Background: More than 10% of UK adults suffer extreme dental anxiety. Effective verbal and non-verbal communication (VNVC) in the dental dyad following handover of a completed Modified Dental Anxiety Scale (MDAS) had been hypothesised to reduce dental state anxiety. This study aims to consider whether: (1) ‘MDAS completion and handover effects long term dental trait anxiety, and (2) ‘what VNVC elements influence patient anxiety reduction?’ Trial Design: Mixed methods: (i) a randomised cross-over study and (ii) an observational study. Methods: Six NHS Highland Salaried Dental Practices were randomised to start either with the experimental arm, where dentally anxious patients (MDAS score = 19 or 5 in any one question) complete and handover MDAS to the dentist, or the control arm where no handover occurred. Within the observational study, all participants had their dental treatment appointment videoed. The primary outcome was dental trait anxiety as measured by MDAS, pre-treatment and at 3 month follow-up. Secondary outcome was dental state anxiety, measured pre and post treatment using both the Spielberger State-Trait Anxiety Inventory (STAI-S) and Heart rate.The observational study analysed the first 2 minutes of video and related this data to the behavioural and affective outcomes. Results: 54 patients agreed to take part in the study with 47 completing 3 month follow-up. The randomised cross-over study found no difference in state or trait dental anxiety however observational outcomes showed dental state anxiety remained high when handover was blocked. A significant lack in decline in dental trait anxiety was shown when dentists blocked patient expressed cues and concerns; this occurred irrespective of patient gender, age or number of appointments received in a 3 month period (F[155.06]=7.51, P=0.009). Conclusions: VNVC flow is fundamental to dyadic balance even within the first two minutes of the patient-dentist interaction. The balanced dyad is key to dental anxiety reduction.

This analysis of secondary data collected from family members of nursing home residents in North Texas (n = 422) used a mixed methods approach to determine if there is a difference in perspectives on quality care among family members of Alzheimer’s/Dementia Special Care Unit (ADSCU) residents compared to those of non-ADSCU residents. Descriptive content analysis was used identify and condense responses to an open-ended question into four meaningful categories of qualities of care. An independent t-test was employed to determine if there was a difference between family members of ADSCU residents and family members of non-ADSCU residents regarding their rating of their loved-ones’ nursing home on the important qualities of care they identified from the open-ended question. Closed-ended questions were organized into indices of these qualities of care, and ordinary least square regression was employed to determine if there were significant differences between perceptions of family members of ADSCU residents and those of non-ADSCU residents regarding care their loved-ones are receiving on these qualities of care, controlling for frequency of visit.

Em cumprimento da Lei 9.394/06, que dita as diretrizes curriculares para cursos de educação superior, determina que as faculdades, inclusive a de Odontologia têm liberdade para programar as disciplinas que se farão presentes ou não em suas grades curriculares. O Conselho Federal de Odontologia na publicação a Resolução 22/2002; decretou a inserção de cinco novas especialidades, dentre elas Odontologia para Pacientes Portadores de Necessidades Especiais. Nesta pesquisa foram analisadas as respostas de um questionário enviado às 175 Faculdades de Odontologia do Brasil em 2005, contendo perguntas relativas a disciplina de Pacientes Portadores de Necessidades Especiais. Responderam ao questionamento 55 (31,43%), das quais 31 (56,36%) afirmaram ter o conteúdo de Pacientes Portadores de Necessidades Especiais em seus programas para graduação. Do universo de 31 faculdades foram encontradas 18 diferentes formas para a nomenclatura adotada na disciplina, sendo as mais freqüentes, Pacientes Especiais (06) e Odontologia para Pacientes Especiais (05). Quanto à vinculação da disciplina, quando existente, em 22 (70,97%) apresentam a modalidade obrigatória e 9 (29,03%) a modalidade optativa. O número de alunos em média que cursam a disciplina, é de: quando obrigatória 46 alunos; quando optativa 22 alunos. O formato da disciplina na maioria das faculdades é semestral sendo que sua localização temporal na grade curricular apresenta maior concentração entre o oitavo e décimo semestre. Os créditos atribuídos à disciplina variam entre 2,1 e 12 créditos (1 crédito = 15 horas/aula). A disciplina é independente em 26 (83,87%) e atuam conexas a outras disciplinas em 4 (12,9%) instituições. Todas as faculdades ministram a disciplina na forma teórica/clínica com exceção de 2 (6,45%) que apresentam o conteúdo de forma teórica. O número máximo de atendimento/clínico/ano é de 2.500 e o mínimo é de 24, havendo algumas variáveis O atendimento clínico é feito por