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Riskbedömning är en väsentlig del av klinikerns vardag. Varje patient ska riskbedömas och riskgrupperas, vilket sedan utgör grund för val av behandling, behandlare och revisionsintervall. I tandvården i Sverige idag används det ett flertal olika stödsystem eller riktlinjer för riskbedömning av oral hälsa. Syftet med studien var att ta reda på vilka stödsystem/riktlinjer som finns för riskbedömning av oral hälsa i Sverige idag och ge en beskrivning av de mest frekvent använda systemen samt göra en jämförelse av dessa. Syftet var också att undersöka huruvida dessa system är evidensbaserade och utvärderade samt att kartlägga kunskapsläget, gällande evidensbasering och utvärdering av stödsystem/riktlinjer, för riskbedömning av oral hälsa. För att skapa oss en allmän bild av stödsystem/riktlinjer för riskbedömning inleddes vårt arbete med en litteraturgenomgång. För att svara på frågeställningen om kunskapsläget över stödsystemens/riktlinjernas evidens och utvärdering, gjordes en systematisk litteraturöversikt. En kartläggning över Folktandvården och kontakt med Praktikertjänst gav oss en bild över vilka system som är aktuella i Sverige idag. För information om de utvalda systemen kontaktades så kallade nyckelpersoner för intervju. Data från intervjuerna har sedan analyserats i relation till vår litteraturgenomgång. Resultaten visar att Beslutsstöd R2 är det system som används mest frekvent inom Folktandvården. Andra förekommande system är Datorstödd Riskbedömning Effica och DentiGroup. Inom Praktikertjänst finns ett system tillgängligt för alla som använder sig av Opus journalsystem. Vår slutsats är att det vetenskapliga underlaget, gällande evidensbasering och utvärdering av stödsystem/riktlinjer, är bristfälligt. / Risk assessment is an essential part of dental practice today. Each patient should be assessed and stratified into a well defined group according to risk. This risk assessment should then affect the choice of prevention and treatment, and intervals for recalls and appropriate level of care. Today, in Swedish dental healthcare, different guidelines are being used as support in the assessment of a patient’s oral health. The aim of this study was to find out, compare and describe the most frequent used guidelines/systems for risk assessment of oral health in Sweden today. A second aim was to examine whether these systems are evidence-based and evaluated, and to identify existing knowledge about evidence-based supporting systems for risk assessment of oral health. A systematic review was made where articles published more than 10 years ago and papers which didn’t involve risk assessment of the whole patient were excluded. The Public Dental Service and Praktikertjänst were contacted and enquired about which systems if any were in use. For more in depth information on these systems, persons with key knowledge were interviewed. The information received was then analyzed in relation to the literature review. The results show that the system most frequently used in the Public Dental Service today is Beslutsstöd R2. Other computerbased systems are Datorstödd riskgruppering Effica and DentiGroup. In Praktikertjänst a system is available for all users of Opus Dental practice management system. Our conclusion is that the scientific evidence, regarding evidence-based and evaluation of support / guidelines are inadequate.

