Tuberculose: limites e potencialidades do tratamento supervisionado

Objetivou-se analisar potencialidades e limites da estratégia do tratamento supervisionado (DOTS) para a tuberculose, sob a percepção de usuários em tratamento e de trabalhadores de saúde de uma supervisão técnica de saúde do município de São Paulo. Entrevistaram-se 4 usuários e 17 profissionais de saúde de nove unidades básicas de saúde, entre abril e junho de 2006, após consentimento livre e esclarecido. Os depoimentos foram decodificados segundo a técnica de análise de discurso. Adotou-se a teoria da determinação social do processo saúde/doença como referencial teórico. Foram potencialidades: criação de vínculo entre profissional/usuário e incentivos ao tratamento, o que favorece a adesão. Foram limites: restrito envolvimento dos profissionais no DOTS e conciliar horário de trabalho do usuário com a supervisão. Reitera-se que a adesão ao tratamento transcende o âmbito biológico, sendo fundamental que os trabalhadores de saúde reconheçam os usuários como portadores de necessidades, não se restringindo apenas à supervisão da tomada de medicamentos.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: Analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostate-specific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

Orthodontic movement of a maxillary incisor through the midpalatal suture A case report

Orthodontic space closure is a treatment alternative when a maxillary central incisor is missing. The objective of this report was to present an unusual treatment in which a right maxillary central incisor was moved through the midpalatal suture to replace the absent contralateral tooth. The biologic aspects and clinical appearance of the recontoured lateral and central incisors were analyzed. The position of the examined teeth and the appearance of the surrounding soft tissues were satisfactory; however, the upper midline frenulum deviated to the left. The incisor was successfully moved with no obvious detrimental effects as observed on the final radiographs. In the radiographic and tomographic examinations, the midline suture seemed to have followed the tooth movement. The patient expressed satisfaction with the results. It was concluded that orthodontic movement of the central incisor to replace a missing contralateral tooth is a valid treatment option, and the achievement of an esthetic result requires an interdisciplinary approach, including restorative dentistry and periodontics. (Angle Orthod. 2012;82:370-379.)

Clinical Performance of Porcelain Laminate Veneers: Outcomes of the Aesthetic Pre-evaluative Temporary (APT) Technique

This article evaluates the long-term clinical performance of porcelain laminate veneers bonded to teeth prepared with the use of an additive mock-up and aesthetic pre-evaluative temporary (APT) technique over a 12-year period. Sixty-six patients were restored with 580 porcelain laminate veneers. The technique, used for diagnosis, esthetic design, tooth preparation, and provisional restoration fabrication, was based on the APT protocol. The influence of several factors on the durability of veneers was analyzed according to pre- and postoperative parameters. With utilization of the APT restoration, over 80% of tooth preparations were confined to the dental enamel. Over 12 years, 42 laminate veneers failed, but when the preparations were limited to the enamel, the failure rate resulting from debonding and microleakage decreased to 0%. Porcelain laminate veneers presented a successful clinical performance in terms of marginal adaptation, discoloration, gingival recession, secondary caries, postoperative sensitivity, and satisfaction with restoration shade at the end of 12 years. The APT technique facilitated diagnosis, communication, and preparation, providing predictability for the restorative treatment. Limiting the preparation depth to the enamel surface significantly increases the performance of porcelain laminate veneers. (Int J Periodontics Restorative Dent 2012;32:625-635.)

