Background: For several decades already, art therapeutic interventions have been part of complex therapeutic programs in institutional treatment of addictive disorders, both domestic and foreign. The concept of the art therapy oscillates between artistic symbolic expression, the art of therapy and clinical practice, where new approaches are being developed on the basis of target groups or therapeutic starting points. Aims: To map the implementation and concept of the art therapeutic component of the program in institutional treatment of addictions. Other sub-objectives are also addressed. Methods: In this qualitative study, preparation and process evaluations focused on therapeutic activity are applied. The sample was selected by self-selection and purposive sampling and contains nine workers from five institutions focused on treatment of addictions. Available documents related to the practice of art therapy and semi-structured interviews with art therapists and their collaborators were used to obtain the data. Text data from documents and transcripts of interviews was processed using the content analysis method with emphasis on ethical aspects especially in the field of data anonymization. Results: The art therapy program usually takes place once a week obligatorily, art therapists are mainly...

Introduction: Identifying patients at risk for chronic musculoskeletal pain can inform evaluation and treatment decisions. The ability of physical therapists to assess patients’ risk for chronic pain without use of validated tools has been questioned. The Ӧrebro Musculoskeletal Pain Questionnaire (OMPQ) is used to determine risk for chronic pain. Methods: The aim of this pragmatic study was to prospectively quantify the agreement between physical therapists’ assessment of patients’ risk for chronic symptoms compared to the OMPQ. Patients were asked to complete the OMPQ during the initial visit. Physical therapists, blinded to OMPQ risk classification, carried out their usual patient assessment procedures. The physical therapists rated patients as either high or low risk for chronic pain based on their clinical assessment. Agreement between therapist and OMPQ was determined using Cohen’s Kappa (κ) and screening accuracy compared clinician risk to the OMPQ risk classification (reference standard) by way of contingency table analysis. Results: Ninety-six (96) patients’ risk classifications and 15 corresponding physical therapists’ risk estimates were available for analysis. The OMPQ identified a 47% prevalence for high risk of chronic pain. Agreement (κ and 95% confidence interval) between physical therapist rating and OMPQ was slight, κ = 0.272 (0.033–0.421), p = .026. Therapists’ sensitivity and specificity (95% CI) for determining risk classifications were 60.0% (44.3–74.3) and 62.8% (48.1–75.6), respectively. The positive and negative likelihood ratios (95% CI) were 1.61 (1.05–2.47) and 0.64 (0.42–0.97). Discussion: The use of validated self-report questionnaires are recommended to supplement clinician prognosis for patients at risk of chronic musculoskeletal pain.

Wenn die Familie in der Entstehung und Genesung einer Essstörung (Anorexie und Bulimie) entscheidend ist, wird sie auch in der Behandlung des essgestörten Kindes eine wesentliche Rolle spielen. In dieser Studie wurden Eltern-Kind-Therapiewochen im stationären Rahmen essgestörter Patientinnen untersucht. In einem Zwei-Gruppen-Studiendesign mit Messwiederholungen wurden Patientinnen, die gemeinsam mit ihren Eltern an der Therapiewoche teilnahmen, mit Klinikpatientinnen verglichen, die nicht an der Therapiewoche teilnahmen. Die Zuteilung auf die Untersuchungsgruppe erfolgte aus verschiedenen Gründen durch die Teilnehmer selbst. Mögliche Konfundierungen durch diese Selbstselektion, die die Ergebnisse zu Fragen der Wirksamkeit der Eltern-Kind-Therapiewochen beeinflussen könnten, wurden vorab durch Regressionsanalysen ermittelt, und in den Berechnungen statistisch kontrolliert. Die Evaluation der Therapiewoche ergab eine hohe Zufriedenheit und Erwartungserfüllung bei den Patientinnen und deren Eltern. Außerdem konnten signifikante Symptombesserungen innerhalb des kurzen Zeitraums von dieser einen Woche nachgewiesen werden. Innerhalb der Familien konnte eine hohe Übereinstimmung festgestellt werden, die sich aber nicht über die Zeit von unmittelbar vor bis nach dem Treatment bedeutsam verändert hat. Das Treatment scheint also nicht bestimmten Familien stärker zu helfen als anderen. Allerdings ließen sich bestimmte Prädiktoren finden, die dazu führten, dass bestimmte Patientinnen stärker von dem Treatment profitierten. Zu diesen Prädiktoren gehörten u.a. die Einflussnahme der Familien auf die Pat sowie das Profitieren der Mütter vom Treatment. Im Vergleich zur Kontrollgruppe nahmen die Patientinnen signifikant stärker an Gewicht zu, schafften es, ihr Ineffektivitätsgefühl von einem deutlich kränkeren Anfangswert bis auf die Anfangs-Belastungsstärke der Kontrollgruppe zu bessern und erkannten stärker die Mitverantwortung ihrer Familie an der Erkrankung. Insgesamt haben sich die Patientinnen während des Klinikaufenthaltes signifikant mit teils großen Effektstärken (im Mittel d = .96) in ihrer Symptomatik gebessert. Eine Halbjahres-Katamnese ergab auf Grund eines Rücklaufes von unter 25% nur wenig Aufschluss. Die Ergebnisse zeigen, wie bedeutsam das Einbeziehen der Familie auch in die stationäre Behandlung sein kann.

