The overall purpose of this study was to examine the relevance of policy factors identified by Mulvale and Bourgeault (2007) on interprofessional collaboration in PHC, by soliciting stakeholders’ perspectives. / ABSTRACT Background: Interprofessional team-based approaches to primary health care (PHC) delivery have gained support in the literature. Interprofessional primary health care (IPC) models of service delivery allow for different professionals to work together to address patients’ needs. Family Health Teams (FHTs) are a newly introduced model of IPC delivery in Ontario. A variety of factors can influence collaboration between professionals in IPC teams. Purpose/Research Objectives: The purpose of this study was to examine stakeholders’ perspectives about policy factors that influence IPC team collaboration, using the example of FHTs in Ontario. Methods: This descriptive study employs semi-structured interviews with key informants from select Ontario FHTs. Directed content analysis was used to examine the Mulvale and Bourgeault (2007) framework. Interviews were conducted with FHT professionals to describe their perspectives on the influence of policy factors in shaping collaboration within their teams and whether identified policy factors acted to enhance or hinder collaboration. Findings: Key informants cited, with highest agreement, economic and regulatory factors as influencing collaboration. Factors agreed upon unanimously by all key informants included funding, provider payment/remuneration, and practice scope. Key informants identified a range of policy factors that hinder collaboration. These included provider payment/remuneration, legal accountability, and the existence of multiple governing bodies. Implications/Conclusion: A number of policy factors were reported to influence collaboration in FHTs in Ontario. Although the findings suggest that incremental reform is possible, widespread policy reform of physician incentives, a key barrier to collaboration, is unlikely. Prospects for reform of this factor may be more promising at an organizational level. / Thesis / Master of Science (MSc)

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-10-26T12:38:22Z No. of bitstreams: 1 Miriane Melo Silveira Moretti_.pdf: 3445281 bytes, checksum: 44551f9aea83fc303ae2efa95ec9209a (MD5) / Made available in DSpace on 2015-10-26T12:38:22Z (GMT). No. of bitstreams: 1 Miriane Melo Silveira Moretti_.pdf: 3445281 bytes, checksum: 44551f9aea83fc303ae2efa95ec9209a (MD5) Previous issue date: 2015-06-30 / UNISINOS - Universidade do Vale do Rio dos Sinos / Este trabalho parte dos caminhos e encontros utilizados para a implantação de um Protocolo de Sepse Grave em um Hospital Universitário. O estudo é de abordagem qualitativa usando o método narrativa auto-referente. Utilizou-se os pressupostos da Educação Permanente em Saúde (EPS) como método de ativação de rede, onde os envolvidos são os atores da equipe assistencial do serviço em estudo, os mesmos foram convidados a pensar na elaboração coletiva de um Protocolo de Sepse Grave. Esta narrativa revela o percurso de uma enfermeira que realiza a construção em rede (rodas em redes) de um Protocolo de Sepse Grave. Aponta as possibilidades e entraves e as construções coletivas que surgiram no percurso com objetivo de subsidiar os serviços de saúde para a construção de coletivos organizados para a produção de saúde. Os resultados do estudo indicam para muitos aprendizados, destacando-se a construção de redes no interior dos serviços de saúde e a importância de atuarmos na perspectiva da linha de cuidado. Além disso, o estudo revela a necessidade de disseminação de uma gestão colegiada no sentido de proporcionar espaço para escuta e conversação para que os profissionais da saúde se sintam parte integrante do processo de cuidado, que atuem na perspectiva usuário-centrada e em busca de um projeto terapêutico singular. / This work of the paths and meetings used for the implementation of a Severe Sepsis Protocol in a University Hospital. The study is a qualitative approach using the self-referential narrative method. We used the assumptions of Continuing Education in Health as network activation method, where those involved are the actors of the health care staff of the department to study, they were asked to think about the collective elaboration of a Severe Sepsis Protocol. This narrative reveals this route a nurse who carries out construction in network (wheels networks) of a Severe Sepsis Protocol. It points out the possibilities and obstacles and collective constructions that have arisen in the course in order to subsidize health services for the construction of organized team for the production of health. The study results indicate for many learnings, network construction to highlighting within the health services and the importance we act from the perspective of care line. In addition, the study reveals the need for dissemination of a collegiate management in order to provide space for listening and speaking for that healthcare professionals feel part of the care process, act on user-centered perspective and looking for a project unique therapeutic.

