Este estudo analisa o processo terapêutico da Medicina Homeopática, destacando a relevância de seus componentes na construção de um espaço interativo entre médicos e pacientes, capaz de propiciar novos sentidos para a compreensão do adoecimento e para a perspectiva da cura. As questões que motivaram o trabalho surgiram a partir de preocupações a respeito da insuficiência do tecnicismo da medicina atual para atender às expectativas dos sujeitos participantes das práticas de saúde. Discutimos que a centralidade da pessoa, no paradigma da Medicina Homeopática. ao privilegiar a situação de adoecimento dos pacientes, confere características específicas à sua abordagem, capazes de resgatar a dimensão do cuidado na ação terapêutica. Tomamos, como base empírica, duas unidades de saúde da cidade de São Paulo, onde foram realizadas entrevistas com médicos e pacientes, e colhidos depoimentos espontâneos que surgiram durante o atendimento clínico da autora. O material obtido foi trabalhado qualitativamente e permitiu identificar certos núcleos de sentidos, tais como, St~jeito, Pessoa, E-;cuta, Ver. Vinculo, Tempo, Cura e Medicamento, capazes de refletirem as dimensões essenciais, que traduzem a especificidade do processo terapêutico da Homeopatia. Através das narrativas de sujeitos da prática homeopática, pudemos evidenciar que a construção de um espaço de intersubjetividade, em que pacientes e médicos possam compartilhar a experiência do adoecer, permite introduzir a perspectiva do cuidado e a possibilidade de um projeto de recuperação da saúde. Tais aspectos foram considerados, ao buscarmos compreender a efetividade da Homeopatia, como prática terapêutica. Um desdobramento relevante deste estudo pode ser a análise dos fundamentos da legitimidade da Medicina Homeopática nas práticas de saúde, segundo critérios que preservem a identidade de sua episteme. / This study analyses the therapeutic process of Homeopathic Medicine. It highlights the relevance o f the components o f homeopathy in the construction o f an interactive setting between doctors and patients capable of providing the process o f becoming ill and the perspective o f cure with new meanings. Concems with respect to the insufficiencies of contemporary technological medicine in attending to the expectations and demands of subjects participating in health practices were the issues that motivated this research. The central position occupied by the person in the paradigm of Homeopathic Medicine is discussed. By granting a privileged position to the situation of becoming ill, specific characteristics are conferred to the approach in question, which enable it to redeem the dimension o f care to therapeutic action. Two health units in Sao Paulo City constitute the empírica! basis for the present study. Interviews with doctors and patients were carried out there, as well as clinicai consultations conducted by the author during the course of which spontaneous statements also emerged and were recorded. The material obtained was submitted to a qualitative analysis which led to the identification of certain nuclei of meaning such as, Subject, Person, Hearing, Looking, Bond, Time, Cure, Medication, capable of reflecting essential dimensions which translate the specificity ofthe homeopathic therapeutic process. The narratives of the subjects involved in homeopathic practice document the construction of an intersubjective setting, where patients and doctors may share the experience of becoming ill. Within this setting, it is possible to introduce the perspective of care and the possibility o f a project o f health recuperation. These aspects were taken into consideration when we strove to comprehend the effectiveness of homeopathy as a therapeutic practice. One of the relevant extensions of this project may be the analysis of the basis of legitimacy of Homeopathic Medicine on health care practices through criteria that preserve the identity of its epistemic.

Objetivou-se com o presente trabalho investigar as relações existentes entre dois espaços de \"cura\": o serviço local de saúde e a instituição religiosa, representada pelas várias Igrejas Pentecostais. A investigação, de corte qualitativo, baseou-se em depoimentos colhidos de sujeitos que frequentavam simultaneamente estes dois espaços de \"cura\". Concluiu-se que os dois espaços são usados conjuntamente e percebidos como nitidamente distintos. Através da análise dos depoimentos foi possível estabelecer uma série de categorias distintivas que permitem especificar as particularidades e diferenças entre o espaço racional científico e o espaço religioso, quando se trata de \"cura\". Concluiu-se também que os sistemas oficiais tem muito a aprender dos \"sistemas religiosos\" notadamente no que diz respeito ao caráter \"acolhedor\" destes últimos. / The objective of this work is to investigate the relationships between two \"cure\" spaces: the local health service and the religious institution represented here by several Pentecostal Churches. The qualitative section investigation was bas.ed on statements taken from people who attended the two \"cure\" spaces simultarieously. We concluded that the two spaces are used concurrently and understood as clearly distinct. Through the analysis of the statements it was possible to establish a series of different categories permitting to specify peculiarities and dissimilarities bet\\veen the -rational - scientific and the religious spaces when we refer to cure\". We have also concluded that the official systems have much to leam from \"religious systems\" especially when considering the \"welcoming\" character o f the latter ones.

