The experience of pregnancy and childbirth is a central life event with special implications for women at high risk. This thesis describes the meaning of pregnancy, childbirth and midwifery care in four qualitative interview studies based on the lifeworld theory. Women were interviewed during pregnancy and within one week after childbirth. Midwives were interviewed concerning midwifery care for women at high risk. In an intervention study, childbirth experience as reported through a post partum questionnaire was compared between women receiving standard care and women who had formulated a birth plan preceded by a questionnaire on their expectations and feelings about childbirth. The findings emphasise that childbearing women at high risk live in an extremely vulnerable situation. The vulnerability is obvious in the use of an individual birth plan, where negative feelings become more frequent in women at high risk than in those with normal pregnancy and childbirth. During pregnancy the women feel a moral commitment towards the child, including feelings of objectification and of exaggerated responsibility. During an obstetrically complicated childbirth the essential meaning is the women’s desire to be recognised and affirmed as individual persons. Like women with normal pregnancy and childbirth, they need an emotionally present midwife who sees, give trust and supports. Good midwifery care of childbearing women at high risk is synthesised as "genuine caring in caring for the genuine". The ethos of caring constitutes the basis of caring. Women’s transition during pregnancy and childbirth is described as a genuinely natural process. Midwives have a special responsibility to encourage and preserve this process within women at high risk. The caring relationship is the core and the most essential tool in the care. Distinctive features in the midwifery care are embodied knowledge, physical as well as emotional presence, sensitivity, a mutual dialogue including shared control between midwife and woman, and confirmation and support of the genuine in each woman. The midwifery care is a struggle and a balance between natural and medical perspectives.

In a large population-based study among adults in northern Europe the relation between occupational exposure and new-onset asthma was studied. The study comprised 13 284 subjects born between 1945 and 1973, who answered a questionnaire 19891992 and again 19992001. Asthma was defined as Asthma diagnosed by a physician with reported year of diagnose. Hazard ratios (HR), for new-onset adult asthma during 19802000, were calculated using a modified job-exposure matrix as well as high-risk occupations in Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. During the observation period there were 429 subjects with new-onset asthma with an asthma incidence of 1.3 cases per 1000 person-years for men and 2.4 for women. A significant increase in new-onset asthma was seen for men exposed to plant-associated antigens (HR 3.6; 95% CI [confidence interval] 1.49.0), epoxy (HR 2.4; 95% CI 1.34.5), diisocyanates (HR 2.1; 95% CI 1.23.7) and accidental peak exposures to irritants (HR 2.4; 95% CI 1.34.7). Both men and women exposed to cleaning agents had an increased asthma risk. When stratifying for atopy an increased asthma risk were seen in non-atopic men exposed to acrylates (HR 3.3; 95% CI 1.47.5), epoxy compounds (HR 3.6; 95% CI 1.67.9), diisocyanates and accidental peak exposures to irritants (HR 3.0; 95% CI 1.27.2). Population attributable risk for occupational asthma was 14% for men and 7% for women. This population-based study showed that men exposed to epoxy, diisocyanates and acrylates had an increased risk of new-onset asthma. Non-atopics seemed to be at higher risk than atopics, except for exposure to high molecular weight agents. Increased asthma risks among cleaners, spray painters, plumbers, and hairdressers were confirmed.

