Bakgrund: Alla barn har rätt att växa upp under trygga förhållanden och inte vara utsatta för våld. Få barn berättar för vuxna att de är utsatta för våld och det ställer stora krav på att skolpersonal identifierar dessa barn. Skolsköterskan träffar regelbundet barn i samband med hälsobesök och har en unik möjlighet att observera och identifiera tecken på att barn utsätts för våld. Syfte: Studiens syfte var att beskriva hur skolsköterskan identifierar barn som är utsatta för våld i hemmet. Metod: Kvalitativ metod med induktiv ansats har använts i studien. Datainsamlingen genomfördes via fokusgruppsintervjuer med semistrukturerade frågor. Resultatet analyserades enligt kvalitativ innehållsanalys. Resultat: Analysen resulterade i ett tema; skolsköterskans vilja, ansvar och öppenhet för att bidra till att skapa goda uppväxtvillkor och fem kategorier; medvetenhet om våldets uttryck och symtom, inkludera frågor om våld och att vara uppmärksam, vara tillgänglig, skapa förtroende och tillit, samarbete med pedagoger och elevhälsoteam samt ökad kunskap och gemensamt styrdokument. Konklusion: Framträdande i studien var skolsköterskans intresse och vilja för att skapa samt främja goda uppväxtvillkor för de barn som de möter i sin profession. Skolsköterskan identifierar barn som utsätts för våld på många olika sätt. Hälsobesöket ses som ett betydelsefullt verktyg för att samtala kring våld och skapar goda relationer. / Background: All children have the right to grow up in safe conditions and not be exposed to violence. Few children tell adults that they are exposed to violence and makes great demands on school staff, to identify these children. The school nurse regularly meets children during health check-up and has a unique opportunity to observe and identify signs of being subjected to violence. Purpose: The purpose of the study was to describe how the school nurse identifies children who are exposed to domestic violence. Method: Qualitative method with inductive approach has been used in the study. Data collection was conducted using focus group interviews with semi-structured questions. The results were analyzed according to qualitative content analysis. Results: The analysis process resulted in the theme of the school nurse's will, responsibility and openness to help create good conditions for growing up and five categories; awareness of the expression and symptoms of violence, including issues of violence and being attentive, being accessible, creating trust and confidence, cooperation with educators and student health teams, as well as increased knowledge and a common governing document. Conclusion: Prominent in the study was the interest and willingness of school nurses to create and promote good growing/life conditions for children they meet in their profession. The school nurse identifies children exposed to violence in many different ways. The health check-up seen as an important tool for talking about violence and creating good relationships.

Dans cette thèse est défendu l'intérêt d'évaluer la santé d'un système/objet industriel multi-composants à travers un bilan de santé multi-niveaux hiérarchiques. Elle a donc pour objet principal de justifier les éléments essentiels du concept de bilan de santé générique qui représente l'état réel d'un système sous la forme d'un vecteur d'indicateurs de différentes natures. Vis-à-vis de ce fondement, la thèse se focalise plus spécifiquement sur les fonctions de détection des anomalies-normalisation et agrégation d'indicateurs pour élaborer un index synthétique représentatif de l'état de santé global pour chaque élément du système. Il est ainsi proposé, une nouvelle approche de détection conditionnelle des anomalies. Cette approche a pour intérêt de quantifier la déviation pour chaque indicateur par rapport à son mode de comportement nominal tout en prenant en compte le contexte dans lequel évolue le système. Une extension à l'exploitation de l'intégrale de Choquet en tant qu'opérateur d'agrégation des indicateurs est aussi proposée. Cette extension concerne, d'une part, un processus d'apprentissage non supervisé des capacités pour le niveau le plus inférieur dans l'abstraction, à savoir celui des composants, et d'autre part, une approche de mise en oeuvre de leur inférence d'un niveau à l'autre. Ces propositions sont appliquées sur un moteur diesel de navire, système essentiel du projet BMCI du pôle MER-PACA dans lequel s'inscrit cette thèse / This work is addressing the health assessment of a multi-component system by means of multi-levels health check-up. Thus scientific Ph. D. objective aims to establish items of a generic health check-up concept. It focuses specifically on the functions of anomaly detection, normalization and aggregation of different indicators to develop a synthetic index representing the overall health status for each element within the system. In that way, it is proposed a new approach for detecting conditional anomalies. This approach has the advantage of quantifying the deviation for each indicator compared to its nominal behavior while taking into account the context in which the system operates. An extension of the Choquet integral used as an operator aggregating indicators is also proposed. This extension regards on the one hand, a process of an unsupervised learning of the capacity coefficients for the lowest level of abstraction, namely components level, and on the other hand, an approach to inference them from one level to another. These contributions are implemented on a ship diesel engine which is the most critical system for the BMCI project of the MER-PACA pole to which this thesis is attached

The overall aim of this thesis was to examine the distribution of health literacy (HL) levels in newly arrived Arabic-, Dari-, or Somali-speaking refugees in Sweden. Further aims were to investigate sociodemographic characteristics associated with inadequate HL in this group, and to investigate whether HL levels are associated with experiences of the health examination for asylum seekers (HEA), health seeking behaviour and health. Three quantitative cross-sectional studies, using data from two different surveys, were conducted among Arabic-, Dari-, and Somali-speaking, newly arrived refugees taking part in courses in Swedish for immigrants or civic orientation. In addition, an explorative qualitative study, based on focus group discussions, was performed on Arabic- and Somali-speaking newly arrived refugees who had taken part in an HEA. All data were collected 2013-2016. The quantitative data were analysed using different statistical methods, foremost descriptive statistics and univariate and multivariate binary logistic regression analyses. The qualitative data were analysed using Graneheim and Lundman’s method for latent content analysis. The main findings were that the majority of Arabic-, Dari-, or Somali-speaking refugees in Sweden have limited functional health literacy (FHL) and/or limited comprehensive health literacy (CHL). Having a low education level and/or being born in Somalia were associated with having inadequate FHL, but not with having inadequate CHL. Limited FHL was associated with inadequate CHL. Experiences of poor quality of communication and having benefited little from the HEA were more common among those with limited CHL, as compared to those with higher CHL. Experiences of communication problems and a lack of information related to the HEA were found in the qualitative studies as well. In addition, it was more common that those with limited CHL reported poor general health and impaired psychological well-being, and that they had refrained from seeking healthcare. In conclusion: limited HL is common among newly arrived refugees in Sweden and seems to be of importance for the experience of the HEA, health-seeking behaviour and health. HL needs to be taken into consideration in the work with refugees in order to increase equity in healthcare and health.