O presente estudo consistiu-se na avaliação clínica e aplicação de testes cognitivos, além da realização de ressonância magnética (RM), de 3 tesla, do cérebro, processada com a técnica de \"Voxel-based Morphometry\" (VBM) e \"Skull Strip\", e 18F-FDG PET -CT processado com \"Statistical Parametric Mapping\" (SPM8) e correção de volume parcial (PVELab), em idosos sem déficits cognitivos (CDR=0), com comprometimento cognitivo leve amnéstico (CCL) (CDR=0,5) e com Doença de Alzheimer leve (DA leve)(CDR de 0,5 a 1). Os objetivos foram comparar os padrões de neuroimagem estrutural e metabólica entre os grupos, assim como correlacionar alterações estruturais volumétricas da RM e alterações metabólicas cerebrais do PET-CT, a um teste funcional, o \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE), nessa mesma amostra. Cada um dos grupo 3 grupos, pareados por idade, contém 30 indivíduos, totalizando amostra de 90. Os resultados dos exames de Neuroimagens, divididos por comparações entre os grupos, e corrigidos pela escolaridade, foram considerados significativos todos os achados nos quais a significância corrigida for <= 0,05 (p-FWEcorr <= 0,05). No CCL x DA foi observado hipometabolismo Giro do Cíngulo à Direita. No grupo DA x CCL foram observados hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Esquerdo, Precuneus Direito e na parte inferior do Lobo Parietal Esquerdo. Na DA x Controle, utilizando-se pesquisa de área a priori e filtros gaussiano de 8mm e 4mm, foi observada redução estatisticamente significante quanto ao volume de substância cinzenta na Amígdala Esquerda e na Amígdala Direita. No PET - CT, da DA, em relação ao grupo controle foram observadas áreas de hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Direito e no Giro Temporal Medial Direito. Na correlação direta do IQCODE, na comparação DA x Controle, no PET - CT evidenciou-se hipometabolismo no Giro Fusiforme Direito. Em conclusão, os resultados das comparações entre os grupos foram semelhantes ao encontrado na literatura para fases iniciais (leves) da patologia e mostraram, ainda, uma tendência a um \"continuum\" do controle até a DA. Por outro lado à correlação do IQCODE no DA x Controle carece de comprovação por outros trabalhos e com outros constructos estatísticos / This study consisted in the clinical evaluation and application of cognitive tests, in addition to magnetic resonance imaging (MRI) of 3 Tesla, of brain, processed with the technique of \"Voxel-based Morphometry\" (VBM) and \"Skull Strip\", and 18F-FDG PET-CT processed by \"Statistical Parametric Mapping\" (SPM8) and partial volume correction (PVELab) in subjects without cognitive impairment (CDR = 0), with amnestic mild cognitive impairment (MCI)(CDR = 0.5) and with mild Alzheimer \'s disease (AD mild)(CDRs of 0.5 to 1). The objectives were to compare the patterns of structural and metabolic neuroimaging between groups, as well as correlate MRI\'s volumetric structural changes and PET-CT\'s metabolic brain with a functional test, the \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE) in this same sample. Each one of three groups, matched by age, contains 30 subjects, totaling 90. The test results of neuroimaging, divided by comparisons between groups, and corrected by education, were considered significant the findings that corrected significance is <= 0.05 (p-FWEcorr <= 0.05). In CCL x DA was observed hypometabolism right cingulate gyrus. In DA x CCL hypometabolism were observed in the left cingulate gyrus, the left precuneus, right precuneus and left inferior parietal lobe. In DA x Control, using the \"a priori\" research area and gaussian filters 8mm and 4mm was observed statistically significant reduction on the volume of gray matter in the left and right amygdala. In PET - CT of DA relative to control group were observed areas of hypometabolisms in left cingulate, right precuneus and in the right medial temporal gyrus. In direct correlation of the IQCODE, compared DA x Control on PET - CT revealed a hypometabolism in the right fusiform gyrus. In conclusion, the results of the comparisons between groups were similar to those found in the literature for early (mild) pathology and showed a \"continuum\" of control to the DA. On the other hand the correlation of the IQCODE in DA x Control lacks confirmation by other studies and other statistical constructs

<p>Старење становништва је велики изазов са којим се суочава светска популација у XXI веку. Становништво Војводине спада у веома старо становништво, а процењује се да ће до средине овог века чак свака трећа особа бити старија од 60 година. Циљ овог рада је био да се процени здравље, разлике у здрављу и коришћење здравствене заштите, као и да се идентификују предиктори&nbsp; здравља и коришћења здравствене заштите код особа старости 65 и више година на територији Војводине. Истраживање представља део Истраживања здравља становништва Србије из 2013. године које је спровело Министарство здравља Републике Србије. Истраживањем је обухваћено 886 испитаника старости 65 и више година са територије Војводине. Инструмент истраживања су били упитници конструисани у складу са упитником Европског истраживања здравља, а подаци о