I Sverige finns det ca 150 000 personer som lider av demenssjukdom. Hos 90 procent av dessa förekommer beteendemässiga och psykiska symtom vid demens (BPSD). BPSD avser symtom som vanföreställningar, hallucinationer, agitation, depression, ångest, upprymdhet, apati, hämningslöshet, irritabilitet, motoriskt avvikande, sömnproblem och aptit. Syftet med studien var att kartlägga registrerade omvårdnadsåtgärder relaterade till beteendemässiga och psykiska symtom vid demens skattade i tre kommuner i sydvästra Sverige. Studien är en deskriptiv retrospektiv registerstudie som studerar historiska mätdata inmatad i BPSD-registret, gällande beteendemässiga och psykiska symtom vid demens samt dess omvårdnadsåtgärder. Studien innefattar registreringar på personer med demenssjukdom och beskrivs kvantitativt. Urvalet i studien är de registreringar där personerna erhållit omvårdnadsåtgärder för beteendemässiga och psykiska symtom vid demens i de tre kommunerna mellan åren 2011-2014. Sammanlagt inkluderades 621 registreringar. Symtomen som visade sig vara mest frekventa vid skattningarna var agitation, irritabilitet samt motoriskt avvikande. De mest registrerade omvårdnadsåtgärderna vid beteendemässiga och psykiska symtom vid demens visade sig vara, lugn ljudmiljö, massage, fysisk aktivitet och musik. Det behövs mer kunskap om omvårdnadsåtgärder och hur dessa kan underlätta symtomen och öka livskvalitén för personer med demenssjukdom. / About 150 000 people in Sweden are suffering from dementia. 90 percent of these experience behavioral and psychological symptoms of dementia (BPSD). BPSD refers to symptoms such as delusions, hallucinations, agitation, depression, anxiety, euphoria, apathy, disinhibition, irritability, aberrant motor behavior, problem sleeping and problems with appetite. The goal of this study was to identify the registered nursing measures related to behavioral and psychological symptoms of dementia estimated in three municipalities in southwestern Sweden. The study is a descriptive retrospective registry study that looks at historical data in the BPSD registry with regard to behavioral and psychological symptoms of dementia and its nursing measures. The study is described quantitatively and includes registrations of people with dementia. The selected records in the study are those where  people received nursing interventions for behavioral and psychological symptoms of dementia in the three municipalities between the years 2011-2014. 621 registrations were included. The symptoms that turned out to be most frequent in the estimates were agitation, irritability, and aberrant motor behavior. Most registered nursing measures in behavioral and psychological symptoms of dementia included quiet environment, massage, physical activity and music. More knowledge is needed about the nursing interventions and how these can facilitate the symptoms and increase quality of life for people with dementia.

Because of the situation around the world with war and poorness many people need to leave their homeland and find safeness in other countries. A big amount of this group is children without company of an adult, so called unaccompanied children. The numbers of unaccompanied children who seek safeness in Sweden grow every year. The aim of this study was to investigate how social workers in four municipalities in south of Sweden experience their work with investigating the needs of unaccompanied children. The aim was also to investigate how the social workers experience their opportunities to meet the children’s needs with personalized interventions. The study is built on semi-structured interviews with six social workers who all have experience or are now working with investigating unaccompanied children. The results of the interviews were analyzed using a system theory perspective and Andrew Abbotts profession theory. We also used the terms grassroots bureaucrats and discretion. The results of our study has shown us that the social workers often feel a certain restriction when it comes to their ability to meet the children’s needs because of the lack of available accommodations. The study also shown that the social workers experience a limitation when it comes to the authority they have as their decisions must be approved by others and not based solely on the individual workers assessment.   The social workers in our study also experience that their work is not taken as seriously as others investigation of children from Swedish families which influence the status and legitimacy that they describe that their profession should have.

Cultural competence learning interventions have been suggested to positively improve knowledge, attitudes, and behaviors in both professional nurses and nursing students. A meta-analysis was used to examine the effectiveness of learning interventions designed to increase the cultural competence in professional nurses and nursing students. This is the first known meta-analysis of studies on cultural competence learning interventions in professional nurses and nursing students. The meta-analysis was done using 13 research studies on cultural competence educational interventions from 1999 to 2010 that were published peer-reviewed literature found in electronic databases. Analyses were computed using a fixed-effect model and effect size data reported in terms of odds-ratio. The Comprehensive Meta-Analysis [Version 2] statistical software was used for the meta-analysis. Results of Orwin's fail-safe N, funnel plot and Duval and Tweedie's Trim and Fill revealed no evidence of publication bias. The meta-analysis demonstrated that seven of the 13 studies' individual educational interventions had a significant positive effect (odds-ratio = 4.2) on improving cultural competency of nursing students and professional nurses. The study was able to determine from the meta-analysis literature that overall, learning interventions of cultural competence in nurses and nursing students significantly translates to a positive effect on the self-perceived cultural competency of nurses and nursing students in terms of knowledge, skills, attitudes, and self-efficacy regardless of intervention type and contact time. However, there is insufficient empirical evidence to support the argument that education and training in cultural competence translates into culturally competent care or that it leads to improved client health outcomes, particularly in nurses and nursing students. The results of this study should be interpreted with caution. Limitations of the study and recommendations for future research are discussed.

