1. Svarbiausi rizikos šeimų kriterijai yra: nedarnios, asocialios, nepilnos šeimos, kuriuose nesugebama tinkamai spręsti susidariusias problemas, rūpintis vaikais, keisti gyvenimo būdą. Dažniausiai tokiuose šeimose poreikių tenkinimas vyksta socialiai nepriimtinais būdais. Socialinės rizikos šeimų atsiradimo priežastys: nestabili ekonominė padėtis Lietuvoje, skurdas, nedarbas, priklausomybė alkoholiui, narkotinėms medžiagoms, vaikų nepriežiūra, socialinių įgūdžių stoka, auklėjimo ypatumai šeimoje, konfliktai šeimoje, visuomenės informavimo priemonių poveikis, vertybių sistemos ypatumai. 2. Vilniaus miesto socialinės paramos centras vykdo šias svarbiausias veiklas: teikia kokybiškas socialines paslaugas ir išmokas Vilniaus miesto gyventojams, kurie negali savarankiškai rūpintis savo asmeniniu (šeimos) gyvenimu ir kuriems būtina pagalba, tenkinant jų būtinuosius poreikius bei sprendžiant socialines problemas. 3. Tyrimu nustatyta, kad: • Vilniaus miesto socialinės paramos centro socialiniai darbuotojai, dirbdami su socialinės rizikos šeimomis, nėra pajėgūs nusistatyti darbo prioritetų – apsiriboja buitinių sąlygų tikrinimu, neatkreipdami dėmesio į kitas esmines šeimų, atsidūrusių krizėje, problemas. • socialinių darbuotojų bendradarbiavimas su kitomis institucijomis, teikiant pagalbą socialinės rizikos šeimoms, vyksta nuolat. • dažniausiai socialiniai darbuotojai bendradarbiauja su Vaiko teisių apsaugos skyriaus vyriausiuoju inspektoriumi, su nepilnamečių reikalų... [toliau žr. visą tekstą] / The subject of social risk families is actual to many countries of the world, especially those which experience still essential social changes. Family is the most important in your life. It is important for your children, our parents and grand parents. It is important due to the fact that it is the foundation of the economy and our civilization. Urgent help is needed by social risk families and there are many of them in Lithuania. For social workers involved in the work with social risk families one of the most important highlights is the co-operation with other institutions. For the research of the co-operation a goal was set – to find out problems in co-operation between social workers working with social risk families and Children‘s Rights Protection Unit (further VTAS). Work tasks: • To analyze scientific literature and legal documents regulating children‘s rights and their protection in social risk families; • on the basis of scientific and methodological literature to define main criteria of social risk families and identify the roots of their appearance; • to disclose the activities of Vilnius social care center and the organization and execution of the help provided to social risk families; • to provide a list of social workers working with social risk families in order to evaluate the co-operation of social workers with other institutions in providing help to social risk families. Methods of work: • Theoretical: analysis of pedagogical and... [to full text]

Bakgrund: Studier visar att en av tre kvinnor världen över har blivit utsatta för våld i en nära relation. Våld i nära relationer finns i alla samhällsklasser och är ett världshälsoproblem. Vårdpersonal kommer ofta i kontakt med kvinnor som blivit utsatta för våld av en manlig partner. Många kvinnor mister livet varje år på grund av konsekvenserna från våldet. Syfte: Att beskriva vårdpersonalens erfarenheter av att vårda kvinnor som blivit utsatta för våld i en nära relation. Metod: Designen är en litteraturöversikt. Datainsamling har skett i databaserna Cinahl och PubMed. Resultat: Resultatet är baserat på 15 vetenskapliga artiklar och visade tre huvudområden: identifiering av kvinnor som lever med våld i en nära relation, hinder för att kunna identifiera de utsatta kvinnorna och vårdpersonalens möte med kvinnor som lever med våld i en nära relation. Vårdpersonalen upplevde svårigheter att identifiera kvinnor som blivit utsatta för våld i nära relationer. Hinder för att utföra screening var framförallt brist på kunskap och utbildning hos vårdpersonalen. Vårdpersonalen upplevde det svårt att möta våldsutsatta kvinnor, på grund av att det fanns svårigheter att distansera sig från de utsatta kvinnorna. Slutsats: Utifrån denna studie kan slutsatsen dras att riktlinjer, kunskap och träning behövs samt rutiner för att kunna utföra screening, för att vårdpersonalen ska kunna identifiera och ge kvinnor som lever med våld i nära en relation en god vård. / Background: Studies show that one of three women worldwide are exposed to intimate partner violence. Intimate partner violence exists in all social classes and is a global health problem. Healthcare professionals often come in contact with women