Abstract In Sweden all persons under the age of 18 are considered children. The age when it is possible to be held responsible for a criminal act, and therefor convicted in court, is 15. Society’s and, perhaps first and foremost, the authority’s attitude towards juvenile crime is that they should not be equal adults in the process within criminal law. Because children are considered essential for the society of tomorrow, it is important to pay extra attention to crimes committed by juveniles. The social services authorities are considered to have the best resources and competence to handle this group of juveniles. In the criminal law process the prosecutor requests a statement regarding the young person who is reasonably suspected of a criminal act. The statement should contain information about if the young person is in need of certain interventions from social services in order to prevent unfavorable development. The conclusion that has been drawn when the statements has been reviewed is that a borderland has been created where social law and criminal law overlap. This overlapping is in a way a collision where social aspects and principles of criminal law have to meet. However, it is not always easy to make both sides satisfied. As a way to meet the needs of both sides the borderland becomes a compromise consisting of the process regarding the juveniles. The purpose of this essay is to describe and understand the compromise that has been made where statements and young juveniles are existing. The aim of this essay is to study 23 statements from social services that prosecutor request and the 23 court records attached to them. All statements and court records are regarding persons between 15 – 17 years old. The study is limited to the period between 2010-01-01 to 2010-12-31. This essay has been from a qualitative point of view where the discourse analysis as an text analytical method has been used to understand the collected statements and court records. Central results is that the statements reviewed in this essay overall are satisfying in fulfilling the social law and criminal law aspects. However the results also point out that an uncertainty within the social services regarding the design of the statements also is to be found. Descriptions of social aspects about the young juvenile behind the statement seems to be important to emphasize.

The world has made important efforts to meet the Millennium Development Goals (MDG) by 2015. However, it is still insufficient and inequalities prevail in the poorest settings. We tracked selected MDG, barriers for their achievement, and community actions that help to accelerate the pace of their accomplishment in two Nicaraguan communities (León and Cuatro Santos). In the first two studies we track the progress of MDG4 (reduce child mortality) using the under-five mortality rate. Inequalities in mortality were mainly assessed by means of maternal education, but other social stratifications were performed on rural-urban residence and sub-regional comparisons between both communities. The last two studies describe community interventions in Cuatro Santos and their association with progress toward MDG1 (poverty reduction). Participation in interventions and poverty were visualized geographically in this remote rural community between 2004 and 2009. Other selected MDG targets were also tracked. These communities will possibly meet MDG4 even before 2015. In León, MDG progress has been accompanied by a decline in child mortality. Despite social inequalities with regard to mortality persisting in education and places of residence, these have decreased. However, it is crucial to reduce neonatal mortality if MDG4 is to be achieved. For example, in León the percentage of under-five deaths in the neonatal period has doubled from 1970 to 2005. In the remote rural area of Cuatro Santos, progress has been accelerated and no child mortality differences were observed despite the level of a mother’s education. Cuatro Santos has also progressed in the reduction of poverty and extreme poverty. The participation of the population in such community interventions as microcredit, home gardening, technical training, safe drinking water, and latrines has increased. Microcredit was an intervention that was unequally distributed in this rural area, where participation was lower in poor and extremely poor households than in non-poor households. In those households that transitioned from poor to non-poor status, microcredit, home gardening, and technical training were associated with this transition. Furthermore spatial analysis revealed that clusters of low participation in interventions overlapped with clusters of high poverty households.

