Class of 2009 Abstract / OBJECTIVES: The purpose of this study is to describe clinical pharmacist services in a nurse practitioner (NP) run clinic and how clinical pharmacists might influence prescribing. METHODS: The description of the clinical pharmacist services is based on a 12-week experience of a clinical pharmacist and senior student pharmacist working with the nurse practitioner and nurse practitioner students. A questionaire was developed and consisted of items relating to the nurse practitioners ability to identify possible interactions of OTC medications, herbals and prescription medications. In addition, the questionnare assessed the comfort level of NP’s taking a prescription medication history, checking a patient’s prescription formulary, and selecting appropriate medication therapies. The questionaire uses a retrospective pretest format and was tested as a method of collecting data on how a pharmacist influenced NP prescribing. The site selected for this study was the Arizona State University Center for Healthcare Innovation (ASU Center) located in the heart of Downtown Phoenix (3rd Ave and Van Buren). RESULTS: Only one nurse practitioner worked at the ASU Center. The facility is new to the neighborhood and does not see many patients. The nurse practitioner partner in this project responded that working with a clinical pharmacist on a regular basis, with more patients would definitely help her hone skills necessary to identify interactions and prescribe according to a patients formulary. CONCLUSIONS: Pharmacists provide value-added services in an ambulatory care clinic run by nurse practitioners and provide valuable education and consultation on drug interactions. Pharmacist influence can be measured successfully to using a questionnaire in a retrospective pretest-posttest study design.

The aim of the study was to analyse and to evaluate ethical climate in Kaunas Sanciai outpatient clinic. Tasks – to evaluate ethical climate in Kaunas Sanciai outpatient clinic; to determine and evaluate ethical climate relationship between varies workers group depending from age, education, work expierence; to identify mostly occurred ethical disturbances in Kaunas Sanciai outpatient clinic. Methods. Investigative were workers (n=237) of Kaunas Sanciai outpatient clinic, interviewed in October-November 2005. The data analysis was performed in 233 (98.3%) persons, using MS Excel and EpiInfo 6.0 statistical programme packages. Results. The major part of Kaunas Sanciai outpatient clinic workers the ethical climate evaluate positive: 77.3% respondents answer, that in the outpatient clinic predominant confidence and honor ambience, 91.9% of persons answer, that each workers committed for own decisions, 73.0% of respondents answer, that predominant friendliness, 67.8% of workers aggreed with affirmation, that the directors of outpatient clinic promote ethical behavior, so the directors are ethical decorum example in 85.5% of persons. Majority (81.1%) respondents answer, that in the outpatient clinic necessary organization members ethical education. Majority of youngest persons and working until one year disagreed with affirmation, that each workers commited for own decision, that in the outpatient clinic predominant friendliness, that organization directors promote workers ethical... [to full text]

The Doctor Interactive Group Medical Appointment (DIGMA) is a group health intervention that combines the services of behavioral health and primary care. The DIGMA was first invented by Edward Noffsinger in 1996, in response to his own difficulties with the overtaxed primary care system at Kaiser Permanente in California (Noffsinger, 1999). Integrating healthcare services in this way has practical implications such as efficient use of resources, treating multiple complaints at once, and beginning to view the mind and body as one (Noffsinger, 1999; Engel, 1977). The DIGMA at the Austin Veterans Outpatient Clinic was designed to address the specific needs of veterans with hypertension. It consists of 4 sessions of 1.5 hours each and addresses such varied topics as exercise, stress-management, nutrition, and medication adherence. These topics are discussed in a group format with the tenets of group psychotherapy (Yalom & Leszcz, 2005) as a backdrop. An exploratory study was warranted to determine whether programs of this sort would be effective on a broad scale. A pretest/posttest design was utilized to determine if the DIGMA was effective at reducing symptoms of hypertension; improving