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Il presente lavoro di tesi si colloca all’interno della tradizione di ricerca nota come Empirically Supported Therapy Relationships, un modello d’indagine centrato sulla natura e sulla funzione della relazione al di là della contrapposizione tra ricerca sugli esiti e ricerca sul processo. I tre studi in cui si articola il lavoro assumono come focus d'indagine porzioni progressive del trattamento: la prima seduta, le prime due sedute, l’intero percorso. Nel primo studio sono messi a confronto differenti esiti terapeutici per verificare se le ricadute sul piano clinico del metodo interpretativo siano riconducibili ad un criterio di presenza/assenza o da ricercare nell’intreccio con altri fattori caratterizzanti il percorso di cura. Il secondo studio si propone di affrontare casi di interruzione prematura del trattamento, differenziati in funzione del raggiungimento o meno della stipulazione di un contratto terapeutico: l’obiettivo è quello di evidenziare le caratteristiche connesse alla diversa fase di abbandono del contesto di cura. Infine il terzo studio, nella forma del single-case study, è incentrato sui momenti di frattura dell’alleanza terapeutica lungo un intero processo terapeutico di quaranta sedute. / The present dissertation refers to the theoretical background known in the literature as Empirically Supported Therapy Relationships, a research tradition focused on the relationship and its nature, beyond the outcome and process research opposition. The three studies included in this work focused on different portions of treatment: respectively the initial intake session, the first two sessions, and the overall treatment. In the first study different outcomes were compared in order to examine if the effects of interpretations were connected to specific factors of psychotherapeutic process. The second study aimed to assess clinical cases of premature termination, differentiated on the basis of the contract attainment: the purpose was to depict specificities due to the different phase of dropping out. Finally, the third study was a single-case research examining alliance ruptures within an entire clinical process of forty sessions.

The purpose of this study was to evaluate the antiretroviral therapy program in primary health care settings in Lesotho. Mixed methods research using a convergent parallel mixed methods design was used to collect both quantitative and qualitative data which were analysed during the same phase of the research process. Two groups of participants participated in the study, the registered nurse group was composed of registered nurses/midwives/nurse clinicians involved in ART service provision and the second group was composed of adults aged 18 years and older who were HIV/AIDS positive. Quantitative data had a compliance rate of 92% and it were analysed using SPSS (23). Qualitative data were analysed using constant comparison analysis and seven themes, fourteen categories and twenty two sub-categories emerged from the data analysis. Findings of the study revealed that the majority of PHC facilities were staffed by registered nurse midwives and nurse clinicians who were qualified, confident, knowledgeable and competent in the execution of duties. Generally there were a large number of patients that sought ART services which were offered on a weekly basis although there was variation in the actual number of days the services were provided. The time patients spent seeking ART services varied across the facilities and ARVs and other drugs were usually available. Challenges in the delivery of ART services included unsatisfactory staffing resulting in the provision of inadequate services and work overload, lack of knowledge of some patients, use of incentives by some partners and too many partners being involved in ART, inadequate documentary evidence and stigma pertaining to the HIV status of individuals. Furthermore, ARVs were reported to make patients feel hungry hence resulting in lack of satisfaction in ART services, ART services were inadequate due to dysfunctional equipment and some patients had been lost due to inability to screen for cancer and there was incomplete monitoring and evaluation of the ART program. However, participants in this study generally showed their acknowledgement of the ART services as they generally improved their health status despite the many challenges that were being faced. / Health Studies / D.Litt.et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / Aromatase inhibitors (AIs) are the current standard of care for the treatment of hormone receptor positive breast cancer in postmenopausal women. Nearly one-half of patients receiving AI therapy develop musculoskeletal toxicity that is characterized by joint and/or muscle pain and approximately one-fourth of patients discontinue their therapy as a result of musculoskeletal pain. Since there are no effective strategies for prevention or treatment, insight into the mechanisms of AI-induced pain is critical to improve treatment. However, there are few studies of AI effects in animal models of nociception. To determine whether AIs produce hypersensitivity in animal models of pain, I examined the effects of AI administration on mechanical, thermal, and chemical sensitivity in rats. The results demonstrate that (1) repeated injection of 5 mg/kg letrozole in male rats produces mechanical, but not thermal, hypersensitivity that extinguishes when drug dosing is stopped; (2) administering a single dose of 1 or 5 mg/kg letrozole in ovariectomized (OVX) rats also induces mechanical hypersensitivity, without altering thermal sensitivity and (3) a single dose of 5 mg/kg letrozole or daily dosing of letrozole or exemestane in male rats augments flinching behavior induced by intraplantar ATP injection. To determine whether the effects of AIs on nociceptive behaviors are mediated by activation or sensitization of peptidergic sensory neurons, I determined whether letrozole exposure alters release of calcitonin gene-related peptide (CGRP) from isolated rat sensory neurons and from sensory nerve endings in rat spinal cord slices. No changes in basal, capsaicin-evoked or high extracellular potassium-evoked CGRP release were observed in sensory neuronal cultures acutely or chronically exposed to letrozole. Furthermore, letrozole exposure did not alter the ability of ATP to augment CGRP release from sensory neurons in culture. Finally, chronic letrozole treatment did not augment neuropeptide release from spinal cord slices. Taken together, these results do not support altered release of this neuropeptide into the spinal cord as mediator of letrozole-induced mechanical hypersensitivity and suggest the involvement of other mechanisms. Results from this dissertation provide a new experimental model for AI-induced hypersensitivity that could be beneficial in delineating mechanisms mediating pain during AI therapy.