledge which has been gained using survey of this work. These pieces of knowledge could get contributive for work of nurses, nursing and paramedical staff as well as for student of nurse schools.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This dissertation aims at reflecting, from a historical-conceptual theoretical framework of medicalization and history of mental health care, how this phenomenon has advanced as part of general health care, also represented by the growth of population use of medication, particularly about the psychopathologies and mental health care in our society, at last the paper performs an analysis of practices and actions of mental health care at a psychosocial attention network, infering how much the medicalizing and de-medicalizing practice is present in the services and care provided, also evaluating how much the phenomenon is harmful/beneficial to practices and care in health. This work is characterized by being a bibliographical review of seminal articles, mainly focused on national authors, being characterized as a strategic health research.The conceptual framework of medicalization goes from the most orthodox criticism to the imperial power of medicine over lives, through Foucault's concept about the process of medicalization being part of the building of State as we know it, until even contemporary thinkers who study the process of de-medicalization and quaternary prevention in health. The mental health care historical investigation shows us how psychopathologies stand out of the socialaté exclusion as a model of psychiatry and mental health care free and was reinserted into the community, being this the brazilian bet originated from the Democratic Italian Psychiatry purpose, having Franco Basaglia as its biggest mentor. We move then to an analysis of how the process of medicalization influences health in general with a quantitative perspective to the growth in the use of medication and qualitative to the amplification of what is disorder and mental illness, to a more detailed analysis of how intrinsic health actions and practices are medicalizing. A final positive aspect of this paper is to always look for an analysis of how much the processes of medicalization and society's loss of autonomy can be broken, also considering that for some health conditions the advance of the biomedic view to care was very important. As a conclusion, this study points to the positive aspects of medicalization, the need for greater exploitation of mental health care, the potential for building autonomy that it brings, and that the pharmaceutical sciences have much to contribute in this field of knowledge. / Esta Dissertação tem por objetivo refletir como a medicalização influencia no cuidado em saúde, em especial na saúde mental. Partindo de um arcabouço teórico histórico-conceitual da medicalização e histórico do cuidado em saúde mental, e analisando como este fenômeno avançou dentro dos cuidados em saúde de uma maneira geral, representado inclusive pelo aumento do uso de medicamentos pela população, mas em especial sobre a loucura e o cuidado em saúde mental da nossa sociedade, por fim o trabalho realiza uma análise das práticas e ações de cuidado em saúde mental em uma rede de atenção psicossocial, inferindo o quanto a prática medicalizante e desmedicalizante esta presente nos serviços e cuidados prestados, sem deixar de avaliar porém o quanto o fenômeno é prejudicial/benéfico para práticas e cuidados em saúde. Este trabalho se caracteriza por ser uma revisão bibliográfica de artigos seminais, principalmente focada em autores nacionais, sendo caracterizado como uma pesquisa estratégica em saúde. O arcabouço conceitual da medicalização vai desde as críticas mais ortodoxas ao poder imperial da medicina sobre as vidas, perpassando pelo conceito de Focault de que o processo de medicalização fez parte inclusive da construção do Estado como conhecemos, até a pensadores contemporâneos que pensam o processo de desmedicalização e de prevenção quaternária em saúde. Já a viagem histórica de cuidado em saúde mental nos mostra como a loucura sai da exclusão social até um modelo de psiquiatria e cuidado em saúde mental em liberdade e reinserido na comunidade, sendo esta a aposta brasileira com origem a partir da proposta de Psiquiatria Democrática Italiana, sendo Franco Basaglia o grande mentor. Partimos então para uma análise de como o processo de medicalização influencia na saúde de uma maneira geral com um olhar quantitativo para o aumento de uso de medicamentos e qualitativo para a ampliação do que é transtorno e doença mental, chegando até uma análise mais esmiuçada de como as ações e práticas de saúde intrínsecas são medicalizantes. Um aspecto positivo final deste trabalho é sempre buscar uma análise do quanto o processo de medicalização e de perca de autonomia da sociedade pode ser quebrado, sem esquecer que para algumas condições de saúde foi de grande importância o avanço do olhar biomédico para o cuidado. Como conclusão este trabalho a ptona aspectos positivos da medicalização, necessidades de exploração maior do cuidado em saúde mental, pelo potencial de construção de autonomia que o mesmo traz e que as ciências farmacêuticas tem muito a contribuir neste campo do conhecimento. / São Cristóvão, SE

