Syftet med studien var att undersöka hur olika behandlingsenheter i Sverige utvärderade effekterna av interventioner för barn med autism 0-6 år, oavsett om det rörde sig om enstaka åtgärder eller hela program. Det var också intressant att se om, och i så fall hur, man tog hänsyn till risker och möjligheter som kunde bidra till variation i utfallen. Kontakt togs med samtliga landstings, och två privata, behandlingsenheter. Brev innehållande information om studien och en enkät med studiens frågor skickades ut. Resultaten visade att man i första hand utvärderade effekterna genom någon form av bedömningstest t ex. PEP, VABS eller ADOS. Något som kan ifrågasättas var huruvida dessa test påvisade en direkt effekt av en interventionsmetod, då dels en förändring hos barnet måste anses naturlig allteftersom barnet blir äldre och dels pga. att testet genomfördes utanför barnets vardagsmiljö. Man tog visserligen hänsyn till risk- och möjlighetsfaktorer genom att anpassa interventionerna efter barnet, familjen och närmiljön men fastställde inte omfattningen av dessa faktorers påverkan. Instrument och metoder för att känna igen risk- och möjlighetsfaktorer, hur de ska hanteras och mätas samt vilken påverkan de har för utfallet behöver utvecklas, och en samstämmighet över hur tillförlitligheten ska säkerställas både när det gäller vilka instrument som ska användas och vilka rutiner som ska gälla behöver komma till stånd. Indirekta interventionsmetoder som innefattar utbildning av, rådgivning och stöd till familj och närmaste bör också utvecklas då dessa både påverkar utfallet av de interventioner man gör samt interaktionen mellan barnet och dess närmaste. / The purpose of this study was to determine how the effects of interventions in autistic children 0-6 years were evaluated in Sweden, regardless of whether it concerned separate measures or entire programs. Furthermore there was an interest to see if and how risk and opportunity factors were taken into account regarding their contributions to the differences in outcome. Contact was established with all county council and two privately run treatment units. A letter containing information about the study and a questionnaire was sent to each. The result showed that the most common method to evaluate the effects was with some kind of test i.e. PEP, VABS or ADOS. It is an open question whether these tests were able to provide a measure of a direct effect of an intervention method, as a progress in development is to be expected naturally regardless of intervention, and also as the tests are performed outside the everyday environment. Risk and opportunity factors are taken into consideration as interventions are adjusted to the child, its family and others concerned but the extent of their influence is not specifically taken into account in evaluation efforts Instruments and methods for evaluating risk and opportunity factors need to be developed. A consensus is urged in how to confirm the reliability and validity of measurements both regarding what instruments to be used and which routines to be used in evaluation. Indirect measures that include education of, advising and supporting the family and others concerned should be designed as these both contribute highly to the outcome of the direct measures as well as the interactions between the child and its close environment.

