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11	Občanskoprávní aspekty poskytování paliativní péče / Civil law aspects of the provision of palliative care Vráblová, Barbora January 2020 (has links) Civil law aspects of the provision of palliative care Abstract This dissertation focuses on topics related to the area of intensive medicine and palliative care. In particular, the clinical environment where legal controversies related to the confrontation of two different approaches, curative and palliative, are discussed. The dissertation follows the structure of the medical law area in common law often called "Law at the end of life". The first part of the dissertation is dedicated to an analysis of relevant concepts in a more general fashion. This includes the concept of medical futility, the legal distinction between 'withholding' and 'withdrawing' life-sustaining treatment and euthanasia. One chapter focuses on the decision-making process at the end of life, and the ways of solving conflicts amongst persons involved in the process. Another chapter is dedicated to a detailed analysis of the Czech regulation of advance directives. The second part of the dissertation focuses on specific issues related to the provision of care at the end of life. These include decisions related to cardiopulmonary resuscitation and DNR orders, the deactivation of pacemakers, and palliative sedation. The final part of the dissertation provides legal analysis of specific cases from clinical practice. The dissertation...
12	Preliminary Evaluation of the WV Prescription Drug Abuse Quitline Zullig, Keith J., Lander, Laura, White, Rebecca J., Sullivan, Carl, Shockley, Clara, Dong, Lili, Pack, Robert P., Fedis, Tara Surber 01 August 2010 (has links) Purpose: To evaluate the effectiveness of the West Virginia Prescription Drug Abuse Quitline (WVPDAQ). Methods: Descriptive data and inferential analyses are provided for the period of operations from 9/11/2008 to 3/1/2010. Chi-square tests for Independence compared differences between callers completing at least one follow-up survey against callers completing only the baseline intake survey were observed. A Wilcoxon signed rank sum test tested differences between the scores of intake callers and follow-up callers at the one-week (n=177) and one-month (n=89) intervals. Results: A total of 1,056 calls were received, including 670 intakes, 177 1st follow-ups, 89 2nd follow-ups, and 36 3rd follow ups, and 84 caller satisfaction surveys. Chi-square analyses determined that callers who only completed the intake survey tended to have initiated drug use at a younger age ([less than or equal to] 39 years of age, [chi square]=7.63, p=.02). Longitudinal findings indicated significant self-reported declines in daily drug use (p<.0001), increased intentions to quit in the next 30 days (p<.0001), and declines in requesting a referral for treatment (p<.0001) at the one-month follow-up. Finally, approximately 19% (n=17) of callers reported obtaining a counseling/ treatment appointment as a result of calling the WVPDAQ at the one-month follow up. Conclusions: Preliminary results suggest the WVPDAQ has established itself as a meaningful resource to combat prescription drug abuse in West Virginia. Sustainable funding and greater integration of the WVPDAQ into existing and developing treatment infrastructure could provide more affordable options for the state of West Virginia and its citizens. Community and Behavioral Health Community Health and Preventive Medicine
13	Kontinuum léčby virové hepatitidy typu C mezi klienty nízkoprahových programů pro uživatele drog v Praze / Continuum of care in HCV treatment among clients of low-threshold programmes for PWUDs in Prague Havlíková, Petra January 2020 (has links) Background: Viral hepatitis C (HCV) represents a major public health problem worldwide and also in the Czech Republic. There are as many as 80,000 people have been living with chronic HCV in Czechia since 2015, most of them are/were drug addicts who have been infected by contaminated syringes. Global and national efforts to eliminate HCV are currently underway, focusing primarily on improving the quality of treatment continuity (sustainability, uninterrupted treatment) which involves ensuring the availability of testing for all patients, patients' involvement in their own treatment, sustaining treatment, achieving a response rate and the necessary follow-up care. Objective: To describe the HCV continuum of care in people who inject drugs (mapping testing rate, treatment uptake and treatment completion), and to describe the factors that affect this process. Based on the collected data, to formulate recommendations for addiction care professionals in order to improve HCV continuum of care. Methodology: A questionnaire survey among clients of low-threshold centres in Prague was carried out. The convenient sample consisted of a total of 60 respondents, 20 from each of the three centres. Data were analyzed using descriptive statistics. Data collection was realised in August 2019. Results: Out of the 60...
