Made available in DSpace on 2014-12-17T15:38:38Z (GMT). No. of bitstreams: 1 YalleFS.pdf: 559499 bytes, checksum: 0f064bad2315cf31ac7b7ddefdcb6b7e (MD5) Previous issue date: 2007-04-27 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The years 1990 disclose the consolidation of the Brazilian Psychiatric Reform project, assumed as official politics by the Health Department, also stirring up discussions, lines of direction and new ways of care. Substitutive services to the psychiatric hospital as CAPS, conviviality centers, therapeutical residences and ambulatory clinics are implemented. This work analyzes the relations that the Specialized Ambulatory Clinic of Ribeira establishes to the services of Mental Health of the public system in the city of Natal/RN, as well as its adjustment to the proposal of the Psychiatric Reform. Through semi-structured interviews and observation, it was possible to gather data which allowed picturing a general characterization of the service: activities, technical group, joint with other institutions, daily routine organization. Such institution develops activities that surpass the traditional character of a clinic- in other words, the psychological/medical appointments - and it mainly greets the ones proceeding from CAPS and psychiatric hospitals. It offers group activities, psychiatric appointments, therapeutical workshops, sheltering and strolls, among others. The institution is composed by a multi-professional team of psychiatrists, psychologists, occupational therapists, nurse s aide and art-educator. The joint of this service with others that make part of the Mental Health Assistance network in Natal is incipient. Due to this fact, some actions and activities that could and should be developed together are just not. Although facing difficulties, the professionals of the Ambulatory Clinic of Ribeira are able to achieve good results and establish care in Mental Health that prioritize sheltering, listening and respect to the user s individuality. The Ambulatory Clinic of Ribeira is organized according to the paradigm of the Psychiatric Reform. Therefore, it offers an attention that stimulates the re-socialization of the users and the exercise of the citizenship and autonomy of those / Os anos 1990 revelam a consolida??o do projeto de Reforma Psiqui?trica brasileira, assumido como pol?tica oficial pelo Minist?rio da Sa?de, e provocador de discuss?es, diretrizes e novos modos de cuidado. Servi?os substitutivos ao hospital psiqui?trico como CAPS, centros de conviv?ncia, resid?ncias terap?uticas e ambulat?rios s?o implementados. Esta disserta??o analisa as rela??es que o Ambulat?rio Especializado da Ribeira estabelece com os servi?os de Sa?de Mental da rede p?blica do munic?pio de Natal/RN e sua adequa??o ? proposta da Reforma Psiqui?trica. Atrav?s de entrevistas semi-estruturadas e observa??o participante colheram-se dados que permitiram tra?ar uma caracteriza??o geral do servi?o: atividades, equipe t?cnica, articula??o com outras institui??es, organiza??o do cotidiano. Tal institui??o desenvolve atividades que extrapolam o car?ter tradicional de um ambulat?rio, ou seja, as consultas m?dico-psicol?gicas. Atende principalmente egressos de CAPS e hospitais psiqui?tricos. Oferece atividades de grupo, consultas psiqui?tricas, oficinas terap?uticas, acolhimento, passeios, entre outras. Possui uma equipe multiprofissional composta por psiquiatras, psic?logas, terapeuta ocupacional, auxiliar de enfermagem e arte-educadora. A articula??o deste servi?o com os demais que integram a rede de assist?ncia em Sa?de Mental de Natal ? incipiente e, em decorr?ncia disso, v?rias a??es e atividades que poderiam e deveriam ser realizadas em conjunto, n?o o s?o. Apesar de enfrentarem dificuldades, os profissionais do Ambulat?rio da Ribeira conseguem alcan?ar bons resultados e efetivar cuidados em Sa?de Mental que priorizam o acolhimento, a escuta e o respeito ? individualidade dos usu?rios. O Ambulat?rio da Ribeira ? organizado segundo o paradigma da Reforma Psiqui?trica e, portanto, oferece uma aten??o que incentiva a ressocializa??o dos usu?rios e o exerc?cio da cidadania e autonomia destes

Esta dissertação se propõe a analisar a atuação administrativa consensual, com enfoque nos acordos substitutivos no processo administrativo sancionador. A questão que se pretende responder consiste em verificar se há necessário relacionamento entre prerrogativas públicas e desenvolvimento das atividades administrativas. Para respondê-la, a consensualidade administrativa é trabalhada em três frentes: normativa, teórica e prática. Na primeira parte, realiza-se a reconstrução do modelo de atuação administrativa típica, formalizada em atos unilaterais e imperativos, a fim de estabelecer o paradigma com o qual a atuação administrativa consensual dialoga. Na seqüência, há a análise do modelo de atuação administrativa consensual, repartida em dois capítulos. No primeiro, são mapeados os debates doutrinários a respeito do tema, indicados os