INTRODUÇÃO: Pacientes candidatos à cirurgia frequentemente experimentam estresse, condição que os torna suscetíveis a desfechos desfavoráveis como exacerbação de dor, maior consumo de analgésicos e anestésicos, aumento no tempo de hospitalização, maior risco de infecção pós- operatória e aumento no risco de cronificação da dor pós-operatória. Embora seja conhecido que a carga de estresse emocional negativa aumente a morbimortalidade perioperatória, faltam instrumentos práticos desenvolvidos para captar as emoções vinculadas a este contexto. OBJETIVOS: Desenvolver um instrumento breve para medir o estresse psicológico pré-operatório (B-MEPS), tornando possível identificar pacientes mais vulneráveis e assim otimizar medidas de controle. PACIENTES E MÉTODOS: Neste estudo transversal foram incluídos 863 pacientes (643 mulheres) agendados para cirurgia eletiva. Idade entre 18 a 60 anos, classificados de acordo com o estado físico da Sociedade Americana da Anestesiologia (ASA) nas classes I-III. Os seguintes instrumentos foram aplicados: o Inventário de Ansiedade Traço-Estado (IDATE), a Escala de Depressão de Montgomery-Asberg, o Self-Reporting questionnaire (SRQ-20) e o Questionário de Expectativa de Futuro (FSPQ). A fim de selecionar os itens mais discriminativos em relação ao estresse, realizou-se uma análise exploratória usando cada um dos instrumentos. Os critérios utilizados no processo de seleção dos itens, por meio da análise discriminante, foram os candidatos à cirurgia por patologia oncológica ou terem reportado dor pós-operatória moderada a intensa [escore na Escala Análogo-Visual (EAV) > 30 mm]. Neste processo foram selecionados 24 itens, os quais foram ajustados utilizando o modelo de crédito parcial generalizado (GPCM), que é um modelo da Teoria de Resposta ao Item (TRI). A partir do GPCM foram selecionados 16 itens. A validade de face foi realizada por um Comitê de especialistas em medicina perioperatória. Os escores do B-MEPS foram correlacionados com o nível de dor reportado na EAV, na maior parte do tempo das primeiras 24 h do período pós-operatório e com o consumo de morfina pós-operatória quantificado em mg/dia. Esta versão refinada do B-MEPS foi aplicada a 40 pacientes (20 mulheres), ASA II-III, candidatos à cirurgia eletiva. Os escores da B-MEPS foram correlacionados com questões cuja valência semântica apresenta situações que expressam a interferência do estresse na vida diária. RESULTADOS: Inicialmente 24 itens com diferentes números de categorias ordinais foram selecionados a partir dos quatros instrumentos. No processo da GPCM, que objetivou dentre outras finalidades maximizar a confiabilidade, foi realizada a eliminação sequencial de itens internamente inconsistentes. Este processo foi finalizado quando não se observou melhora no nível de consistência nos 16 itens remanescentes, cujo coeficiente alfa de Cronbach foi de 0,83. A TRI propôs modificações nos itens de resposta pelas características das categorias nas Curvas de Resposta ao Item. A curva que avalia a relação entre a localização do conteúdo de traços latentes dos itens sugere que estes apresentam melhor desempenho para identificar níveis de estresse mais levados. O desempenho do conjunto final de itens foi correlacionado com variáveis clínicas relacionadas ao estresse emocional perioperatório como dor (r = 0,23, P < 0,01) e consumo de morfina (r = 0,17, P < 0,01). Um Comitê de experts em medicina perioperatória (N = 30) avaliou a clareza dos itens do B-MEPS usando uma escala análogo-visual de zero a 10. A média global do conjunto de itens foi 8.53 (1,54) e por sugestão deste Comitê o item 16 foi eliminado por falta de clareza. Dois itens do SRQ-20, que apresentavam possibilidade respostas dicotômicas, passaram a ter três possibilidades de respostas. Os escores da versão final preliminar do B-MEPS foram correlacionados com questões cuja valência semântica apresenta situações que expressam a interferência do estresse na vida diária, respondidas por pacientes candidatos à cirurgia eletiva, visando uma validação concorrente preliminar. CONCLUSÃO: Nosso estudo permitiu construir o B-MEPS, que é o resultado do refinamento do conjunto de itens selecionados a partir de instrumentos clássicos para avaliar a carga emocional negativa, a partir da TRI. O conjunto de itens remanescentes apresentou satisfatório nível de consistência interna e o seu escore está correlacionado ao nível de dor. A validação de face e uma pré-validação concorrente preliminar foram realizadas. Este estudo, portanto, concretiza a validação preliminar do B-MEPS como um instrumento útil para ser validado em futuro estudo prospectivo, com o intuito de avaliar a capacidade do B-MEPS predizer desfechos clínicos e orientar o planejamento de intervenções que possam para maximizar o cuidado perioperatório. Embora, este instrumento ainda possa sofrer pequenos ajustes ou adições de algum item após nova analise de TRI prevista após estudo prospectivo com grande numero de pacientes. / INTRODUCTION: