O adequado planejamento e implementação de serviços comunitários para cuidados de pacientes com transtornos mentais graves depende do conhecimento sobre as características destes transtornos e sobre a necessidade de cuidados destes pacientes. O presente estudo visou investigar características da população de pessoas com transtorno mental grave (TMG) em áreas de São Paulo e sua evolução em um período de um ano, utilizando desenho de corte transversal seguido de coorte prospectivo. Foram avaliados sintomas psiquiátricos, ajustamento social, violência, uso de serviços e uso de álcool, tabaco e substâncias psicoativas. Foram incluídos 192 participantes na primeira fase do estudo e reavaliados 149 (77,6%). O diagnóstico mais frequênte foi o de esquizofrenia (59.7%); 6.8% dos indivíduos apresentaram ajustamento social pobre e 120 (81.6%) não toveram internação psiquiátrica nos últimos 12 meses / Adequate planning and implementation of community-based care for patients with functional psychoses requires good knowledge about the occurrence and characteristics of the illnesses, and about the sufferers' needs for care. The aims of the present study were to investigate characteristics of a population with severe mental illness (SMI) São Paulo the evolution in one year, using a cross-sectional study followed by a prospective cohort. Assessments included psychiatric symptoms, social adjustment, services use, violence and patterns of alcohol, tobacco and drug use. From 192 subjects included at the cross-sectional study, 149 (77.6%) were re-assessed, at 1-year follow-up. Of the 149 subjects, the most frequent diagnosis was schizophrenia (59.7%); 6.8% presented poor social adjustment, and 120 (81.6%) had no psychiatric admissions in the 1-year follow-up

Introdução: Os mecanismos responsáveis pela evolução do diabetes associado à obesidade entre pacientes bariátricos são alvos de muitos estudos atualmente. As principais linhas de pensamento envolvem alterações no índice de massa corporal (IMC), hormônios gastrointestinais, inflamação sistêmica e a reformatação ou reeducação alimentar. A maioria destes quesitos foi examinada sob a ótica do curto prazo, sendo que informações concernentes a casos com 10 anos de pós-operatório ainda são escassos. Objetivos: Avaliar o desfecho da homeostase glicídica tardio após a DGYR, em pacientes com e sem diabetes prévio, e documentar os parâmetros clínicos e nutricionais que diferenciem estes grupos. Metodologia: Estudo observacional controlado retrospectivo e prospectivo de 100 pacientes submetidos à derivação gástrica em Y de Roux. Estes pacientes foram divididos em dois grupos iniciais, um com diabetes no pré-operatório e outro sem diabetes. Em seguida, os dois foram subdivididos em quatro subgrupos conforme a evolução do diabetes, sendo eles refratário, responsivo, estáveis e não estáveis, respectivamente. Dados demográficos, laboratoriais, nutricionais, prescrições medicamentosas e evolução clínica do diabetes no pós-operatório a longo prazo foram coletados. Resultados: Dos 96 pacientes efetivamente avaliados, a idade situou-se em 50,39 (± 10,98) no grupo refratário, 56,63 (± 8,29) no grupo responsivo, 47,62 (± 10,72) no grupo estável e 48,17 (± 10,45) no grupo não estável. O sexo feminino prevaleceu em todos os grupos. Uma taxa de 66,7% dos pacientes com diabetes alcançaram a remissão da doença após a DGYR, o tempo de diagnóstico de diabetes pré-operatório se relacionou com o grupo refratário, e uma população de novos diabéticos se configurou tardiamente em pacientes sem a doença no período pré-operatório. Conclusão: 1) A derivação gástrica em Y de Roux induziu remissão em 66,7% dos pacientes com diabetes prévio; 2) O tempo de diagnóstico de diabetes tipo 2 esteve associado com ausência da resposta cirúrgica; 3) Pacientes euglicêmicos desenvolveram diabetes após a intervenção na proporção de 17,7%, comprovando que a proteção do procedimento bariátrico contra a instalação do diabetes tipo 2 se atenua com o passar dos anos; 4) Tanto os pacientes com a glicemia anormal quanto os euglicêmicos submetidos à DGYR, necessitam de um seguimento a longo prazo do homeostase glicídica / Introduction: The mechanisms responsible for the development of diabetes associated with obesity among bariatric patients are targets of many ongoing studies. The main lines of thought involve changes in body mass index (BMI), gastrointestinal hormones, systemic inflammation and reformatting nutritional education. Most of these issues were examined from a short term perspective, with information concerning cases after 10 years still scarce. Objectives: Evaluate the outcome of long term of glucose homeostasis after DGYR in patients with and without previous diabetes, and document the clinical and nutritional parameters that differentiate these groups. Methods: An observational retrospective and prospective controlled study with 100 patients undergoing Roux-en-Y gastric bypass. These patients were divided into two initial groups, one with diabetes preoperatively and another without. Then the two groups were subdivided into four subgroups according to the evolution of diabetes, namely refractory, responsive, stable and unstable respectively. Demographic, laboratory, nutritional, and clinical information along with drug prescriptions were collected Results: Among the 96 patients effectively studied, age was 50.39 (± 10.98) in the refractory group, 56.63 (± 8.29) in the responsive group, 47.62 (± 10.72) in the stable group and 48 , 17 (± 10.45) in the unstable group. Females were the majority in all groups. About 66,7% of patients with diabetes achieved disease remission after DGYR, and duration of diabetes was associated with the refractory group. A population of new-onset diabetes was identified in patients without disease in the preoperative period. Conclusion: 1) Roux-en-Y gastric bypass induced remission in 66,7% of patients with previous diabetes; 2) Duration of diagnosis of type 2 diabetes was associated with surgical response, 3) Euglycemic patients developed diabetes after the intervention in the proportion of 17,7%, proving that the protection of bariatric procedure against type 2 diabetes is attenuated over the years; 4) Both patients with abnormal glucose profile as well as those euglycemic undergoing DGYR, require long follow-up of glucose homeostasis

