Ce travail de recherche s'inscrit dans le contexte d'une étude épidémiologique de cohorte. De septembre 1999 à décembre 2003, une vaste étude longitudinale comportant 2 ans de suivi avait été lancée en Belgique grâce à un financement de la Politique Scientifique Fédérale (PSF). Elle sintitulait: "Etude de cohorte des déterminants étiologiques et pronostiques des maux de dos liés à la profession". Cette étude était conduite par plusieurs centres de recherche . Dans un souci de visibilité internationale, elle porte le nom de BELCOBACK Study (BELgian COhort study on low BACK pain). Comme toute étude épidémiologique, l'étude BELCOBACK vise à mettre en relation l'exposition à une série de facteurs de risque et l'apparition de plaintes en relation avec une problématique de santé. Ainsi, la précision de cette relation dépend à la fois de la précision de l'estimation de l'exposition et de la précision de l'estimation de l'effet santé. Dans le contexte présent, l'effet santé correspond à l'apparition d'un épisode de lombalgie dont l'objectivation est davantage basée sur le symptôme que sur des critères cliniques. Ainsi, en épidémiologie, le questionnaire est bien la méthode de choix pour évaluer la lombalgie. La précision avec laquelle l'exposition est évaluée est moins consensuelle et plus complexe car un plus grand choix de méthodes est possible. Dans ce domaine, les méthodes les plus précises, comme les mesures directes par instrumentation du sujet, sont aussi les plus coûteuses et les plus difficiles à appliquer à un large effectif. Or, dans toute étude épidémiologique, l'effectif doit être important pour des raisons de puissance statistique. En sachant qu'il existe un cadre budgétaire limitatif, il est donc généralement nécessaire d'aboutir à un compromis de "coût-précision" dans le choix des méthodes d'évaluation à mettre en uvre. L'étude BELCOBACK ne faisant pas exception à cette règle, le choix des méthodes d'évaluation est donc au centre de ce travail. L'objectif de celui-ci consiste à évaluer l'exposition professionnelle aux facteurs de risque mécaniques de la lombalgie, en utilisant une méthodologie qui présente une précision suffisante tout en restant dans des limites de coûts acceptables. Un état de la question sera dabord présenté. Il vise à résumer lépidémiologie de la lombalgie dans la population générale et dans la population active, les méthodes dévaluation de la lombalgie, les facteurs de risque professionnels de la lombalgie et leurs méthodes dévaluation. Dans létude BELCOBACK, les deux instruments de mesures retenus pour lévaluation des risques mécaniques de la lombalgie étaient le questionnaire auto-administré et les observations directes. Les deux premiers chapitres sont dès lors consacrés au développement et à la validation de ces instruments. Le dernier chapitre est, quant à lui, consacré à létude des relations entre lincidence des lombalgies et le niveau dexposition évalué par les méthodes développées.

This study describes the reading ability of 26 middle school students, and the ways in which their reading development is supported in two different classrooms. In order to scrutinize results of students at different reading levels, three focus students were selected.This thesis has four aims. One is to use tests to examine the students’ reading ability as regards their decoding skills and reading comprehension as well as to study other cognitive skills related to reading ability. Another is to describe the students’ reading ability and attitudes towards reading from their own as well as their teachers’ perspectives. A third aim is to analyze how the results of different parts of the study are related to one another. The fourth and final aim is to analyze the classroom activities with a special focus on how reading ability is supported.The study combines quantitative analyses of the students’ reading ability with qualitative analyses of classroom activities. The quantitative sections of the study include various reading tests as well as the teachers’ assessment of the students’ reading development and their answers to selected questions in a student questionnaire concerning their view on reading.The results reveal that several of these students haven´t automated their decoding ability in Grade 4, but that nevertheless most of the students attain their grade level in a reading comprehension test in Grade 4 as well as the goals of a national reading test in Grade 5. However, most of the questions in these two tests require answers that can be explicitly found in the text and do not require any deeper reading comprehension such as inference making for instance. The results also show that these students are unable to assess whether reading is easy for them, but can assess their own reading ability if the purpose is to compare their reading skills with their classmates. The classroom observations indicate that despite quite extensive text work in the classrooms, students who need to develop their decoding abilities receive little support, and that although classroom work focusing on text comprehension is quite frequent, this does not often include deeper levels such as inference making.