14	Assessment of health-related quality of life of adult highly active anti-retroviral therapy recipients at the Kagera Regional Hospital Tanzania. Magafu, Mgaywa. 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style="font-size: 10pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / ">Background: The care and treatment for people with HIV/AIDS (PLWHA) at the Kagera regional hospital began in February 2005. It is important to evaluate quality of life (QOL) of highly active anti-retroviral therapy (HAART) recipients periodical to assess HAART&rsquo / s effectiveness. This study aimed to assess the health-related QOL (HRQOL) of HAART recipients and determine factors associated with it, two years after the programme had started at the kagera regional hospital in Tanzania. Results: The HRQOL of HAART recipients was generally lower than that of the general population. However, the general health perceptions (p=0.191) and mental health (p=0.161) means score of HAART recipients were not different from those of the Tanzanian general population. About 89% of the HAART recipients reported better health than in the previous years. Chronic diseases were associated with lower HRQOL of HAART recipients independently of other factors. HAART recipients with chronic diseases co-morbidity were more likely to score below the general population&rsquo / s mean score for mental health (p=0.007). While the effect of chronic diseases on HRQOL among those who recorded CD4+ cell increase was negative (OR=13.6,95%CI=3.7 / 49.9), there was no effect on those who did not have such an increase. Adherence to ARVs and CD4+ cell count were not associated with HRQOL. &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / <span style=""> <o:p></o:p></span></span></p> <p style="margin-bottom: 0.0001pt / line-height: normal / " class="MsoNormal"><span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><o:p>&nbsp / </o:p></span></p> <span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style=""> </span><o:p></o:p></span></p> <p>&nbsp / </p> HIV/AIDS People living with HIV/AIDS Highly active anti-retroviral therapy care and treatment anti-retroviral therapy Kagera regional hospital Tanzania.
15	Personality disorder : no longer a diagnosis of exclusion? : law, policy and practice in Scotland Nuttall, L. D. January 2013 (has links) Personality disorder has been and continues to be a contested diagnosis. Those who attract this form of diagnosis have been particularly vulnerable to the effects of stigma and have tended to be excluded from service provision. This thesis provides an examination of how recent developments in law, policy and practice have impacted upon the status of personality disorder as a diagnosis of exclusion in Scotland. The theoretical framework that provides this thesis with its structure is derived from the post-empiricist approach proposed by Derek Layder. This approach seeks to contextualise emergent inductive findings within a broader historical and contemporary analysis. In the case of this research the broader context consists of the interplay between mental health law, policy and practice in the field of mental health and the diagnosis of personality disorder more specifically. The empirical enquiry at the core of this thesis is based upon an analysis of the views, beliefs and expectations of front-line staff (psychiatrists and social workers qualified as mental health officers) involved in the process of assessment and service provision. In addition to front-line staff (n = 27) a range of key informants who were in a position to shed light on the strategic imperatives underpinning recent developments in law and policy were also interviewed. This analysis is contextualised within a review of key developments in law and policy that have particular significance for anyone who may attract a diagnosis of personality disorder. Despite the ostensibly inclusive approach towards those who may attract a diagnosis of personality disorder evident within the Mental Health (Care and Treatment) (Scotland) Act 2003, the reality is a highly selective and very limited inclusion of those who attract this form of diagnosis. The effective inclusion of those who may attract a diagnosis of personality disorder has been obstructed by several key impediments: 1: an insufficiently robust policy framework to drive forward the process of inclusion; 2: residual ambivalence towards the legitimacy of the diagnosis of personality disorder itself and the legitimacy of the claims made upon services by those who may attract a diagnosis of personality disorder; 3: insufficient and inadequately focused resources; 4: service structures that have not been redesigned sufficiently to engage successfully with service users who may attract a diagnosis of personality disorder. As a consequence of these impediments to inclusion, the majority of those who may attract a diagnosis of personality disorder in Scotland are likely to continue to face high levels of marginalisation and exclusion. 300