who have experienced intimate partner violence. Many women lose their lives each year as a result from the violence. Purpose: To describe the healthcare professionals experience of taking care of women who have experienced intimate partner violence. Method: The method is a literature review. Data collection has taken place in databases Cinahl and PubMed. Results: The results is based on 15 scientific articles and three main areas emerged in the outcome: identification of women who lives with intimate partner violence, barriers to identifying the vulnerable women and healthcare professionals meeting with women who have experienced intimate partner violence. Healthcare professionals experience difficulties in identifying women who were exposed to intimate partner violence. Barrier to performing screening were primarily lack of knowledge and training in healthcare professionals. The healthcare professionals experienced it difficult to meet women who lived with intimate partner violence, due to the difficulty of distancing themselves from vulnerable women. Conclusions: From this study, the clue can be drown that guidelines, knowledge and training are needed, and also routines for screening, in order to identify women who are living with intimate partner violence.

Background: in the late 1970s, HIV had a sudden outbreak in Africa, and in the late 1980 ́s the rest of the world was informed about the epidemic. Due to increased level of the infected people around the world HIV has been the cause of many deaths worldwide, and unfortunately HIV continues to spread. HIV is today, considered to be a incurable virus disease, but due to antiviral medication that allows individuals who are infected with HIV cancause of spreading HIV during 1980, which subjected these men to stigmatizing and discriminatory attitudes, especially in health care.  Aim: To explore how homosexual HIV-infected men describe their experiences of treatment from healthcare professionals. Method:  A literature review based on six qualitative articles, three quantitative article and one mixed approach article Results: The result consisted of one main themes and three subthemes. The first theme is experienced lack of knowledge with three subthemes: experiences of worthy care, experience of being denied care and the experiences of stigmatizing and/ or discriminatory attitudes. The main theme highlights how healthcare professionals lack of knowledge affects healthcare. The different subthemes discusses HIV-infected homosexual men ́s experiences of healthcare as both negative and positive. Discussion: The discussions are divided into four sections: the need for increased knowledge, experiences of being denied care and/or experiences of worthy care, stigmatization and discriminatory attitudes impact on patients care and geographical differences. This section was discussed by using Katie Eriksson nursing theory about care suffering, the background of the literature review and by using new research. / Bakgrund: I slutet av 1970-talet fick HIV ett plötsligt utbrott i Afrika, och i slutet av 1980-talet fick resten av världen höra talas om epidemin. Sjukdomen har orsakat många dödsfall världen över, och fortsätter att spridas sig. Idag anses HIV att vara en obotlig virussjukdom, som på grund av antivirala mediciner gör att individer som är smittade med HIV kan leva ett normalt liv. Homosexuella HIV-smittade män blev under 1980-talet skuldbelagda för att förorsaka HIV. Som resultat av detta har dessa män utsatts för stigmatiserande och diskriminerande attityder, speciellt inom sjukvården. Syfte: Att undersöka hur homosexuella HIV-smittade män beskriver sina upplevelser kring bemötandet från hälso- och sjukvårdspersonal. Metod: En litteraturöversikt som baserades på sex kvalitativa artiklar, tre kvantitativa artiklar och en mixad metod. Resultat: Resultatet bestod av ett huvudteman och tre subteman. Det första temat var: Upplevd kunskapsbrist, med tre subteman: upplevelsen av att få värdig vård, upplevelsen att bli vägrad vård samt rädsla för stigmatiserande och/eller diskriminerande attityder. Huvudtemat lyfter upp hur hälso- och sjukvårdspersonalens kunskapsbrist påverkar sjukvården. De olika subteman behandlar HIV-smittade homosexuella mäns upplevelser av sjukvården som både negativ och positiv. Diskussion: Resultatdiskussionen delades in i fyra avsnitt: upplevelsen av att bli nekad vård och/eller upplevelsen av att bli hörd, stigmatiserande och diskriminerande attityders påverkan på patientens vård, behov av ökad kunskap samt geografiska skillnader. Avsnittet diskuteras utifrån Katies Erikssons omvårdnadsteori om vårdlidande, litteraturöversiktens bakgrund samt med hjälp av ny forskning.

