<p>Syftet var att undersöka fyra hälsovägledares uppfattningar och strategier för att motivera individer till viktminskning. Avsikten var även att utreda vad de bygger sina uppfattningar och strategier på, samt att jämföra deras strategier med befintliga teorier om beteendeförändring såsom Motiverande samtal, Stages of change, Social learning theory och Health belief model. Teorierna valdes då de belyser hur en beteendeförändring kan gå till samt att de varit fram­gångsrika i tidigare forskning. Studien är kvalitativ och genomfördes med ostrukturerade intervjuer där respondenterna valdes genom ett bekvämlighetsurval. De fyra hälsovägledarna arbetade med att motivera individer till viktnedgång, alla hade utbildning inom hälso­främjande arbete som varierade mellan en vecka till flera år. Resultatet visade på att hälso­vägledarna använder sig av befintliga teorier samt av strategier som bygger på deras utbildning och egna erfarenheter. De förändrar sin arbetsmetod efterhand som de får ny kunskap samt då de reflekterar över sitt arbetssätt, vilket tyder på att de är reflekterande praktiker.</p>

Syftet var att undersöka fyra hälsovägledares uppfattningar och strategier för att motivera individer till viktminskning. Avsikten var även att utreda vad de bygger sina uppfattningar och strategier på, samt att jämföra deras strategier med befintliga teorier om beteendeförändring såsom Motiverande samtal, Stages of change, Social learning theory och Health belief model. Teorierna valdes då de belyser hur en beteendeförändring kan gå till samt att de varit fram­gångsrika i tidigare forskning. Studien är kvalitativ och genomfördes med ostrukturerade intervjuer där respondenterna valdes genom ett bekvämlighetsurval. De fyra hälsovägledarna arbetade med att motivera individer till viktnedgång, alla hade utbildning inom hälso­främjande arbete som varierade mellan en vecka till flera år. Resultatet visade på att hälso­vägledarna använder sig av befintliga teorier samt av strategier som bygger på deras utbildning och egna erfarenheter. De förändrar sin arbetsmetod efterhand som de får ny kunskap samt då de reflekterar över sitt arbetssätt, vilket tyder på att de är reflekterande praktiker.

Addiction to drugs is a widely acknowledged problem in South Africa. Newer developments in the study of addiction include behaviours such as gambling and sex as part of a broader syndrome. International research has established that most people with one addiction are at risk for co-occurring addictions which are frequently undiagnosed and untreated. Multiple addictions (MA) have been shown to combine in specific patterns to produce addiction interaction disorder (AID) resulting in a more complex, treatment- resistant illness. This was the first study South Africa to investigate if people with substance use disorders had other addictions. The research had three aims: to establish if in-patients admitted to three drug rehabilitation centres had other addictions, to investigate the extent of the MA and AID and to determine whether the treatment programmes managed them appropriately. The study employed the mixed methods research design and was located at three in-patient facilities in Durban, KwaZulu-Natal. During the first phase, discussion groups were held with professionals that explored their perceptions of MA, AID and current treatment programmes. The second phase involved a survey of 123 participants screened for poly-substance abuse, sex (including internet) addiction and problem gambling. The third phase utilised in-depth interviews with 25 participants displaying MA to understand the development of addiction, AID and treatment received. The data were analysed utilising descriptive and statistical analysis for the survey data, and thematic analysis for the in-depth interviews and discussion groups. The study found a high incidence of MA within the survey population of 54%; 37% of participants tested positive or at risk for problem gambling and 41% tested positive for sex addiction with 24% of the participants being positive for both. In-depth interviews revealed high rates of trauma, especially for the female participants and demonstrated the complex interrelationship between addictions. AID was identified in all 25 participants. In KwaZulu- Natal, it appears that MA and AID are currently not being assessed or treated. The study highlights the need for a broader conceptualisation of addiction which would improve current assessment and treatment and has implications for further training of professionals and addiction policy in South Africa. / Ph.D. University of KwaZulu-Natal, Durban 2013.

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The main aim of this graduation thesis is to define the term of secondary prevention of drug addiction, which is sometime apprehended in different ways in The Czech Republic. I try to include this new definition to our drug policy and classify target groups and bring new methods to the secondary prevention of drug addiction. The thesis is focused on the terms drug, dependence syndrome and prevention and I use various definitions and opinions. I describe and briefly evaluate the system of drug policy and the place of secondary prevention. The occasional users and their families and friends are defined as a target group. The motivational interviewing is the main method in the secondary prevention. The thesis is structured into six parts and in the last part there are some practical examples from two low-thershold facilities for children and youth.