Every year many people all over the world are killed and severely injured in road traffic accidents. Even though driving too fast is a behaviour well known to contribute to both the number and the outcome of these accidents, drivers are still speeding. The general aim of this thesis, and its five empirical studies, is therefore to further the knowledge about drivers speeding behaviour by using the theory of planned behaviour and the model underpinning the driver behaviour questionnaire as frames of reference. The behavioural data used is obtained from field trials with intelligent speed adaptation and the speed reducing potential of this system is also examined. The results show that attitude towards exceeding the speed limits, subjective norm, perceived behavioural control and moral norm from the theory of planned behaviour, but also violations and inattention errors from the model underpinning the driver behaviour questionnaire, can be used to predict drivers’ everyday speeding behaviour. These two models can also be combined in order to gain further knowledge about the causes of speeding. Identification of drivers’ beliefs about exceeding the speed limits gives further insight into the underlying cognitive foundation of their attitude, subjective norm and perceived behavioural control. This provides valuable information for future design of speed reducing measures. Regarding intelligent speed adaptation, the results show that the ISA speed-warning device greatly reduces the amount of time drivers spend above the speed limits, and to some extent also reduces their mean speeds, but that this effect decreases with time. Although the drivers are not totally satisfied with the experience of the ISA speed-warning device, they like the idea and can see its usefulness. As the device tested is a first generation ISA speed-warning device, further research has the potential to greatly improve the system.

Communication of care is essential in the multidisciplinary health care system and the patient record is an important tool for communication. The electronic patient record was introduced to facilitate the documentation of care, as well as the communication and evaluation of care. District nurses met the patient independently of other caregivers at the surgery or in the patient’s home. Documentation by district nurses is assumed to contribute to the view of the patient so that safe care can be carried out in primary health care. This thesis investigates and analyses the electronic nursing documentation in primary health care with emphasis on the content, district nurses’ experiences of documentation and how the information in the documentation was used. A further aim was to implement and evaluate the effect on standardised nursing documentation, using patients with leg ulcer as an example. A sample of 239 district nurses, 430 general practitioners and 74 care unit managers answered questionnaires about the nursing documentation and the use of it. One hundred and nine nursing records were audited. Quantitative and qualitative methods were used for data analysis. Documentation by district nurses lacked clear nursing status, judgment (nursing diagnosis) and nursing goals. Legal requirements were not fulfilled. Medical facts were carefully documented while relevant issues to nursing occurred only seldom. District nurses stated that they were satisfied with their documentation but were in need of education. The focus of the in-service training for documentation was technical rather than involving nursing issues. Fifty-eight per cent of the general practitioners read the nursing documentation always or often and found it valuable. They had problems, however, finding the information because of the unclear nursing status, the lack of district nurses’ judgement and the large quantity of notes regarding routine activities in district nurses’ documentation. The nursing documentation was used by 75 % of the care unit managers for evaluating resources and by 51 % for evaluating care. The categories ’prioritisation’, ’inadequate nursing records’, and ’lack of interest’, illustrate for what reasons the care unit mangers did not use the documentation for evaluation of care. In order to advance district nurses documentation, a standardised nursing wound care record was designed and implemented in nine primary health care centers, with a total of 83 district nurses. Eight primary health care centers were used as a control group, including 56 district nurses. A questionnaire was sent to the district nurses and 102 nursing records were audited before and after implementation. The standardised nursing record improves the descriptions of patient’s health history and status. Nursing diagnoses were more frequently used but were of low quality. Using the standardised nursing wound care record was experienced by the district nurses as being more timeconsuming but also more informative about the patient. Furthermore the knowledge in documentation increased among the district nurses in the intervention group. Improvement of nursing documentation is necessary in order to obtain documentation that fulfills legal requirements. The managers had a great responsibility to upgrade the documentation, which can be effected by continuing support. Documentation must be seen as a means of transferring information about the patient and of determining whether the best care has been given. A standardised documentation could increase the possibility to compare and determine the value of care. Strengthening the awareness of nursing among district nurses should involve strengthening the documentation, which ought to lead to safer care for the patient.