The relationship that develops between a client and therapist is arguably one of the most important factors toward achieving positive outcomes from therapy. Although the therapeutic alliance has been well studied, there is a paucity of research related to the impact of this relationship when the client is an offender, of Aboriginal ancestry, or psychopathic. The present study employed an archival design in which a sample of 427 treated sexual offenders were examined with regard to their experience of therapeutic alliance with their primary therapists. Offenders who were admitted to the Clearwater Sex Offender Program at the Regional Psychiatric Centre Hospital in Saskatoon (RPC Prairies) between 1998 and 2005 completed a measure that rated the strength of their relationship with their primary therapists using the Working Alliance Inventory (WAI) roughly three months after program admission. Approximately 46% of the sample was of Aboriginal ancestry, while the majority of the balance (approximately 52%) was Caucasian. A sub-sample of 111 offenders was also scored on the PCL-R. Analysis of WAI scores among Aboriginal and non-Aboriginal offenders demonstrated a significant difference on the Bond scale of the WAI, suggesting that although the bonds between Aboriginal offenders and their primary therapists were not as strong as they were between non-Aboriginal offenders and therapists, Aboriginal offenders were still able to identify and agree on the goals and the tasks of the treatment (weaker bonds notwithstanding). Aboriginal offenders also spent slightly less time in treatment overall than their non-Aboriginal counterparts. The present research also found that as the scores on the WAI increased, rates of treatment noncompletion decreased, the implications of which would seem to highlight the need to foster and maintain strong therapeutic relationships. In terms of outcome, perhaps unexpectedly, results of the present research found that WAI was not a significant predictor of any recidivism criteria. Aboriginal Ancestry was related to non-sexual violent reconvictions and general reconvictions, but not sexual recidivism. Moreover, offenders who were both Aboriginal and reported low WAI scores were the most likely to recidivate in a non-sexual violent manner and in general, but not sexually. An examination of the relationship of working alliance to psychopathy found that WAI and PCL-R scores were not significantly correlated overall; however, a negative inverse relationship between the Lifestyle and Emotional facets with total WAI score was noted, suggesting that callous-unemotional traits and lifestyle were associated with weaker alliance. Interestingly, these correlations were not evident in the Aboriginal sample suggesting that other factors, aside from levels of psychopathy, were associated with working alliance in this ancestral group. In addition, results of the present analysis revealed WAI and PCL-R together, were better able to predict sexual recidivism for non-Aboriginal offenders than for Aboriginal offenders; however, the WAI and PCL-R jointly predicted nonsexual violent recidivism, but only for non-Aboriginal offenders, and jointly predicted general recidivism for both ancestral groups. Together, the results of this study attempt to further advance our understanding of the therapeutic alliance and its link to treatment outcome, Aboriginal ancestry, and psychopathy.

Emotional intelligence and self-determined motivation have been independently identified as important personal variables that are liable to foster optimal work functioning. However, the relationship between these two variables has never been assessed. Furthermore, research has also provided evidence that supervisor support, a social variable, is considered to be a significant source of influence on self-determined behaviour regulation. Thus the primary objective of the project was to jointly assess emotional intelligence and supervisor support as antecedents of self-determined work motivation; secondly, to assess the associations of self-determined work motivation on work outcome variables and psychological welfare; and thirdly, to examine the association between emotional intelligence and psychological well-being on 512 police source handlers. Specifically, it was proposed that emotional intelligence would be positively associated to self-determined work motivation and would display a unique association with work motivation, once the variance from supervisor support has been controlled for. It was further proposed that self-determined work motivation would, in turn, be positively associated with positive work outcomes; specifically, job satisfaction, job performance, future work intentions, and psychological well-being. Lastly, it was hypothesized that emotional intelligence would be positively associated to psychological well-being. Data was analyzed using structural equations modeling. Results revealed that emotional intelligence and supervisor support were both uniquely associated with work motivation. Together, these two variables explained a high proportion of the variance of work motivation. Work motivation, in turn, was positively associated with job satisfaction, job performance, future work intention, and psychological well-being. Emotional intelligence and psychological well-being were also positively associated. Overall, the findings of this thesis provide a basis for future research aimed at determining the causal relationship between emotional intelligence and self-determined motivation. It is further suggested that findings gleaned from this study can provide a better understanding of how certain interpersonal behaviours can impact specific work outcomes, which can provide researchers and practitioners with information to improve individual and organizational outcomes of interest.

Little research has examined which individual factors may predict mental health court diversion outcome. Using data provided by a non-profit mental health services agency operating in the Durham Region in Ontario, this study examined 419 persons with mental illness participating in a post-charge diversion program. Socio-demographic and clinical characteristics were employed to investigate the relationship between clientspecific factors and level of program completion. Logistic regression results revealed that unemployment was a significant predictor of program completion. Employment and symptom severity were predictive of partial completion of court diversion. Additionally, participants who did not complete programming were more likely to have a concurrent disorder and were more likely to be residentially unstable than participants who did complete programming. These findings are discussed with respect to their implications for practice and future research. / UOIT