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

The Emergence of the Post-Socialist Welfare State - The Case of the Baltic States : Estonia, Latvia and Lithuania

This dissertation takes a step towards providing a better understanding of post-socialist welfare state development from a theoretical as well as an empirical perspective. The overall analytical goal of this thesis has been to critically assess the development of social policies in Estonia, Latvia and Lithuania using them as illustrative examples of post-socialist welfare state development in the light of the theories, approaches and typologies that have been developed to study affluent capitalist democracies. The four studies included in this dissertation aspire to a common aim in a number of specific ways. The first study tries to place the ideal-typical welfare state models of the Baltic States within the well-known welfare state typologies. At the same time, it provides a rich overview of the main social security institutions in the three countries by comparing them with each other and with the previous structures of the Soviet period. It examines the social insurance institutions of the Baltic States (old-age pensions, unemployment insurance, short-term benefits, sickness, maternity and parental insurance and family benefits) with respect to conditions of eligibility, replacement rates, financing and contributions. The findings of this study indicate that the Latvian social security system can generally be labelled as a mix of the basic security and corporatist models. The Estonian social security system can generally also be characterised as a mix of the basic security and corporatist models, even if there are some weak elements of the targeted model in it. It appears that the institutional changes developing in the social security system of Lithuania have led to a combination of the basic security and targeted models of the welfare state. Nevertheless, as the example of the three Baltic States shows, there is diversity in how these countries solve problems within the field of social policy. In studying the social security schemes in detail, some common features were found that could be attributed to all three countries. Therefore, the critical analysis of the main social security institutions of the Baltic States in this study gave strong supporting evidence in favour of identifying the post-socialist regime type that is already gaining acceptance within comparative welfare state research. Study Two compares the system of social maintenance and insurance in the Soviet Union, which was in force in the three Baltic countries before their independence, with the currently existing social security systems. The aim of the essay is to highlight the forces that have influenced the transformation of the social policy from its former highly universal, albeit authoritarian, form, to the less universal, social insurance-based systems of present-day Estonia, Latvia and Lithuania. This study demonstrates that the welfare–economy nexus is not the only important factor in the development of social programs. The results of this analysis revealed that people's attitudes towards distributive justice and the developmental level of civil society also play an important part in shaping social policies. The shift to individualism in people’s mentality and the decline of the labour movement, or, to be more precise, the decline in trade union membership and influence, does nothing to promote the development of social rights in the Baltic countries and hinders the expansion of social policies. The legacy of the past has been another important factor in shaping social programs. It can be concluded that social policy should be studied as if embedded not only in the welfare-economy nexus, but also in the societal, historical and cultural nexus of a given society. Study Three discusses the views of the state elites on family policy within a wider theoretical setting covering family policy and social policy in a broader sense and attempts to expand this analytical framework to include other post-socialist countries. The aim of this essay is to explore the various views of the state elites in the Baltics concerning family policy and, in particular, family benefits as one of the possible explanations for the observed policy differences. The qualitative analyses indicate that the Baltic States differ significantly with regard to the motives behind their family policies. Lithuanian decision-makers seek to reduce poverty among families with children and enhance the parents’ responsibility for bringing up their children. Latvian policy-makers act so as to increase the birth rate and create equal opportunities for children from all families. Estonian policy-makers seek to create equal opportunities for all children and the desire to enhance gender equality is more visible in the case of Estonia in comparison with the other two countries. It is strongly arguable that there is a link between the underlying motives and the kinds of family benefits in a given country. This study, thus, indicates how intimately the attitudes of the state bureaucrats, policy-makers, political elite and researchers shape social policy. It confirms that family policy is a product of the prevailing ideology within a country, while the potential influence of globalisation and Europeanisation is detectable too. The final essay takes into account the opinions of welfare users and examines the performances of the institutionalised family benefits by relying on the recipients’ opinions regarding these benefits. The opinions of the populations as a whole regarding government efforts to help families are compared with those of the welfare users. Various family benefits are evaluated according to the recipients' satisfaction with those benefits as well as the contemporaneous levels of subjective satisfaction with the welfare programs related to the absolute level of expenditure on each program. The findings of this paper indicate that, in Latvia, people experience a lower level of success regarding state-run family insurance institutions, as compared to those in Lithuania and Estonia. This is deemed to be because the cash benefits for families and children in Latvia are, on average, seen as marginally influencing the overall financial situation of the families concerned. In Lithuania and Estonia, the overwhelming majority think that the family benefit systems improve the financial situation of families. It appears that recipients evaluated universal family benefits as less positive than targeted benefits. Some universal benefits negatively influenced the level of general satisfaction with the family benefits system provided in the countries being researched. This study puts forward a discussion about whether universalism is always more legitimate than targeting. In transitional economies, in which resources are highly constrained, some forms of universal benefits could turn out to be very expensive in relative terms, without being seen as useful or legitimate forms of help to families. In sum, by closely examining the different aspects of social policy, this dissertation goes beyond the over-generalisation of Eastern European welfare state development and, instead, takes a more detailed look at what is really going on in these countries through the examples of Lithuania, Latvia and Estonia. In addition, another important contribution made by this study is that it revives ‘western’ theoretical knowledge through ‘eastern’ empirical evidence and provides the opportunity to expand the theoretical framework for post-socialist societies.