health promoting behavior; increasing self-efficacy to manage hypertension; and increasing internal health locus of control while decreasing chance and powerful others health locus of control. Groups were conducted over a period of seven months with a total of 73 male veterans enrolled in the study. The final n was 58. Findings indicated that both systolic and diastolic blood pressure readings were reduced significantly from pretest to posttest. Health promoting behavior increased significantly; hypertension self efficacy increased significantly; and locus of control did not change significantly from pretest to posttest. The exploratory study concluded that the DIGMA may be efficacious for a variety of aspects of the management of hypertension. It is suggested that further research be conducted but that integrating services in this way can lead to improved patient outcomes and can also be cost-effective. / text

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-24T19:40:57Z No. of bitstreams: 1 ManoelPazLandim_dissert.pdf: 2190052 bytes, checksum: 481993ad32fdeb90f77a1b27bf9d7949 (MD5) / Made available in DSpace on 2018-10-24T19:40:57Z (GMT). No. of bitstreams: 1 ManoelPazLandim_dissert.pdf: 2190052 bytes, checksum: 481993ad32fdeb90f77a1b27bf9d7949 (MD5) Previous issue date: 2017-07-05 / The causal relationship between hypertension and the development of target organ damage (TOD) is very well established, but the contribution of absolute blood pressure values to the genesis of TOD has been questioned. This study makes a comparative analysis between the values of Blood Pressure and the triggering of Target Organ Lesions in a hypertensive population, in order to verify the possibility of a dependence between high blood pressure figures and the appearance of lesions. Objective - To relate blood pressure levels obtained by ABPM with the appearance of LVH, stroke, CAD and microalbuminuria in a selected population of hypertensive patients. Casuistic and Methods: One hundred and sixty two patients belonging to the FAMERP hypertension outpatient clinic who met the inclusion criteria were studied, and the occurrence of the outcomes was considered. The minimum period of follow-up was five years and the maximum period was fifteen years. At the end of the data collection, statistical analyzes were sufficient to answer if higher values of arterial pressure were related, or not, to greater number of TOD. We also sought to confirm existence of other related variables, which could contribute positively or negatively to the appearance of the outcomes. Results: Only the increase in left ventricular mass and the occurrence of CAD are significantly related to the abnormal behavior of the arterial pressure and, even then, only to the nocturnal mean higher than the reference for mass increase and the diastolic mean of 24 hour ABPM recorded at the end of the observation period for the CAD. The appearance of outcomes, objective of this study is significantly more related to metabolic factors, comorbidities and/or to epidemiological parameters than to the increase in numerical values of blood pressure. The appearance of microalbuminuria in the multivariate analysis was positively related to DMII (p= 0.0029) and TG (p= 0.003). The same can be observed for stroke (male gender with p= 0.009; HDL= 0.016; PAD= 0.003; microalbuminuria p= 0.003 and LVH at the end of the observation p= 0.029). Diabetes mellitus II was also protagonist in the evolution for LVH, with p= 0.030 in the univariate analysis and p= 0.037 when there was multivariate refining. When studying the onset of CAD, besides the pressure component, we have also recorded age older than or equal to 65 years (p= 0.019 in the univariate comparison and p= 0.002 in the multivariate), HDL-c (p= 0.009 in the univariate and p= 0.004 in the multivariate) and PAD (p= 0.047). Conclusions: Increases in blood pressure levels lato sensu were not accompanied by a corresponding increase in the number of CAD, LVH, stroke or microalbuminuria in the studied population, except non dipper / Introdução: A relação causal entre hipertensão e o desenvolvimento de lesões de órgãos-alvo (LOA) está muito bem estabelecida, mas a contribuição dos valores absolutos da pressão arterial na gênese das LOA tem sido questionada. Este estudo faz uma análise comparativa entre os valores de Pressão Arterial e o desencadeamento de Lesões de Órgão-Alvo em uma população de hipertensos, de maneira a verificar a possibilidade de ter havido entre eles uma dependência