Syftet med studien var att beskriva vilket stöd gastric bypass-opererade upplever att de behöver före och efter sin operation. Studien hade en beskrivande design och sjutton gastric bypass-opererade svenskar deltog. Data insamlades genom semistrukturerade frågeformulär via mail och materialet analyserades genom kvalitativ innehållsanalys. Resultatet redovisas i tre kategorier och ett tema. Kategorin Känna sig utelämnad beskriver hur deltagarna upplevde ett bristande stöd från sjukvården inför sin operation. I kategorin framkom en saknad av psykologiskt stöd både före och efter gastric bypass-operationen. Kategorin beskriver också den bristande uppföljningen efter operationen. Kategorin Känna trygghet skildrar betydelsen av information före ingreppet och vikten av att vara förberedd på livet efter operationen. Kategorin visar hur viktigt stöd från sjukvården, anhöriga och andra opererade var för att känna trygghet. Den tredje kategorin, Stå på egna ben, visar att de gastric bypass-opererade tog eget ansvar för att söka information före och efter operationen och att de då inte var i behov av stöd från sjukvården. Temat Så stor, men ändå så liten - att ta eget ansvar för ett livsavgörande beslut, men ändå behöva stöd med förbindelsen framkom ur kategorierna och beskriver vilket stöd de gastric bypass-opererade upplever att de behöver före och efter sin operation. / The aim of the study was to describe what kind of support patients who undergo gastric bypass-surgery needs. The study had a descriptive design and seventeen Swedish participants who’ve had a gastric bypass were recruited. Data were collected by a semi structured question form through mail and the material was analyzed using qualitative content analysis. The result is presented in three categories and one theme. The category Feeling left out describes how the participants experienced a lack of support before their surgery. In this category a lack of psychological support, both before and after surgery, came out. The category also describes the loss of follow-up after surgery. The category Feeling at ease describes the importance of information before surgery and to be prepared for life after surgery. The category also shows the importance of support from healthcare services, relatives and other people who’ve had a gastric bypass, to feel at ease. The third category, To stand on my own two feet, showed that the participants took own responsibility to get as much information as possible before and after surgery and that they were not in need of support from healthcare services. The theme So big, but still so small – to take own responsibility for a life changing decision, but still be in need of support with the connection emerges from the categories and describes the patients need of support before and after gastric bypass.

Environmental Impact Assessment (EIA) is a planning process used to predict, assess, mitigate, and monitor the potential environmental and social impacts that may be associated with a proposed development project. Essential to the efficacy of EIA is follow-up - a post-decision process that attempts to understand EIA outcomes and provides feedback on project development and learning processes to improve environmental management practices. While considerable literature on follow-up related themes exists, the actual implementation and engagement of all stakeholders involved with follow-up in post-consent decision stages lacks or is not done well. That being said, in northern Canada, and in the mining sector in general, much of this post-decision activity is occurring under a new institutional arrangement: privatized community-industry Environmental Agreements and associated community-based monitoring programs. Based on a case study of follow-up in northern Saskatchewans uranium mining industry, this thesis examines both the institutional development of EIA follow-up and the role and contribution of community-based Environmental Agreements to EIA follow-up and impact management practices. This thesis adopted a manuscript-style format; both utilized a combined methodology of document review and semi-structured interviews. The first manuscript focuses on the institutional development of follow-up in the northern Saskatchewan uranium mining industry, giving context to the current situation. Results demonstrate that follow-up in Saskatchewans uranium industry has transformed and is characterized by four themes ranging from little or no follow-up to a new system that now includes a participatory yet privatized process based on privatized agreements. Results suggest that follow-up has evolved to a current emphasis on environmental management incorporating a community-centric approach, recognition of socioeconomic issues in monitoring programs, and an increased community and industry presence in follow-up and monitoring activities. The second manuscript examines the nature and scope of the northern Saskatchewan uranium industrys Environmental Agreement and its potential role in EIA follow-up. Results indicate that although privatized Environmental Agreements and community-led monitoring programs complement and supplement formal EIA follow-up processes and contribute to environmental management practices, they do not have the capacity to replace EIA follow-up. Results from this thesis advance current knowledge and understanding of the evolution of EIA follow-up and the current role and contribution of privatized agreements to post-decision follow-up and impact management practices.

