Tidigare forskning har visat att barn som föds för tidigt är en sårbar grupp som löper ökad risk för funktionsnedsättningar, kognitiva och motoriska nedsättningar samt beteendeavvikelser. Kunskapen är begränsad om hur för tidigt födda ungdomar upplever sin livskvalitet och om hur väl de anpassat sig efter sina förutsättningar. Föreliggande uppsats jämförde livskvalitet enligt QOLI anpassat för ungdomar och psykisk hälsa enligt SDQ vid 18 års ålder hos 105 prematurt födda ungdomar och 54 ungdomar i en matchad kontrollgrupp. Trots en lägre kognitiv och exekutiv funktion rapporterade de för tidigt födda ungdomarna lika god livskvalitet som kontrollgruppen. Det förelåg skillnader i rapporterade kamratrelationer då de för tidigt födda ungdomarna sa sig vara mer ensamma och upplevde sig som mindre populära än kontrollgruppen. Båda grupperna hade en hög förekomst av emotionella svårigheter och flickor var särskilt drabbade. Resultatet pekar på att de för tidigt födda ungdomarna har anpassat sig väl efter sina förutsättningar. / Stockholm Neonatal Project

The aim of this quantitative study is to describe the prevalence of mental health problems within the group of children and adolescents who receive support from two in home care units within the social services of Rinkeby-Kista and Södermalm stadsdelsförvaltning in Stockholm. Another purpose is to examine whether socioeconomic background and/or gender are associated with the prevalence of poor mental health, or mental health problems of a specific kind, in the studied population. Mental health is measured with the SDQ, a behavioral screening questionnaire that is widely used in Sweden and internationally. The study is based on data collected by the two units, which routinely screen children and adolescents with the SDQ. The main results of this study indicate that mental health problems are common in the studied population. The proportion of the children and adolescents who are found to be at risk of developing mental health problems that amount to a psychiatric diagnosis is twice as large as in a community sample. Very few statistically significant associations were found between the variables gender or socioeconomic background and mental health. We have analyzed the results of this study with Bronfenbrenner’s ecological theory.

Differences in family structure have been linked to several mental health outcomes, where children living in a nuclear family setting are best-off, while children in joint physical custody are second best followed by those living mostly and only with one parent. One of the biggest changes in recent years is that joint physical custody is growing more common. The dependent variables in this thesis were three dimensions of mental health from the Strengths and Difficulties Questionnaire. Data from 6th and 9th graders in the entire Sweden 2009 was used. Regression modelling showed differences in mental health between the family structures throughout, although children in  joint physical custody was not significantly different from those in nuclear families (reference category) in half of the models. Children living mostly with one parent reported the third worst levels of problematic behaviour and prevalence of low prosocial behaviour while those living with just one parent were worst off. Stratifying by gender did reveal small coefficient differences and so did controls for birth region. This thesis, although in a line of other publications based on this study can help shape future guidelines for e.g. social workers.