Bakgrund: Psykisk ohälsa är ett växande samhällsproblem. Attityder av negativt slag presenteras som en grund för stigmatisering som preciserades redan av de gamla grekerna. Integrationen av stigma är ett problem för samhället då det påverkar och influerar våra tankar och handlingar. Vidare kan det bidra till hur vårdrelationen kommer att se ut vilket i sin tur kan bli positivt eller negativt. Hur sjuksköterskan uttrycker sina attityder mot patienter spelar således en viktig roll. Detta för att kunna ge alla patienter den personcentrerade och goda vård de har laglig rätt till få. Syfte: Att beskriva hur hälso- och sjukvårdspersonal uttrycker deras attityder gentemot patienter med psykisk störning. Metod: En litteraturöversikt med datainsamling från databaserna CINAHL Complete, Medline och PsycINFO. Resultat: Både positiva och negativa attityder återfanns i resultatet. Även stigmatisering av personer med psykisk ohälsa förekom. Patienter med psykiska störningar blev även misstrodda för sina fysiska symtom då de sökte somatisk vård. Attityder visade sig skilja sig beroende på erfarenhet, utbildning och var de arbetar. Det framkom en kunskapsbrist och ett kunskapsbehov. Vidare efterfrågas utbildning och mer träning i möten med personer med psykisk störning av hälso-och sjukvårdspersonal. Diskussion: Resultatet diskuteras utifrån bakgrunden samt Joyce Travelbees teori om den mellanmänskliga relationen. I resultatet framkom att både positiva och negativa attityder uttrycks gentemot patienter med psykisk störning. Även stigmatisering förekom i form av uttryckta attityder och som strukturellt problem. Hälso-och sjukvårdspersonal lyfter deras kunskap om psykisk ohälsa som bristfällig och en önskan om att öka kunskapen. / Background: Mental illness is a growing problem in the society. Attitudes of negative character are presented as the ground for stigmatizing and since the old Greeks we have been forming the meaning of the word stigma. Stigma has become wider and more integrated in the society. The integration of stigma is a growing problem due to its impact and influence in the way we humans think and act. In addition this can be a contribution to how the healthcare relationship turns out, it may be positive or negative. However the expressed attitudes against patients play an important role in the hope of providing good care. Aim: The aim of this study is to describe how healthcare professionals express their attitudes towards patients with mental disorder. Method: The method used by the authors is a structured review of the literature using databases such as CINAHL Complete, Medline and PsycINFO. Results: The result showed that healthcare workers express both positive and negative attitudes, even stigmatization occurs. Patients with mental disorder were also misbelieved for their physical symptoms. Healthcare professionals mixed attitudes varied depending on work experience, education and place of work. The need for more education was expressed by a big number   of participants. Discussion: The result has been discussed based on the background and Joyce Travelbee’s theory, Human-to-Human Relationship. The result revealed both positive and negative attitudes towards people with mental illness. Also stigmatization was highlighted in the form of expressed attitudes and structural problem. Healthcare professionals also underline their knowledge of mental illness as being inadequate and a wish for increased knowledge was expressed.

This study examines the impact of the transition from diploma to degree on the initial education and training of three para-professions in England; chiropody, occupational therapy (OT) and radiography. It focuses on the nature of and reasons for changes to their initial professional education and training and the potential impact of these changes on their professionalisation. The study adopted a multiple method approach; a historical review, which included documentary sources and interviews with key informants, aimed at identifying how and why these three para-professions wanted to achieve all-graduate entry, and the use of case studies to explore the differences between the diploma and degree courses. It is concluded that the achievement of all-graduate entry for these para-professions was an unintended consequence of the policies of the then government. As a result of the achievement of all-graduate entry changes were made to the respective diploma courses of these para-professions. The extent of these changes were related to the level of control and influence that the professional bodies exercised over the diploma courses. All the degree courses shared the following features: the development of autonomous, reflective practitioners who are life-long learners, an emphasis on theory rather than practice, and emphasis on propositional knowledge and the study of research methods. Although the degree courses for these para-professions achieved approval from HEIs it is argued that degree education is a contested concept. It is apparent that the para-professionals believed that the achievement of all-graduate entry would improve their professional status. However, it is evident from the study findings that it served to maintain rather than enhance their social status and market position. Changes to the initial education and training of these para-professionals were the results of the para-professionals having to respond to prevailing social, political and economic circumstances. If they had not taken this action it is suggested that their social status and market position may have been adversely affected.