Background: Physical activity (PA) is an important component of a healthy pregnancy and has consistently been associated with improved weight management and a reduced risk of pregnancy complications. While the percentage of pregnant women meeting PA guidelines internationally is alarmingly low, no such data exists for the Canadian population. PA in pregnancy may also be a useful intervention for preventing and managing cardiometabolic dysfunction, but research in pregnancy is limited. Objectives: 1) To describe the PA and exercise habits of women in early pregnancy and assess the percentage of women meeting SOGC/CSEP guidelines for exercise in pregnancy; 2) To determine the association of PA with maternal cardiometabolic health in early pregnancy. Study Design: Maternal blood samples, and PA, dietary, and adiposity measures were collected from a subset of women in early pregnancy (12 – 17 wk gestation) upon enrollment in the Be Healthy in Pregnancy RCT. Fasted blood samples were analyzed for glucose, triglycerides, insulin, leptin, adiponectin and C-reactive protein (CRP). Self-reported and objectively measured PA were assessed using the PARmed-X for Pregnancy and an accelerometer. PA was quantified by three parameters: daily step count, energy expenditure (kcal/day) and meeting the SOGC/CSEP recommendations. Results: For the 198 participants of age 31 ± 4 years; BMI 25.4 ± 4.7kg/m2; at 13 ± 2 wk gestation (mean ± SD), 19.2% reported not exercising in early pregnancy. Approximately half of participants met the minimum SOGC/CSEP recommendation (15 min, 3x/wk), but only 14.2% met the preferred SOGC/CSEP recommendation (30 min, 4x/wk). Meeting the preferred recommendation was associated with lower CRP. Daily step count and energy expenditure (kcal/day) were not significantly associated with glucose, triglycerides, insulin, leptin, adiponectin or CRP. Percent body fat and a higher diet quality were associated with some of the cardiometabolic biomarkers. Conclusion: In a healthy pregnant cohort, while the majority had PA below recommendations, measured PA was not associated with most cardiometabolic biomarkers thus cardiometabolic risk in early pregnancy was low. / Thesis / Master of Science (MSc)

South Africa is a water-scarce country and over the years, the quality of water resources has deteriorated due to poor effluent discharge, agricultural, industrial, mining and human activities. The major contributing factors of poorly-treated or inadequately treated wastewater may be attributed to: (a) the poor design and construction of wastewater treatment plants; (b) lack of qualified process controllers; (c) non-compliance with applicable legislation; (d) lack of proper monitoring; and (e) management issues with regard to wastewater treatment plants. Water quality is important as many communities depend on water resources for their daily activities and livelihood. There is a need therefore to build and manage wastewater treatment plants effectively as they have an impact on water quality. Wastewater treatment plants in South Africa are regulated by the Constitution of the Republic of South Africa, 1996, the National Environmental Management Act 107 of 1998, the National Water Act 36 of 1998, the Water Services Act 108 of 1997, Provincial legislation, Municipal by-laws and other Government policies applicable to Local Government. Chapter 7 of the Constitution inter alia, provides that Local Government has the duty to provide a safe and healthy environment to its community in a sustainable manner. Schedule 4B of the Constitution imposes the function of delivering water, sanitation and wastewater treatment services on Municipalities. This responsibility rests on District Municipalities but may be performed by a Local Municipality if the district municipality lacks the capacity to do so. Although Local Government has the right to govern on its own initiative the affairs of its communities, it needs support and monitoring from other spheres of Government (National and Provincial) to ensure the delivery of wastewater treatment services in a sustainable manner. In this study, Ba-Phalaborwa Local Municipality is used as an example of a Municipality in the Limpopo Province faced with challenges related to the operation and management of its wastewater treatment plant. This study aims to determine who should be responsible for the regulation of wastewater treatment plants in Ba-Phalaborwa Local Municipality area in order to ensure service delivery to communities in a sustainable manner. In order to deal with the challenges experienced by Local Government in dealing with wastewater treatment plants, the study considers Best Practice Guidelines and external service delivery mechanisms, specifically in the form of Public-Private Partnerships. The study concludes with recommendations based on Best Practice Guidelines which Municipalities can use to avoid wastewater pollution and proposes management mechanisms in managing a Public-Private Partnership effectively in order to ensure that they provide service delivery in a sustainable manner. / LLM (Environmental Law and Governance), North-West University, Potchefstroom Campus, 2014