Relação entre inteligência emocional, satisfação com a vida e práctica desportiva

[POR] Este estudo tem por objectivo verificar a existência de diferenças entre grupos de praticantes, de idade e de género na inteligência emocional ena satisfação com a vida, assim como descrever a relação entre estas duas variáveis. [ES] Este estudio tiene como objetivo verificar la existencia de diferencias entre los grupos de profesionales, la edad y el género en la inteligencia emocional y la satisfacción con la vida, así como describir la relación entre estas dos variables. [EN] This study aims to verify the existence of differences between groups of practitioners, age and gender on emotional intelligence and satisfaction with life, as well as describe the relationship between these two variables.

Patient-Therapeut-Bindung bei Drogenabhängigen: Instrumentenvalidierung und Therapieevaluation

In der vorliegenden Arbeit wird zum einen ein Instrument zur Erfassung der Patient-Therapeut-Bindung validiert (Client Attachment to Therapist Scale, CATS; Mallinckrodt, Coble & Gantt, 1995), zum anderen werden Hypothesen zu den Zusammenhängen zwischen Selbstwirksamkeitserwartung, allgemeinem Bindungsstil, therapeutischer Beziehung (bzw. Therapiezufriedenheit), Patient-Therapeut-Bindung und Therapieerfolg bei Drogen-abhängigen in stationärer Postakutbehandlung überprüft. In die Instrumentenvalidierung (einwöchiger Retest) wurden 119 Patienten aus 2 Kliniken und 13 Experten einbezogen. Die Gütekriterien des Instrumentes fallen sehr zufriedenstellend aus. An der naturalistischen Therapieevaluationsstudie (Prä-, Prozess-, Post-Messung: T0, T1, T2) nahmen 365 Patienten und 27 Therapeuten aus 4 Kliniken teil. Insgesamt beendeten 44,1% der Patienten ihren stationären Aufenthalt planmäßig. Auf Patientenseite erweisen sich Alter und Hauptdiagnose, auf Therapeutenseite die praktizierte Therapierichtung als Therapieerfolgsprädiktoren. Selbstwirksamkeitserwartung, allgemeiner Bindungsstil, Patient-Therapeut-Bindung und Therapiezufriedenheit eignen sich nicht zur Prognose des Therapieerfolgs. Die zu T0 stark unterdurchschnittlich ausgeprägte Selbstwirksamkeits-erwartung steigert sich über den Interventionszeitraum, wobei sich ein Moderatoreffekt der Patient-Therapeut-Bindung beobachten lässt. Es liegt eine hohe Prävalenz unsicherer allgemeiner Bindungsstile vor, welche sich über den Therapiezeitraum nicht verändern. Die patientenseitige Zufriedenheit mit der Therapie steigt von T1 zu T2 an. Die Interrater-Konkordanz (Patient/Therapeut) zur Einschätzung der Patient-Therapeut-Bindung erhöht sich leicht von T1 zu T2. Im Gegensatz dazu wird die Therapiezufriedenheit von Patienten und Therapeuten zu beiden Messzeitpunkten sehr unterschiedlich beurteilt. Die guten Testgütekriterien der CATS sprechen für eine Überlegenheit dieses Instrumentes gegenüber der Skala zur Erfassung der Therapiezufriedenheit. Deshalb sollte die Patient-Therapeut-Bindung anhand dieses Instrumentes in weiteren Forschungsarbeiten an anderen Patientenkollektiven untersucht werden, um generalisierbare Aussagen zur Validität treffen zu können.