pressupostos teóricos da consensualidade no Direito Administrativo e enfrentada a questão da viabilidade de a Administração Pública transacionar pela análise crítica dos princípios da supremacia e da indisponibilidade do interesse público. No segundo capítulo, é identificado o modelo de consensualidade adotado pelo Direito Administrativo brasileiro com base na apreciação das normas que prevêem instrumentos consensuais levantadas. A terceira parte da dissertação destina-se a avaliar o plano prático da atuação administrativa consensual por meio do estudo empírico do compromisso de cessação, na qualidade de acordo substitutivo no processo administrativo sancionador do CADE. Neste capítulo, são depreendidos os principais impasses relacionados à atividade sancionatória e a forma de emprego do referido acordo administrativo pela autoridade antitruste a fim de verificar os efeitos da consensualidade na prática do Direito Administrativo. Ao final, são analisados os principais vetores dos acordos substitutivos, quais sejam, legalidade, negociação das prerrogativas públicas, controle judicial e cultura repressiva prevalecente na Administração Pública. Na conclusão, a questão é retomada e as hipóteses lançadas - viabilidade da negociação das prerrogativas públicas e preferência dos acordos substitutivos pelo Poder Público em razão dos expressivos efeitos positivos que detêm - testadas. / This essay intends to analyze the consensual administrative action, approaching to the substitutive agreements in the administrative process for imposition of sanctions. The question to be answered herein is to verify if there is a necessary relation between public prerogatives and development of administrative activities. To answer it, the administrative consensus is worked in three perspectives: normative, theoretical and practical. In the first part, it is done the reconstruction of the typical administrative actions model, formalized in unilateral and imperative acts, in order to establish the paradigm to which the consensual administrative action dialogues. After that, it is done the analysis of the consensual administrative action, distributed in two chapters. In the first, doutrinariess debates involving the theme are identified, consensuss theoretical premises in Administrative Law are indicated and the issue of availability of transaction in Public Administration is faced by the principles of supremacy and non-availability of public interests critical analysis. In the second chapter, it is identified the model of consensus adopted by brazilian Administrative Law through appreciation of the norms that dispose about consensual instruments. The essays third part intends to evaluate the practical field of the consensual administrative action through empirical study of the consent decree, as a substitutive agreement, in the CADEs administrative process for imposition of sanctions. In this chapter, it is recognized the main problems with the imposition of sanctions and the use of that administrative agreement by the antitrust authority, in order to discover the consensus effect in Administrative Law. Finally, substitutive agreements main guides are analyzed, which are: legality, public prerogatives negotiation, judicial control and repressive culture that prevails into Public Administration. In the conclusion, the question is retaken and the hypotheses exposed - negotiation of the public prerogatives availability and preference of the substitutive agreements bi Public Power because of its expressive positive effects - tested.

No ensino da medicina veterinária esta implícito o uso de animais para o aprendizado das mais diversas habilidades profissionais, sendo que na maioria das vezes os animais utilizados nas práticas pedagógicas sofrem algum tipo de prejuízo ou morrem para este fim. Com o aumento da preocupação ética em relação aos animais, nas últimas duas décadas, surgiu a necessidade de se substituir estes métodos de ensino onde havia prejuízo aos animais e ao aprendizado do aluno, por métodos humanitários. Este estudo teve como objetivo avaliar o conhecimento e opinião dos alunos das Faculdades de Medicina Veterinária brasileiras acerca da implementação dos chamados “métodos substitutivos“ ao uso prejudicial de animais e os métodos que estão sendo utilizados atualmente. Foram obtidas 1383 respostas de estudantes de medicina veterinária de 26 estados brasileiros e do Distrito Federal, que responderam questionário semiaberto divulgado de forma online e as respostas foram submetidas à uma analise estatística que nos permitiu concluir que 47,9% dos entrevistados desconhecem a principal legislação acerca do uso de animais, 66,4% afirmaram conhecer o que é um método substitutivo ao uso de animais, 87,7% entendem como "uso prejudicial de animais” a eutanásia de um animal saudável para fins didáticos”; 55,6% acreditam que métodos substitutivos podem sim substituir o uso de animais, desde que seja o método apropriado e que a principal vantagem desta substituição seria o