The prevalence of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBLs) and carbapenemases is increasing worldwide. Therapeutic options for infections with these bacteria are limited not only by the production of ESBLs and carbapenemases, which confer resistance to cephalosporins and carbapenems, but also by frequent co-resistance to other antibiotics. The overall aim of this thesis was to obtain a better understanding of multidrug-resistant E. coli and K. pneumoniae in relation to epidemiology, selection and susceptibility to antibiotic therapy. In a prospective study ESBL-producing E. coli was found to spread easily through international travel. Twenty-four of 100 Swedes travelling outside Northern Europe acquired ESBL-producing E. coli in the intestinal flora. The risk was highest for travelers visiting India and those suffering from gastroenteritis during travel. To minimize selection of ESBL-producing K. pneumoniae during a hospital outbreak with these bacteria, an educational antibiotic intervention was performed at Uppsala University Hospital in 2006. The primary aim of the intervention was to reduce the consumption of parenteral cephalosporins. An immediate and radical reduction of cephalosporins was demonstrated with interrupted time series analysis. The outbreak declined during 2007 and no increased resistance to replacement antibiotics was detected. The impact of ESBL production on the antibacterial activity of ertapenem was studied in time-kill experiments. It was shown that porin-deficient subpopulations with reduced susceptibility to ertapenem frequently emerged in ESBL-producing E. coli during exposure to ertapenem at concentrations simulating human pharmacokinetics. Further, the antibacterial effects of antibiotic combinations against four strains of K. pneumoniae producing carbapenemases of the metallo-beta-lactamase type were studied in time-kill experiments. Double and triple combinations of aztreonam, fosfomycin, meropenem, rifampin and colistin at clinically relevant static concentrations were effective despite that the bacteria were frequently resistant to the individual drugs. These results indicate that there is a largely unexplored potential of antibiotic combination therapy for multidrug-resistant K. pneumoniae.

Students with persistent challenging behaviors are associated with negative school, community, and transition outcomes. The presence of challenging behavior is due in part to social skills deficits that are in need of remediation. Although social skills interventions are commonly provided to this student population, they are often ineffective at promoting behavior generalization and maintenance, which is necessary for improving social outcomes and developing social competency. Social skills interventions also fail to consider the individual characteristics of social skills deficits when they are conceptualized. Function-based social skills and replacement behavior interventions may be effective at addressing these concerns. This dissertation study investigated the effects of function-based social skills and replacement behavior interventions on the problem behavior of three students who attended a public elementary school in rural Central Texas. Results show an experimental effect for two of the three participants when observation data on challenging behaviors for baseline and treatment phases were compared. Generalization of behavior change was also measured for all three participants, with analysis of observation data indicating a positive effect for two of the three participants. vi Maintenance of behavior change was strong for two participants. The limited effectiveness of the intervention for one participant may be explained in part by the absence of intervention components that may have been critical to student success. Lower levels of implementation fidelity also may explain the limited effectiveness of the intervention. A social validity measure indicated that participating teachers and an assistant teacher viewed the interventions positively. A comparison of pre and post intervention scores on the teacher report form of the Behavior Assessment Scale for Children show some improvement in student composite scores, particularly Externalizing Behaviors. However, student composite scores still fell in the Clinically Significant or At-Risk range. / text

