Purpose: Postnatal depression has significant negative outcomes for both mother and baby. Cognitive-behavioural interventions have proven promising in its treatment, but there are a number of barriers, specific to the postnatal period, which lead to low take-up of treatment. Online interventions may circumvent some of these barriers. However, evidence of long-term follow-up is sparse, in spite of the importance of knowing how such treatments work over the longer-term. Methods: Long-term follow-up of postnatal women participating in a feasibility randomised controlled trial of NetmumsHWD, an online behavioural activation treatment with telephone support. Results: Retention rates of over 70 percent were obtained. There were small but non-significant effects of treatment on depressive symptomology and behavioural activation scores at 16 months post-randomisation. Baseline depression and behavioural activation scores predicted attrition prior to the implementation of outreach strategies for data collection; these systematic differences in attrition disappeared post-implementation. Measures of treatment adherence were not related to outcome. Conclusions: Collection of long-term follow-up data from postnatal women appears feasible. The findings demonstrate the importance of outreach in maximising retention, especially in relation to the generalizability of results. Future research should consider ways to assess treatment engagement and its relationship with outcome.

Using 12-month post treatment Timeline Followback drinking reports, data extrapolated from shorter time windows (e.g., 1 month, 6 months) were used to estimate total annual drinking. The objective was to determine whether data from a shorter time window would provide an estimate of annual drinking sufficiently consistent with the full year report such that it can be used in place of the full report. Data for this study were obtained from problem drinkers who voluntarily participated in a randomized controlled trial of a mail-based intervention. Complete follow-up data were obtained for 467 of the 825 participants who completed a 12-month Timeline Followback of their post intervention drinking. The results of this study suggest that 3 months is the necessary minimum time window to best represent annual posttreatment drinking with alcohol abusers. The major implication of this finding is that alcohol treatment outcome studies can use a shorter posttreatment time window, which is more time and resource efficient, over which to obtain follow-up data with little to no loss in the representativeness of that data.

We aimed to determine the short- and long-term effects on growth, body composition, metabolic and inflammatory markers following supplementation with the probiotic Lactobacillus paracasei ssp. paracasei F19 (LF19) during weaning. Methods: One-hundred and seventy-nine healthy, infants in Umeå city, Västerbotten County were randomised to daily intake of cereals with (n=89) or without (n=90) LF19 108 colony-forming units from 4 to 13 months of age. Weight, length, head circumference and body composition, assessed by skinfold thickness, were examined at 4, 5.5, 6.5, 9, 12 and 13 months of age. Venous blood was drawn at 5.5 and 13 months. In all, 171 infants completed the intervention and were invited to a follow-up at 8-9 years of age between 2009 and 2011, 120 children participated. Weight, height, sagittal abdominal diameter and body composition (using Dual Energy X-ray Absorptiometry-scan) were measured. Data on weight and height at 4 years were collected from medical records. The families filled out a 4-day food record and a food frequency questionnaire, physical activity was assessed using a pedometer for 7 days. At 5.5, 13 months and 8-9 years of age we analysed the serum blood lipid profile. At 8-9 years fasting glucose, insulin, aspartate and alanine transaminases were analysed in serum. Homeostatic Model Assessment index was calculated. At follow-up serum adiponectin, high-sensitivity C-reactive protein and plasma C-peptide, ghrelin, gastric inhibitory polypeptide, glucagon-like peptide 1, glucagon, insulin, leptin, plasminogen activator inhibitor-1, resistin and visfatin were analysed. For characterisation of the plasma metabolome, a subgroup (n=40) was analysed at 5.5 and 13 months of age by gas chromatography time-of-flight mass spectrometry (GC-TOF/MS) analysis and in all (n=112) children at the follow-up using untargeted GC-GC/MS. Results: There were no differences between the LF19 and placebo group regarding body weight, length/height at any assessment from 4 months to 8-9 years of age; nor were there any differences between the groups in body composition. In the LF19 group 19 % were overweight/obese, the corresponding number was 21 % in the placebo group (p=0.78). Analysed metabolic and inflammatory markers, both during the intervention and the follow-up did not differ between the two groups. At 13 months of age lower levels of palmitic acid and palmitoleic acid (both p<0.04) and higher levels of putrescine (p<0.01) were seen in the LF19 compared to the placebo group. These differences did not persist at 8-9 years of age. At that age, we found statistically stronger models when comparing overweight/obese and normal weight children as well as in relation to sex. Conclusion: Early intervention with the probiotic LF19 at the time of weaning exerted transient effects on the metabolome. In a long-term perspective, we found neither benefit nor harm on growth, body composition, metabolic or inflammatory markers following supplementation with LF19 during weaning.

Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively. Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss. Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type. We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage. Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative.

<p>Syftet med arbetet är att kartlägga och att finna möjligheter till förbättringar i projektflödet. Arbetet berör de delar av företaget som befinner sig i ett tidigt skede av projektflödet eftersom ändringar i dessa skeden kan göras till en liten kostnad. Informationsinsamling har skett genom fria samtal, dock med vissa förberedda frågor. Information har inhämtats från flera delar av projektflödet så som försäljning, projektledning och konstruktion. Vi har kommit fram till att det är värt att lägga mer resurser på förbättringsarbete och se över ansvarsfördelningen för detta. Man bör även se över reklamationerna som till antalet är för många och många av felen är likartade.</p> / <p>The main purpose of this thesis is to survey and find possibilities of improvements in the project flow. The report only touches the parts of the company which are located in the early parts of the project flow, hence alterations can be made at a low cost. The gathering of information was made by open conversations, with some prepared questions. The information has been gathered from several parts of the company such as sales, project management, and construction et cetera. We consider it to be profitable to increase the resources in the improvement work. The company should also investigate the distribution of responsibility in the work of improvement. The complaints are too many and many of the faults are similar.</p>

The purpose of this study was to investigate the effectiveness of an evaluation procedure designed to assist special educators improve their instruction. A single subject, multiple baseline across subjects design was used to test this evaluation procedure, the Special Educator Improvement Procedure (SEIP), with six teachers of self-contained special education students over a seven week period. The SEIP was composed of the following components: (1) presenting multiple videotaped samples of the subject's teaching performance to a team of evaluators, including the subject, the subject's supervisor, a peer and another educator chosen by the subject; (2) having the evaluation team assess the subject's instruction using the revised Teacher Performance Assessment Instruments (TPAI-R); (3) allowing the subject to compare his or her self assessment with the assessments of other evaluation team members; and (4) having team members make specific suggestions as to how the evaluatee might improve his or her instruction. Following the seventh week of the study, two independent observers used the TPAI-R to rate videotaped samples of the subjects' teaching. These ratings were used to test the prediction that subjects who participated in the SEIP would be ranked higher on the TPAI-R than would subjects who had not yet participated in the SEIP. However, the results of statistical analyses using Revusky's R(,n) statistic and Tukey's HSD procedure did not support this prediction. At the conclusion of the study, evaluation team members completed an experimenter developed questionnaire. An analysis of their responses supported the predictions that (1) the participants would rate the SEIP as being very beneficial for helping special educators improve their teaching and (2) the TPAI-R was a good instrument for assessing the adequacy of special educator's teaching, but failed to support the prediction that the participants would rate their participation in the SEIP feedback session as being very beneficial. It was concluded that the results of the study were inconclusive regarding the effectiveness of the SEIP in assisting special educators to improve their instruction. It was suggested that additional research be conducted using a revised version of the SEIP.

The primary aim was to compare the effectiveness of smoking cessation interventions of different intensities in a clinical dental and a telephone setting in Sweden. Methods: A total of 300 smokers were randomized to High or Low Intensity Treatment (HIT or LIT) at the Public Dental Service, County Council of Västmanland. Effectiveness (abstinence rate) was measured after 1yr (paper I) and 5-8yrs (paper III). A cost-effectiveness analysis was conducted, based on intervention costs, number of abstinent participants after 1yr, and a Markov modelling of future costs and health (in QALYs) consequences (paper II). In paper IV, 586 callers to the Swedish National Tobacco Quitline (SNTQ) were randomized to high-intensity proactive or low-intensity reactive service, and effectiveness was measured after 1 yr. Effectiveness measures were self-reported point prevalence, 6-month continuous abstinence, and sustained abstinence. Results: Absolute quit rates were 7% higher with HIT than with LIT on all measures and increased by 8% from 1yr to 5-8yrs. Point prevalence was 23% vs. 16% (p=.11) after 1yr and 31% vs. 24% (p=.16) after 5-8yrs. Six-month continuous abstinence was 18% vs. 9% (p =.02) after 1yr and 26% vs.19% (p=.18) after 5-8yrs. Sustained abstinence was 12% vs. 5% (p =.03) after 5-8yrs. Nicotine dependence was a strong predictor for abstinence at 1yr and achieved abstinence at 1yr was a strong predictor for abstinence at long-term follow-up. The cost-effectiveness analysis showed that both HIT and LIT were cost-effective, and LIT was even cost-saving compared with doing nothing. HIT was more costly and more effective than LIT, and the cost of each extra QALY gained by HIT was 100,000SEK, which is considered very cost-effective in Sweden. Proactice and reactive services were equally effective at the SNTQ. Point prevalence was 27% and 6-month continuous abstinence was 21% after 1yr. Being smoke-free at baseline was the strongest predictor for abstinence at 1yr. Conclusion: Support at high as well as low intensity in a clinical dental setting in Sweden and at the SNTQ was effective in achieving smoking cessation. Both high- and low-intensity interventions were very cost-effective in a clinical dental setting.