Die vorliegende Arbeit befasst sich mit der Prävention psychischer Erkrankungen bei Kindern und Jugendlichen. Sie verbindet fünf Publikationen. Wird zunächst die besondere Eignung von Schule als Setting zur Förderung psychischer Gesundheit erörtert, verdeutlicht eine systematische Übersichtsarbeit den Bedarf in diesem Bereich, und stellt die Bedeutung einer Kombination von Informationsvermittlung und direktem Kontakt mit Betroffenen heraus. Im zweiten Teil der Arbeit werden sowohl qualitative wie auch quantitative Evaluationen von Interventionen des Leipziger Vereins \"Irrsinnig Menschlich e.V.\" vorgestellt. Zum einen wurden Schüler, Lehrer und Eltern der Projektschulen des \"Schulcoach\"-Projekts in Fokusgruppen und mittels Fragebögen befragt, welche Entwicklungen diese spezielle Form der systemischen Betreuung angestoßen hat und welchen Einfluss die Schulcoaches auf die Rolle der psychischen Gesundheit im Schulalltag nahmen. Des Weiteren werden Schüler mittels einer qualitativen Fokusgruppen-Erhebung gezielt nach der äußeren Gestaltung, der thematischen Ausrichtung und dem Nutzungsverhalten von eigens gestalteten Informationsmaterialien, den \"Info-Pocket-Guides\", befragt. Die Ergebnisse dieser Evaluationen werden schließlich vor dem Hintergrund des Eingangs dargestellten Bedarfs diskutiert.:1. Bibliographische Beschreibung 2. Einführung 2.1. Die Prävalenz psychischer Störungen und ihre Auswirkungen 2.2. Psychische Gesundheit bei Kindern und Jugendlichen 2.3. Die Rolle der Schule als Setting für präventive Maßnahmen 2.4. Ziele dieser Arbeit 3. Schule als Setting zur Prävention psychischer Störungen: Chancen, Perspektiven und Beispiele guter Praxis 4. School-based prevention programs for depression and anxiety in adolescence: a systematic review 5. Übergang 6. Die Förderung psychischer Gesundheit in der Schule durch Schulcoaches: Evaluation eines Modellprojekts in Sachsen 7. Do \"School Coaches\" make a difference in school-based mental health promotion? – Results from a large focus group study 8. Info-Pocket-Guides als Beitrag zur Prävention psychischer Erkrankungen: Wie bewerten SchülerInnen Inhalt, Design und Nutzen? 9. Diskussion 10. Zusammenfassung 11. Literaturverzeichnis I. Danksagung II. Erklärung über die eigenständige Abfassung der Arbeit III. Curriculum Vitae IV. Publikationen

Student health consists of several professions that together build a team with several professions. The team works to promote students' mental and physical health. The goal for student health is that all participating professions work together to ensure that all students feel involved, valuable and motivated to achieve the official school goals. Depending on how well this teamwork operates, it can either be an enabling or hindering factor for the student's participation in school activities. This study aims to investigate how a student health team can best work to create the sense of context that the school requires both by law and its required values. The study is based on two popular science books about health and unhealthiness in school and a fiction book with a "case description" of two teenage girls from different psychosocial environments feeling mentally ill. The results of the study show that student health teams can function well as there is a clear structure and determination among all participating professions. Some issues the popular science books discussed were the need to focus on health promotion and to provide adequate time for the required preventive work. A further development of this study is recommended to gain an understanding of the individual thoughts in student health and thereby make a comparison with the study that we have done through our interpretation of the literature.

Background: Police officers are at high risk for mental and physical health problems and suicidal ideation. The specific risk factors are numerous and concern stressful missions and administrative aspects of the police profession. So far, the police get only little training on specific missions as well as on coping with stress and suicidal ideation in the police profession. In this study we test the efficacy of the online training COPS (Coping with Suicide) for police officers. Methods: A total of 142 police officers fromGermany and Switzerland participated in the study; complete data (baseline and post) are available from 102 participants. The training consisted of three modules covering the topics of delivering death notifications, dealing with individuals with suicidal ideation and dealing with one’s own distress and suicidal ideation in the police profession. The primary outcomes are perceived knowledge and self-rated competence regarding the contents of the program, actual knowledge as well as symptoms of depression and anxiety (PHQ-9), and attitudes toward suicide (ATTS). The data are collected at baseline and after completing the training. Results: We found a significant increase in knowledge as well as in perceived competence after completing the training. Mental health and attitudes toward suicide did not change significantly. Years on the job had no moderating effect on the effectiveness of the training. Discussion: The results suggest that a short e-learning program significantly improves knowledge and self-rated competence in delivering death notifications, in suicide prevention and stress management. It can be easily integrated into the daily routine of police-officers, and participants could participate at their own pace and from any location. One limitation of this study is the lack of a control-group. Further advantages and limitations of this study are discussed.

Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 7 uppsatser.

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