Early Onset Obsessive-Compulsive Disorder With and Without Tics

Introduction: Research suggests that obsessive-compulsive disorder (OCD) is not a unitary entity, but rather a highly heterogeneous condition, with complex and variable clinical manifestations. Objective: The aims of this study were to compare clinical and demographic characteristics of OCD patients with early and late age of onset of obsessive-compulsive symptoms (OCS); and to compare the same features in early onset OCD with and without tics. The independent impact of age at onset and presence of tics on comorbidity patterns was investigated. Methods: Three hundred and thirty consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD were evaluated: 160 patients belonged to the ""early onset"" group (EOG): before 11 years of age, 75 patients had an ""intermediate onset"" (IOG), and 95 patients were from the ""late onset"" group (LOG): after 18 years of age. From the 160 EOG, 60 had comorbidity with tic disorders. The diagnostic instruments used were: the Yale-Brown Obsessive Compulsive Scale and the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS), Yale Global Tics Severity Scale; and Structured Clinical Interview for DSM-IV Axis I Disorders-patient edition. Statistical tests used were: Mann-Whitney, full Bayesian significance test, and logistic regression. Results: The EOG had a predominance of males, higher frequency of family history of OCS, higher mean scores on the ""aggression/violence"" and ""miscellaneous"" dimensions, and higher mean global DY-BOCS scores. Patients with EOG without tic disorders presented higher mean global DY-BOCS scores and higher mean scores in the ""contamination/cleaning"" dimension. Conclusion: The current results disentangle some of the clinical overlap between early onset OCD with and without tics. CNS Spectr. 2009; 14(7):362-370

Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Film och mening : En receptionsstudie om spelfilm, filmpublik och existentiella frågor

In what ways and under what circumstances can a movie be a resource for individuals and their thoughts about existential matters? This central research question has been investigated using a both quantitative and qualitative approach. First, a questionnaire was distributed amongst 179 Swedish students to provide a preliminary overview of film habits. The questionnaire was also used as a tool for selecting respondents to individual interviews. Second, thirteen interviews were conducted, with viewers choosing their favourite movie of all time. In the study socio-cognitive theory and a schema-based theoretical tool is adopted to analyze how different viewers make use of movies as cultural products in an interplay between culture and cognition in three contexts; a socio-historic process, a socio-cultural interaction with the world and inner psychological processes. Summarizing the interviews some existential matters dominated. Matters of immanent orientation were in the foreground. Transcendental questions received much less attention. Summarizing the schema-based theoretical question, assessing which cognitive schema structures the narratives were processed through, the study found an emphasis on a combination of two main cognitive structures, person schema and self schema. Detailed person schematic cognitive processes about fictitious characters on the screen and their role model behaviour were combined by the respondents with dynamic cross-references to detailed self schematic introspections about their own characteristics, related to existential matters at some very specific moments in their lives. The viewers in the study seem to be inspired by movies as a mediated cultural resource, promoting the development of a personal moral framework with references to values deeply fostered by a humanistic tradition. It is argued that these findings support theories discussing individualised meaning making, developing ‘self-expression values’ and ‘altruistic individualism’ in contemporary western society.

Manoeuvring between anxiety and control : Patients experience of learning to live with diabetes: a lifeworld phenomenological study

Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices.

Forskning med juridiska förvecklingar : Om tolkningsflexibilitet i kontroversen om mässlingsvaccination och autism

Medical research with jurisdictional consequences: interpretative flexibility in the controversy over MMR vaccination and autism Based on the empirical case of the controversy of MMR vaccination and autism around the turn of the millennium, this paper argues for the analytical importance of the concept of “interpretative flexibility”. As shown, this concept is useful not only for the small subfield of sociology of scientific knowledge (SSK) but also for the broader social sciences. First we analyse, by reference to interpretative flexibility, the initial dispute within medical research concerning evidence for and against a possible link between the measles component of the MMR vaccine and autism. In a second step we move beyond this traditional application of the concept, showing how the interpretative flexibility of the research results remains in society although consensus has been reached in the medical community. This further step is exemplified by two legal events, in Sweden and the US respectively. In both these cases the difficulties in providing uncontested evidence affected institutions and practices at great distance and with different outcomes. Our findings suggest the importance of not only applying the concept of interpretative flexibility to classical scientific laboratory disputes, but also connecting it to its societal manifestations.