This two-part study of the criminal investigation process first evaluated the frequency with which patrol officers solve cases assigned to the investigations division and then examined how detectives spent their time, both on case assignments and on other activity not related to current case assignment. Cases assigned to the investigations division for follow up were examined to determine how often a case was cleared by the patrol officer. The detective's time was then evaluated in order to determine how much time detectives spent on investigative tasks and other activities. This study confirms that the patrol officer should be given more time to conduct preliminary investigations for specific cases, and that tasks performed by detectives could be shifted to other personnel in the department. Both actions should serve to positively impact case clearance rates.

The aim of this study is to investigate how social services handles and experiences threats in the workplace with focus on prevention and how follow up work is conducted. Data collection involved six qualitative interviews with four social workers and two unit managers. The results indicate that social workers normalizes threats at the workplace and that the leadership is crucial for both prevention and follow up. Routines at work are important but social workers are rarely informed or updated about these routines. Social workers experience that follow up is not a priority by their unit managers and after a threat social workers have a lack of time to take care of themselves. Unit managers experience the importance of routines for prevention of threats in the workplace. As unit managers they have the biggest responsibility when threats occur in the workplace and follow up should include an individual plan for every social worker. Both social workers and unit managers agrees that the experience is enough when determining if a threat is real or not.

Background Multiple sclerosis (MS) is an autoimmune disease characterised by inflammatory damage to the central nervous system (CNS). Accumulated CNS injury can be quantified as brain atrophy, definable as a reduction in brain parenchymal fraction (BPF). BPF correlate with disability in MS and is used routinely as an endpoint in clinical trials. In 2009/2010, a new MS clinical care program, that includes follow-up of BPF, was introduced at Umeå University Hospital (NUS). Levels of neurofilament light polypetide (NFL) and glial fibrillary acidic protein (GFAP) in cerebrospinal fluid (CSF) are markers of axonal and astrocytic injury, respectively, and also potential surrogate biomarkers for BPF decline. The goals of this thesis were to establish age-adjusted values of BPF in healthy individuals and to relate these to the BPF values from individuals with MS as well as to the levels of NFL and GFAP in CSF. Another goal was to investigate if expanded disability status scale (EDSS)-worsening could be predicted in a clinical MS cohort and if BPF measurements could contribute to such predictions. Methods A group of 111 healthy individuals volunteered to participate in the studies. A total of 106 of these underwent MRI with BPF measurements, 53 underwent lumbar puncture (LP) with measurement of NFL and GFAP and 48 underwent both MRI and LP. Three different automatic and one manual method were utilised to determine BPF. A literature search on BPF in healthy individuals was performed for the purpose of a systematic review. For studying disability progression in MS, all individuals with MS followed at NUS and included in the Swedish MS registry were included if they had matched data on BPF, EDSS and lesion load as part of clinical follow-up (n=278). Results BPF as well as NFL and GFAP levels in CSF were all associated with age. NFL was associated with BPF and GFAP, but only the association with GFAP was retained when adjusting for age. Significant differences were found between different methods for BPF determination. In the MS population, BPF was associated with EDSS. Only progressive disease course could predict EDSS worsening. Conclusion The data on BPF and levels of NFL and GFAP in CSF of healthy individuals can aid in the interpretation of these variables in the setting of MS. Knowledge on differences in BPF data from different methods for BPF determination can be useful in comparing data across studies, but also highlights the need for a commonly accepted gold standard. The correlation between GFAP and NFL levels in CSF may indicate an association between glial and axonal turnover that is independent of the aging effect on the brain. However, the low number of volunteers for LP precluded clear conclusions. An association between BPF and EDSS was seen in the MS group. The ability to predict EDSS worsening in the clinical MS cohort was limited.