- / Every year in England and Wales, 105,000 people sufferfrom uncontrolled cancer pain and are rarely offered community pharmacy medicine consultations (e.g. Medicines Use Reviews -MURs)[1]. Our aim was to examine how patients with cancer pain deal with their pain medication and to investigate their experiences of and attitudes towards community pharmacy.

L'objectif de ce travail est double : contribuer à la théorisation de ce qu'il est convenu d'appeler les Nouvelles Pratiques Philosophiques, d'une part, et fournir un appui méthodologique à ceux qui exercent, ou souhaitent exercer, dans cette discipline, de l'autre. Il s'agira d'établir une passerelle entre les Nouvelles Pratiques Philosophiques, telles qu'elles se développent aujourd'hui et le milieu universitaire, afin de donner aux étudiants en philosophie un débouché professionnel autre que l'enseignement académique ou la recherche. Il apparaît en effet que le manque de débouchés professionnels pour la philosophie en France, en dehors de l'enseignement et de la recherche universitaire, explique en partie la désaffection des étudiants pour cette matière et que celle-ci aurait tout intérêt à s'ouvrir à des pratiques professionnelles qui répondent aujourd'hui à une véritable demande de la part du grand public et dont le principal intérêt est de fournir un outil pertinent d'éducation populaire. / The objective of this work is twofold: to contribute to the theory of the so-called New Philosophical Practices, on one hand, and provide methodological support to those working or wish to engage in this discipline , the other. It will establish a bridge between the New Philosophical Practices, as they are now developing and academia, to give philosophy students an outlet other than professional academic teaching or research. It appears that the lack of professional opportunities for philosophy in France, apart from teaching and academic research, partly student disaffection for this matter and that it would do well to open for business practices that today meet a real demand from the public and whose primary interest is to provide relevant public education tool.

Darbo tikslas: Įvertinti privalomų profilaktinių sveikatos patikrinimų apimtis ir vyresnio mokyklinio amžiaus moksleivių bei mokyklose dirbančių visuomenės sveikatos priežiūros specialistų požiūrį į juos. Darbo uždaviniai: Išsiaiškinti moksleivių privalomųjų profilaktinių sveikatos patikrinimų apimtis ir dokumentų pildymo kokybę. Įvertinti vyresniųjų klasių moksleivių požiūrį į privalomus profilaktinius sveikatos patikrinimus bei palyginti miesto ir kaimo moksleivių, merginų ir vaikinų požiūrius. Įvertinti mokyklose dirbančių visuomenės sveikatos priežiūros specialistų požiūrį į privalomus profilaktinius moksleivių sveikatos patikrinimus . Tyrimo metodika. Darbe buvo derinama kiekybinė ir kokybinė tyrimo metodologija. Kaišiadorių rajone 2007 m. apklausta 280 vyresniųjų klasių moksleivių: 55 proc. merginų ir 45 proc. vaikinų iš jų 57 proc. tiriamųjų gyvena mieste ir 43 proc. -kaime. Statistinė duomenų analizė atlikta SPSS 12.0 duomenų analizės paketu. Diskusijoje dalyvavo 6 visuomenės sveikatos priežiūros specialistai. Analizuota į mokyklos sveikatos kabinetus patenkanti sveikatos pažymų informacija. Rezultatai. Nustatyta, kad sveikatos pažymą į mokyklą atnešė absoliuti dauguma (97,4 proc.) moksleivių, tačiau sveikatą jie tikrinasi dažniausiai todėl, kad į mokyklą reikalaujama atnešti pažymą (61,9 proc. merginų ir 51,2 proc. vaikinų bei daugiau kaip pusė moksleivių gyvenančių mieste ir kaime). Iš mokykloms pateiktų pažymų tik 34,98 proc. buvo pilnai užpildytų. Daugiau kaip... [toliau žr. visą tekstą] / Aim of the Study: To assess the range of compulsory preventive health check-ups and the sudents as well as school health care specialists‘ attitude towards them. Objectives of the Study: To evaluate the range of compulsory preventive health check-ups and and the quality of document filling in Kaišiadorys District. To assess the attitude of senior class students towards compulsory preventive health check-ups, and to compare the difference between the attitude of students living in the town and countryside. To assess the attitude of school health care specialists towards compulsory preventive health check-ups. Methods of the survey The qualitative (interview) and quantative methods were combined in the study. In 2007, an ananymous questionnaire survey was carried out, during which 280 people were interviewed: 55% of girls and 45% of boys. 57% of those interviewed lived in the town and 43% of them were rural residents. The statistic analysis of data was performed on the basis of documents SPSS 12.0/w. Six health care specialists working in the schools of the district also participiated in the survey.. The information of health certificates presented to the school health rooms was taken as a basis of the analysis. Results It has been determined that the total (97,4 % ) of students presented health certificates, however, they went for check-ups because school demands the health certificate (61.9 % of girls and 51.2 % of boys more than half of both students living in the... [to full text]