entre altas cifras tensionais e o aparecimento de lesões. Objetivos: Relacionar os níveis de pressão arterial obtidos pela monitorização ambulatorial da pressão arterial M.A.P.A. com o aparecimento de hipertrofia ventricular esquerda (HVE), acidente vascular cerebral (AVC), doença arterial coronariana (DAC) e microalbuminúria (MICROALB) em uma população selecionada de hipertensos. Casuística e Métodos: Estudamos 162 pacientes pertencentes ao ambulatório de Hipertensão da faculdade de medicina de São José do Rio Preto (FAMERP) que obedeceram aos critérios de inclusão e consideramos o aparecimento dos desfechos. O prazo mínimo de acompanhamento foi de cinco anos e o máximo de quinze anos. Ao final da coleta de dados fizemos as análises estatísticas suficientes para responder se valores mais altos de pressão arterial estiveram ou não relacionados com maior número de LOA. Também procuramos a existência de outras variáveis afins que pudessem contribuir positiva ou negativamente para o surgimento dos desfechos. Resultados: O aumento da massa ventricular esquerda e o surgimento de DAC estiveram relacionados significativamente com o comportamento anormal da pressão arterial. A média noturna superior à referência esteve relacionada positivamente com o aumento da massa e a média diastólica da M.A.P.A. de 24 horas registrada ao final do período de observação para a DAC. O surgimento dos desfechos, objetivo deste trabalho, esteve muito mais ligado a fatores metabólicos, co-morbidades e ou a parâmetros epidemiológicos do que ao aumento dos valores numéricos da pressão arterial. Na análise multivariada o surgimento de microalbuminúria relacionou-se positivamente com diabetes melitus tipo II (DMII) com p=0,0029 e triglicerídeos (TG) com valor de p=0,003. O mesmo pôde ser observado para AVC, gênero masculino com p= 0,009; fração HDL colesterol (HDL-c) com p= 0,016; doença arterial periférica (DAP) com valor de p= 0,003; possuir microalbuminúria (p= 0,003) e ter hipertrofia ventricular esquerda (HVE) ao término da observação, p= 0,029. DM II também se associou com a evolução para HVE, com p= 0,030 na análise univariada, e p= 0,037 quando houve o refino multivariado. Para o desfecho AVC, HDL-c, microalbuminúria e presença de DAP se associaram a este desfecho. Registramos outros fatores relacionados ao desfecho doença arterial coronariana (DAC), ou seja, idade ≥65 anos (p = 0,019 na comparação univariada e p = 0,004 na multivariada), possuir DAP (p = 0,47) e HDL-c (p = 0,009 na univariada e p = 0,004 na multivariada). Conclusões: O valor das cifras tensionais avaliadas pela M.A.P.A. não se associam a aumento de risco para número de DAC, HVE, AVC ou Microalbuminúria na população estudada, com exceção de descenso noturno incompleto ter se associado ao desenvolvimento de aumento da massa ventricular esquerda e da média diastólica de 24h ter se relacionado positivamente com a evolução para DAC. A fração HDL colesterol (HDL-c) correlaciona-se com a evolução para DAC e AVC. A concomitância de doença arterial periférica (DAP) previa está ligada a DAC e de Microalbuminúria (MICROALB) e hipertrofia ventricular esquerda (HVE) a AVC. Diabetes Mellitus (DM) relaciona-se a aumento da massa ventricular esquerda (MASS VE) e MICROALB. Os valores de triglicerídeos e de ácido úrico (AU) ligam-se ao desenvolvimento de MICROALB.

People living with heart failure (PLHF) should be screened for symptoms at every healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires were compared and assessed with the gold standard laboratory test for HF (NT-proBNP) for sensitivity and specificity. For HF, the SHEFS was the most sensitive (83%) compared to the NT-proBNP, but the MLHFQ was most specific (89%). When compared to the MLHFQ as the standard, SHEFS was 71% sensitive, and 73% specific for HF. Similarly, when compared to the KCCQ, the SHEFS was both, 75% specific and sensitive in identifying HF. However, the rate of correlation to a positive or negative NT-proBNP test results was the highest for the SHEFS (87%). All 3 questionnaires were statistically significant in predicting admission to hospital for HF in the past 6 months (p = 0.02 to 0.03). Finally, given the shortest length and simplicity of use, the SHEFS was selected by the stakeholders to be the standard screening tool for the clinic. This project contributes to positive social change by providing the first reported comparison in the literature to implement questionnaires in a clinic to assess symptoms for PLHF attending an arrhythmia devices clinic.