The term criminal career is used to describe the course or progress of criminal activity: its onset, duration, termination, severity, and change in severity. Such a term has important implications, given that significant criminal justice, social, and health policies such as crime control, parole, and correctional treatment and management are predicated on achieving the reduction of criminal careers of serious, repeat offenders. Despite its conceptual simplicity, however, criminal career is often treated as having no depth or scope, for example, merely as the number of crimes or length of prison sentence. These indices often give no or little consideration to criminal career parameters and tend to account for only a small portion of the construct of criminal careers. Ideally, a simple metric to measure the onset, duration, termination, severity, and change in severity of a pattern of criminal activities is needed to facilitate the description and measurement of criminal careers of offenders. <p>The Criminal Career Profile (CCP), which uses commonly available criminological information and requires minimal professional skills to execute, can be considered a simple and precise measure of criminal careers. The CCP is a chronological representation on a Cartesian plane of the time in years an offender has spent in prison (y-axis) plotted against the time in years spent out of prison (x-axis) of all incarcerations and time spent in the community. Given that the CCP is a step function, a regression line can be generated. Serious crimes are generally given longer sentences, and more time in than out of prison would generate a steeper regression line. Shallower regression lines result from less time in than out of prison. As such, the CCP regression line can be considered an indication of the seriousness of offending, and the slope or angle of the regression line can be considered a quantitative index of criminal career severity. Larger slopes or angles (used in this Program of Research) suggest more serious criminal careers. Conversely, smaller slopes or angles suggest less serous criminal careers. Taken altogether, the CCP can provide a quantitative measure of criminal careers: its onset (age at first conviction, which is plotted as the first point on a CCP graph), duration (total time in and out of prison since onset), severity (CCP slope/angle), change in severity (change in CCP slope/angle), and termination (end point or when the CCP slope or angle becomes smaller and closer to 0).<p>This Program of Research was done to assess the CCPs validity and utility in measuring offenders criminal career. More specifically, the investigation focused on the seriousness of criminal careers. A number of criteria were used to validate the CCP angles ability to measure criminal career severity. In Study 1, psychopaths and violent recidivists showed a significantly larger CCP angle than nonpsychopaths and violent nonrecidivists, respectively. Finer groupings based on risk (high, medium, and low), a number of risk measures (Psychopathy Checklist Revised, Violence Risk Scale, and Violence Risk Scale Sexual Offender Version), and different types of offenders (i.e. violent, nonviolent, sexual, Dangerous Offenders) were used in Study 2. Two consistent findings across different groups of offenders in Study 2 were CCP angles significantly varied as a function of risk group and correlated with risk ratings. The pattern of results was that larger CCP angles tended to be associated with worse risk groups. In Study 3, both treated offenders and treatment dropouts showed a reduction in CCP angles from pre- to post-treatment. A nonsignificant interaction of group by treatment, however, suggests that post-treatment changes could not be attributed to treatment. Finally, Study 4 showed that CCP angles change with age. Taken altogether, the results of the four studies provided converging evidence for the validity of the CCP as a measure of criminal careers and the CCP angle as a measure of criminal career severity.

Attendre un enfant est généralement un événement heureux pour un couple. Toutefois, lorsqu’une hospitalisation de la femme survient en raison d’une grossesse à risque élevé, l’expérience des futurs parents peut se transformer en véritable cauchemar. Jusqu’à maintenant, les savoirs disponibles suggèrent que cet événement imprévu ait de nombreux impacts sur les futurs parents. Néanmoins, ce sujet n’a été abordé que selon une perspective maternelle ou paternelle, sans s’intéresser au caractère systémique de la situation. Cette étude qualitative de cas multiples propose d’explorer l’expérience de couples vivant l’hospitalisation de la femme en raison d’une grossesse à risque élevé, dans une perspective systémique et constructiviste. Des entrevues semi-dirigées ont été réalisées auprès de 7 couples dont la femme était, au moment de l’entrevue, hospitalisée en raison d’une grossesse à risque élevé. L’analyse qualitative des données s’est inspirée de la thématisation et a tenu compte des cadres théoriques et épistémologique choisis, étant respectivement l’approche systémique familiale de Wright et Leahey (2013) et le constructivisme. Les résultats suggèrent que l’hospitalisation est marquée par l’intensité des émotions ressenties. Les futurs parents ressentent presque constamment des sentiments d’inquiétude, d’incertitude et de solitude. Il est toutefois intéressant de constater que le couple lui-même subit des changements au cours de l’hospitalisation. En ce sens, cet événement requiert une immense réorganisation, laquelle touche plusieurs systèmes gravitant autour du système conjugal. Enfin, afin de faire face à l’intensité et à l’imprévisibilité de la situation, les couples sont amenés à solliciter un soutien externe et à puiser dans leurs propres ressources internes. En lien avec les cadres théoriques et épistémologiques choisis, ces résultats conviennent de la nécessité d’adopter une vision systémique et contextuelle afin de développer des soins infirmiers concordants avec l’expérience des couples. Cela ramène à la nécessité de réaliser d’autres études