Essa tese se constitui em uma reflexão crítica que contempla o desemprego do mercado de trabalho formal dos trabalhadores brasileiros e argentinos e sua passagem para o emprego/ocupação na informalidade. Além disso, diagnosticamos, por meio de depoimentos, os efeitos da mudança de emprego sobre a saúde física e mental do grupo de trabalhadores que participou deste estudo. Investigamos também a visibilidade e eficácia dos programas públicos de emprego e saúde dos dois países. Desenvolvemos um conjunto de reflexões teóricas versando sobre as mudanças do mercado de trabalho e o novo padrão de desenvolvimento capitalista, e o processo de informalidade e as razões que levam à inserção dos trabalhadores no mercado de trabalho informal e suas conseqüências sociais. Conceituamos saúde, saúde física e mental, promoção da saúde e trabalho para analisar as políticas públicas e suas influências na saúde dos cidadãos. Caracterizamos e analisamos o complexo saúde/trabalho/informalidade/inseguridade social na Argentina e no Brasil. Através de Sondagem, traçamos o perfil de ex-empregados do mercado de trabalho formal que hoje estão empregados/ocupados na informalidade, e verificamos os agravos na saúde física e mental dos trabalhadores. Dentre os resultados alcançados, destacamos os seguintes: o trabalhador se sente inseguro por estar à margem do Sistema Público de Seguridade Social; a demissão produz um impacto nitidamente marcante sobre a saúde física e mental do trabalhador imediatamente após a sua concretização; os sintomas/sentimentos mais citados derivados da demissão e da passagem para a informalidade são inapetência, insônia, tensão nervosa, paranóia, medo, depressão, aumento na agressividade, sentimentos de impotência psíquica, medo do futuro, desesperança, tristeza, raiva, dores de cabeça e dores de estomago, entre outros. Além disso, constatamos a presença freqüente de distúrbios nas relações interpessoais, com reflexo acentuado na família do ex-empregado; a condição de informalidade, por estar associada à inseguridade social, contribui de forma significativa para o sentimento de desamparo do ex-empregado; a maioria dos trabalhadores acredita que o governo deva criar mecanismos que possibilitem enfrentar a condição de inseguridade social na qual vivem. Diagnosticamos também elementos que podem levar ao questionamento e aprimoramento de programas públicos de emprego e saúde, com o objetivo de torná-los operacionais e eficazes. A principal diferença de comportamento observada entre os trabalhadores argentinos e brasileiros da amostra, refere-se à auto-estima, estrutura emocional com maior resistência para suportar cargas emocionais, consciência política e social e formação educacional. / Esta tesis se constituye en una reflexión crítica que contempla el desempleo en el mercado de trabajo formal de los trabajadores brasileños y argentinos y su pasaje para el empleo/ocupación informal. Además, diagnosticamos, por medio de declaraciones, los efectos del cambio de trabajo sobre la salud física y mental del grupo de trabajadores que participaron de este estudio. Investigamos también la visibilidad y eficacia de los programas públicos de empleo y salud de los dos países. Desarrollamos un conjunto de reflexiones teóricas versando sobre los cambios del mercado de trabajo y el nuevo patrón de desarrollo capitalista; y el proceso de informalidad y las razones que llevan a la inserción de los trabajadores en el mercado de trabajo informal y sus consecuencias sociales. Conceptuamos salud, salud física y mental, promoción de la salud y trabajo para analizar las políticas públicas y sus influencias en la salud de los ciudadanos. Caracterizamos y analizamos el complejo salud /trabajo/informalidad/inseguridad social en Argentina y en Brasil. A través de Sondeo, trazamos el perfil de ex empleados del mercado de trabajo formal que hoy están empleados/ocupados en la informalidad, y verificamos los daños en la salud física y mental de los trabajadores. Entre los resultados alcanzados, destacamos los siguientes: el trabajador se siente inseguro por estar al margen del Sistema Público de Seguridad Social; el despido produce un impacto nítidamente marcante sobre la salud física y mental del trabajador inmediatamente después de que se concreta; los síntomas/sentimientos más citados derivados del despido y del pasaje para la informalidad son inapetencia, insomnio, tensión nerviosa, paranoia, miedo, depresión, aumento de la agresividad, sentimientos de impotencia psíquica, miedo del futuro, desesperanza, tristeza, rabia, dolores de cabeza y dolores de estómago, entre otros. Además, constatamos la presencia frecuente de disturbios en las relaciones interpersonales, con reflejo acentuado en la familia del ex empleado; la condición de informalidad, por estar asociada a la inseguridad social, contribuye de forma significativa, para el sentimento de desamparo del ex empleado; la mayoría de los trabajadores cree que el gobierno debe crear mecanismos que posibiliten enfrentar la condición de inseguridad social en la que viven. Diagnosticamos también elementos que pueden llevar al cuestionamiento y perfeccionamiento de programas públicos de empleo y salud, con el objetivo de volverlos operacionales y eficaces. La principal diferencia de comportamiento observada entre los trabajadores argentinos y brasileños de la muestra se refiere a: autoestima, estructura emocional con mayor resistencia para soportar cargas emocionales, conciencia política y social