Gymnasisters skrivande : En studie av genre, textstruktur och sammanhang

Students in upper secondary school write in a number of different genres, and do this in school contexts as well as in their spare time. The study presented here is an overview of this activity and the genres concerned. The theoretical framework of the study is that of genre theory whereby genre is understood as a socially situated concept. The study is based on 2 000 texts gathered from students on different study programmes all over Sweden in the school year of 1996-97. The texts were written in different situations. The most important distinction made here is between test texts (i.e. texts from national tests) and self-chosen texts, which may come from schoolwriting or spare-time writing. The texts are categorized according to genre. This text inventory shows a repertoire of 33 different genres in the text material. A small number of genres, such as story, book-review and expository essay dominate the school writing. The test genres differ from this pattern in that they clearly imitate texts with a genuine communicative intent. The most frequent genres are studied further and each of them is demonstrated by an interpretative reading. This reading shows that the genres differ considerably with respect to genre character and stability of text structure. A quantitative study of text length and variation in vocabulary further shows that texts written by two categories of students, those on vocationally oriented programmes and those on programmes preparing for higher education, differ significantly. Reference cohesion is studied in a smaller sample of the texts. This lexico-semantic mechanism of cohesion proves to exhibit an interrelation with variation in vocabulary as well as with text type. One particular cohesive tie, inference, shows different patterns in texts written by the two categories of students mentioned above.

Dokumentationens dilemman : Förskollärare samtalar om pedagogisk dokumentation

Abstract  Pedagogical documentation is a certain procedure for documenting that, in recent years, has been embraced in several Swedish preschools. Teachers document children’s actions and conversations usually by photos or video recordings. This documentation is to be used for a pedagogical purpose. However, studies and governmental inspections have shown that pedagogical documentation gives rise to many questions among preschool teachers. The purpose of this study is to gain insight into what is being expressed when preschool teachers discuss pedagogical documentation, focusing on themes of content and on the participants’ expressions of their points of view. The data is comprised of transcriptions from audio recordings of discussions conducted in a research circle. The participants are eight preschool teachers that met over the course of one year. Each meeting focused on the documentation provided by a different participant. In that way the contents of the discussions were framed by the teachers own questions and narratives. Theoretically, the study departs from Social Constructionism and Discursive Psychology. The preschool teachers’ utterances have been analyzed using concepts of interpretative repertoires and ideological dilemmas. The results show the main themes to be: Knowledge content in a preschool setting, children’s learning, the teacher’s role and implementation of pedagogical documentation. The participants’ joint position is that the knowledge content at the preschool level is defined by the curriculum for the preschool. Concerning children’s learning and the teacher’s role, two main standpoints are disclosed. Ideologically those standpoints derive from two opposing theories of education. Based on how the standpoints have been expressed I have called them ”predetermined learning” versus ”non-predetermined learning”. One main distinction between the standpoints is that predetermined learning emphasizes the results of learning, while non-predetermined learning emphasizes the processes of learning. The participants’ utterances show that teachers tend to subscribe to the idea that there is only one acceptable way of working with pedagogical documentation. This sometimes creates performance anxiety and feelings of not succeeding and has led to arguments advocating an alternate approach; pedagogical documentation can be done in many ways. The ideological dilemmas within the discourse can be perceived as resources by which the participants argue about knowledge, learning, teaching and about the implementation of pedagogical documentation.