Syftet med denna studie var att beskriva hur patienterna upplevde Brännskadeteamets ettårsuppföljning. Studien har en deskriptiv design med såväl kvalitativa som kvantitativa data. Som underlag för studien har en utvärderingsenkät använts, svaren är insamlade under tidsperioden 2001- juni 2008. Svarsfrekvensen var hög (81,4%), 57 patienter av 70 hade besvarat enkäten. Bemötandet skattades av samtliga patienter som mycket bra (77,2%) eller bra (22,8%). Samtliga patienter som hade ställt frågor ansåg att de hade fått svar på sina frågor (93%) medan en mindre grupp svarade att de ej hade ställt några frågor (7%). Informationen innan besöket ansågs som dålig eller mindre bra av 4 patienter (7,1%), bra/tillräcklig av 33 patienter (57,9%) och mycket bra av 19 patienter (33,3%). Informationen under besöket ansågs vara bra eller mycket bra av samtliga patienter utom en som klassade den som mindre bra. Fyra av de fem kommentarerna som skrivits till frågorna gällde brister i information och förberedelse. Majoriteten av patienterna (93%) ansåg att tiden för besöket var lagom. Brännskadeteamets ettårsuppföljning är unik och den anpassas i möjligaste mån efter varje patients behov. Svaren på enkäten visar att detta lyckats ganska bra, men att informationen innan besöket behöver förbättras. / The purpose of this study was to describe the burn patients´ experience of the one-year follow-up, with a multidisciplinary team. The study has a descriptive design with both qualitative and quantitative data. An evaluation questionnaire was used to collect data. The answers are collected in the period from 2001 until June 2008. The response rate was high (81.4%), 57 patients out of 70 had responded to the survey. The patients replied that they were treated very good (77.2%) or good (22.8%). All patients that had asked any questions felt that they had received answers to their questions (93%) a smaller group replied that they had not asked any questions (7%). The information before the visit was considered as poor or less good by 4 patients (7.1%), good/sufficient by 33 patients (57.9%) and very good by 19 patients (33.3%). Information during the visit was considered to be good or very good by all patients except one who rated it as less good. Four out of the five written comments was about issues related to gaps in information and preparation. The majority of all patients (93%) were satisfied with the length of time of the visit. The multidisciplinary one-year follow-up, at the Burn Center, is unique and the aim is to adjust the follow-up visit after each patient's needs. The results show that it has succeeded quite well, but that the information given before the visit needs to be improved.

Bakgrund Uppföljning av utskrivna patienter inom intensivvård har utvecklats under de senaste decennierna, där fokus varit patienternas återhämtning och upplevelse av intensivvårdstiden. Huruvida sjukvårdspersonal har behov av uppföljning har varit oklart. Därför var syftet med denna studie att undersöka intensivvårdssjuksköterskors behov av uppföljning av utskrivna patienter och behovets relation till känsla av sammanhang (KASAM).   Metod En tvådelad enkät, med fokus på behov av uppföljning och KASAM, delades ut till intensivvårdssjuksköterskor vid sex intensivvårdsavdelningar i Västra Götaland under våren 2011.   Resultat Av 216 distribuerade enkäter returnerades 143 (66,2 %). Drygt 80 % av intensivvårdssjuksköterskorna skattade sig ha ett behov. Det fanns ingen skillnad i personliga faktorer (ålder, kön, erfarenhet, KASAM) mellan de med behovet och de utan. Vanligaste sätten att följa upp på var att besöka patienten, kontakta patientens sjuksköterska och att läsa i patientens journal. De vanligaste orsaker till behovet av uppföljning var feedback på utförda åtgärder samt av empati för patienten. Knappt 12 % såg nackdelar med att följa upp, medan drygt 67 % såg nackdelar med att inte följa upp.   Konklusion Intensivvårdssjuksköterskor har ett behov av att följa upp utskrivna patienter. Detta behov kan vara knutet till sjuksköterskans profession, snarare än till sjuksköterskans personliga egenskaper. Orsaken till behovet kan ses som två huvudsyften; verksamhetens lärande och patientens förståelse. / Background Follow-up on discharged patients in intensive care has emerged in the last decades. Focus has been patient recovery and experiences from the intensive care units (ICU). It is however unknown whether health care workers have a need of follow-up on discharged patients. Hence, the aim of this study was to survey ICU-nurses need of follow-up on discharged patients and the correlation to sense of coherence (SOC).   Method A two-parted questionnaire, with focus on the need of follow-up and SOC, was distributed to ICU-nurses at six ICU’s in the west ofSwedenin 2011.   Result A total of 216 questionnaires were distributed, and 143 was returned (66.2%). Approximately 80% of the ICU-nurses indicated that they had a need of following up on discharged patients. No personal attribute (age, gender, working experience, SOC) differed between those with a need and those without a need. The most common way of practically follow-up on patients was by visiting the patient, contacting the patient’s nurse, and by reading the patient’s electronical journal. The general reason for the need of follow-up was to gain feedback on the preformed interventions (nursing and medical), and by empathy for the patient. Almost 12% of the ICU-nurses emphasized disadvantages by following-up on discharged patients. But just over 67% experienced disadvantages with not performing follow-up on discharged patients.   Conclusion There is a need among ICU-nurse to follow-up discharged patients. This need could be connected to the nursing profession, rather than the nurses’ personal attributes. The reason of the need of follow-up could be interpreted as two main objectives; Organizational learning and Patient understanding.