INTRODUCTION: The inflammation observed in patients with IBD can negatively impact the intake or absorption of vitamin D. This can increase the risk of disease relapse, impact patients’ quality of life, and increase the risk of IBD related surgeries. In addition to the traditional observation that vitamin D deficiency may be a comorbid manifestation of IBD, there is now growing evidence pointing to serum vitamin D levels as a pathogenic factor contributing to the initiation and propagation of mucosal inflammation in patients with IBD. It is well-established that variation in clinical practice leads to less optimal outcomes in any clinical setting. The relative scarcity of clinical and translational studies is even more pronounced in the pediatric population. OBJECTIVES: The primary objective of this study is to quantify the prevalence of clinician assessment of vitamin D levels in pediatric patients with IBD. We will also look at this behavior in subpopulations and compare their vitamin D status. It is secondary for this study to also describe variations in physician practices with respect to the testing and treatment of vitamin D deficiency at a single tertiary care IBD Center. METHODS: We conducted a retrospective cohort study on consecutive patients with UC, CD, and ID, that were followed in the ambulatory program in the Center for Inflammatory Bowel Disease at Boston Children’s Hospital from 1/1/2014 to 12/31/2014. We identified 498 patients and collected their demographic information, serologic testing, and physician prescribing behavior. RESULTS: Out of the entire population, 64% of the patients were vitamin D deficient (vitamin D level below 32 ng/ml). 24% of the patients received vitamin D supplementation. Vitamin D deficiency was less prevalent in patients with UC than those with CD, with an OR of 0.64 (95% CI 0.43-0.94). Out of the ones receiving supplementation, 37% of them were deficient. In terms of physician practice trends, 62% of the patients were not formally prescribed supplementation. 14.5% of those who were prescribed supplementation were receiving 50,000 IU weekly, and the rest receiving 400 – 2,000 IU daily. Patients with vitamin D levels below 20 ng/ml were more likely to receive the high dose vitamin D prescription (OR 11.5) than those with levels between 20 and 30 ng/ml (OR 5.7). CONCLUSIONS: Our study suggests that despite high prevalence of vitamin D deficiency in pediatric patients with IBD, there is a lack of consensus with respect to the assessment of vitamin D levels and consistency in prescribing vitamin D supplementation. With the potential role that vitamin D plays in IBD pathology and suggestions of the therapeutic effects of vitamin D supplementation, further studies are needed to explore this area.

Bakgrund: Kommunikation är en nyckelfaktor för att kunna bedriva en säker och tillfredsställande vård. Vårdteamet består av flera olika professioner som behöver kommunicera för att uppnå satta mål. Av alla vårdskador är 70% orsakade på grund av bristande kommunikation. För att öka patientsäkerheten krävs det att vårdteamet har rutiner för att säkerställa att patientinformation överförs på ett säkert sätt. Inte minst mellan läkare och sjuksköterska krävs ett säkert kommunikationssystem eftersom professionerna samarbetar kontinuerligt. Syfte: Att belysa sjuksköterskors erfarenheter av interprofessionell kommunikation med läkare och dess betydelse för patientsäkerheten. Metod: Litteraturstudie baserad på tio vetenskapliga artiklar med kvalitativ ansats som granskats, analyserats och sammanställts till ett resultat. Resultat: Sju teman har framställts i resultatet bestående av “Roller”, “Tidsbrist”, “Förminskning”, “Anpassad kommunikation”, “Brist på information”, “Följder för patienten av bristande kommunikation” och “Teamarbete”. Konklusion: Sjuksköterskor upplever att deras kunskaper inte tas på allvar av läkarna. När läkarna undanhåller information om patienten upplevs frustration. De anser att en god relation till läkaren gynnar kommunikationen. För att förmedla information till läkarna krävs det att sjuksköterskrona anpassar sin kommunikationsstil beroende på specifik läkare och situation. / Background: Communication is a key factor to be able to provide safe and satisfactory care. The healthcare team consists of multiple professions who need to communicate to achieve their goals. 70% of all instances where the patient comes to harm in healthcare is because of communication errors. To increase the patient safety the healthcare team needs routines to ensure that patient information is transferred between the professions in a safe manner. Especially between the nurse and the physician the communication needs to function since the two professions corporate continuously. Aim: To examine nurses experiences of communication with physicians and the impact on patient safety. Methods: A literature review based on ten scientific articles with qualitative data that has been reviewed, analysed and compiled to a result. Results: Seven themes were produced in the results consisting of “Roles”, “Lack of time”, “Diminishing”, “Adapted communication”, “Lack of information”, “Consequences for the patient because of lack in communication” and “Teamwork”. Conclusion: The nurses experience that their knowledge is not taken seriously by the physicians. When the physicians are withholding information, the nurses feel frustration. They believe that a good relation with the physician improves the communication. To mediate information to the physicians the nurses sometimes need to adapt their communication style depending on which physician they are communicating with.