Background: Alzheimer???s disease and related dementias (ADRD) are often improperly or under-diagnosed in primary care; yet, it is expected that community-based care will be an increasingly important source of support for ADRD patients. In Ontario, primary care has continued to expand its services to include health team models, such as family health teams (FHTs) to provide multidisciplinary collaborative care for patients. Within such teams, memory clinic teams have also been implemented, which are clinic days set up typically once or twice a month to provide interprofessional collaborative care specifically for ADRD patients by trained health care providers (HCPs). Objective: Little is known about the experience of HCPs who work in primary care memory clinic team settings to provide care for ADRD patients. This study explored these experiences. Specifically, questions were asked around the rewards, challenges and motivations with working in the memory clinic structure and providing support to ADRD patients. Methods: A phenomenological approach was used. One-on-one semi-structured interviews were completed with 12 interprofessional team members in two primary care memory clinic teams. Interviews were transcribed and analyzed using Colaizzi???s (1978) method of analysis. Results: Overall, seven subthemes were found which describe the HCP experience. The first two subthemes describe experiencing the journey with the patient and caregiver. HCPs want to support patients while maintaining the patient???s dignity. They also balance emotional dilemmas with responsibilities. The next two subthemes describe experiencing the journey with the team. HCPs feel valued and connected to their team members. The memory clinic structure offers unique care provider experiences. Lastly, three subthemes were found which describe the personal and professional rewards of the experience. HCPs found thrilling complexities within the patient population in the memory clinic and that working in the clinic they are able to experience ongoing learning opportunities. HCPs also described that the memory clinic offers personal and professional fulfillment. Discussion: HCPs described an overall positive experience working in the memory clinic to support ADRD patients. HCPs take pride in being able to support patients and caregivers. Knowing that they are making a difference and doing good work are motivations to continue to work with complex populations, such as ADRD patients. HCPs enjoy working in close proximity to one another, respect their team members, and enjoy learning from each other. Team members motivate each other to stay and work with the ADRD population in primary care memory clinics. HCPs reap many rewards associated with working in a ???tight-knit??? memory clinic team setting for ADRD patients. As the number of HCPs working in team settings continues to grow in Canada, it is important to look at the experiences of these teams to understand the rewards, challenges and motivations of team members. Conclusions: These findings provide more context in understanding how to motivate future HCPs to work with more complex populations such as ADRD patients. Future research should address the outcomes of these clinics by exploring patient and family caregiver experiences with specialized teams, as it is important to gain their experiences to enhance the care practices for these individuals.

As polÃticas pÃblicas de saÃde na Ãrea materno-infantil tÃm como foco principal a atenÃÃointegral Ãs mulheres durante o ciclo gravÃdico-puerperal e à crianÃa no primeiro ano de vida, visando garantir a saÃde da gestante e da crianÃa, alÃm de prevenir a morte materna e/ouinfantil. As aÃÃes de saÃde nesta Ãrea no Brasil tÃm sido priorizadas e apresentaram avanÃos ao longo das Ãltimas dÃcadas. O objetivo deste estudo foi analisar a partir do Sistema deInformaÃÃo da AtenÃÃo BÃsica, a evoluÃÃo da saÃde infantil e das gestantes, nos Ãltimos dez anos em Fortaleza. Trata-se de um estudo observacional, descritivo, com abordagem quantitativa. O estudo foi realizado em Fortaleza, tendo sido a coleta dos dados realizada no perÃodo de 2 a 30 de janeiro de 2012. A populaÃÃo foi composta por crianÃas menores de dois anos e gestantes cadastradas no Sistema de InformaÃÃo da AtenÃÃo BÃsica. Fez-se a anÃlise dos principais indicadores da saÃde materno-infantil, atravÃs de tabelas (apÃndice A) e grÃficos produzidos nos programas Word e Excel do Microsoft Office. No perÃodo analisado, ocorre uma variaÃÃo de 6,7% (2005) a 7,9% (2002 e 2008) para o baixo peso ao nascer. O aumento nos Ãndices de