abstract: Overview: Transition from the pediatric to adult care setting for 'emerging adults' (ages 18- 26) continues to develop as a growing concern in health care. The Adolescent Transition Program teaches chronically ill 'emerging adults' disease self-management skills while promoting a healthy lifestyle. Transferring this knowledge is vital for successful health care outcomes. Unfortunately, patients who have been transferred to the adult care setting, report that they felt lost in the system due to lack of communication between care teams, inadequate support systems, and insufficient disease management knowledge. To address these gaps, the design of the physical environment must adapt to these challenges while also meeting the needs of various chronic illnesses. Methodology: Design thinking or human-centered design was utilized as the vehicle to discover unmet 'emerging adult' and adolescent health clinician needs. Ethnographic research methods involved observations at adolescent health clinics and in learning environments outside of the healthcare setting as well as interviews with 5 outpatient adolescent clinicians. A survey was also conducted with 16 'emerging adults' to understand how they learn. Lastly, a literature review explored the history of the adolescent, adolescent development, adolescence and chronic illness, and The Adolescent Transition Program. Results: Findings revealed that physical environment must be conducive to meet a variety of clinical and education activities such as chronic disease management, support adolescent development, and should be more human-centered. The space should transform to the patient education or clinical activity rather than the activity transforming to the space. Five design recommendations were suggested to ensure that the outpatient clinic supported both clinician and 'emerging adults' needs. / Dissertation/Thesis / M.S.D. Design 2014

The subject of this diploma thesis is the elaboration of project documentation for the construction of a civic amenity building for outpatient care, with associated establishments, namely a pharmacy and a café. The building is designed on a plot of land located in the center of the town of Chotěboř in the Havlíčkův Brod district. The polyclinic is designed as a partially basement, free-standing rectangular building with overhanging entrances to individual establishments. The outpatient department has three floors. Underground vertical structures are designed as reinforced concrete walls, above-ground peripheral and internal load-bearing masonry is made of ceramic blocks, ceiling structures are made of prestressed panels. A double-reinforced concrete monolithic staircase and an elevator are designed in the building. Non-load-bearing internal structures are solved using plasterboard structures and the whole building is covered with a single-skin flat vegetation roof.

Diese Arbeit untersucht die Wirksamkeit des monoklonalen Antikörpers Belimumab bei Patient*innen mit systemischem Lupus erythematodes in einer monozentrischen Routinekohorte. Besonderes Augenmerk lag auf der Betrachtung des Ansprechens einzelner Organmanifestationen. Es sollten Subgruppen mit hoher oder niedriger Wahrscheinlichkeit für ein Ansprechen identifiziert werden. Es erfolgte eine retrospektive Auswertung von regelmäßig und standardisiert erhobenen Patient*innendaten. Betrachtet wurden dokumentierte Symptome, Laborparameter und daraus abgeleitete klinische Scores. Betrachtet wurden 4 Zeitpunkte in den ersten 12 Monaten der Therapie und ein weiterer Last visit-Zeitpunkt zur Evaluation des Langzeiterfolges. Bei Patient*innen, deren Therapie vorzeitig beendet wurde, wurden die Werte der letzten Beobachtung unter Therapie übernommen. Es erfolgte eine Auswertung in Untergruppen, abhängig vom Nachweis von Organmanifestationen zu Therapiebeginn. Untersucht wurde ein aussagekräftiges Studienkollektiv mit eher niedriger Krankheitsaktivität. Die Therapie mit Belimumab am UKD wurde für die meisten Patient*innen als erfolgreich bewertet; von 