телесној маси, телесној висини и крвном притиску су добијени мерењем. Резултати су показали да су имали већу шансу да процене своје здравље као лошије жене (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), сиромашни (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), испитаници са умереним до тешким ограничењима у обављању кућних активности (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), са присутним јаким болом (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), благим депресивним симптомима или депресивном епизодом (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), оболели од две или више хроничних болести (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) и испитаници са лошијом социјалном подршком (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Предиктори посете лекару опште медицине били су виши ниво образовања, боље материјално стање, веће издвајање из сопствених прихода за ванболничку здравствену заштиту и мултиморбидитет, док су чешће били хоспитализовани мушкарци, особе нижег нивоа образовања, испитаници који су процењивали своје здравље као лоше или веома лоше. Истраживање је потврдило да постоје значајне неједнакости у здрављу и коришћењу здравствене заштите код старих особа у Војводини, које је потребно смањити свеобухватним јавноздравственим политикама и интервенцијама.</p> / <p>Starenje stanovništva je veliki izazov sa kojim se suočava svetska populacija u XXI veku. Stanovništvo Vojvodine spada u veoma staro stanovništvo, a procenjuje se da će do sredine ovog veka čak svaka treća osoba biti starija od 60 godina. Cilj ovog rada je bio da se proceni zdravlje, razlike u zdravlju i korišćenje zdravstvene zaštite, kao i da se identifikuju prediktori&nbsp; zdravlja i korišćenja zdravstvene zaštite kod osoba starosti 65 i više godina na teritoriji Vojvodine. Istraživanje predstavlja deo Istraživanja zdravlja stanovništva Srbije iz 2013. godine koje je sprovelo Ministarstvo zdravlja Republike Srbije. Istraživanjem je obuhvaćeno 886 ispitanika starosti 65 i više godina sa teritorije Vojvodine. Instrument istraživanja su bili upitnici konstruisani u skladu sa upitnikom Evropskog istraživanja zdravlja, a podaci o telesnoj masi, telesnoj visini i krvnom pritisku su dobijeni merenjem. Rezultati su pokazali da su imali veću šansu da procene svoje zdravlje kao lošije žene (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), siromašni (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), ispitanici sa umerenim do teškim ograničenjima u obavljanju kućnih aktivnosti (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), sa prisutnim jakim bolom (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), blagim depresivnim simptomima ili depresivnom epizodom (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), oboleli od dve ili više hroničnih bolesti (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) i ispitanici sa lošijom socijalnom podrškom (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Prediktori posete lekaru opšte medicine bili su viši nivo obrazovanja, bolje materijalno stanje, veće izdvajanje iz sopstvenih prihoda za vanbolničku zdravstvenu zaštitu i multimorbiditet, dok su češće bili hospitalizovani muškarci, osobe nižeg nivoa obrazovanja, ispitanici koji su procenjivali svoje zdravlje kao loše ili veoma loše. Istraživanje je potvrdilo da postoje značajne nejednakosti u zdravlju i korišćenju zdravstvene zaštite kod starih osoba u Vojvodini, koje je potrebno smanjiti sveobuhvatnim javnozdravstvenim politikama i intervencijama.</p> / <p>Aging is the great challenge of the XXI century. Population of Vojvodina is very old, and projections indicate that by 2050 one in three persons will be older than 60 years. The aim of this study was to evaluate health, health differences and health care utilization, as well as to indentify predictors of health and health care utilization in people aged 65 and over in Vojvodina. The study represents part of the National health survey Serbia conducted in 2013 by the Ministry of Health of Republic of Serbia. Study included 886 examinees aged 65 and over who were interviewed on the territory of Vojvodina. The instruments were questionnaires designed according to the European Health Interview Survey questionnaire, and data on body mass, body height and blood pressure were measured. Results showed that the highest odds of assessing their health as poor had women (OR=2.14; 95%CI=[1.42-3.23]; p&lt;0.001), participants who belonged to the poor class (OR=2.92; 95%CI=[1.18-7.20]; p=0.020), who had difficulties with instrumental activities of daily living (OR=3.33; 95%CI=[1.28-8.69]; p=0.014), with severe pain (OR=2.81; 95%CI=[1.20-6.60]; p=0.017), with mild depressive symptoms or depressive episode (OR=8.90; 95%CI=[3.71-21.32]; p&lt;0.001), with 2 or more chronic conditions (OR=13.25; 95%CI=[4.05-43.3]; p&lt;0.001) and with poor social support (OR=3.00; 95%CI=[1.08-8.34]; p=0.035). Predictors of visits to general practitioner were higher educational level, affiliation to advantage classes, more out of pocket payment for outpatients health care, and multimorbidity, while the highest odds of hospitalization had males, participants who had low level of education, who assessed their health as poor or very poor. This study confirmed that there are significant differences in health and health care utilization in elderly in Vojvodina, which need to be reduced by comprehensive public health policies and interventions.</p>