The purpose of this qualitative study was to describe the ways in which Orìsà priests and their clients conceptualize issues and concerns described by Western based approaches as mental health problems. The two research questions guiding this inquiry included: (a) how do Orìsà priests and their clients conceptualize issues and concerns associated with mental health problems in Western psychology and (b) what methods and techniques do Orìsà priests and their clients use to address issues or concerns associated with mental health problems in Western psychology? This study was grounded in African-centered theory by providing a cultural lens to guide the research design, data collection, and analysis. Data were collected during semi-structured individual interviews with four Orisa priests in a three phase model, for a total of 12 interviews. The study also included three focus groups (six informants per group), who did not participate in the individual interviews. Each group met for two sessions, for a total of six focus groups. Bracketing of assumptions by research team members and use of a reflexive journal was used to ensure credibility and dependability of the data (Creswell, 1998). Data analysis consisted of a recursive process divided into multiple steps, to help strengthen methodological rigor and verification of study procedures. The three part process included codebook development, code application, and data analysis. Three major themes emerged from the data. The first theme, The Conceptualization of Mental Health Problems as Spiritual Matters included one subtheme, Transgenerational Transmission. The second theme, Origins of Mental Health Problems, included three subthemes (Western Socialization, Spiritual Forces, and Ifa as a Healing System). The final theme, Addressing Mental Health Problems, included three subthemes (The Divination Process, Referrals, and Western Therapy). Results of this study indicate that respondents primarily conceptualize mental health problems as spiritual matters and seek to address these problems with the help of an Orìsà priest. In addition, some respondents sought the services of a Western trained therapist for the same issue. Practice and research implications are discussed.

To date, little research has explored the utility of inter-personal confrontation as a strategy for the reduction of homonegative attitudes and/or behaviours among heterosexual women. Consequently, the purpose of the current study was to explore three unique aspects of such confrontations among a sample of heterosexual women from the University of Saskatchewan. These three aspects were: 1) to what extent do high- and low-prejudiced womens reactions to confrontations of subtle homonegative behaviour differ; 2) what differences exist in the way that heterosexual women respond to bias directed towards gay men than to bias directed towards lesbian women; 3) what effect does the vested interest of a confronter have on heterosexual womens reaction to confrontations of homonegative behaviour. A 2(target condition) X 2(modern homonegativity endorsement) X 4(confronter type) between-subjects design was used wherein 286 female volunteers completed a questionnaire booklet developed for the project. The questionnaire booklet asked participants to first imagine themselves in a scenario where they would be confronted for engaging in subtle homonegative behaviour and to then indicated how they would think, feel, and behave in response to such a confrontation. The results indicated that low-prejudice participants reacted with greater negative-self directed affect (e.g., guilt) and compunction (e.g., apologize for behaviour) than high-prejudice participants when confronted by either a gay man or lesbian woman. Such reactions are important as they mark the initiation of a self-regulatory cycle that allows the individual to avoid such biased behaviour in the future. Limitations of the study and directions for future research concerning inter-personal confrontations of homonegativity are also presented.

Stickrädsla förekommer bland personer i alla åldrar och kan i vissa fall leda till att den som är stickrädd undviker att uppsöka sjukvård, något som kan påverka personens hälsa. Eftersom blodprovstagningar, injektioner och infusioner utförs varje dag inom sjukvården finns risken att sjuksköterskan förr eller senare träffar på en vuxen person som är stickrädd. Syftet med litteraturstudien var att beskriva vilka omvårdnadsåtgärder som kan lindra obehag hos vuxna personer med stickrädsla. Resultatet från vetenskapliga publikationer pekar på att olika lindrande omvårdnadsåtgärder finns att tillgå. Studier visar att bemötandet från vårdpersonalen och psykoterapeutiska metoder kan ha betydelse för personer som är rädda för att bli stuckna. Information och undervisning innefattar omvårdnadsåtgärder som kan bidra till ökad självständighet och livskvalitet, när stickrädslan minskar. Även anpassning av medicinteknik och användning av lokalbedövande läkemedel kan dämpa upplevelsen av obehag för den som är stickrädd, vilket kan leda till att en behandlings följsamhet blir bättre. Genom kunskap om lindrande omvårdnadsåtgärder kan vårdpersonal reducera obehag för vårdsökande personer som upplever stickrädsla vid användning av kanyler. Därigenom kan vårdkvaliteten för den som är stickrädd öka och vårdkontakten bli en positiv upplevelse. / Needle fear exists among people of all ages and might lead to avoidance of medical attention, which can affect the person's health. As blood tests, injections and infusions are performed on daily basis in healthcare, there is a possibility that nurses sooner or later will meet adults who are afraid of needles. The purpose of this study was to describe interventions that can ease discomfort for adults with fear of needles. The results of scientific publications indicate that different interventions are available. Studies show that the response from caregivers and psychotherapeutic methods may be important for people who are afraid of being stung. Information and education includes interventions that may contribute to a greater independence and quality of life, when needle fear decreases. Also adjustment of medical technology and use of local anesthetic drugs can reduce the experience of discomfort for those who are afraid of needles, which could lead to improvement of treatment adherence. Through knowledge of which interventions that can ease needle fear, caregivers can reduce discomfort for persons in need of care when cannulas are used. This increases healthcare quality, concerning those who are afraid of needles and the contact will become a satisfying experience.

