Dissertationen zum Thema „Injury situation“

Background: Trauma is a significant public health problem both in the UK and beyond. It can have a devastating impact on individuals, their family and society. The care of injured patients has long been thought to be sub-standard in the UK and patient outcomes were noted to be worse than other developed countries. Between 2010-12 regional trauma systems were introduced in England, with the aim of improving survival and long-term outcomes of injured patients. The aim of this study was to critically assess the implementation of these trauma systems on processes and outcomes of care in two regions of England. Methods: A systematic review was undertaken to identify studies evaluating the association between an inclusive trauma system and patient outcome. A mixed-methods approach was used for the study. Data on trauma deaths were obtained from the UK Office for National Statistics (ONS). The Trauma Audit and Research Network (TARN) database was interrogated to provide data on all patients who presented to hospital within two years before and two years after trauma system implementation. A time-series analysis and a before and after study, using a comparator region to control for temporal trends, was undertaken for each region. Twenty semi-structured interviews with Emergency Department (ED) staff were conducted to gain a broader understanding of the effect of this change. Data were then merged and areas of convergence and discrepancy highlighted. Results: The systematic review identified eight observational studies that all demonstrated a significant fall in the odds of death when patients presenting with traumatic injuries were treated within such a system. However, they were deemed to represent a very low-quality body of evidence. ONS data demonstrated that whilst trauma mortality rates were stable, between 30- 50% die outside of hospital. Analysis of TARN data demonstrated that, following system implementation, a greater proportion of injured patients were seen at Major Trauma Centres (MTCs), quality of care indices such as time to CT scan improved and mortality fell. Analysis of the interviews revealed seven main themes and whilst all staff welcomed the commitment to improve trauma care, some, especially outside of the MTCs, expressed concerns about disengagement and being unable to provide the level of care expected. Conclusions: This study adds to the body of evidence supporting the role of inclusive trauma systems in improving quality of care indices and patient outcomes. Contrary to some other studies, this study has shown improvements within two years, particularly at MTCs. Whilst most ED staff interviewed corroborated this view, some barriers to delivering high quality trauma care were felt to remain. Whilst trauma was once seen as a disease of young men and motor vehicle collisions, it is now dominated by falls in the elderly population and trauma systems must be able to meet their needs. Further research is warranted to learn more about the large population of trauma patients that do not survive to reach hospital. Perhaps some of the greatest future improvements of trauma systems are to be found here.

Situation awareness (SA) has been developed in occupations other than nursing to improve decision making (DM) for optimal performance and outcomes. There are some studies exploring the use of situation awareness by nurses in simulated settings but few have examined SA in clinical practice. Because of this paucity of evidence nurses’ use of situation awareness in practice is not fully understood. Studies examining decision making by nurses have indicated that clinical decisions arising from a lack of awareness of patient needs in busy, complex clinical environments can compromise care. In ward environments, compromised care often results in the omission of ‘basic’ nursing interventions which may include pressure injury prevention. This thesis explored the use of situation awareness by nurses in medical/surgical wards as the precursor to decision making and the influences on situation awareness whilst making pressure injury prevention decisions in practice.<br>Thesis (PhD Doctorate)<br>Doctor of Philosophy (PhD)<br>School of Nursing and Midwifery<br>Griffith Health<br>Full Text