fato de que são métodos eticamente aceitáveis onde não há crueldade contra animais” (57,3%) e a principal desvantagem seria o custo para aquisição (51,8%). Cerca de 93% indicaram que há utilização de animais no seu curso, sendo que a principal espécie o cão (76,5%) e a anatomia apontada como a disciplina que mais utiliza animais. Quanto as aulas de técnica cirúrgica, o método mais citado foi o uso de cadáveres preservados (27,2%).Quanto a utilização de métodos substitutivos, 47,3% responderam que seus cursos utilizam estes métodos e que a disciplina que mais utilizava métodos como manequins, simuladores, vídeos, e softwares era a de anatomia, seguidas das disciplinas de clinica e cirurgia de pequenos animais, que utilizavam atendimento clinico de animais da comunidade ou de ONGs. De acordo com os dados analisados, podemos afirmar que os alunos de Instituições de ensino públicas tiveram mais contato com o conceito dos 3Rs que os alunos de Instituições de ensino privadas e que não há diferenças significativas entre as Instituições públicas e privadas quanto ao uso de métodos substitutivos. Diante destes resultados, faz-se necessário um esforço de toda comunidade acadêmica, dos docentes, dos coordenadores e do comitê de ética da escola no sentido de se desenvolver e implantar métodos didáticos humanitários e eficazes, que possam ir ao encontro das necessidades e posicionamentos éticos dos estudantes de medicina veterinária / In veterinary medicine teaching is implicit the use of animals for learning different professional skills, and most of the time these animals used in pedagogical practices suffer some kind of injury or die for this purpose. With the increasing of the ethical concern for animals in the last two decades, emerged the necessity to replace these teaching methods to humane methods. This study aimed to evaluate the implementation of the "substitutive methods" to the harmful use of animals in veterinary teaching and training in Brazilian Schools, through information obtained from undergraduate students. They were obtained 1383 answers of veterinary medical students from 26 Brazilian states and the Federal District, who responded an online semi-open questionnaire, the responses were submitted to a statistical analysis and we concluded that 47.9% of respondents are unaware of the main legislation about the use of animals, 66.4% said they knew what is a substitute method to animal use, 87.7% perceive as "harmful use of animals' - euthanasia of healthy animals for teaching purposes"; 55.6% believe that substitutive methods can replace the use of animals, but depends of the method, the main advantage of these humane methods is the fact that they are ethically acceptable and avoid animal cruelty"(57.3%) and the main problem would be the cost of acquisition (51.8%). About 93% indicated that use animals in its course, and the main specie is the dog (76.5%) and the anatomy was considered the discipline that use most animals. In the surgical classes, the most cited method was the use of preserved cadavers (27.2%). Regarding the use of substitutive methods, 47.3% answered that their courses using these methods and the discipline that most used methods such as mannequins, simulators, videos, and software was the anatomy, followed by clinical disciplines and surgery of small animals who used clinical care of animals from the community or NGOs. According to the data analysed, we can say that most students of public education institutions had contact with the concept of the 3Rs than students in private educational institutions and there are no significant differences between public and private institutions on the use of substitutive methods. According to this result, is necessary an effort of the academic community (teachers, coordinators and school ethics committee) in order to develop and implement humane and effective teaching methods, which can meet the ethical requirements and positions of students of veterinary medicine

Esta pesquisa caracteriza-se como um estudo de caso, realizado no Núcleo de Atenção Psicossocial - NAPS “Maria Boneca”, um serviço substitutivo de Saúde Mental, na cidade de Uberaba-MG e busca compreender a dinâmica da gerência do referido serviço, enquanto um instrumento capaz de propiciar mudanças nas práticas de atenção ao paciente portador de sofrimento mental. O pressuposto deste estudo é creditar à gerência a potência de dar ao serviço substitutivo de saúde mental uma organização e dinâmica capaz de produzir no portador de sofrimento mental uma vida mais humana, mais digna e cidadã, permitindo-lhe participar do mundo em sociedade, não com o traço da estranheza e periculosidade, como geralmente lhe é atribuído, mas como alguém portador de uma diferença. A pesquisa foi realizada com dez (10) trabalhadores do NAPS, um por categoria profissional, sendo escolhidos pelo critério da antigüidade, com os quais foram realizadas entrevistas semi-estruturadas. O material empírico foi organizado segundo o método do Discurso do