The purpose of this paper was to examine how clients on the unit for adults at Södemalms district administration (Stockholm, Sweden) with severe mental illness and substance abuse differs from other clients with substance abuse at the baseline and at follow-up one year later. We have used a quantitative method and analyzed material from ASI-interviews performed at the adult drug abuse unit at Södermalm during the time period 2002-2010. At the baseline the clients with substance abuse and co-occurring severe mental illness have more problems than other clients, primarily in the area of mental health. They spend more time alone and are more likely to engage in illegal activities. Interviewers assess their situation as more serious and that they need more help in all of ASI's areas of life than other clients. Persons with severe mental illness have improved during the follow-up. However, the numbers of homeless people have increased and fewer have jobs. Meanwhile, more people have a regular income from the social security, their somatic status has improved, fewer hang out with people who have an active addiction, they engaged not so much in crime. Furthermore, the proportion of heavy use alcohol and narcotics has declined. Mental health improved significantly. The proportion meeting the threshold of severe mental disorder is reduced from 47% to 29%. The risk of suicide attempts in the last month reduced from 5% to 1%.

Personer som drabbats av depression återfaller/återinsjuknar ofta en eller flera gånger i livet. Forskning har visat att b la demografiska faktorer, residualsymtom och insomni är prediktorer för återfall. Syftet med studien var därför att undersöka betydelsen av demografiska faktorer, residualsymtom och insomni för nivån av depression 6-12 månader efter avslutad behandling på en psykiatrisk specialistmottagning. Urvalet var alla patienter som diagnosticerats med depression eller recidiverande depression och genomgått KBT-terapi under perioden 2008 – september 2013, och som hade uppföljningsdata vid sex eller tolv-månader, vilket sammanlagt var 111 patienter. Beroendevariabel var resultat på formuläret Patient Health Questionnaire (PHQ-9). Resultaten visade att patienter med residualsymtom inte försämrades signifikant mellan eftermätningen och uppföjningsmätningen, ett fynd som inte överensstämmer med forskning på området. Regressionsanalyser visade ingen signifikant påverkan av kön, ålder och utbildningsnivå på senare nivå av depression vid uppföljningsmätning. Däremot visade regressionsanalyser att sömnbesvär, mätt med formuläret Insomnia Severity Index (ISI), vid framför allt eftermätning hade ett samband med senare nivå av depression vid uppföljningsmätningen. Resultaten indikerade att kvarstående sömnbesvär då behandlingen avslutades predicerade senare nivå av depression. Slutsatsen är att ett tillägg av en sömnintervention för de patienter som har insomni då behandlingen avslutas kan minska sannolikheten för återfall i depression. Då många patienter saknade uppföljningsdata kunde inga säkra slutsatser dras.

The aim of this dissertation is to examine the implementation of the Addiction Severity Index (ASI) in social services and how it affects the encounter between the clients and their social workers. As structured interviews are unusual in social service based addiction care there is concern that they will have negative consequences on the relation between the social workers and their clients. The first study therefore investigates the clients’ acceptance of the ASI. The results show that 95 % of the clients accepted the ASI and that 85% viewed it in positive terms. Approximately 8% reported feeling violated by one question without this having any negative effect on the relation to the social workers or confidence in the social services. The results did not give empirical support for negative effects of the ASI. In the second study a comparison was made between a group that had participated in an assessment session using the ASI and a group with which the ASI had not been used. The results show that there is no difference in perception of “the alliance” or “negative experiences” with or without the ASI, but that the clients’ feeling of “own competence” is lower when the ASI is employed. The question of whether the reduced feeling of own competence among the clients is an expression of greater realism and reduced denial or only the negative effect of increased helplessness on the clients’ self-esteem can not be resolved in this study. In the third study, based on the same groups participating in the second study, the social workers were also asked to judge how the clients experienced such assessment sessions. The results show that the social workers’ assessment of the clients’ experiences differed from the clients’ own experiences regarding the “alliance” and “clients’ own feelings of competence”. However, the social workers made a correct assessment of the clients’ “negative experiences” of the sessions. The two different forms of session, with or without the ASI, did not influence the social workers’ assessment of the clients’ perceptions. The fourth study presents the results of a national questionnaire completed by 555 members of staff in social services, the prison service, and addiction services. The results show that supervisors and bosses take an increasingly greater responsibility for ASI training and that opportunities for using the ASI varied according to the place of work. Differences can probably be explained by different services being in different phases of implementation at the time of the study. The ASI has primarily been used in direct client work and only to a minor extent for follow-ups and evaluation. The number of ASI interviews carried out is small especially for those trained prior to 1999.

