This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough. GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection. In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions. / On the day of the public defence the status of the articles IV and V was: Accepted.

Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM). Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II & III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

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No. of bitstreams: 1 luvizutto_gj_dr_bot.pdf: 2479589 bytes, checksum: 29a51ed15da908051b8667068b430e40 (MD5) Previous issue date: 2016-06-16 / Não recebi financiamento / Introdução: A negligência espacial unilateral (NEU) é caracterizada pela incapacidade de reportar ou responder pessoas ou objetos do lado contralateral à lesão cerebral, e ocorre principalmente após Acidente Vascular Cerebral (AVC) do lobo parietal direito, sendo associada à pior desfecho funcional à longo prazo. Objetivo: Os objetivos desta tese foram: normatizar os principais testes diagnósticos de NEU e verificar a relação com fatores sócio-demográficos na população brasileira; avaliar as variáveis bioquímicas que interferem na NEU na fase aguda do AVC; e revisar sistematicamente os principais tratamentos farmacológicos na NEU em pacientes após AVC. Método: Para o primeiro objetivo foi realizado estudo transversal em 150 indivíduos sem alterações neurológicas, sendo aplicados: teste face-mão (TFM), testes de cancelamento de linhas (TCL), cancelamento de estrelas (TCE) e bisseção de linhas (TBL). Os resultados dos testes foram relacionados com o perfil sócio demográfico da população, sendo estipulado pontos de cortes para a normalidade; para o objetivo 2 foi realizado estudo observacional em 40 indivíduos com diagnostico de NEU após AVC. Foram aplicados os TCL, TCE e TBL, sendo relacionado com o nível de hemoglobina na fase aguda do AVC corrigido para potenciais confundidores; para o objetivo 3 foi realizado revisão sistemática de literatura por meio de ensaios clínicos randomizados e quasi-randomizados para determinar o melhor tratamento farmacológico. Resultados: os resultados do objetivo 1 estão apresentados nos artigos 1 e 2; o objetivo 2 no artigo 3; e o objetivo 3 no artigo 4. Conclusão: Com base nos resultados obtidos dos artigos 1 e 2, o TFM apresenta taxa de normalidade entre 8 a 10 estímulos sensoriais, com prevalência de extinção associada com o grau de escolaridade e aumento da idade; no TCL o ponto de corte para considerar NEU é acima de 0 e no TCE acima de 2, ambos associados à idade. No TBL o ponto médio de corte para considerar NEU foi de 6,6 mm, associado com pior escolaridade. No artigo 3 foi observado que quanto menor o valor de hemoglobina na fase aguda do AVC, pior o desempenho nos testes de NEU; No artigo 4 foi observado que a efetividade e segurança dos tratamentos farmacológicos para NEU após AVC permanecem incertos, necessitando de ensaios clínicos randomizados adicionais para avaliar o efeito deste tratamento. / Background: Unilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects presented on the side contralateral to the lesioned side of the brain and has been associated with poor functional outcomes. Objective: The objectives of this thesis were: to standardize the USN tests and verify the relationship with socio-demographic data in the Brazilian population; evaluate the biochemical variables that influence in USN tests after acute stroke; and systematically review the pharmacological interventions to treat USN after stroke. Method: For the first aim, we performed a cross-sectional study of 150 individuals without neurological changes by applying: face-hand test (FHT), line cancellation test (LCT), star cancellation test (SCT) and line bisection test (LBT). The test results were related to the sociodemographic data, with cutoff points being stipulated to define USN; the second aim was achieved by conducting an observational study of 40 individuals with USN after acute stroke. The tests applied – LCT, SCT and LBT – were correlated with the hemoglobin level in the acute phase of stroke corrected by confounders; the third aim was analyzed by a systematic review of randomized controlled trials and quasi-randomized clinical trials to determine the efficacy of pharmacological intervention. Results: The first aim is presented in Articles 1 and 2, the second aim in Article 3 and the third in Article 4. Conclusion: Based on the results of Articles 1 and 2, the FHT shows normal rate between 8-10 sensory stimuli, with an extinction prevalence associated with the education level and increasing age; The LCT cutoff point to define is USN above 0 and SCT above 2, and both were associated with age. The LBT cutoff point to indicate NEU was 6.6 mm, associated with poorer education level. Article 3 reveals the relationship between a lower hemoglobin level in acute phase of stroke with worse performance on USN tests; Article 4 reports that the effectiveness and safety of pharmacological treatments for USN after stroke remain uncertain, requiring additional randomized clinical trials to evaluate the effect of treatment.

