Ätproblem hos barn är relativt vanliga och existerar både hos i övrigt friska barn och hos barn med andra sjukdomar och diagnoser. I vissa fall är ätproblemen så allvarliga att de leder till malnutrition. Ofta delas ätproblem in i kategorier beroende på om man tycker sig se en medicinsk orsak eller inte, man skiljer därmed på organiska och icke-organiska problem. Detta arbete fokuserar främst på det som i litteraturen brukar kallas matvägran. Syftet var att belysa området i stort genom att presentera och diskutera aktuell litteratur och forskning om matvägran samt att kritiskt granska olika förklarings-modeller och begrepp. Tre fall av barn med matvägran beskrivs också. Beskrivningarna är baserade på information som lämnats av barnens mödrar i intervjuer och syftar till att beskriva hur naturalförloppet vid matvägran kan se ut samt att undersöka föräldrarnas attityder och känslor kring problemet i sig och kring vårdkontakter. Gemensamma drag var bland andra att barnen haft problem med att äta redan från början och att de alla kräkts frekvent. Mödrarna i de tre fallen beskriver också att de är besvikna över vården av deras barn. Genomgången av etiologi och orsaksteorier pekar mot att matvägran sannolikt är en komplex samverkan mellan en rad olika fysiologiska, psykologiska och miljömässiga faktorer. Att kalla besvären antingen organiska eller icke-organiska kan vara missvisande. Huruvida barnet uppvisar en ovilja eller aversion mot att äta borde vara avgörande för val av behandling och behandlingen bör utformas så att barnets integritet respekteras. / Feeding problems in children are common and exist both in otherwise healthy children and in children with medical conditions. In some cases the feeding problems are severe enough to cause malnutrition. A distinction is often made between organic feeding problems, which are thought to be caused by a medical condition and non-organic problems, where no obvious medical reason can be found. This study was primarily focused on what is referred to as food refusal. The aim of the study was to illuminate the area by presenting and discussing current research as well as critically view common terminology and theories. Three case studies of children with food refusal are also posed. The descriptions are based on information extracted from interviews of their mothers and aim to describe how the natural course of food refusal can present itself as well as to explore parental attitudes and feelings around the problem itself and around contacts with the health care system. Some of the common denominators were that the children all exhibited feeding problems from the beginning and that they have suffered frequent vomiting. The mothers have been disappointed with the care that their children have received. The review of etiology and theories points towards food refusal being a complex interplay between physiological, psychological and environmental factors. To label the problem as being either organic or non-organic can be misleading. Weather the child exhibits an aversion or unwillingness to eat should be an important aspect in choosing treatment form and respecting the child´s integrity should be a priority in treatment.

Objetivos: Estimar la prevalencia y los factores asociados a la intención de vacunación (IDV) contra la COVID-19 en el Perú. Materiales y métodos: Estudio transversal analítico utilizando una encuesta realizada por la Universidad de Maryland, EUA, en Facebook. La variable dependiente fue la IDV. Se calcularon razones de prevalencia (RP) crudas y ajustadas, con sus intervalos de confianza al 95% (IC95%), mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación de variables sociodemográficas, el cumplimiento de estrategias comunitarias de mitigación, los síntomas de la COVID-19, la salud mental y la aceptación de la vacunación ante la recomendación (AVR) por diversos actores y autoridades sanitarias. Resultados: Se analizaron los datos de 17 162 adultos. La prevalencia general de la IDV fue del 74,9%. Se asociaron a una menor prevalencia de la IDV ser de sexo femenino (RP = 0,95; IC95%: 0,94-0,97), vivir en un pueblo (RP = 0,95; IC95%: 0,91-0,99) o en una aldea u otra área rural (RP = 0,90; IC95%: 0,86-0,93) y la AVR de políticos (RP = 0,89; IC95%: 0,87-0,92). Contrariamente, tener síntomas de COVID-19 (RP = 1,06; IC95%: 1,03-1,09), inseguridad económica (RP = 1,04; IC95%: 1,01-1,06), miedo a enfermar o que un familiar enferme de COVID-19 (RP = 1,49; IC95%: 1,36-1,64) y la AVR de familiares y amigos (RP = 1,10; IC95%: 1,08-1,12), trabajadores de la salud (RP = 1,29; IC95%: 1,26- 1,32), la Organización Mundial de la Salud (RP = 1,34; IC95%: 1,29-1,40) y funcionarios del gobierno (RP = 1,18; IC95%: 1,15-1,22) se asociaron con mayor prevalencia de IDV. Conclusiones: Tres cuartas partes de los encuestados manifiestan IDV. Existen factores potencialmente modificables que podrían mejorar la aceptación de la vacuna. / Objectives: To estimate the prevalence and factors associated with COVID-19 vaccination intention (VI) in Peru. Materials and methods: Analytical cross-sectional study using the survey conducted by the University of Maryland, USA, on Facebook. The dependent variable is VI. Crude and adjusted prevalence ratios (PR) were calculated, with their 95% confidence intervals (95%CI) using generalized linear models of the Poisson family, to evaluate the association of sociodemographic variables, com- pliance with community mitigation strategies, symptoms of COVID-19, mental health and acceptance of vaccination before the recommendation (AVR) by various actors and health authorities, with the ITV. Results: Data from 17,162 adults were analyzed. The overall prevalence of VI was 74.9%. A lower prevalence of VI was associated with the female sex (PR=0.95; 95%CI:0.94-0.97), living in a town (PR=0.95; 95%CI:0.91-0.99) or village or other rural area (PR=0.90; 95%CI:0.86-0.93) and the AVR of politicians (PR=0.89; 95%CI:0.87-0.92). Conversely, having COVID-19 symptoms (PR=1.06; 95%CI:1.03-1.09), economic insecurity (PR=1.04; 95%CI:1.01-1.06), fears of becoming seriously ill or that a family member becomes seriously ill from COVID-19 (PR=1.49; 95%CI:1.36-1.64) and the AVR of family and friends (PR=1.10; 95%CI: 1.08-1.12), healthca- re workers (PR=1.29; 95%CI: 1.26-1.32), World Health Organization (PR=1.34; 95%CI: 1.29-1.40) and government officials (PR=1.18; 95%CI: 1.15-1.22) was associated with a higher prevalence of VI. Conclusio of the respondents had VI. There are potentially modifiable factors that could improve vaccine acceptance.