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of school children’s health and to analyse factors influencing the recording of schoolchildren’s health in the School Health Record (SHR). An additional aim is to evaluate family nursing interventions as a tool for the school nurses in the School Health Service (SHS).Methods: The thesis comprises four papers. A combination of qualitative and quantitative methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early adolescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separately. Qualitative content analyses were used to analyze the interview text with the school nurses and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically.Findings: The findings showed that nurses judged the schoolchildren’s mental health as deteriorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environment and family relations. The latter seemed to be the most important factor affecting schoolchildren’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the improper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families experienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was supported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families.Conclusions: The results indicate that school nurses have a deep knowledge about schoolchildren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would demand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level. / Syfte: Avhandlingens övergripande syfte är att undersöka skolsköterskors uppfattning om skolbarns hälsa och att analysera faktorer som påverkar dokumentation av skolbarns hälsa i skolhälsovårdsjournalen. Ett ytterligare syfte är att utvärdera modeller för familjeinterventioner som redskap för skolsköterskor i skolhälsovård.Metoder: Avhandlingen består av fyra delarbeten. En kombination av kvalitativa och kvantitativa metoder användes. I delarbete I genomfördes intervjuer med ett strategiskt urval av skolsköterskor (n=12). Intervjuerna analyserades med kvalitativ innehållsanalys. I delarbeten II och III distribuerades en nationell enkät till ett representativt urval av Sveriges skolsköterskor (n=129). Manifest innehållsanalys användes vid analys av de öppna frågorna. I delarbete IV genomfördes en interventionsstudie med familjesamtal, inspirerad av modeller för familjefokuserad omvårdnad utvecklade i Kanada. Skolflickor i tidig adolescens med återkommande subjektiva hälsoproblem (n=4) och deras föräldrar i samarbete med deras verksamma skolsköterskor (n=2) ingick i studien. Separata utvärderingsintervjuer genomfördes med familjer och skolsköterskor. Intervjuerna analyserades med kvalitativ och manifest innehållsanalys respektive. The Strengths and Difficulties Questionnaire (SDQ) användes som före/efter test vid interventionen och resultatet bearbetades statistiskt manuellt. Deskriptiv statistik användes för analys av demografisk data i samtliga delarbeten.Resultat: Resultatet visade att skolsköterskorna bedömde skolbarnens mentala hälsa som försämrad särskilt bland flickor och i socioekonomiskt utsatta områden. Individuella livsstilsfaktorer påverkade skolbarnens fysiska hälsa och den mentala hälsan var i stor utsträckning påverkad av skolmiljö och familjerelationer. Det sistnämnda verkade vara den mest betydelsefulla påverkansfaktorn för skolbarnens mentala hälsa. Bedömningen av den fysiska hälsan baserades på hälsokontroller och hälsosamtal medan spontana besök var vanligare för bedömning av den mentala hälsan. Dokumentation av mentala hälsa var en utmaning för skolsköterskorna. Svårigheterna kunde relateras till etiska överväganden, tradition och tidsbrist samt till skolhälsovårdsjournalens struktur som inte ansågs uppfylla dagens krav. Skolsköterskorna uttryckte en rädsla för att journalanteckningarna skulle märka skolbarnet för livet. Framtida tolkningar relaterade till skolbarnet själv, föräldrar eller andra/påföljande vårdgivare uttrycktes som hinder för att dokumentera mental och social hälsa. Familjesamtal visade sig vara användbara i skolhälsovården. De medverkande flickorna och deras familjer kände sig bekräftade i att deras känslor och reaktioner var normala. De sade sig bli medvetna om egna styrkor och möjligheter vilket styrktes av SDQ som visade ett ökat välbefinnande efter sammankomsterna, både hos skolbarnen och hos föräldrarna. Skolsköterskorna var positiva till att arbeta med familjesamtal och upplevde sig mer som samverkanspartner än som expert. Samtalen ledde till att en förändringsprocess startade i familjerna enligt skolsköterskorna.Slutsatser: Resultatet indikerar att skolsköterskor har en djup kunskap om skolbarns hälsa som sannolikt kunde tas tillvara på ett bättre sätt ur ett folkhälsoperspektiv på såväl nationell som lokal nivå. Behovet av att utveckla skolhälsovårdsjournalen efter dagens behov och fördjupad kunskap om de upplevda svårigheterna att dokumentera skolbarns mentala hälsa är uppenbar. Familjesamtal, där skolsköterskan intar en roll som samverkanspartner, visade sig användbara och kan sannolikt överföras till andra hälsoproblem bland skolbarn. Bronfenbrenners utvecklingsekologiska systemteori och andra modeller för hälsodeterminanter används för att illustrera skolsköterskans arbete med skolbarns hälsa på såväl en individuell nivå som folkhälsonivå.