Orientador: Luiz Antônio de Lima Resende / Resumo: Introdução: A negligência espacial unilateral (NEU) é caracterizada pela incapacidade de reportar ou responder pessoas ou objetos do lado contralateral à lesão cerebral, e ocorre principalmente após Acidente Vascular Cerebral (AVC) do lobo parietal direito, sendo associada à pior desfecho funcional à longo prazo. Objetivo: Os objetivos desta tese foram: normatizar os principais testes diagnósticos de NEU e verificar a relação com fatores sócio-demográficos na população brasileira; avaliar as variáveis bioquímicas que interferem na NEU na fase aguda do AVC; e revisar sistematicamente os principais tratamentos farmacológicos na NEU em pacientes após AVC. Método: Para o primeiro objetivo foi realizado estudo transversal em 150 indivíduos sem alterações neurológicas, sendo aplicados: teste face-mão (TFM), testes de cancelamento de linhas (TCL), cancelamento de estrelas (TCE) e bisseção de linhas (TBL). Os resultados dos testes foram relacionados com o perfil sócio demográfico da população, sendo estipulado pontos de cortes para a normalidade; para o objetivo 2 foi realizado estudo observacional em 40 indivíduos com diagnostico de NEU após AVC. Foram aplicados os TCL, TCE e TBL, sendo relacionado com o nível de hemoglobina na fase aguda do AVC corrigido para potenciais confundidores; para o objetivo 3 foi realizado revisão sistemática de literatura por meio de ensaios clínicos randomizados e quasi-randomizados para determinar o melhor tratamento farmacológico. Resultados: os resul... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

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No. of bitstreams: 1 delianevileladeoliveira.pdf: 2301067 bytes, checksum: f01e829116b34f9daf190e8d706de303 (MD5) Previous issue date: 2013-07-11 / Resumo: Pesquisa quantiqualitativa cuja trajetória metodológica visou analisar as representações sociais da punção venosa entre indivíduos adultos que vivenciaram a experiência com o processo de punção de vasos periféricos. Adotou-se múltiplos métodos e técnicas. Na abordagem quantitativa foi realizado um survey e no delineamento qualitativo foram utilizadas entrevistas individuais com aplicação das técnicas de “recorte e colagem de gibi” e “evocação livre”. A aplicação destas técnicas visou captar as variáveis intervenientes sobre o processo de punção de vasos periféricos e subsidiar a identificação dos elementos e caracterizar a relevância da representação social sobre tal processo. Dados obtidos no período de outubro/2012 a fevereiro/2013, por meio de entrevistas individuais gravadas e registro cursivo em diário de campo, realizados numa instituição hospitalar (setor de internação convencional) e num serviço de terapia renal substitutiva. Amostra de seleção completa. Após a aplicação dos critérios de elegibilidade e exclusão, foram realizadas 365 abordagens de coleta de dados, tendo participado 235 pessoas na fase do survey, das quais 120 estavam internadas, 75 estavam em hemodiálise e 40 coletaram sangue. Houve abordagem individualizada do questionário com auxílio para preenchimento. Técnica de evocação aplicada a partir de entrevista com participação de 90 pessoas, sendo 30 delas internadas, em coleta de sangue ou em tratamento hemodialítico. Foram obtidas 444 palavras/expressões evocadas para cinco das solicitadas. Na aplicação da técnica de “recorte e colagem de gibi” e gravação do discurso explicativo participaram 60 pessoas, sendo 20 em cada situação abordada. Foi oferecido o mesmo material de figuras para os participantes desta etapa. Um mesmo participante integrou uma ou mais técnicas. Os dados do survey foram tratados em software Statistical Package for the Social Sciences (SPSS) versão 20 com análise descritiva. Os dados provenientes da evocação formaram o corpus, sendo consolidados no software EVOC versão 2000 com análise pela técnica do quadro de quatro casas. E os conteúdos obtidos pela técnica de recorte e colagem de gibi foram consolidados no software NVivo versão 10 e analisados segundo similitude de expressões. Todas as informações foram abordadas com padrões de anonimato, utilizando nomes de flores, pedras ou cores. Foram atendidos todos os requisitos éticos e legais de pesquisa envolvendo seres humanos. No perfil dos participantes da fase survey predominou a participação de mulheres na coleta de sangue e de homens internados ou em tratamento hemodialítico; com idade mais nova entre mulheres que coletavam sangue; predomínio de pele declarada como branca (40%), menos de nove anos de escolaridade (65%), união estável (55%) e filhos. Sendo o processo de punção de vasos um procedimento técnico/científico, os usuários, porém, se apropriam do