Patients who are candidates for surgery often undergo stress, a condition that makes them susceptible to unfavorable outcomes, such as exacerbated pain, greater consumption of analgesic and anesthetics, longer stay in hospital, greater risk of postoperative infection and increased risk of chronification of postoperative pain. Although it is known that the amount of negative emotional stress increases perioperative morbidity and mortality, not many practical instruments have been developed to pick up the emotions connected to this context.. OBJECTIVES: To develop a brief instrument to measure preoperative emotional stress (B-MEPS), enabling the identification of more vulnerable patients and thus optimizing control measures. PATIENTS AND METHODS: In this cross-sectional study, 843 patients were included (643 women) scheduled for elective surgery, age between 18 and 60 years, classified according to the physical status of the American Society of Anesthesiology (ASA) in classes I-III. The following instruments were applied: the State and Trait Anxiety Inventory (STAI), the Montgomery-Asberg Depression Scale, the Self-Reporting Questionnaire (SRQ-20 and the Questionnaire on Expectations for the Future (FSPQ) Future self-perception questionnaire. In order to select the most discriminative items regarding stress, an exploratory analysis was performed using each of the instruments, The criteria used in the process of selecting the items, by means of discriminant analysis, are that they were candidates for surgery due to an oncological pathology, or that they had reported moderate to intense postoperative pain [score on the Analogue-Visual Scale AVS > 30 mm]. In this process 24 items were selected which were adjusted using the generalized partial credit model (GPCM), which is a model of the Theory of Response to Item (TRI). Sixteen items were selected based on the GPCM. The face validity was performed by a Committee of specialists in perioperative medicine. The B-MEPS scores were correlated with the level of pain reported in the AVS, mostly in the first 24 hours of the postoperative period, and with the consumption of morphine postoperatively, quantified as mg/day. This refined version of B-MEPS was applied to 40 ASA II-III patients (20 women) who were candidates for elective surgery. The B-MEPS scores were correlated with questions whose semantic valence present situations that express the interference of stress in everyday life. RESULTS: Initially, 24 items with different numbers of ordinal categories were selected based on the four instruments. In the GPCM process which, among other goals included maximizing reliability, the sequential elimination of internally inconsistent items was performed. This process was finalized, when no improvement was found in the level of consistency in the 16 remaining items, whose Cronbach’s Alpha coefficient was 0.83. The TRI proposed modifications in the response items due to the characteristics of the categories in the Curves of Response to the Item. The curve that evaluates the relationship between the location of the content of latent traits of the items suggests that these present a better performance to identify higher levels of stress. The performance of the final set of items was correlated with clinical variables related to perioperative emotional stress, such as pain (r = 0.23, P < 0.01) and consumption of morphine (r = 0.17, P < 0.01). A Committee of experts in perioperative medicine (N=30) evaluated the clarity of the items of B-MEPS using an analogue-visual scale from zero to 10.. The global mean of the set of items was 8.53 (1,54) and per suggestion of this Committee, item 16 was eliminated due to lack of clarity. Two items of the SRQ-20, which presented the possibility of dichotomous answers acquired three possible answers. The scores of the preliminary final version of B-MEPS were correlated with questions whose semantic valence presents situations that express the interference of stress in everyday life, answered by patients who were candidates to elective surgery, aiming at a preliminary concurrent validation. CONCLUSION: Our study allowed constructing B-MEPS, which is the result of the refinement of the set of items selected from classical instruments to evaluate the negative emotional load based on TRI. The set of remaining items presented a satisfactory level of internal consistency and its score is correlated with the level of pain. Face validation and a preliminary concurrent pre-validation were performed. This study, thus, materializes the preliminary validation of B-MEPS as a useful instrument to be validated in a future prospective study, aiming at evaluating the capacity of B-MEPS to predict clinical outcomes and guide the planning of interventions that can maximize perioperative care. However, this instrument may still undergo small adjustments or additions of some item after a new TRI analysis foreseen after a prospective study with a large number of patients.