Children’s risk for overweight and obesity is particularly high in rural areas of the United States. Many health, psychosocial, and economic consequences are associated with childhood overweight and obesity, which concerns health researchers and professionals. But how and why might rural children be more at risk for being overweight and obese? This dissertation investigates childhood overweight and obesity in rural settings through three separate studies. First, a systematic literature review was conducted to identify determinants and mechanisms of childhood obesity-related behaviors that are specific to rural locations. The findings from the review show that lack of health resources and poverty within the rural environment may impact children’s social environment and individual factors. However, results are inconclusive and there continues to be a lack of studies focusing on linking environmental influence with individual factors. Second, a meta-analysis of current research evidence was conducted to assess the efficacy of rural interventions designed to reduce childhood overweight and obesity. Results showed that interventions have been efficacious yet modest, with a mean effect size of 0.18. Moderating variables were also examined. Mean intervention effect size was moderated by children’s age and intervention duration. Last, secondary data were used to examine the association between rural food stores and availability and affordability of fresh fruits and vegetables. A multilevel analytical approach was used to determine if rural location was associated with availability and affordability of fresh fruits and vegetables. After controlling for other variables, results showed that rural location was not associated with fruit and vegetable availability and affordability. The findings from this dissertation suggest that the area of rural childhood overweight and obesity remains understudied. More research is needed in order to understand the mechanisms of social ecological influences on diet, physical activity, and childhood overweight and obesity. This area of research, however, is rife with opportunities for public health education and promotion. Public health educators can help promote and advocate for environmental conditions that support healthy lifestyles.

ABSTRACT TECHNICAL AND APPLIED FEATURES OF FUNCTIONAL BEHAVIORAL ASSESSMENTS AND BEHAVIOR INTERVENTION PLANS by Shannon M. Hawkins When conducted correctly, functional behavior assessments (FBAs) can help professionals intervene with problem behavior using function-based interventions. Despite the fact that researchers have shown that effective interventions are based on function, recent investigators have found that most behavioral intervention plans (BIPs) are written without regard to the function of students’ problem behaviors as documented in their FBAs. This study was conducted to examine the overall technical adequacy of FBAs and BIPs within one educational system to evaluate reliance on the outcomes of FBAs in the development of BIPs. The technical and applied features of a randomly selected sample of 134 FBA/BIPs of students with disabilities, ages 3-21 years, who were receiving services due to their severe emotional and behavioral disorders (SEBD) or autism spectrum disorders (ASD) within the Georgia Network of Educational and Therapeutic Services (GNETS) were analyzed. In addition, similarities and differences between function-based strategies specified in BIPs were examined. Logistic regression was used to reveal the probability that a given behavioral function can predict which intervention(s) might be chosen. A series of chi-square tests of independence and a multinomial logistic regression model were used to examine how BIP component variables, demographic variables, behavioral function variables, and behavioral intervention variables related to each other statistically. Components described as critical in research literature for conducting FBAs and developing BIPs were absent from a significant number of the student files. Results suggest few of the prescribed interventions were likely to be related to function. The findings extend research on FBAs and BIPs, particularly as they are used with students with SEBD and autism, documenting that a significant number of BIPs are developed without regard of the function of the problem behavior.