Le refus scolaire anxieux est un phénomène complexe et multiforme qui peut avoir des conséquences graves au niveau familial, professionnel et sur le fonctionnement psychique de l’adolescent. La reconnaissance précoce est importante car le pronostic dépend en partie de la rapidité de l’intervention. Cependant, le refus scolaire anxieux est un objet encore mal défini, ce qui entrave sa prise en charge et la reconnaissance du phénomène par l’ensemble des partenaires. A ce jour, il n’existe pas d’outil commun aux différents professionnels pour aider au repérage précoce. L’objectif général de cette recherche était de créer et de valider un auto-questionnaire de repérage du refus scolaire anxieux au collège. Trois études ont été menées successivement en utilisant une approche intégrative et une méthodologie mixte (qualitative pour l’étude 1 et quantitative pour les études 2 et 3). L’étude 1 a été l’occasion, à l’aide d’entretiens (N = 42), de recenser et d’organiser les différentes manifestations du refus scolaire anxieux au collège de façon à pouvoir créer ensuite les items du questionnaire. L’analyse de contenu a mis en évidence un modèle de description du refus scolaire en quatre grands thèmes. L’étude 2 (N = 22) a permis d’élaborer la version pilote du questionnaire (SChool REfusal EvaluatioN ; SCREEN). Cette étude portait sur les étapes de création et de sélection des items et sur la création de la structure du questionnaire. L’étude 3 (N = 584) a porté sur la validation de la SCREEN auprès de collégiens et de patients et la mise en évidence de scores seuils pour le repérage du refus scolaire anxieux. Les analyses factorielles indiquent que la SCREEN est composée de 18 items repartis en 4 facteurs. Une analyse en courbe ROC et une standardisation des résultats ont déterminé des scores seuils. Les résultats indiquent de bonnes qualités psychométriques de la SCREEN (sensibilité de .88 et spécificité de .89 ; alpha de Cronbach de .84). Le modèle issu de l’étude 1, ainsi que le questionnaire, peuvent être utilisés dans les établissements scolaires comme dans les services de soins, à des fins de recherche ou dans le cadre d’une pratique clinique. La SCREEN peut contribuer à l’orientation plus rapide des adolescents, aider au développement des études empiriques sur le refus scolaire anxieux et favoriser le travail de partenariat entre les différents acteurs. / Anxiety-based school refusal is a complex, ill-defined phenomenon related to several dimensions social, family, school, psychological…). This anxious absenteeism is a clinical reality with consequences on the adolescent’s family and professional perspectives and on his/her psychological functioning. As the prognosis depends to a large extent on early clinical care, early diagnosis is crucial. While a specific assessment is required, there is still no common tool that school professionals and health care professionals may use.The goal of this research was the creation and the validation of a self-reported screening tool for assessing school refusal.Three studies were carried out successively using an integrative approach and qualitative method (Study 1) or a quantitative method (Studies 2 and 3). The first study, with interviews (N = 42), aimed at a conceptual and operational definition of this construct. The content analysis revealed a descriptive model of school refusal comprising four different themes. The second study (N = 22) concerned the creation of the pilot version of the questionnaire (SChool REfusal EvaluatioN; SCREEN): generation of items, selection of items and creation of the questionnaire. The last study (n = 584) involved the validation of the SCREEN with a community sample of teenagers and a clinical sample. Analyses revealed a 4-factor model structure with 18 items. ROC analyses and standardization revealed a cut-off for screening school refusal. Results suggested that the tool has good psychometric properties (sensitivity .88; specificity .89; Cronbach’s alpha .84).The SCREEN and the descriptive model of school refusal can be helpful both at school and in health care services, for research and clinical practice. The SCREEN is useful for early clinical care, empirical studies, and for developing partnerships between school educators and health care professionals.