Bakgrund: Många patienter uttrycker ett behov av att fylla den minneslucka som finns sedan intensivvårdstiden både vad gäller tid och innehåll. Detta var anledningen till att vårdpersonal på intensivvårdsavdelningar började använda dagbok till kritiskt sjuka patienter. Syfte: Att belysa patienters upplevelser av att ta del av sin dagbok från vårdtiden på intensivvårdsavdelning. Metod: Litteraturöversikt. Artikelsökning utfördes i databaserna CINAHL och PubMed. I resultatet ingick tio vetenskapligt granskade artiklar, sju kvalitativa och tre kvantitativa. Resultat: Patienterna upplevde det som värdefullt att läsa dagboken och att titta på fotografierna eftersom det gav dem en uppfattning om vad som hade hänt och hur sjuka de hade varit. Genom dagboken fick patienterna en större sjukdomsinsikt och en mer realistisk målsättning för tillfrisknandet. Det var krävande och det väcktes starka känslor och reaktioner hos patienterna när de läste i dagboken. Dagboken fungerade som ett stöd för lång tid framöver. Patienterna uppskattade detaljerad och kontinuerligt skriven information och att dagboken var skriven med en personlig och mänsklig ton samt med ett språk som var lätt att förstå. Fotografier upplevdes av de flesta patienterna som positivt och blev ett bevis på vad de gått igenom. Det uppföljande återbesöket på IVA mottagning beskrevs av patienterna som betydelsefullt för att öka förståelsen av innehållet i dagboken och av vad som hänt under vårdtiden på IVA. Slutsats/Konklusion: Tidigare kritiskt sjuka patienter upplever, genom att ta del av dagbok från vårdtiden på intensivvårdsavdelning, större förståelse och bearbetning av sin sjukdomsperiod, vilket skulle kunna medföra förbättrad hälsa och ökad livskvalitet.

Bayesian approaches to the regression analysis for longitudinal measurements are considered. The history of measurements from a subject may convey characteristics of the subject. Hence, in a regression analysis with longitudinal measurements, the characteristics of each subject can be served as covariates, in addition to possible other covariates. Also, the longitudinal measurements may lead to complicated covariance structures within each subject and they should be modeled properly. When covariates are some unobservable characteristics of each subject, Bayesian parametric and nonparametric regressions have been considered. Although covariates are not observable directly, by virtue of longitudinal measurements, the covariates can be estimated. In this case, the measurement error problem is inevitable. Hence, a classical measurement error model is established. In the Bayesian framework, the regression function as well as all the unobservable covariates and nuisance parameters are estimated. As multiple covariates are involved, a generalized additive model is adopted, and the Bayesian backfitting algorithm is utilized for each component of the additive model. For the binary response, the logistic regression has been proposed, where the link function is estimated by the Bayesian parametric and nonparametric regressions. For the link function, introduction of latent variables make the computing fast. In the next part, each subject is assumed to be observed not at the prespecifiedtime-points. Furthermore, the time of next measurement from a subject is supposed to be dependent on the previous measurement history of the subject. For this outcome- dependent follow-up times, various modeling options and the associated analyses have been examined to investigate how outcome-dependent follow-up times affect the estimation, within the frameworks of Bayesian parametric and nonparametric regressions. Correlation structures of outcomes are based on different correlation coefficients for different subjects. First, by assuming a Poisson process for the follow- up times, regression models have been constructed. To interpret the subject-specific random effects, more flexible models are considered by introducing a latent variable for the subject-specific random effect and a survival distribution for the follow-up times. The performance of each model has been evaluated by utilizing Bayesian model assessments.