College football is big business, earning slightly more than $1 billion in profit in the last few years. As a result of its popularity, fans of the game devour massive amounts of information about college teams and their players. Less known are the non-academic challenges college football players face, in addition to the typical concerns shared with their non-athletic peers. Along with academic and cognitive challenges, the ability to effectively navigate non-academic areas - such as personal, social and cultural - is critical to the development and holistic growth of today’s college football players. These factors can affect a student's ability to thrive or persist toward graduation. In this report, I explore the specific challenges of African American college football players at predominantly White institutions. Within this scope, I will examine the growth of college football in addition to the reach and impact it has on African American families. Within these communities, research shows a pervasive focus on playing professional football. Some players believe that college football is a mere stepping stone on the road to a professional career. The reality is that very few college football players are chosen to play professionally – actually less than .2%. This report explores some of the psychosocial issues that can impact the on and off the field success of African American college football players at predominantly White institutions The goal of this work is to lay a foundation and make an argument for counseling and therapeutic support targeted to, but not exclusively for African American college football players. As systems that seek to understand growth and change for optimum mental and physical well-being, the field of counseling and sports psychology present intervention models that can be useful for today’s African American college football players. / text

This thesis analyzes the infamous Mara Salvatruchas (MS-13) in Central America, an international gang that has become increasingly powerful and violent. I will examine the cycle of violence perpetuated by the urban structure in Central America, which is characterized by economic and social segregation and sometimes violent oppression, resulting in part from neoliberal economic policies. I will critically review a variety of current MS-13 interventions in El Salvador and elsewhere, and examine how policies have impacted the growth of this international threat. Successful examples of community-based gang interventions, specifically targeted to reach youth, will be examined to determine important components of effective, bottom-up gang interventions that may be applied in El Salvador. / text

A primary function of the pediatric oncology nurse is to provide symptom management to children with cancer. Symptom management strategies have been published, but there is scarce literature examining neither the actual use of these nursing interventions, nor the effects of using these interventions on the nurses' perceived work environment. The purpose of this study was to examine the nursing interventions used in treating pediatric oncology patients' symptoms, as well as the emotional sequelae from providing this care. Phase One of this study examined the content validity of the newly developed Nurses Distress and Interventions for Symptoms Survey (NDISS) utilizing content experts. Phase Two of this study involved both the reliability testing of the NDISS by test-retest and served as a pilot for Phase Three. In Phase Three, a national sample of pediatric oncology nurses was surveyed about their patients' symptoms, the nurses' distress from the symptoms, the nursing interventions used to treat the symptoms, the perceived efficacy of the nursing interventions, and their job satisfaction. The response rate was 53%, and analysis of study hypotheses were evaluated using Pearson's correlation and multiple regression analyses. The main study variables were not related in the hypothesized direction; therefore four of the six hypotheses were not supported. However, quantity and perceived effectiveness of nursing interventions were both found to act as mediators in the study model, and as a result, these two hypotheses were retained. The results of the survey demonstrated a high frequency of distressing patient symptoms as perceived by nurses (mean 6, range 0-7); nurses rated their distress from these symptoms as moderate (mean 2.9, range 0-4); nurses used an average of 12.7 nursing interventions per symptom (range 0-38); nurses found the nursing interventions moderately effective (mean 2.5, range 0-4); and nurses had moderately high overall job satisfaction (mean 3.9, range 1-5). Although many of the hypotheses were not supported, interesting trends in the data were found. In addition, the findings provided elucidation of specific nursing interventions used by pediatric oncology nurses as well as a description of the effects of providing patients' symptom management, including nurses' distress, perceived effectiveness of nursing interventions, and job satisfaction.

This study evaluated the influence of academic, behavioral, and sociocultural variables on the implementation of Schoolwide Positive Behavior Support (SWPBS), a system intended to improve discipline in school buildings. The number of schools that are implementing SWPBS has been increasing dramatically over the years as school violence continues to rise and solutions are needed to improve school climate. This study examined the relationship between three categories of variables and the level of implementation of SWPBS in three multiple regression analyses. The categories were school demographic variables (i.e., ethnicity, socio-economic status, teacher: student ratio, percentage of teachers who are out-of-field), severity of need for change (suspensions, office referrals, percentage of students below grade level in reading), and team process variables (coaching, team functioning, administrative support). Of these variables, team functioning was the only one found to be sign ificantly related to implementation. A second component of the study involved collecting data relating to factors that were enablers or barriers to the implementation of SWPBS. Two-hundred and thirty-six school personnel completed a survey, Schoolwide Implementation Factor Survey (SWIF). The survey derived three factors through a factor analysis: school, staff, and students; principal; and assistant principal. These factors were all found to have a high Cronbach's alpha for internal consistency. There were significant differences between schools with a high, middle, and low level of implementation on all of these factors, with respondents from high implementing schools scoring the highest on all factors,and respondents from low implementing schools scoring the lowest. The item on the survey rated as the most helpful in the implementation process was "Expectations and rules that are clearly defined," while the item rated as the most problematic in the implementation process was "Adequat e funding for PBS." Overall, the results highlighted the complexity of implementing a system-wide change.(i.e., ethnicity, socio-economic status, teacher: student ratio, percentage of teachers who are out-of-field), severity of need for change (suspensions, office referrals, percentage of students below grade level in reading), and team process variables (coaching, team functioning, administrative support). Of these variables, team functioning was the only one found to be significantly related to implementation. A second component of the study involved collecting data relating to factors that were enablers or barriers to the implementation of SWPBS. Two-hundred and thirty-six school personnel completed a survey,Schoolwide Implementation Factor Survey (SWIF). The survey derived three factors through a factor analysis: school, staff, and students; principal; and assistant principal. These factors were all found to have a high Cronbach's alpha for internal consistency. There were signific ant differences between schools with a high, middle, and low level of implementation on all of these factors, with respondents from high implementing schools scoring the highest on all factors,and respondents from low implementing schools scoring the lowest. The item on the survey rated as the most helpful in the implementation process was "Expectations and rules that are clearly defined," while the item rated as the most problematic in the implementation process was "Adequate funding for PBS." Overall, the results highlighted the complexity of implementing a system-wide change.