Hospitals stand to lose millions of dollars in revenue due to patients who leave without treatment (LWT). Grounded in queueing theory, the purpose of this correlational study was to examine the relationship between daily arrivals, daily staffing, triage time, emergency severity index (ESI), rooming time, door-to-provider time (DTPT), and LWT rates. The target population comprised patients who visited a Connecticut emergency room between October 1, 2017, and May 31, 2018. Archival records (N = 154) were analyzed using multiple linear regression analysis. The results of the multiple linear regression were statistically significant, with F(9,144) = 2902.49, p < .001, and R2 = 0.99, indicating 99% of the variation in LWT was accounted for by the predictor variables. ESI levels were the only variables making a significant contribution to the regression model. The implications for positive social change include the potential for patients to experience increased satisfaction due to the high quality of care and overall improvement in public health outcomes. Hospital leaders might use the information from this study to mitigate LWT rates and modify or manage staffing levels, time that patients must wait for triage, room placement, and DTPT to decrease the rate of LWT in the emergency room.

The purpose of this study was to understand how social workers experienced working with Addiction Severity Index (ASI) in relation to the goal set by the National Board of Health and Welfare. The method is spread nationwide and therefore it is of great importance to examine how the social workers themselves experience the demands and the resources surrounding ASI. We choose to do a qualitative study interviewing eight social workers at six different occasions. The result was analyzed using Max Weber’s ideal type bureaucracy and Michael Lipsky’s thesis on street-level bureaucrats. We found that the social workers consider the method useful when used from without their own purposes. The standards set by the National Board of Health and Welfare was considered hard to achieve because of the complexity of the method. Among other things the valuation done by both social worker and client was regarded as tough and therefore the results of the interview are at risk of not becoming reliable. We found that the outcome of the interview depends on the performer.

<p>The purpose of this study was to <em>understand</em> how social workers experienced working with Addiction Severity Index (ASI) in relation to the goal set by the National Board of Health and Welfare. The method is spread nationwide and therefore it is of great importance to examine how the social workers themselves experience the demands and the resources surrounding ASI. We choose to do a qualitative study interviewing eight social workers at six different occasions. The result was analyzed using Max Weber’s ideal type bureaucracy and Michael Lipsky’s thesis on street-level bureaucrats. We found that the social workers consider the method useful when used from without their own purposes. The standards set by the National Board of Health and Welfare was considered hard to achieve because of the complexity of the method. Among other things the valuation done by both social worker and client was regarded as tough and therefore the results of the interview are at risk of not becoming reliable. We found that the outcome of the interview depends on the performer.</p>

This thesis describes studies into the psychometric properties of a Swedish language version of the Adolescent Drug Abuse Diagnosis (ADAD) instrument. The psychometric properties of this instrument have been examined in two previous studies: an American study was conducted by the developers of the interview, Friedman and Utada (1989), and a Swiss study was undertaken by Bolognini et al. (2001). The American and the French (as used in the Swiss study) versions of ADAD exhibit good validity and reliability, in the form of both interrater reliability and the internal consistency of the composite scores. Study I evaluated the psychometric properties of the Swedish version of the ADAD interview in normal adolescents and adolescents with antisocial problems. It was found that the instrument has good interrater reliability, that the composite scores exhibit moderate internal consistency, and that the concept validity was acceptable and similar to that of the American and Swiss versions. The results also showed that the problem areas of ADAD produced meaningful correlations. The interviewer ratings, the adolescent’s ratings and the composite scores were compared and discussed. Some problems concerning the composite scores were discovered and will need to be analyzed in future studies. Study II investigated the utility and problems associated with the composite scores in the ADAD within and between normal adolescents and adolescents with antisocial problems. When comparing interviewer severity ratings and composite scores within the two groups, the composite scores were found to behave differently to the interviewer ratings. For normal adolescents, the composite scores are generally higher than the interviewer ratings, but for the adolescents with antisocial problems the reverse is true. The interviewer severity ratings seem to be the most appropriate outcome when the objective is to separate antisocial and normal groups of adolescents from each other. The difference between the two groups is smaller as measured by composite scores. The composite scores appear to function as viable indicators of current problems in all areas except for Medical and Alcohol problem area. The critical items within the Medical and Alcohol composite scores are explored and discussed.  Study III investigated the concurrent and predictive validity of the ADAD Psychological status and problem area. Concurrent validity was demonstrated by significant correlations between the ADAD, Youth Self Report (YSR) and Beck Depression Inventory (BDI) scores. The predictive validity of this problem area of the ADAD was tested by exploring its correlations with the YSR, BDI, and DICA problem ratings; moderate correlations were observed, suggesting that in clinical practice, the ADAD Psychological status and problem area may be a useful tool for the assessment and measurement of current psychological problems. The utility obtained by making decisions using the test is substantial. Overall, the results of these studies indicate that the Swedish version of ADAD appears to be a psychometrically good instrument for assessing the severity of adolescents’ problems and their need for treatment, but there are some problems with the Medical and Alcohol composite scores.

