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Hintergrund: Psychische Auffälligkeiten beginnen häufig im Kindesalter und können in psychische Störungen münden. Vorhandene Präventionsangebote werden trotz Wirksamkeit nur spärlich in Anspruch genommen. Ziel war zu prüfen, inwiefern durch die Etablierung einer Versorgungskette Risikokinder frühzeitig identifiziert und Präventionsmaßnahmen zugewiesen werden können, sowie inwieweit indikative Präventionsprogramme schlussendlich in Anspruch genommen werden. - Methoden: In einer prospektiven Implementationsstudie wurde während der regulären U9- bis U11-Gesundheitsuntersuchungen (Altersbereich: 5–10 Jahre) der „Strengths and Difficulties Questionnaire“ als Screeninginstrument an Familien ausgegeben. Diese erhielten von ihren Kinderärzt*innen unmittelbar eine Ergebnisrückmeldung und im Falle von grenzwertig auffälligen emotionalen oder Verhaltensproblemen eine Empfehlung für ein indikatives Präventionsprogramm. Vor Programmteilnahme fand im Vorgespräch eine Indikationsprüfung statt. - Ergebnisse: Im Raum Dresden beteiligten sich n = 46 (38,7 %) Kinderärzt*innen am Projekt. In n = 28 Kinderarztpraxen nahmen n = 3231 (86,4 %) Familien am Screening teil, n = 864 (26,7 %) Kinder, deren Familien eine Ergebnisrückmeldung erhielten, bekamen eine Präventionsempfehlung. Zur Präventionsprogrammteilnahme meldeten sich n = 118/864 (13,7 %) Familien selbstständig. n = 215/624 (35,5 %) zeigten Interesse nach projektinitiierter Kontaktaufnahme. Über andere Zugangswege kamen n = 139 Teilnahmeanfragen. n = 337 (n = 461; über alle Zugangswege) Vorgespräche wurden geführt. Schließlich nahmen n = 237 (n = 337) Kinder ein indikatives Präventionsprogramm in Anspruch. - Schlussfolgerung: Eine Ausweitung der Vorsorgeuntersuchung auf psychische Auffälligkeiten ist umsetzbar, nützlich und erfährt breite Akzeptanz. Um eine Versorgungskette einzurichten, sollte eine Angebotsstruktur etabliert werden, um damit die Zuweisung zu und Inanspruchnahme von Präventionsmaßnahmen zu ermöglichen. / Background: Mental health problems usually have their onset in childhood. Undiagnosed, they may progress into mental disorders. Despite their effectiveness, existing preventive programs have been rarely used. We aimed to examine to what extent the establishment of a care chain can identify children at high risk at an early stage and assign them to preventive interventions. In addition, prevention program participation was assessed. - Methods: In a prospective implementation study, the Strengths and Difficulties Questionnaire was administered as a screening instrument to families during regular pediatric health examinations (U9–U11, child age 5–10 years). Families received feedback directly from the pediatrician, and in the case of borderline abnormal emotional or behavioral problems, a recommendation for an indicative prevention program. Program indication was additionally determined in an entry examination prior to program participation. - Results: In the area of Dresden (Germany), n = 46 (38.7%) pediatricians participated in the project. In n = 28 pediatric practices, n = 3231 (86.4%) families participated in the screening and n = 864 (26.7%) children received a prevention recommendation. Of the families, n = 118/864 (13.7%) self-registered for the prevention programs, n = 215/624 (35.5%) showed interest after being contacted by the study teamn. Through other pathways, n = 139 families requested participation. Clinical evaluation interviews to assess prevention indication were conducted in n = 337 children (n = 461; via all entry pathways). Finally, n = 237 (n = 337) children participated in an indicated prevention program. - Conclusion: Expanding screening to mental health problems during regular health checkups is feasible, useful, and widely accepted. In order to implement a care chain, a supply structure should be established to enable referral to and uptake of preventive interventions.

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of schoolchildren’s health and to analyse factors influencing the recording of school-children’s health in the School Health Record (SHR). An additional aim is to evaluate fam-ily 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 quantita-tive 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 ad-olescence 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 separate-ly. Qualitative content analyses were used to analyze the interview text with the school nurs-es 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 dete-riorated, 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 environ-ment and family relations. The latter seemed to be the most important factor affecting school-children’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 im-proper 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 ex-perienced 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 sup-ported 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 schoolchil-dren’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 de-mand 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.