O presente estudo validou para a Língua Portuguesa a escala de graduação do paciente com hidrocefalia de pressão normal (HPN) desenvolvida na Língua Inglesa como \"Grading scale for idiopathic normal pressure hydrocephalus\". Duas traduções independentes da escala de HPN foram feitas por médicos brasileiros, fluentes na Língua Inglesa. Após harmonização dessas, a tradução resultante foi retrotraduzida independentemente por dois outros médicos, que desconheciam a escala original. Seguiu-se a última tradução e revisão para a Língua Portuguesa por uma profissional tradutora da área da saúde. A comparação da versão final traduzida com a escala original foi realizada pelo comitê multiprofissional que não estava envolvido no processo de tradução, pontuando-se para item distúrbio de marcha: 0 ausente; 1 marcha instável, mas independente; 2 anda com um apoio; 3 anda com 2 apoios ou andador e 4 não é possível andar. No item demência: 0 ausente; 1 sem demência aparente, mas apático; 2 socialmente dependente, mas independente na residência; 3 parcialmente dependente na residência e 4 totalmente dependente. Incontinência Urinária: 0 ausente; 1 ausente, mas com polaciúria ou urgência miccional; 2 às vezes, apenas à noite e 4 frequente. Para obtenção da pontuação final, devem-se somar os itens, sendo que, quanto maior o escore final, maior comprometimento do paciente. O resultado foi pré-testado em um estudo-piloto. A versão final da escala de HPN para o Português, bem como as escalas de equilíbrio de Berg, índice de marcha dinâmica e \"timed up and go\" foram aplicadas simultaneamente em cento e vinte e um pacientes consecutivos com diagnóstico médico de hidrocefalia de pressão normal (setenta e três homens e quarenta e oito mulheres) que procuraram o Ambulatório de Hidrodinâmica Cerebral, da Divisão de Neurocirurgia Funcional do Instituto de Psiquiatria do Hospital das Clínicas de São Paulo da FMUSP, no período de julho de 2010 a março de 2012. Foram testadas as propriedades psicométricas do questionário, como confiabilidade e validade. A idade mediana foi de 71,09 anos (intervalo de 35 a 92 anos). O período médio de reteste para a escala de HPN foi de sete dias. Nenhuma alteração do formato original da escala foi observada no final do processo de tradução e adaptação cultural. O grau de concordância e reprodutividade foi alta, como demonstrado pela medida de concordância Kappa, com excelente correlação intraobservador para itens da escala de HPN individualmente avaliados: marcha (0,8), demência (0,90) e incontinência (0,87). Na análise interobservador, o resultado foi excelente, com item marcha (0,91), demência (0,86) e incontinência (0,87). A correlação entre a escala de HPN com as demais escalas foi considerada de moderada a satisfatória para a maioria dos itens, variando de -,069 a 0,55 na correlação de Pearson. A avaliação individual entre escalas sobre os itens incontinência urinária, demência e marcha foram também satisfatórias e estatisticamente significantes. A versão para o Português da escala de graduação do paciente com HPN foi traduzida e validada com sucesso para aplicação em pacientes brasileiros de ambos os sexos, apresentando satisfatória confiabilidade e validade / The current study validated to Portuguese language the graduation scale for patients with normal pressure hydrocephalus (NPH) developed on English language as \"Grading scale for idiopathic normal pressure hydrocephalus\". Two translations independent of NPH scale were done by Brazilian doctors, fluent on English language. After harmonization of both, the resulting translation was back-translated independently by two other doctors, that unaware to the original scale. Followed the last translation and revision to Portuguese language by a professional translator of health area. The comparison of last translated version with original scale was performed by one multiprofessional committee not involved on translation process. Was established specific punctuation to components of NPH classical triad, the punctuation to gait: 0 absent; 1 unstable gait, but independent; 2 walk with a support; 3 walk with 2 supports or walker an 4 is not possible to walk. On dementia item: 0 absent; 1 without apparent dementia, but apathetic; 2 socially dependent, but independent on resistance; 3 partial dependent on resistance and totally dependent. Urinary incontinence: 0 absent, 1 absent but with pollakisuria or urinary urgency, 2 sometimes, just at night; 3 sometimes even during the day and 4 frequently. The obtained final punctuation was given by summation of three items, and the higher the final punctuation, greater involvement of the patient. The result was pre-tested in a pilot study. The last version of NPH to Portuguese, as well the Berg balance scales, Dynamic Gait Index and \"timed up and go\" were applied simultaneously in 121 consecutive patients with medical diagnostic of normal pressure