afin de perfectionner la compréhension de l’expérience. Certaines pistes d’interventions infirmières sont néanmoins énoncées, afin d’amener les infirmières à considérer la situation du point de vue de l’expérience conjugale, dont les défis de réorganisations extérieurs et des relations conjugales. Enfin, il est proposé que l’infirmière puisse agir afin de renforcer la capacité des couples à composer avec les conséquences de l’hospitalisation anténatale. / Planning to have a child is most of the time a joyful event for a couple. However, the same event might becomes a real nightmare when the woman is hospitalized because of an at high risk pregnancy. To date, researches exploring this abrupt event have suggested that it may conduct to numerous impacts on future parents. Even though, the subject has only been explored using a maternal or paternal perspective, without considering the systemic aspect of the situation. This qualitative multiple case study suggests to explore the couples’ experience regarding the hospitalization of the woman because of an at high risk pregnancy, in a systemic and constructivist approach. Semi-directed interviews have been conducted with seven couples with a woman hospitalized because of an at high risk pregnancy, at the moment of the interview. Qualitative data analysis was inspired of thematization and took into account the theoretical and epistemological approach, respectively the Wright and Leahey (2013) family approach and constructivism. Results suggest the hospitalization is touched by intense emotions, such as feeling almost all the time worries, uncertainties and loneliness. It is however interesting to note that even the couple himself is touched by changes resulting of the hospitalization. According to that, this event requires a huge reorganization, which implies loads of systems gravitating around the couple’s system. Lastly, in order to face the intensity and the unpredictability of the situation, couples are asking for external support, while using their own internal resources. Concerning the theoretical and epistemological approach chosen to realize this study, results confirm the necessity of adopting a systemic and contextual vision in order to develop nursing cares appropriate with couples’ experience. Besides, it becomes essential to duplicate this type of study to perfection the actual comprehension of the event. However, nursing interventions relating to the external reorganization and the couple relation reorganization are proposed, in order to reinforce nurses’ consideration of the couple’s experience. Only then, it is suggested that nurses can influence couples’ capacity to face the consequences of the antenatal hospitalization.

<p>The main sources of teacher stress stem from difficulty in maintaining classroom discipline, time pressures, workload demands, excessive change, being evaluated by others, challenging relationships with colleagues and poor working conditions. This study therefore highlights the significant relationship between occupational stressors and the stress experienced by teachers at high risk secondary schools in the Western Cape. Occupational stress is related to job satisfaction, job overload and job control. The coping strategies of teachers at high risk secondary schools are explored. The results indicate that there were no significant relationships between teacher stress and job satisfaction, job overload and job control at high risk secondary schools in the Western Cape. Job satisfaction however, showed an inverse, albeit not significant relationship to teacher stress. Furthermore, male and female teachers respond differently to these occupational stressors. Females were more prone to the experience of stress than males. The recommendations are based on the conclusions drawn from the study. In conclusion, occupational stress is considered a major source of stress for teachers, which needs to be addressed more vigorously at high risk secondary schools in the Western Cape.</p>

This research involves the exploration of the potential, as well as the problems, of early adolescents’ relationships in the context of the school-and-home in a high-risk community in South Africa. Although researchers indicate that school performance and academic success is of key importance concerning positive youth development (You & Nguen, 2011), many South African adolescents are still part of the high incidence of repeating greades and drop-out statictics in this country (Louw, Bayat & Eigelaar-Meets, 2011). This study highlights one of the factors for school success, namely, the involvement of primary care givers in the school community. There is a need to explore adolescents’ perceptions of their primary care givers’ involvement in the school community, within the context of a high-risk South African community, since research within Positive Psychology also explores those resources which promote wellbeing and resilient coping. This study made use of the qualitative method and the results have been presented in an article format, as part of the dissertation. The aim of the article was to explore early adolescents’ perceptions of their primary care-givers’ involvement in the school community in a high-risk community. Participants (N=12) between the ages of twelve to fourteen years, from one school in the Delft Community, Cape Peninsula, were chosen in an un-biased fashion. The Delft community is one of the twenty identified high-risk communities in South Africa. Demographic information shows that the majority of the participants’ care-givers are not the biological parents. The findings indicate that early adolescents percieve their primary caregivers’ involvement in the school community, in a high-risk community, in the following ways: The meeting of basic needs, such as the provision of food, clothing and a home is essential for the adolescent’s school career; the emotional colour of the involvement of care givers is mostly negative, since school visitations involve the handling of problems, or the prevention of further problems; the early adolescent’s understanding