baixo peso ao nascer, a partir de 2006, provavelmente se deve a ampliaÃÃo da cobertura das equipes da estratÃgia saÃde da famÃlia no municÃpio, levando a uma expansÃo no monitoramento deste indicador, atravÃs do registro das equipes de saÃde da famÃlia. No perÃodo analisado, a prevalÃncia das infecÃÃes respiratÃrias agudas foi superior à prevalÃncia da diarreia em crianÃas menores de dois anos. Para a diarreia, a proporÃÃo variou de 6,5% (2010) a 12,75% (2006). Enquanto para as infecÃÃes respiratÃrias agudas houve uma variaÃÃo de 8,9% (2010) a 17,3% (2002). As taxas elevadas de diarrÃia e infecÃÃo respiratÃria aguda em menores de dois anos em Fortaleza, indicam a necessidade de um acompanhmento mais rigoroso para as crianÃas dessa faixa etÃria. Verificou-se um decrÃscimo na taxa de mortalidade infantil a cada ano, tendo o ano de 2002 uma taxa de mortalidade infantil de 22,4 por mil nacidos vivos e chegando ao ano de 2011 com uma taxa de 1,7 por mil nascidos vivos. As trÃs situaÃÃes que foram avaliadas em relaÃÃo Ãs gestantes acompanhadas pelas equipes de saÃde da famÃlia, permitem inferir que o atendimento as gestantes deve passar por melhorias e qualificaÃÃo profissional. A captaÃÃo precoce das gestantes deve ser intensificada, para que as mesmas compareÃam à consulta de prÃ-natal e para que o inÃcio deste ocorra o mais precocemente possÃvel, e as vacinas sejam aplicadas em tempo hÃbil. O estudo permitiu realizar uma anÃlise da situaÃÃo de saÃde das crianÃas e das gestantes nos Ãltimos dez anos em Fortaleza, podendo contribuir para que as equipes da estratÃgia saÃde da famÃlia possam refletir sobre a necessidade de mudanÃas e de melhor planejar as intervenÃÃes no territÃrio adscrito sob sua responsabilidade sanitÃria. / The public health policies on maternal infant health have mainly focused on comprehensive care to women during the pregnancy and puerperal cycle and also to the child in the first year of life. This is done in order to ensure the health of the mother and also the child so that to prevent maternal deaths and / or child. Health actions in this area in Brazil have been prioritized and have presented advances over the past decades. The objective of this study is to analyze the health situation of children and women in the last ten years in Fortaleza based on the Information provided by the System of Primary Care. This is an observational descriptive study with a quantitative approach. The study was conducted in Fortaleza. The data collection happened from January 2nd to 30th, 2012. The population consisted of children under two years old, and pregnant women enrolled in the Information System of Primary Care. It was done an analysis of key indicators of maternal and infant health, through tables(Appendix A) and graphs produced in Word and Excel programs of Microsoft Office. Over the analysed period, there is a variation of 6.7% (2005) to 7.9% (2002 and 2008) to low weight birth. The increase in rates of low weight birth since 2006, probably occured due to the increased number of teams of strategy family health care in the city leading to an expansion of the monitoring of this indicator, through registration done by the family health teams. Over this period, the prevalence of acute respiratory infections was higher than the prevalence of diarrhea in children under two years. For diarrhea, the proportion ranged from 6.5% (2010) to 12.75% (2006). As for acute respiratory infections there was a variation from 8.9% (2010) to 17.3% (2002). The high rates of diarrhea and acute respiratory infections in children under two years in Fortaleza, indicate the need for a more rigorous monitoring for this age group. There was a decrease in infant mortality rate each year and the year 2002 had an infant mortality rate of 22.4 per thousand born alive and reaching the year 2011 a rate of 1.7 per thousand live births. The three situations that were evaluated in relation to pregnant women accompanied by family health teams, allow us to infer that the care of pregnant women should be improved and and have a better professional qualification. The early uptake of pregnant women must be intensified so that pregnant women attend the prenatal appointments and the start of prenatal care occurs as early as possible, and vaccines are applied in a timely manner. The study allowed us an analysis of the health situation of children and pregnant women in Fortaleza over the last ten years, contributing to the family health teams strategy in order to prepare adequately the planning of interventions in the territory under their sanytary responsibility.