hydrocephalus (73 men and 48 women) who sought the Ambulatory of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas in Sao Paulo from FMUSP, on period July / 2010 to march / 2012. The psychometric properties, reliability and validity of questionnaire were tested. The mean age was 71,09 years, ranging from 35 to 92 years. The period of mean retest was 7 days. None change to the original format of the scale was observed at the end of the translation process and cultural adaptation. The rate of agreement and reproducibility was high, as confirmed by measure of agreement of Kappa, with excellent intra-observer correlation for NPH scale items individually evaluated: gait (0,80), dementia (0,90) and incontinence (0,87). The correlation between the NPH scale with the other scales was considered moderate to satisfactory for most items, ranging from - 069 to 0.55 in Pearson correlation. The individual evaluation between scales on the items on urinary incontinence, dementia and gait were also satisfactory and stistically significant. The Portuguese version of the graduation scale for patients with NPH was successfully translated and validated for use in Brazilian patients of both genders, with satisfactory reliability and validity

O presente estudo consistiu-se na avaliação clínica e aplicação de testes cognitivos, além da realização de ressonância magnética (RM), de 3 tesla, do cérebro, processada com a técnica de \"Voxel-based Morphometry\" (VBM) e \"Skull Strip\", e 18F-FDG PET -CT processado com \"Statistical Parametric Mapping\" (SPM8) e correção de volume parcial (PVELab), em idosos sem déficits cognitivos (CDR=0), com comprometimento cognitivo leve amnéstico (CCL) (CDR=0,5) e com Doença de Alzheimer leve (DA leve)(CDR de 0,5 a 1). Os objetivos foram comparar os padrões de neuroimagem estrutural e metabólica entre os grupos, assim como correlacionar alterações estruturais volumétricas da RM e alterações metabólicas cerebrais do PET-CT, a um teste funcional, o \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE), nessa mesma amostra. Cada um dos grupo 3 grupos, pareados por idade, contém 30 indivíduos, totalizando amostra de 90. Os resultados dos exames de Neuroimagens, divididos por comparações entre os grupos, e corrigidos pela escolaridade, foram considerados significativos todos os achados nos quais a significância corrigida for <= 0,05 (p-FWEcorr <= 0,05). No CCL x DA foi observado hipometabolismo Giro do Cíngulo à Direita. No grupo DA x CCL foram observados hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Esquerdo, Precuneus Direito e na parte inferior do Lobo Parietal Esquerdo. Na DA x Controle, utilizando-se pesquisa de área a priori e filtros gaussiano de 8mm e 4mm, foi observada redução estatisticamente significante quanto ao volume de substância cinzenta na Amígdala Esquerda e na Amígdala Direita. No PET - CT, da DA, em relação ao grupo controle foram observadas áreas de hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Direito e no Giro Temporal Medial Direito. Na correlação direta do IQCODE, na comparação DA x Controle, no PET - CT evidenciou-se hipometabolismo no Giro Fusiforme Direito. Em conclusão, os resultados das comparações entre os grupos foram semelhantes ao encontrado na literatura para fases iniciais (leves) da patologia e mostraram, ainda, uma tendência a um \"continuum\" do controle até a DA. Por outro lado à correlação do IQCODE no DA x Controle carece de comprovação por outros trabalhos e com outros constructos estatísticos / This study consisted in the clinical evaluation and application of cognitive tests, in addition to magnetic resonance imaging (MRI) of 3 Tesla, of brain, processed with the technique of \"Voxel-based Morphometry\" (VBM) and \"Skull Strip\", and 18F-FDG PET-CT processed by \"Statistical Parametric Mapping\" (SPM8) and partial volume correction (PVELab) in subjects without cognitive impairment (CDR = 0), with amnestic mild cognitive impairment (MCI)(CDR = 0.5) and with mild Alzheimer \'s disease (AD mild)(CDRs of 0.5 to 1). The objectives were to compare the patterns of structural and metabolic neuroimaging between groups, as well as correlate MRI\'s volumetric structural changes and PET-CT\'s metabolic brain with a functional test, the \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE) in this same sample. Each one of three groups, matched by age, contains 30 subjects, totaling 90. The test results of neuroimaging, divided by comparisons between groups, and corrected by education, were considered significant the findings that corrected significance is <= 0.05 (p-FWEcorr <= 0.05). In CCL x DA was observed hypometabolism right cingulate gyrus. In DA x CCL hypometabolism were observed in the left cingulate gyrus, the left precuneus, right precuneus and left inferior parietal lobe. In DA x Control, using the \"a priori\" research area and gaussian filters 8mm and 4mm was observed statistically significant reduction on the volume of gray matter in the left and right amygdala. In PET - CT of DA relative to control group were observed areas of hypometabolisms in left cingulate, right precuneus and in the right medial temporal gyrus. In direct correlation of the IQCODE, compared DA x Control on PET - CT revealed a hypometabolism in the right fusiform gyrus. In conclusion, the results of the comparisons between groups were similar to those found in the literature for early (mild) pathology and showed a \"continuum\" of control to the DA. On the other hand the correlation of the IQCODE in DA x Control lacks confirmation by other studies and other statistical constructs