Denna studie har, genom en tvärsektionell design, undersökt relationen mellan positiv och negativ självbild och fyra aspekter av internaliserad och externaliserad problematik. Självskattningsinstrumenten Structural Analysis of Social Behavior och Strengths and Difficulties Questionnaire har fyllts i av en klinisk grupp bestående av 327 ungdomar i åldrarna 12 - 19 år. Data har analyserats med hjälp av stiganalys. Resultatet visade en positiv relation mellan negativ självbild och både uppförandeproblem och emotionell problematik, samt en negativ relation mellan positiv självbild och emotionell problematik. Sammanfattningsvis tyder resultatet från denna studie på att en klinisk ungdomsgrupp har liknande relation mellan självbild och problembeteende som ungdomar utan psykopatologisk problematik; där en negativ självbild associeras med mer- och en positiv självbild associeras med mindre problembeteenden. Studiens resultat accentuerar betydelsen av att inkludera både interpersonella och intrapersonella aspekter när problembeteenden utreds och behandlas. / This study examined the relationship between positive and negative self-concept and four aspects of internalized and externalized problem behaviors, through a cross-sectional design. The self-assessment instruments Structural Analysis of Social Behavior and Strengths and Difficulties Questionnaire were completed by a clinical group consisting of 327 adolescents aged 12-19 years. Data were analyzed through path analysis. The results showed a positive relationship between negative self-concept and both behavioral and emotional problems, as well as a negative relationship between positive self-concept and emotional problems. In conclusion, the result of this study suggests that a clinical youth group has a similar relationship between self-concept and problem behavior as do young people without psychopathological problems; where a negative self-concept is associated with more- and a positive self-concept is associated with less problem behaviors. The study's results accentuate the importance of including both interpersonal and intrapersonal aspects when problem behavior is investigated and treated.

Strukturerade ledarledda fritidsaktiviteter, SLF, har ett starkt samband med positiva utfall i ett livslopp. Samtidigt är ostrukturerade fritidsaktiviteter starkt relaterade till negativa utfall i ett livslopp. Den här studien undersöker relationen mellan deltagande i olika fritidsaktiviteter och övergrepp och försummelse av barn från föräldrarna, barns beteendeproblem och externaliserande beteende. Data från 1305 barn, 676 flickor och 629 pojkar, medelålder 14,88 år, användes från forskningsprogrammet Longitiduinal Research on Development In Adolescence, LoRDIA. Data samlades in via självskattningsformulär i klassrumsmiljö. Data analyserades genom Chi-2-test, Pearsons R och logistisk regression. Relativ risk, RR, beräknades. De huvudsakliga slutsatserna visar att alla fem typer av övergrepp och försummelse, beteendeproblem och externaliserande beteende, samt övergrepp och/eller försummelse i kombination med externaliserande beteende har ett signifikant samband med lågt deltagande i SLF och ett högt deltagande i ostrukturerade fritidsaktiviteter. Beteendeproblem har en predicerande påverkan på lågt deltagande i SLF, medan en pappa i arbete eller studier har en predicerande påverka på högt deltagande i SLF. Sexuella övergrepp, externaliserande beteende och beteendeproblem har den högsta RR för högt deltagande i ostrukturerade fritidsaktiviteter, medan beteendeproblem, känslomässig försummelse och sexuella övergrepp har den högsta RR för lågt deltagande i SLF. Implikationer för forskningen och praktiken diskuteras. / Organized leisure time activities, OLTA, is proven to be related to positive life outcomes in life. Meanwhile unstructured leisure time activities are related to negative life outcomes. This study examines the relationship between participation in leisure time activities and child abuse and neglect, conduct problems and externalizing behavior. Data from 1305 children, 676 girls and 629 boys, mean age 14,88, was used from the longitudinal multidisciplinary research program LoRDIA (Longitudinal Research on Development In Adolescence). Data was collected via self-report questionnaires in classroom settings. The data was analyzed via Chi-2, Pearson’s R, and logistic regression. Relative risk ratio, RR, was calculated. The main results show that all five types of abuse and neglect, conduct problems and externalizing behavior, and abuse/neglect combined with externalizing behavior is significant related to low participation in OTLA, and high participation in unstructured leisure time activities. Conduct problems is a single predictor of low participation in OTLA, whereas an employed or studying dad is a single predictor of high participation in OTLA. Sexual abuse, externalizing behavior and conduct problems has the highest RR for high participation in unstructured leisure time activities, whereas conduct problems, emotional neglect and sexual abuse has the highest RR for low participation in OTLA.