Introdução - A Agência Nacional de Saúde Suplementar determinou, em 2008, que os planos de saúde oferecessem seis consultas anuais com nutricionista. Objetivo - Avaliar os determinantes da demanda por consultas de nutrição em uma operadora de autogestão em saúde entre 2009 e 2011. Métodos - Trata-se de um estudo retrospectivo realizado a partir dos registros administrativos dos beneficiários da Sabesp Previdência. A demanda foi estimada por meio de um modelo tobit para os gastos com consultas de nutricionista. Foram incluídas variáveis demográficas, socioeconômicas, de estado de saúde e de influência familiar. Resultados - A influência familiar, o sexo, o estado civil, a escolaridade e o estado de saúde no período e passado foram os principais determinantes do gasto com consultas de nutrição. A elasticidade renda da demanda, embora estatisticamente significante (p<0,1), foi pequena em relação ao efeito das demais variáveis e a idade não teve impacto significativo. A baixa probabilidade estimada de realizar gastos mostrou que ele é subutilizado. Conclusão - Os resultados evidenciaram a necessidade de estímulo à utilização, numa perspectiva de prevenção de doenças, promoção da saúde e redução dos custos assistenciais no setor de saúde suplementar. / Introduction - The Brazilian private health sector regulatory agency determined, back in 2008, that the insurance plans should offer six nutrition consultations. Objective - To assess the nutrition consultations demand determinants in health insurance plan between 2009 and 2011. Methods - This is retrospective study performed using data from Sabesp Previdência. We used Tobit model to analyze the expenditure on nutritional consultations and tested demographic, socioeconomic, health status and family influence variables. Results - Family influence, sex, marital status, education and health status were the expenditure main. Income elastic of demand, although statistically significant, wasn\'t expressive when compared to other variables effects. Age had no significant impact on individual nutrition consultation expenditure. The low probability of having expends with nutrition consultations showed it is an underutilized service. Conclusion- The results highlighted the need to stimulate the demand for nutrition consultations, in concordance with a disease prevention, health promotion and healthcare care reduction perspective in private health care sector.

Enhancement of the quality of outpatient services and the problems of accessibility of services become more and more important part of the health care reform. The importance of increasing the provision of the services in outpatient institutions and developing of outpatient services of physicians-specialists are the priorities in the plan of re-structuring of health care. Aim of the study. To analyze the provision and tendencies of the secondary and tertiary level outpatient services to inhabitants of the area Vilnius Territorial Patient Fund in 2003-2005. Objectives. To evaluate the provision of the secondary level outpatient services by specialty, by municipalities and age groups. To analyze the tertiary level outpatient services by municipalities. To evaluate the changes and tendencies in providing secondary and tertiary level outpatient services. Materials and methods. Analysis was done using the data of health insurance information system SVEIDRA on inhabitants registered to primary health care institutions and outpatient services provided to inhabitants of the area of Vilnius Territorial Patient Fund in 2003-2005. In order to evaluate distribution of services by municipalities, the number of outpatient services per one inhabitant, registered to primary health care institution, was calculated. Four age groups (0-5, 5-18, 18-65, over 65 years old) were chosen to analyze distribution of services by age groups. The existence of statistically significant differences was... [to full text]

This thesis aims to make contributions at substantive, methodological and theoretical levels. First, the findings from three observational studies are combined to identify obstacles to the use of shared decision-making in modern psychiatric practice. Particular attention is paid to how patients' choices about their treatment are facilitated or constrained by the actions of mental health professionals. A typology of pressure is constructed, based on detailed analyses of how pressure is applied and resisted in routine encounters (outpatient consultations) and "crisis' situations (assessments for compulsory admission to hospital, and ward rounds in acute inpatient care). Findings from two ethnographies and one conversation analysis (CA) study are presented. 'Meaning' is central to the write-up of each set of findings, however while the analytic focus of the ethnographies is 'insider' knowledge and meanings, in the CA study it is gn the activities that make those meanings possible in the first place. The methodological contribution of the thesis stems from its demonstration of how to produce a coherent, unified research account from two very different versions of qualitative inquiry. Despite the potential for analytic inconsistency, the thesis arguably has far greater force and persuasiveness as a result of the attempt to combine, compare and contrast findings from three studies. It is contended that a sound theoretical base for sociological research may be created by combining Goffman's micro-sociology with Foucault's analyses of disciplinary power/knowledge in one of a number of ways. A Goffmanian 'home base' is adopted for this thesis, with Foucauldian thinking applied to add a historical, 'macro' dimension to the analysis that Goffman's work so conspicuously lacks. Foucault's work also provides the conceptual tools for examining the more subtle form of control through expertise that would be missed in a purely Goffmanian study.