The main objective of my dissertation was to evaluate the biomedical and psychosocial factors associated with pain and disability in patients following traumatic upper extremity nerve injuries. This was approached by conducting 3 studies. The first study surveyed peripheral nerve surgeons regarding the assessment of pain in patients with nerve injury. The results showed that only 52% of surgeons always evaluate pain in patients referred for motor/sensory dysfunction. Pain assessment frequently includes verbal response and assessment of psychosocial factors is infrequent. The second study was a retrospective review to assess disability, as measured by the Disabilities of the Arm, Shoulder and Hand (DASH), in patients with chronic nerve injury. Results showed substantial disability (mean DASH 52 + 22) and a significantly lower health status (p < 0.001) compared with well-established norms. In the regression model, the factors associated with the DASH (R2 = 44.5%) were pain, older age and nerve injured. The third study was a cross-sectional evaluation of the biomedical and psychosocial factors associated with pain and disability after upper extremity nerve injury in 158 patients. DASH scores were significantly higher in patients with workers’ compensation or litigation (p = 0.03), brachial plexus injuries (p < 0.001) and unemployed patients (p < 0.001). In the multivariable regression analysis, the final model explained 52.7% of the variance with these predictors; pain intensity (Beta = .230, p = 0.006), nerve injured (Beta = -.220, p = 0.000), time since injury (Beta = -.198, p = 0.002), pain catastrophizing (Beta = .192, p = 0.025), age (Beta = .187, p = 0.002), work status (Beta = .179, p = 0.008), cold sensitivity (Beta = .171, p = 0.015), depression score (Beta = .133, p = 0.066), workers’ compensation/litigation (Beta = .116, p = 0.049) and gender (Beta = -.104, p = 0.09). Future investigation regarding treatments of the factors that are associated with disability and chronic pain will assist to improve health related quality of life in patients with traumatic nerve injury.

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.

Die periprothetische Fraktur ist eine schwerwiegende Komplikation nach Implantation einer Hüftendoprothese und stellt hohe Anforderungen an das Therapieregime, den Operateur und das Material. Die Wahl des Therapieverfahrenes ist vom Frakturtyp, der Knochenqualität, der Prothesenstabilität und vom Allgemeinzustand des Patienten abhängig. Die Vergleichbarkeit der Ergebnisse zwischen verschiedenen Studien wird einerseits durch die individuellen Therapiestrategien und andererseits durch die Vielzahl an unterschiedlichen Klassifikationen erschwert. Das in der vorliegenden Arbeit anhand einer Vergleichsgruppen-Analyse nachuntersuchte Studienkollektiv bestand aus n = 23 Patienten in der Hauptgruppe und n = 19 Patienten in der Kontrollgruppe, deren klinische Behandlung zwischen 2002 und 2008 am Uniklinikum Leipzig durchgeführt wurde. Hierbei handelte es sich hauptsächlich um geriatrische Patienten mit einem erhöhten Frauenanteil. Die Analyse erfolgte mit einer medianen Follow-Up Zeit der Nachuntersuchung von zwei Jahren. Im Vergleich zu in Literaturdaten angegebenen Ursachen für die Implantation einer Hüftendoprothese zeigte sich in der Hauptgruppe eine höhere Rate an Patienten mit ursprünglicher proximaler Femurfraktur im Vergleich zu Coxarthrose. Die Studie ergab darüber hinaus, dass ein hohes Patientenalter bei der Primärimplantation zu einer kürzeren Standzeit der Prothese führte (p = 0,01++). Zur periprothetischen Fraktur war häufig unterhalb der Prothesenspitze lokalisiert und in den überwiegenden Fällen durch ein Niedrig-EnergieTrauma in Verbindung mit prädisponierenden Faktoren bedingt. Im Widerspruch mit der Literatur ereignete sich die periprothetische Fraktur in unserer Untersuchung häufiger und zeitlich eher bei Patienten mit zementierter Hüftendoprothese als bei denjenigen mit nicht zementierter Endoprothese (Beals and Tower, 1996). Die operative Frakturversorgung erfolgt bei gelockerter Endoprothese durch einen Prothesenwechsel und bei fester Endoprothese durch eine Osteosynthese. Die unterschiedlichen Frakturtypen und Versorgungsarten führten nicht zu einem signifikant unterschiedlichen funktionellen Ergebnis der Patienten, wobei im Vergleich der Frakturtypen vom Trend her Patienten mit Johansson I Fraktur das beste funktionelle Resultat erreichten. Bezüglich der Komplikationsrate zeigte sich in der plattenosteosynthetisch versorgten Patientengruppe im Vergleich zu der durch einen Prothesenwechsel versorgten Gruppe eine signifikant erhöhte Rate an Revisionseingriffen. Im Unterschied zur Kontrollgruppe war die postoperative Komplikationsrate in der Hauptgruppe erhöht und das funktionelle Endergebnis in den Scoresystemen signifikant schlechter. Bei der Therapie der periprothetischen Fraktur traten trotz der guten objektiven Beweglichkeit, Schmerzen und Einschränkungen in der Gehfähigkeit auf, die zu einer deutlichen Reduktion der Alltagskompetenzen führten. Aus diesem Grund sollten die Ziele der Therapie periprothetischer Frakturen in der Frakturprävention, Therapieoptimierung und Nachsorgeverbesserung liegen. Zu achten ist dabei auf eine individuell ausreichende postoperative Schmerztherapie und intensive frühfunktionelle physiotherapeutische Behandlung mit Förderung der Selbstständigkeit, wobei eine weitere wissenschaftliche Begleitung und Analyse der Behandlungsergebnisse zukünftig wünschenswert wäre.