Submitted by admin tede (tede@pucgoias.edu.br) on 2018-10-01T20:40:48Z No. of bitstreams: 1 Neldinei Faleiro de Siqueira.pdf: 389306 bytes, checksum: 66c35eabb74d07f22c2e892dbd725794 (MD5) / Made available in DSpace on 2018-10-01T20:40:48Z (GMT). No. of bitstreams: 1 Neldinei Faleiro de Siqueira.pdf: 389306 bytes, checksum: 66c35eabb74d07f22c2e892dbd725794 (MD5) Previous issue date: 2003-03-28 / It has a purpose to undestand the meaning therapy effects on religions rite to mothers who have children cecith serious illness, this when they are inside the hospital institution. To gighitht the facts are the comprehension of those religious rite in a critical moment in those mother’s life wich are emotional fragility, fears anguish and eagernes. They search for ansuceis in the “transcendent place” to settle doun the anguish with illness and the fear of death. Terrin (1998) expresses: in critical moments of life people search for religion, and in cases of illness this kind of search ain to oletain health, trealment and explanation to the suffering borh fisic and emotional for the potont and it’s family. Is has the objective to verify what the religious rite means to children’s motheres achem those children are in the hospital with serious ilness. The facts that were colected, were interoreted in it’s phenonenon methody wich goes furthes to describe the religious rite in desinty as well as sence. It has used remark techniques, studies and interveus well organized. It is established thar religious rites do settle down the fears, anguishand eagernes fron the mothers who deals with illnes. Religion has a poucerful meaning on this moments. / Tem–se como propósito compreender o efeito terapêutico do rito religioso, para as mães de crianças com doenças graves na instituição hospitalar. Destaca-se fatores para a compreensão do efeito desses ritos, em um momento crítico da vida dessas mães, em estado de fragilidade emocional com medos, angústias e ansiedades. Há a busca de respostas no “transcendente” para emenizar a angústia da doença e o medo da finitude (morte). Terrin (1998) expressa que nos momentos críticos da vida as pessoas buscam a religião, e no caso das doenças essa busca visa sobretudo a obtenção da saúde, cura, de respostas e explicações para o sofrimento físico e emocional do ser doente. Tem-se como objetivo geral verificar a ação terapêutica do rito religioso para as mães de crianças com doenças graves na instituição hospitalar. Os dados coletados, foram interpretados à luz do método fenomenológico, que além de descrever os ritos religiosos em sua densidade, os analisa em seu sentido. Utilizou-se como técnicas a observação participante, estudo de caso e entrevistas semiestruturadas. Constatou-se que no contexto hospitalar o rito religioso tem o efeito terapêutico de diminuir os medos, angústias e ansiedades das mães frente a doença. É que a religião tem uma força poderosa neste contexto.

