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.

The purpose of the study was to provide training and follow-up sessions for Sunday school teachers to increase the use of inclusive teacher behaviors (opportunities to respond, behavior specific praise, and opportunities to participate) for educating a child with moderate to severe disability. A multiple baseline across behaviors design was used to evaluate the effectiveness of training and follow-up sessions for a Sunday school teacher that had a child with moderate to severe disability in her class. The results showed training and follow-up were effective in teaching inclusive teacher behaviors within a church setting.

Interpersonal violence is a matter of growing concern. Where the safety of the common man is concerned, the dangerousness of mental patients, the ongoing de-institutionalization within psychiatry, and the role of alcohol is disputed. In order to analyze the significance of abuse and mental disorder in violent behaviour, this subject was approached from two different perspectives; from a specific violent offence - homicide - examining the mental status of the offenders, and from individuals with a specific mental disorder - schizophrenia -and assessing the rate of criminal offence amongst them. Homicides in northern Sweden and in Stockholm, legally characterized as murder, manslaughter or assault and causing another’s death, and homicides followed by the offenders’ suicide, were studied. Medicolegal autopsy records, police reports, pretrial psychiatric reports and court records were collected and scrutinized. The criminal records of 644 persons, discharged from hospitals in Stockholm with a diagnosis of schizophrenia, were studied. The relative risk of criminal offence was analyzed by indirect standardization using the general population as a standard. Violent offenders were further examined from psychiatric records. In the homicide material, 16 females and 160 males killed 94 men, 78 women, and 15 children. Forty percent of all surviving offenders were abusers without a major mental disorder, 39% were mentally disordered, 11% committed suicide, and 10% were considered "normal". The abusers and their victims were older, often socially and mentally deteriorated, and well known to each other. The victim was the prime aggressor in half of the cases. Killings by mentally disordered persons and by those who committed suicide were characterized by intimacy between offender and victim; one third were also abusers. Multiple homicides and child murder were mainly seen among homicide-suicice cases. The "normal" offenders were more often of foreign origin and two thirds of the victims initiated the violence by physical attacks. Relatively more of the homicides in northern Sweden concerned intimate parties, use of firearms, and cases of homicide-suicide, as compared to homicides in Stockholm where drug abuse was more prevalent. Sixteen offenders (9%) in the homicide sample had schizophrenia (all males), while 38 subjects (6%) in the cohort of schizophrenics had committed a violent offence. No homicide was recorded and most of the offences were of minor severity. The rate of violent offence was four times higher in the study group as compared to the general population. Most homicides involved closely related persons with separation and dependence as the dominating psychological theme, especially in homicide- suicide cases. Intoxication was regularly seen among the abusers but not among the non-abusers. The acute effect of alcohol intoxication may be of lesser importance in violence as compared to the long-term effects of abuse. Schizophrenics do not impress as a particularly dangerous group. Prevention by psychiatry is difficult; most offenders did not have any contact with psychiatry prior to the act. / <p>S. 1-70: sammanfattning, s. 71-176: 5 uppsatser</p> / digitalisering@umu

A large number of children and teenagers are placed in foster care for various reasons. Social services have a responsibility to follow up youths and ensure that they have the same opportunity for positive development as other young people. A qualitative study was conducted with an abductive perspective by gathering material from social workers in this particular field. The research design of this study is an interview study. The theoretical premise was Bronfenbrenners ecosystem theory and Maslows hierarchy of needs theory. The aim of this study was to examine how social services work to secure youths life situation and how social workers promotes teenagers perspective in their work. The collected material was analyzed thematically. Results showed that all social workers in the study perceived that a functioning schooling and network around the teenagers is important. Another outcome was that frequent follow-up work in foster care is important and that four of six municipalities have one responsible social worker that only follows teenagers in foster care. One of the municipalities which do not have one responsible social worker as a separate position is under preparation to develop this profession. A further result in this study was that social workers variously promote teenagers perspective in their work.