16	Schizophrenic rehospitalisation and expressed emotion in Zulu South Africans : a pilot study. Potter, Sebastian Ruxton. January 2000 (has links) The impact of the emotional climate in the home of the schizophrenic on relapse has been researched extensively through the construct of Expressed Emotion (EE). Most often patients from high EE homes have a higher relapse rate than those from low EE homes. This is a robust finding throughout many western and some non-western countries. However, no published research documents EE status and relapse in African countries. This study reports on the EE status and rehospitalisation rates of 29 Zulu-speaking schizophrenic patients in a South African sample. EE was assessed using a translated version of the Level of Expressed Emotion (LEE) scale, a 60 - item, self-report measure developed in Canada (Cole & Kazarian, 1988). A multistage translation procedure, comprising back-translation, the committee approach and decentering was employed. The Zulu SCL-90-R was administered as an indicator of psychological distress. Follow-up data on rehospitalisation was collected nine months after index admission. Results indicated somewhat unsatisfactory internal reliabilities on some of the subscales of the Zulu LEE scale. High scores on the Zulu LEE scale were not significantly predictive of rehospitalisation at follow-up; however, they were significantly predictive of greater previous admissions. The psychometric properties of the Zulu SCL-90-R were found to be satisfactory, indicating the validity of using this instrument for the purpose of screening for psychiatric illness. Zulu schizophrenics were found to have a lower rehospitalisation rate (17% at nine month follow-up) than found in international studies. The course for female schizophrenics was better than that for male schizophrenics. Findings are inconclusive regarding the impact of EE on the course of schizophrenia in a Zulu sample. / Thesis (M.Soc.Sc.)-University of Natal, Pietermaritzburg, 2000. Schizophrenia--Treatment. Schizophrenia--KwaZulu-Natal. Schizophrenia--Relapse. Schizophrenics--Rehabilitation. Theses--Psychology. Schizophrenia--Social aspects. Schizophrenics--Family relationships. Schizophrenics--Care and treatment. Zulu (African People)--Mental health
17	Assessment of health-related quality of life of adult highly active anti-retroviral therapy recipients at the Kagera Regional Hospital Tanzania. Magafu, Mgaywa. 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mso-paper-source:0 / } div.WordSection1 {page:WordSection1 / } --> </style><!--[if gte mso 10]> <style> / Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal" / mso-tstyle-rowband-size:0 / mso-tstyle-colband-size:0 / mso-style-noshow:yes / mso-style-priority:99 / mso-style-qformat:yes / mso-style-parent:"" / mso-padding-alt:0in 5.4pt 0in 5.4pt / mso-para-margin-top:0in / mso-para-margin-right:0in / mso-para-margin-bottom:10.0pt / mso-para-margin-left:0in / line-height:115% / mso-pagination:widow-orphan / font-size:11.0pt / font-family:"Calibri","sans-serif" / mso-ascii-font-family:Calibri / mso-ascii-theme-font:minor-latin / mso-fareast-font-family:"Times New Roman" / mso-fareast-theme-font:minor-fareast / mso-hansi-font-family:Calibri / mso-hansi-theme-font:minor-latin / mso-bidi-font-family:"Times New Roman" / mso-bidi-theme-font:minor-bidi / } </style> <![endif]--> <p style="margin-bottom: 0.0001pt / line-height: normal / " class="MsoNormal"><span style="font-size: 10pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / ">Background: The care and treatment for people with HIV/AIDS (PLWHA) at the Kagera regional hospital began in February 2005. It is important to evaluate quality of life (QOL) of highly active anti-retroviral therapy (HAART) recipients periodical to assess HAART&rsquo / s effectiveness. This study aimed to assess the health-related QOL (HRQOL) of HAART recipients and determine factors associated with it, two years after the programme had started at the kagera regional hospital in Tanzania. Results: The HRQOL of HAART recipients was generally lower than that of the general population. However, the general health perceptions (p=0.191) and mental health (p=0.161) means score of HAART recipients were not different from those of the Tanzanian general population. About 89% of the HAART recipients reported better health than in the previous years. Chronic diseases were associated with lower HRQOL of HAART recipients independently of other factors. HAART recipients with chronic diseases co-morbidity were more likely to score below the general population&rsquo / s mean score for mental health (p=0.007). While the effect of chronic diseases on HRQOL among those who recorded CD4+ cell increase was negative (OR=13.6,95%CI=3.7 / 49.9), there was no effect on those who did not have such an increase. Adherence to ARVs and CD4+ cell count were not associated with HRQOL. &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / <span style=""> <o:p></o:p></span></span></p> <p style="margin-bottom: 0.0001pt / line-height: normal / " class="MsoNormal"><span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><o:p>&nbsp / </o:p></span></p> <span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style=""> </span><o:p></o:p></span></p> <p>&nbsp / </p> HIV/AIDS People living with HIV/AIDS Highly active anti-retroviral therapy care and treatment anti-retroviral therapy Kagera regional hospital Tanzania.