A forma de tratar os pacientes pode ser ensinada não somente pela teoria e prática formais, mas principalmente pelas atitudes do mestre e pela relação médico paciente que ele estabelece. O principal objetivo deste trabalho é avaliar os efeitos positivos ou deletérios da visita médica em grupo ao leito dos pacientes da Enfermaria da Clínica Médica Geral pois ela pode melhorar ou piorar a ansiedade e a depressão já contidas e instaladas no paciente e testar um modelo de visita médica hospitalar que priorize o paciente enquanto sujeito. Estudaram-se 95 pacientes com idades entre 16 e 65 anos, divididos em três grupos: um com 36 pacientes chamado G0 que passa visita na enfermaria mas não discute à beira do leito; outro com 34 pacientes chamado G1 que passa visita na enfermaria e discute à beira do leito e um novo, experimental, com 25 pacientes chamado G2, com visita na enfermaria e nova forma de discutir ao leito, com participação ativa do paciente em seu processo de recuperação . O Método utilizado foi: todos os pacientes, na véspera da visita, foram submetidos à escala HAD para medir ansiedade e depressão e à parte pré-visita do Questionário de Avaliação da Internação do Paciente da Clínica Médica Geral (QAIPCMG). No dia da visita, após a mesma, reaplicou-se aos três grupos a escala HAD, a parte pós-visita do QAIPCMG , a qual contém um quadro de Sentimentos e Sensações a serem escolhidos como tendo sido sentidos pelos pacientes durante a visita médica, o Teste de Apercepção Temática - TAT, pranchas 1 e 15 e o Questionário Desiderativo. Os critérios de inclusão foram: pacientes com doenças crônicas menores e agudas maiores internados há mais de uma semana e não mais do que duas. Para a análise estatística utilizaram-se os testes: Qui quadrado e Kruskal Wallis. As medidas de ansiedade e depressão da escala HAD pré e pós visita não apresentaram diferenças estatisticamente significantes. O grupo experimental G2, que se apresentou, propôs ao paciente que se sentasse, não usou termos técnicos para discutir o caso, explicou quais eram as medidas propostas para continuar o tratamento, pediu sua autorização para realizar novos exames e procedimentos, olhou e ouviu suas colocações, obteve referências de alegria (p= 0,0009) e tranqüilidade (p= 0,0058) por parte dos pacientes, estatisticamente significantes quando comparados às respostas dos outros dois grupos. O grupo G2 referiu um número maior de aspectos positivos observados na visita médica, (p = 0,0186) se comparados aos grupos G0 e G1. Os testes psicológicos projetivos possibilitaram medir e analisar as capacidades de abstração e elaboração mental de 52% da amostra, apontando que, nos 3 grupos 37,68% dos pacientes, mostrou boa capacidade para elaborar o impacto da internação e da doença, porém 40% apresentou pouca capacidade para conter aspectos negativos de suas personalidades. Conclui-se que, se não se cuidar do que e como se fala, não olhando e ouvindo o paciente, considerando-o como sujeito, a visita médica pode ser iatrogênica. / How to treat patients is something that can be taught not merely by theory and formal practices, but mainly through the teacher’s attitudes and how the physician-patient relationship is established. The main goal of this paper is to assess positive or deleterious effects of a group medical visit to patients’ bedsides at Internal Medicine Infirmary, as visits can improve or worsen anxiety and depression already existing in patients and test a model for hospital medical visits which allocates priority to patients as subjects. 95 patients with ages between 16 and 65 were studied, divided into three groups: one with 36 patients called G0, visiting patients with no discussion at the bedside; another with 34 patients called G1, visited in the infirmary with discussions, and a new, experimental group with 25 patients called G2, with infirmary visits and a new mode of discussion by the bedside, with the patient’s active participation in the recovery process. The method used was: the day before the visit, all patients underwent the HAD scale to measure anxiety and depression and the pre-visit part of the Questionnaire to Assess Hospitalization. On the day of the visit, after the call, the HAD scale was once again applied to the three groups, and the after visit part of the Questionnaire, using the chart on Feelings and Sensations that are selected to reflect patients feelings during the visit, the Theme Apperception Test - TAT, diagrams 1 and 15 and the Desiderative Questionnaire. Inclusion criteria included: patients with minor or greater chronic diseases extending for more than a week, not exceeding two weeks. The following tests were used for statistical analysis: chi square and Kruskal Wallis. The HAD scale measurements of anxiety and depression