South Africa is a water-scarce country and over the years, the quality of water resources has deteriorated due to poor effluent discharge, agricultural, industrial, mining and human activities. The major contributing factors of poorly-treated or inadequately treated wastewater may be attributed to: (a) the poor design and construction of wastewater treatment plants; (b) lack of qualified process controllers; (c) non-compliance with applicable legislation; (d) lack of proper monitoring; and (e) management issues with regard to wastewater treatment plants. Water quality is important as many communities depend on water resources for their daily activities and livelihood. There is a need therefore to build and manage wastewater treatment plants effectively as they have an impact on water quality. Wastewater treatment plants in South Africa are regulated by the Constitution of the Republic of South Africa, 1996, the National Environmental Management Act 107 of 1998, the National Water Act 36 of 1998, the Water Services Act 108 of 1997, Provincial legislation, Municipal by-laws and other Government policies applicable to Local Government. Chapter 7 of the Constitution inter alia, provides that Local Government has the duty to provide a safe and healthy environment to its community in a sustainable manner. Schedule 4B of the Constitution imposes the function of delivering water, sanitation and wastewater treatment services on Municipalities. This responsibility rests on District Municipalities but may be performed by a Local Municipality if the district municipality lacks the capacity to do so. Although Local Government has the right to govern on its own initiative the affairs of its communities, it needs support and monitoring from other spheres of Government (National and Provincial) to ensure the delivery of wastewater treatment services in a sustainable manner. In this study, Ba-Phalaborwa Local Municipality is used as an example of a Municipality in the Limpopo Province faced with challenges related to the operation and management of its wastewater treatment plant. This study aims to determine who should be responsible for the regulation of wastewater treatment plants in Ba-Phalaborwa Local Municipality area in order to ensure service delivery to communities in a sustainable manner. In order to deal with the challenges experienced by Local Government in dealing with wastewater treatment plants, the study considers Best Practice Guidelines and external service delivery mechanisms, specifically in the form of Public-Private Partnerships. The study concludes with recommendations based on Best Practice Guidelines which Municipalities can use to avoid wastewater pollution and proposes management mechanisms in managing a Public-Private Partnership effectively in order to ensure that they provide service delivery in a sustainable manner. / LLM (Environmental Law and Governance), North-West University, Potchefstroom Campus, 2014

Background: People who use illegal drugs are disproportionately affected by HIV and hepatitis C, stigmatization and social exclusion. Health inequities are worsened by drug policy of criminalization, which thwarts health promotion efforts and hinders access to services. To address these inequities, people who use drugs are increasingly included in decisions that affect them by sitting on policy, service delivery and research committees. This study addressed a gap in understanding how power inequities are transformed in committees where people who use drugs are at the table. Methods: In partnership with the Drug Users Advocacy League and the Society of Living Illicit Drugs Users, this participatory critical emancipatory inquiry explored power relations in four committees in Ontario and BC. Data were collected in 2013 through meeting observations, interviews, demographics surveys and document reviews. Data analysis was guided by theoretical frameworks grounded in critical theory and transformative learning theory. Results: Findings confirmed striking socioeconomic inequities between people who use drugs and others at the table. Inconsistent measures were taken by committees to alleviate barriers to inclusion. Despite openness to inclusion, committee members tended to underestimate people who use drugs. The presence of local organizations of people who use drugs ensured a more democratic selection of their representatives to sit on committees. Once at the table, creating a safe space entailed building trust, authentic relationships, relational and reflective dialogue, and skilled facilitation. Democratic practices of negotiated relationships and consensus-based decision-making enhanced meaningful inclusion. A structural environment in which drug policy criminalizes people who use illegal drugs hindered capacity to transform power inequities by feeding stigma, which worsens health and social inequities. Committees were committed to inclusion of people who use drugs though capacity to do so varied due to budgetary and human resources constraints. Study limitations, practice implications and future research directions are offered. / Graduate / 0700 / 0680 / lynnebel@uvic.ca