INTRODUÇÃO: Pacientes candidatos à cirurgia frequentemente experimentam estresse, condição que os torna suscetíveis a desfechos desfavoráveis como exacerbação de dor, maior consumo de analgésicos e anestésicos, aumento no tempo de hospitalização, maior risco de infecção pós- operatória e aumento no risco de cronificação da dor pós-operatória. Embora seja conhecido que a carga de estresse emocional negativa aumente a morbimortalidade perioperatória, faltam instrumentos práticos desenvolvidos para captar as emoções vinculadas a este contexto. OBJETIVOS: Desenvolver um instrumento breve para medir o estresse psicológico pré-operatório (B-MEPS), tornando possível identificar pacientes mais vulneráveis e assim otimizar medidas de controle. PACIENTES E MÉTODOS: Neste estudo transversal foram incluídos 863 pacientes (643 mulheres) agendados para cirurgia eletiva. Idade entre 18 a 60 anos, classificados de acordo com o estado físico da Sociedade Americana da Anestesiologia (ASA) nas classes I-III. Os seguintes instrumentos foram aplicados: o Inventário de Ansiedade Traço-Estado (IDATE), a Escala de Depressão de Montgomery-Asberg, o Self-Reporting questionnaire (SRQ-20) e o Questionário de Expectativa de Futuro (FSPQ). A fim de selecionar os itens mais discriminativos em relação ao estresse, realizou-se uma análise exploratória usando cada um dos instrumentos. Os critérios utilizados no processo de seleção dos itens, por meio da análise discriminante, foram os candidatos à cirurgia por patologia oncológica ou terem reportado dor pós-operatória moderada a intensa [escore na Escala Análogo-Visual (EAV) > 30 mm]. Neste processo foram selecionados 24 itens, os quais foram ajustados utilizando o modelo de crédito parcial generalizado (GPCM), que é um modelo da Teoria de Resposta ao Item (TRI). A partir do GPCM foram selecionados 16 itens. A validade de face foi realizada por um Comitê de especialistas em medicina perioperatória. Os escores do B-MEPS foram correlacionados com o nível de dor reportado na EAV, na maior parte do tempo das primeiras 24 h do período pós-operatório e com o consumo de morfina pós-operatória quantificado em mg/dia. Esta versão refinada do B-MEPS foi aplicada a 40 pacientes (20 mulheres), ASA II-III, candidatos à cirurgia eletiva. Os escores da B-MEPS foram correlacionados com questões cuja valência semântica apresenta situações que expressam a interferência do estresse na vida diária. RESULTADOS: Inicialmente 24 itens com diferentes números de categorias ordinais foram selecionados a partir dos quatros instrumentos. No processo da GPCM, que objetivou dentre outras finalidades maximizar a confiabilidade, foi realizada a eliminação sequencial de itens internamente inconsistentes. Este processo foi finalizado quando não se observou melhora no nível de consistência nos 16 itens remanescentes, cujo coeficiente alfa de Cronbach foi de 0,83. A TRI propôs modificações nos itens de resposta pelas características das categorias nas Curvas de Resposta ao Item. A curva que avalia a relação entre a localização do conteúdo de traços latentes dos itens sugere que estes apresentam melhor desempenho para identificar níveis de estresse mais levados. O desempenho do conjunto final de itens foi correlacionado com variáveis clínicas relacionadas ao estresse emocional perioperatório como dor (r = 0,23, P < 0,01) e consumo de morfina (r = 0,17, P < 0,01). Um Comitê de experts em medicina perioperatória (N = 30) avaliou a clareza dos itens do B-MEPS usando uma escala análogo-visual de zero a 10. A média global do conjunto de itens foi 8.53 (1,54) e por sugestão deste Comitê o item 16 foi eliminado por falta de clareza. Dois itens do SRQ-20, que apresentavam possibilidade respostas dicotômicas, passaram a ter três possibilidades de respostas. Os escores da versão final preliminar do B-MEPS foram correlacionados com questões cuja valência semântica apresenta situações que expressam a interferência do estresse na vida diária, respondidas por pacientes candidatos à cirurgia eletiva, visando uma validação concorrente preliminar. CONCLUSÃO: Nosso estudo