Introdução: apesar do crescimento exponencial do interesse na pesquisa do zumbido, dos avanços científicos e do aprimoramento das técnicas terapêuticas observados nas duas últimas décadas, ainda é praticamente um consenso o fato da cura ser um objetivo inatingível. A ausência de estudos relativos à total remissão do zumbido e a escassez de discussões sobre o assunto revelam a descrença dos profissionais, o que funciona como reforço negativo para os pacientes que sofrem e almejam a cura. Objetivo: o presente estudo propõe a busca e a entrevista de indivíduos que já alcançaram a remissão total do zumbido para identificar possíveis características comuns do paciente, do zumbido ou do tipo de tratamento realizado. Método: Foram realizadas as seguintes estratégias de busca de participantes: 1) análise de banco de dados; 2) busca pelos parentes de pacientes que mencionam a cura; 3) divulgação da pesquisa em aulas ministradas a profissionais; 4) divulgação na internet. Foram incluídos os seguintes indivíduos: a) de qualquer sexo, idade, escolaridade ou nível socio-econômico; b) que tenham apresentado zumbido diariamente por pelo menos três meses em qualquer época da vida; c) que tenham apresentado remissão total do zumbido por pelo menos 6 meses; d) em casos de reaparecimento do zumbido, este deveria durar no máximo dois dias e ser desencadeado ou associado a algum evento claro. Foram excluídos os indivíduos que não responderam aos nossos contatos após três tentativas e aqueles que se encontravam em grau de habituação ou mascaramento do zumbido, mas que ainda o percebiam Resultados: a amostra final foi de 63 participantes. A idade variou de 14 a 89 anos (Média=52,69; Dp=16,33) e com predomínio do gênero feminino (68,25%). As características mais comuns do zumbido antes da remissão total foram: a) localização bilateral (52,31%); b) percepção diária de sons do tipo tom puro (57,14%); c) média de incômodo na escala visual analógica (0 a 10) de 7,57 e Dp 2,43, sendo 61,9% dos casos com incômodo alto (8 a 10) e apenas 22,22% sem limitação das atividades diárias; d) duração média de 49,07 meses (variância de 5.91), sendo 55,56% de casos crônicos (duração superior a 12 meses) e 44,44% de casos subagudos (duração de 4 a 12 meses). O número de tratamentos realizados até a remissão foi predominantemente de 0 a 2 (58,73%). O tipo de tratamento mais comum responsável pelo sucesso foi medicação (36,51%). Dentre os 57 dos 63 participantes que haviam realizado audiometria tonal, 47,62% tinham limiares normais. O tempo médio de remissão total do zumbido em meses foi de 92,03 (Dp 99,24). Conclusões: os pacientes que alcançaram remissão total do zumbido foram prioritariamente do gênero feminino, com percepção de sons do tipo tom puro, com nota de incômodo alta, audiometria normal bilateral e com poucas tentativas de tratamento. A localização (uni ou bilateral) e o tempo de duração do zumbido (subagudo ou crônico) não influenciaram a obtenção da remissão total. Apesar do incômodo alto e da repercussão na qualidade de vida da maioria dos pacientes, parece haver um subtipo de zumbido mais propenso à remissão total e duradoura com a instituição de um tratamento / Introduction: Despite the exponential growth of interest in tinnitus research, besides scientific advances and improvements in therapeutic techniques observed in last two decades, it is still a consensus that the total remission is an unattainable goal until now. The absence of studies on tinnitus remission and the scarcity of discussions on this subject reveal the practitioners\' disbelief, what represents a negative reinforcement for patients who suffer and seek the cure Objective: the present study proposes to search and interview individuals who have experienced the total remission of tinnitus in order to identify possible common features about patients, tinnitus or treatments. Method: The following strategies to search candidates were used: 1) database analysis; 2) search for the relatives of patients who mention the cure; 3) divulgation of the research in events for health professionals; 4) announcements on the web. The following individuals were included: a) of any gender, age, education or socioeconomic level; b) those who had tinnitus for at least three month period at any time of life; c) those who have presented tinnitus total remission for over 6 months; d) in cases of tinnitus recurrence, this should last no more than two days and had been triggered by some clear event. Subjects who did no respond to at least tree attempts of contact and those found in any degree of habituation or masking of tinnitus were excluded. The final sample was composed of 63 participants. The age varied from 14 to 89 years (mean = 52.69, SD = 16.33), female gender predominated (68.25%). The most common characteristics of tinnitus before remission were: a) bilateral location (52.31%); b) daily perception of a pure tone (57.14%); c) average score at visual analogue scale (0 to 10) of 7.57 and SD 2.49; 61.9% of cases with high discomfort (8 to 10) and only 22.22% without limitation of daily activities; d) average duration of 49.07 months (variance of 5.91), 55.56% of chronic cases (lasting more than 12 months) and 44.44% of subacute cases (duration of 4 to 12 months). The number of treatment attempts needed to reach total remission was 0 to 2 (58.73%). The most common type of treatment was medication (36.51%). Of the 57 participants who had tonal audiometry, 47.62% had normal thresholds. So far, the average duration of the total remission was 92,03 months (SD 99,24). Conclusions: patients who achieved total remission of tinnitus were primarily female, perceiving a tonal type of sound, with a high level of discomfort, with symmetrically normal audiometry and limited treatment attempts. The location (bilateral or unilateral) and duration of tinnitus (subacute or chronic) did not influence total remission. Despite of the severe repercussion on patient\'s quality of life, there seems to be a tinnitus subtype more prone to total and long-term remission after the institution of a certain treatment