The focus of this study was to explore how Clinical Psychologists narrate their experience of relatedness within a multi-disciplinary team. Mental health services in the UK are facing increased financial pressure and a necessity for all professionals to justify their role. In this context value often appears to be placed on the cheapest way of providing individual, independent care for clients rather than on the relational value of job satisfaction, joint working and therapeutic relationships. The aim of this study was to explore the experience of Clinical Psychologists and through this contribute to thinking around collaborative and interdisciplinary working. This study was guided by eight individual semi-structured interviews which were conducted with Clinical Psychologists who work in Multi-Disciplinary working age adult Community Mental Health Teams and explored using Narrative Analysis. The participants consisted of seven females and one male who had been qualified between three and fifteen years and were working at various pay bands between 7 and 8c. Four relational narratives were found. These were connections to the self of the psychologist, connections to clients, connections with colleagues and connections with the system. The first relational aspect was how the Clinical Psychologists in this study storied their ability to remain connected to their own humanity and their personal values within the context of their Multi-Disciplinary Teams. The second level involved the stories about relationships and connections with clients, particularly thinking about the perceived impact and consequences of the other relational levels for the clients and their safety. The third relational aspect was the stories that Clinical Psychologists told about their sense of relatedness to their colleagues within their teams and the importance of having time available for this. Finally, the fourth level, which was evident within all the other relationships, was of the impact of the wider system and context. These stories emerged from the analysis process with the understanding that the interviews were co-constructed and represented multiple voices. This study confirmed that despite a history of both research and legislation highlighting the benefits and values of inter-professional working and compassion the reality remains elusive. To achieve these aims there needs to be a shift in focus from short-term planning evaluating efficiency in relation only to perceived financial value, to thinking more widely and long-term about relational value. There is a need for investment and recognition of the aspects of team working that are less easy to quantify financially. Further research could explore the experience of other professional groups within CMHTs, and other MDTs, and of clients. This would give a voice to individuals who did not have an explicit voice in this research.

Made available in DSpace on 2014-12-17T13:53:16Z (GMT). No. of bitstreams: 1 EvelinCAR.pdf: 567410 bytes, checksum: b7c0c3cd63ebc68e2668e5484e00e43d (MD5) Previous issue date: 2007-08-31 / The inclusion of the dentist in the Family Health Program (FHP) teams designates a reorganization of the mouth health care in your country and establishes a new scenario in Brazilian odontology, through of a new way to organize the basic health care, creating conditions to consolidate in mouth health practice actions, in the level of the basic attention, the validation of Unique Health System (UHS) constitutional principles. The purpose of this research is to verify if the actuation of mouth health teams (MHT) dentists, in Natal city north sanitary district, is tuned with FHP goals.The target research population was composed by all dentists working in Basic Health Units (BHU) of Natal north sanitary district. Fifth-eight questionnaires were applied and using open and closed questions we look for identify the functional characteristics of each BHU, the dentists professional attributions on each BHU, as well as the clinical procedures that they execute. This research also searched to identify the factors that facilitate and/or difficult the inclusion process and the dentists activities performance on these BHUs, as well as the necessary actions to north sanitary district MHTs to fulfill the objectives proposed by FHP. The results point that the inclusion of mouth health actions in north sanitary district FHPs brought the incorporation of new values to the used practices. Whoever, its necessary a more frequent evaluation of the carried actions, in a way they can be adapted to the real community necessities, and, is fundamental the data accompaniment, for that these serve of base for planning and redirecting activities, in a way that we do not have only a reproduction of traditional practices, fragmented and isolated, but a truly substitution of the traditional practices and a new way of promoting health / A inclus?o do dentista nas equipes do Programa de Sa?de da Fam?lia (PSF) assinala uma reorganiza??o da aten??o ? sa?de bucal em nosso pa?s e estabelece um novo cen?rio na odontologia brasileira, atrav?s de uma nova forma de organizar a aten??o b?sica ? sa?de, criando condi??es para consolidar nas a??es da pr?tica em sa?de bucal, no n?vel da aten??o b?sica, a valida??o dos princ?pios constitucionais do SUS. O objetivo deste estudo ? verificar se a atua??o dos dentistas nas Equipes de Sa?de Bucal (ESB) do Distrito Sanit?rio