Äldre och ensamhet : En kartläggning av sociala insatser för äldre personer i Dalarnas kommuner

Det finns begränsat med forskning kring hur biståndshandläggare inom äldreomsorgen arbetar med ensamhet hos äldre personer. Med anledning av detta är studiens huvudsakliga syfte att undersöka hur biståndshandläggare i Dalarnas kommuner arbetar med att utreda sociala behov till följd av ensamhet hos äldre personer samt att ta reda på vilka kommunala sociala insatser som erbjuds för dessa individer och på vilka grunder. Studien är genomförd utifrån en kvantitativ ansats, där vi har använt oss av en enkät, som innehåller frågor som avser att besvara syftet. Tolkningsramen för analysen av det empiriska materialet utgörs av Lipskys teori om gräsrotsbyråkrati. Studiens resultat visar att det finns behov av att både utöka och utveckla kommunernas utbud av sociala insatser för äldre personer samt att utveckla rutiner för hur man ska arbeta med ensamhet hos äldre personer. Studien påvisar ett behov av mer forskning, både internationell och nationell, kring hur biståndshandläggare arbetar med att identifiera ensamhet hos äldre personer.

Facilitation of learning in specialist nursing training in the PICU : the supervisors´ concerns in the learning situation

With the aim to unfold nurses’ concerns of the supervision of the student in the clinical caring situation of the vulnerable child, clinical nurses situated supervision of postgraduate nursing students in the Pediatric Intensive Care Unit (PICU) are explored. A qualitative approach, interpretive phenomenology, with participant observations and narrative interviews, was used. Two qualitative variations of patterns of meaning for the nurses’ clinical facilitation were disclosed in this study. Learning by doing theme supports the students learning by doing through performing skills and embracing routines. The reflecting theme supports thinking and awareness of the situation. As the supervisor often serves as a role model for the student this might have an immediate impact on how the student applies nursing care in the beginning of his or her career. If the clinical supervisor narrows the perspective and hinders room for learning the student will bring less knowledge from the clinical education than expected, which might result in reduced nursing quality.

A formação de cestas de produtos em situações de compras repetidas : uma verificação empírica sobre a associação entre produtos em dois supermercados de Porto Alegre

Este documento constitui uma dissertação de mestrado, requisito parcial para a obtenção do grau de Mestre em Administração pela Universidade Federal do Rio Grande do Sul. O assunto é uma pesquisa sobre associações de compra do consumidor em situações de compras repetidas, envolvendo uma revisão da bibliografia pertinente ao tema, bem como uma pesquisa descritiva a partir dos dados de dois varejos supermercadistas de Porto Alegre, buscando um melhor entendimento sobre o tema. Os principais produtos da pesquisa são a construção teórica de sustentação à formação das cestas de produtos, a utilização dos dados contidos nos cupons de compra de dois supermercados de Porto Alegre com o objetivo de verificar a existência de associações estáveis ao longo do tempo, bem como uma análise interpretativa dos resultados encontrados. As conclusões da pesquisa são a apresentação e a caracterização das associações estáveis encontradas nas lojas e a comparação entre as mesmas, o que possibilita importantes implicações para o estudo das associações de compra. Além disso, algumas hipóteses são geradas entre as associações e o volume de vendas dos supermercados, que deverão ser objeto de estudos futuros.

Dança: forma, técnica e poesia do movimento : na perspectiva de construção de sentidos coreográficos

A presente dissertação se construiu sobre o pressuposto de que forma, técnica e poesia são premissas que embasam uma determinada visão de dança enquanto manifestação artística do corpo humano em movimento. Norteia também este estudo a perspectiva de que as relações que se estabelecem no momento de execução de uma dança instauram processos de significação. Desse modo, este trabalho teve como principais objetivos: - entender a dança enquanto uma atividade artística que se constrói no(s) corpo(s) em movimento; - refletir sobre a elaboração de possíveis significados quando da criação e execução de uma dança; - descrever a dança como uma ação criadora que se faz no corpo humano em movimento. Para atingir os objetivos propostos utilizou-se a fenomenologia como método de investigação, optando-se, assim, por realizar uma descrição da dança que já é, ao mesmo tempo, uma maneira de compreendê-la. Como conseqüência deste procedimento buscou-se demontrar que: - a dança dever ser entendida enquanto arte porque ela resulta de um processo de transformação de uma matéria-prima - o movimento humano - através do uso de procedimentos técnicos e formativos, que resultam em obras coreográficas que se dão a reconhecer através de seu intrínseco caráter de forma; - o movimento é o que toma visível os possíveis sentidos/significados de uma dança: a realização de sentidos coreográficos se dá no contexto de uma coreografia e só se efetua plenamente quando os sentidos são retomados e revividos pelos espectadores; - os processos de criação coreográfica baseados em ações formativas proporcionam o desenvolvimento de uma disponibilidade corporal para a dança. Tal disponibilidade corporal está alicerçada, principalmente, numa inteligência e numa memória corporais, que dispõem o dançarino a exercer suas potencialidades criadoras através da dança. A concepção da dança como forma, técnica e poesia do movimento aponta para uma possibilidade de recuperação, através da dança, de saberes relativos ao corpo, ao movimento e à sensibilidade.