INTRODUÇÃO: A dependência de cocaína/crack está associada a prejuízos neuropsicológicos, principalmente nas funções executivas, estas gerenciadas predominantemente pelo córtex préfrontal do cérebro. O jogo de xadrez é uma atividade que recruta funções executivas e tem sido empregado na reabilitação de pacientes com outros transtornos psiquiátricos; porém, nenhum estudo, até hoje, avaliou o impacto deste jogo em pacientes com dependência química. OBJETIVO: Investigar a viabilidade e o impacto de uma abordagem inovadora, o Xadrez Motivacional, com foco na estimulação das funções executivas, especialmente em memória de trabalho, planejamento e tomada de decisões. MÉTODOS: Foram selecionados 72 pacientes entre 18 e 45 anos que estavam internados na Enfermaria do Comportamento Impulsivo (ECIM) do IPq-HC-FMUSP com diagnóstico de dependência de cocaína/crack. Os pacientes foram divididos em dois grupos, o Grupo Intervenção (n=42), submetido ao Xadrez Motivacional (intervenções por meio de estratégias de Entrevista Motivacional e jogo de xadrez) e o Grupo Controle, (n=30) submetido a atividades recreativas. Os pacientes foram avaliados pré e pós intervenção (aproximadamente um mês de abstinência) através de testes neuropsicológicos e escalas de autopreenchimento. RESULTADOS: Foi observada melhoria significativa na maioria das funções avaliadas, em ambos os grupos (intervenção e controle), porém a participação no Grupo Intervenção associou-se com uma melhoria mais significativa em memória de trabalho verbal. CONCLUSÃO: Estes resultados são promissores por demonstrarem a viabilidade do Xadrez Motivacional nesta população e, principalmente, por auxiliar significativamente na melhoria da memória de trabalho no Grupo Intervenção / INTRODUCTION: Crack cocaine dependence is associated with neuropsychological impairments, mainly in executive functions, managed predominantly by the prefrontal cortex. The game of chess is an activity that recruits executive functions and has been used in the rehabilitation of patients with other psychiatric disorders, but no study to date has evaluated the impact of this game on patients with substance dependency. OBJECTIVE: To investigate the feasibility and impact of an innovative approach, Motivational Chess, focusing on executive function stimulation, especially in working memory, planning and decision making. METHODS: The study enrolled 72 patients between 18 and 45 years who were admitted in the Impulsive Behavior Ward (ECIM) of IPq-HC-FMUSP diagnosed with crack/cocaine dependence. Patients were divided into two groups, the intervention group (n=42) underwent Motivational Chess (interventions using Motivational Interviewing strategies and chess game) and the control group (n=30) was submitted to recreational activities. Patients were assessed pre and post intervention (approximately one month of abstinence) using neuropsychological tests and self-report scales. RESULTS: We found significant improvement in most of the functions evaluated in both groups (control and intervention), but participation in the intervention group was associated with a more significant improvement in verbal working memory. CONCLUSION: These results are promising to show the feasibility of this approach of cognitive stimulation in this population and mainly to aid significantly improve of working memory

Bakgrund: Risken att utveckla hjärt- och kärlsjukdom samt diabetes typ 2 ökar vid ohälsosamma levnadsvanor. Ett av distriktssköterskans uppdrag är att arbeta hälsofrämjande för att förebygga dessa sjukdomar. Sörmlands hälsoprogram är en del i ett hälsofrämjande arbete och riktar sig till 40-, 50- och 60-åringar inom Region Sörmland. Syfte: Att identifiera och beskriva inbjudna deltagares erfarenheter av hälsosamtalet i Sörmlands hälsoprogram. Metod: Deskriptiv design med kvalitativ ansats. Semistrukturerade intervjuer genomfördes med stöd av en intervjuguide. Tio personer som deltagit i hälsosamtalet är informanter i föreliggande studie. Datan analyserades med tematisk analys enligt Braun och Clarke. Resultat: Analysen resulterade i två övergripande teman; Deltagarnas erfarenheter av samtalets kringliggande faktorer och Samtalets olika dimensioner och dess betydelse. Under vardera temat finns två underliggande subteman som skildrar resultatet. Slutsats: Sörmlands hälsoprogram som helhet och hälsosamtalet som en del i detta uppskattas av de som deltar. Hälsosamtalet upplevs som respektfullt och neutralt där informanterna beskriver att de får tid att reflektera och komma till insikt om sina levnadsvanor och att det skapar en ökad motivation. / Background: The risk of developing cardiovascular disease and type 2 diabetes increases with unhealthy living habits. One of the district nurse's tasks is to work in health promotion to prevent these diseases. Sörmland's health program is part of a health promotion work and is aimed at 40-, 50-and 60-year-old in the Region of Sörmland. Aim: To identify and describe invited participants' experiences of the health dialogue in Sörmland's health program. Method: Descriptive design with qualitative approach. Semi-structured interviews were conducted with the help of an interview guide. Ten people who participated in the health dialogue are informants in the present study. The data were analyzed using thematic analysis according to Braun and Clarke. Results: The analysis resulted in two overall themes; The participants' experiences of the surrounding factors of the health dialogue and the different dimensions of the health dialogue and its significance. Under each theme, there are two underlying subthemes that depict the result. Conclusion: Sörmland's health program as a whole and the health dialogue as part of this are appreciated by those who participate. The health dialogue is perceived as respectful and neutral where the informants describe that they are given time to reflect and gain insight into their living habits and that it creates an increased motivation.