Norte do Munic?pio de Natal RN, est? em sintonia com as diretrizes do PSF. A popula??o integrante da pesquisa foi composta por todos os dentistas lotados nas Unidades B?sicas de Sa?de (UBS) do Distrito Sanit?rio Norte de Natal-RN. Foram aplicados 58 question?rios e atrav?s de perguntas fechadas e abertas procurou-se identificar as caracter?sticas operacionais de funcionamento de cada UBS, as atribui??es profissionais dos dentistas em cada UBS e os procedimentos cl?nicos executados pelos mesmos. Esse instrumento procurou tamb?m identificar os fatores que facilitam e/ou dificultam o processo de inclus?o e o desempenho das atividades dos dentistas nessas UBS, bem como a??es necess?rias para que as ESB do Distrito Sanit?rio Norte cumpram os objetivos previstos pelo PSF. Os resultados encontrados apontam que a inclus?o das a??es de sa?de bucal no PSF do Distrito Sanit?rio Norte trouxe a incorpora??o de novos valores ?s pr?ticas exercidas. No entanto, ? preciso que haja uma avalia??o mais freq?ente das a??es realizadas, de modo que essas sejam adaptadas ?s reais necessidades da comunidade, e ainda, ? fundamental o acompanhamento dos dados, para que esses sirvam de base para o planejamento e redirecionamento das atividades afim de que n?o se tenha apenas uma reprodu??o de pr?ticas tradicionais, fragmentadas e isoladas, mas uma verdadeira substitui??o das pr?ticas tradicionais exercidas e um novo jeito de se fazer sa?de

Bakgrund: Tusentals kvinnor och flickor mördas årligen på grund av heder internationellt och det är oftast av manliga släktingar för att återta hedern för familjen. Socialstyrelsen beskriver hedersrelaterat våld en kränkning av de mänskliga rättigheterna. Elevhälsoteamet på skolan har ett ansvar att identifiera barn som far illa eller som är i riskzon. Hederskultur bland flickor i grundskolan kan utmärka sig på olika sätt, det kan uppstå situationer där flickor inte får deltaga i olika aktiviteter i skolan på grund av att de blivit tillsagda av sina föräldrar att de inte får, simundervisning är vanligt förekommande exempel. Skolsköterskan har en betydelsefull roll i att via hälsosamtalet kunna identifiera flickor som lever i en hederskultur och ge stöttning och vägledning. Syfte: var att beskriva skolsköterskans erfarenheter av att möta flickor i grundskolan som lever i en hederskultur. Metod: Studien är en empirisk studie utifrån en kvalitativ design med induktiv ansats. Semistrukturerade intervjuer genomfördes där totalt sex stycken deltagare intervjuades. Datainsamlingen analyserades utifrån en kvalitativ innehållsanalys. Resultat: Resultatet visade att hälsosamtalet är ett viktigt verktyg för att kunna identifiera flickor som lever i en hederskultur. Att ge stöttning till flickorna i skolan som lever i en hederskultur är viktigt och kunde innebära tjejgrupper, där flickorna fick möjlighet att diskutera om normer och värderingar kopplat till hederskultur. Samarbete med hela elevhälsoteamet, lärare och socialtjänst framkom vara viktigt och ett måste för att kunna arbeta hälsofrämjande. Slutsats: För att kunna hjälpa flickor i grundskolan som lever i en hederskultur krävs det att samtliga professioner i skolan erhåller utbildning inom ämnet. Med ett fungerade samarbete kan flickorna tidigt identifieras och erbjudas stöttning och vägledning. Författarna anser att vidare forskning behöver tillämpas inom området. / Background: Thousands of women and girls are murdered every year because of honor, it is often by male relatives to regain the honor of family. The National Board of Health and Welfare describes honor-related violence violations of human rights. The student health team at the school has a responsibility to identify children who are doing badly or who are at risk. Honor culture among girls in primary school can be distinguished in different ways, there may be situations where girls are not allowed to participate in different activities in school due to being told by their parents that they are not allowed, swimming lessons are common examples. The school nurse has an important role in being able to identify girls who live in an honor culture through the health conversation and provide support and guidance. Aim: The aim was to describe the school nurse's experiences of meeting girls in primary school who live in an honor culture. Method: The study was an empirical study based on and qualitative design with an inductive approach. Semi-structured interviews were conducted where a total of six participants were interviewed. The data collection was analyzed on the basis of a qualitative content analysis. Results: The results showed that the health conversation is an important tool for being able to identify girls who live in a culture of honor. Giving support to the girls in the school who live in an honor culture is important and could involve girl groups,where the girls had the opportunity to discuss norms and values linked to honor culture. Cooperation with the entire student health team, teachers and social services emerged to be important and a must in order to be able to work to promote health. Conclusion: In order to be able to help girls in elementary school who live in an honor culture, it is required that all professions in the school receive education on the subject. By a working collaboration, the girls can be identified early and offered support and guidance. The authors believe that further research needs to be applied in this area.