La cognition sociale, i.e. notre capacité à attribuer des états mentaux à autrui et à identifier ses émotions, est souvent perturbée dans certaines pathologies telles que le traumatisme crânien (TC). Cette capacité est traditionnellement évaluée à l’aide de tâches sous format « papier-crayon » n’impliquant pas le participant dans une situation d’interaction sociale. Pourtant, la cognition sociale est fondamentale dans nos interactions sociales car elle nous permet de comprendre le discours et le comportement d’autrui. Ainsi, dans ce travail de thèse, nous avons évalué les capacités d’attribution d’états mentaux et de reconnaissance émotionnelle de personnes ayant subi un TC à l’aide de tâches les impliquant activement dans une situation de communication (tâche de communication référentielle et tâche EViCog), ce qui n’a jamais été fait dans cette pathologie. La tâche EViCog (Evaluation de la cognition sociale en interaction virtuelle), créée pour cette étude, permet d’avoir des conversations audio-visuelles avec des humains virtuels, qui expriment des émotions et produisent du discours nécessitant d’inférer leurs états mentaux. Les résultats ont montré que les difficultés des personnes TC étaient encore plus importantes pour la tâche en situation d’interaction (tâche EViCog) par rapport à des tâches traditionnelles au format « papier-crayon ». Par ailleurs, en situation d’interaction, les performances de cognition sociale semblent dépendre en partie des capacités mnésiques (mémoire autobiographique et du contexte), ainsi que des fonctions exécutives, alors que pour les tâches traditionnelles, les performances ne seraient expliquées que par certaines capacités exécutives<br>Social cognition, i.e. the ability to attribute mental states to others and to identify emotions, is often impaired in various pathologies, such as traumatic brain injury (TBI). This ability is traditionally assessed with “paper-and-pencil” tasks that do not involve the participant in a social interaction situation. However, social cognition is central in our daily social interactions, as it helps us understand others’ speech and behavior. Thus, in this study, we assessed mental state attribution and emotion recognition abilities of TBI participants, using tasks that involve the participant in a communication situation (referential communication task and EViCog task). The EViCog task (social cognition evaluation in virtual interaction), designed for this research, provides audio-visual conversations with virtual humans, which express emotions and produce speech requiring mental state inference. The results showed that the difficulties of the TBI participants were even more important for the task in interaction situation (EViCog task) compared to traditional tasks in paper-and-pencil format. Moreover, in interaction situation, social cognition performance seemed to rely on mnemonic abilities (autobiographical memory and context memory), and on executive functions, while for traditional tasks, performances were only explained by some executive abilities

La protection intégrée des cultures (PIC) apparaît comme une stratégie durable de protection des plantes contre les bioagresseurs, satisfaisant les exigences à la fois économiques, écologiques et sanitaires auxquelles est confrontée l’agriculture. L’amélioration des connaissances sur les interactions entre les bioagresseurs et les pratiques agricoles est indispensable afin de concevoir des méthodes de lutte plus économes en produits phytosanitaires Le modèle IPSIM (Injury Profile SIMulator), développé dans ce travail de thèse, vise à simuler l’effet des pratiques culturales, du pédoclimat et de l’environnement de la parcelle sur les dégâts causés par les bioagresseurs sur une culture. Ce modèle est basé sur une approche hiérarchique et agrégative. Ce travail décrit la base conceptuelle de la modélisation IPSIM et son application pour construire le modèle IPSIM-Wheat, simulant les profils de dégâts sur le blé en fonction des pratiques culturales et de l’environnement biotique et abiotique. Plusieurs modèles ont été conçus pour prédire les sévérités de six maladies, un ravageur et les plantes adventices du blé. Ces modèles contribuent ainsi au développement d’IPSIM-Wheat, dont une première version est présentée pour des bioagresseurs majeurs en interaction. Ce futur modèle pourra contribuer à concevoir des systèmes de culture incluant du blé, moins soumis aux pressions biotiques et moins dépendants des pesticides<br>Integrated pest management (IPM) appears as a sustainable strategy to protect plants against pest while answering the economical, ecological, and toxicological expectations that agriculture must face. The effects of cultural practices on pest dynamics have to be thoroughly analyzed in order to reduce the reliance of cropping systems on pesticides. A model, named IPSIM ((Injury Profile SIMulator), currently under development in this thesis, aims at simulating the effects of cropping practices, as well as soil, climate and field environment on the injuries caused by multiple pests of a given crop. This model is based on a hierarchical and aggregative approach. This study describes the conceptual basis of the modeling and its applications in order to develop IPSIM-Wheat, a model simulating injury profiles on wheat. Thus, several models have been designed to predict six diseases, one insect pest and weeds. This study thus contributes to the development of IPSIM-Wheat which will help design innovative sustainable wheat-based cropping system