duplas de alunos em 24 (82,76%), individual em 3 (10,34%). Das vinte e quatro faculdades que não abordam o conteúdo de Pacientes Portadores de Necessidades Especiais, 6 (25%) declaram existir serviço anexo para o atendimento destes indivíduos. Quando da não existência de disciplina nem de serviço anexo à faculdade a maioria das instituições encaminham o paciente para o Serviço Público. Em 5 (9,09%) faculdades afirmaram possuir programas de extensão. Após grande reflexão, observou-se a necessidade de uma maior atenção das faculdades com a questão dos ensinamentos acerca Pacientes Portadores de Necessidades Especiais uma vez que a revisão de literatura afirma haver maior disposição e segurança do dentista em atender esta população quando já tenham vivenciado esta realidade na graduação. / In compliance with Law 9.394/06 that establishes the curricular parameters for graduate education, Dentistry colleges may include at their own discretion the disciplines that will be integral to their programs. In its 22/2002 Resolution, the Federal Dentistry Council has determined the inclusion of five new specialization areas among them, Dentistry for the Handicapped. In this research we have analyzed the answers to a survey sent in 2005 to the 175 Brazilian Dentistry Colleges with questions concerning the disciplines related to the Handicapped. Fifty-five institutions (31,43%) replied and 31 (56,36%) confirmed that classes concerning the Handicapped are present in their graduate programs. In this universe of 31 colleges we found 18 different names used for the disciplines, while the most frequent were: Pacientes Especiais (06) and Odontologia para Pacientes Especiais (05). As to being mandatory, 22 (70,97%) established it as a prerequisite for graduation and 9 (29,03%) as an optional credit. The students attending such classes in average numbers are: 46 when mandatory and 22 when optional. In most colleges it is a semester discipline highly concentrated between the eighth and the tenth semesters. The credits attributed to discipline vary between 2.1 and 12 credits. The discipline is independent in 26 colleges (83,87%) and connected to other disciplines in 4 (12,9%). All colleges teach the discipline it theoretical and clinical classes except two (6,45%) that have only theoretical classes. The maximum number of clinical procedures is 2500 and the minimum number is 24, while there are some variables. The clinical attendance is by pairs of students in 24 (82,76%) and individual in 3 (10,34%). Of the twenty-four colleges that do not have Handicappedoriented disciplines, 6 (25%) declared that they do have a complementary service that attends such individuals. Where there is neither the discipline nor the complementary service, most institutions refer the patients to the Public Clinics. Five (9,09%) Colleges informed that they have Handicapped-oriented extension programs. We have verified that the Universities should pay more attention to the aspect of teaching about the Handicapped, as textbook information says that a dentist will be more willing and self-assured in treating such patients if he/she has already been through such experience in graduate school.

Em cumprimento da Lei 9.394/06, que dita as diretrizes curriculares para cursos de educação superior, determina que as faculdades, inclusive a de Odontologia têm liberdade para programar as disciplinas que se farão presentes ou não em suas grades curriculares. O Conselho Federal de Odontologia na publicação a Resolução 22/2002; decretou a inserção de cinco novas especialidades, dentre elas Odontologia para Pacientes Portadores de Necessidades Especiais. Nesta pesquisa foram analisadas as respostas de um questionário enviado às 175 Faculdades de Odontologia do Brasil em 2005, contendo perguntas relativas a disciplina de Pacientes Portadores de Necessidades Especiais. Responderam ao questionamento 55 (31,43%), das quais 31 (56,36%) afirmaram ter o conteúdo de Pacientes Portadores de Necessidades Especiais em seus programas para graduação. Do universo de 31 faculdades foram encontradas 18 diferentes formas para a nomenclatura adotada na disciplina, sendo as mais freqüentes, Pacientes Especiais (06) e Odontologia para Pacientes Especiais (05). Quanto à vinculação da disciplina, quando existente, em 22 (70,97%) apresentam a modalidade obrigatória e 9 (29,03%) a modalidade optativa. O número de alunos em média que cursam a disciplina, é de: quando obrigatória 46 alunos; quando optativa 22 alunos. O formato da disciplina na maioria das faculdades é semestral sendo que sua localização temporal na grade curricular apresenta maior concentração entre o oitavo e décimo semestre. Os créditos atribuídos à disciplina variam entre 2,1 e 12 créditos (1 crédito = 15 horas/aula). A disciplina é independente em 26 (83,87%) e atuam conexas a outras disciplinas em 4 (12,9%) instituições. Todas as faculdades ministram a disciplina na forma teórica/clínica com exceção de 2 (6,45%) que apresentam o conteúdo de forma teórica. O número máximo de atendimento/clínico/ano é de 2.500 e o mínimo é de 24, havendo algumas variáveis O atendimento clínico