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付記する学位プログラム名: デザイン学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22803号 / 情博第733号 / 新制||情||125(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 矢守 克也, 特定教授 川上 浩司 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

Assisted suicide in the perspective of the Czech criminal law and a comparison with the common law Abstract The strict prohibition on assisted suicide does not reach full acceptance among the members of the Czech society, regardless of their professional or non-professional background, similarly as it did not reach full acceptance in some of the common law countries, which consequently departed or are soon to depart from this regulatory conception. The objective of the two so far proposed Czech bills was identical, however, owing to the lack of clarity and detail, which certainly did not amount to the seriousness of the issue they aimed to regulate, none of them was successful. Hence, the legislative works were recommenced last year and resulted in the third bill, which claimed to be much more elaborative on the key issues and accordingly precise in the usage of language. Although the bill has not been introduced yet, the assumptions based not only on the territorial proximity are, that its prime source of inspiration resided mostly in the permissive regulatory attitude towards assisted suicide (or voluntary, active and intentional, euthanasia) as implemented in the European countries. However, notwithstanding the utter differences in the conception of the common law legal system, especially for such...

Många misstag i vården har sin grund i bristande samverkan mellan sjuksköterskor och läkare. Sjuksköterskor har ett holistiskt synsätt med fokus på omvårdnad, medan läkare har ett biomedicinskt synsätt med fokus på att bota sjukdom. Trots detta förväntas de båda professionerna kunna samverka. Studiens syfte var att belysa faktorer som sjuksköterskor upplever påverkar samverkan med läkare. Studien utfördes i form av en litteraturstudie. Tolv resultatartiklar bearbetades genom en innehållsanalys, vilket resulterade i fyra övergripande teman: Förhållningssätt som handlade om attityder och en förståelse för den andres profession. Involvering berörde delaktighet och ett delat beslutsfattande. Interaktion handlade om kommunikation och relationsskapande. Slutligen lyftes Organisationens struktur som en påverkande faktor genom skilda arbetssätt och hierarkiska strukturer. Sjuksköterskor och läkare är de två viktigaste professionerna inom klinisk sjukvård och de förväntas samverka i team. Ändå implementeras ingen form av utbildning eller information om vad den andres profession innebär med ansvar, utveckling och kunskapsnivå. Samverkan mellan sjuksköterskor och läkare innefattar många olika faktorer som korrelerar, vilket gör samverkan till en komplex process som kräver kunskap, engagemang och handlingskraft. / Many mistakes in healthcare are due to a lack of cooperation between nurses and physicians. Nurses have a holistic approach with a focus on nursing, while doctors have a biomedical approach with a focus on curing disease. Despite this, the two professions are expected to cooperate. The aim of the study was to shed light on factors which nurses experiencing affects cooperation with physicians. The study was conducted in the form of a literature study. Twelve result articles were processed through a content analysis, which resulted in four overarching themes: Approach that contained attitudes and an understanding of the other’s profession. Involvement included participation and shared decision making. Interaction emphasized communication and relationships. Finally, Structure of the organisation was expressed as an influencing factor by differing work procedures and hierarchical structures. Nurses and physicians are the two most important professions in clinical health care system, and they are expected to cooperate in teams. Nevertheless, no form of education or information is implemented about what the other’s profession entails with responsibility, development, and level of knowledge. Cooperation between nurses and physicians includes many different factors that correlate, which makes cooperation a complex process that requires knowledge, commitment, and drive.

The work deals with the registration of incoming patients to the physician. In the theoretical section summarizes the current technical solutions used in practice to record the waiting clients to provide various services. One chapter is devoted to describing the identifiers occurring in the population. The result is to design a custom solution based on reading data from health care cards.