27 Therapien wurden 21 (78 %) von den behandelnden Ärzt*innen als erfolgreich eingeschätzt, was auf eine gute Wirksamkeit in der Population hinweist. Die Zahl symptomfreier Personen stieg innerhalb von 12 Monaten von 1 auf 7 und im weiteren Therapieverlauf auf 10. Es zeigten sich signifikante Änderungen von klinischen Scores und Komplementproteinen; so fiel der mediane SLEDAI von 6 auf 4 Punkte und das mediane C4 stieg von 0,09 g/l innerhalb von 12 Monaten auf normwertige 0,10 g/l sowie im weiteren Verlauf auf 0,16 g/l. Die mittlere Prednisolondosierung wurde innerhalb von 12 Monaten von 5,8 mg/d auf 5,0 mg/d und langfristig auf 3,3 mg/d gesenkt. Belimumab zeigte sich bei 6 von 6 Patient*innen mit Exanthem und 4 von 6 Patient*innen mit Arthritis mit fast vollständigem Symptomrückgang sehr gut wirksam. Von 10 Patient*innen mit einem initialem Prednisolonbedarf von ≥ 7,5mg/d konnten 6 ihre Prednisolondosis um mindestens 25 % senken. Das Symptom Fatigue wurde bei 6 von 18 Patient*innen nach 12 Monaten nicht mehr dokumentiert. Von 11 Patient*innen mit Raynaud-Symptomatik wurde ebendiese nach 12 Monaten nur noch von 7 dokumentiert. Es zeigten sich keine Hinweise auf eine Wirksamkeit auf Leuko- oder Thrombopenie. In weiteren Studien könnte die Wirksamkeit von Belimumab bei Patient*innen mit Lupusnephritis, Raynaud-Symptomatik, Fatigue, hämatologischer Beteiligung und niedriger Krankheitsaktivität weiter untersucht werden.:INHALTSVERZEICHNIS III ABKÜRZUNGSVERZEICHNIS VIII 1 EINLEITUNG 10 1.1 Systemischer Lupus erythematodes (SLE) 10 1.1.1 Geschichte 10 1.1.2 Epidemiologie 11 1.1.3 Ätiologie und Pathogenese 11 1.1.4 Symptome 12 1.1.4.1 Konstitutionell 14 1.1.4.2 Hämatologisch 14 1.1.4.3 Neuropsychiatrisch 14 1.1.4.4 Mukokutan 14 1.1.4.5 Serositis 15 1.1.4.6 Muskuloskelettal 15 1.1.4.7 Renal 15 1.1.4.8 weitere Symptome 15 1.1.5 Diagnostik 16 1.1.5.1 Anamnese 16 1.1.5.2 Klinische Untersuchung 16 1.1.5.3 Labordiagnostik 16 1.1.6 Aktivitätsmessung 17 1.1.7 Letalität 17 1.1.8 Sozioökonomische Belastung und QOL-Einschränkung 18 1.1.9 Klassifikationskriterien 19 1.1.10 Aktivitätsscores 20 1.1.11 Therapie 20 1.1.11.1 Basismaßnahmen 21 1.1.11.2 Glukokortikoide 21 1.1.11.3 DMARDs (disease-modifying anti-rheumatic drugs) 21 1.1.11.4 Cyclophosphamid 22 1.2 Belimumab 23 1.2.1 Wirkmechanismus 23 1.2.2 Zulassungsstudien 23 1.2.2.1 Studienpopulation 24 1.2.2.2 nachgewiesene Effekte 24 Unerwünschte Arzneimittelwirkungen (UAW) in den Zulassungsstudien 25 1.2.2.3 Zulassung 26 1.2.3 Belimumab in der klinischen Anwendung 26 2 FRAGESTELLUNG 27 3 MATERIAL UND METHODEN 28 3.1 Studienkollektiv 28 3.2 Ethik 28 3.3 Erhobene Daten 28 3.3.1 Charakterisierung des Studienkollektivs 29 3.3.2 Datumsangaben 29 3.3.3 Zeitpunkte 29 3.3.4 Zeitpunktabhängige Parameter 30 3.3.5 Erhobene, nicht aussagekräftige Daten 32 3.3.6 Organmanifestationen 32 3.4 Quellen 33 3.4.1 Patient*innenakte 34 3.4.2 Ärztliche Verlaufsdokumentation 34 3.4.3 Medikamente 35 3.4.4 SLE-Bogen 35 3.4.5 Laborwerte 36 3.4.6 Berechnung von klinischen Scores 37 3.4.7 Therapieerfolg 37 3.4.8 Dokumentationsungenauigkeiten 37 3.5 Statistische Verfahren 38 3.5.1 Normalverteilung 38 3.5.2 Signifikanztests 39 4 ERGEBNISSE 41 4.1 Studienkollektiv 41 4.1.1 Allgemeine Zusammensetzung 41 4.1.2 Erfüllung der EULAR/ACR2019-Kriterien 43 4.1.3 Antikörperstatus 44 4.1.4 Charakterisierung der einzelnen Patient*innen 45 4.2 Zeitpunktübergreifende Ergebnisse 49 4.2.1 Auswertungszeitraum 49 4.2.2 Therapiedauer 50 4.2.3 Zeitpunkte und beendete Therapien 50 4.2.4 Therapieerfolg 51 4.2.5 Krankheitsschübe und Prednisolonstoßtherapien 52 4.2.6 weitere Medikamente 53 4.2.7 Unerwünschte Arzneimittelwirkungen 53 4.3 Zeitpunktabhängige Ergebnisse 55 4.3.1 Datumsdifferenzen 55 4.3.2 Prednisolonbasistherapie 56 4.3.3 Symptome 56 4.3.4 Paraklinik 58 4.3.5 Scores 58 4.3.6 Angaben auf der visuellen Analogskala 59 4.4 Auswertung nach Patient*innengruppen 61 4.4.1 Indikationsrelevante Organbeteiligungen 61 4.4.2 Patient*innen mit Arthritis 62 4.4.3 Patient*innen mit Fatigue 64 4.4.4 Patient*innen