é feito por duplas de alunos em 24 (82,76%), individual em 3 (10,34%). Das vinte e quatro faculdades que não abordam o conteúdo de Pacientes Portadores de Necessidades Especiais, 6 (25%) declaram existir serviço anexo para o atendimento destes indivíduos. Quando da não existência de disciplina nem de serviço anexo à faculdade a maioria das instituições encaminham o paciente para o Serviço Público. Em 5 (9,09%) faculdades afirmaram possuir programas de extensão. Após grande reflexão, observou-se a necessidade de uma maior atenção das faculdades com a questão dos ensinamentos acerca Pacientes Portadores de Necessidades Especiais uma vez que a revisão de literatura afirma haver maior disposição e segurança do dentista em atender esta população quando já tenham vivenciado esta realidade na graduação. / In compliance with Law 9.394/06 that establishes the curricular parameters for graduate education, Dentistry colleges may include at their own discretion the disciplines that will be integral to their programs. In its 22/2002 Resolution, the Federal Dentistry Council has determined the inclusion of five new specialization areas among them, Dentistry for the Handicapped. In this research we have analyzed the answers to a survey sent in 2005 to the 175 Brazilian Dentistry Colleges with questions concerning the disciplines related to the Handicapped. Fifty-five institutions (31,43%) replied and 31 (56,36%) confirmed that classes concerning the Handicapped are present in their graduate programs. In this universe of 31 colleges we found 18 different names used for the disciplines, while the most frequent were: Pacientes Especiais (06) and Odontologia para Pacientes Especiais (05). As to being mandatory, 22 (70,97%) established it as a prerequisite for graduation and 9 (29,03%) as an optional credit. The students attending such classes in average numbers are: 46 when mandatory and 22 when optional. In most colleges it is a semester discipline highly concentrated between the eighth and the tenth semesters. The credits attributed to discipline vary between 2.1 and 12 credits. The discipline is independent in 26 colleges (83,87%) and connected to other disciplines in 4 (12,9%). All colleges teach the discipline it theoretical and clinical classes except two (6,45%) that have only theoretical classes. The maximum number of clinical procedures is 2500 and the minimum number is 24, while there are some variables. The clinical attendance is by pairs of students in 24 (82,76%) and individual in 3 (10,34%). Of the twenty-four colleges that do not have Handicappedoriented disciplines, 6 (25%) declared that they do have a complementary service that attends such individuals. Where there is neither the discipline nor the complementary service, most institutions refer the patients to the Public Clinics. Five (9,09%) Colleges informed that they have Handicapped-oriented extension programs. We have verified that the Universities should pay more attention to the aspect of teaching about the Handicapped, as textbook information says that a dentist will be more willing and self-assured in treating such patients if he/she has already been through such experience in graduate school.

The aim of this thesis was to acquire knowledge about patient participation in everyday life of persons with dementia living in SCUs in nursing homes. Data collection and analysis in studies I-III was carried out according to Grounded Theory. Data was collected by open non- participant observations during 51 hours, and conversations with 8 residents and 17 health care personnel (I), interviews carried out twice with 12 relatives (II) and 11 nursing personnel (III), and by a study specific questionnaire based on the findings from study I-II to 233 relatives (IV). Descriptive and non-parametric statistics were used (IV). Presence of nursing personnel in body, mind and morality was found to be the prerequisite for patient participation (I). This required personnel with high competence in dementia care, commitment to and interest in the resident, and continuity in their work (I, III). Wellbeing and dignity in the resident’s everyday life was found to be the most important goal, not necessarily a high level of patient participation (II-III). The level of participation had to be adjusted to the resident’s ability and wish to take part in decisions in the very moment. However, the level was often primarily adjusted to suit the personnel’s ideas about how to carry out daily care (I, III). Relatives had an important role in the participation process by interacting, and exchanging information, with the personnel. By forming a basis for individualised care in this way, relatives made a difference to the resident’s everyday life and contributed to their wellbeing and dignity (II-IV). The SCU’s context also affected patient participation (I-IV). Patient participation must be given attention by leaders and be prioritised in dementia care. Nursing personnel can enhance patient participation by promoting relatives’ partaking in the participation process, as this has potential for further contributing to quality of care.