before and after the visits did not present significant statistical differences. The G2 experimental group introduced itself and proposed to the patient that he/she sit, avoided using technical terms to discuss the case, explained the measures being set forth to continue treatment and requested authorization to carry out new tests and procedures, heard the patient’s comments, obtained references on happiness (p= 0,0009) and calmness (p= 0,0058) expressed by patients that were statistically significant when compared to the responses of the other two groups. Group G2 referred to a greater number of positive aspects observed in the medical visits, (p = 0,0186) when compared to groups G0 and G1. The projective psychological enabled the measurement and analysis of the capacity for abstraction and mental elaboration of 52% of the sample, demonstrating that in the 3 groups, 37,68% of the patients had a good ability to elaborate on the impact of hospitalization and the disease, whilst 40% had little capacity when it came to containing or controlling negative aspects in their personalities. The conclusion therefore is that if no caution is taken on how to speak to patients, if physicians do not look at and listen to patients, considering them as subjects, medical visits may be iatrogenic.

En röststörning kan sägas föreligga då rösten inte fungerar eller låter som den brukar så att det påverkar kommunikationen. Prevalensen för röststörningar uppskattas till omkring 6 % av den vuxna befolkningen. När rösten inte fungerar som den ska leder det till emotionella, sociala och funktionella svårigheter för individen och har negativ inverkan på livskvaliteten. Voice- Related Quality of Life (V-RQOL) är ett självskattningsformulär som mäter vilken inverkan en röststörning kan ha på individens livskvalitet. Detta instrument är internationellt välanvänt, men har inte funnits översatt till svenska. Syftet med föreliggande uppsats var att översätta och validera V-RQOL för en svensk population. Översättningen skedde genom så kallad back translation och den svenska versionen fick namnet Röstrelaterad livskvalitet (RRL). RRL och Rösthandikappindex (RHI) distribuerades i pappersformat till en röstpatientgrupp (n = 88) och en röstfrisk grupp (n = 110). Reliabiliteten av domänerna och samtliga tio påståenden på RRL var hög för patientgruppen med Cronbach’s alfa- värden från 0.82 till 0.90. Det fanns en tydlig relation mellan den självskattade röstkvaliteten och poängen på RRL och formuläret kunde även differentiera mellan röstpatienter och röstfriska. Dessa resultat indikerar att formulärets begreppsvaliditet är god. Pearson’s korrelationsanalys visade att det fanns en signifikant negativ korrelation mellan RRL:s och RHI:s domäner och totalpoäng. Detta starka samband mellan ”the gold standard”, RHI, och RRL innebär en god kriterierelaterad validitet för formuläret. Sammanfattningsvis visar resultaten att RRL har hög reliabilitet och god validitet, dessutom är formuläret kort vilket innebär en liten arbetsinsats. Formuläret anses därför vara ett pålitligt och värdefullt tillägg i den kliniska bedömningen av röststörningar. / A voice disorder can be said to exist when the voice does not work or sound as it normally should in a manner so that it interferes with communication. The prevalence of voice disorders is estimated to be about 6 % of the adult population. When the voice does not work as it should it may lead to emotional, social and functional difficulties for the individual and with negative effects on the quality of life. Voice- Related Quality of Life (V-RQOL) is a self-reporting questionnaire which measures the effect of a voice disorder on the quality of life of an individual. The instrument is frequently used internationally, but no Swedish translation has existed. In the present study, the purpose was to translate and validate V-RQOL for a Swedish population. The method for translating the questionnaire was back translation. The translated questionnaire was given the Swedish name Röstrelaterad livskvalitet (RRL). RRL and the Swedish version of The Voice Handicap Index, Rösthandikappindex (RHI), was distributed to a group of voice patients (n = 88) and a group of non-voice patients (n = 110). The reliability of the domains and the combined items of RRL was high according to Cronbach’s alpha with alpha values ranging from 0.82 to 0.90. There was a strong relation between the self–estimated voice quality and the scores on RRL, and the RRL- questionnaire was shown to differentiate between voice patients and non-voice patients. These results indicate that the construct validity of the questionnaire is good. Pearson’s correlation analysis demonstrated a significant negative correlation between the domains and total scores of RRL and RHI. This strong relation between “the gold standard”, RHI, and RRL proved that the criterion validity of the questionnaire is good. In summary the results show that RRL has a high reliability and good validity, in addition to this, the questionnaire is short and requires minimal work. The questionnaire is therefore considered to be a reliable and valuable addition to the clinical assessment of voice disorders.