Im Rahmen der vorliegenden Arbeit wurden von Juli bis Oktober 2008 alle auf allgemeinpädiatrischen Stationen der Krankenhäuser Wurzen, Borna und Torgau behandelten Kinder und Jugendliche im Alter von 3 bis 16 Jahren mittels Strengths and Difficulties Questionnaire (SDQ, Goodman 1997) untersucht. Anhand der Elternfrage-bögen (n=414) wurden insgesamt 11,8% (95%KI: 8,7-14,9) der beurteilten Patientinnen und Patienten als psychisch auffällig und weitere 10,4% (95%KI: 7,5-13,3) als grenz-wertig eingestuft. Somit lag der Gesamtanteil psychischer Auffälligkeiten in der pädiatrischen Inanspruchnahmepopulation signifikant über dem der Allgemein-bevölkerung (gemessen im Kinder- und Jugendgesundheitssurvey, Robert- Koch-Institut, KiGGS-Studie 2003-2006). Durch den zusätzlichen Einsatz eines fallbezogenen standardisierten Personalfragebogens konnte erfasst werden, dass das Pflegepersonal bei 31,6%, die behandelnden Ärztinnen und Ärzte bei 15,6% aller Patientinnen und Patienten psychische Symptome wahrnahmen. Der konkrete Bedarf an kinder- und jugendpsychiatrischen Konsilen lag bei 12,4%. Die Expertenangaben aus den ergänzend durchgeführten strukturierten Interviews verdeutlichten die Notwendigkeit einer Intensivierung der Kooperation zwischen Pädiatrie und Kinder- und Jugendpsychiatrie und belegten gemeinsam mit den Fragebogenergebnissen den Bedarf frühzeitiger kinder- und jugendpsychiatrischer Interventionen.

To push the envelope of DCT-based lossy image/video compression, this thesis is motivated to revisit design of some fundamental blocks in image/video coding, ranging from source modelling, quantization table, quantizers, to entropy coding. Firstly, to better handle the heavy tail phenomenon commonly seen in DCT coefficients, a new model dubbed transparent composite model (TCM) is developed and justified. Given a sequence of DCT coefficients, the TCM first separates the tail from the main body of the sequence, and then uses a uniform distribution to model DCT coefficients in the heavy tail, while using a parametric distribution to model DCT coefficients in the main body. The separation boundary and other distribution parameters are estimated online via maximum likelihood (ML) estimation. Efficient online algorithms are proposed for parameter estimation and their convergence is also proved. When the parametric distribution is truncated Laplacian, the resulting TCM dubbed Laplacian TCM (LPTCM) not only achieves superior modeling accuracy with low estimation complexity, but also has a good capability of nonlinear data reduction by identifying and separating a DCT coefficient in the heavy tail (referred to as an outlier) from a DCT coefficient in the main body (referred to as an inlier). This in turn opens up opportunities for it to be used in DCT-based image compression. Secondly, quantization table design is revisited for image/video coding where soft decision quantization (SDQ) is considered. Unlike conventional approaches where quantization table design is bundled with a specific encoding method, we assume optimal SDQ encoding and design a quantization table for the purpose of reconstruction. Under this assumption, we model transform coefficients across different frequencies as independently distributed random sources and apply the Shannon lower bound to approximate the rate distortion function of each source. We then show that a quantization table can be optimized in a way that the resulting distortion complies with certain behavior, yielding the so-called optimal distortion profile scheme (OptD). Guided by this new theoretical result, we present an efficient statistical-model-based algorithm using the Laplacian model to design quantization tables for DCT-based image compression. When applied to standard JPEG encoding, it provides more than 1.5 dB performance gain (in PSNR), with almost no extra burden on complexity. Compared with the state-of-the-art JPEG quantization table optimizer, the proposed algorithm offers an average 0.5 dB gain with computational complexity reduced by a factor of more than 2000 when SDQ is off, and a 0.1 dB performance gain or more with 85% of the complexity reduced when SDQ is on. Thirdly, based on the LPTCM and OptD, we further propose an efficient non-predictive DCT-based image compression system, where the quantizers and entropy coding are completely re-designed, and the relative SDQ algorithm is also developed. The proposed system achieves overall coding results that are among the best and similar to those of H.264 or HEVC intra (predictive) coding, in terms of rate vs visual quality. On the other hand, in terms of rate vs objective quality, it significantly outperforms baseline JPEG by more than 4.3 dB on average, with a moderate increase on complexity, and ECEB, the state-of-the-art non-predictive image coding, by 0.75 dB when SDQ is off, with the same level of computational complexity, and by 1 dB when SDQ is on, at the cost of extra complexity. In comparison with H.264 intra coding, our system provides an overall 0.4 dB gain or so, with dramatically reduced computational complexity. It offers comparable or even better coding performance than HEVC intra coding in the high-rate region or for complicated images, but with only less than 5% of the encoding complexity of the latter. In addition, our proposed DCT-based image compression system also offers a multiresolution capability, which, together with its comparatively high coding efficiency and low complexity, makes it a good alternative for real-time image processing applications.