Compliance lebertransplantierter Patienten mit dem Immunsuppressivum Tacrolimus bei 2x täglicher im Vergleich zu 1x täglicher Einnahme

Compliance lebertransplantierter Patienten mit der immunsuppressiven Therapie ist unerlässlich für den lang-fristigen Erfolg der Lebertransplantation. Aus Non-Compliance mit der immunsuppressiven Therapie können Abstoßungsreaktionen, Organverlust oder sogar Tod resultieren. Hauptziel der vorliegenden Studie war die erstmalige Evaluation der Compliance bei Einnahme von Prograf® (zweimal tägliche Einnahme von Tacrolimus) im Vergleich zur Einnahme von Advagraf® (einmal tägliche Einnahme von Tacrolimus). Von Interesse war außerdem die Fragestellung, ob sich die Compliance bezüglich der immunsuppressiven Therapie mit dem Zeitabstand zur Transplantation verändert. rnDie Compliancemessung wurde offen mittels MEMS® (Aardex Ltd., Schweiz) durchgeführt, der Patient war also über die Compliancekontrolle informiert. Mittels MEMS® konnten Datum und Uhrzeit der Dosisentnahme dokumentiert und damit zuverlässig das gesamte Compliancemuster über im Durchschnitt 176 Tage mit der zweimal täglichen Einnahme und 188 Tage mit der einmal täglichen Einnahme pro Patient erfasst werden. 65 Patienten mit dem Basisimmunsuppressivum Prograf® wurden in die prospektive, nicht-interventionelle Studie eingeschlossen und nach Per Protokoll-Analyse konnten die Daten von 63 in Mainz lebertransplantierten Patienten ausgewertet werden (Prograf®: Gruppe 1: 15 Patienten (Pat.), Gruppe 2: 23 Pat., Gruppe 3: 22 Pat., Drop-outs: 3 Pat.; Advagraf®: Gruppe 1: 16 Pat., Gruppe 2: 23 Pat., Gruppe 3: 23 Pat., Drop-outs: 1 Pat.). Die Dosing Compliance (DC), definiert als Prozent der Tage, an denen der MEMS®-Behälter korrekt geöffnet und die Dosis höchstwahrscheinlich korrekt eingenommen wurde, war der primäre Zielparameter. Weitere Methoden der Compliancemessung, wie der Pill Count, mehrere Fragebögen (Selbsteinschätzung, Patientenwissen-, Morisky-, MESI-, HADS-, SF-36- und Patientenzufriedenheit-Fragebogen) sowie die Blutspiegelmessung wurden eingesetzt, um die Compliance der Patienten umfassend charakterisieren zu können. rnDer Median der DC mit der zweimal täglichen Einnahme betrug 97% bei Pat. > 6 m.p.t. < 2 y.p.t., 97% bei Pat. > 2 y.p.t. < 5 y.p.t. und 98% bei Pat. > 5 y.p.t. (p=0,931; Kruskal-Wallis-Test). Der Median der DC von Tacroli-mus bei einmal täglicher Einnahme (Advagraf®) betrug 99% bei Pat. > 6 m.p.t. < 2 y.p.t., 98% bei Pat. > 2 y.p.t. < 5 y.p.t. und 97% bei Pat. > 5 y.p.t. (p=0,158; Kruskal-Wallis-Test). Insgesamt zeigten die Patienten während des gesamten Beobachtungszeitraums von 12 Monaten eine gute Compliance für die Einnahme ihres Immun-suppressivums. Die Timing Compliance (TiC)-raten lagen auf einem niedrigeren Niveau als die Dosing- und Taking Compliance (TC)-raten. Die Complianceraten der drei Subgruppen unterschieden sich nicht signifikant. Die Patienten mit dem geringsten Abstand zur Transplantation zeigten bei beinahe allen Messmethoden die höchste Compliance im Gegensatz zur etwas