Die Zielstellung der Arbeit besteht darin zu untersuchen, in welchem Umfang Motivation und Opferbereitschaft eines Unternehmers auf die Leistungskraft des Unternehmens wirken, und inwieweit demographische Faktoren wie Geschlecht und Alter die persönlichen Ansichten des Unternehmers, dessen Motivation, dessen Opferbereitschaft und die Start-up-Hürden beeinflussen. Im Weiteren geht es darum, die Bedeutung des Unternehmertums für die Wirtschaft zu analysieren, vor allem in den fünf neuen Bundesländern und insbesondere in Sachsen. Untersuchungsergebnisse in Bezug auf Persönlichkeitsmerkmale des Unternehmers im Zusammenhang mit dem Erfolg des eigenen Unternehmens werden vorgestellt. Es werden Hypothesen über den Zusammenhang zwischen Motivation, Opferbereitschaft und den Unternehmenserfolg aufgestellt und mit Methoden der mathematischen Statistik beurteilt. Schließlich werden die wesentlichen Merkmale eines Unternehmers beschrieben. Um statistische Analysen durchzuführen und tragfähige Aussagen zu gewinnen, wurden zuerst Fragebögen am mehr als 100 neugegründete Unternehmen verschickt. Im Rücklauf kamen 102 Fragebögen in die engere Auswertung. Es wurden zwei Faktorenanalysen mit SPSS durchgeführt, wobei hier insgesamt 35 erfasste Merkmale (mit jeweils 5 Merkmalsausprägungen) zur Unternehmensgründung eingegangen sind und 7 Faktoren für die weitere Betrachtung ausgewählt wurden: - Grad der Unabhängigkeit - Priorität der Familie - Grad der Selbständigkeit - Politische Entscheidungsmotive - Priorität des Unternehmens - Konfliktpotential - Risiken im Lebensunterhalt Mithilfe des Chi-Quadrat-Unabhängigkeitstests wurde abschließend der paarweise Zusammenhang jeweils zwischen einem der genannten 7 Faktoren und den zwei für die Zielgröße „Erfolg des Unternehmen“ ausgewählten Merkmale „Umsatzwachstum“ und „Kapitalrückfluss – Investition“ untersucht, um hier wesentliche Abhängigkeiten aufzudecken. / The purpose of this paper is to analyse the factors of successful entrepreneurship, whether or not age, sex or personal traits such as motivation and level of risk / sacrifice determine the outcome of business or if more external factors are the key drivers. Furthermore the research focusses on entrepreneurship in the New Laender, particularly Saxony, after the reunification and the importance for the economy in general. The research was done through interviews and mail-outs of questionnaires to more than 100 recently founded enterprises of which 102 replies were utilized in the final analyses. Hypotheses of potential correlation between personal traits and characteristics and success of business were analysed and tested using SPSS factor analyses. The SPSS analysis concentrated on 35 characteristics with 5 different values and an additional 7 factors: - Level of independence - Priority of family - Level of self-reliance - Political motivation in decision making - Priority of the business itself - Conflict potential - Level of risk taking Utilizing the ‚Chi-Square-Independence‘ - test further correlation analyses was performed to investigate the 7 factors and their individual relation / dependency with the two main characteristics Growth of Turnover and Return on Investment

The modern hospice movement emerged in the 1960s as a grassroots social movement that attempted to restore an holistic and contextualised approach to the care of people at the end of life. This approach embraced the lived experience of the dying person at the centre of care across physical, emotional, social and spiritual domains of life. To achieve this, the care of dying people was largely removed from mainstream health care systems to promote more holistic and socially contextualised dying. In recent decades, the evolution of palliative care demonstrates the gradual return of palliative care services to the mainstream. It has been asserted that, in this process, palliative care services have progressively abandoned the social context of dying people, increasing instead an emphasis on "physical care [while] simultaneously de-emphasizing psychological, social and spiritual care" (Kellehear, 1999a, p.76). Kellehear and others have proposed that the repositioning of palliative care within mainstream health care systems has increased a focus upon illness and disease at the expense of health and wellbeing. Subsequently, conventional palliative care services have been criticised for not adequately locating end of life care within the social contexts in which death and dying take place. In an attempt to address this problem, Australian sociologist Allan Kellehear proposed an approach to end of life care that brought together the core concerns of palliative care with the principles and practices of health promotion (Kellehear, 1999b). Whilst their congruence is not immediately apparent, these two fields have been increasingly examined for their potential