Bakgrund: Att en patient motsätter sig behandling kan vara av religiösa, etiska eller moraliska skäl. Eftersom sjuksköterskans huvuduppgifter i sitt arbete är att främja hälsa, förebygga sjukdom, återställa hälsa samt att lindra lidande så är det av intresse att undersöka sjuksköterskans upplevelse av att vårda patienter som motsätter sig behandling. Syfte: Syftet var att beskriva sjuksköterskors upplevelse av att vårda patienter som motsätter sig behandling. Metod: En allmän litteraturstudie med induktiv ansats genomfördes och fyra kategorier framkom. Resultat: Resultatet visar att sjuksköterskors upplevelser av att vårda patienter som motsätter sig behandling innebär att: ha en god relation med patienten, respektera patientens autonomi, argumentera för patientens behandling, samt känna emotionell påverkan av patientens beslut. Det visade sig att en god relation mellan patient och sjuksköterska var viktigt när patienten motsätter sig behandling. Sjuksköterskor respekterade patienters autonomi även om de ibland försökte argumentera för att patienter skulle ta emot behandling. Sjuksköterskor kunde uppleva starka känslor som maktlöshet, frustration och ilska när patienten motsatte sig behandling. Konklusion: Studien visade att relationen mellan sjuksköterskan och patienten var viktigt i vårdandet av patienter som motsätter sig behandling. Sjuksköterskorna var noga med att respektera patientens autonomi. Ville inte patienten ta emot behandling försökte sjuksköterskan att få patienten att ta emot behandling. Fungerade inte detta kunde starka känslor upplevas. / Background: A patient’s refusal of treatment may be for religious, ethical, or moral reasons. Since the nurse’s main task in her work is to promote health, restore health, prevent illness and relieve suffering, it is of interest to investigate the nurse’s experience of caring for patients who refused treatment. Aim: The aim of this study was to describe the nurse’s experiences of caring for patients who refused treatment. Method: A literature review with an inductive approach and four categories emerged. Result: The study shows that nurse’s experiences of caring for patients who refuse treatment are: have a good relationship with the patient, respecting the patient’s autonomy, arguing for the patient’s treatment, and feel an emotional impact. It turned out that a good relationship between the patient and the nurse was important when the patient refused treatment. Nurses respected patient’s autonomy even although they sometimes tried to argue that patients would receive treatment. Nurses could experience strong feelings such as powerlessness, frustration, and anger when the patients refused treatment. Conclusion: The study showed that a good relationship between the nurse and the patient was important in the care of patients who refused treatment. The nurses were careful to respect the patient’s autonomy. If the patient did not want to receive treatment, the nurse tried to get the patient to receive treatment. If this did not work, strong feelings could be experienced.

(in English): This thesis focuses on pragmatic competence of Czech students of Japanese, specifically on the speech act of refusal. The aim is to find out how students differ in comparison to native speakers of Japanese. Another aim is to compare Japanese students based on the length of their stay in Japan, their Japanese proficiency, and the textbook used at the beginner level. The theoretical part describes pragmatic competence, politeness theory, the speech act of refusal and its specifics in Japanese. The practical part focuses at the analysis of refusals from the Discourse Completion Task (DCT) using semantic formulas. Usage of these formulas by native speakers and student are then compared. Found differences from the native speakers are further examined among students according to Japanese proficiency, length of their stay in Japan and textbook used at the begginer level. Finally, the results are summarized.

No description available.