Vår studie syftar till att undersöka vilken upplevd roll några studie- och yrkesvägledare har eller skulle kunna ha i elevhälsoteam. Vi har genomfört kvalitativa intervjuer med sex olika informanter, fyra studie- och yrkesvägledare och två elevhälsoteamansvariga och tittat på deras erfarenheter och åsikter kring studie- och yrkesvägledarnas roll i elevhälsoteam. Våra forskningsfrågor är: Hur ser studie- och yrkesvägledarnas roll ut och hur används dennes kompetenser i elevhälsoteamens arbete? Hur ser de elevhälsoteams-ansvariga på studie- och yrkesvägledarens roll och kompetenser i elevhälsoteamen? Hur upplever studie- och yrkesvägledarna och de EHT-ansvariga samarbetet mellan studie- och yrkesvägledarna och övriga professioner i elevhälsoteamen? Resultatet visar att samtliga av studiens informanter är eniga om att studie- och yrkesvägledare ska ingå i elevhälsan. Det framkommer att studie- och yrkesvägledare besitter kompetenser som ingen annan i elevhälsoteam har, om bland annat utbildningsvägar, skolgångar och samtalsfärdigheter. Vidare framkommer det att det tvärprofessionella samarbetet i elevhälsan visar sig både ha för- och nackdelar. / Our study aims to explore what experienced role some school counselors have or could have in school-health teams. We have explored this through qualitative interviews with six different informants, four school counselors and two leaders of school-health teams. We have examined their experiences and opinions about the school counselor’s role in school- health teams. Our research questions are: How does the school counselor’s role look like and how are their competencies being used in school-health teams? How does leaders of school-health teams see the school counselor’s role and competencies in the work done by school-health teams? How does the school counselor and the leader of the school-health teams experience the cooperation between the school counselor and the other members of the school-health team? The results show that all our informants agree that the school counselor should be a part of the school-health team. They also agree that the school counselor have competencies that no other member of the school-health team have, including knowledge about educational routes, schooling, and conversation methodology. Furthermore, our study shows that the interprofessional cooperation in the school-health team prove to have both pros and cons.

Chronic pain is usually defined as pain of more than three months duration. The prevalence of chronic pain among the general population in Sweden is 18%. Compared with the general population, these patients report lower life satisfaction, decreased activity in daily life and higher levels of depression with decreased work ability, and increased sick leave. Research indicates that multimodal rehabilitation (MMR) programmes, including cognitive behavioural approaches for patients disabled by chronic pain, are effective for return to work. The primary aim of this thesis was to assess outcomes by a long-term follow-up of patients with chronic musculoskeletal pain. Furthermore, the aim was to evaluate two different rehabilitation strategies regarding impact on pain intensity, activity, depression, life satisfactions, and sick leave. Two groups, comprising 255 (between the years 1999-2002) and 296 (between 2007-2008) patients respectively, from the Pain Rehabilitation Clinic at Umeå University Hospital, Sweden, were all assessed by interdisciplinary teams. They completed questionnaires regarding pain intensity, disability, life satisfaction, anxiety and depression, and sick leave, before intervention, immediately after intervention (only the first group; n=255), and at one-year follow-up, after participating in a MMR programme in a specialist clinic, or after receiving a rehabilitation plan (RP) with follow-up in primary care. Allocation to either of the two groups was based on the initial interdisciplinary team assessment. Furthermore, a five-year follow-up of 158 patients with whiplash injury was conducted. Pain intensity decreased and life satisfaction increased significantly regarding somatic health in both groups, at follow-up. In addition, depression improved and disability decreased to a higher extent after participating in the MMR programme as compared to RP and subsequent follow-up in primary care. Patients’ positive beliefs about recovery, and positive expectations about work correlated with favourable rehabilitation outcomes. Sick leave at one year follow-up decreased in both groups. Regarding whiplash injury, patients who reported moderate or severe disability also reported significantly higher pain intensity, depression and post-traumatic stress scores and lower perception of general health compared with patients who reported mild or no disability. In conclusion, MMR programmes seem to be beneficial by decreasing pain intensity, depression, disability and sick leave among patients with chronic musculoskeletal pain. Furthermore, patients’ positive beliefs correlate with more favourable long-term outcomes. An interdisciplinary team assessment based on a biopsychosocial approach may be of value for selection of rehabilitation strategy.