Orientador: José Raimundo de Souza Passos / Resumo: O setor de florestas plantadas no Brasil, e particularmente de eucaliptos, tem significativa participação na produção nacional representando 1,3% do PIB. O acirramento da competição entre as empresas de base florestal faz com que estas busquem por alternativas para minimizar o aumento dos custos produtivos aliadas ao aumento da produtividade de suas florestas plantadas. No entanto, um dos aspectos da garantia desta produtividade está relacionada à fitossanidade das florestas plantadas. Neste sentido, o objetivo deste trabalho é quantificar o efeito da ferrugem, causada por Austropuccinia psidii Winter na produtividade de povoamentos do Eucalyptus grandis utilizando uma abordagem de modelagem estatística. Inicialmente, foi proposto um novo Índice de Severidade da Ferrugem (ISF) com o objetivo de quantificar o efeito da doença no tempo, definido como a média ponderada entre as categorias de severidade com o inverso da idade das árvores. Ajustaram-se os modelos lineares generalizados com o objetivo de verificar o efeito dos fatores “fazenda” e “severidade” da doença (doente/sadia) no volume máximo amostral (m3). Foram também ajustados modelos de regressão linear generalizados para verificar o efeito do ISF no volume máximo amostral (m3) das árvores. As curvas de crescimento das árvores por região/fazenda foram ajustadas utilizando-se modelo de regressão não linear Gompertz. Após os ajustes, foram estimados os volumes das árvores aos 51, 60, 66 e 72 meses de idade para cada uma d... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The planted forest sector in Brazil, and particularly eucalyptus, has a significant participation in national production, representing 1.3% of Gross Domestic Product. The increased competition among forest-based companies makes them search for alternatives to minimize the increase in production costs combined with the increase in the productivity of their planted forests. However, one aspect of ensuring this productivity is related to the health of planted forests. In this sense, the aim of this paper is to measure the effect of rust disease, caused by Austropuccinia psidii Winter on the productivity of Eucalyptus grandis stands by the statistical modeling approach. Initially, a new Rust Severity Index (ISF) was proposed in order to quantify the effect of the disease over time, defined as the weighted average between the severity categories with (or and) the inverse of the age of the trees. The generalized linear models were adjusted in order to verify the effect of the factors "farm" and "severity" of the disease (sick / healthy) on the maximum sample volume (m3). Generalized linear regression models were also adjusted to verify the effect of the ISF on the maximum sample volume (m3) of the trees. The growth curves of the trees by region / farm were adapted using a non-linear Gompertz regression model. After the adjustments, the tree volumes at 51, 60, 66 and 72 months of age were estimated for each of the severity categories (sick / healthy). In this way, the percentage dif... (Complete abstract click electronic access below) / Doutor

One of the most influential disturbances for stream fish assemblages is large-scale declines in flow caused by periods of drought. Although stream characteristics are known to influence the response of stream fishes to drought, we asked if ecological traits of stream fishes determine, in part, their population level response to drought. To test for ecological trait-based responses to drought in a stream fish assemblage, we quantified species abundances over a period of 5 years that represented a wet to dry period. We sampled stream fishes in Yellow Creek, Wyoming, USA, a high elevation stream dependent on snow-storage for most of its flow. There were five regularly occurring species in the study site: redside shiner (Richardsonius balteatus), northern leatherside chub (Lepidomeda copei), mottled sculpin (Cottus bairdi), speckled dace (Rhinichthys osculus), and mountain sucker (Catostomus platyrhynchus). We used size class, species, and drought measures as predictors of abundance. Mean Palmer drought severity index over the growing season from the previous year (one year lag) provided the best predictor of stream fish abundances. Four of five species showed strong declines in abundance in response to drought conditions (mountain sucker abundance was not affected), but ecological traits of species were not good predictors of the magnitude of response to drought. Northern leatherside chub are most vulnerable to local extirpation during times of severe drought. Overall, juveniles showed a greater decline in abundance than adults in response to drought. Climate models predict that mountain streams will experience changes in flow regime, which may exacerbate effects of drought. Low flow refuge habitat may need to be incorporated into stream restoration designs to help increase recolonization in streams, especially for stream fishes that are most vulnerable to local extirpation and that have low recolonization rates.

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