Urban homelessness is one of the most blatant forms of social exclusion in advanced capitalist societies. In Canada, the United States, and the United Kingdom, homelessness has become particularly entrenched due to systemic forces such as global economic recession, the restructuring of regional economies, the dismantlement of the welfare state, and the erosion of affordable housing that together have pushed more people towards economic marginality and housing insecurity. Despite years of advocacy and 'high profile' government investments, homelessness has persisted as an intransigent social problem. A central purpose of this doctoral thesis is to provide some insight into how homelessness is being 'managed' in one Canadian city. The papers gathered together in this dissertation are based on three years of ethnographic fieldwork (conducted between 2006 and 2009) in a medium-sized, de-industrializing city in the province of Ontario. The specific focus of the thesis is the emergency shelter system. Over the past ten years, a number of new social service models have emerged in response to rising rates of homelessness. As these have been adopted homeless shelter systems in many Canadian cities have undergone significant reconfigurations. This thesis focuses on some of the new 'management spaces' that are emerging in this unfolding policy context. The first paper explores the experiences of voluntary sector organizations and local state authorities. The second paper explores the experiential dimensions of a unique service environment providing emergency shelter and social services. The third paper examines the personal experiences of chronically homeless men as they adapt to life in an innovative 'special care' facility. / Thesis / Doctor of Philosophy (PhD)

Annotation This thesis deals with problematic of learning disabilities in secondary schools. The topic itself is deeply covered in foreign literature, but in Czech Republic, it has not yet been thoroughly described. The thesis offers a close look on the problematic of learning disabilities from the students' side as well as from the side of the teachers. One of the important parts of the thesis is secondary symptoms of dyslexia, which begins to appear in adolescence. These difficulties do not only affect education on secondary schools, but they also affect personal life of the dyslexic and later they are reflected at work. The thesis also includes advices how to compensate secondary symptoms. Main goal of the research was to discover, whether there is adequate care given to these dyslexic students and whether they are interested in such a specific care. On the side of the teachers, it was examined, whether they are sufficiently prepared for the work with the dyslexic students, how they perceive the students with dyslexia during the classes and how they are trying to help to these students. The conclusion of the thesis presents findings from the individual interviews with students and teachers which, together with research results, led me to draw topics for school practice. Keywords Dyslexia,...

Krankenhäuser stehen vor der Herausforderung eine steigende Anzahl von Menschen mit Demenz versorgen zu müssen. Diese Personengruppe gilt als hochvulnerabel und ist durch einen Krankenhausaufenthalt in erhöhtem Maße von negativen Begleiterscheinungen betroffen. Neben der Erschwernis, sich auf die unbekannte Situation im Krankenhaus einstellen zu können, ist bei ihnen das Risiko funktioneller Verluste während des Aufenthaltes erhöht. Dies hat häufig Einbußen in der Selbstständigkeit und der gewohnten Lebensführung zur Folge. Aufgrund dieser und weiterer Beobachtungen wurden zur Verbesserung der Situation von Menschen mit Demenz in Krankenhäusern in den letzten Jahren demenzsensible Konzepte entwickelt und umgesetzt. Ein Ansatz für eine demenzsensible Versorgung kann dabei die Einrichtung sogenannter Spezialstationen darstellen, die mit einem umfassenden Versorgungskonzept den Bedürfnissen von Menschen mit Demenz im Krankenhaus begegnen. Das