Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2008. / Härtill 4 uppsatser.

Anxiety disorders commonly co-occur in children and adolescents with an autism spectrum disorder (ASD). Recently, treatment of anxiety using cognitive behavioral therapy (CBT) has been modified and studied in youth with ASD, with results consistently demonstrating positive treatment outcomes. In typically developing populations, CBT gains are well maintained as long as 14-years post-treatment; however, maintenance of CBT has not yet been studied in anxious youth with ASD. Using a sample of 32 youth who previously completed one of three CBT for anxiety in ASD treatment studies, the present study re-assessed parent report of anxiety symptoms in youth, 12-26 months (M = 17.16 Months; SD = 4.32) following treatment completion. Retrospective data from the original studies' screening/baseline and post-treatment time points were used in combination with newly obtained follow-up data to determine treatment maintenance. Compared to baseline, follow-up scores on all measures of anxiety were associated with large effects for treatment. Compared to post-treatment, no significant differences in scores were observed; however, scores on the Pediatric Anxiety Rating Scale suggested a small effect for return in symptoms. While the percentage of individuals with remission of their primary anxiety diagnosis was identical at post-treatment and follow-up, significantly fewer individuals were rated as responders at follow-up as compared to post-treatment. Similar to CBT for anxiety in neurotypical youth, CBT for anxiety in youth with ASD appears to be relatively durable over a one to two year interval. Despite this, a significant portion of participants demonstrate some level of symptom regression. Future study should investigate factors associated with poor treatment maintenance, as well as modifications or additions to treatment protocols (e.g., booster sessions) that may help maintain treatment gains.

Background: Various follow-up studies show that there are deficiencies in the care of patients affected by stroke. In order to provide good care according to the National Board of health and welfare and national guidelines for stroke care systematic quality audits need to be carried out. Purpose: To investigate if the local guidelines for stroke care in Örebro County are followed and to explore how people with stroke experience care and rehabilitation in hospital, primary care and community. Method: Primary health care records were reviewed using quality indicators in the local stroke guidelines. Samples of patients were obtained from the County´s three hospitals. Differences between men and women, younger and older, were analysed with chi-squared test. Eleven people were interviewed about their experiences of care, rehabilitation, support and participation. The interviews were analysed with qualitative content analysis. Result: 123 records were reviewed and for 69% referrals had been sent to the primary health care. Of the referred patients 78% were followed up within 6 months. Men were treated in significantly higher extent with lipid-lowering medicines compared with women, and people below 75 years in significantly higher extent than those over 75 years. Diagnosis was significantly more frequent registered in records for younger people. The interviewed people were at large satisfied with the hospital care. Those who lived in municipal residents enjoyed company of the staff and the other people living there but could also feel restricted by the ward routines and partially lose their autonomy. Some experienced the primary health care as a security while others experienced a lack of follow-up despite the fact that it happened.  Several felt not involved in the health care planning, but instead relied on staff´s judgement. Conclusion: Quality indicators were met in large in the primary health care but there were differences between gender and between older and younger. People were generally satisfied with care but they did not feel involved in the health care planning. People living in municipal  residents experienced some shortcomings and described loss of autonomy.

Data from longitudinal surveys give rise to many statistical challenges. They often come from a vast, heterogeneous population and from a complex sampling design. Further, they are usually collected retrospectively at intermittent interviews spaced over a long period of time, which gives rise to missing information and loss to follow-up. As a result, duration data from this kind of surveys are subject to dependent censoring, which needs to be taken into account to prevent biased analysis. Methods for point and variance estimation are developed using Inverse Probability of Censoring (IPC) weights. These methods account for the random nature of the IPC weights and can be applied in the analysis of duration data in survey and non-survey settings. The IPC estimation techniques are based on parametric estimating function theory and involve the estimation of dropout models. Survival distributions without covariates are estimated via a weighted Kaplan-Meier method and regression modeling through the Cox Proportional Hazards model and other models is based on weighted estimating functions. The observational frameworks from Statistics Canada's Survey of Labour and Income Dynamics (SLID) and the UK Millenium Cohort Study are used as motivation, and durations of jobless spells from SLID are analyzed as an illustration of the methodology. Issues regarding missing information from longitudinal surveys are also discussed.