Les constructeurs automobiles sont tenus de respecter des minima sécuritaires vérifiés lors de crash-tests normalisés, d'où un nombre de scénarios de tests limité ne tenant pas compte des particularités individuelles. Ce mémoire propose d'évaluer le comportement humain réel en phase de pré-crash sur simulateur de conduite. L'expérimentation, intégrant un scénario d'accident difficilement évitable, a permis d'étudier le comportement de 76 conducteurs dont 40 sur simulateur dynamique. Pour ce groupe, 43 voies de mesures centrées sur le conducteur ont été intégrées au protocole. Parmi les résultats obtenus, on retiendra la possible détection précoce de l'accident, pour la moitié des conducteurs, sur la base de leur interaction avec le véhicule. Les manœuvres d’évitement amènent 25% des sujets à positionner l'avant-bras devant le volant au moment de l’impact. Cette situation peut compromettre l'efficacité des airbags, ce qui est vérifié sur banc statique, par le déploiement d'airbags face à un mannequin de type Hybrid III-50%. La projection du bras entraine un impact de 120g à la tête. De plus, l'intégration de membres supérieurs issus de SHPM montre que la situation provoque des fractures de l'avant-bras. Un modèle numérique a été conçu pour estimer les effets de la position atypique lors d'un crash frontal à 50km/h. L'accélération de la tête atteint 270g, synonyme de risques lésionnels élevés. Enfin, une modification technologique des airbags est proposée, basée sur l'hypothèse que la détection à distance peut permettre un déclenchement anticipé et plus lent des airbags. Testée expérimentalement et numériquement, cette évolution permet de respecter les critères lésionnels<br>Automakers are lawfully required to achieve a minimum level of security which is checked during standardized crash tests. This results in a limited number of scenarios, which do not take individual specificities into account. This dissertation evaluates real human behaviour during the pre-crash phase, by means of a driving simulator. The experiment, integrating an unavoidable accident, studied the behaviour of 76 drivers, of which 40 drivers on a dynamic simulator. Concerning this group, 43 acquisition channels dedicated to drivers were added. From the results, one can retain that the crash can be predicted for half of the drivers through the observation of their behaviour and their interaction with the car. Due to swerving manoeuvres, 25% of the drivers have their forearm just in front of the steering wheel at the time of crash. This situation may compromise the efficiency of the airbags, that is verified experimentally on a static bench, by the deployment of airbags in front of a Hybrid III-50% dummy. The throwing of the arm causes an impact of 120 g to the head. In a second stage, the integration of left upper limbs from PMHS reveals that the situation is likely to generate fractures in the forearm. A numerical model has been designed to estimate the consequences of the atypical position during a frontal crash at 50km/h. The head acceleration reaches 270 g, synonymous with high lesion risks. Finally, a technological modification of the airbags is proposed to reduce this risk. The assumption is made that the use of remote sensors technologies can allow an early detection of the crash and therefore slower triggering of airbags. Tested experimentally and then numerically, this technical evolution reduces the violence of the impact to respect the injury criteria

Background: The anterior cruciate ligament (ACL) is the most commonly injured ligament in the human body. The injury often occurs in pivoting sports. A common consequence after ACL injury is kinesiophobia, which can contribute to prolonged rehabilitation and delayed return to sport. Increased understanding of psychological factors such as kinesiophobia could facilitate the rehabilitation process for ACL-patients. Objectives: To explore in which situations and movements ACL-injured individuals experience kinesiophobia, and which are most common. The associations between the number of fearful situations described and the scores in questionnaires regarding kinesiophobia were also evaluated.  Methods: Tampa Scale of Kinesiophobia (TSK), Anterior Cruciate Ligament - Return to Sports after Injury (ACL-RSI) and a custom made Kinesiophobia after ACL injury (KAAI) questionnaire were used. Data were analysed using Spearman’s Rho test. Answers to open-ended questions were categorized and provided qualitative input. Results: Common situations and movements considered fearful by ACL-injured persons were pivoting movements, situations with increased load on the injured knee, and walking on slippery/uneven ground. Significant correlations were seen between TSK and KAAI_TOTAL scores (rho = 0.728; p = 0.007), ACL-RSI and KAAI_TOTAL scores (rho = -0.755; p = 0.003), and ACL-RSI and TSK scores (rho= -0.828; p&lt; 0.001).  Conclusion: This study shows that a higher number of situations and movements considered fearful might associate with higher levels of kinesiophobia in ACL-injured persons. Higher self-efficacy and readiness to return to sport might associate with fewer situations and movements considered fearful, e.g. pivoting movements and walking on slippery ground. Knowledge of this may improve rehabilitation in this field.<br>Bakgrund: Främre korsbandet är det mest frekvent skadade ligamentet i människokroppen. Skadan sker ofta i sporter med pivoterande rörelser. En vanlig psykologisk konsekvens efter främre korsbandsskada är rörelserädsla, vilket kan orsaka förlängd rehabilitering och försenad återgång till idrott. Ökad kunskap om faktorer som rörelserädsla kan underlätta rehabiliteringsprocessen för personer med främre korsbandsskada. Syfte: Att undersöka i vilka situationer och rörelser som personer med främre korsbandsskada upplever rörelserädsla, samt vilka som är vanligast förekommande. Dessutom, att beräkna sambandet mellan poängen från enkäter angående rörelserädsla. Metod: Tampa Scale of Kinesiophobia (TSK), Anterior Cruciate Ligament - Return to Sports after Injury (ACL-RSI), och en specialutformad enkät (KAAI) skickades till deltagarna. Insamlad data analyserades med hjälp av korrelationstestet Spearman’s rho. Svar på öppna frågor kategoriserades och bidrog med ett kvalitativt perspektiv. Resultat: Pivoterande rörelser, situationer med ökad belastning på det skadade knäet och gång på halt/ojämnt underlag var de vanligast förekommande befarade situationer och rörelser hos deltagarna. Signifikanta korrelationer påvisades mellan TSK och KAAI_TOTAL poäng (rho = 0.728; p = 0.007), ACL-RSI och KAAI_TOTAL poäng(rho = -0.755; p = 0.003) samt ACL-RSI och TSK poäng (rho= -0.828; p&lt; 0.001). Slutsats: Denna studie visar att ett större antal befarade situationer och rörelser kan associeras till högre nivåer av rörelserädsla hos personer med främre korsbandsskada. Högre tilltro till sin egen förmåga och större beredskap att återgå till idrott kan associeras med färre befarade situationer och rörelser. Exempel på dessa är pivoterande rörelser och gång på halt underlag. Kunskap om detta kan underlätta rehabilitering inom detta område.