Syfte: Denna uppsats syftar till att göra en undersökning bland Länsförsäkringars kunder, vilket är intressant då försäkringsbranschen säljer en produkt som det inte går att ta på och som kunden betalar för trots att han eller hon troligtvis aldrig kommer att använda produkten och faktiskt helst inte ens vill utnyttja densamma. Syftet med arbetet är att undersöka följande: • Varför stannar Länsförsäkringars befintliga kunder kvar inom företaget? • Varför väljer en person att bli kund hos Länsförsäkringar? • Tycker kunderna att det är viktigt att ha bank, försäkring och liv inom samma bolag? • Tycker kunderna att det är viktigt med en ”egen” personlig kontakt hos sitt bolag? • Vad är det för likheter samt olikheter mellan Länsförsäkringars kunder i Gävle, Bollnäs och Söderhamn? Metod: För att utföra studien har ett flertal olika tillvägagångssätt utnyttjats: 1. Litteraturstudie 2. Enkätundersökning 3. Statistisk bearbetning av enkätsvaren Resultat & slutsats: De viktigaste slutsatserna som jag har kommit fram till är följande: • Länsförsäkringars nya kunder värdesätter priset mest medan däremot de befintliga kunderna värdesätter personal och service mest. • Länsförsäkringar måste marknadsföra fördelarna med konceptet bank, försäkring och liv inom samma bolag för att det ska kunna fungera som ett konkurrensmedel. • För att Länsförsäkringar ska lyckas med att införa en ”egen” personlig kontakt måste fördelarna med detta marknadsföras till kunderna. • Några väsentliga skillnader kan inte utläsas mellan orterna Gävle, Bollnäs och Söderhamn. Förslag till fortsatt forskning: • Att genomföra djupintervjuer eller en enkätundersökning bland de kunder som har lämnat Länsförsäkringar för att se varför de lämnade företaget. • Att genomföra ytterligare studier på de 40 procent av de nya kunderna som valde Länsförsäkringar för prisets skull. Verkar de representera en grupp människor som ofta byter bolag för att få lägsta pris? Uppsatsens bidrag: Uppsatsen ger dels Länsförsäkringar, men även andra som är intresserade, möjlighet att få en inblick i vilka av Länsförsäkringars konkurrensmedel som uppskattas av deras kunder. / Aim: This thesis aims to study customers of Länsförsäkringar. This study is interesting because insurance companies sale invisible products. Even the customer who pays for a product, is not probably going to use or want to use it. The aim of my paper is to investigate the followings: • Why do the existing customers of Länsförsäkringar stay with the company? • Why does a person chose to become a customer at Länsförsäkringar? • Do the customers find it important to have bank, insurance and life with the same company? • Do the customers find it important with a personal contact of their own at their company? • What similarities and differences are there between the customers of Länsförsäkringar in Gävle, Bollnäs and Söderhamn? Method: To conduct this study I have made use of several different procedures: 1. Study of literature 2. Questionnaire survey 3. Statistical work on the questionnaire Result & Conclusions: The most important conclusions that I have come to see are the following: • The new customers of Länsförsäkringar seem to value price the most while the existing customers value staff and service the most. • Länsförsäkringar has to market the benefits with the concept bank, insurance and life within the same company in order to make it work as a competitive advantage. • To succeed with implementing a “personal contact” Länsförsäkringar has to market the benefits of it to the customers. • No major differences can be found between the localities Gävle, Bollnäs and Söderhamn. Suggestions for future research: • To carry out more thorough interviews or a questionnaire survey among the customers who have left Länsförsäkringar in order to see why they left the company. • To conduct further studies of the 40 percent of the new customers who choose Länsförsäkringar for the sake of the price. Do they seem to represent a group of people who often switch companies in order to get the lowest price? Contribution of the thesis: The thesis gives not only Länsförsäkringar, but also others that are interested, an opportunity to get an insight in which of Länsförsäkringar competitive advantages that are appreciated by their costumers.

The Trappan Model is one of the most implemented treatment programs for children who have experienced domestic violence. This study undertakes a wider evaluation of the model through a pilot study. The approach is both quantitive and qualitative. Theory as well as the Strengths and Difficulties Questionnaire have been used to fulfil the aim. The design is pre-post. The respondents are thirteen children who have undergone Trappan treatment programs in Uppsala during 2007. Pre-tests and comparison groups have been used to ascertain the psychological, emotional and behavioural health of the children prior to treatment. It is evident that the children have fewer peer relationships than other children before treatment, positive changes have occurred after treatment regarding the active social development of the children.