Bakgrund och syfte: Personer som drabbas av en höftfraktur är en stor patientkategori, och till följd av en ökande andel äldre i befolkningen kommer den att bli ännu större. Majoriteten av dessa patienter kommer att åka in till sjukhus med ambulans. För att minska patientens lidande och uppkomst av komplikationer är det prehospitala omhändertagandet viktigt. Syftet med denna studie var att jämföra ambulanssjuksköterskans specifika omvårdnadsåtgärder vid vård av patient med höftfraktur före respektive efter införandet av en ny vårdkedja, ”Raka spåret”, och då framförallt se om givandet av smärtlindring förändrats. ”Raka spåret” innebär att ambulanspersonalen utför en del av de åtgärder som tidigare gjorts på akutmottagningen och transporterar patienten direkt till röntgen.   Metod: Metoden var en retrospektiv studie med komparativ design där två grupper med 15 patienter i varje grupp jämfördes mot varandra. Patienterna i båda grupperna hade haft en höftfraktur och förts in med ambulans mellan klockan 0800-2200. Den ena gruppen fördes in innan ”Raka spåret” fanns och den andra gruppen fördes in efter införandet. En anledning till ”Raka spåret” var att öka förståelsen hos ambulanspersonalen för att ett strukturerat omhändertagande, där särskilt smärtlindring och trycksårsprofylax betonades, har stor betydelse för patientens fortsatta vård.   Resultat: Resultatet visade att efter införandet av ”Raka spåret” utfördes fler prehospitala omvårdnadsåtgärder av ambulanssjuksköterskorna. Alla patienter i gruppen år 2010 fick perifer venkateter (PVK) och på 13 patienter togs EKG. Fler patienter fick smärtlindring efter införandet av ”Raka spåret”, innan fick 60 % smärtlindring mot 93 % efter ”Raka spåret. Att införa ”Raka spåret” antydde en förbättring i omhändertagandet av patienter med höftfraktur och det framkom med tydlighet att detta ledde till ett mer homogent omhändertagande.  Det visade också, att när det fanns riktlinjer för att patienten ska smärtlindras, skedde smärtlindring i större utsträckning. Detta var en pilotstudie utan möjlighet till generaliseringar av resultatet, för att kunna göra detta krävs ett större antal patienter. / Background and purpose:People who suffer from a hip fracture are a large category of patients, and as a result of an increasing proportion of older people, it will be even greater. The majority of these patients will go to the hospital by ambulance. To reduce the suffering of the patient and the occurrence of complications the prehospital care is important. The purpose of this study was to compare the specific prehospital nursing interventions for patients with hip fracture before and after the introduction of a new chain of care, "Straight track". Especially to see if the initiation of pain management has changed. "Straight track" means that ambulance nurses carry out some of the measures that earlier was done in the emergency room and transporting the patient directly to radiology.   Method:The method was a retrospective study of comparative design in which two groups with 15 patients in each group were compared against each other. Patients in both groups had a hip fracture and went in by ambulance between 08 am to 10 pm. One group was transported before the "Straight track" began and the second group was transported after the introduction. One purpose of the direct route was to increase understanding, of the ambulance nurses, that a structured treatment, especially with relief of pain and pressure ulcer prophylaxis, has great significance for the patients continued care.   Result: The results showed that after the introduction of the "Straight track" there was more pre-hospital care measures carried out by emergency nurses. All patients in the group from 2010 had peripheral venous catheter and 13 patients undergoing an ECG. More patients got pain relief after the introduction of the "Straight track". Before there were 60% that got pain relief and after there were 93% that got pain relief.Introducing “Straight track” suggested an improvement in the care of patients with hip fracture and it showed with clarity that this led to a more homogeneous treatment. It also showed that when there were guidelines for the patient to get pain relieve then it was given to a greater extent. This was a pilot study without possibility to draw any general conclusions, this requires a larger number of patients.