As aplicações comerciais e científicas das resinas epoxídicas dependem diretamente da combinação entre resina/endurecedor/acelerador, tornando-o um sistema reativo bastante complexo, cuja determinação dos seus parâmetros de cura é um problema multivariável de tempo, temperatura e concentração de reagentes. É necessário o conhecimento de suas etapas de cura e de seu mecanismo cinético para obtenção das melhores propriedades mecânicas, elétricas e térmicas, com a finalidade de conseguir uma resina epoxídica de alto desempenho. As técnicas analíticas comumente empregadas na determinação da cura de resinas epoxídicas como também de diversas outras resinas poliméricas são: a calorimetria exploratória diferencial (DSC) e a análise dinâmico-mecânica (DMA). Neste trabalho, dois sistemas reativos foram analisados: o primeiro, resultante da combinação de resina DGEBA com endurecedor à base de amina alifática; o segundo composto pela resina DGEBA reagida com endurecedor à base de anidrido e catalisado por amina terciária. É apresentada a metodologia empregada na determinação dos parâmetros cinéticos para os dois sistemas epóxi utilizando a análise por DSC isotérmica e não isotérmica, a técnica DMA isotérmica, e como complementos análises isotérmicas por análise reológica e análise dielétrica (DEA) para determinação dos tempos de gelificação e vitrificação que caracterizam cada um dos distintos estágios de cura. Enquanto o sistema epóxi-amina se caracteriza por uma cinética de reação rápida, o sistema epóxi-anidrido apresenta cinética de reação lenta, sendo necessária a adição do acelerador para acelerar a reação, que é otimizada em altas temperaturas. O modelo cinético de Sourour-Kamal e o método Isoconversional foram aplicados respectivamente aos dados experimentais isotérmicos e não-isotérmicos de DSC para obtenção de constantes de reação do sistema. Os resultados encontrados apresentaram excelente concordância com o descrito na teoria de que é possível detectar estágios de cura pelas técnicas de análise dielétrica e dinâmico-mecânica. Também é possível comprovar a eficácia do modelo de Sourour-Kamal, pois apresenta um excelente ajuste com os dados experimentais, enquanto o método Isoconversional, é eficiente na previsão do tempo de cura isotérmico de resinas epoxídicas a partir de dados experimentais não-isotérmicos. As energias de ativação encontradas para as resinas epóxi-amina e epóxi-anidrido tem correspondência com o descrito na literatura. Conclui-se que as técnicas analíticas utilizadas neste trabalho são complementares entre si. / The commercial and scientific applications of epoxy resins depend upon the combination between resin/curing agents/catalyst, turning it a reactive system relatively complex, whose cure parameters determination is a multivariable problem of time, temperature and reagents concentration. It is necessary the knowledge of its curing kinetics mechanism to obtain the best mechanical, electrical and thermal properties, aiming at get high performance epoxy resins. The analytical techniques mostly used in cure determination of epoxy resins as well as in other polymeric thermoset resins are the Differential Scanning Calorimetry (DSC) and the Dynamic Mechanical Analysis (DMA). In this work, two reactive systems were analyzed: the first, based on DGEBA resin with aliphatic amine hardener; the second, composed by DGEBA resin cured by anhydride hardener and tertiary amine catalyst. It is presented the methodology used to determinate the kinetics parameters for the two epoxy systems utilizing isothermal and non-isothermal analysis by Differential Scanning Calorimetry; isothermal analysis by Dynamic Mechanical Analysis, and complementarly Rheological analysis and Dielectric Analysis for determining gelation and vitrification times which describe each one of distinct cure steps. The epoxy-amine system is characterized by a fast reaction kinetic, while the epoxy-anhydride system presents low reaction kinetic, being necessary the addiction of a catalyst for accelerating the reaction, which is improved at high temperatures. The kinetic model of Sourour-Kamal and the Isoconversional method were applied to obtain the kinetics parameters to the isothermal and non-isothermal DSC data, respectively. The experimental results presented good agreement with the theory, making possible to detect the cure stages by dielectric and dynamic mechanical analyses. It is also observed the efficiency of Sourour- Kamal model, because it presented an excellent fitting with the experimental data, while the Isoconversional method is efficient to predict the isothermal cure time by the non-isothermal experimental data. The calculated activation energies for both epoxy-amine and epoxyanhydride resins have agreed with the literature values. The DMA and DEA analytical techniques are complementary between themselves.