Teen Triple P is a behavioural family intervention for parents of adolescents. It is a multi-level intervention package that allows the strength and format of the intervention to be tailored to the needs of the family. Teen Triple P is available in three modalities: individual; group; and self-directed programs. This research investigated whether a self-directed program, Self-directed Teen Triple P, which consists of a parent workbook and video is sufficient to reduce risk factors known to be associated with the development of serious emotional and behavioural problems in adolescents and enhance protective factors. The present research sought to: a) determine the impact of a self-directed behavioural family intervention program on parents’ perceptions of their adolescent’s behaviour; b) assess the efficacy and consumer acceptance of a self-directed parenting intervention; c) identify clinical implications arising from this research to assist practitioners in the appropriate use of self-directed behavioural family intervention programs; and d) examine the psychometric properties of treatment outcome measures for use with adolescents and their parents. A central tenet of this research is the principal of sufficiency that is, examining the ability of a behavioural family intervention to produce desirable outcomes for adolescents and their parents under lowest intervention and cost conditions. Fifty-one Queensland families with children in Year 7 or 8, aged 11-14 years, were recruited from the community by means of flyers distributed to schools, newspaper and radio advertisements. Participants were randomly assigned to 1 of 3 conditions: (1) Standard self-directed Teen Triple P, a 10 module workbook program supplemented by a video; (2) Enhanced Self-directed Teen Triple P, the same program as Standard self-directed Teen Triple P, but included 10, 15-minute weekly telephone consultations with a Triple P therapist to assist in tailoring the program to meet the individual family’s needs; or (3) Waitlist control, a comparison group who initially only completed the measures, but later went on to do a replication of the standard intervention. The program was implemented with average recruitment (61%), and moderate attrition rate (23.5%). At post-intervention, using parent report measures of adolescent behaviour and parenting practices, parents in the enhanced condition reported significantly fewer adolescent behaviour problems and less use of dysfunctional parenting strategies than parents in the waitlist condition. Parents in the standard condition reported improvements in some areas but not as large or wide-spread as the enhanced group. Improvements were maintained at 3-month follow-up. There was no significant difference among conditions at post-intervention or follow-up on parents’ self-report measures of depression, anxiety, stress or relationship quality. The psychometric properties of measures of adolescent functioning, parenting style, relationship satisfaction and parental adjustment previously reported on different samples were confirmed. An underlying factor structure for the Parent Problem Checklist was identified and implications for its use discussed. Modifications to the scoring of the Consumer Satisfaction Questionnaire are discussed in the light of its factor structure. This research provides important information regarding the efficacy of a self-directed behavioural family intervention as an early intervention for families of early adolescents experiencing some problematic behaviour. It also provides some clinical implications of using self-directed interventions with families.

O presente trabalho procura examinar a experiência psicanalítica através das consultas terapêuticas de Winnicott, levando-se em conta sua realização em instituições públicas de saúde brasileiras e buscando uma leitura não-ortodoxa da construção do dispositivo psicanalítico. Para isto, propõe-se, em um primeiro momento, o estudo sobre a questão do afeto e da intensidade na experiência analítica a partir das teorizações iniciais sobre transferência na obra freudiana. Em seguida discute-se a contribuição ferencziana com relação à noção de tato e a intensidade própria de sua prática clínica, priorizando-se a fase final de sua obra, momento em que o foco de seu trabalho dirigia-se mais agudamente às questões referentes ao lugar do analista, aos sentimentos contra-transferenciais e à elasticidade da técnica. Num terceiro momento, propõe-se um exame das idéias de Winnicott a respeito do manejo e o uso do objeto e as suas implicações na teorização sobre a transferência. Finalmente, pretende-se pensar o campo de afetação que se dá na clínica psicanalítica a partir dos conceitos de introjeção em Ferenczi, o surgimento dos sensos de eu e afetos de vitalidade na teoria de Stern e a relação de tais conceitos com alguns dos pressupostos winnicottianos, para fundamentar a possibilidade de transferências produtivas nas consultas terapêuticas. / This paper seeks to examine the psychoanalytic experience through Winnicotts therapeutic consultations, taking into consideration their being held in Brazilian public health institutions, and aiming at a non-orthodox interpretation of the construction of the psychoanalytic device. To that effect, it firstly proposes the study of the issue of affection and intensity in the analytic experience, in light of the initial theorization about transference in Freuds work. Secondly, Ferenczis contribution regarding the notion of touch and the intensity characteristic of his clinical conduct are discussed, giving priority to the final stages of his work, when his focus was most sharply directed to issues related to the analysts place, to countertransferential feelings, and to the elasticity of the technique. Thirdly, a study is proposed of Winnicotts ideas about the handling and use of the object and their implications in the theorization about transference. In the end, we intend to consider the field of affectation which occurs in the psychoanalytic clinic, in light of Ferenczis introjection concepts, the development of the senses of self and vitality affects in Sterns theory, and the relation of those concepts to some of Winnicotts postulates, in order to substantiate the possibility of productive transferences in therapeutic consultations.