Probiotics are live microorganisms which confer a health benefit to the host. The literature strongly supports the benefits of probiotic therapy in preterm infant populations, specifically in the prevention of necrotizing enterocolitis (NEC) and mortality. To this end, probiotics are routinely given to premature infants in several European and Asian countries. However, in spite of the current evidence and neonatal feeding practices elsewhere, probiotic supplements are rarely prescribed in nurseries in North America. Furthermore, there is little or no literature on factors which affect clinical decision-making regarding probiotic supplementation. The study implemented a cross-sectional descriptive survey. The purpose of this study was to: (i) describe current practices involving probiotic supplementation of preterm infant enteral feeds; and (ii) identify factors that affect willingness of health care professionals to support the use of probiotics. Probiotic use was examined in Neonatal Intensive Care Units (NICUs) in Canada and the United States using two cross-sectional internet-based surveys. Survey #1 focused on current practices and targeted neonatologists who serve as clinical directors or department heads. The results were analysed using descriptive statistics. Survey #2 addressed factors that affect probiotic supplementation of preterm infant feedings, and had two versions: the first version targeted physicians and nurse practitioners whereas version 2 targeted neonatal nurses. The development of Survey #2 was guided by the Theoretical Domain Framework which evaluates factors which may affect the willingness of Health Care Professionals to support the use of probiotics in neonatal practice. The results of survey #2 were analysed using Chi-Square, Fisher’s Exact Test, and One-Way ANOVA. The results of the study indicated that only a small proportion of NICUs are administering probiotics to preterm infants and practices vary. The most significant factors influencing clinical decision-making regarding probiotic supplementation were knowledge about probiotics and the evidence, perceptions about the evidence and safety of probiotics, and knowledge about probiotics and clinical guidelines. Improving knowledge about probiotics, addressing safety issues of probiotics products, expanding the evidence base, and developing clinical guidelines may contribute to increased use of probiotics in NICUs. / October 2016

Bakgrund: Cytostatikabehandling är vanligt inslag vid behandling av bröstcancer och kan medföra en lång tid av kämpande mot både sjukdomen, behandlingen och andra svåra upplevelser. Cytostatikabehandling är förknippat med exempelvis diverse biverkningar som kan påverka bröstcancer patienterna. Syfte: Att undersöka underlättande hjälpmedel, som inte inkluderar materiella saker som proteser, kryckor och rullstolar, utan andra medel som vården kan bidra med för att skapa en mera positivare upplevelse av behandlingen samt att undersöka de psykiska upplevelser hos kvinnor med bröstcancer som genomgått cytostatikabehandling. Ett annat syfte var att ta reda på hur kvinnans syn på livet, alltså livskvalitén, påverkas. Metod: Litteraturstudie med hjälp av systematiska översikter, kvalitativa- och kvantitativa artiklar. Resultat:Olika hjälpmedel som hälso- och sjukvården kan implementera eller använda i större utsträckning för att hjälpa bröstcancer patienterna vid cytostatikabehandlingen. Mycket tyngd ligger på fysisk, psykiskt och socialt stöd, utbildning för personal- och patienter och information från hälso- och sjukvårdens sida. Denna studie visar dessutom att kvinnorna genomgår fyra faser under cytostatikabehandlingen i och med det får hälso- och sjukvården får en ökad förståelse om den psykologiska processen och kan hjälp lättare erbjudas. Psykiska upplevelser är starkt kopplat till uppkomna biverkningar och det finns kompletterande behandlingar som exempelvis guidade bildspråk, vilket underlättade upplevelsen av cytostatikabehandlingen. Att livskvalitén förändras är i de flesta fall relaterat till själva behandlingen och negativa biverkningar som uppkommer exempelvis ångest, depression och en allmän känsla av att vara mindre nöjd med sitt liv. Genom användande av olika behandlingsalternativ och kritiska åtgärdsstrategier kan biverkningarna reduceras och livskvalitén förbättras. Slutsats: Hälso- och sjukvårdpersonalen kan genom förbättrade insatser hjälpa bröstcancer patienterna under