Konzept beinhaltet neben therapeutischen und pflegerischen Interventionen auch räumliche Maßnahmen, durch die therapeutisch-medizinische Ziele wie der Erhalt des funktionellen Status unterstützt werden sollen. In dieser Dissertation wurde der Einfluss der baulich-gestalterischen Parameter der Raumkonzepte von Spezialstationen auf die Verbesserung der Mobilität und Selbsthilfefähigkeit von Behandelten mit kognitiven Einschränkungen untersucht. Dafür wurden 35 Spezialstationen räumlich quantitativ evaluiert und mit Behandlungsergebnissen hinsichtlich der Veränderung der Selbsthilfefähigkeiten und der Mobilität korreliert. Inhalte der räumlichen Datenerhebung waren Gebäudetypologien, Stationsgrößen, Raumprogramme und Space Syntax Analysen sowie die Umsetzung demenzsensibler Gestaltungskriterien. Es zeigte sich eine Vielfalt an Raumkonzepten der Spezialstationen sowie verschiedene Umsetzungsmöglichkeiten in der Raumgestaltung, die von krankenhausüblicher Gestaltung abweicht. Der Umsetzungsgrad demenzsensibler Gestaltungskriterien auf den Stationen war hoch. Durch die statistische Datenanalyse konnten Zusammenhänge nachgewiesen werden zwischen dem Umsetzungsgrad demenzsensibler Gestaltung und der Verbesserung der Fähigkeiten zur Selbsthilfe der Behandelten. Des Weiteren zeigten räumliche Merkmale, die zu einer Erhöhung der zurückzulegenden Strecken auf der Station führten, positive Effekte auf die Verbesserung der Mobilität der Behandelten. Im Ergebnis dieser Arbeit wird argumentiert, dass demenzsensible Gestaltung ein Treiber hin zu einem menschenzentrierten Krankenhaus darstellen kann. Es wird ein Modell für ein integratives Stationskonzept präsentiert, das zur Stärkung von Selbsthilfefähigkeiten und Mobilität der Behandelten beitragen soll und dabei unterschiedliche Reizdichten für Menschen verschiedener Vulnerabilität berücksichtigt.:Danksagung Inhaltliche Kurzfassung Inhaltsverzeichnis Einleitung 1 Menschen mit Demenz im Krankenhaus 1.1 Einführung zentraler Begriffe 1.1.1 Demenz und kognitive Einschränkungen 1.1.2 Abgrenzung Demenz, Delir und Depression 1.1.3 (Akut-)Krankenhaus 1.1.4 (Akut-)Geriatrie 1.2 Demenz als (Neben-)Diagnose im Krankenhaus 1.2.1 Altersstruktur in Krankenhäusern 1.2.2 Das Krankheitsbild Demenz 1.2.2.1 Verlust kognitiver Funktionen 1.2.2.2 Formen der Demenz 1.2.2.3 Verlauf der Krankheit und Einteilung in Schweregrade 1.2.2.4 Krankheitshäufigkeit und Risikofaktoren 1.2.2.5 Möglichkeiten von Therapie und Behandlung 1.2.3 Prävalenz von Demenz im Krankenhaus 1.2.4 Gründe für den Krankenhausaufenthalt 1.2.5 Krankenhausaufenthalt als kritische Situation 1.2.5.1 Das Risiko der erhöhten Vulnerabilität 1.2.5.2 Erleben und Verhalten im Krankenhaus 1.2.5.3 Übersichtsarbeiten zur Versorgungssituation 1.2.6 Bedeutung für den klinischen Alltag 1.2.6.1 Perspektive des Krankenhauspersonals 1.2.6.2 Perspektive der Krankenhausbetreiber 1.3 Funktionsverluste und die Bedeutung körperlicher Aktivität 1.3.1 Zusammenhang von Aktivität und Kognition 1.3.2 Förderung der Selbsthilfefähigkeiten und der Mobilität 1.3.3 Aktivierung im Rahmen der geriatrischen Komplexbehandlung 1.3.4 Instrumente zur Erfassung von Selbsthilfefähigkeiten und Mobilität 1.3.4.1 Selbsthilfe: Barthel Test 1.3.4.2 Mobilität: Timed “Up & Go“ Test 1.4 Spezialstationen für Menschen mit Demenz 1.4.1 Situation in Deutschland 1.4.2 Empfehlungen für den Betrieb von Spezialstationen 1.4.3 Ergebnisse aus Evaluationen von Spezialstationen international 1.4.4 Ergebnisse aus Evaluationen von Spezialstationen in Deutschland 1.5 Initiativen und Empfehlungen für ein Demenzsensibles Krankenhaus 1.5.1 Internationale Initiativen 1.5.2 Entwicklung in Deutschland 1.5.3 Bewertungsinstrumente 1.6 Zusammenfassung 2 Unterstützung durch Architektur 2.1 Theoretischer Hintergrund 2.1.1 Einheit von Mensch und Umwelt 2.1.2 Raum und Gesundheit 2.1.3 Raum und Bewegung 2.1.3.1 Einführung in die Theorie der Space Syntax 2.1.3.2 Gebäudeanalysen mit Space Syntax 2.1.3.3 Analysen von Bewegungsverhalten in Gesundheitsbauten 2.1.4 Raum