Estudos que comprovem a superioridade de um fármaco em relação a outros já existentes no mercado são de grande interesse na prática clínica. Através deles a Agência Nacional de Vigilância Sanitária (ANVISA) concede registro a novos produtos, que podem curar mais rápido ou aumentar a probabilidade de cura dos pacientes, em comparação ao tratamento padrão. É de suma importância que os testes de hipóteses controlem a probabilidade do erro tipo I, ou seja, controlem a probabilidade de que um tratamento não superior seja aprovado para uso; e também atinja o poder de teste regulamentado com o menor número de indivíduos possível. Os testes de hipóteses existentes para esta finalidade ou desconsideram o tempo até que o evento de interesse ocorra (reação alérgica, efeito positivo, etc) ou são baseados no modelo de riscos proporcionais. No entanto, na prática, a hipótese de riscos proporcionais pode nem sempre ser satisfeita, como é o caso de ensaios cujos riscos dos diferentes grupos em estudo se igualam com o passar do tempo. Nesta situação, o modelo de chances proporcionais é mais adequado para o ajuste dos dados. Neste trabalho desenvolvemos e investigamos dois testes de hipóteses para ensaios clínicos de superioridade, baseados na comparação de curvas de sobrevivência sob a suposição de que os dados seguem o modelo de chances de sobrevivências proporcionais, um sem a incorporação da fração de cura e outro com esta incorporação. Vários estudos de simulação são conduzidos para analisar a capacidade de controle da probabilidade do erro tipo I e do valor do poder dos testes quando os dados satisfazem ou não a suposição do teste para diversos tamanhos amostrais e dois métodos de estimação das quantidades de interesse. Concluímos que a probabilidade do erro tipo I é subestimada quando os dados não satisfazem a suposição do teste e é controlada quando satisfazem, como esperado. De forma geral, concluímos que é imprescindível satisfazer as suposições dos testes de superioridade. / Studies that prove the superiority of a drug in relation to others already existing in the market are of great interest in clinical practice. Based on them the Brazilian National Agency of Sanitary Surveillance (ANVISA) grants superiority drugs registers which can cure faster or increase the probability of cure of patients, compared to standard treatment. It is of the utmost importance that hypothesis tests control the probability of type I error, that is, they control the probability that a non-superior treatment is approved for use; and also achieve the test power regulated with as few individuals as possible. Tests of hypotheses existing for this purpose or disregard the time until the event of interest occurrence (allergic reaction, positive effect, etc.) or are based on the proportional hazards model. However, in practice, the hypothesis of proportional hazards may not always be satisfied, as is the case of trials whose risks of the different study groups become equal over time. In this situation, the proportional odds survival model is more adequate for the adjustment of the data. In this work we developed and investigated two hypothesis tests for clinical trials of superiority, based on the comparison of survival curves under the assumption that the data follow the proportional survival odds model, one without the incorporation of cure fraction and another considering cure fraction. Several simulation studies are conducted to analyze the ability to control the probability of type I error and the value of the power of the tests when the data satisfy or not the assumption of the test for different sample sizes and two estimation methods of the quantities of interest. We conclude that the probability of type I error is underestimated when the data do not satisfy the assumption of the test and it is controlled when they satisfy, as expected. In general, we conclude that it is indispensable to satisfy the assumptions of superiority tests.