permitiu construir o B-MEPS, que é o resultado do refinamento do conjunto de itens selecionados a partir de instrumentos clássicos para avaliar a carga emocional negativa, a partir da TRI. O conjunto de itens remanescentes apresentou satisfatório nível de consistência interna e o seu escore está correlacionado ao nível de dor. A validação de face e uma pré-validação concorrente preliminar foram realizadas. Este estudo, portanto, concretiza a validação preliminar do B-MEPS como um instrumento útil para ser validado em futuro estudo prospectivo, com o intuito de avaliar a capacidade do B-MEPS predizer desfechos clínicos e orientar o planejamento de intervenções que possam para maximizar o cuidado perioperatório. Embora, este instrumento ainda possa sofrer pequenos ajustes ou adições de algum item após nova analise de TRI prevista após estudo prospectivo com grande numero de pacientes. / INTRODUCTION: Patients who are candidates for surgery often undergo stress, a condition that makes them susceptible to unfavorable outcomes, such as exacerbated pain, greater consumption of analgesic and anesthetics, longer stay in hospital, greater risk of postoperative infection and increased risk of chronification of postoperative pain. Although it is known that the amount of negative emotional stress increases perioperative morbidity and mortality, not many practical instruments have been developed to pick up the emotions connected to this context.. OBJECTIVES: To develop a brief instrument to measure preoperative emotional stress (B-MEPS), enabling the identification of more vulnerable patients and thus optimizing control measures. PATIENTS AND METHODS: In this cross-sectional study, 843 patients were included (643 women) scheduled for elective surgery, age between 18 and 60 years, classified according to the physical status of the American Society of Anesthesiology (ASA) in classes I-III. The following instruments were applied: the State and Trait Anxiety Inventory (STAI), the Montgomery-Asberg Depression Scale, the Self-Reporting Questionnaire (SRQ-20 and the Questionnaire on Expectations for the Future (FSPQ) Future self-perception questionnaire. In order to select the most discriminative items regarding stress, an exploratory analysis was performed using each of the instruments, The criteria used in the process of selecting the items, by means of discriminant analysis, are that they were candidates for surgery due to an oncological pathology, or that they had reported moderate to intense postoperative pain [score on the Analogue-Visual Scale AVS > 30 mm]. In this process 24 items were selected which were adjusted using the generalized partial credit model (GPCM), which is a model of the Theory of Response to Item (TRI). Sixteen items were selected based on the GPCM. The face validity was performed by a Committee of specialists in perioperative medicine. The B-MEPS scores were correlated with the level of pain reported in the AVS, mostly in the first 24 hours of the postoperative period, and with the consumption of morphine postoperatively, quantified as mg/day. This refined version of B-MEPS was applied to 40 ASA II-III patients (20 women) who were candidates for elective surgery. The B-MEPS scores were correlated with questions whose semantic valence present situations that express the interference of stress in everyday life. RESULTS: Initially, 24 items with different numbers of ordinal categories were selected based on the four instruments. In the GPCM process which, among other goals included maximizing reliability, the sequential elimination of internally inconsistent items was performed. This process was finalized, when no improvement was found in the level of consistency in the 16 remaining items, whose Cronbach’s Alpha coefficient was 0.83. The TRI proposed modifications in the response items due to the characteristics of the categories in the Curves of Response to the Item. The curve that evaluates the relationship between the location of the content of latent traits of the items suggests that these present a better performance to