Sujeito Coletivo e a análise do material, feita segundo a análise de conteúdo, na vertente da Análise Temática. Do movimento de análise foi possível identificar dois (2) grandes temas: A expressão da subjetividade no trabalho em saúde mental – um trabalho muito especial e O processo de trabalho participativo enquanto um componente da gerência nos serviços substitutivos. É identificado no estudo, segundo os trabalhadores entrevistados, a importância do processo de gerência nos serviços, principalmente naqueles que pretendem atender aos portadores de sofrimento mental, demanda tão segregada socialmente e tão excluída da convivência social, especialmente da familiar. Evidencia-se a importância da participação dos usuários nos processos decisórios, pois os mesmos colaboram no sentido de permitir aos pacientes uma vivência integradora da vida e uma busca de sua identidade perdida por anos a fio nas internações psiquiátricas, e o (re)encontro com a cidadania. O trabalho aponta, como formas de participação nas decisões instâncias como a Assembléia Geral, a Reunião Clínica e as decisões que ocorrem de maneira informal, denominada de “decisões de corredor”. No estudo feito, a equipe de trabalhadores do NAPS “Maria Boneca”, se considera coesa, afetuosa, portadora de um projeto coletivo, apesar de dificuldades e diferenças; mesmo a equipe se colocando como condutora do processo gerencial, existem membros que desejariam ver no serviço uma gerência mais autoritária e hierárquica. / This study is characterized as a case study conducted in the Nucleus of Psychosocial Care – NAPS Maria Boneca, a substitute mental health service in the city of Uberaba, Minas Gerais State. It aimed at understanding the management dynamics in that service as an instrument that can propitiate changes in the practice of caregiving to patients with mental suffering. This study assumes that managers should be given the power to provide the substitute mental health service with an organization and dynamics that could offer patients with mental suffering a more human, respectale and rightful life, thus allowing them to participate in the social world, not under the shadow of strangeness or perilousness that is usuallly cast over them, but as people who bear a difference. The study was conducted with 10 (ten) workers from NAPS, one from each professioal category, who were selected according to the antiquity criterion and to whom the interviews were applied. The empirical material was organized according to the Collective Subject’s Discourse method and the analysis of such material was made through content analysis based on Thematic Analysis. From the analytical movement, it was possible to identify 2 (two) broad themes: The expression of subjectivity in mental health work – a very special type of work and The participative work process as a management component in substitute services. According to the interviewed workers, the importance of the management process in services, especially in those intending to assist mental health patients, is identified – a demand that is so discriminated socially and excluded from social living, particularly from social life. The importance of the participation of users in decision-making processes is emphasized since they contribute in order to offer patients an integrating life experience and an opportunity to search for their identity lost through the years of psychiatric hospitalizations and to the re-encountering with citizenship. The work suggests the following forms of participation in decision making: General Assembly, Clinical Meeting and the decisions that were made informally and denominated “hallway decisions”. The team of workers at NAPS Maria Boneca regards itself as cohesive, affectionate, and involved with a collective project in spite of the difficulties and differences, in addition to playing the role of a conductor of the managerial process, although there are members who would like the service to have a more authoritarian and hierarchical management.

Les maladies lysosomales forment un groupe hétérogène d’une cinquantaine d’affections qualifiées de « rares ». Actuellement, seulement 9 maladies lysosomales disposent d’un traitement spécifique, principalement par enzymothérapie substitutive, mais les effets bénéfiques sont souvent limités. Le manque de ciblage pour le Récepteur du Mannose 6-Phosphate (RM6P), responsable de l’internalisation dans les lysosomes, expliquerait en partie cette efficacité modérée des enzymes thérapeutiques. Dans ce contexte, nous avons développé une approche de ciblage innovante basée sur des Analogues synthétiques du Mannose 6-Phosphate fonctionnalisés sur l’Aglycone (appelés AMFA) afin de répondre aux besoins non satisfaits par les traitements actuels.Les travaux de cette thèse portent principalement sur la maladie de Pompe, myopathie causée par la déficience d’une enzyme lysosomale, l’Alpha Glucosidase Acide (GAA), responsable de la conversion du glycogène en glucose. Afin d’améliorer l’adressage de