School attendance problems experienced by children are a concern across Canadian educational systems. Higher rates of attendance issues exist among children who experience emotional and behavioural difficulties, which places them at heightened risk for poor educational outcomes. Frequently explored in educational research are variables related to school attendance problems among the general child population, however, a shortage of literature exists that explores these elements among children with emotional and behavioral difficulties. To address this void, this mixed-methods study explored child and educational elements that surrounded the school attendance problems of a sample of children receiving mental health services at a community clinic. Together, analyses of data gathered from the CANS, SDQ, and client files indicated that dynamic and reciprocal relationships existed among children’s emotional, behavioural, social, and academic difficulties which contributed to their attendance and overall educational experiences. These results corroborate existing research related to school attendance problems, however, provide unique insights into the profiles of this particular population and how their needs can be better met to promote more positive school experiences.

A partir de l’hémodialyse, nous étudierons certains problèmes plus généralement liés à la maladie chronique mais aussi la fin de vie pour mettre en tension trois dualités : l’exactitude et la vérité, les morales déontologiques et téléologiques, et la logique d’équivalence et de surabondance. Dans la maladie chronique, nous nous intéresserons aux cas où il existe une contradiction entre le devoir thérapeutique du médecin et la volonté de la personne malade. Nous montrerons que ces refus de soin en dialyse sont sous-tendus par une tension entre l’exactitude technique des traitements proposés et la vérité éthique et existentielle de la personne. Dans la fin de vie, nous nous poserons la question de savoir quand commence l’obstination déraisonnable, comment définir sa limite, et comment limiter ou arrêter la dialyse tout en étant certain de ne pas réaliser un homicide ? Nous montrerons également que les normes, les indicateurs et les protocoles prolifèrent pour participer à une standardisation des pratiques de plus en plus hégémonique, où plusieurs moteurs sont à l’œuvre, comme la rationalité néolibérale et la gestion du risque.  Ceci aboutit à un désenchantement des soignants. Un constat apparait : l’exactitude, la technique, les morales déontologiques rabattues sous forme de protocoles et la logique d’équivalence deviennent envahissantes. A l’inverse la vérité du sujet, l’éthique, la responsabilité de l'autre vulnérable, le don d’hospitalité tendent à être précarisés. La riposte à cette dérive pourrait être la réhabilitation de la singularité du sujet et la création de métaphore vive entre exactitude technique et la vérité éthique. Enfin, nous montrerons comment lorsqu’il existe un dilemme lié à une tension entre technique et éthique, la mise en place d’une réunion d’éthique nous a permis d’apporter la réponse la plus humaine possible et de favoriser le développement d’une culture d’équipe. / From hemodialysis, we will study certain problems more generally related to chronic disease but also to the end of life bring out the tension between three dualities: the accuracy and the truth, déontological and teleological ethics, and the logics of equivalence and superabundance. In chronic illness, we will be interested in cases where there is a contradiction between the medical duty of the physician and the will of the sick person. We will show that these refusals of care in dialysis are underpinned by a tension between the technical accuracy of the proposed treatments and the ethical and existential truth of the person. In the end of life, we will ask ourselves the question of when unreasonable obstinacy begins, how to define its limit, and how to limit or stop dialysis while being sure not to perform a homicide? We will also show that norms, standards, indicators and protocols proliferate to participate in a standardization of increasingly hegemonic practices, where several drivers are at work, such as neoliberal rationality and risk management. This leads to a disenchantment of caregivers. One observation emerges: the accuracy, the technique, the déontological ethics folded in the form of protocols and the logic of equivalence become invasive. Conversely, the truth of the subject, ethics, the responsibility of the other vulnerable, the gift of hospitality tend to be precarious. The response to this drift could be the rehabilitation of the singularity of the subject and the creation of a metaphor between technical accuracy and ethical truth. Finally, we will show how, when there is a dilemma linked to a tension between technique and ethics, the setting up of an ethics meeting allowed us to provide the most humane answer possible and to foster the development of a team culture.