identify higher levels of stress. The performance of the final set of items was correlated with clinical variables related to perioperative emotional stress, such as pain (r = 0.23, P < 0.01) and consumption of morphine (r = 0.17, P < 0.01). A Committee of experts in perioperative medicine (N=30) evaluated the clarity of the items of B-MEPS using an analogue-visual scale from zero to 10.. The global mean of the set of items was 8.53 (1,54) and per suggestion of this Committee, item 16 was eliminated due to lack of clarity. Two items of the SRQ-20, which presented the possibility of dichotomous answers acquired three possible answers. The scores of the preliminary final version of B-MEPS were correlated with questions whose semantic valence presents situations that express the interference of stress in everyday life, answered by patients who were candidates to elective surgery, aiming at a preliminary concurrent validation. CONCLUSION: Our study allowed constructing B-MEPS, which is the result of the refinement of the set of items selected from classical instruments to evaluate the negative emotional load based on TRI. The set of remaining items presented a satisfactory level of internal consistency and its score is correlated with the level of pain. Face validation and a preliminary concurrent pre-validation were performed. This study, thus, materializes the preliminary validation of B-MEPS as a useful instrument to be validated in a future prospective study, aiming at evaluating the capacity of B-MEPS to predict clinical outcomes and guide the planning of interventions that can maximize perioperative care. However, this instrument may still undergo small adjustments or additions of some item after a new TRI analysis foreseen after a prospective study with a large number of patients.

Neste trabalho realizou-se a avaliação de pacientes com doenças inflamatórias intestinais (DII) - doença de Crohn (DC) e retocolite ulcerativa idiopática (RCUI) quanto às variáveis psicológicas estresse e modos de enfrentamento utilizado frente à situação de doença. Investigaram-se, ainda, as relações entre estas variáveis e diferentes aspectos clínicos das DII. Os grupos de pacientes com DC e RCUI foram compostos por 25 integrantes cada, que foram comparados com igual número de controles doentes (CD) e saudáveis (CS), sendo estes últimos selecionados dentre os acompanhantes dos pacientes. Empregaram-se instrumentos padronizados e validados de avaliação psicológica: escala de eventos vitais e inventário de enfrentamento. Os resultados mostraram que proporções elevadas e semelhantes (64 80%) dos integrantes dos quatro grupos apresentaram-se sob estresse intenso, ocorrendo, porém, diferenças entre os grupos quanto aos tipos de eventos vitais estressantes experimentados. O estresse intenso se mostrou maior e associado significativamente à idade mais avançada na DC e à doença em atividade na RCUI. Quanto aos modos de enfrentamento, na DC e na RCUI, verificaram-se proporções semelhantes e significativamente superiores à do grupo CD de casos utilizando a estratégia de confronto (40% vs. 12%; p=0,01). Na DC, a proporção de pacientes utilizando a estratégia de resolução de problemas foi significativamente maior que na RCUI (96% vs. 80%; p=0,05). Na RCUI, a proporção de pacientes utilizando a estratégia de fuga/esquiva (96%) foi significativamente maior (p=0,05) que nos grupos CD (80%) e CS (76%). A utilização das várias estratégias de enfrentamento parece ser afetada, na DC, por sexo, escolaridade e estado de atividade da doença. Na RCUI, houve efeito das variáveis: escolaridade, estado de atividade e duração da doença e estresse intenso. Estes dados indicam a ocorrência de estresse intenso nos pacientes, independente do tipo de doença e, também nos acompanhantes. A DC e a RCUI se diferenciam quanto às estratégias de enfrentamento mais utilizadas e pelos fatores que as afetam, o que deve ser levado em consideração no estabelecimento de medidas de intervenção psicológica necessárias ao cuidado integral ao paciente. / This work aimed at assessing emotional stress and