Introdução. Desde 2006 a Assistência Farmacêutica da Coordenação de Atenção Básica da Secretaria Municipal da Saúde de São Paulo (SMS-SP) recebeu, por ano, em média, cerca de 125 solicitações de medicamentos não constantes da Relação Municipal de Medicamentos Essenciais - Remume-SP, antes de 2011, e a partir deste ano 250 solicitações, demanda que ainda não foi objeto de estudo para se conhecer de forma sistemática sua natureza e as implicações quanto à regulação sob o marco do acesso racional a fármacos.Objeto do estudo. Avaliou-se as solicitações de produtos farmacêuticos não constantes da Remume-SP, de 2008 a 2013. Método. Análise de documentos, segundo a prática médica com base em provas científicas, de solicitação de medicamentos não disponíveis na Remume-SP decorrente de prescrição médica por meio de Formulário de Justificação para aquisição de medicamentos não constantes da Remume-SP, e oriunda de serviços da SMS-SP no período do estudo. Resultado. Analisou-se os processos advindos de 1.174 solicitações, de 2008 a 2013, que levou à não autorização de aquisição de 58,9 por cento (N=692), pelos seguintes motivos: 1- não há prova suficiente na literatura, 15 (17 por cento ); 2- consta da Remume-SP, 11 (1 por cento ); 3- disponível na SES-SP, 56 (8 por cento ); 4- informação clínica insuficiente, 151 (22 por cento ); 5- fornecimento CACON, 10 (1 por cento ); 6- fármaco desnecessário, 18 (3 por cento ); 7- indicação de outro fármaco, ou outra concentração do fármaco solicitado, ou outro acessório, ou ainda outro tratamento (cirúrgico, por exemplo), 169 (24 por cento ); 8- solicitação de parecer de área técnica relacionada, 62 (9 por cento ); 9- paciente não acompanhado em serviço municipal de saúde, 12 (2 por cento ); 10- erro de prescrição, 39 (6 por cento ); 11- não há prova suficiente na literatura e informação clínica insuficiente, 49 (7 por cento ). As razões do não acolhimento do pedido do médico estão apresentadas em exemplos, das principais categorias farmacêuticas, considerando-se a variedade das solicitações, todos documentados pela literatura e extraídos dos processos de solicitações. Faz-se recomendações para a melhoria da regulação da prescrição farmacológica e possíveis ajustes na relação entre os formuladores e executores de políticas do município e os conjuntos dos prescritores, tendo como centro das preocupações a segurança do usuário do SUS e a melhoria do acesso a fármacos com a melhor relação benefício-risco. / Introduction. Since 2006, the Assistência Farmacêutica da Coordenação de Atenção Básica da Secretaria Municipal da Saúde de São Paulo (SMS-SP) (Coordination on Pharmaceutical Care of the Municipal Health Secretariat of São Paulo) received about 125 requests yearly, on average,before2011, and after this year, 250 requests yearly for drugs not listed in the Relação Municipal de Medicamentos Essenciais (Municipal Register of Essential Medicines) REMUME-SP, demand whose object of study was not known in a systematic nature and whose implications regarding regulation were not studied under the framework of rational access to drugs. Object of the study. Evaluate requests for pharmaceuticals not listed in REMUME-SP, from 2008 to 2013. Method. Analysis of documents, according to medical practice based on scientific evidence, of request for products not available in REMUMESP, prescribed via Form Justification for the purchase of drugs not listed in REMUME - SP, and generated from SMS-SP, during the studied period. Results. Analysis of processes arising from 1.174 requests, 2008 to 2013, has brought to the non-permit of acquisition of 58,9 per cent (N=692), due to the following reasons: 1- there is not enough evidence in the literature, 15 (17 per cent ); 2- listed in Remume-SP, 11 (1 per cent ); 3- available in SES-SP, 56 (8 per cent ); 4- insufficient clinical information, 151 (22 per cent ); 5- supplied by CACON, 10 (1 per cent ); 6- unnecessary drug, 18 (3 per cent ); 7- indication of other drug, or other concentration of the requested drug, or other device, or still other treatment (surgical, for example), 169 (24 per cent ); 8- solicitation of report from related technical area, 62 (9 per cent ); patient not cared by the municipal health service, 12 (2 per cent ); 10- prescription mistakes, 39 (6 per cent ); 11- there is not enough evidence in the literature and not sufficient clinical information, 49 (7 per cent ). The reasons of the non-acceptance of the medical requests are presented in examples, from the main pharmaceutical categories which were requested, considering its variety, all documented in the literature and extracted from the processes of solicitation. Recommendations on the improvement of medical prescription are done and possible arrangements of prescription in the relationship among policy makers and executors in the municipality and the sets of prescribers, whose main concern is the safety of users of SUS and improving access to drugs with the best benefit-risk relation.