mesmo de forma particular, havendo destaque de algumas etapas em detrimento de outras. Foi possível identificar as variáveis intervenientes (exposição às diferentes situações e ocasiões de ocorrência do processo de punção de vasos) comparando-as com as variáveis de desfecho, ou seja, com os sentimentos, percepções e comportamentos dos participantes diante do processo de punção de vasos sanguíneos. Houve modificação de percepções, de sentimentos e de comportamentos ao longo das etapas do processo de punção dos vasos. No período que antecedeu a introdução da agulha no interior do vaso houve predomínio de sentimentos de medo, desconforto, ansiedade, indiferença e normalidade e foram adotados comportamentos de silêncio, colaboração, normalidade e de "acostumado", embora xx acompanhados pelo nervosismo das pessoas que fizeram hemodiálise. O período de introdução da agulha foi vivenciado com sentimentos de dor e desconforto e comportamentos de colaboração, silêncio e nervosismo, com ocasional desvio do olhar para não acompanhar o procedimento técnico realizado. Manter a agulha no interior do vaso gerou predomínio de sentimentos de limitação de movimento e desconforto quando o período foi prolongado e houve comportamento de colaboração. O sentimento de alívio e a sensação de ardência foram aqueles que predominantemente emergiram por ocasião da remoção do cateter do interior do vaso e os participantes mencionaram adotar comportamentos de colaboração e de indiferença frente à remoção. No período pós-remoção predominaram os sentimentos de indiferença, alívio, normalidade e nada e comportamentos de silêncio e colaboração, caracterizando a não percepção deste momento como uma etapa do processo, exceção feita às pessoas que realizaram hemodiálise. Os resultados evidenciaram que a estrutura das representações sociais do processo de punção de vasos foi composta pelos elementos centrais de dor e medo. Como elementos periféricos apareceram a insegurança, quem punciona, habilidade profissional, resultado, repuncionar e sangrar, configurando uma abordagem negativa ou neutra expressa em diferentes situações de punções que se apoiaram em experiências, informações, julgamento de valores, concepção de sua finalidade e percepção sensorial, o que foi reafirmado pela técnica de recorte e colagem. Captar as representações sociais através dos sentimentos e comportamentos, bem como, conhecimentos, valores e experiências das pessoas que possuem seus vasos puncionados para fins de coleta de sangue, terapêutica farmacológica ou hemodialítica durante o processo de punção possibilitou fazer uma releitura da punção de vasos. Enquanto atividade processual, evidenciaram-se demandas de cuidado para as quais o enfermeiro dispõe de oportunidades para imprimir ao cuidado orientações educacionais, ações terapêuticas e gerenciais e captar/utilizar evidências a partir da investigação. Foram caracterizadas respostas dos indivíduos para as quais o enfermeiro é capaz de minimizar sentimentos e comportamentos negativos e favorecer formas positivas de enfrentamento. Ao propor-se uma abordagem quantiqualitativa, utilizando múltiplos métodos e técnicas a partir de um recorte conceitual e metodológico, a presente investigação mostrou-se enriquecedora e criativa e trouxe como limite a não comparação entre os participantes enquanto grupos que possuem vivências peculiares no processo de punção de vasos sanguíneos. / Abstract: Quanti-qualitative research whose methodological route intended to analyze the social representations of venipuncture among adults who have experienced the peripheral vessels puncture. Multiple methods and techniques were adopted. During the quantitative approach a survey research was conducted, while in the qualitative approach individual interviews were taken, applying the techniques of "cutting and pasting of comics" and "free recall". The application of these techniques aimed to capture intervening variables on the process of puncturing peripheral vessels and support the identification of elements and characterize the relevance of the social representation of this process. Data obtained from October 2012 to February 2013 through individually recorded interviews and field diary, both conducted in a hospital (regular hospitalization area) and in a program of renal replacement therapy. Sample selection complete. After applying the eligibility and exclusion criteria, there were 365 approaches for data collection, 235 people participated in the phase of the survey, of whom 120 were hospitalized, 75 were on hemodialysis and 40 collected blood samples. There was individualized approach and help to fill the questionnaire. Evocation technique applied in the interviews, with