There has recently been an intense debate about the increased rate of bipolar disorders (BPD) in children and adolescents observed in clinical settings. Thus, there is great interest in child and adolescent symptoms of hypomania and whether these symptoms subsequently will develop into BPD. More knowledge about early signs could give insight into the development of the disorder. There are also concerns that hypomanic symptoms in adolescence indicate excess risk of other health conditions. It has been reported that patients with mood disorders have a high consumption of prescription drugs in different ATC classes. The primary objective of this thesis was to better understand the mental health outcome of adolescents with hypomania spectrum symptoms and to identify early risk factors for adult bipolar disorder among adolescents with mood disorders. In order to widen the scope and investigate health outcome of mood disorder in general psychopharmacological outcomes were included. A community sample of adolescents (N=2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes, while another 197 fulfilled the criteria for major depressive disorder (MDD) without a history of a hypomania spectrum episode. A follow-up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed. Univariate and multivariate analyses were used. The results indicate that the phenomenology of the hypomania spectrum episodes during childhood and adolescence per se does not predict adult bipolar disorder. However, having both affective symptoms during adolescence and a family history of bipolar disorder increases the risk of developing bipolar disorders in adulthood. Disruptive disorder in childhood or adolescence as well as family histories of BPD emerged as significant risk factors that differentiated between the future development of BPD and MDD. Adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes in adulthood. Both groups are at increased risk for subsequent mental health problems, high consumption of prescription drugs, and high health care use, compared with the control group. The high rates of prescription drugs in many ATC classes found among the former depressed females seem to indicate a series of co-morbid somatic illnesses. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course. Characteristics such as disruptive disorders and family history warrant particular attention.

Rehabilitation of edentulous patients with Implant-supported Complete Fixed Dental Prosthesis (ICFDP) is a well-documented treatment option. This dissertation assessed the relation between the rate of biological/mechanical complications and the type of metal framework alloy, length of cantilever extension. The results showed that long-term clinical outcomes of ICFDP were favorable. While 30% of patients experienced biological complications, 66.6% of the prostheses needed to be repaired during follow-up period. The risk of prosthesis failure and mechanical complications was significantly higher in silver-palladium frameworks as compared with palladium-silver or type IV gold alloys. The length of cantilever was not correlated with the amount of marginal bone loss. The rate of marginal bone loss around anterior implants was higher than that of posterior implants associated with cantilever segments. The treatment improved the patients’ quality of life and 96% of patients would undergo the same treatment again if required.

Rehabilitation of edentulous patients with Implant-supported Complete Fixed Dental Prosthesis (ICFDP) is a well-documented treatment option. This dissertation assessed the relation between the rate of biological/mechanical complications and the type of metal framework alloy, length of cantilever extension. The results showed that long-term clinical outcomes of ICFDP were favorable. While 30% of patients experienced biological complications, 66.6% of the prostheses needed to be repaired during follow-up period. The risk of prosthesis failure and mechanical complications was significantly higher in silver-palladium frameworks as compared with palladium-silver or type IV gold alloys. The length of cantilever was not correlated with the amount of marginal bone loss. The rate of marginal bone loss around anterior implants was higher than that of posterior implants associated with cantilever segments. The treatment improved the patients’ quality of life and 96% of patients would undergo the same treatment again if required.

国立情報学研究所で電子化したコンテンツを使用している。

Graduates from 1950 to 2010 with a B.S. degree in animal science from the Department of Animal Science of Texas A&M University were sent questionnaires by e-mail to collect information on how graduates of the department were being influenced in their career decisions by their educational experiences in the department and how they perceived selected components of the program. The questionnaire contained questions about their backgrounds and their careers. It also contained 23 statements to which respondents answered using a 5-point scale from strongly disagree to being strongly agree. Approximately 3,000 questionnaires were e-mailed, and 633 with full data were returned. Male respondents were found to have more agricultural experience than females. Almost half of the males reported that they were in careers related to their animal science degree while slightly more than one-fourth of the females indicated animal science-related careers. Participants who were very experienced in agriculture prior to college were more likely to be in a career related to their animal science degree than were those with other levels of experience. Participants responded with their levels of agreement to statements about their experiences in animal science courses. The statements with the highest level of agreement involved practical, hands-on and generic skills and attributes, industry involvement, and current issues in animal science. Graduates agreed that hands-on involvement with animals in courses and involvement with industry leaders were important. Similarly, they agreed that character, integrity, and work ethic were important attributes to develop in students. Communication skills?both oral and written?were highly important, too. On the other hand, graduates believed that the animal science curriculum did not emphasize creativity and did not provide enough flexibility to emphasize specialized areas of animal science such as companion animals. Continual research about animal science graduates, their academic programs, and their careers is important to track the ever-changing demands and needs of the agricultural industry and of students.

Thesis (M.A.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 12, 2009) Includes bibliographical references.