ABSTRACT This thesis investigates a range of everyday interactions of traumatic brain injury (TBI) subjects when compared with control subjects to examine whether there are differences in the overall structure of interactions, in the way information is exchanged and in the wording which is used. Analyses from systemic functional linguistics including generic structure potential analysis, exchange structure analysis and analysis of politeness markers were used to examine the interactional impairments reported to follow TBI. Results indicated that TBI subjects differed from controls in their use of interpersonal language resources. These differences were exaggerated when subjects were interacting with someone in authority. When placed in a more powerful role, TBI subjects were able to utilise language resources to a similar extent to controls across the three levels of analysis. This thesis has important implications for the assessment and management of interactional communication impairments which may follow TBI, including suggestions for therapy with the person with TBI and for communication partners of people with TBI including therapists, family members and the community.

Thesis (M.A.) -- University of Maryland, College Park, 2008.<br>Thesis research directed by: Dept. of Criminology and Criminal Justice. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.

Rapporten innehåller analysen av 26 olika situationer inom ishockey. Situationerna är hårda tacklingar från olika matchar och ligor. Analyserade tacklingar resulterade INTE i hjärnskakning, likadana situationer kan ge upphov till hjärnskakning. Målet med projektet är bland annat skapa en kontrollgrupp för studierna i hjärnskakning inom ishockey. Tidigare studier utfördes för situationer som resulterar i hjärnskakningar. Rapporten pekar kort på huvudet och nackens anatomi d.v.s. skalp, hjärnan och skallben. Begreppet hjärnskakning med dess symptom förklarades också. I valda video sekvenserna analyserades huvudets kinematik och kollisionssekvenser mellan huvud och den andra parten som kan vara en annans axel, huvud, arm eller is eller glasvägg(plexiglas). Resultatet ska komma överens med tidigare gjorda arbete.<br>The report includes analysis of 15 different situations in Ice-hockey. The situations are hard tackles from different matches and leagues. The analyzed tackles did Not resulted to concussion, but similar situations can be concussions. The goal of the project includes creating a control group for the studies of concussions in ice-hockey. Previous or parallel studies have been down to situations that result to concussions. The report indicates short to head and neck anatomy that is scalp, brain and skull. The concept of concussion with its symptoms explained in this report. The selected video sequences were analyzed head kinematics and collision sequences between the head and the other part that may be another person's shoulder, head, arm or ice or glass wall. When the video sequences were analyzed attempted to controll the head speed, head acceleration and the tackles angle. The results should agree with previous works.