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While online video communication has become a part of many people's lives, it still lacks an important aspect of human interaction – eye contact. Conventional technology does not provide the ability to share eye contact online. The NUNA machine is a unique communication unit that enables this shared virtual eye contact (VEC). The aim of this study was to explore how people experience VEC in a virtual therapeutic setting, specifically in a Motivational Interview (MI). This experience was specifically juxtapositioned to an in-person setting as it provides eye contact as a natural part of the conversation. Research questions included how participants would experience eye contact in a MI setting in 1) a video conference with shared eye contact and 2) an in-person conversation, how participants would make sense of the perceived differences between the settings, and which value participants saw in VEC. In the MI, participants first spoke to each other using the NUNAs and then seamlessly continued their conversation in-person. After this exposure, they took part in qualitative interviews sharing their experience and how they made sense of it. These qualitative interviews were then analyzed by conducting qualitative content analysis. In total, 10 university students, approximately in their 20s, were interviewed. The results suggest that VEC acts as an antagonist to the disembodiment that is inherent to virtual interactions by providing connection and increasing the degree of realness with which the vis-à-vis is perceived. It further revealed that the NUNA setting provided a focused environment in which participants felt like they could work on their emotions and feel validated by and committed to their vis-à-vis. Thus, VEC may strengthen therapeutic alliance and be a promising tool for online psychotherapy by providing a higher degree of realness as would be natural for in-person conversations. / Videokommunikation online har blivit en del av många människors liv, men det saknas fortfarande en viktig aspekt av mänsklig interaktion - ögonkontakt. Konventionell teknik ger inte möjlighet att ha ögonkontakt online. NUNA-maskinen är en unik kommunikationsenhet som möjliggör denna delade virtuella ögonkontakt (VEC). Syftet med den här studien var att undersöka hur människor upplever VEC i en virtuell terapeutisk miljö, särskilt i en motiverande intervju (MI). Den här upplevelsen var särskilt jämförbar med en personlig miljö eftersom ögonkontakt är en naturlig del av samtalet. Forskningsfrågorna omfattade hur deltagarna skulle uppleva ögonkontakt i en MI-miljö i 1) en videokonferens med ögonkontakt och 2) ett personligt samtal, hur deltagarna skulle förstå de upplevda skillnaderna mellan miljöerna och vilket värde deltagarna såg i VEC. I MI-miljön talade deltagarna först med varandra med hjälp av NUNA och fortsatte sedan sömlöst sitt samtal i en personlig konversation. Efter denna exponering deltog de i kvalitativa intervjuer där de delade med sig av sina erfarenheter och hur de tolkade dem. Dessa kvalitativa intervjuer analyserades sedan med hjälp av kvalitativ innehållsanalys. Sammanlagt intervjuades 10 universitetsstudenter, ungefär i 20-årsåldern. Resultaten tyder på att VEC fungerar som en antagonist till den kroppslöshet som är inneboende i virtuella interaktioner genom att tillhandahålla anslutning och öka graden av realitet med vilken motparten uppfattas. Vidare framkom att NUNA-miljön skapade en fokuserad miljö där deltagarna kände att de kunde bearbeta sina känslor och känna sig bekräftade av och engagerade i sin samtalspartner. VEC kan således stärka den terapeutiska alliansen och vara ett lovande verktyg för psykoterapi på nätet genom att ge en högre grad av realitet, vilket vore naturligt vid personliga samtal.