of school success greatly matches that of his/her primary care- givers and is seen mostly in terms of either “pass” or “fail”; and early adolescents’ school careers and primary care-givers’ involvement within the context of a high-risk community involve experiences such as the exposure to continued poverty with various implications such as hunger, walking to school in an unsafe environment, as well as gang-violence, crime and substance abuse. This study shows that, besides the challenges that are associated with the adolescent life-phase, early adolescents also have to deal with various other problems that emanate from a high-risk community. These problems are generally matters of survival, and it is clear that these risks further strain well-being and the development thereof. Poor involvement of primary caregivers in the school community is one of the realities which early adolescents in a high-risk community have to deal with, and this poor involvement is indicative of not providing life essentials, as well as personal interest and encouragement. It is further the experience of negative emotions, such as fear in general and the “scared-ness” indicates adolescents’ fear for their own safety, as well as that of their friends and family. The participants in this study have all been affected directly and/or indirectly by the trauma of gang violence and the untimely death of a family member. In the midst of these challenges, the primary caregivers are mostly uninvolved in these vulnerable adolescents’ lives. Primary care-givers visit the school community mainly when they are summoned to handle “problems”. Primary care-givers generally have a negative association with the school community. The less negative experience of emotions indicates the absence of serious problems, such as the not-completion of school work. The scarce occurrence of positive emotions, such as primary care-givers that show compassion with early adolescents when they experience disappointment, is actually part of the participants’ experiences. The primary care- givers’ active helping with the early adolescents’ school tasks is uncommon and it is mostly focused on the prevention of the repetition of school grades. The presence of a family member (extended family) with school meetings has great value for the early adolescents’ perception of family as a protective factor for the well-being of the young person. This study presents an important contribution to Positive Psychology, as valuable information is presented to understand the early adolescent’s well-being and the context thereof. The specific descriptions of early adolescents’ perceptions of the involvement of their primary care-givers in the school community provide a description of the potential which can be unlocked in school-and-life choices. Findings have implications for policies regarding the promotion of well-being. Recommendations for further study are given. Possibilities for application includes the importance of the ecological impact and of partnerships, so that problems and the development of well-being can be addressed by primary care givers, school communities, faith communities, NGOs and universities. / MA (Psychology), North-West University, Potchefstroom Campus, 2014

This thesis is concerned with the application of recently developed epidemiological and statistical tools to inform the optimisation of a national surveillance strategy of considerable importance to human health. The results of a series of epidemiological investigations of surveillance strategies for zoonotic Salmonella are presented. Salmonella are one of the most common and serious zoonotic foodborne pathogenic bacteria globally. These studies were motivated by the increasing focus on the cost-effectiveness of surveillance while maintaining consumer confidence in food supply. Although data from the Danish Salmonella surveillance and control programme has been used in these investigations, the techniques may be readily applied to other surveillance data of similar quality. The first study describes the spatial epidemiological features of Danish Salmonella surveillance and control programme data from 1995 to 2004, using a novel method of spatially adaptive smoothing. The conditional probability of a farm being a case was consistently high in the the south-west of Sonderjylland on the Jutland peninsula, identifying this area for further investigation and targeted surveillance. The identification of clustering of case farms led into the next study, which closely examines one year of data, 2003, for patterns of spatial dependency. K-function analyses provided evidence for aggregation of Salmonella case farms over that of all farms at distances of up to six kilometres. Visual semivariogram analyses of random farm-level effects from a Bayesian logistic regression model (adjusted for herd size) of Salmonella seropositivity, revealed spatial dependency between pairs of farms up to a distance of four kilometres apart. The strength of the spatial dependency was positively associated with slaughter pig farm density. We describe how this might inform the surveillance programme by potentially targeting herds within a four kilometre radius of those with high levels of Salmonella infection. In the third study, farm location details, routinely recorded surveillance information, and industry survey data from 1995 were combined to build a logistic seroprevalence model. This identified wet-feeding and specific pathogen free herd health status as protective factors for Salmonella seropositivity, while purchasing feed was a risk factor. Once adjusting for these covariates, we identified pockets of unexplained risk for Salmonella seropositivity and found spatial dependency at distances of up to six km (95% CI: 2–35 km) between farms. A generalised linear spatial model was fitted to the Jutland data allowing formal estimation of the range of spatial correlation and a measure of the uncertainty about it. There was a large within-farm component to the variance, suggesting that gathering more farm level information would be advantageous if this