Radiation polymerization is a rapid, sustainable process, requiring no environmentally damaging solvents and less energy than thermal polymerization methods. This process is used extensively each year to produce millions of tons of films, coatings, inks, and adhesives. In this work, kinetic- and property-control strategies were developed for three underdeveloped areas of radiation polymerization: free-radical electron beam (EB) polymerization, free-radical/cationic hybrid photopolymerization, and cationic shadow cure. Raman spectroscopy, an analytical technique for studying photopolymerization kinetics, was established as a method of determining the conversion of EB-initiated polymer films. This technique, in conjunction with dynamic mechanical analysis (DMA), was used to investigate the impact of chemical structure on the magnitude of EB dose rate effects (DREs). A strong correlation was determined between the DRE magnitude and monomer size, which may be attributed to chain transfer opportunities. A preliminary predictive relationship was developed to estimate the magnitude of the DRE using the property shift caused by changes in dose, enabling scale-up of process variables for polymers prone to dose rate effects. In addition, a protocol was developed to produce films with equivalent energy deposition for both EB and photopolymerizations, allowing the effect of the initiating radiation to be studied. Distinct kinetic and physical property differences were shown in the resulting EB- and photo-initiated films, despite equivalent initiation energies and energy rates. Monomer chemistry was determined to be an important factor in the magnitude of these differences. In order to control the phase separation that can occur in free-radical/cationic hybrid systems, the cationic AM mechanism was promoted through a hydroxyl group located on the (meth)acrylate, covalently bonding the (meth)acrylate and epoxide networks. The impact of the AM mechanism on the reaction kinetics and physical properties was studied using real-time Raman spectroscopy and DMA to compare a hydroxyl-containing acrylate and methacrylate to non-hydroxyl-containing controls. The promotion of the AM mechanism improved epoxide conversion and network homogeneity. The affect on the (meth)acrylate kinetics correlated to the propagation rate of the neat (meth)acrylate. It was also demonstrated that the glass transition temperature of the hybrid system could be controlled by varying the ratio of (meth)acrylate to epoxide. Cationic shadow cure, which offers a means of circumventing the light penetration limitations in photopolymerization, was modeled using a central composite design. This model was shown to be predictive of both shadow cure length and gel fraction while varying effective irradiance, exposure time, exposure area, and sample depth. Moreover, the model helped ascertain the impact of each variable and its interactions: shadow cure length was most influenced by sample depth, but the gel fraction was reliant on the other three variables. Active center mobility was also qualitatively tracked, and it was established that the section of solid polymer formed during illumination was restricting the movement of the active centers, preventing complete cure. Through this discovery, a new method of shadow cure was developed, termed transferable shadow cure (TSC). This new method separates the initiation and propagation mechanisms, and, as the name suggests, allows for the active-center-containing monomer to be transferred to areas unreachable by light before solidifying. Conversion of the TSC, as determined via Raman spectroscopy, was also modeled using a central composite design. The model predicts TSC conversion is equally dependent on effective irradiance, sample depth, and exposure time, but independent of exposure area. Through the development of control strategies in these three areas, this work provides a better fundamental understanding of radiation polymerization, as well as guidelines that aid in product design and technology expansion.