mit Exanthem 67 4.4.5 Patient*innen mit Raynaud-Symptomatik 68 4.4.6 Patient*innen mit hämatologischer Beteiligung 70 4.4.7 Patient*innen mit hohem Prednisolonbedarf 74 4.4.8 Patient*innen mit aktiver Lupusnephritis 76 5 DISKUSSION 78 5.1 Stärken und Schwächen der Studie 78 5.1.1 Anzahl der Patient*innen 78 5.1.2 Definition des Therapieerfolgs 78 5.1.3 Schubförmiger Verlauf der Erkrankung 79 5.1.4 Systematischer Fehler der Scores 79 5.1.5 Fortführung der letzten Beobachtung bei Patient*innen mit beendeter Therapie 80 5.1.6 Last visit-Zeitpunkt 80 5.1.7 Auswertung nach Patient*innengruppen 80 5.2 Studienkollektiv 82 5.2.1 Allgemeine Zusammensetzung 82 5.2.2 Erfüllung der EULAR/ACR2019-Kriterien 84 5.2.3 Antikörperstatus 86 5.3 Zeitpunktübergreifende Ergebnisse 87 5.3.1 Therapieerfolg 87 5.3.2 Krankheitsschübe und Prednisolonstoßtherapien 87 5.3.3 weitere Medikamente 87 5.3.4 Unerwünschte Arzneimittelwirkungen 87 5.4 Zeitpunktabhängige Ergebnisse 89 5.4.1 Datumsdifferenzen 89 5.4.2 Prednisolonbasistherapie 89 5.4.3 Symptome 89 5.4.4 Paraklinik 89 5.4.5 Scores 90 5.4.6 Angaben auf der visuellen Analogskala 91 5.5 Auswertung nach Patient*innengruppen 92 5.5.1 Indikationsrelevante Organbeteiligungen 92 5.5.2 Patient*innen mit Arthritis 93 5.5.3 Patient*innen mit Fatigue 93 5.5.4 Patient*innen mit Exanthem 93 5.5.5 Patient*innen mit Raynaud-Symptomatik 94 5.5.6 Patient*innen mit hämatologischer Beteiligung 94 5.5.7 Patient*innen mit hohem Prednisolonbedarf 94 5.5.8 Patient*innen mit aktiver Lupusnephritis 95 5.6 Relevanteste Ergebnisse 96 5.7 Ausblick 97 6 ZUSAMMENFASSUNG 98 7 SUMMARY 99 LITERATURVERZEICHNIS 106 ANHANG 123 DANKSAGUNG 124 ANLAGE 1: ERKLÄRUNG ZUR ERÖFFNUNG DES PROMOTIONSVERFAHRENS 125 ANLAGE 2: ERKLÄRUNG ZUR EINHALTUNG AKTUELLER GESETZLICHER VORGABEN 126

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<p>The overall aims of this research were to develop methods of identifying adolescents with unhealthy and/or risk-taking behavior with special reference to sexuality, and to evaluate support measures for young people in need of such interventions. A further aim was to assess strategies for preventing unhealthy and/or risk-taking behavior. Data were obtained by questionnaires (studies I, III, IV and V) and interviews (study II).</p><p>The results showed that young men involved in unintended pregnancies would benefit from active participation in the decision making regarding continuation or termination of the pregnancy, and from support at Outpatient Clinics for Adolescents in Sweden, including information together with the partner (I).</p><p>It was also concluded that consideration should be paid to questions and problems, e.g. feelings, apprehensions, moral issues and psychosocial factors, that require individual support from personnel with knowledge and resources to help young men in this difficult situation (II).</p><p>Among the most important findings regarding young men who had been involved in an unplanned pregnancy were that in this group a high percentage had previously considered suicide and that anabolic steroids were frequently used, compared with young men without experience of pregnancy (III).</p><p>The finding that unprotected intercourse occurred in a fairly high frequency among 13- to 18-year-olds, despite massive education and easy access to contraceptives, gives reason for further considerations regarding appropriate ways of providing information to young people (IV).</p><p>Girls and boys in vocational programs in Swedish high schools exhibit more risk-taking behaviors than those in theoretical programs and these two groups differ in clustering and accumulation of these behaviors. This means that preventive interventional strategies need to be elaborated with regard to these differences, with the aim of improving health maintenance among adolescents (V).</p><p>Child-and-youth centers with a developmental and research capacity need to be established with the broad purpose of drawing up health prevention programs for children and young people.</p>