Introduktion: Patienter kan drabbas av vårdskador i samband med positionering med operation. Det är operationssjuksköterskan som tillsammans med operationsteamet ansvarar för patientens positionering. Syftet med studien var att beskriva operationssjuksköterskor uppfattningar av vårdåtgärder som utförs i samband med positionering av patient i benstöd. Metod: Studien har genomförts med kvalitativ metod och datainsamlingsmetod var enskilda intervjuer. Databearbetning har genomförts med kvalitativ innehållsanalys. Resultat: Analysen resulterade i två kategorier med tillhörande sex subkategorier. Den första kategorin visar att vårdåtgärder som operationssjuksköterskor utför i samband med positionering är anpassade efter patientens kroppsliga förutsättningar och behov. Den andra kategorin visar att operationssjuksköterskor tar ansvar för och kontrollerar att positioneringen utförs med bästa möjliga avlastning att tryck och sträckning undviks. Det framkommer vidare att riktlinjer fyller en viktig funktion för att tiden i benstöden inte skall överskridas. Det är viktigt att operationsteamet samarbetar för att söka lösningar som passar patienten. Slutsats: Denna studie visar att för en lyckad positionering i benstöd behöver hänsyn tas till patientens kroppsbyggnad och behov. Ett pre- och intraoperativt samtal ger kunskap om behov som patienten har inför positioneringen. Studien visar att operationssjuksköterskor tar ansvar för och kontrollerar att positioneringen utförs på riktigt sätt och bevakar att tiden i begränsas genom att följa riktlinjer. De kontrollerar positioneringen innan drapering sker och har en handlingsberedskap under hela operationen för att skydda patienten. Vid begränsningar att ligga i benstöd provas läget ut tillsammans med patienten innan spinalbedövningen ges för att förhindra att skador uppstår. Studien visar vidare att patientens delaktighet är viktig för att uppnå bästa möjliga avlastning i samband med positioneringen samt att hela operationsteamet samarbetar och bidrar med nya flexibla lösningar på problem som uppstår. / Introduction: Patients may suffer from medical injuries associated with surgery positioning. There is the theatre nurse together with the operating team who is responsible for the patients positioning. The aim of the study was to describe theatre nurses perceptions of nursing interventions conjunction with the positioning of the patient in leg bearer. Method: The study was conducted using qualitative methodology and data collection method was individual interviews. Data processing was carried out with qualitative content analysis. Results: The analysis resulted in two categories with the associated six subcategories. The first category shows that health interventions performed by the theatre nurses is adopted for the patients’ physical conditions and needs. The second category shows that theatre nurses take responsibility for and control the positioning that it is carried with the best possible relief of pressure and tension are avoided. It proves that guidelines serves an important function to prevent the time in leg bearer from being exceeded. It is important that the operating team working together to find solutions. Conclusion: This study shows that for a successful positioning in the leg bearer need to take account of patient's body conditions and needs. A pre- and intraoperative dialogue provides knowledge about the patients’ needs prior to positioning. The study shows that theatre nurses take responsibility for and make sure that positioning is carried out properly and monitor the time in restricted following the guidelines. They control the positioning before draping is done and has a readiness to act throughout the surgery to protect the patient. When limitations to lie in the leg bearer the position are tried out together with the patient before spinal anesthesia is given to prevent damage. The study further shows that the patient's participation is important for achieving the best possible relief in connection with the positioning and that the whole operating team collaborates and contributes with new flexible solutions to problems.