approach was to be used to target surveillance strategy. The fourth study again considers data from the whole study period, 1995 to 2004. A detailed temporal analysis of the data revealed there was no consistent seasonal pattern and correspondingly no benefit in targeting sampling to particular times of the year. Spatiotemporal analyses suggested a local epidemic of increased seroprevalence occured in west Jutland in late 2000. Lorelogram analyses showed a defined period of statistically significant temporal dependency, suggesting that there is little value in sampling more frequently than every 10 weeks on the average farm. The final study uses findings from the preceding chapters to develop a zero-inflated binomial model which predicts which farms are most at risk of Salmonella, and then preferentially samples these high-risk farms. This type of modelling allows assessment of similarities and differences between factors that affect herd infection status (introduction) and those that affect the seroprevalence in infected herds (persistence and spread). The model suggested that many of the herds where Salmonella was not detected were infected but at a low prevalence. Using cost and sensitivity, we compared the results with those under the standard sampling scheme based on herd size, and the recently introduced risk-based approach. Model based results were less sensitive, but showed significant cost savings. Further model refinements, sampling schemes, and the methods to evaluate their performance are important areas for future work, and should continue to occur in direct consultation with Danish authorities.

This thesis is concerned with the application of recently developed epidemiological and statistical tools to inform the optimisation of a national surveillance strategy of considerable importance to human health. The results of a series of epidemiological investigations of surveillance strategies for zoonotic Salmonella are presented. Salmonella are one of the most common and serious zoonotic foodborne pathogenic bacteria globally. These studies were motivated by the increasing focus on the cost-effectiveness of surveillance while maintaining consumer confidence in food supply. Although data from the Danish Salmonella surveillance and control programme has been used in these investigations, the techniques may be readily applied to other surveillance data of similar quality. The first study describes the spatial epidemiological features of Danish Salmonella surveillance and control programme data from 1995 to 2004, using a novel method of spatially adaptive smoothing. The conditional probability of a farm being a case was consistently high in the the south-west of Sonderjylland on the Jutland peninsula, identifying this area for further investigation and targeted surveillance. The identification of clustering of case farms led into the next study, which closely examines one year of data, 2003, for patterns of spatial dependency. K-function analyses provided evidence for aggregation of Salmonella case farms over that of all farms at distances of up to six kilometres. Visual semivariogram analyses of random farm-level effects from a Bayesian logistic regression model (adjusted for herd size) of Salmonella seropositivity, revealed spatial dependency between pairs of farms up to a distance of four kilometres apart. The strength of the spatial dependency was positively associated with slaughter pig farm density. We describe how this might inform the surveillance programme by potentially targeting herds within a four kilometre radius of those with high levels of Salmonella infection. In the third study, farm location details, routinely recorded surveillance information, and industry survey data from 1995 were combined to build a logistic seroprevalence model. This identified wet-feeding and specific pathogen free herd health status as protective factors for Salmonella seropositivity, while purchasing feed was a risk factor. Once adjusting for these covariates, we identified pockets of unexplained risk for Salmonella seropositivity and found spatial dependency at distances of up to six km (95% CI: 2–35 km) between farms. A generalised linear spatial model was fitted to the Jutland data allowing formal estimation of the range of spatial correlation and a measure of the uncertainty about it. There was a large within-farm component to the variance, suggesting that gathering more farm level information would be advantageous if this approach was to be used to target surveillance strategy. The fourth study again considers data from the whole study period, 1995 to 2004. A detailed temporal analysis of the data revealed there was no consistent seasonal pattern and correspondingly no benefit in targeting sampling to particular times of the year. Spatiotemporal analyses suggested a local epidemic of increased seroprevalence occured in west Jutland in late 2000. Lorelogram analyses showed a defined period of statistically significant temporal dependency, suggesting that there is little value in sampling more frequently than every 10 weeks on the average farm. The final study uses findings from the preceding chapters to develop a zero-inflated binomial model which predicts which farms are most at risk of Salmonella, and then preferentially samples these high-risk farms. This type of modelling allows assessment of similarities and differences between factors that affect herd infection status (introduction) and those that affect the seroprevalence in infected herds (persistence and spread). The model suggested that many of the herds where Salmonella was not detected were infected but at a low prevalence. Using cost and sensitivity, we compared the results with those under the standard sampling scheme based on herd size, and the recently introduced risk-based approach. Model based results were less sensitive, but showed significant cost savings. Further model refinements, sampling schemes, and the methods to evaluate their performance are important areas for future work, and should continue to occur in direct consultation with Danish authorities.