l’enzyme thérapeutique aux lysosomes via le RM6P, nous avons fonctionnalisé la GAA recombinante humaine (rhGAA) avec les AMFA. Nos études sur la forme adulte de la maladie ont démontré une augmentation significative de l’internalisation et pour la première fois, chez des souris âgées modèles de la maladie, une restauration de la santé musculaire et une amélioration significative de la fonction motrice ont été observées (article 1). Nous nous sommes ensuite intéressés aux propriétés de la rhGAA-AMFA. Nous avons démontré que l’efficacité de la rhGAA-AMFA n’était pas uniquement due à une meilleure internalisation mais également à une meilleure maturation intracellulaire de l’enzyme (article 2). En effet, nos résultats ont démontré que chez les patients atteints de la maladie de Pompe, il existe une surexpression des phosphatases acides ACP2 et ACP5. Ces phosphatases peuvent détruire le signal mannose 6-phosphate (M6P) naturellement présent sur l’enzyme, ce qui interrompt sa maturation en forme active. L’AMFA, contrairement au M6P, est insensible à cette dégradation et assure donc la stabilité de l’adressage de l’enzyme in vitro, mais également in vivo.L’ensemble de ces résultats suggèrent que le greffage des AMFA sur des enzymes recombinantes représente une nouvelle solution thérapeutique pour le traitement de la maladie de Pompe et potentiellement pour le traitement d’autres maladies lysosomales. / Lysosomal diseases form a heterogeneous group of about fifty rare diseases. At present, only 9 lysosomal diseases have a specific treatment, mainly by enzyme replacement therapy but the beneficial effects appear often limited. The lack of targeting for the Mannose 6-Phosphate Receptor (M6PR), responsible for internalization into the lysosomes, would partly explain this moderate efficiency of the therapeutic enzymes. In this context, we have developed an innovative targeting approach based on Mannose 6-Phosphate Synthetic Analogues Functionalized at the Aglycone position (called AMFAs) to address the unmet needs of current treatments.The work of this thesis focuses mainly on Pompe disease which is a myopathy caused by the deficiency of a lysosomal enzyme, Acid Alpha Glucosidase (GAA), responsible for the conversion of glycogen into glucose. In order to improve the targeting of the therapeutic enzyme to lysosomes via the M6PR, we have functionalized the human recombinant GAA (rhGAA) with the AMFAs. Our studies on aged mice model of the adult form of the disease have demonstrated a significant increase of the enzyme internalization and for the first time, the restoration of muscle health and the significant improvement in motor function (article 1). We then investigated the properties of rhGAA-AMFA. We have proved that the effectiveness of rhGAA-AMFA is not only due to a better cell uptake but also to a more complete intracellular processing of the enzyme (article 2). Indeed, our results demonstrated that in myoblasts of patients affected by Pompe disease there is an overexpression of ACP2 and ACP5 acid phosphatases. These phosphatases can destroy the mannose 6-phosphate signal (M6P) naturally present on the enzyme, therefore possibly interrupting its processing into the active form. AMFA, unlike M6P, is insensitive to this degradation and thus ensures the stability of enzyme addressing in vitro, but also in vivo.All together, these results suggest that the grafting of the AMFAs on recombinant enzymes represents a new therapeutic solution for the treatment of Pompe disease and potentially for other lysosomal diseases.

Benzodiazepines have been widely prescribed since the 1960s for the management of adverse symptoms related to anxiety, depression, and sleep problems. They were regarded as an efficacious medication when compared with their predecessor, barbiturates. Within 10 years of their introduction, concerns began to be raised regarding their potential to produce dependence and withdrawal symptoms when ceased, including symptoms not present prior to their being prescribed. Subsequent research focussed on establishing effective strategies to ameliorate the adverse symptoms experienced even when the daily intake was slowly reduced. The aim of the work undertaken for this doctorate was to establish whether there was a role for cognitive behaviour therapy (CBT) in benzodiazepine cessation. The initial step in conducting the research for this doctorate was to obtain a detailed understanding of the current state of research on benzodiazepine cessation. Study 1 therefore focussed on establishing the effectiveness of treatment approaches used to assist individuals to cease benzodiazepine use. A Meta-analysis of treatment strategies undertaken in general practice and outpatient settings established that brief intervention resulted in superior cessation rates at post-treatment than routine care. Gradual dose reduction plus CBT was slightly superior to gradual dose reduction alone. However, substitutive pharmacotherapies in combination with gradual dose