<p>This essay describes how the author gradually gets a deeper understanding for his profession and the development of his professional skills, attitude and practice. </p><p>The essay contains two main narratives representing examples from the author´s occupational practice, and through those narratives he tells how his practice alters and develops. These stories are also the basis for considering different aspects on how to get good models for practising a profession when you are a beginner, and how to manage ethical dilemmas. </p><p>The starting point is when the author in the beginning of his career as a rural pastor is visiting a seriously ill parishioner at a province hospital. The course and the outcome of this call is surprising the young pastor, and the author tries to analyze the background to the outcome and assesses several possible explanations for the result of his call. </p><p>The narrative is used to examine the attitude, the professional skills and the social and existential context for the author at that time. The patriarchal patterns in the parish are illuminated and questioned. </p><p>In the second part of the essay the author investigates what will happen when pastoral cure transforms to psychotherapy, and how the author deals with phenomena in the therapeutical process such as idealization and secondary traumatization. </p><p>On basis of texts written by among others Ingela Josefson, Fredrik Svenaeus, Christian Nilsson and Ulla Ekström von Essen the author seeks explanation for the development of his practical knowledge. With references to philosofers as Plato, Aristotle, H.G. Gadamer, Hannah Arendt, Dreyfus&Dreyfus among others he discusses how the theory of practical knowledge can be used in describing the development of professional skill and professional ethics in a person being both curate and psychotherapist.</p><p> </p>

This essay describes how the author gradually gets a deeper understanding for his profession and the development of his professional skills, attitude and practice.  The essay contains two main narratives representing examples from the author´s occupational practice, and through those narratives he tells how his practice alters and develops. These stories are also the basis for considering different aspects on how to get good models for practising a profession when you are a beginner, and how to manage ethical dilemmas.  The starting point is when the author in the beginning of his career as a rural pastor is visiting a seriously ill parishioner at a province hospital. The course and the outcome of this call is surprising the young pastor, and the author tries to analyze the background to the outcome and assesses several possible explanations for the result of his call.  The narrative is used to examine the attitude, the professional skills and the social and existential context for the author at that time. The patriarchal patterns in the parish are illuminated and questioned.  In the second part of the essay the author investigates what will happen when pastoral cure transforms to psychotherapy, and how the author deals with phenomena in the therapeutical process such as idealization and secondary traumatization.  On basis of texts written by among others Ingela Josefson, Fredrik Svenaeus, Christian Nilsson and Ulla Ekström von Essen the author seeks explanation for the development of his practical knowledge. With references to philosofers as Plato, Aristotle, H.G. Gadamer, Hannah Arendt, Dreyfus&amp;Dreyfus among others he discusses how the theory of practical knowledge can be used in describing the development of professional skill and professional ethics in a person being both curate and psychotherapist.

In practice, data are frequently incomplete in one way or another. It can be a significant challenge to make valid inferences about the parameters of interest in this situation. In this thesis, three problems involving such data are addressed. The first two problems involve interval-censored life history data with mismeasured covariates. Data of this type are incomplete in two ways. First, the exact event times are unknown due to censoring. Second, the true covariate is missing for most, if not all, individuals. This work focuses primarily on the impact of covariate measurement error in progressive multi-state models with data arising from panel (i.e., interval-censored) observation. These types of problems arise frequently in clinical settings (e.g. when disease progression is of interest and patient information is collected during irregularly spaced clinic visits). Two and three state models are considered in this thesis. This work is motivated by a research program on psoriatic arthritis (PsA) where the effects of error-prone covariates on rates of disease progression are of interest and patient information is collected at clinic visits (Gladman et al. 1995; Bond et al. 2006). Information regarding the error distributions were available based on results from a separate study conducted to evaluate the reliability of clinical measurements that are used in PsA treatment and follow-up (Gladman et al. 2004). The asymptotic bias of covariate effects obtained ignoring error in covariates is investigated and shown to be substantial in some settings. In a series of simulation studies, the performance of corrected likelihood methods and methods based on a simulation-extrapolation (SIMEX) algorithm (Cook \& Stefanski 1994) were investigated to address covariate measurement error. The methods implemented were shown to result in much smaller empirical biases and empirical coverage probabilities which were closer to the nominal levels. The third problem considered involves an extreme case of interval censoring known as current status data. Current status data arise when individuals are observed only at a single point in time and it is then determined whether they have experienced the event of interest. To complicate matters, in the problem considered here, an unknown proportion of the population will never experience the event of interest. Again, this type of data is incomplete in two ways. One assessment is made on each individual to determine whether or not an event has occurred. Therefore, the exact event times are unknown for those who will eventually experience the event. In addition, whether or not the individuals will ever experience the event is unknown for those who have not experienced the event by the assessment time. This problem was motivated by a series of orthopedic trials looking at the effect of blood thinners in hip and knee replacement surgeries. These blood thinners can cause a negative serological response in some patients. This response was the outcome of interest and the only available information regarding it was the seroconversion time under current status observation. In this thesis, latent class models with parametric, nonparametric and piecewise constant forms of the seroconversion time distribution are described. They account for the fact that only a proportion of the population will experience the event of interest. Estimators based on an EM algorithm were evaluated via simulation and the orthopedic surgery data were analyzed based on this methodology.