Résumé : L’objectif de ce travail est d’étudier ce qui amène une personne malade à formuler un refus de traitement, à partir d’une triple approche. Celle du patient et de ses proches, celle des professionnels confrontés à ce refus, celle d’un groupe de réflexion éthique, pluri professionnel, rassemblant des représentants des sciences humaines, ainsi que des « citoyens ordinaires » non professionnels de santé, apportant le regard de la cité. Chercher le sens d’un refus consiste à analyser et décrypter une volonté de la personne que quelque chose se produise ou ne se produise pas, et correspond à la dialectique du don et de l’acceptation du soin. Refuser un traitement n’est pas refuser un soin. Les situations de refus constituent un champ de réflexion sur nos comportements, individuels et collectifs, nos doutes, nos incertitudes ainsi que sur des valeurs en conflit. Ce travail étudie la complexité des problèmes rencontrés à ce sujet en pratique clinique quotidienne, pour en approfondir le questionnement dans l’interaction qui se joue entre les différents acteurs. Il montre aussi l’importance des méthodes de travail à mettre en place pour favoriser l’éthique du dialogue. Face aux choix auxquels sont confrontés ceux qui assument la responsabilité de la décision, la question se pose de savoir vers quelles ressources se tourner pour favoriser la réflexion éthique, évitant l’arbitraire des convictions personnelles. / Abstract : The objective of this work is to study what brings a sick person to formulate a refusal of treatment, based on a three-pronged approach. One of the patient and his relatives, one of professionals faced with this refusal, and one of a multi-professional ethics reflection group, bringing together representatives of humanities and social sciences, as well as “ordinary citizens”, bringing the outside eye of the city. Looking for the meaning of a refusal consists of analyzing and decoding a willingness of the person that something happens or does not happen, and corresponds to the dialectic of the gift and acceptance of the care. To refuse a treatment doesn’t mean refusing care. Situations of refusal pave the way for reflection about our individual and collective behavior, our doubts, our uncertainties as well as conflicting values. This work explores the complexity of such problems encountered in daily clinical practice, in order to deepen the questioning about the interaction played between the different actors. It also shows how important it is to working methods that promote the ethics of dialogue. Considering the choices faced by those who assume the responsibility for the decision, the question arises of which resources to use to promote ethical reflection, avoiding the arbitrary nature of personal convictions.

Background: The anti-vaccination movement has gained attention in the media over the last few years, which has revived the debate as to whether parents should vaccinate their children or not. Infections, whose incidence has previously been declining as a result of compliance to national immunization programmes, have made a resurgence and the protection of the society that comes with vaccinations is decreasing. Vaccines are one of the most cost-efficient measures available to health care to prevent spreading of diseases and decrease mortality at the population level. Aim: To study the factors that influence parents’ decisions not to vaccinate their children in accordance with national immunization programmes to increase the understanding of these decisions. Method: A scoping review of articles retrieved from the databases PubMed and CINAHL. A content analysis was used to interpret content and create context. The result was based on 23 articles. Results: Several reasons why parents don't vaccinate their children were uncovered. A fear of adverse effects and a lack of trust in health care, authorities and vaccines were prominent reasons for vaccination refusal. Where parents gathered information, how they defined health and culture or religion where other factors that influenced the decision not to vaccinate. Conclusion: The main findings indicate a lack of trust in authorities, health care or vaccines among parents. Gathering information from the internet and media have contributed to ignorance about and a fear of the effects of vaccines. Health care staff need to improve their person-centered care and adapt information about vaccines to the recipient. / Bakgrund: Antivaccinationsrörelsen har fått medial uppmärksamhet de senaste åren, vilket har aktualiserat debatten huruvida föräldrar ska vaccinera eller inte vaccinera sina barn. Infektioner, vars utbredning tidigare minskat till följd av följsamhet till vaccinationsprogram, har åter fått fäste och det samhällsskydd som följer vaccinationer har minskat. Vaccin är en kostnadseffektiv åtgärd inom hälso- och sjukvården för att förhindra smittspridning och minska mortaliteten på befolkningsnivå. Syfte: Undersöka faktorer som påverkar föräldrars beslut att inte vaccinera sina barn enligt nationella vaccinationsprogram för att öka förståelsen för dessa beslut. Metod: Scoping review baserad på artiklar hämtade ur databaserna PubMed och CINAHL. Innehållsanalys tillämpades för att förstå innehåll och skapa sammanhang. Resultatet baseras på 23 artiklar. Resultat: I resultatet framkom olika skäl till att föräldrar inte vaccinerar sina barn. Rädsla för biverkningar och bristande tillit till sjukvården, myndigheter och vaccin var framträdande orsaker till vaccinvägran. Var föräldrar inhämtade information, hur de definierade hälsa samt kultur och religion var andra faktorer som påverkade beslutet att inte vaccinera. Slutsats: Resultatets primära fynd baseras på någon form av bristande tillit till myndigheter, sjukvården eller vaccin hos föräldrarna. Internet och media som informationskälla har bidragit till felaktiga uppfattningar om och rädsla för vacciners effekt. Sjukvården måste bli bättre på personcentrerad vård och individanpassa information om vaccin.