benefits in the provision of end of life care. In the current policy climate in Australia, there is an imperative to consider how end of life support services might be improved through adopting a health promoting palliative care approach. The aim of this study has been to investigate the integration of health promotion principles and practice by a selected palliative care service by examining the qualitative impact of this change on the organisation. Specifically, it endeavoured to identify the factors that advanced or impeded this integration by examining how the structures and processes of, and outcomes for, the organisation reflected a health promoting approach. To meet these aims, this study undertook an in-depth examination of the implementation of a health promoting palliative care model by a community based palliative care organisation. Based in a constructionist-interpretivist paradigm, a mixed-method (QUAL+quant), instrumental case study research design was utilised to capture multiple perspectives of the implementation process. Data collection comprised examination of 127 organisational documents, 32 in-depth interviews with staff, volunteers and consumers, 5 focus groups with staff and volunteers, and 25 carer questionnaires. Qualitative data were subject to thematic analysis, with supplementary quantitative data analysed to generate descriptive statistics. The findings demonstrated a large number of complex and interrelated enabling and impeding factors to the implementation in the case study site. These factors have been grouped into four key themes which have been examined in light of the aims of this study and the issues identified in a comprehensive review of the literature. This study found that: ◦ Conceptual congruence between health promotion and palliative care was a fundamental starting point in the implementation of a health promoting palliative care model. ◦ Where conceptual congruence was clear, activities associated with the model that were regarded as beyond conventional approaches to palliative care core business were viewed favourably by stakeholders and were less likely to encounter resistance within the organisation. ◦ When systematic approaches to organisational change, such as quality improvement systems, were rigorously applied, the impact of the transition upon stakeholders was qualitatively less. ◦ Where this transition had been effectively made, consumers, staff, volunteers and members of the wider community were seen to benefit. This study adds to the current discourse regarding the intersection between end of life support and health promotion, and provides insight into how palliative care organisations might undertake the transition from conventional models to a health promoting palliative care approach.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 6 uppsatser.

This study investigated the factors, best practice, advantages and disadvantages that influence the use of radio frequency identification (RFID) self-help circulation services for service delivery by South African academic libraries with specific emphasis on the University of South Africa (Unisa) Library. Unisa Library Services is the only library service in South Africa that has implemented a fully-fledged RFID self-help circulation service. There must therefore be reasons why other libraries in South Africa have not implemented this type of service. Accordingly, a need was identified to investigate the aspects that should be considered before a library decides to implement such a circulation service. There was also a need to identify the factors, best practice, advantages and disadvantages that influence the use of RFID self-help circulation services. The study gives a brief overview of RFID technology and its use in libraries internationally with specific emphasis on its use for self-help circulation purposes. Through a literature study, certain factors, best practice, advantages and disadvantages that influence the use of RFID self-help circulation services were identified. The identified factors, best practice, advantages and disadvantages were subsequently used to compile questionnaires to obtain information from Unisa library users (students and staff). Only Unisa staff and students who were situated close to Unisa campuses with RFID self-help circulation services were included in the study. During the analysis of the data collected additional factors, best practice, advantages and disadvantages were identified. Recommendations were compiled regarding the factors, best practice, advantages and disadvantages that influence the use of RFID self-help circulation services. These recommendations are meant as a guide for South African libraries when making decisions on the possible implementation and use of RFID self-help circulation services. / Information Science / M.A. (Information Science)