The lifetime prevalence of posttraumatic stress disorder (PTSD) ranges from 1 to 14 percent in the general population. Diagnosis is based on criteria that address hallmark symptoms of the disorder from re-experiencing the trauma to hyperarousal, emotional numbing, and avoidance of memories, thoughts, or feelings associated with the event. PTSD is particularly prevalent in vulnerable populations and comorbid with substance use disorders, serious mental illness, or both. Psychological treatment options are more strongly recommended than pharmacological treatment by the American Psychological Association (APA); however, the efficacy of psychotherapy is less studied in vulnerable populations for fear that substance use or mental health outcomes will worsen. Prolonged exposure (PE) therapy and cognitive processing therapy (CPT) are the most investigated forms of cognitive behavioral therapy (CBT) in vulnerable populations and involve overcoming the trauma through repeated exposure for PE or processing with a clinician for CPT. A review of all randomized controlled trials (RCTs) that have evaluated the effect of either form of CBT on non-combat PTSD, substance use disorder (SUD), and mental health outcomes found that PE administered alongside SUD treatment had the greatest positive impact on PTSD and SUD outcomes. PE also had a better impact than CPT on PTSD outcomes in individuals with PTSD and serious mental illness (SMI); however, neither form of CBT performed substantially better than the other with respect to mental health outcomes. In future studies, the impact of psychological treatments on PTSD and other health outcomes needs to be assessed on the same variables in larger populations of vulnerable individuals that are inclusive and representative of those receiving care for SUD and SMI in community health care settings.

Racial segregation in California prisons is a primary means of maintaining control and safety for inmates and correctional staff, yet little is understood about how racial segregation in prison impacts reentry of offenders into the community. The research question examined in this study focused on how living in the racial segregation of a California State prison, for 2 years or more might influence African-American, White, and Latino men's ability to interact with other races in a culturally diverse community upon release. Using Donald Clemmer's theory of prisonization as the foundation, the purpose of this phenomenological study was to understand the experiences of men who lived in a racially segregated environment in prison regarding post-release reintegration. Specifically, their experiences with interacting in a culturally diverse environment after prison were examined to understand how behaviors and attitudes in prison were adapted by formerly incarcerated men in community life. A sample of 15 formerly incarcerated males were interviewed in response to posted fliers and community presentations. Collected data were analyzed between and among races for similar responses to the interview questions according to the Van Kaam method. Fourteen of the 15 participants reported that racial reintegration added challenges such as difficulty trusting and interacting with races other than their own post release, and additionally they stated they were grateful to return to a culturally diverse community. Positive social change stemming from this study include recommendations to prison leaders to introduce social skill building training into reintegration programming that supports former inmates to more effectively interact with diverse populations as they transition to community life.

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No description available.

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Masters of Science. Johannesburg 2012 / Background: The detrimental effects of prolonged mechanical ventilation (MV) on the respiratory muscles, especially the diaphragm, are well documented and it is crucial that MV should be discontinued as soon as possible to prevent added complications and additional risks to patients with critical illness. The spontaneous breathing stage of MV can be managed as a rehabilitation and conditioning phase for the respiratory muscles due to the fact that the respiratory muscles are more active during this stage of MV. Weaning strategies that provide insufficient respiratory work, too high a respiratory muscle load or insufficient respiratory muscle rest may lead to respiratory muscle fatigue and consequently failed weaning and extubation. The aim of this research project was to develop an individualised continuous positive airway pressure (CPAP) weaning programme and test its effects on the outcomes of extubation in the adult ventilated patient. Method: An experimental, prospective, non-randomised, sequential study of two groups of subjects was performed. Forty eight subjects [group one: n =24 (control) and group two: n = 24 (intervention)], who were mechanically ventilated for longer than 48 hours, in an open adult, general intensive care unit were recruited. Subjects in the control group were weaned according to the standard weaning programme of the test setting at the time; and those in the intervention group were weaned according to an individualised CPAP programme. This weaning programme was developed utilising three principles of muscle rehabilitation namely; daily stepwise progression, sufficient rest and recovery periods and adapted to the individual needs and progression of each subject. Objective measurements such as the rapid shallow breathing index (RSBI), RSBI rate and the maximum inspiratory pressure (MIP) were used to determine the subjects in group two’s readiness for a spontaneous breathing trial. The primary outcomes assessed were time spent in the different stages of MV, rate of failure to sustain spontaneous breathing in stage 3 of MV, successful extubation and mortality rate. Results and Discussion: The difference in rate of failure to sustain spontaneous breathing between the two groups was statistically significant (p = 0.01) with 10 events of failure in group one and three in group two. The rate of successful extubation from MV between groups one and two was 70.8% and 91.7% iv respectively (p=0.52). The mortality rate was 33.3% for group one and 8.3% for group two (p = 0.02). The difference in the total time spent on MV (days) did not differ significantly (group one = 8.6 (± 0.40) days; group two = 9.3 (±0.32) days; p = 0.75). The results yielded from this study suggest that the use of a multidisciplinary team model and an individualised CPAP programme aids successful extubation from MV as the success rate was much higher in the intervention group than in the control group without adding additional time on MV. Conclusion: Results from this study showed that the implementation of an individualised CPAP programme during the spontaneous breathing stage of MV may improve the outcomes of extubation in adult ventilated patients.