participation of 90 people, 30 of them hospitalized for blood collection or hemodialysis. With the inductive term appointed (process of vessel puncture). We obtained 444 words/expressions evoked to five of the requested. In applying the technique of "cutting and pasting of comics" and recording the explanatory discourse 60 people participated, 20 in each situation addressed. The same comics were shown to the participants of this step. A participant joined one or more techniques. For the treatment of the survey data, with descriptive analysis, was used the Statistical Package for Social Sciences (SPSS) version 20. Evocation data formed the corpus, consolidated in EVOC 2000 version, and were analyzed through the fourhouse board technique. The contents obtained by the technique of cutting and pasting the comics were consolidated into NVivo software version 10 and analyzed according to similarity of expressions. All information has been addressed with patterns of anonymity, using names of flowers, stones or colors. We met all ethical and legal requirements for research involving humans. In the survey phase participants profile predominated the participation of women in blood sample collection and men hospitalized or undergoing hemodialysis, with younger age among women who collected blood; predominance of skin declared as white (40%), less than nine years of education (65%), marital stability (55%) and children. As the process of vessel puncture is a technical/scientific procedure, users, however, interpret it in a particular way, featuring some steps over others. It was possible to identify the intervening variables (exposure to different situations and times of occurrence of vessels puncture processes) compared with the outcome variables, i.e., the feelings, perceptions and behaviors of the participants before the process of puncturing blood vessels. There was a modification of perceptions, feelings and behaviors throughout the stages of the process of vessels puncturing. In the period preceding the introduction of the needle inside the vessel there was a predominance of feelings of fear, discomfort, anxiety, indifference and normality and behaviors of xxii silence, collaboration, normality and "being used to" were adopted, although accompanied by the nervousness of those people in hemodialysis. The length of the needle insertion was experienced with feelings of pain and discomfort and behaviors of collaboration, silence and nervousness, with occasional gaze deviation, not to follow the technical procedure performed. Maintaining the needle in the vessel predominantly generated feelings of limitation of movement and discomfort when the period was extended. There was also the behavior of collaboration. The feeling of relief and burning sensation were predominantly those who emerged during the removal of the catheter inside the vessel and the participants mentioned to adopt behaviors of collaboration and indifference to the removal. In the post-removal time predominated feelings of indifference, relief, normality and nothing and behaviors of silence and collaboration, showing the non-perception of this moment as a step of the process, except to people who underwent hemodialysis. The results showed that the structure of social representations of vessel puncture was composed by the central elements of pain and fear. The peripheral elements appeared insecurity, who punctures, professional skill, result, repuncturing and bleed, setting a neutral or negative approach expressed in different puncture situations that relied on experience, information, value judgment, conception of its purpose and sensory perception, what was reaffirmed by the technique of cutting and pasting. To capture the social representations through the feelings and behaviors, as well as knowledge, values, experiences of people own their vessels punctured for the purpose of blood collection, drug therapy or hemodialysis during puncture, allowed to reread the puncture of vessels. While a procedural activity, care demands showed up for which the nurse has opportunities to print educational guidelines, therapeutic and management actions and to capture/use evidences from the investigation. Answers of individuals were characterized for which the nurse is able to minimize negative feelings and behaviors and to encourage positive ways of coping. In proposing a quanti-qualitative approach, using multiple methods and techniques from a conceptual and methodological framework, this research proved to be enriching and creative and brought as its limitation the not comparison of the participants while groups that have peculiar experiences in the process of blood vessels puncturing.