geringeren Compliance der Patienten mit größerem Abstand zur Transplantation. Die während der Advagraf®-Phase mittels MEMS® gemessenen DC-, TC- und TiC-raten fielen höher aus als bei Einnahme von Prograf® (p(DC)=0,003; p(TC)=0,077; p(TiC)=0,003; Wilcoxon Vorzeichen-Rang-Test). Dieses Ergebnis untermauert die in anderen Indikationen gefundene Complianceverbesserung durch die einmal tägliche Arzneimittelgabe im Vergleich zur zweimal täglichen Gabe. Die Auswertung der Drug Holidays ergab für die Advagraf®-Phase hingegen niedrigere Complianceraten als für die Prograf®-Phase. Dieses Ergebnis ist auf die Definition des Drug Holidays (keine Arzneimitteleinnahme über 48 h) zurück zu führen. Die Chance Advagraf® einmal pro Tag zu vergessen ist doppelt so hoch, als Prograf® dreimal aufeinander fol-gend zu vergessen. Mit einer verhältnismäßigeren Definition von Drug Holidays (Einnahmepause von 72 Stun-den bei einmal täglicher Einnahme von Advagraf® entsprechend drei ausgelassenen Dosen von Prograf®) ist die Compliancerate 81%. Die Ergebnisse des Pill Counts waren sowohl bei Einnahme von Prograf® als auch von Advagraf® mit der jeweils gemessenen TC vergleichbar, was die Zuverlässigkeit der Messergebnisse bes-tätigt. rnDie zusätzlich eingesetzten Methoden verifizierten das Ergebnis der höheren Compliance mit der einmal tägli-chen Einnahme. Die während der Advagraf®-Phase beantworteten Fragebögen zeigten einen Trend zu besserer Compliance und Lebensqualität. Lediglich die Ergebnisse des MESI-Fragebogens und der Blutspiegelmessungen wichen sowohl während der Prograf®- als auch während der Advagraf®-Phase stark von den Ergebnis-sen der anderen Methoden ab. rnUnter Einbeziehung aller mittels MEMS® und Pill Count objektiv gemessenen Complianceparameter konnten während der Prograf®-Einnahme 54 von 60 Pat. (90%) und während der Advagraf®-Phase 59 von 62 Pat. (95%) als compliant eingestuft werden. Aufgrund subjektiver Compliancemessungen waren 49 von 58 Pat. (84%) während der Prograf®- und 54 von 59 Pat. (92%) während der Advagraf®-Phase als compliant einzustufen. Es wurde beobachtet, dass die zeitlich korrekte Einnahme der Morgendosis einfacher und bei Einmalgabe zu bevorzugen ist. Die wochentagsbezogene Auswertung ergab erwartungsgemäß, dass am Wochenende (Samstag und Sonntag) am häufigsten Dosen ausgelassen wurden. rnDie Umstellung von Prograf® auf Advagraf® stellte kein Problem dar. Beinahe alle Patienten waren dankbar und zufrieden mit der Reduzierung der Dosierungsfrequenz und der größeren Unabhängigkeit durch die entfallene abendliche Einnahme. Der positive Einfluss der geringeren Dosierungshäufigkeit auf die Langzeitcompliance der Patienten, ist ein hinreichender Grund die Entwicklung von Formulierungen zur einmal täglichen Ein-nahme für weitere Immunsuppressiva zu fordern. Insbesondere bei den häufig eingesetzten Kombinationstherapien von Immunsuppressiva würde der Effekt der Complianceverbesserung noch verstärkt werden, wenn alle eingesetzten Immunsuppressiva zur einmal täglichen Gabe geeignet wären.