SAMMANFATTNING Under 2006 påbörjades arbetet med att nationellt höja kvaliteten på praktiskt socialt arbete. Socialstyrelsen gav då ut nya råd och riktlinjer för hur socialtjänsten kan stärka och utveckla sitt behandlingsarbete. Utifrån detta blir det allt vanligare att mer strukturerade manualer och behandlingsinstrument införs i arbetet. Ett sådant instrument är Youth Outcome Questionnaire, som under hösten 2007 implementeras i en kommunal behandlingsverksamhet i Örebro. Syftet med studien är att undersöka hindrande och möjliggörande faktorer som omgärdar implementeringen av ett behandlingsinstrument i en behandlingsverksamhet för ungdomar på institution. Syftet preciseras genom följande frågeställningar: Hur följdes det behandlingsarbetet upp innan implementeringen av instrumentet? Vad har föranlett att enheten beslutat att införa det nya behandlingsinstrumentet Y-OQ 2.0? Vilka möjliggörande eller hindrande faktorer har föregått implementeringsarbetet av instrumentet? Vilka negativa eller positiva faktorer framkommer i det praktiska handhavandet och tillämpningen av instrumentet? Studien har en kvalitativ ansats och bygger på semistrukturerade intervjuer med sex personer ur personalgruppen i den aktuella verksamheten. Tolkningsramen utgörs i huvudsak av implementeringsteori. Resultatet visar att personalen har en positiv inställning till arbetet med instrumentet. Man har inte tidigare arbetat utifrån strukturerade utvärderingsmetoder i form av instrument eller manualer och en majoritet av respondenterna ser behovet av utvärdering i verksamheten. Hindrande faktorer under implementeringen visar sig främst i att man upplever utbildningen som något bristfällig och att man inte heller fått någon handledning kring instrumentet. Detta har lett till osäkerhet kring användandet av detta liksom hur man ska använda de resultat som framkommer, vilket också visar på de praktiska svårigheter detta medfört. De möjliggörande faktorerna handlar till stor del om personalens positiva attityd och vilja att använda sig av det nya verktyget. I diskussionen förs resonemang kring implementeringens effekter på behandlingsverksamheten och instrumentets tillämpningsområde inom behandlingsarbetet. Nyckelord: Implementering, implementeringsteori, behandlingsinstrument, Youth Outcome Questionnaire (Y-OQ 2.0), institutionsbehandling

Nickel stands out as the main cause of contact allergy in both children and adults, which has given rise to concern and the introduction of regulations by official bodies. Today´s youths are frequently exposed to body piercing and orthodontic treatment. Changes in youth lifestyle practices are also likely to influence nickel exposure and thus, the occurrence of nickel allergy. However, against patient and parental concern regarding nickel exposure to orthodontic appliances, often evoked by allergies following piercing, stand results from studies indicating that early orthodontic appliance treatment may reduce, rather than increase, prevalence of nickel allergy; a finding that has been suggested to result from tolerance induction by early exposure to nickel via the oral route. The objective of the present thesis was to investigate the association between nickel allergy and exposure to different orthodontic appliances and lifestyle, in particular piercing, as well as to study nickel release from orthodontic appliances into the oral cavity. Furthermore, one objective was to establish baseline prevalence data of nickel allergy in a Swedish adolescent population. Data was generated from a cross-sectional survey, in which about 6000 youths completed a questionnaire and almost 4500 of these were patch-tested for contact allergy. Information on exposure to orthodontic appliances was verified by dental records, whilst nickel content in saliva and dental biofilm was measured in a clinical study. Questionnaire data demonstrated a reduced risk of nickel allergy when orthodontic treatment preceded piercing (OR 0.5; 95 % CI 0.3-0.8) and similar results were found for data verified from dental records, however statistical significance was lost when adjusting for background factors (OR 0.6, 95 % CI 0.4-1.0). Exposure to full fixed appliances with NiTi-containing alloys, as well as a pooled ‘high nickel-releasing’ appliance group prior to piercing correlated with a significantly reduced risk of nickel allergy and a trend towards a reduced risk with exposure duration. Nickel could also be found in significantly higher concentrations from dental plaque samples, but not saliva samples, in orthodontic patients who were well into treatment compared to patients who had not been exposed to orthodontic appliances. The effect was not found to be due to differences in estimated dietary nickel intake between the two groups. Significantly more girls than boys (13.3 % versus 2.5 %) were found to be patch-test positive to nickel. Positive nickel tests were also most prevalent in occupational programmes and least prevalent in natural science programmes, indicating differences in lifestyle and exposure to nickel. Dropout from testing was handled using a missing-value analysis. This internal validation showed that our results overestimated the occurrence of nickel allergy to a minor degree. More girls than boys reported piercing, vegetarian/vegan diet, and smoking practices, whereas an interesting shift in tattooing prevalence was observed with a larger proportion of girls reporting this practice compared to boys. Sex, number of piercings, smoking and orthodontic appliance treatment prior to piercing were found to influence weighted risk estimates of nickel allergy. To conclude, although orthodontic patients are exposed to nickel intraorally, we found no increased risk of sensitising adolescents to nickel by the use of oral orthodontic appliances. On the contrary, early orthodontic treatment preceding piercing reduced the risk of nickel allergy by a factor of 1.5-2.0. This reduced risk appears to be associated with estimated nickel release of the appliance and duration of treatment, in all supporting a hypothesised induction of immunological tolerance via oral administration of nickel. Our study also showed a strong association between lifestyle and nickel allergy. Although there have been changes in lifestyle over time, as indicated by the strong shift in tattooing practices, no large change in nickel allergy prevalence was found compared with previous Swedish data. Our data will serve as a baseline for future studies of the effect of nickel exposure regulations, such as the Nickel Directive, and for studies of lifestyle changes and their effects on nickel allergy.