This thesis is concerned with the application of recently developed epidemiological and statistical tools to inform the optimisation of a national surveillance strategy of considerable importance to human health. The results of a series of epidemiological investigations of surveillance strategies for zoonotic Salmonella are presented. Salmonella are one of the most common and serious zoonotic foodborne pathogenic bacteria globally. These studies were motivated by the increasing focus on the cost-effectiveness of surveillance while maintaining consumer confidence in food supply. Although data from the Danish Salmonella surveillance and control programme has been used in these investigations, the techniques may be readily applied to other surveillance data of similar quality. The first study describes the spatial epidemiological features of Danish Salmonella surveillance and control programme data from 1995 to 2004, using a novel method of spatially adaptive smoothing. The conditional probability of a farm being a case was consistently high in the the south-west of Sonderjylland on the Jutland peninsula, identifying this area for further investigation and targeted surveillance. The identification of clustering of case farms led into the next study, which closely examines one year of data, 2003, for patterns of spatial dependency. K-function analyses provided evidence for aggregation of Salmonella case farms over that of all farms at distances of up to six kilometres. Visual semivariogram analyses of random farm-level effects from a Bayesian logistic regression model (adjusted for herd size) of Salmonella seropositivity, revealed spatial dependency between pairs of farms up to a distance of four kilometres apart. The strength of the spatial dependency was positively associated with slaughter pig farm density. We describe how this might inform the surveillance programme by potentially targeting herds within a four kilometre radius of those with high levels of Salmonella infection. In the third study, farm location details, routinely recorded surveillance information, and industry survey data from 1995 were combined to build a logistic seroprevalence model. This identified wet-feeding and specific pathogen free herd health status as protective factors for Salmonella seropositivity, while purchasing feed was a risk factor. Once adjusting for these covariates, we identified pockets of unexplained risk for Salmonella seropositivity and found spatial dependency at distances of up to six km (95% CI: 2–35 km) between farms. A generalised linear spatial model was fitted to the Jutland data allowing formal estimation of the range of spatial correlation and a measure of the uncertainty about it. There was a large within-farm component to the variance, suggesting that gathering more farm level information would be advantageous if this approach was to be used to target surveillance strategy. The fourth study again considers data from the whole study period, 1995 to 2004. A detailed temporal analysis of the data revealed there was no consistent seasonal pattern and correspondingly no benefit in targeting sampling to particular times of the year. Spatiotemporal analyses suggested a local epidemic of increased seroprevalence occured in west Jutland in late 2000. Lorelogram analyses showed a defined period of statistically significant temporal dependency, suggesting that there is little value in sampling more frequently than every 10 weeks on the average farm. The final study uses findings from the preceding chapters to develop a zero-inflated binomial model which predicts which farms are most at risk of Salmonella, and then preferentially samples these high-risk farms. This type of modelling allows assessment of similarities and differences between factors that affect herd infection status (introduction) and those that affect the seroprevalence in infected herds (persistence and spread). The model suggested that many of the herds where Salmonella was not detected were infected but at a low prevalence. Using cost and sensitivity, we compared the results with those under the standard sampling scheme based on herd size, and the recently introduced risk-based approach. Model based results were less sensitive, but showed significant cost savings. Further model refinements, sampling schemes, and the methods to evaluate their performance are important areas for future work, and should continue to occur in direct consultation with Danish authorities.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.