Einstellungen zur Demokratie in Kambodscha : Niveau und Determinanten der Demokratieunterstützung

Die vorliegende Arbeit beschäftigt sich mit der Frage, wie stark die Unterstützung eines demokratischen politischen Systems in der kambodschanischen Bevölkerung ist und welche Faktoren auf der Mikroebene die Demokratieunterstützung in Kambodscha beeinflussen. Hierfür werden das Unterstützungsmodell von Dieter Fuchs und die Modernisierungstheorie von Seymour Lipset für die Analyse von Einstellungen in einem autoritären politischen System modifiziert und entsprechend angepasste Hypothesen [zum Einfluss der Modernisierungsfaktoren auf die Demokratieunterstützung] formuliert. Nachdem die im Datensatz vorhandenen Einzelindikatoren zu Faktoren verdichtet und Probleme des Demokratieverständnisses und der Item-Nonresponse diskutiert wurden, werden Daten der zweiten Welle der Asian Barometer Survey 2008 analysiert. Die empirischen Ergebnisse zeigen zwar, dass eine substantielle Minderheit das autoritäre Regime des Landes und seine Entscheidungsträger kritisch betrachtet, die Bindung an liberal-demokratische Werte aber eher schwach ausgeprägt ist. Bi- und multivariate Analysen deuten auf einen Einfluss von Faktoren wie Bildung, Einkommen und Wohnort hin und bestätigen somit weitgehend die Modernisierungstheorie, allerdings mit einer bedeutsamen Abweichung: Größere Zufriedenheit mit der eigenen wirtschaftlichen Lage führt zwar zu einer stärkeren Bindung an demokratische Werte, gleichzeitig aber auch zu einer größeren Unterstützung des autoritären Regimes und seiner Entscheidungsträger.

A daily perspective on work interruptions

Diese Dissertation basiert auf einem theoretischen Artikel und zwei empirischen Studien.rnrnDer theoretische Artikel: Es wird ein theoretisches Rahmenmodell postuliert, welches die Kumulierung von Arbeitsunterbrechung und deren Effekte untersucht. Die meisten bisherigen Studien haben Unterbrechungen als isoliertes Phänomen betrachtet und dabei unberücksichtigt gelassen, dass während eines typischen Arbeitstages mehrere Unterbrechungen gleichzeitig (oder aufeinanderfolgend) auftreten. In der vorliegenden Dissertation wird diese Lücke gefüllt, indem der Prozess der kumulierenden Unterbrechungen untersucht wird. Es wird beschrieben,rninwieweit die Kumulation von Unterbrechungen zu einer neuen Qualität vonrn(negativen) Effekten führt. Das Zusammenspiel und die gegenseitige Verstärkung einzelner Effekte werden dargestellt und moderierende und mediierende Faktoren aufgezeigt. Auf diese Weise ist es möglich, eine Verbindung zwischen kurzfristigen Effekten einzelner Unterbrechungen und Gesundheitsbeeinträchtigungen durch die Arbeitsbedingung ‚Unterbrechungen‘rnherzustellen.rnrnStudie 1: In dieser Studie wurde untersucht, inwieweit Unterbrechungen Leistung und Wohlbefinden einer Person innerhalb eines Arbeitstages beeinflussen. Es wurde postuliert, dass das Auftreten von Unterbrechungen die Zufriedenheit mit der eigenen Leistung vermindert und das Vergessen von Intentionen und das Irritationserleben verstärkt. Geistige Anforderung und Zeitdruck galten hierbei als Mediatoren. Um dies zu testen, wurden 133 Pflegekräften über 5 Tage hinweg mittels Smartphones befragt. Mehrebenenanalysen konnten die Haupteffekte bestätigen. Die vermuteten Mediationseffekte wurden für Irritation und (teilweise) für Zufriedenheit mit der Leistung bestätigt, nicht jedoch für Vergessen von Intentionen. Unterbrechungen führen demzufolge (u.a.) zu negativen Effekten, da sie kognitiv anspruchsvoll sind und Zeit beanspruchen.rnrnStudie 2: In dieser Studie wurden Zusammenhänge zwischen kognitiven Stressorenrn(Arbeitsunterbrechungen und Multitasking) und Beanspruchungsfolgen (Stimmung und Irritation) innerhalb eines Arbeitstages gemessen. Es wurde angenommen, dass diese Zusammenhänge durch chronologisches Alter und Indikatoren funktionalen Alters (Arbeitsgedächtniskapazität und Aufmerksamkeit) moderiert wird. Ältere mit schlechteren Aufmerksamkeitsund Arbeitsgedächtnisleistungen sollten am stärksten durch die untersuchten Stressoren beeinträchtigt werden. Es wurde eine Tagebuchstudie (siehe Studie 1) und computergestützternkognitive Leistungstests durchgeführt. Mehrebenenanalysen konnten die Haupteffekte für die abhängigen Variablen Stimmung (Valenz und Wachheit) und Irritation bestätigen, nicht jedoch für Erregung (Stimmung). Dreifachinteraktionen wurden nicht in der postulierten Richtung gefunden. Jüngere, nicht Ältere profitierten von einem hohen basalen kognitivenrnLeistungsvermögen. Ältere scheinen Copingstrategien zu besitzen, die mögliche kognitive Verluste ausgleichen. rnrnIm Allgemeinen konnten die (getesteten) Annahmen des theoretischen Rahmenmodellsrnbestätigt werden. Prinzipiell scheint es möglich, Ergebnisse der Laborforschung auf die Feldforschung zu übertragen, jedoch ist es notwendig die Besonderheiten des Feldes zu berücksichtigen. Die postulieren Mediationseffekte (Studie 1) wurden (teilweise) bestätigt. Die Ergebnisse weisen jedoch darauf hin, dass der volle Arbeitstag untersucht werden muss und dass sehr spezifische abhängige Variablen auch spezifischere Mediatoren benötigen. Des Weiteren konnte in Studie 2 bestätigt werden, dass die kognitive Kapazität eine bedeutsamernRessource im Umgang mit Unterbrechungen ist, im Arbeitskontext jedoch auch andere Ressourcen wirken.