reduction did not result in a superior outcome to gradual dose reduction alone, and substitutive pharmacotherapy plus abrupt benzodiazepine cessation was less effective than gradual dose reduction. While, providing CBT in conjunction with gradual dose reduction offered a superior outcome than gradual dose reduction alone, current evidence does not identify the CBT strategies that contributed to the superior outcome. The next step in the development of the CBT intervention involved obtaining a deep appreciation of the issues relating to cessation from the perspective of General Practitioners (GPs) and Benzodiazepine Users (BzUs). Accordingly, Study 2 administered semi-structured interviews about benzodiazepine use and its cessation to 28 GPs and 23 BzUs. Responses were analysed using the Consensual Qualitative Research approach, as it enabled comparisons to be made between the views of the two groups of interviewees. The study identified commonality between GPs and BzUs on reasons for commencing use, the role of dependence in continued use, and the importance of lifestyle change in its cessation. BzUs felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before prescribing benzodiazepines. Few GPs had assisted a patient to cease use reportedly due to the required time and the expectation of a poor outcome. There was a perception that patients wanted a pharmacological solution to their problems. A critical gap in assessment instruments that are needed for a comprehensive assessment of the outcomes from a treatment trial was identified. In particular, there was no measure of benzodiazepine expectancy or self-efficacy concerning maintenance of benzodiazepine dose reduction. Therefore, Study 3 adapted existing expectancy and self-efficacy measures form other substance domains to verify their applicability to benzodiazepines. Current BzUs (n = 155) were invited to complete two questionnaires either online or via hard copy. Principal component analysis (PCA) of a newly developed Benzodiazepine Expectancy Questionnaire (BEQ) resulted an 18-item, 2-factor scale, while a Benzodiazepine Refusal Self Efficacy Questionnaire (BRSEQ) formed a 16-item, 4-factor scale, Confirmatory factor analysis (CFA) in a second sample (n = 139) confirmed these internal structures, reducing the BEQ to 12 items and the BRSEQ to 14 items respectively. The qualitative study suggested that many GPs would be reluctant to engage in psychological support for benzodiazepine cessation and it was evident that specialist services would be unable to provide substantial support especially in rural and remote areas. Accordingly, it was decided to develop a treatment that was remotely delivered. The initial pilot used a correspondence-based approach, delivered via the postal service. Study 4 comprised a small pilot comparing GP managed gradual dose reduction, plus CBT via mail (M-CBT), which was either delivered immediately (IM-CBT) or after 3 months (DM-CBT). Despite substantial efforts over a 2 year period to recruit GPs and BzUs, only 6 received the allocated intervention. It was decided to trial the intervention as an internet-delivered program to enhance its accessibility to BzUs. Access to the program was promoted through the project website and links from high profile support websites. Study 5 was an uncontrolled trial of internet-based CBT (I-CBT). Access was provided to all newsletters, although, participants were given a suggested sequence for access. Despite placement on the internet and cross-listing on several key websites, the study still only recruited 35 participants (3 of which received the program by mail). Of the 32 undertaking the program via the internet, 21 completed the 3-month assessments and 14 the 6-month assessments. Eight participants reduced their weekly benzodiazepine intake by at least 50%, by 3 months, with five ceasing use at 6 months. A significant increase in self-efficacy, and a decrease in depressive symptoms and dependence were seen. Providing CBT either via mail or the internet assisted some participants to reduce or cease long-term benzodiazepine use. Recruitment to both M-CBT and I-CBT was limited, despite substantial attempts to market the intervention. The studies undertaken for this doctorate make a unique contribution to improving treatment outcomes for people wishing to cease long-term benzodiazepine use. They also provide direction for more extensive studies to definitively establish the nature of effective treatment. The current evidence clearly supports the importance of gradual dose reduction and the role of CBT in further improving treatment outcomes. However, engagement of both BzUs and GPs remains challenging. Remote delivery of CBT via mail or the internet may assist with improving access to CBT, but it does not solve the problem of GP and BzU engagement. An effective system-wide program to address long-term benzodiazepine use will require that incentives for GP involvement (a disincentive for long-term prescription) are in place.