This thesis compromise four studies, three regarding psychometrics and norms of parent rating scales, and one study regarding effectiveness of two different interventions. A normative sample consisting of 1443 parents with children aged 10 to 13 years old, was used in the Study I, II and III. In Study IV, 231 self-referred parents with children aged 10-13 years old with externalizing behavior problem (EBP) were randomized to either Family Check-Up (FCU) or iComet. The Strengths and Difficulties Questionnaire (SDQ) used in Study I proved to be a reliable and valid instrument with high internal consistency, clear factor structure and high correlation with other similar instruments. In addition, the results support the online use of SDQ as well as using norms obtained through traditional administration even when the SDQ has been administrated online. The Emotion Regulation Questionnaire (ERQ) investigated in Study II was shown to have adequate reliability and construct validity. The specific use of expressive suppression or cognitive reappraisal as a parental emotion regulation strategy was correlated as expected to the couple’s satisfaction, family warmth, and the employment of adequate discipline strategies. Swedish norms for self-rated ERQs are also presented. Study III investigated the Parental Knowledge and Monitoring Scale (PKMS), which was shown to be a useful instrument for assessing parental knowledge and its sources. Family climate appears to moderate important relationships between parental knowledge and conduct problems with implications for such things as family interventions. Finally, a person-oriented analysis was used in Study IV to subtype the children according to combinations of prosocial behavior and EBP, such as different levels of attention deficit hyperactivity disorder (ADHD) symptoms and/or oppositional defiant disorder (ODD) behaviors. Despite being a heterogeneous group of children with EBP, they were meaningfully grouped into significantly different profiles. Both FCU and iComet resulted in post-treatment measurement within non-clinical range for three of the five profiles. The two profiles that included high levels of ADHD behaviors at baseline assessment continued to have residual symptoms post intervention.

Background Despite enormous advances in therapy, phenylketonuria (PKU) remains an incurable, inherited metabolic disease requiring life-long treatment with potential to negatively impact quality of life and psychological well-being. Therefore, the aim of this study was to screen early diagnosed and continuously treated children with PKU on psychological strengths and behavioral difficulties. Methods Evaluation of psychological strengths and behavioral difficulties in 49 patients with PKU (23f, 2-17 years) by Strengths and Difficulties Questionnaire (SDQ; self-report 11-17 years and parent-report 2-17 years). Comparison to age, sex and BMI-matched healthy controls (n = 98; 46f). Results In patients with PKU and healthy controls median SDQ Total Difficulties Score and median scores of subscales were within the normal range in parent- and self-report, irrespective of sex and age group (children 2-10 years, adolescents 11-17 years). No influence of long-term metabolic control in PKU on SDQ could be revealed. The 2- to 10-year-old boys with PKU showed significantly higher scores in Prosocial Behavior compared to their healthy peers (P = .032). Likewise, adolescent boys with PKU showed fewer Conduct Problems (parent-report, P = .006). Adolescent girls with PKU rated themselves more often as abnormal in the subscale Emotional Problems compared to their healthy peers (P = .041). This subscale was also responsible for a significantly different Total SDQ Difficulties Score between patients and their parents' report (P = .008). Discussion SDQ represents a suitable instrument within the care for patients with PKU. Specific aspects, however, require separate consideration and evaluation with respect to this chronic disease. Special attention should be paid on adolescent PKU girls who seem to be at risk to develop emotional problem.