L’objectif principal de ce travail était d’évaluer les situations à risque de TMS chez les utilisateurs de fauteuil roulant manuel (FRM). Pour cela un indice d’inconfort articulaire biomécanique basé sur une cotation par logique floue a été créé. Il fut ensuite utilisé dans trois situations d’usage courant du FRM : propulsion, transfert et franchissement. L’objectif secondaire de ce travail était d’identifier les articulations les plus délétères au sein de chaque activité. L’étude 1 a permis de mettre en évidence que l’Inconfort Articulaire est moyen lors de la propulsion sur sol plat et augmente avec la pente. L’étude 2 souligne que la stratégie de positionnement du tronc lors d’un transfert par pivot n’influence pas le niveau de risque déjà important du transfert mais que le niveau d’inconfort varie entre les deux bras. Enfin la troisième étude a permis de mettre en évidence un niveau de risque plus important au cours du franchissement d’obstacle que lors de la propulsion. La montée des roues arrière étant la phase la plus exigeante. L’analyse des activités de la vie quotidienne a pour objectif d’évaluer les AVQ les plus délétères pour les utilisateurs de FRM afin « d’orienter » l’utilisation du FRM pour préserver leurs MS en limitant les activités les plus à risques. L’Indice d’Inconfort Articulaire focal de chaque activité a permis de mettre en évidence les articulations les plus à risques au cours de chaque activité : le poignet et l’épaule. La prévalence importante des TMS chez les utilisateurs de FRM et la survenue possible tout au long de leur vie nécessite la mise en place d’un suivi avec pour objectif premier de prévenir l’apparition des TMS<br>The main objective of this work was to evaluate MD risk situations in manual wheelchair users (MWU). To do a biomechanical joint discomfort index based on a fuzzy quote was created. It was then used in three common use cases of MWU: propulsion, transfer and curb ascent. The secondary objective of this study was to identify the most deleterious joints within each activity.The study 1 helped highlight the discomfort Articular is medium during propulsion on level ground and increases with the slope. The study 2 emphasizes that the positioning strategy of the trunk during a pivot transfer does not affect the already high level of risk transfer but the level of discomfort varies between the two arms. Finally, the third study to show a higher level of risk in the curb ascent that during propulsion. The rise of the rear wheels is the most demanding phase.Analysis of the daily activities (DA) aims to assess the most deleterious DA for MWU in order to "guide" the MW use to preserve their UL by limiting the most risky activities. The focused articular discomfort index of each activity helped to highlight the most at-risk joints in each activity: the wrist and shoulder. The high prevalence of MDs among MWU and possible occurrence throughout their lifetime requires the establishment of a monitoring with the primary objective to prevent the development of MDs. We observed in these studies that the level of risk varies from one skill to another as well as joint stress. However, to be complete analysis of the risk level should be taking into account environmental aspects

碩士<br>中華醫事科技大學<br>職業安全衛生系暨碩士班<br>107<br>In recent years, environmental health has become more and more important, and the cleaning industry has flourished. The cleaning industry service has provided professional and high-quality service with the introduction of corporate management concepts. However, most of the cleaning personnel are middle and high age groups, and their work is repetitive. Heavy-strength and unnatural posture types are prone to musculoskeletal discomfort, so the clean industry is a high-risk group of musculoskeletal discomfort, and the proportion of musculoskeletal discomfort in domestic occupational disease notification cases has increased in recent years. This phenomenon not only causes labor to be unable to work due to musculoskeletal discomfort or affects work efficiency, but also causes productivity to decrease and social costs to increase. Therefore, this study explores the health hazards and causes of musculoskeletal discomfort in cleaning personnel and seeks ways to improve. This study is aimed at the basic medical information and discomfort investigation of the employees of a company cleaning company. The content structure of the questionnaire includes: (1) basic personal data , (2) whether it has caused injury due to work, (3) investigation of symptoms in various parts, (4) other, parts of skeletal muscle discomfort Explore it. The NMQ Nordic Skeletal Muscle Injury Questionnaire was used to find out the correlation between the symptoms of skeletal muscle discomfort in the cleansing staff and to investigate the conscious discomfort. And propose improved tools and design workflow for follow-up. The questionnaire was based on a paper questionnaire. The subjects were divided into an experimental group (with 19 use improvement tools) and a control group (23 without improvement tools), and the same questionnaire was administered to the same group three months later. A total of 42 employees and 84 questionnaires. The recovery questionnaire will collect the data separately. After the database is established, it will be imported into the statistical analysis software SPSS 21.0. The data analysis method uses descriptive statistics to understand the distribution of each disguised state of the subject. Inferential statistics were analyzed by Chi-Square to examine the differences and correlations between skeletal muscle injury symptoms and variables. The sample of this study averaged 50.4 years old and had a 6.03 qualification in cleaning work. The average height was 171.1 cm and the average weight was 73.85 kg. There were 26 people who felt unwell because of work relationship. Labor musculoskeletal injury, according to the neck, left shoulder, left elbow, left wrist, left thigh, left knee, left ankle, upper back, lower back, right shoulder, right elbow, right wrist, right thigh, right knee, right ankle, etc. The chi-square test for the influence of "whether it feels musculoskeletal discomfort" shows 8 variables such as neck, upper back, lower back, right shoulder, right elbow, right wrist, right thigh, right knee and whether or not to feel musculoskeletal discomfort. Related. According to the improved cleansing personnel, according to the post-improvement discomfort questionnaire, the number of significant items in the chi-square test was found to be significantly improved, and the degree of discomfort was also significantly reduced, which proved that the replacement of the working tools can significantly improve the musculoskeletal injuries of the employees. This study explores whether employees' skeletal muscles are harmed and their severity, and tools to improve the level of employee bone damage. Most of the cleaning staff are middle and high age groups. The high repeatability of work is easy to cause discomfort to the musculoskeletal, and the age and the musculoskeletal injury gradually appear. Therefore, the prevention of musculoskeletal injuries is more important. For such questions, here are the suggestions: 1. Provide more cleaning machines for employees, such as sweeping cars, mopping cars, waxing cars, etc. 2. Have systematic planning of labor work. Don't always do the same work by the same person. It will be changed once in a while. For example, the person who was responsible for cleaning the floor will exchange with the person who cleans the glass after a period of time. Wear of the same part. Keywords: Skeletal muscles, cleaning company, questionnaire, Nordic skeletal muscle injury questionnaire, repeatability