und Demenz 2.1.4.1 Anforderungs-Kompetenz-Modell 2.1.4.2 Modell der progressiv verminderten Stressschwelle 2.1.4.3 Bedürfnisbedingtes Demenz-Verhaltensmodell 2.2 Demenzsensible Krankenhausarchitektur 2.2.1 Gestaltungsprinzipien demenzsensibler Architektur 2.2.2 Gestaltungsziele und Planungsempfehlungen zu demenzsensibler Krankenhausarchitektur 2.2.3 Studienlage 2.2.3.1 Studienauswahl 2.2.3.2 Charakteristika der Studien 2.2.3.3 Bauliche und gestalterische Themenschwerpunkte 2.2.3.4 Implikationen für die Krankenhausumgebung 2.2.4 Instrumente zur Bewertung der Krankenhausarchitektur 2.3 Modellprojekte zur Steigerung des Bewegungsverhaltens 2.4 Zusammenfassung und abgeleiteter Forschungsbedarf 3 Empirische Untersuchung: Raumkonzepte von Spezialstationen und ihr Einfluss auf die Verbesserung von Selbsthilfe und Mobilität 3.1 Fragestellung und Ziel der Untersuchung 3.2 Methodik 3.2.1 Studiendesign 3.2.2 Methodisches Vorgehen 3.2.2.1 Erfassung der Grunddaten 3.2.2.2 Erfassung der Raumdaten 3.2.2.3 Erfassung der Zielgrößen Selbsthilfe und Mobilität 3.2.2.4 Statistisches Modell 3.2.2.5 Selektion der Variablen 3.3 Raumkonzepte von Spezialstationen 3.3.1 Grunddaten der untersuchten Stationen 3.3.2 Baulich-strukturelle Merkmale 3.3.2.1 Raum- und Flächenprogramm 3.3.2.2 Einsehbarkeitsanalysen nach Space Syntax 3.3.3 Demenzsensible Gestaltungsmerkmale 3.3.3.1 Umsetzungsgrad der Empfehlungen 3.3.3.2 Beispiele der Umsetzung 3.4 Untersuchung der Einflussfaktoren auf Selbsthilfe und Mobilität der Behandelten 3.4.1 Beschreibung der Gesamtstichprobe 3.4.1.1 Behandlungsergebnisse Selbsthilfe 3.4.1.2 Behandlungsergebnisse Mobilität 3.4.2 Stichprobe und Behandlungsergebnisse im Kontext der Geriatrie 3.4.3 Einfluss baulich-struktureller Merkmale 3.4.3.1 Raum- und Flächenprogramm 3.4.3.2 Einsehbarkeitsanalysen nach Space Syntax 3.4.4 Einfluss demenzsensibler Gestaltungsmerkmale 3.5 Interpretation der Ergebnisse 3.5.1 Merkmale zur Unterstützung der Selbsthilfe 3.5.2 Merkmale zur Förderung der Mobilität 3.5.3 Limitationen der Untersuchung 3.6 Zusammenfassung und Schlussfolgerung 4 Empfehlungen zur Weiterentwicklung von Krankenhausstationen 4.1 Ausblick Spezialstationen 4.2 Potential demenzsensibler Gestaltung 4.3 Integratives Stationskonzept 4.3.1 Gestaltungsleitende Ziele 4.3.2 Anforderungen an das Raumkonzept 4.3.3 Integrativer Zusammenschluss 4.3.4 Einordnung in die DIN 13080 4.4 Hinweise für Gestaltungsempfehlungen 4.5 Zusammenfassung Schlussfolgerung und Ausblick Abkürzungsverzeichnis Abbildungsverzeichnis Tabellenverzeichnis Literaturverzeichnis Anhang Anhang 1: Geriatrische frührehabilitative Komplexbehandlung Anhang 2: Übersicht über die eingeschlossenen Studien Anhang 3: Ablaufdiagramm der Datenerhebung Anhang 4: Erhebungsinstrumente Anhang 5: Datenblätter der Spezialstationen

This dissertation titled "Special catechesis. Theory and Practice" explores the methods of teaching religion to mentally handicapped children. The research focuses on the presentation of theoretical and practical methods introduced by D, Jucha, J. Madeja, D.Doroszewka, B. Janosz and other significant Polish catechists. The theoretical part, besides a systematicly processed terminology also deals with the actual content and the main aim of special-care catechesis. In addition, it provides an interpretation the dignity of man as it can be found in some church archives. Last, but not least, attention is drawn to the important role of families, parishes and catechists. The second, practical, part is inspired by the methods of B. Janosz - whether it is put to creative use along with new teaching materials as well as new communication tools that motivate mentally handicapped children for active participation in special-care classes. The author of this study concluded that even the weakest must be provided adequate catechesis as every human being, no matter how limited, is capable of growth to sanctity. These people feel the need and are entitled to life in faith. There is a need for oligo-catechesis and it is unquestionable.