The diagnosis of Parkinson’s disease (PD) follows the UK Brain Bank Criteria, which demands bradykinesia and one additional symptom, i.e. rigidity, resting tremor or postural instability. The latter is not a useful sign for the early diagnosis of PD, because it does not appear before Hoehn and Yahr stage 3. Early symptoms of PD which precede the onset of motor symptoms are hyposmia, REM sleep behavioral disorder, constipation, and depression. In addition, an increasing number of patients whose PD is related to a genetic defect are being described. Thus, genetic testing may eventually develop into a tool to identify at-risk patients. The clinical diagnosis of PD can be supported by levodopa or apomorphine tests. Imaging studies such as cranial CT or MRI are helpful to distinguish idiopathic PD from atypical or secondary PD. SPECT and PET methods are valuable to distinguish PD tremor from essential tremor if this is clinically not possible. Using all of these methods, we may soon be able to make a premotor diagnosis of PD, which will raise the question whether early treatment is possible and ethically and clinically advisable. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Nowadays there is no unified method of prevention and correction of flat feet both in children in general, as well as in young athletes. The study was focused on development and justification of rehabilitation program of flat feet in young athletes of various specializations. Based on analyzed data, we formulated actuality of the above mentioned problem, studied anatomy of foot and described pathogenesis of foot deformation. 22 young athletes aged 5-6 years were recruited for the study. Questionnaire, planthography and analysis for vertical jumps with the use of force plate were applied. We developed rehabilitation program for young athletes with flat feet with the use of rough surfaces. Effectiveness of the proposed rehabilitation was confirmed during the experimental study. Guidelines and recommendations for trainers and physical therapists were developed for inclusion of this program into training process. / На сегодняшний день одной из важных проблем является отсутствие единой методики по профилактике и коррекции плоскостопия как среди детей, так и юных спортсменов. Цель исследования – разработать и обосновать программу реабилитации плоскостопия у юных спортсменов различной спортивной специализации. На основе проанализированных данных научной литературы была сформулирована актуальность проблемы, изучена анатомия стопы, описаны причины и механизм возникновения деформации. Исследование проводилось среди 22 спортсменов различной специализации в возрасте 5-6 лет с помощью опроса, плантографии и тензоплатформы. В результате исследования была разработана программа реабилитации при плоскостопии у юных спортсменов с использованием неровных поверхностей, проведен эксперимент. По результатам работы была выявлена эффективность программы реабилитации при плоскостопии. Были разработаны методические рекомендации для тренеров и специалистов в данной области по включению предлагаемой программы реабилитации в учебно-тренировочный процесс.

<p dir="ltr"><a href="" target="_blank">Almost every case of cervical cancer in the United States is medically preventable with vaccination and proper screening, yet many Americans are insufficiently screened. Over 12 thousand American women suffered from cervical cancer in 2018</a>¹ causing 4 thousand deaths, with over a third in women who had never received a routine screening test².</p><p dir="ltr">New, sensitive testing techniques for cervical cancer screening are facilitating HPV testing without evaluating the cells collected in the sample by eye. This opens the door to new, accessible methods of screening such as rapid testing in clinic and at home, self-sampling, and mail-in testing. As cervical cancer morbidity and mortality is largely a result of healthcare inequities, these methods may have a significant impact on cervical cancer outcomes.</p><p dir="ltr">The goal of this project is to create a proof-of-concept, sample-to-answer rapid test to be used for cervical cancer screening in Indiana outpatient clinics. We began the project by conducting interviews and a survey to explore Indiana clinician perspectives on cervical screening methods such as self-sampling, rapid testing, and home-based screening. Clinicians preferred in-clinic testing with same-visit results, in the hopes that face-to-face explanation of results and scheduling follow-up care in person would improve patient retention for these important follow-up tests. To create such a test, we augmented an isothermal nucleic acid amplification method that copies 13 of the 14 high-risk human papillomavirus (hrHPV) types with an endogenous b-globin sample control and a simple colorimetric lateral flow strip (LFS) readout. When tested with HPV 16 the assay achieved a limit of detection of 1000 HPV copies per reaction, which would detect endocervical samples deemed ‘sufficient’ by clinical guidelines. It also performs in endocervical cells using methods and equipment that could be implemented in an outpatient clinic. The final test accepts swabs or brushes of endocervical cells, lyses them in 5 minutes, copies the target DNA and a sample adequacy control, and delivers the readout within 40 minutes on an LFS readout. Future directions for this assay include soliciting feedback from clinicians and other stakeholders about the prototype developed, adapting the assay to interferents of clinical endocervical samples, and adding probes for other HPV types, such as HPV 18 and eventually the other hrHPV types.</p>

The topic of the master thesis is Special education support for children from socially excluded localities in education in preschools and primary schools. The thesis deals with the topic of social disadvantage of children of pre-school and elementary school age. The theoretical part is focused on defining the terms social disadvantage and socially excluded area. Furthermore, the thesis deals with the influence of the families on social learning of children and the consequences of social disadvantage on the children's development and education. Two chapters of the thesis deal with the possibilities of support for socially disadvantaged children. One of them is devoted to the provision of support measures at schools, the other one defines some strategies and programs aimed at the development of the children. The practical part analyses the results of a research survey mapping the level of development of particular selected functions in children from socially excluded areas. The used research method was testing. The research involved testing of 10 children from socially excluded areas and their results were compared to the testing results of other 10 children who were not from socially excluded areas. The research survey confirmed that socially disadvantaged pupils show poorer results in tests....

Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization. Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings. It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians. Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease. Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values. In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.