Celem mojej pracy badawczej jest ukazanie zmian w rozwoju osobowym kobiet wskutek doznania niepełnosprawności ruchowej jako sytuacji granicznej oraz określenie czy i w jakim zakresie sytuacja ta jest czynnikiem dynamizującym ich rozwój osobowy, czy wręcz przeciwnie powodującym wystąpienie w nim różnego rodzaju nieprawidłowości. Badaniami objęto grupę 40 kobiet dobranych w sposób celowy. Wszystkie badane kobiety doznały nagłej utraty sprawności, poruszają się przy pomocy wózka inwalidzkiego, doznanie niepełnosprawności pojawiło się po 17 roku życia, a czas trwania niepełnosprawności przekracza 2 lata. W badaniu zastosowano pięć metod badawczych, z czego dwie metody: Historia życia McAdamsa, wywiad "Ja i moja niepełnosprawność" - własnego autorstwa, to metody biograficzne, natomiast pozostałe trzy: Skala Badania Obrazu Własnej Osoby (Skala Samooceny) W. H. Fitts'a, Skala Postaw Wobec Choroby - M. Wandrasza, Skala Wartości Schelerowskich - SWS - P. Brzozowskiego, - to metody kwestionariuszowe. Wyniki wskazują, że większość niepełnosprawnych kobiet poradziła sobie z sytuacją graniczną, jaką jest nagłe doznanie niepełnosprawności i powróciła na drogę rozwoju osobowego. Jednak dynamika rozwoju, a więc jego tempo, harmonijność, spójność oraz ciągłość, była różna dla wielu kobiet. Dzięki przeprowadzonej analizie skupień udało się wyłonić trzy grupy badawcze, które charakteryzowały się zbliżonym dynamizmem rozwoju osobowego. Dwie grupy badanych kobiet ropoczęły drogę rozwoju osobowego, natomiast jedna grupa nadal znadowała się w strefie utraconego rozwoju.<br>The aim of my paper is to present changes in personal development of women who sustained physical disability as a border situation, as well as to determine whether and in what scope their situation prompts their personal development, or whether it has quite opposite effect that causes various abnormalities. Research has been conducted in a group of forty women that meet certain criteria. All the women experienced a sudden loss of physical ability which took place no sooner than after they finished 17 years old, they move with the usage of wheelchairs, and they have been disabled for at least 2 years. In the research, five methods have been applied, two of them being biographical methods: Historia życia McAdamsa, and an interview Ja i moja niepełnosprawność of my own authorship; whereas Skala Badania Obrazu Własnej Osoby (Skala Samooceny) by W. H. Fitts, Skala Postaw Wobec Choroby by M. Wandrasz, and Skala Wartości Schelerowskich by P. Brzozowski are surveys. As the research indicates, the majority of disabled women handled the border situation caused by sudden loss of physical ability well, and they continued their personal development. However, the tempo, harmoniousness, cohesion, and continuity of development were different for each of the women. By conducting a cluster analysis, three study groups that displayed similar level of personal development were determined. Two groups began their physical development, whereas one group found itself in stagnation.