18	A case study, with specific reference to the role of parents, in the teaching and learning of a residential special school for children with autism Hubbard, Robert Graham January 2015 (has links) Context: The purpose of this research was to examine if the educational approach (the Approach) adopted at Kilnbarn Residential Special School (the School) secured the developmental learning pathways for its pupils. All pupils were diagnosed with Autistic Spectrum Disorder (ASD), Severe Learning Difficulties (SLD) and many had single or multiple comorbid conditions. The research sought to understand how their parents could be substantive partners and co-creators in the design, modification, and implementation of the Approach. It was a unique feature of Kilnbarn’s Approach to fulfil the potential of parents to be co-creators and co-therapists in their child’s progress. Objective: The case study became one of the instruments in which to test the School’s effectiveness in meeting the needs of its pupils. It enabled a review of the School’s methodology, curriculum and organisational practices. The Approach was designed to provide secure developmental learning pathways for its pupils, improving their quality of life and independence. Method: The case study design, was chosen as it was considered the most appropriate research model. A Parents’ Questionnaire, distributed annually over 3 consecutive years (2004-6) was the evidential basis for this study. Interviews and collected data were used to analyse and evaluate the progress of the School through parents’ eyes. Results: The combination of parents working with professionals to maximise the culture of “technical eclecticism” seems to be, in the light of this case study, best suited to the needs of children diagnosed with autism, SLD and comorbid conditions. The child should be immersed in a consistent approach across all areas of their life. Improvements in well-being, communication and joint action routines, sleep balance, a healthy diet, physical exercise, incontinence and behaviours was observed. Conclusion The study identified that parents could be substantive partners and influencers in the design and modification of the Kilnbarn Approach. The Approach secured developmental learning pathways for its pupils and appeared to improve their quality of life. Parents as co-creators and co-therapists had regained ownership of their child’s quality of life, learning outcomes and personal development. From the experience and unique evidence of this case study schools should utilise and profit from the mass resource of their parents. It has been shown that the Kilnbarn Approach was, during the research, an effective and suitable intervention for the many children it served. It is hoped that further studies in this field will explore the concept of a “technical eclectic” approach that further validates and brings together interventions that are conceptually grounded and incorporates evidence-based focused intervention practices. 371.9
19	Examining sexual and reproductive health needs of adolescents infected with HIV at Chiedza Child Care Centre, Harare, Zimbabwe Murimba, Lynnette 01 1900 (has links) The study examined the sexual and reproductive health needs of adolescents infected with HIV and AIDS. This was a qualitative study that involved semi-structured interviews and observation. The sampling method used was purposive and it entailed 10 adolescents (4 boys and 6 girls) who are living with HIV at Chiedza Child Care Centre in Zimbabwe. This study revealed that adolescents’ sexual and reproductive health needs are the desire to have sex, desire to have children, the need for prevention of unwanted pregnancy and care and treatment support. However, their knowledge of HIV and AIDS was inadequate. Adolescents also revealed their lack of proper information regarding their health care and treatment needs. However, adolescents illustrated an adequate knowledge of the services available for them for their health, treatment and care needs. The study recommended that there is need to strengthen the provision of information and services on adolescents’ sexual and reproductive health issues. The study also recommended that counsellors should improve their counselling skills so that they can empower adolescents living with HIV to be able to negotiate condom usage, matters of dating and handling relationships. / Sociology / M. A. (Social Behaviour Studies in HIV and AIDS) Adolescents living with HIV and AIDS Sexual needs Reproductive Health needs Health care and treatment needs Youth friendly services Health care services 362.196979205081096891
20	Avaliação da qualidade de vida e interação familiar em idosos institucionalizados Bruno Gilberto de Melo e Silva 27 May 2013 (has links) Universidade Católica de Pernambuco / Introdução: Na fase da velhice, as alterações hormonais, culturais e psicossociais do idoso requerem cuidados adicionais por parte dos familiares, podendo aumentar a demanda por Instituições de Longa Permanência de Idosos, como uma alternativa de suporte para atender às necessidades de saúde e proporcionar atividades que garantam qualidade de vida aos idosos. A literatura aponta que essa mudança no contexto de vida tende a alijar o idoso do convívio familiar e social, prejudicando a sua qualidade de vida. Objetivo: Avaliar a qualidade de vida e a interação familiar em idosos institucionalizados. Método: Trata-se de um estudo de caráter quantitativo e qualitativo, de corte transversal e de prevalência, no qual envolveu uma estratégia de ação em que todos os participantes foram submetidos às mesmas atividades. A amostra foi constituída por 88 idosos residentes em instituições públicas (89,8%), de ambos os sexos (46 homens, 42 mulheres), cuja idade média foi de 73,95 (DP=6,52) variando entre 65 e 93 anos. Os participantes foram agrupados em três faixas etárias: idoso jovem (55,7%), idoso velho (35,2%) e idoso mais velho (9,1%). Foi realizada individualmente uma entrevista e aplicados dois questionários para avaliar a qualidade de vida; WHOQOL_BREF e WHOQOL_OLD. Resultados: Pela extração do alpha de Cronbach a consistência interna obtida do WHOQOL_BREF foi boa (α=0,84) e a do WHOQOL_OLD foi satisfatória (α=0,75), indicando uma adequação desses instrumentos para a avaliação da qualidade de vida nesta população. As médias foram comparadas através do teste t, verificando-se que os escores masculinos foram mais elevados que os femininos em ambos os questionários, sendo esta diferença significativa apenas no WHOQOL_OLD (t= 3,505, p<0,01). Essa significância foi identificada nas facetas atividades passadas, presentes e futuras (t (86)= 3,414, p<0,01) e participação social (t (86)= 2,841, p<0,01), sempre os homens apresentando escores mais elevados de qualidade de vida nas questões existenciais sobre sentido da vida, disposição física, aceitação da aparência, atividades ocupacionais, realizações pessoais, uso do tempo e nível de atividades pessoais e comunitárias. A análise temática de conteúdo foi realizada com 30 entrevistas, sendo escolhidas as respostas dos 15 idosos que apresentaram os escores mais elevados e os 15 menores escores no WHOQOL_OLD. Foram eleitos dois temas principais visão institucional e interação familiar. A visão institucional revelou quatro núcleos de sentido: cuidados, diversão e lazer, novas amizades e bem-estar. A interação familiar evidenciou três núcleos de sentido: manutenção do bom vínculo, conflito ativo e rompimento do vínculo. Discussão: o fator institucionalização não parece ter sido o determinante de uma percepção melhor ou pior sobre a qualidade de vida, pelo fato dos idosos, independentemente do escore obtido, ressaltarem com muita ênfase os aspectos e benefícios advindos da vida institucionalizada, mesmo nos casos em que o afastamento do contexto familiar era mais sentido. Considerações finais: A relação entre a qualidade de vida e interação familiar é o que parece influir mais fortemente nessa percepção, sinalizando a importância de se atentar para a manutenção de um vínculo familiar mais salutar, promovendo ações que minimizem os efeitos deletérios dos conflitos familiares sobre a saúde e qualidade de vida dos idosos. / Introduction: In the phase of the senility, the psychosocial, cultural, and hormonal alterations of the elder demand additional cares on the part of the relative, increasing the demand by Institutions of Long Permanence of Elders, as an alternative to support to attend the needs of health and provide activities that guarantee elders quality of life. The literature points out that changing the context of life tend to remove elders of the social and family closeness, injuring its quality of life. Objective: To evaluate quality of life and the family interaction with elders institutionalized elders. Method: This study deals with qualitative and quantitative character, a cross cut and predominance, in which involved a strategic action that all participants were submitted to the same activities. The sample was constituted by 88 resident elders in public institutions (89,80%), of both the sexes (46 men, 42 women), whose average age was of 73.95 years old (DP=6,52) varying between 65 and 93 years old. The participants were grouped in three age groups: young elder (55,70%), old elder (35,20%) and older elder (9,10%). It was carried out individually an interview and applied two questionnaires to evaluate the quality of life; WHOQOL_BREF and WHOQOL_OLD. Results: By extraction of the alpha of Cronbach the internal consistency obtained of the WHOQOL_BREF was good for WHOQOL_OLD was satisfactory indicating an adaptation of those instruments to evaluate life quality in this population. The average were compared through the test t, verifying that the male scores were higher than female score in both questionnaires, being this significant difference barely in the WHOQOL_OLD (t = 3.505, p<0,01). That significance was identified in the future, present, and past activities facets (t (86) = 3.414, p<0,01) and social participation (t (86) = 2.841, p<0,01), always men presented scores of life quality more elevated in the existential questions about life sense, physical arrangement, appearance acceptance, occupational activities, personal achievements, use of the time, community and personal activities levels. The thematic content analysis was carried out with 30 interviews, being chosen answers of 15 elders that presented higher scores and 15 lower scores in the WHOQOL_OLD. Were chosen two main subjects institutional vision and family interaction. The institutional vision revealed four nuclei of sense: cares, fun and leisure, new friendships and welfare. The family interaction showed up three nuclei of sense: maintenance of the good bond, active conflict and bond rupture. Discussion: The institutionalization factor does not mean to have determinant a better or worse perception about the quality of life, by the fact of the elders, independently of the score obtained, stand out with a lot emphasis on aspects and on resulting benefits of institutionalized life, even in cases that the family distance context was more sense. Final considerations: The relation between the quality of life and family interaction is what influence more strongly in that perception, signaling the importance to have of be a more salutary family bond, promoting actions to minimize the harmful effects of the family conflicts about the health and quality of life of the elders. dissertações psicologia clínica idosos - cuidado e tratamento idosos - relações com a família qualidade de vida idosos - assistência em instituições dissertations clinical psychology elderly - care and treatment elderly - family relationships quality of life elderly - care in institutions PSICOLOGIA

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