Performance analysis and analysis for performance : a study of Villa-Lobos's Bachianas Brasileiras No. 9

This study of Villa-Lobos’s Bachianas Brasileiras No. 9 aims at gaining insight into the decision-making processes of translating a score into a musical performance. Chapter I presents a discussion of selected issues related to interpretative analysis. Chapter II is an overview of the approaches to recording comparison deemed relevant to the present study. Chapter III is a comparative study of the vocal and string versions of Bachianas Brasileiras No. 9, while Chapter IV offers a structural analysis of the work. Chapter V compares four recordings: the composer’s own with the Orchestre National de La Radiodiffusion Française—EMI 7243 5 66964 2 6; Odaline de la Martinez and the BBC Singers, LNT 102; Michael Tilson Thomas and the New World Symphony —RCA 09026-68538-2; and my own CD, Construção, Orquestra de Câmara Theatro São Pedro- Limited Edition (live recording made on December 11, 1995 in Bayreuth, Germany). This comparison utilizes data obtained with the software Tempo. The tabulation of these results is shown in graphs that compare how matters of tempo flexibility affect each performance. This multi-faceted study shows that although painstaking analysis can lead to insightful solutions, the fleeting nature of musical performance requires an open mind and imagination to deal with the often contradictory directives of the score.

Qual a importância do trabalho voluntário para sustentabilidade de organizações não-governamentais?

A presente dissertação trata do trabalho voluntário nas instituições privadas sem fins lucrativos de pequeno porte. O estudo tem como principal objetivo a investigação a respeito do impacto do trabalho voluntário na sustentabilidade dessas instituições por meio do estudo de caso da organização não-governamental Colcha de Retalhos. Como objetivo secundário buscou-se analisar as motivações, significados e benefícios do trabalho voluntário para o voluntariado. O estudo se caracteriza como descritivo-interpretativo, por uma abordagem predominantemente qualitativa, os dados foram coletados através de entrevistas estruturadas e pesquisa documental. Os dados revelam aspectos importantes para a pesquisa e fomentou o estudo de assuntos vinculados ao voluntariado trazido pelos próprios entrevistados, tais como: cidadania, tensões nas relações entre voluntários e famílias atendidas, voluntários e escolas e voluntários e voluntários. Questões próprias do voluntariado e do Terceiro Setor são abordadas com o intuito de embasar as análises e conclusões do estudo. Os resultados apontam para um impacto positivo do trabalho voluntário na sustentabilidade das instituições sem fins lucrativos de pequeno porte.

O medo no contexto organizacional

This study looked for identify the causes and the effects of fear in the individuals within the organizational context. The procedure for data collection consisted in a questionnaire divided in two stages, and applied in 76 individuals. The first stage consisted in a words evocation test and the second, as a complementary mode, was composed by four open questions. The theory of social representations and the central nucleus theory were the foundations of the data analysis of the words evocation test. The processing of the open questions was consisted in an interpretative analysis, based in the presented theoretical referencial and supported by the respondents social representation of fear. In the enterprises context, different causes and effects of fear had been found in the inserted individuals. However, in its majority, it was identified that the biggest individuals fears are the unemployment, the threats, punishments, the unstable and unsafe environments of work, the unfair competition, the collusions, sabotages, tricks, the incapacity to do its work¿s tasks and the abusive increase of the work load. On the other hand, about the fear¿s effects, there is a frequent physiological and psychological instability when they had been submitted in high work loads. The fear is an excellent creativity, innovation and aptitude repressor, and it is capable to generate disgusts, frustrations, defensive postures, standstills and to increase the jobs navigability.