Cette thèse étudie l’accompagnement, en France, des personnes atteintes de maladie d’Alzheimer ou de maladie apparentée au sein des établissements d’hébergement pour personnes âgées dépendantes. Elle articule trois niveaux d’enquête et d’analyse : investigation socio-historique des politiques publiques et de la pensée professionnelle relatives à ces établissements et à la place qu’y a pris la problématique de la maladie d’Alzheimer (et des maladies apparentées) ; enquête de type ethnographique dans un corpus restreint d’établissements ; élargissement de l’analyse à un niveau macrosociologique qui réinscrit le corpus restreint dans le contexte national.Face à la vision dominante, sectorielle et fondée sur l’« adaptation à une population cible », on découvre, en examinant l’expérience effective des professionnels et les choix assumés par les directions des établissements concernés, une réalité plus nuancée. Se révèle une pensée du « commun », avec le double enjeu de « tenir ensemble » la collectivité des résidents et de fournir un accompagnement de qualité pour tous. Deux modes d’accompagnement semblent s’opposer, dans un contexte de débats constants et d’occultation de réelles alternatives, l’un fondé sur la ségrégation des personnes atteintes de troubles cognitifs (accompagnement spécifique dans des espaces spécifiques, qui s’est largement imposé comme norme) et l’autre opposé à la ségrégation. Au-delà de cette opposition, l’accompagnement des personnes atteintes de troubles cognitifs se construit bien davantage dans une subtile dialectique fondée non seulement sur une hybridation de formes différentes d’aide et de soins, mais aussi sur l’invention de pratiques nouvelles. La norme est le spécifique, la pratique est l’invention. Il en résulte que non seulement la place faite aux résidents atteints de troubles cognitifs mais aussi la fonction sociale que peut remplir un accompagnement qui sache les compter s’avèrent ambivalents. Si l’étiquette attribuée à ces résidents soumet leur existence à des contraintes institutionnelles particulières, on observe en même temps qu’ils bénéficient d’un traitement privilégié dont les professionnels ont à coeur de faire profiter le plus grand nombre. L’accompagnement de la maladie d’Alzheimer y apparait alors comme porteur des potentialités d’un laboratoire de transformations valant pour l’ensemble des résidents. / This research studies dementia care in nursing home, in France. It articulates three levels of analysis : a socio-historical investigation of public policies and professionals thinking about the importance given to dementia in nursing homes; an ethnographic field survey in a limited corpus of nursing homes; an extension to a macro-sociological level to put this reality back into its national context.Facing the dominant sector-wide approach based on an “adaptation to a target population” model, by observing the experience of the professionals and the managers’ choices, we discover a more complex reality, fostered by a global approach which attempting to combine two issues: the cohabitation of the whole community of residents and the provision of good care for all. Two mains ways seem to be opposed, in a context of constant debates and occultations of alternatives, the first one based on segregation of people with dementia (specific care in special unit that is widely accepted as standard), the second one opposing this segregation. Beyond that, care is built as a subtle dialectic based not only on an hybridization of different forms of care but also on the creation of new practices. Specific is the standard, creation is the practice. As a result, the place given to people with dementia and the social function of a care that account them, are ambivalent. The label assigned to them submit their life to institutional constraints. In the same time, they receive a privileged treatment, that professionals want to extend to all residents. Dementia care appears then as a social laboratory for changes, applies for each residents.