Tidigare forskning visar att det finns brister i den samsyn och samverkan mellan skolpersonal som är en framgångsfaktor för hög måluppfyllelse i grundskolan (Nilholm & Göransson, 2013; SOU 2010:95; www.skolinspektionen.se; m fl). Mentorer, lokala elevhälsoteam och skolledare är de aktörer som ansvarar för utbildningen till elever med olika förutsättningar. Graden av samsyn dessa aktörer emellan är därför intressant. Denna studies syfte har varit att identifiera och beskriva eventuella mönster i mentorers, lokala elevhälsoteams och skolledares uppfattningar om extra anpassningar och särskilt stöd, utifrån frågeställningar om anledningar till olika insatser, vem/vilka som ska ansvara för insatserna samt om orsaker till bristande insatser. En totalundersökning i en kommun har genomförts via webbenkät och kvantitativ multivariat analys. Utgångspunkterna har varit socialkonstruktivistisk teori om ett kontextberoende lärande tillsammans med andra, och ett relationellt perspektiv på skolsvårigheter.  Studien visar att störst samsyn finns kring det faktum att inte alla elever med behov ges tillräckligt stöd i skolorna, och att tid för arbete för dessa elever saknas i personalens scheman. Viss samsyn finns också angående när elever ska ges stöd, men i mindre grad gällande vem/vilka som ska utföra insatserna. Studien har också visat att en relativt stor andel av respondenterna upplever bristande samsyn med kollegor gällande att se/tolka behov hos elever, avgöra lämpliga åtgärder samt utföra åtgärderna, samtidigt som alla tre grupperna i hög grad är överens om att de själva sällan eller aldrig har bristande kompetens gällande just att tolka behov och avgöra/utforma åtgärder.  Resultaten visar att samsyn och samverkan behöver vidareutvecklas inom skolorna via strategiska kontaktytor. Utifrån resultaten och teorin bör samtalen handla om uppdragsuppfattning, elevsyn och gemensamma strategier för ökad inkludering, delaktighet och måluppfyllelse. / Previous research shows that there are shortcomings in the consensus and collaboration among school personnel, a success factor for high achievement in primary school (Nilholm & Göransson, 2013; SOU 2010:95; www.skolinspektionen.se; m fl). Mentors, local student health teams and school leaders are those responsible for the education of students with different qualifications. The degree of consensus between these actors is therefore interesting. The purpose of this study has been to identify and describe any patterns of mentors' , local student health teams' and school leaders' perceptions about additional adjustments and special support, based on the questions of reasons for different actions, who/which is responsible for action and reasons for lack of action.  A total survey in a municipality has been conducted via online questionnaire and quantitative multivariate analysis. The starting point has been the social constructivist theory of context-dependent learning with others, and a relational perspective on school difficulties.    The study shows that the greatest consensus is about the fact that not all students in need are given sufficient support, and that time to work for these students is lacking in staff schedules. Some consensus is also about which students should receive support, but less so regarding which staff should perform it. The study has also shown that a relatively large proportion of respondents perceive lack of consensus with colleagues regarding interpreting the needs of pupils, determining appropriate actions and bringing them into action, while all three groups largely agree that themselves rarely or never lack of expertise regarding just that;  interpreting the needs and determining/performing measures.   The results show that consensus and collaboration need to be developed within schools through strategic contacts. Based on the results and theory, the discourse should be about assignment, perception of difficulties and concerted strategies for greater inclusion, participation and achievement.