Die klinischen Langzeitergebnisse des vorderen Kreuzbandersatz mit dem Patellarsehnentransplantat nach durchschnittlich 13,8 Jahren waren nicht zufriedenstellend. Hauptursachen hierfür waren operativ-technische Mängel, wie Fehlpositionierung der Bohrkanäle und die Fixierung der Transplantate in einer zu hohen Kniebeugestellung. Diese Abweichungen führten zu signifikant schlechteren Bewegungsausmaßen sowohl in der Streckung als auch in der Beugung. Insbesondere bei zu weit ventral positionierter femoraler Bohrkanalanlage resultierte ein erhebliches Beugedefizit mit Stressbelastung auf das femorotibiale Kompartiment, ähnlich einem Nußknackerphänomen. Bei zu weit ventral positioniertem tibialen Bohrkanal wurde eine signifikante Verringerung der Extension beobachtet. Die Patienten mit gleichzeitiger Meniskusresektion hatten signifikant höhere arthrotische Veränderungen. Sowohl die zum damaligen Zeitpunkt allgemein anerkannte Operationstechnik als auch die postoperative Rehabilitation ist zeitlich überholt und entspricht nicht den gegenwärtigen internationalen Standards. In der experimentellen Untersuchung zum Einwachsverhalten einer autologen vorderen Kreuzbandplastik am Kaninchenmodell konnte der Einfluss und die Wirkung von manipulativ wirkenden Faktoren auf die Ausbildung eines stabilen Bindegewebsregenerates belegt werden. Sowohl der fibrinstabilisierende Faktor XIII als auch die eingesetzte Transplantat-Splitting-Technik zeigten eine positive Wirkung auf den Ein- und Umbau sowie den biomechanischen Ausrissfestigkeiten der Transplantate. Die alleinige Wirkung des Faktor XIII spielt vor allem in der Frühphase eine stimulierende Rolle auf die Initiierung der Umbauvorgänge und der ossären Intergration der Knochenblöcke. Mittel- und langfristig wird die Ausbildung von belastungsstabilen Kollagenfibrillen durch andere weitestgehend unbekannte Einflussfaktoren bestimmt. Die neuartig entwickelte Transplantat-Splitting-Technik erwies sich für den Transplantatumbau ebenfalls als vorteilhaft. Mit dieser Transplantatbearbeitung wurde die Grundlage für eine frühzeitige synoviale Ernährung der Bündel gewährleistet. Durch die artifizielle Gewebsläsion werden reparative Vorgänge beschleunigt. Auf der Grundlage der experimentell gewonnenen Daten kann die Transplantat-Splitting- Technik für die klinische Erprobung und Praxiseinführung empfohlen werden. / The clinical long term results mean 13,8 years after anterior cruciate ligament reconstructions with bone-patellar tendon-bone transplant were not satisfied. Main reasons were technical errors, malpositioning of the bone tunnels and fixation of the transplant in a too high degree of flexion. As a result the patients had significant reductions of motion in extension as well as in flexion. Especially in cases with an anterior femoral bone tunnel position the patients had a loss of flexion and high degree of shear forces in the femoro-tibial compartment similar a nutcracker phenomenon. In ACL reconstructions with an anterior tibial bone tunnel position could be observed a loss of extension. Patients with concomitant meniscal resection showed significant higher rate of osteoarthrotic changes. Both, the former operative technique and the postoperative rehabilitation programme had no clinical relevance today and are replaced by new standards. In an experimental study regarding to the remodeling process of an autologous anterior cruciate ligament plasty in a rabbit model could be examined factors which influencing the maturation process of the graft. The fibrin stabilizing factor XIII as well as the transplant splitting technique showed a positive effect in the remodelling process and the pull-out strength of the transplants. In the early phase the factor XIII activated the initial remodeling and the osseous ingrowth of the bone blocks. In middle and long term period of remodeling there plays unknown factors an important role for building of force restraint collagen fibrils. The new developed splitting technique had some additional advantages. Using these technique the basis of early synovial nutrition could be realized. The artificial tissue lesion leads to an acceleration of the reparative response. On the basis of the experimental data the transplant splitting technique can be recommended and introduce in the clinical trial.