O presente trabalho procura examinar a experiência psicanalítica através das consultas terapêuticas de Winnicott, levando-se em conta sua realização em instituições públicas de saúde brasileiras e buscando uma leitura não-ortodoxa da construção do dispositivo psicanalítico. Para isto, propõe-se, em um primeiro momento, o estudo sobre a questão do afeto e da intensidade na experiência analítica a partir das teorizações iniciais sobre transferência na obra freudiana. Em seguida discute-se a contribuição ferencziana com relação à noção de tato e a intensidade própria de sua prática clínica, priorizando-se a fase final de sua obra, momento em que o foco de seu trabalho dirigia-se mais agudamente às questões referentes ao lugar do analista, aos sentimentos contra-transferenciais e à elasticidade da técnica. Num terceiro momento, propõe-se um exame das idéias de Winnicott a respeito do manejo e o uso do objeto e as suas implicações na teorização sobre a transferência. Finalmente, pretende-se pensar o campo de afetação que se dá na clínica psicanalítica a partir dos conceitos de introjeção em Ferenczi, o surgimento dos sensos de eu e afetos de vitalidade na teoria de Stern e a relação de tais conceitos com alguns dos pressupostos winnicottianos, para fundamentar a possibilidade de transferências produtivas nas consultas terapêuticas. / This paper seeks to examine the psychoanalytic experience through Winnicotts therapeutic consultations, taking into consideration their being held in Brazilian public health institutions, and aiming at a non-orthodox interpretation of the construction of the psychoanalytic device. To that effect, it firstly proposes the study of the issue of affection and intensity in the analytic experience, in light of the initial theorization about transference in Freuds work. Secondly, Ferenczis contribution regarding the notion of touch and the intensity characteristic of his clinical conduct are discussed, giving priority to the final stages of his work, when his focus was most sharply directed to issues related to the analysts place, to countertransferential feelings, and to the elasticity of the technique. Thirdly, a study is proposed of Winnicotts ideas about the handling and use of the object and their implications in the theorization about transference. In the end, we intend to consider the field of affectation which occurs in the psychoanalytic clinic, in light of Ferenczis introjection concepts, the development of the senses of self and vitality affects in Sterns theory, and the relation of those concepts to some of Winnicotts postulates, in order to substantiate the possibility of productive transferences in therapeutic consultations.

Introdução - A Agência Nacional de Saúde Suplementar determinou, em 2008, que os planos de saúde oferecessem seis consultas anuais com nutricionista. Objetivo - Avaliar os determinantes da demanda por consultas de nutrição em uma operadora de autogestão em saúde entre 2009 e 2011. Métodos - Trata-se de um estudo retrospectivo realizado a partir dos registros administrativos dos beneficiários da Sabesp Previdência. A demanda foi estimada por meio de um modelo tobit para os gastos com consultas de nutricionista. Foram incluídas variáveis demográficas, socioeconômicas, de estado de saúde e de influência familiar. Resultados - A influência familiar, o sexo, o estado civil, a escolaridade e o estado de saúde no período e passado foram os principais determinantes do gasto com consultas de nutrição. A elasticidade renda da demanda, embora estatisticamente significante (p<0,1), foi pequena em relação ao efeito das demais variáveis e a idade não teve impacto significativo. A baixa probabilidade estimada de realizar gastos mostrou que ele é subutilizado. Conclusão - Os resultados evidenciaram a necessidade de estímulo à utilização, numa perspectiva de prevenção de doenças, promoção da saúde e redução dos custos assistenciais no setor de saúde suplementar. / Introduction - The Brazilian private health sector regulatory agency determined, back in 2008, that the insurance plans should offer six nutrition consultations. Objective - To assess the nutrition consultations demand determinants in health insurance plan between 2009 and 2011. Methods - This is retrospective study performed using data from Sabesp Previdência. We used Tobit model to analyze the expenditure on nutritional consultations and tested demographic, socioeconomic, health status and family influence variables. Results - Family influence, sex, marital status, education and health status were the expenditure main. Income elastic of demand, although statistically significant, wasn\'t expressive when compared to other variables effects. Age had no significant impact on individual nutrition consultation expenditure. The low probability of having expends with nutrition consultations showed it is an underutilized service. Conclusion- The results highlighted the need to stimulate the demand for nutrition consultations, in concordance with a disease prevention, health promotion and healthcare care reduction perspective in private health care sector.