Upper limb function is important for individuals with tetraplegia because upper limb function supports global function for these individuals. As a result, a great deal of time and effort has been devoted to the restoration of upper limb function. Appropriate outcome measures that can be used to characterize the neurological status of the upper limb have been one of the current barriers in substantiating the efficacy of interventions. Techniques and protocols to evaluate changes in upper limb neurological status have not been applied to the SCI population adequately. The objectives of this thesis were to develop a measure; which is called the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP). Development of the scoring approach, testing for reliability and construct validity, and determining impairment and function relationships specific to the upper limb neurological were established. The GRASSP is a clinical measure of upper limb impairment which incorporates the construct of “sensorimotor upper limb function”; comprised of three domains which include five subtests. The GRASSP was designed to capture information on upper limb neurological impairment for individuals with tetraplegia. The GRASSP defines neurological status with numerical values, which represent the deficits in a predictive pattern, is reliable and valid as an assessment technique, and the scores can be used to determine relationships between impairment and functional capability of the upper limb. The GRASSP is recommended for use in the very early acute phases after injury to approximately one year post injury. Use of the GRASSP is recommended when a change in neurological status is being assessed.

The main objective of my dissertation was to evaluate the biomedical and psychosocial factors associated with pain and disability in patients following traumatic upper extremity nerve injuries. This was approached by conducting 3 studies. The first study surveyed peripheral nerve surgeons regarding the assessment of pain in patients with nerve injury. The results showed that only 52% of surgeons always evaluate pain in patients referred for motor/sensory dysfunction. Pain assessment frequently includes verbal response and assessment of psychosocial factors is infrequent. The second study was a retrospective review to assess disability, as measured by the Disabilities of the Arm, Shoulder and Hand (DASH), in patients with chronic nerve injury. Results showed substantial disability (mean DASH 52 + 22) and a significantly lower health status (p < 0.001) compared with well-established norms. In the regression model, the factors associated with the DASH (R2 = 44.5%) were pain, older age and nerve injured. The third study was a cross-sectional evaluation of the biomedical and psychosocial factors associated with pain and disability after upper extremity nerve injury in 158 patients. DASH scores were significantly higher in patients with workers’ compensation or litigation (p = 0.03), brachial plexus injuries (p < 0.001) and unemployed patients (p < 0.001). In the multivariable regression analysis, the final model explained 52.7% of the variance with these predictors; pain intensity (Beta = .230, p = 0.006), nerve injured (Beta = -.220, p = 0.000), time since injury (Beta = -.198, p = 0.002), pain catastrophizing (Beta = .192, p = 0.025), age (Beta = .187, p = 0.002), work status (Beta = .179, p = 0.008), cold sensitivity (Beta = .171, p = 0.015), depression score (Beta = .133, p = 0.066), workers’ compensation/litigation (Beta = .116, p = 0.049) and gender (Beta = -.104, p = 0.09). Future investigation regarding treatments of the factors that are associated with disability and chronic pain will assist to improve health related quality of life in patients with traumatic nerve injury.

Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.