Patienter med somatisk och psykiatrisk samsjuklighet är en sårbar och vårdmässigt komplex grupp som löper större risk, jämfört med normalpopulationen, att avlida i förtid till följd av sjukdomar som kunde ha förebyggts. Bristande socioekonomiska resurser tycks vara en förklaring men forskning visar också på sämre bemötande av patientgruppen samt att fler diagnostiska misstag görs vid samsjuklighet. Syftet med denna studie var att undersöka hur läkare inom somatiken upplever svårigheter i diagnostik och behandling gällande samsjukliga patienter. Semistrukturerade intervjuer genomfördes med tio läkare verksamma inom somatisk vård. Induktiv tematisk analys visade att läkarnas upplevelser kunde delas in i fyra teman; Osäkerhet, Relationen, Kapacitet och Integration. Resultaten visar att läkare upplever svårigheter kopplat till individen, patient-läkar-relationen och vården i stort. Kärnkategorin Otillräcklighet är beskrivande för samt genomsyrar samtliga teman och handlar om en otillräcklighet i hela vården, hos såväl patient som vårdpersonal och organisation. Dessa fynd bekräftar dels tidigare forskning och tillför fördjupade perspektiv i en svensk kontext. Behov finns av vidare kvantitativ forskning inom ämnet för ett mer generaliserbart resultat. / Patients with somatic and psychiatric comorbidity constitute a vulnerable and care-wise complex group at higher risk, compared to the general population, of premature death due to preventable diseases. A lack of socio-economic resources seems to be one explanation, but research also shows that these patients are subjected to worse interpersonal treatment and that more diagnostic mistakes are made in relation to comorbid patients. The purpose of this study was to investigate how physicians in the somatic care experience difficulties in diagnosis and treatment of comorbid patients. Semi-structured interviews were conducted with ten physicians in the somatic care. Inductive thematic analysis showed that the experiences could be categorized into four themes; Uncertainty, The relationship, Capacity and Integration. The results show that physicians experience difficulties relating to the individual, the patient-physician-relationship, and the care system as a whole. The core category Insufficiency is descriptive of all themes and refers to an insufficiency regarding the patient herself as well as the staff and the organization. The findings confirm previous research and adds an in-depth perspective in a Swedish context. There is a need for future quantitative research on this topic in order to generate more generalizable results.

Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2019 / Introduction: After-hours diagnostic imaging is essential in the majority of large public hospitals, as it plays a vital role in the treatment and management of patients. Radiologists are not always available after hours to provide reports on radiographic images since, nationally and globally, there is a shortage of these professionals. Radiographic images are frequently interpreted by emergency physicians after hours. Thus, while diagnostic imaging represents an essential component in patient care (including management and treatment), according to the literature, a significant cause of clinical error occurs through the misinterpretation of radiographic images by emergency physicians. The aim of this study was to determine emergency physicians’ views on whether there was a need for an after-hours diagnostic radiology reporting service in emergency departments at some public hospitals, in the Durban Metropole. It is important to note that in addition to the above, this study calculated the number of radiographic examinations performed after-hours, and the number that was reported by the radiologist during office hours, since there was no radiology cover after hours. Methods: A descriptive cross-sectional quantitative survey design was employed using a self-administered questionnaire as a data collection instrument completed by emergency physicians at four public hospitals. In addition, additional data was collected to determine the number of radiographic examinations that had been performed after hours, at the selected four public hospitals over a period of three months, as well as the number of radiographic examinations that was reported on. This enabled the authors to determine the number of radiographic examinations that went unreported during this study period. Results: A total of 39 emergency physicians participated in the survey, with a mean and median age of 39.46 and 38 years, respectively (SD = 9.11 years). The results of this study showed that between 0.1% and 0.6% of radiographic examinations performed after hours were reported on by radiologists during office hours, for this study period. This implies that less than 1% of all examinations produced after hours at the four public hospitals, received a radiology report. Emergency physicians felt that the interpretation of images took up valuable time. The survey found that there was near total consensus amongst respondents on whether they prefer after-hours reporting to be performed by a radiologist as 46.2% (n = 18) of the respondents strongly agreed and 41.0% agreed (n = 16). Furthermore, a total of 35.9% (n=14) of respondents agreed and 43.6% (n=17) strongly agreed, that having a reporting radiographer reporting on radiographic images after-hours, would benefit patient flow. The survey also found that 92% of the sampled emergency physicians agreed (59.0% strongly agreed and 33.3% agreed, respectively) that there was a need for further training in the interpretation of radiographic images. Discussion: From the above results, it is evident that since the majority of radiographic examinations went unreported after hours, the task to interpret the radiographic images is left to the emergency physicians as part of their patient management. Conceivably, this added image interpretation results in a further increase in the workload of emergency physicians. It is therefore not surprising that emergency physicians preferred that after-hours reporting of radiographic images be done by radiologists. According to the literature, reporting radiographers also play a role in alleviating the workload of emergency physicians and improving patient flow, by providing a report for the radiographic images during after-hours. Thus, reporting radiographers afford emergency physicians additional time to concentrate on patient treatment, resulting in faster patient throughput. Reporting on radiographic images is not yet included in the scope of the South African radiographer. The findings of this study, though, suggested that there was a need for emergency physicians to undergo training in the interpretation of radiographic images. Conclusion: The study recommends that an after-hours reporting service be considered for the four public hospitals concerned. It is recommended that the heads of the emergency and radiology departments further consider offering courses on radiographic image interpretation for emergency physicians.