O presente trabalho tratou das sentenças aditivas e das sentenças substitutivas no Direito italiano e no Direito brasileiro (mais especificamente, na jurisprudência do Supremo Tribunal Federal). Tais técnicas alternativas (ou “atípicas”) de decisão no controle de constitucionalidade foram criadas pela Corte Constitucional na Itália e, com o tempo, passaram a ser utilizadas por outros tribunais ao redor do mundo, inclusive – conforme a doutrina mencionada no trabalho – pelo Supremo Tribunal Federal no Brasil. O objetivo do trabalho foi analisar como tais modelos (ou tipos) decisórios são utilizados pela Corte Constitucional na Itália e como foram “importados” para o Brasil pela jurisprudência do Supremo Tribunal Federal. Inicialmente, estudou- se, de modo detalhado, o controle de constitucionalidade na Itália, que é exercido pela Corte Constitucional por via incidental (ou por via de exceção) ou por via principal (ou por via de ação). Em seguida, abordou-se o “arsenal” de modelos (ou tipos) decisórios da Corte Constitucional no controle de constitucionalidade, do qual fazem parte as sentenças aditivas e as sentenças substitutivas. Por fim, examinaram- se algumas decisões do Supremo Tribunal Federal que – de acordo com a doutrina mencionada no trabalho – são tidas como exemplo de sentenças aditivas e de sentenças substitutivas. Verificou-se que o Supremo Tribunal Federal não utiliza as fórmulas que, na Itália, são encontradas no dispositivo das sentenças aditivas e das sentenças substitutivas da Corte Constitucional nem admite expressamente – no dispositivo das decisões – que emprega sentenças aditivas e sentenças substitutivas, o que pode indicar que tais modelos (ou tipos) decisórios não precisam ser “importados” para o Brasil. Constatou-se, ainda, que as referências às sentenças aditivas, do modo como são feitas pelos Ministros nas decisões do Tribunal, representam grave violação à ideia de segurança jurídica, que está contida no princípio do Estado de Direito, e vulneram, pois, a própria Constituição. / The present essay adressed the additive sentences and the substitutive sentences in Italian Law and in Brazilian Law (more especifically, in the Federal Supreme Court jurisprudence). Such alternative (or “atypical”) techniques of decision in judicial review were created by the Constitucional Court in Italy and, with time, started being used by other courts around the world, including – according to the doctrine mentioned in this essay – the Federal Supreme Court in Brazil. The goal of this essay was to analise how these decision models (or types) are used by the Federal Supreme Court. Initially, the judicial review in Italy, which is exercised by the Constitutional Court by incidental via (or exceptional via) or by mainly via (or through action), was studied, in detail. Then, the “arsenal” of models (or types) of decision of the Constitutional Court in judicial review, which comprises the additive sentences and the substitutive sentences, was approached. Lastly, some decisions of the Federal Supreme Court that – according to the doctrine mentioned in this essay – are considered as example of additive sentences and of substitutive sentences were examined. It was found that the Federal Supreme Court does not use the formulas that, in Italy, are found in the device of the additive sentences and of the substitutive sentences of the Constitutional Court, nor expressly acknowledges – in the device of decisions – that employs additive sentences and substitutive sentences, which may indicate that such models (or types) of decision-making do not need to be “imported” to Brazil. It was also found that the references to the additive sentences, the way they are made by Justices in the Court’s decisions, represent a serious violation of legal certainty idea, which is contained in the Rule of Law principle, and undermines, therefore, the Constitution itself.

The topic of my thesis is called Current Questions about Foster Care in the Czech Republic. European Union organizations and UNICEF organizations, due to the information from experts, have been drawing attention to the fact, that there is a high percentage of children under the age of three years living in various institutions. It is therefore necessary for the state to increase the support for substitutive family care. The theoretical part describes the function and defects of a family, psychic deprivation of children, the history of foster care, the institution of foster care and its new forms and other. The target of the research and hypothesis is stated in the practical part. The target of the thesis is an attempt to clarify all the reasons why children live in institutions and why finding a substitutive family for them is difficult. The targeted sample was represented by 110 children from all regions of the Czech Republic except the South Bohemia region. These children{\crq} s collection of documents was forwarded in the second half of the year 2007 to the Regional Council of South Bohemia Region. In accordance with the target of the work following hypothesis were determined: Hypothesis no. 1: Most of the targeted children have serious disabilities. Hypothesis no. 2: The targeted sample were mainly children between 7 {--} 10 years old. Hypothesis no.3: The most frequent reason why children stay in institutions is the fact that their parents are not able to look after them. Hypotheses have been refuted. Characteristic of research sample processed.