<p>After decades of investigation, we still have to deal withthe problem of environmental effects of the use of de-icingsalt on roads. Lacking useful indicators of the system, westill do not know the environmental utility of ameliorativemeasures taken. The thesis aims at</p><p>i) describing the system of de-icing practices and theirenvironmental effects with special reference to the exposure ofthe roadside environment to air-borne salt and damage to Norwayspruce seedlings and ii) at proposing indicators for afollow-up system. By collecting bulk deposition and relatingthe deposition pattern to factors concerning wind androad-maintenance characteristics, the influence of thesefactors on air-borne exposure is investigated. By exposingNorway spruce (<i>Picea abies</i>(L.) Karst.) seedlings to roadsideconditions the influence ofsalt exposure on the degree ofdamage is investigated. Based on a comparison of severalsystems of monitoring, improvements are suggested by proposingnew indicators for salt use and its environmental effects.</p><p>A large part of the salt that is applied on the road surfacewill be transported by air and deposited on the ground in theroadside. While the vast majority of the salt will be depositedwithin some tens of metres of the road, some may still be windtransported several hundred metres away. The wind directionplays an important role for the deposition already at adistance of some ten metres from the road. Wind speedinfluences the distance to which the salt is transported.Chloride concentration in unwashed needles collected after thesalting season is positively related to the bulk deposition ofCl during the exposure. The degree of damage can be describedby a sigmoid curve of response to the Cl concentration inneedles. Improvements to the follow-up system are suggested byproposing indicators of the driving forces, pressures, states,impacts and possible responses as regards the undesired impactson water resources, vegetation and the roadside scenery as asocietal asset.</p><p><b>Keywords:</b>road, de-icing salt, air-borne, environmentalimpact, vegetation damage, Norway spruce, seedling, follow-up,monitoring, indicator</p>

Thesis (M.Ed.)--University of North Carolina Wilmington, 2009. / Title from PDF title page (February 16, 2010) Includes bibliographical references (p. 45-46)

Problem: Older adults may change their view on what is important to their health-related quality of life (HRQOL). They may alter their opinion about areas relevant to HRQOL (reconceptualization), or how important these areas are to them (reprioritization), and this can be referred to as response shift (RS). Overtime, changes in HRQOL may be imprecise (underestimated or overestimated) if RS occurs. Providing detailed information about RS in the older adult population will have many implications for health professionals, family members, caregivers, policy makers, and researchers. The purpose was to explore RS in HRQOL in community-dwelling older men. Methods: Data from the Manitoba Follow-up Study (MFUS) was used as 360 older men returned the Successful Aging Questionnaire in each of five years (2007-2011). The participants identified the importance of 15 items, which reflect the physical (2 items), mental (5 items), and social domains (8 items) of HRQOL. Descriptive analysis was performed using SPSS21. An individualized method was used to identify different aspects of RS at group and individual levels, as well as the item level. Predictors of RS were also identified using logistic regression in a one-year period. Results: Mean age of participants was 89.7 years (SD 2.9) in 2011. Across 15 items over a one-year period, RS varied from a low of 9.3% for the ‘being mentally aware’ item to 39.3% for the ‘having goals/making plans’ item. Because we were examining RS of 15 items, it was very uncommon to find older men with no RS on all items. Only 27 out of 360 older men (7.5%) provided the same response on all the items they answered at both times (2010-2011). The average of the percent of people showing RS over 15 items, across four time periods, within three domains, was 24.4%. Reprioritization was more common in physical and mental domains, respectively, whereas reconceptualization was seen mainly in the social domain. Further, most of those who showed reprioritization, showed a decrease in importance, while most of those who showed reconceptualization, dropped a concept. Older men who were older, married, living independently, and recently did not participate in activities, were more likely to show RS in certain items. Older men with lower self-rated health were less likely to show RS. Conclusions: Data from the MFUS presents an opportunity to assess RS by using an individualized method that is simple to conduct and interpret in research and clinical settings. This method provides extensive demonstration of RS including magnitude, timing, type, direction, and predictors. RS should be considered an important part of aging, when planning resources and individualizing interventions for the older adult population. Future studies should design a method that evaluates RS individually, similar to our method. / October 2015

Survivors of childhood cancer are a relatively new phenomenon in the medical world. The introduction of treatment protocols in the 1970s started a trend in curing children of cancer that historically had been a death sentence. Under these treatment protocols children were given different treatment regimens based on past research that helped remove cancerous cells from their bodies, but were later found to be the cause of treatment related morbidities years into the future; for most survivors roughly ten to 20 years post treatment. These morbidities, commonly called late-effects, are the prime reason that survivors of childhood cancer need to participate in survivorship care. Survivors of childhood cancer are particularly vulnerable to late-effects because the majority of them receive their treatment at a time when their bodies are still growing and developing. Survivorship care services vary by site, but all maintain the common goals of providing long-term follow up for the survivor and education about the ways in which treatments may affect a survivors’ health as they age. Similar to many other facets of healthcare and medicine, there are many populations who do not participate in survivorship care. The purpose of this research is to identify possible barriers to care, assess the level of impact these barriers have upon the survivor’s potential for participation and provide suggestions as to how these barriers can be mitigated. Additionally, this research highlights areas that need further research and analysis.