The Central Asian country of Tajikistan is the poorest of the former Soviet republics; it is also prone to a plethora of natural hazards including mass wasting, flood, and extreme temperature. This thesis seeks to characterize how vulnerable rural Tajik mountain communities are to prolonged cold. The primary focus was in Navobod, in the Zeravshan Valley of Tajikistan, where semi-structured interviews were conducted with 31 households, the village leader and doctor, and school staff. The results from the interviews were compared with GIS analysis of the region. Interviews indicated that the area is highly vulnerable to the impacts of prolonged cold. These rural residents continue to practice unsustainable land use, primarily for agricultural and biofuel resources. With unreliable sources of income, a fragile national economy, and decreased access to markets, these residents are ill-equipped to mitigate the impacts of prolonged cold weather. GIS results largely supported interview results.

Bakgrund: En normal graviditet räknas från det att befruktningen skett tills barnet föds, upp till graviditetsvecka 40. Risker för fetala komplikationer ökar när graviditeten fortskrider efter 40 fullgångna graviditetsveckor. Förekomsten av inducerade förlossningar har ökat under de senaste decennierna både i Sverige och resten av världen. Enligt de nya nationella riktlinjerna i Sverige bör kvinnan vara i värkarbete, eller ha fött sitt barn innan graviditetsvecka 42+0. Målet med induktion är att minimera riskerna och sträva efter barnets och moderns hälsofrämjande. Syfte: Syftet var att undersöka hur induktion av förlossning i graviditetsvecka 41 påverkar maternella medicinska förlossningsutfall. Metod: En litteraturöversikt med ett systematiskt tillvägagångssätt genomfördes. Databassökning skedde i databaserna PubMed och CINAHL, vilket genererade 15 kvantitativa artiklar till studiens resultat. Resultat: Studiens huvudfynd sammanfattades med tre huvudkategorier. Den första kategorin var: Induktionens påverkan på akut kejsarsnitt. Den andra kategorin: Induktions påverkan på operativa förlossningar. Den tredje kategorin var: Induktionens påverkan på övriga maternella medicinska komplikationer. Slutsats: Studien fann motstridiga fynd gällande hur induktion under prolongerad graviditet påverkade maternella medicinska förlossningsutfall. Resultaten gällande hur induktion påverkade andelen av akuta kejsarsnitt samt operativa förlossningar var inte entydiga. Påverkan på övriga maternella medicinska komplikationer visade inte någon statistisk signifikant skillnad. / Background: A normal pregnancy is counted from the time fertilization took place until the child is born, up to week 40 of pregnancy. Risks for fetal complications increase as the pregnancy progresses after 40 weeks. The labor inductions have increased in recent decades both in Sweden and the rest of the world. According to the new national guidelines in Sweden, the woman should be in labor, or have given birth to her child before pregnancy week 42+0. The goal of induction is to minimize the risks and strive to promote the health of the child and the mother. Aim: to evaluate how induction of labor at 41 weeks affects maternal medical delivery outcomes. Method: A general literature review with a systematic approach was performed. The data was collected via the databases PubMed and CINAHL. 15 articles with quantitative method were included in the study. Result: The main findings of the study were summarized in three main categories: 1. The impact of induction on emergency caesarean section; 2. The impact of induction on operative deliveries; 3. The impact of the induction on other maternal medical complications. Conclusion: The study found inconsistent findings regarding how induction during prolonged pregnancy affected maternal medical delivery outcomes. The results regarding how induction affected the proportion of emergency cesarean sections and operative deliveries were not clear-cut. The impact on other maternal medical complications did not show any statistically significant difference.