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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.

Endometriosis is defined as the presence of endometrial cells outside the uterine cavity. The underlying symptom is pain, endometriosis is often associated with primary or secondary sterility, and it is assumed to be involved in the development of female dyspareunia and algopareunia. There are many theories regarding the cause of the disease, however, none of them affects the complex state of the disease which occurs in the population according to statistics in 10-15 % of women. In women with a diagnosis of sterility and infertility, the incidence of endometriosis is described in more than 40 %. Also, more than 50 % of women describe the most diverse forms of dyspareunia and algopareunia that affect not only women's own lives but also their relationships. The illness thus becomes important not only from a purely medical point of view but also from a psychosocial point of view. It should be noted that there is currently no known specific laboratory marker to diagnose endometriosis. Likewise, there is no unambiguous solution within the therapy, whether it is conservative, surgical, or combined. An important fact is that endometriosis is diagnosed with a considerable delay, according to statistics; it takes up to 11 years from the discovery of the first, often indefinite symptoms, to the unequivocal...

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Self-concept, discussed as a scholarly topic since the time of Socrates and Plato, is an important theoretical construct in education because self-concept is considered to be a desirable trait and a facilitator of positive future behavior. The purpose of this study was to examine the relationship between the characteristics of students enrolled in career and technical education (CTE) programs and students' self-concept scores as measured by specific subscales from the Self-Description Questionnaire (SDQ). A total of 196 male and 89 female secondary students (Grades 9-12) enrolled in arts, audio/video technology and communications cluster courses in North Central Texas school districts participated in the study. Student characteristic variables of interest were age, gender, CTE program enrollment, and participation in CTE. The self-concept subscales analyzed were General, Academic, Verbal, Math, and Problem Solving. A canonical correlation analysis was conducted using the four student characteristic variables as predictors of the five self-concept variables to evaluate the multivariate shared relationship between the two variable sets. The full model across all functions explained about 23% of the variance between the variable sets. Function 1 explained 15% of the shared variance and Function 2 explained 7% of the variance that remained. This study detected a relationship between specific student characteristics and self-concept as measured on certain domain-specific first-order factors. Gender and participation in CTE were found to be related to verbal self-concept and problem-solving self-concept. Results suggest that females in arts-based CTE programs have a higher verbal self-concept than their male counterparts; male students have a higher problem-solving self-concept. Results further suggest that students with a high level of participation in CTE also have high verbal and problem-solving self-concepts.

The present thesis sought to compare participation in social types of play of children with and without hyperactivity in a Swedish preschool context. Based upon observational design of cross-sectional type, this study was built on a secondary analysis of data collected within two previous research projects that were merged into one dataset. A total of 583 children (n = 298 boys) aged 16 to 72 months (M = 52.55, SD = 11.01) were initially included in the sample. Preschool teachers rated children’s behavior difficulties on a hyperactivity scale using Strengths and Difficulties Questionnaire (SDQ). Structured observations of children’s attendance, engagement, verbal interaction, proximity and location during associative and cooperative interaction were conducted across day-long visits by three trained researchers using Children Observation in Pre- school (COP) tool. Conditional probability looping syntaxes were created and Independent sample t-Tests were used to analyze the data. Out of 572 children included in the analysis, n = 60 (10,2%) were rated as having some form of hyperactivity. On the whole, the findings illustrated that the observed averages of attendance and overall engagement in social types of play did not differ significantly between children with and without hyperactivity. However, an in-depth analysis of participation patterns, linked to contextual and environmental factors such as proximity and play location, revealed several considerable differences between the two groups of children. It seems that preschoolers with hyperactive behavior seek social play opportunities as much as their typical behavior peers, but the quality aspects of their experience defined by a specific context and environment may differ further as the interaction develops. Contextual and environmental factors are crucial determinants to take into account when studying participation. Play, operating as a natural booster of self-regulation and engagement may have the potential to serve as a mediating factor accommodating hyperactivity and promoting participation in Early Childhood Education settings.