Introduction et recension des écrits : Récemment, les suicides de vétérans et d’athlètes professionnels ont attiré l’attention sur l’association entre le TCC et le suicide. Les lignes directrices concernant la prise en charge en santé mentale dans cette population demeurent fragmentaires. Les objectifs de cette thèse sont de 1) déterminer si une association existe entre le TCC subi dans l’enfance et le suicide futur, 2) explorer si les personnes qui se sont suicidées ont consulté un psychiatre dans l’année précédant le suicide et évaluer si cela diffère selon que la personne ait eu un TCC ou non, 3) décrire et qualifier l’offre québécoise de santé mentale offerte en réadaptation aux enfants et aux adultes ayant subi un TCC. Méthodologie : Le volet épidémiologique consiste en une étude de cohorte rétrospective sur un échantillon de 135 703 enfants ayant reçu des services médicaux au Québec en 1987 et suivis jusqu’en 2008. Le volet qualitatif comprend un sondage auprès des gestionnaires des programmes de réadaptation TCC du Québec, des groupes de discussion avec des cliniciens et des entrevues avec des survivants de TCC et leurs proches. Résultats : Notre étude épidémiologique confirme une association significative entre le TCC subi dans l’enfance (HR 1,49 IC95% 1,04- 2,14), dans l’adolescence (HR 1,57, IC 95% 1,09-2,26) et à l’âge adulte (HR 2,53, IC95% 1,79-3,59) et le suicide. Malgré un risque de suicide plus élevé, les personnes avec un TCC et qui se sont suicidées n’ont pas consulté de psychiatre plus fréquemment que les personnes sans TCC (OR 1,29, IC 95% 0,75- 2,24). Par ailleurs, notre étude qualitative révèle que les forces du système actuel incluent une bonne qualité des services, mais qu’il existe des faiblesses au niveau de l’accès aux médecins spécialisés, du dépistage systématique et de l’accès aux services à long terme. Nos recommandations incluent le développement d’une approche coordonnée en santé mentale, l’implication automatique d’un gestionnaire de cas et l’amélioration des mécanismes d’accès après le congé.<br>Introduction and Literature Review: Recent suicides of veterans and professional athletes have signalled a possible association between traumatic brain injury (TBI) and suicide. Guidelines for management of mental health and suicide prevention in this population remain fragmentary. The objectives of this thesis are to 1) determine whether there is an association between childhood TBI and future suicide, 2) explore whether persons who committed suicide consulted with a psychiatrist in the year prior to suicide and if persons with a TBI consulted more than those without a TBI 3) describe mental healthcare provided in rehabilitation in Quebec to children and adults TBI survivors. Methodology: The epidemiological component consists of a retrospective cohort study of 135,703 children receiving medical services in Quebec in 1987 and followed until 2008. The qualitative component includes a survey of managers of Quebec TBI rehabilitation programs, as well as focus groups with clinicians and interviews with TBI survivors and their caregivers. Results: Our epidemiological study confirms a significant association between TBI suffered in childhood (HR 1.49, 95% CI 1.04, 2.14) in adolescence (HR 1.57, 95% CI 1.09, 2.26) and in adulthood (HR 2.53, 95% CI 1.79, 3.59) and suicide. Despite a higher risk of suicide, people with a TBI who committed suicide did not consult a psychiatrist more often than people without TBI (OR 1.29, 95% CI 0.75- 2.24). According to our qualitative findings, current strengths include good quality of services, but there are weaknesses in access to specialized physicians, routine screening and access to long-term services. Our recommendations include the development of a coordinated approach to mental health, automatic involvement of a case manager and improvement of access to follow-up services after discharge. Conclusion: The risk of suicide is increased in young persons with TBI compared to those without. Well-coordinated and long-term monitoring should be promoted.

Thesis (Ph. D.)--Michigan State University, 2004.<br>Includes bibliographical references (leaves 262-269). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.