coping strategies in patients with inflammatory bowel diseases (IBD): Cohns disease (CD) and ulcerative colitis (UC), as well as studying the relationships between this psychological variables and demographical and clinical characteristics. Groups of patients with CD and UC (N=25) were compared with equal number of subjects from two control groups: healthy caregivers (HC) and patients with other digestive diseases (DC). Validated and standardized psychological tools, such as a stressful live events scale and a ways of coping questionnaire were utilized. Results showed that substantial proportions (64 80%) of subjects pertaining to each of the four groups were under severe stress, with a number of inter-group differences regarding the most quoted stressful event. Severe stress was associated with older age in CD patients, and with disease activity in UC patients. Regarding coping strategies, IBD patients showed an increased proportion of utilization of confrontation (40% vs. 12%; p=0.01), when compared to the DC group. In the CD group, there was a higher proportion of patients utilizing the problem solving strategy, than in the UC group (96% vs. 80%; p=0.05). In the UC group, the proportion of patients utilizing the avoidance strategy (96%) was significantly greater (p=0.05) than in both DC (80%) and HC (76%) groups. In IBD patients, coping styles seemed to be affected by sex (only in the CD group), educational level and disease activity, as well as by disease duration and severe stress (only in the UC group). Our data therefore show that severe emotional stress occurs not only in IBD and other digestive disease patients but also in their caregivers. CD and UC patients show different coping styles, which seems also to be affected by distinct demographical and clinical variables. These findings should be taken into account when designing psychological interventions, which are needed for a more comprehensive health care.

Text in Afrikaans / Die verweer van nie-patologiese ontoerekeningsvatbaarheid in die Suid-Afrikaanse strafreg word bespreek. Hierdie verweer is van onlangse oorsprong en verskil van die verwere van ontoerekeningsvatbaarheid as gevolg van jeugdigheid en geestesongesteldheid soos in artikel 78(1) van die Strafproseswet 51 van 1977 uiteengesit word. Die verweer van nie-patologiese ontoerekeningsvatbaarheid dek gevalle waar dit deur faktore soos emosionele spanning veroorsaak is. Hierdie verweer staan ook as die algemene ontoerekeningsvatbaarheidsverweer bekend. In 'n aantal beslissings, soos onder andere, S v Arnold 1985 (3) SA 256 (C); S v Campher 1987 (1) SA 940 (A) en S v Chretien 1981 (1) SA 1097 (A), word die gevolgtrekking gemaak dat die verweer van nie-patologiese ontoerekeningsvatbaarheid wei in die Suid-Afrikaanse strafreg bestaansreg het. Ten einde met 'n verweer van nie-patologiese ontoerekeningsvatbaarheid te slaag, is die blote ipse dixit van die beskuldigde onvoldoende. 'n Behoorlike grondslag vir die verweer moet gele word. Die bewyslas in die geval van 'n verweer van nie-patologiese ontoerekeningsvatbaarheid word bespreek. / The defence of non-pathological criminal incapacity in the South African criminal law is discussed. It is a relatively new defence and should be distinguished from the defences such as youth and mental illness set out in section 78(1) of the Criminal Procedure Act 51 of 1977. This defence covers cases in which criminal capacity is excluded by factors such as intoxication and emotional stress. It is also known as a general defence of criminal incapacity. In a number of cases, inter alia in S v Arnold 1985(3) SA 256 (C); S v Campher 1987 (1) SA 940 (A) and S v Chretien 1981 (1) SA 1 097 (A) the conclusion is reached that the defence, non-pathological criminal incapacity, does have a right of existence in the South African criminal law. In order to successfully raise the defence on non-pathological criminal incapacity, the mere ipse dixit of the accused is insufficient. A proper foundation for the defence must be laid. The onus of proof is discussed. / Criminal & Procedural Law / LL. M.