O objetivo principal desta dissertação é analisar o processo de industrialização da economia brasileira, entre 1930 e 1980, sob uma ótica evolucionária. Ademais, se buscará analisar o catching-up que possibilitou a inserção da economia brasileira no quarto paradigma tecno-econômico, entre 1956-1980. E o subsequente falling-behind dessa economia, que entravou a sua entrada no paradigma tecno-econômico da tecnologia da informação. Como objetivos específicos emerge, em primeiro lugar, a necessidade de se descrever os aspectos tecnológicos, econômicos e institucionais desses dois paradigmas. Em segundo lugar se demonstrará de que maneira o Processo de Substituição de Importações foi fundamental para a inserção da economia brasileira no paradigma da produção em massa. E em terceiro lugar, se demonstrará que o legado institucional dessa mesma estratégia de desenvolvimento veio a ser um obstáculo à inserção da economia brasileira no quinto paradigma tecno-econômico. Destarte, a hipótese assumida é de que a dificuldade enfrentada pelo Brasil para assimilar os fatores-chave derivados da quinta revolução tecnológica advém da precária estrutura institucional construída ao longo da industrialização via substituição de importações. A passividade tecnológica e fragilidade institucional desse modelo de desenvolvimento, que não estabeleceu um nexo micro-macro, foi um obstáculo à endogenização do processo inovativo e impediu que a indústria brasileira ficasse em sintonia com a tecnologia dominante. / The main objective of this dissertation is to analyze the process of industrialization of the Brazilian economy, between 1930 and 1980 under an evolutionary perspective. Moreover, it will try to analyze the catching-up which allowed the insertion of the Brazilian economy in the fourth techno-economic paradigm, from 1956 to 1980. Besides that it will investigate the subsequent falling-behind of this economy, which impeded their entry into the techno-economic paradigm of information technology. The specific objectives emerge, first, the need to describe the technological, economic and institutional features those two paradigms. Secondly it will demonstrate how the Import Substitutive Process was essential for the insertion of the Brazilian economy in the paradigm of mass production. And thirdly, it will demonstrate that the institutional legacy of that development strategy came to be an obstacle to the insertion of the Brazilian economy in the fifth techno-economic paradigm. Thus, the assumption made is that the difficulty faced by Brazil to assimilate the key factors derived from the fifth technological revolution comes from poor institutional structure built along the industrialization through import substitution. Technological passivity and institutional weakness of this model of development, which has not established a micro-macro link, was an obstacle to endogenization of the innovative process and prevented the Brazilian industry to stay in tune with the dominant technology.

O objetivo principal desta dissertação é analisar o processo de industrialização da economia brasileira, entre 1930 e 1980, sob uma ótica evolucionária. Ademais, se buscará analisar o catching-up que possibilitou a inserção da economia brasileira no quarto paradigma tecno-econômico, entre 1956-1980. E o subsequente falling-behind dessa economia, que entravou a sua entrada no paradigma tecno-econômico da tecnologia da informação. Como objetivos específicos emerge, em primeiro lugar, a necessidade de se descrever os aspectos tecnológicos, econômicos e institucionais desses dois paradigmas. Em segundo lugar se demonstrará de que maneira o Processo de Substituição de Importações foi fundamental para a inserção da economia brasileira no paradigma da produção em massa. E em terceiro lugar, se demonstrará que o legado institucional dessa mesma estratégia de desenvolvimento veio a ser um obstáculo à inserção da economia brasileira no quinto paradigma tecno-econômico. Destarte, a hipótese assumida é de que a dificuldade enfrentada pelo Brasil para assimilar os fatores-chave derivados da quinta revolução tecnológica advém da precária estrutura institucional construída ao longo da industrialização via substituição de importações. A passividade tecnológica e fragilidade institucional desse modelo de desenvolvimento, que não estabeleceu um nexo micro-macro, foi um obstáculo à endogenização do processo inovativo e impediu que a indústria brasileira ficasse em sintonia com a tecnologia dominante. / The main objective of this dissertation is to analyze the process of industrialization of the Brazilian economy, between 1930 and 1980 under an evolutionary perspective. Moreover, it will try to analyze the catching-up which allowed the insertion of the Brazilian economy in the fourth techno-economic paradigm, from 1956 to 1980. Besides that it will investigate the subsequent falling-behind of this economy, which impeded their entry into the techno-economic paradigm of information technology. The specific objectives emerge, first, the need to describe the technological, economic and institutional features those two paradigms. Secondly it will demonstrate how the Import Substitutive Process was essential for the insertion of the Brazilian economy in the paradigm of mass production. And thirdly, it will demonstrate that the institutional legacy of that development strategy came to be an obstacle to the insertion of the Brazilian economy in the fifth techno-economic paradigm. Thus, the assumption made is that the difficulty faced by Brazil to assimilate the key factors derived from the fifth technological revolution comes from poor institutional structure built along the industrialization through import substitution. Technological passivity and institutional weakness of this model of development, which has not established a micro-macro link, was an obstacle to endogenization of the innovative process and prevented the Brazilian industry to stay in tune with the dominant technology.