<p>This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).</p><p>Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.</p><p>Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.</p><p>Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.</p><p>The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.</p>

<p>Allt fler organisationer bedrivs i projektform idag. Därför är det betydelsefullt att organisationer har väl fungerande projektredovisningssystem.</p><p>Den här uppsatsen behandlar projektredovisningssystemet, TimeEase, hos SABO AB. Tyngdpunkten i uppsatsen ligger på utvärderingen av det här systemet. En utvärdering som bygger på medarbetarnas åsikter och funderingar kring TimeEase. I uppsatsen beskriver vi medarbetarnas inställning mot TimeEase och förklarar med hjälp av olika teorier varför det förhåller sig på det sättet.</p><p>Uppsatsen grundar sig på intervjuer och en enkätundersökning där medarbetarna fick svara på frågor angående TimeEase. Svaren kopplas till projektteorier som handlar om projektuppföljning och projektekonomi samt förändringsprocesser som beskriver införandet av nya IT- verktyg i organisationen.</p><p>Undersökningen visar att en stor del av medarbetarna är missnöjda med projektredovisningssystemet TimeEase samtidigt som de anser att det kan vara ett bra verktyg om det användes på rätt sätt. Det innebär att TimeEase måste utvecklas för att det ska fylla dess syfte.</p> / <p>At present, more companies are run by projects, and therefore it is very important for them to have an operational accounting system.</p><p>This essay examines the accounting system, TimeEase, at SABO AB. The emphasize is on the evaluation of the accounting system. An evaluation based on employees opinions and thoughts on TimeEase. This describes employee attitude towards TimeEase and explains it with various theories reason behind it.</p><p>This essay is based on interviews and an questionnaire which were handed out to the employees who voluntarily answered questions concerning TimeEase. The answers from the questionnaire we received were related to the theories which explains project follow-up, project finances and changing process which describes introduction of new information technology system.</p><p>This examination reveals that the majority of the employees are dissatisfied with TimeEase, but also that is a good system if used properly. This implies that TimeEase has to develop to fulfill its purpose.</p>

<p>Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. </p><p>Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients.</p><p>Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. </p><p>Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. </p><p>Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed.</p><p>Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.</p>

<p>Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.</p>

Allt fler organisationer bedrivs i projektform idag. Därför är det betydelsefullt att organisationer har väl fungerande projektredovisningssystem. Den här uppsatsen behandlar projektredovisningssystemet, TimeEase, hos SABO AB. Tyngdpunkten i uppsatsen ligger på utvärderingen av det här systemet. En utvärdering som bygger på medarbetarnas åsikter och funderingar kring TimeEase. I uppsatsen beskriver vi medarbetarnas inställning mot TimeEase och förklarar med hjälp av olika teorier varför det förhåller sig på det sättet. Uppsatsen grundar sig på intervjuer och en enkätundersökning där medarbetarna fick svara på frågor angående TimeEase. Svaren kopplas till projektteorier som handlar om projektuppföljning och projektekonomi samt förändringsprocesser som beskriver införandet av nya IT- verktyg i organisationen. Undersökningen visar att en stor del av medarbetarna är missnöjda med projektredovisningssystemet TimeEase samtidigt som de anser att det kan vara ett bra verktyg om det användes på rätt sätt. Det innebär att TimeEase måste utvecklas för att det ska fylla dess syfte. / At present, more companies are run by projects, and therefore it is very important for them to have an operational accounting system. This essay examines the accounting system, TimeEase, at SABO AB. The emphasize is on the evaluation of the accounting system. An evaluation based on employees opinions and thoughts on TimeEase. This describes employee attitude towards TimeEase and explains it with various theories reason behind it. This essay is based on interviews and an questionnaire which were handed out to the employees who voluntarily answered questions concerning TimeEase. The answers from the questionnaire we received were related to the theories which explains project follow-up, project finances and changing process which describes introduction of new information technology system. This examination reveals that the majority of the employees are dissatisfied with TimeEase, but also that is a good system if used properly. This implies that TimeEase has to develop to fulfill its purpose.

Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients. Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed. Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.

Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.