Text in Afrikaans / Die verweer van nie-patologiese ontoerekeningsvatbaarheid in die Suid-Afrikaanse strafreg word bespreek. Hierdie verweer is van onlangse oorsprong en verskil van die verwere van ontoerekeningsvatbaarheid as gevolg van jeugdigheid en geestesongesteldheid soos in artikel 78(1) van die Strafproseswet 51 van 1977 uiteengesit word. Die verweer van nie-patologiese ontoerekeningsvatbaarheid dek gevalle waar dit deur faktore soos emosionele spanning veroorsaak is. Hierdie verweer staan ook as die algemene ontoerekeningsvatbaarheidsverweer bekend. In 'n aantal beslissings, soos onder andere, S v Arnold 1985 (3) SA 256 (C); S v Campher 1987 (1) SA 940 (A) en S v Chretien 1981 (1) SA 1097 (A), word die gevolgtrekking gemaak dat die verweer van nie-patologiese ontoerekeningsvatbaarheid wei in die Suid-Afrikaanse strafreg bestaansreg het. Ten einde met 'n verweer van nie-patologiese ontoerekeningsvatbaarheid te slaag, is die blote ipse dixit van die beskuldigde onvoldoende. 'n Behoorlike grondslag vir die verweer moet gele word. Die bewyslas in die geval van 'n verweer van nie-patologiese ontoerekeningsvatbaarheid word bespreek. / The defence of non-pathological criminal incapacity in the South African criminal law is discussed. It is a relatively new defence and should be distinguished from the defences such as youth and mental illness set out in section 78(1) of the Criminal Procedure Act 51 of 1977. This defence covers cases in which criminal capacity is excluded by factors such as intoxication and emotional stress. It is also known as a general defence of criminal incapacity. In a number of cases, inter alia in S v Arnold 1985(3) SA 256 (C); S v Campher 1987 (1) SA 940 (A) and S v Chretien 1981 (1) SA 1 097 (A) the conclusion is reached that the defence, non-pathological criminal incapacity, does have a right of existence in the South African criminal law. In order to successfully raise the defence on non-pathological criminal incapacity, the mere ipse dixit of the accused is insufficient. A proper foundation for the defence must be laid. The onus of proof is discussed. / Criminal and Procedural Law / LL. M.

Einführung: Im Sommersemester 2011 wurde an der Universität Göttingen das interdisziplinäre Kursprojekt „Tod und Sterben – eine Reflexion im Anatomiekurs“ eingeführt. Dieses Gemeinschaftsprojekt der Abteilungen Palliativmedizin, Medizinische Psychologie und Soziologie sowie Anatomie dient als Reflexionsimpuls der Vorbereitung auf den anatomischen Präparierkurs und beinhaltet Aspekte wie Würde und Distanz im Umgang mit dem menschlichen Leichnam im Präpariersaal sowie deren Bezüge zum späteren ärztlichen Handeln. Die Implementierung des aus einem Vorlesungsbeitrag und einem Seminar bestehenden Pilotprojektes wurde wissenschaftlich begleitet und evaluiert. Neben der formalen Kursevaluation wurden Vorerfahrungen der Göttinger Medizinstudierenden mit dem Thema Tod und Sterben, ihre Einstellung zu Beginn des Präparierkurses sowie die Verknüpfung des Anatomiekurses mit emotionaler Belastung, Somatisierungsstörungen und emotionaler Abstumpfung exploriert. Methoden: Mittels eigens konzipierter Fragebögen wurden die Studierenden vor Beginn des Präparierkurses (Tag1), im Anschluss an das reflexive Seminar (Tag 3) und abschließend am letzten Präparierkurstag (Tag 88) befragt. Die Daten wurden mit Hilfe der Programme EvaSys, STATISTICA, SPSS und Excel bearbeitet und es wurden Signifikanztests, Varianz- und Reliabilitätsanalysen durchgeführt. Die Auswertung der offenen Fragen erfolgte in Anlehnung an die Qualitative Inhaltsanalyse nach Mayring. Ergebnisse: Bei einer Rücklaufquote von im Mittel 64,2% entsprach die durchschnittliche Geschlechtsverteilung aller 3 Fragebögen 37,3% männlich und 62,7% weiblich bei einem Durchschnittsalter von 21,9 Jahren. Bei den Medizinstudierenden der Universität Göttingen besteht bereits zu Beginn des Präparierkurses eine große Spannbreite an Vorerfahrungen mit dem Thema Tod und Sterben: Nahezu die gesamte Studierendenschaft hat bereits Todesfälle im familiären Umfeld erlebt. Die meisten Studierenden waren im Vorfeld gegenüber dem Anatomiekurs eher positiv eingestellt, Angst spielte nur für 1/5 der Befragten eine Rolle. Der Präparierkurs ist mit einer emotionalen Belastung verbunden, wenn auch die tatsächlich erlebte psychische Belastung weitaus geringer war als initial von den Studierenden befürchtet; allerdings empfanden rückblickend immerhin noch 61,7% den Präparationskurs in verschiedener Intensität psychisch belastend. 