behandlingsperioden. / Introduction: Chemotherapy is a common element in the treatment of breast cancer and can lead to a long period of struggling against the disease, the treatment and other difficult experiences. Chemotherapy is also associated with, for example, various side effects that can affect the breast cancer patients. Purpose: To investigate tools, that doesn’t include material things such as prostheses, crutches or wheelchairs, other average that can contribute to creating a more positive experience of the treatment and to investigate the physical experiences of women with breast cancer undergoing chemotherapy. Another aim was to find out how the women feels about their lives, their quality of life, is being affected. Method: Literature study using systematic reviews, qualitative- and quantitative articles. Results: Different tools that healthcare can implement or use in a greater extent during the chemotherapy treatment to help the patients. Much emphasis is on physical, psychological and social support, training for staff and patients and information from the health care side. This study also shows that women undergoes four phases during chemotherapy and this leads to that health care gets a better understanding of the psychological process and can much easier offer assistance.Physical experiences are strongly linked to the side effects and there are complementary therapies such as guided imagery, which reduced the experience of chemotherapy. The quality of life changes are in most cases related to the treatment and adverse side effects that arise such as anxiety, depression and a general feeling of being less satisfied with their lives. By using different treatments and critical intervention strategies, the side effects can be reduced and the quality of life improves. Conclusion: The healthcare staff can through different enhanced efforts help breast cancer patients during the treatment period.

Autism spectrum disorders (ASDs) are chronic and pervasive developmental disorders; children with ASDs require more multidisciplinary services than children with other developmental, behavioral, and emotional disorders (Kogan et al., 2008). Little research has been done on the practices and perspectives of the professionals providing services to children with ASDs. Evidence-based practice (combining use of evidence-based interventions [EBIs], family-centered care [FCC] respecting patient/family values, and clinical expertise) leads to the best outcomes for children with ASDs (APA Presidential Task Force on Evidence-Based Practice, 2006). The aim of this study was to assess the extent to which psychological constructs (attitudes, subjective norms, perceived behavioral control) within the Theory of Planned Behavior (Ajzen, 1991) are helpful for understanding the behavior of professionals in regards to two areas of evidence-based practice: recommending and/or providing EBIs and using a FCC approach to care with children with ASDs. Professionals (N=709) providing direct services to children with ASDs were recruited from different disciplines (Education, Medicine/Nursing, Occupational and Physical Therapy, Psychology, Social Work, Speech Language Pathology/Audiology) and were asked to fill out an Internet or paper survey including measures on TPB constructs and EBI and FCC behavior. Participants were recruited from a convenience Internet sample and a stratified random sample of online provider listings (from professional and autism-specific organizations). Professionals’ attitudes and familiarity with EBIs significantly predicted their self-reported recommendation and provision of EBIs in the positive direction. Professionals’ attitudes, perceived-behavioral control, and years in practice significantly predicted self-reported use of an FCC approach with children with ASDs in the positive direction. There was a trend for explicit training on EBI or FCC to predict professionals’ behavior, but these findings did not reach conventional levels of significance. Subjective norms did not significantly predict EBI or FCC behavior. Discipline membership did not moderate the relationship between TPB and EBI and FCC self-reported behavior measures. The TPB is a useful framework for better understanding professionals’ evidence-based practice behavior. This study sheds light on practices and perspectives of professionals working with children with ASDs and highlights areas for future research and training with this population.

