RESUMO
BACKGROUND: Impairment of myocardial flow reserve (MFR) in aortic stenosis (AS) with normal left ventricular function relates to the haemodynamic severity. OBJECTIVES: To investigate whether myocardial blood flow (MBF) and MFR differ in low-flow, low-gradient AS depending on whether there is underlying true-severe AS (TSAS) or pseudo-severe AS (PSAS). METHODS: In 36 patients with low-flow, low-gradient AS, dynamic [13N]ammonia PET perfusion imaging was performed at rest (n = 36) and during dipyridamole stress (n = 20) to quantify MBF and MFR. Dobutamine echocardiography was used to classify patients as TSAS (n = 18) or PSAS (n = 18) based on the indexed projected effective orifice area (EOA) at a normal flow rate of 250 ml/s (EOAI(proj )
Assuntos
Estenose da Valva Aórtica/diagnóstico , Circulação Coronária/fisiologia , Adulto , Idoso , Estenose da Valva Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Estudos de Casos e Controles , Ecocardiografia sob Estresse , Feminino , Humanos , Masculino , Tomografia por Emissão de Pósitrons , Adulto JovemAssuntos
Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Terapia Trombolítica , Tomografia Computadorizada de Emissão , Idoso , Circulação Coronária , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Radioisótopos de Rubídio , Resultado do TratamentoRESUMO
The Family Project Approach (FPA) has been developed as an alternative to the placement of conduct-disordered adolescents into care. Since 1987, the target group of this project has been extended to include maltreated children and to parents who are in despair because of persistent child behaviour problems and other stressors. This article gives an overview of this home-based approach and the most important research results. One main starting point for FPA is that parents should be supported so that they can fulfil their child-rearing responsibilities. In families where the children are neglected or maltreated and in families where the parents feel desperate and powerless, the fundamental attitude of the FPA worker plays a decisive role. Process-outcome research corroborates the importance of encouraging and validating the parents' positive qualities and expertise.
Assuntos
Maus-Tratos Infantis/terapia , Transtornos do Comportamento Infantil/terapia , Terapia Familiar/métodos , Serviços de Assistência Domiciliar , Relações Pais-Filho , Adolescente , Transtorno da Personalidade Antissocial/psicologia , Transtorno da Personalidade Antissocial/terapia , Criança , Maus-Tratos Infantis/psicologia , Transtornos do Comportamento Infantil/psicologia , Terapia Combinada , Feminino , Humanos , Delinquência Juvenil/prevenção & controle , Delinquência Juvenil/psicologia , Masculino , Poder Familiar/psicologia , SocializaçãoRESUMO
At the current stage of development in the family therapy field, exploratory, small-scale process studies are necessary in order to understand through what interpersonal processes child and family change occur. The goal of this article is to show how relevant therapist-parent interactions within family-based approaches can be explored and linked to the reduction in childrearing and behavior problems. Sequential analyses on 13 treatments using the Family Project Approach revealed that, within the most successful treatments, therapist and parent interact in a collaborative way in the phase of Direct Influence. In the beginning of this treatment phase, the therapist must activate the parents to tackle the problems actively. Further explorations indicated that a collaborative interaction pattern between therapist and mother during the first three sessions of therapy contributes to a better outcome.