39% der Probanden litten während des Kurses in unterschiedlichem Ausmaß unter Somatisierungstörungen. Die Mehrzahl der Befragten (81,4%) stimmte in unterschiedlichem Maße der Aussage zu, dass der Präparierkurs zu einer gewissen emotionalen Abstumpfung beigetragen hat. Obwohl mehr als die Hälfte der Studierenden sich bereits selbst in irgendeiner Form auf den Umgang mit Verstorbenen vorbereitet hat, erachteten alle Befragten eine angeleitete Vorbereitung auf den Umgang mit Verstorbenen als sinnvoll. Die Kursevaluation bestätigte, dass der interdisziplinäre Kursteil einen Impuls zur Selbstreflexion gegeben hat. So wurden die Studierenden nicht nur angeregt, über die Thematik Tod und Sterben nachzudenken, sondern ein Großteil der Studierenden fühlte sich auch durch die im Seminar erarbeiteten Aspekte zu Empathie, Würde und Distanz besser auf den Umgang mit Verstorbenen vorbereitet. Schlussfolgerung: Der eingeführte Kurs „Tod und Sterben – eine Reflexion im Anatomiekurs“ stellt eine sinnvolle und notwendige Vorbereitung auf den Umgang mit Verstorbenen im Präparationskurs dar. Auch wenn viele Medizinstudierenden bereits außerhalb des Anatomiekurses Erfahrungen mit Tod und Sterben gesammelt haben, sind emotionale Belastungsreaktionen unumstritten und bedürfen somit einer Vorbeugung oder Intervention.

MPH / Department of Public Health / Introduction: It has been noted that stress is considered a major global health challenge. This is because it affects the well-being of service providers, especially those working in the human service sector, such as educators. The sources of stress are attributed to social factors, discipline of students, occupational pressures and workload. Studies have shown that stress is a silent killer that affects the health and productivity of educators, leading to mental, physical, emotional and behavioral illnesses. Educators in the Malamulele North East Circuit are confronted with work challenges and continue experiencing stress. Purpose: The study aimed at finding out the experienced stressors by educators in public high schools of Malamulele North East circuit, Vhembe District. Method: The study was conducted in Malamulele North East public high schools. Malamulele North East is situated in Vhembe District, Limpopo Province, South Africa. A qualitative approach using explorative and descriptive design was adopted for the study. A sample of twelve educators was chosen from the target population by means of convenience sampling and data was collected through a face to face individual in-depth interview. Interviews and discussions were audio-recorded, transcribed and coded into larger themes, categories and sub-categories. Results: The following themes were derived from data analysis: factors considered to be sources of stress, perceived effects of stress among high school educators, strategies that educators use to cope with stress and strategies to manage the experiences of stress for educators. The study showed that different factors at schools have a great impact on educators. All the educators were affected by stressors in their work daily and adopted some coping strategies. However, these educators required continued intervention to manage the stress. Conclusions: The findings showed that all educators were experiencing stress in their work environment and were affected personally as well as professionally. Hence, the DOE needs to design strategies for continues support in order to manage the stress.