This study aims to investigate elementary models of social relations in Turkish cultural context and to link these models with horizontal and vertical individualism and collectivism and personal value priorities. Fiske (1992) suggested that four elementary relationship models: communal sharing, authority ranking, equality matching, and market pricing motivate, organize, generate, coordinate, and evaluate almost all social relations. First, the Modes of Relationship Questionnaire (MORQ) asessing the four relational models was adopted to Turkish. Second, systematical associations of relational models with horizontal and vertical individualism and collectivism and personal value priorities were examined. It was expected that horizontal cultural dimensions would predict equality matching and vertical dimensions would predict authority ranking, individualism would be linked to market pricing and collectivism would be linked to communal sharing. For personal value priorities, self-trancendence values would be associatedwith communal sharing, self-enhancement with authority ranking and market pricing, and conservation with authority ranking. Participants (N = 214) completed the MORQ, the Individualism and Collectivism Scale (INDCOL), and the Portrait Values Questionnaire (PVQ). The four factor-structure of the relational models was supported in comfirmatory factor analyses. The hypothesized associations between relaitonal models, cultural orientations, and personal priorities were mostly supported. The results indicated that collectivism predicted communal sharing, vertical dimensions predicted authority ranking, horizontal collectivism predicted equality matching, and vertical individualism predicted market pricing. It was also found that self-trancendence predicted communal sharing and equality matching, self-enhancement predicted authority ranking and market pricing, and conservation predicted authority ranking.Theoretical, methodological, and practical implications of the findings were discussed considering previous work and cultural context.

This thesis deals with methological issues in the study of chemical exposure and sick building syndrome (SBS). SBS is a combination of general, mucosal and skin symptoms that some people experience when staying in specific buildings. The aim was to find chemical patterns associated with SBS, but also to address methological problems in such study. The plan was to conduct a case-control study comparing the two groups’ chemical exposure, where cases were defined as those having at least one general, one mucosal and one skin symptom each week the last three months. For the planning it was necessary to know if cases and controls could be selected from the same building. If everyone in a building have the same chemical exposure it is no use to compare exposure between two persons at the same workplace. In the first paper exposure to more than 100 compounds is compared between 79 participants working in eight buildings. It was found that for the majority of compounds the variation in exposure was larger within buildings than between buildings, which means that cases and controls could be allowed to work in the same building. The second paper is a comparison of three adsorbents usability in finding differences in chemical exposure between SBS cases and controls. This was done by using chemometrical methods but comparisons of sampled amounts, blank values and reproducibility were also done. Tenax TA was found to be the best adsorbent, hence used in the case-control study. In recent years ozone and ozone reaction products with unsaturated volatile organic compounds (VOCs) has been in focus. Nitrogen dioxide is another gas affecting oxidation of reactive VOCs. Formaldehyde is an irritant formed when unsaturated VOCs are oxidised, and in some studies a relation with SBS has been found. In paper three the relation between personal exposure to formaldehyde, nitrogen dioxide, ozone, terpenes and SBS has been investigated among more than 200 office workers in a case control study in Umeå and Vasa. Cases (based on symptoms during the week of measurements) had lower ozone exposure than controls. No further associations were found at present exposure levels. A planed analysis of relations to VOCs could not be done due to analytical problems, and problems due to difficulties with consistent identification of compounds in a very large data set. These problems are further discussed in the thesis. In the case-control, study participants answered questionnaires about symptoms during "the past three months", "right now" (when answering the questionnaire), and during the week of exposure measurements. In the fourth paper the stability of symptoms were compared by answers at different occasions. It was found that the case/control concept was as stable as individual symptoms. More participants with atopic disease and those 41 years old or younger changed class compared with those without atopic disease and older participants. Measurement activities appeared to make participants report more symptoms. Fatigue, dry eyes and dry skin are suggested to be symptoms with strongest, and illness/dizziness to be weakest association with IAQ. / KLUCK-projektet