Sexual health of ethnic minority MSM in Britain (MESH project): design and methods

Background Men who have sex with men (MSM) remain the group most at risk of acquiring HIV infection in Britain. HIV prevalence appears to vary widely between MSM from different ethnic minority groups in this country for reasons that are not fully understood. The aim of the MESH project was to examine in detail the sexual health of ethnic minority MSM living in Britain. Methods/Design The main objectives of the MESH project were to explore among ethnic minority MSM living in Britain: (i) sexual risk behaviour and HIV prevalence; (ii) their experience of stigma and discrimination; (iii) disclosure of sexuality; (iv) use of, and satisfaction with sexual health services; (v) the extent to which sexual health services (for treatment and prevention) are aware of the needs of ethnic minority MSM. The research was conducted between 2006 and 2008 in four national samples: (i) ethnic minority MSM living in Britain; (ii) a comparison group of white British MSM living in Britain; (iii) NHS sexual health clinic staff in 15 British towns and cities with significant ethnic minority communities and; (iv) sexual health promotion/HIV prevention service providers. We also recruited men from two "key migrant" groups living in Britain: MSM born in Central or Eastern Europe and MSM born in Central or South America. Internet-based quantitative and qualitative research methods were used. Ethnic minority MSM were recruited through advertisements on websites, in community venues, via informal networks and in sexual health clinics. White and "key migrant" MSM were recruited mostly through Gaydar, one of the most popular dating sites used by gay men in Britain. MSM who agreed to take part completed a questionnaire online. Ethnic minority MSM who completed the online questionnaire were asked if they would be willing to take part in an online qualitative interview using email. Service providers were identified through the British Association of Sexual Health and HIV (BASHH) and the Terrence Higgins Trust (THT) CHAPS partnerships. Staff who agreed to take part were asked to complete a questionnaire online. The online survey was completed by 1241 ethnic minority MSM, 416 men born in South and Central America or Central and Eastern Europe, and 13,717 white British MSM; 67 ethnic minority MSM took part in the online qualitative interview. In addition 364 people working in sexual health clinics and 124 health promotion workers from around Britain completed an online questionnaire. Discussion The findings from this study will improve our understanding of the sexual health and needs of ethnic minority MSM in Britain.