This qualitative study sought insights into forced migrant youths’ sense of belonging. The study was part of the Youth Migration Project, an ongoing investigation of how young forced migrants construct their identities, sense of belonging, and future aspirations while perched on the edge of mainstream society – without normative entitlements or a voice in decision-making about their futures. Through purposive and snowball recruitment methods, the project gathered narratives of 52 forced migrant youth aged 11 to 17 who were born in conflict areas of Asia and Africa, primarily in Myanmar, Afghanistan, Syria, Pakistan, Iran, and Somalia. In the present study, I focused on the experiences of eight forced migrant female participants living in prolonged displacement in Malaysia. My guiding research question was: How do the processes and experiences of forced migration shape migrant youths’ sense of belonging? Through a mixed-method approach, including a novel, arts-based peer-mediated storyboard narrative method, now known as Storyboard Peers, and follow-up interviews, youth shared their migration narratives, the challenges they faced while living in Malaysia, and their expectations and aspirations for their futures. The theme of safety figured prominently in the girls’ accounts and I constructed the themes of physical safety and social safety to represent the data the girls contributed. The girls’ sense of belonging and feeling at home had a direct relationship with feeling safe, valued, and loved. I also found that their physical and social environments informed their sense of belonging. Sense of belonging is neither a static nor a fixed concept; rather it is a flexible, everchanging, and reconstructed with ongoing, everyday experiences, reflections on the past, and anticipations of what the future could hold. The girls’ accounts conveyed that feelings of “belongingness” and “at home” shifted from tangible places and familiar faces to abstract concepts such as love, peace, and family. Overall, feeling safe and “at home” were rooted in basic needs being met. My findings lead me to call for governments and nongovernmental organizations to significantly reduce the length of time that youth spend in transit, promote safety, combat discrimination, fulfill basic needs, and ensure access to education and healthcare. / Graduate

Myxedema coma and pituitary apoplexy are well-known life-threatening endocrine emergencies. The coincidence of these entities is exceedingly rare. Myxedema coma occurring as a result of pituitary lesion is a much less seen entity. A high index of suspicion is often required for early diagnosis as it is of particular importance in improving survival outcomes. We present a rare case of a patient with myxedema coma presenting as bradycardia and hypotension secondary to pituitary apoplexy, which was confirmed on magnetic resonance imaging (MRI). The patient was managed conservatively with levothyroxine and stress doses of steroid, with the resolution of hemodynamic changes and a decrease in the size of the suprasellar mass.

Introduction: Prolonged neonatal jaundice is defined as persistent jaundice at two-three weeksof age. Prolonged neonatal jaundice is usually harmless but one in 2500 newborns have jaundicedue to cholestasis, why further investigation must be made. Region Örebro County introduced anew referral routine for prolonged neonatal jaundice 2021-02-12 that allows for follow up inLindesberg or Karlskoga instead of Örebro alone, and only three variables need to be mentionedfor the referrals to be considered complete, contrary to previous six. Aim: To compare Region Örebro County’s current and previous referral routine for prolongedneonatal jaundice in regard to compliance and complete referrals. Methods: A chart review was performed of all children born in Region Örebro County between2021-02-12 and 2022-02-01 with either sampled bilirubin and/or diagnosis code p.55, p.57-59. Results: A statistically significant difference was observed between the routines regarding stoolcolour (p=0.004), general condition (p<0.001), complete referrals (p<0.001) and length ofinvestigation (p<0.001). Significantly fewer patients were lost during investigation (p<0.002) orhad no feedback on their test results (p<0.011). Two cases of cholestasis were found. The meanvalue of conjugated bilirubin was higher in patients who saw a doctor. Few children werereferred from Lindesberg or Karlskoga. Conclusion: The current routine had more complete referrals, shorter investigation times andless absence of feedback as well as fewer patients lost during investigation. Sick patients wereidentified before getting critically ill. Shifting the entire investigation to primary care andimplementing stool charts could possibly improve the routine further.