<b>Background:</b> Individuals with intellectual disabilities (ID) have a higher prevalence of comorbid psychiatric disorders and challenging behaviours compared to the general population. Though less common, one area of concern among those with ID is pica (the ingestion of inedible substances). To date, there is little knowledge of pica, particularly with respect to its risk factors and social consequences. The closure of Ontario's three remaining facilities by 2009 underscores the importance of having knowledge of complex behaviours such as pica for improving supports and services in the community for these individuals. The aim of this study is to better understand the characteristics and support needs of adults with ID and pica. This study is comprised of a quantitative and qualitative component. <b>QUANTITATIVE STUDY</b> <b>Objectives:</b> To investigate the prevalence, risk factors, social and medical characteristics of pica. To determine how pica is managed in terms of hours of supervision, receipt of interventions, and psychotropic medication. <b>Methods:</b> Secondary data analysis was performed on two samples as part of cross-sectional study: 1008 persons with ID from Ontario's facilities and 420 community-dwelling adults with ID from southwestern Ontario. All persons had been assessed using the interRAI Intellectual Disability (interRAI ID)?a comprehensive and standardized instrument that measures a variety of domains for support planning. Bivariate and multivariate analyses were restricted to the facility sample due to the small size of persons with pica in the community. <b>Results:</b>The overall prevalence of pica was 22. 0% and 3. 3% in the facilities and the community, respectively. Logistic regression analysis showed that being male, cognitive functioning, autism, and being non-verbal were associated with a higher odds of having pica, whereas activities of daily living (ADL) was a protective factor. A quadratic relationship was observed between cognitive function and pica: the risk of pica increased with severity of cognitive impairment up to moderate to severe levels of impairment and then diminished among those with very severe cognitive impairment. Behaviour management, self-care skills, and 8 hours or more of one-to-one supervision were more likely to be provided to persons with pica. Compared to persons without pica, persons with pica had higher rates of being prescribed antipsychotic medication. Surprisingly, pica was not associated with higher rates of gastrointestinal health problems, with the exception of acid reflux. The negative social outcomes of pica, however, were many: pica was associated with higher odds of not having a strong and supportive relationship with family, lack of contact with family or other close relations, and absence of participation in social and recreational activities. <b>QUALITATIVE STUDY</b> <b>Objective:</b> To determine the support needs of adults with ID and pica from the perspective of direct-care staff of facility and community settings. <b>Methods</b>: Through two focus groups, the perspectives of four staff from Huronia Regional Centre (HRC), and six staff from community agencies from southwestern Ontario were examined. Transcripts were analyzed thematically for factors that facilitated or hindered the management of pica. <b>Results:</b> Qualitative data revealed three categories that underpinned reduction in pica: preventative measures (environmental controls, close supervision, and the provision of alternative activities), formal supports, and familiarity with the individual. On the other hand, inadequate staff support, lower functioning level of the individual, and lack of knowledge acted as barriers to managing and reducing pica. These barriers were associated with persons participating in fewer recreational activities and community outings, and in some cases the use of mechanical restraints. Barriers specific to each setting in the management of pica were also illuminated. Staff in both settings tended to be self-sufficient and isolated in managing this complex behaviour. <b>Conclusions:</b> Results suggest that attention should be equally paid to the potential social consequences of pica rather than solely to its health risks. Higher staff to client ratios, and training and education for staff to provide more active support to promote individuals' engagement in recreational activity and community integration is needed. Key recommendations also focus on educating and training staff on the risk factors and appropriate management of pica. Improving the collaboration and knowledge exchange among developmental service agencies is also recommended to enhance the management of pica among caregivers. Lastly, the community at large needs education on pica to foster more inclusive community living for those with ID.

To date, little research has explored the utility of inter-personal confrontation as a strategy for the reduction of homonegative attitudes and/or behaviours among heterosexual women. Consequently, the purpose of the current study was to explore three unique aspects of such confrontations among a sample of heterosexual women from the University of Saskatchewan. These three aspects were: 1) to what extent do high- and low-prejudiced womens reactions to confrontations of subtle homonegative behaviour differ; 2) what differences exist in the way that heterosexual women respond to bias directed towards gay men than to bias directed towards lesbian women; 3) what effect does the vested interest of a confronter have on heterosexual womens reaction to confrontations of homonegative behaviour. A 2(target condition) X 2(modern homonegativity endorsement) X 4(confronter type) between-subjects design was used wherein 286 female volunteers completed a questionnaire booklet developed for the project. The questionnaire booklet asked participants to first imagine themselves in a scenario where they would be confronted for engaging in subtle homonegative behaviour and to then indicated how they would think, feel, and behave in response to such a confrontation. The results indicated that low-prejudice participants reacted with greater negative-self directed affect (e.g., guilt) and compunction (e.g., apologize for behaviour) than high-prejudice participants when confronted by either a gay man or lesbian woman. Such reactions are important as they mark the initiation of a self-regulatory cycle that allows the individual to avoid such biased behaviour in the future. Limitations of the study and directions for future research concerning inter-personal confrontations of homonegativity are also presented.