Work-related behavior and experience patterns and predictors of mental health in German physicians in medical practice

Background and Objectives: Work-related stress and burnout among physicians are of increasing relevance. The aim of this study was to investigate work-related behavior and experience patterns and predictors of mental health of physicians working in medical practice in Germany. Methods: We surveyed a stratified, random sample of 900 physicians from different specialties. The questionnaire included the standardized instruments Work-related Behavior and Experience Pattern (AVEM) and the Short Form-12 Health Survey (SF-12). Results: Only one third of physicians reported high or very high general satisfaction with their job, but 64% would choose to study medicine again. Only 18% of physicians presented a healthy behavior and experience pattern. Almost 40% presented a pattern of reduced motivation to work, 21% were at risk of overexertion, and 22% at risk for burnout. Willingness to study medicine again, fulfilled job expectations, professional years, marital status, and behavior patterns were significant predictors of mental health and accounted for 35.6% of the variance in mental health scores. Job-related perceptions also had a significant effect on burnout. Conclusions: The strong influence of work-related perceptions suggests a need for realistic expectation management in medical education, as well as support in stress management and coping strategies during medical training.

Comparative Study of Informal Health Care Networks and Elderly Health Status in Argentina and Cuba

The objective of this study is to evaluate the impact of informal care support networks on the health status, life satisfaction, happiness and anxiety of elderly individuals in Argentina and Cuba. Recent economic changes, demographic changes, the structure of families and changes in women?s labor participation have affected the availability of informal care. Additionally, the growing number of elderly as a percentage of total population has significant implications for both formal and informal care in Argentina and Cuba. Methods: The SABE - Survey on Health, Well-Being, and Aging in Latin America and the Caribbean, 2000 was used as the data source. The survey has a sample of 10,656 individuals aged 60 years and older residing in private households occupied by permanent dwellers in 7 cities in the Latin American and Caribbean region. My study will focus on the Buenos Aires and Havana samples in which there were 1043 individuals and 1905 individuals respectively. General sampling design was used to establish comparability between countries. Individuals requiring assistance are surveyed on their source of help and the relative impact of informal versus paid help is measured for this group. Other measures of social support (number of living children, companionship and number of individuals living in the same dwelling) are used to measure networks for the full sample. Multivariate probit regression analyses were run separately for Cuba and for Argentina to evaluate the marginal impacts of the types of social support on health status, life satisfaction, happiness and anxiety. Results: For Argentina, almost all of the family help variables positively impact good health. Getting help from most other members of the family negatively impacts satisfaction with life. Happiness is affected differently by each of the family help variables but community support increases the likelihood of being happy. Although none of the family or community help variables show statistical significance, most negatively affect anxiety levels. In Cuba, all of the social support variables have a positive marginal impact on the health status of the elderly. In this case, some of the family and community help variables have a negative marginal impact on life satisfaction; however, it appears that having those closest to the elderly, children, spouse, or other family, positively impacts life satisfaction. Most of the support variables negatively impact happiness. Receiving help from a child, spouse or parent is associated with a marginal increase in anxiety, whereas receiving help from a grandchild, another family member or a friend actually reduces anxiety. Discussion: The study highlights the necessity for enhancing the coordination of various care networks in order to provide adequate care and reduce the burdens of old age on the individual, family and society and the need for consistent support for the caregivers. More qualitative work should be done to identify how support is given and what comprises the support. The constant change and advancement of the world, and the growth of the Latin American and Caribbean region, suggests that more updates studies need to be done.

Wear of double crown systems: electroplated vs. casted female part

The wear of telescopic crowns is a common problem often reducing the patient's satisfaction with the denture and resulting in a renewal of the denture. The study aims to compare the wear behavior of conical crowns using electroplated copings (group E ) with standard telescopic crowns with cast female parts (group C).