Summary: The subject of this paper is providing of lege artis health care in the system of public health insurance. The aim of the thesis is to analyse the basic terminology, current legislation and its application in practice. Lex artis is in law an uncertain term, difficult to define, therefore its frequent usage should be restricted in the future. Due to the personal experience of the author there are many practical examples from the Czech health care system used in the paper. Related case law is taken into account continuously with the exception of the separately stated recent court judgment of the Constitutional Court of the Czech Republic. The study is divided into four main chapters, introduction and conclusion. The first chapter is dedicated to the concept of lege artis in detail, its terminology and relation to the current legislation. Further subchapters deal with available health care standards and their obligation. The final parts analyze the lege artis restrictions and way of its assessment. The second chapter is dedicated to the concept of public health insurance. First, the term is defined and the current law is considered. The following parts examine the issue of health insurance companies and the network of health care facilities. Chapter three presents the labor law aspects of lege artis...

Les dispositifs de publication et d'échanges d'information sur Internet ont pu susciter l'intérêt du marketing qui est à l'écoute des usagers sur le web afin de tirer parti de leur créativité et des informations délivrées sur les produits et les services. Dans cette thèse, nous cherchons à rendre compte du travail d'encadrement des collectifs d'usagers par des professionnels du marché sur Internet. En effet, l'organisation des usagers en réseaux, qui échangent expertises et opinions sur les entreprises, les produits et services, peut compliquer la mise en place de dispositifs de captation. Le travail d'encadrement peut tout d'abord porter sur la canalisation d'informations échangées sur des produits et services, au sein de communautés existantes. Nous avons exploré le marché des dispositifs de veille sur Internet et les usages spécifiques de ces outils par un grand fournisseur d'accès à Internet. Dans un deuxième temps, nous avons analysé le travail relationnel entrepris par des professionnels de la communication vis-À-Vis de blogueurs ciblés afin de favoriser la construction de discours positifs sur les produits et services. Nous avons démontrés que ceux-Ci développent des stratégies de calcul de leurs intérêts sur le long terme et aménagent les discours sur la marque en fonction de leur ligne éditoriale. Afin d'assurer la pérennité des liens avec un plus grand nombre de clients, les professionnels peuvent choisir de mettre en place des cadres sociotechniques afin d'héberger des communautés. Nous nous sommes appuyées sur des observations ethnographiques de communautés mises en place par des entreprises de biens et services afin de rendre compte des dispositifs de cadrage des liens, depuis des échanges de proximité entre un client et une marque vers des liens horizontaux entre collectifs et professionnels autour des produits. Si les sites communautaires sont des lieux d'aménagement spécifique de liens entre consommateurs et produits, ils sont aussi des espaces où s'organise la gestion des expressions collectives afin d'éviter la rupture des liens. Nous nous sommes intéressées à deux dispositifs qui mettent en évidence ce travail avec d'une part, un forum institutionnel mis en place par un grand fournisseur de services, et d'autre part une plateforme qui accueille des "débats" entre experts et usagers d'une grande entreprise de transport. Les entretiens et recueils de données sur les sites montrent des formes de détournement des règles par les usagers, et les rôles adaptés de professionnels officiels et officieux en interaction avec les clients. / The devices of publication and exchange of information on Internet have interested marketing services that take advantage of their creativity and information provides on products and services. In the thesis, we try to report on the work of supervision of communities of users by market professionals on the Internet. Indeed, the organization of users in networks, exchanging expertise and opinions on companies, products and services, can complicate the implementation of capture devices. The framing can first consist in channeling information exchanged on products and services, within communities. We first explored the market of devices aimed at monitoring discussions between users and specific uses of these tools by a large Internet service provider. In a second step, we analyzed the relational work undertaken by professionals of communication with target bloggers in order to promote a positive discourse on products and services. We demonstrate that they develop strategies for calculating their interests in the long run and talk about the brands according to their editorial strategies. To ensure the continuity of links with a larger number of clients, professionals can choose to implement sociotechnical framework, in order to host communities. We reported the framing devices of links from local exchanges between a client and a brand to horizontal linkages between community and professional around the products thanks to an ethnographic observation of communities set up by companies of goods and services. Social networking sites permit specific configuration of links between consumers and products, and they also organize collective expressions in order to avoid breaking links between companies and consumers. We have been interested in two devices that highlight this work: an institutional forum set up by a major supplier of services, and also a platform that hosts debates between experts and users of a large transport company. The interviews and data collections on the sites show us that the users can circumvent the rules and official and unofficial professionals in interaction with customers have to adjust their roles.