Thesis (Ph.D.)--McMaster University, 2006. / Supervisor: Susan J. Elliott. Includes bibliographical references (leaves 166-171).

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

Syftet med föreliggande studie var att undersöka relationen mellannätverk, samverkan, ej fungerande samverkan och vårdtid förpatienter som vårdats på rättspsykiatriska kliniker i Sverige.Rättspsykiatriska vården syftar till rehabilitering och minskning avrisken för återfall i brott. Tidigare forskning har visat att nätverk ochsamverkan kan påverka vårdtidens längd. I analysen ingick 316patienter som registrerats mellan år 2014-2015 för rättspsykiatriskvård. Data från kvalitetsregistret RättspsyK genererade fyra variablerför studien att analysera; vårdtid, nätverk, samverkan och ejfungerande samverkan. Studiepopulationen delades in i grupper omkort och lång vårdtid. Vårdtiden baseras på medianvårdtiden pårättspsykiatrin. Fishers exakta test visade emellertid att resultatetsaknade statistisk signifikans och går inte i linje med tidigareforskning. Trots att sociala kontakter enligt tidigare forskning ärbetydelsefull för återhämtningsprocessen finns det anledning att fråndenna studies resultat anta att relationen mellan nätverk, samverkanoch vårdtid är mer komplext än vad studier tidigare visat. / The aim of the present study was to examine the relationship betweennetwork, cooperation, non-functioning cooperation and length of stayfor patients treated in forensic psychiatry in Sweden. Forensicpsychiatric care aims to rehabilitate and reduce the risk ofreoffending. Previous research has shown that network andcooperation can affect the length of care. The analysis included 316patients registered between 2014-2015 for forensic psychiatric care.Data from the quality registry RättspsyK generated four variables;length of care, network, cooperation and non-functioning cooperation.The study population was divided into short and long care time groupsbased on the median length of care in forensic psychiatry. Fisher'sexact test showed that the result lacked statistical significance and isnot in line with previous research. There is reason to assume from thisstudy's findings that the relationship between networks, cooperationand length of care is more complex than previous studies have shown.

Syftet med denna uppsats var att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelse av mötet med kunderna utifrån aspekterna kvalitet, tid och makt. Vi har genomfört en kvalitativ intervjustudie med sex personer som arbetar inom hemtjänstverksamheten. Studiens resultat har analyserats och tolkats utifrån teorierna socialkonstruktionism och roll­teori samt begreppet relationell makt. Resultaten visar att tiden är central i mötet mellan hem­tjänstpersonal och kunder då den inverkar på när och hur länge insatserna ska utföras. Lyhörd­het och att utgå från kundens behov och önskemål definieras som god omsorgskvalitet medan maktförhållandet växlar mellan hemtjänstpersonal och kund utifrån varje unikt om­sorgs­möte. För att få en ökad förståelse och kunskap för hemtjänstpersonalens upplevelser av mötet med kunderna behöver aspekterna kvalitet, tid och makt belysas och analyseras i en och samma kontext. Resultaten visar att de tre aspekterna samverkar i mötet och analysen med­verkar till att nå en djupare förståelse för hemtjänstpersonalens upplevelser. / The purpose of this study was to gain a deeper understanding and knowledge of home based care giver´s experiences of the encounter with clients from three perspectives: quality, time and power. We conducted a qualitative interview study with six people working in home based care. Our results have been analyzed and interpreted by the theories social construc­tionism and role theory and the concept of relational power. The results of the study demon­strate that time is central for the encounter between home care giver´s and clients affecting both when and how long the care should be performed. Responsiveness and putting the client´s needs in focus are defined as good quality of care, while the power relationship between home care givers and clients changes between each unique encounter. To get a deeper understanding and knowledge of home care givers experiences of the encounter with clients the three aspects: quality, time and power, needs to be highlighted and studied in the same context. The results demonstrate that the three aspects interact in the encounter and analyzing these together creates a deeper understanding of home care giver´s experience of the encounter.

<p>The Swedish and the Finnish compulsory care legislation that regards abusers differ in several ways. The arguments for compulsory care and for the time which one will receive compulsory care are dissimilar. The aim of this thesis is to describe and analyse which arguments for compulsory care and the length of the care time that has been expressed in the Swedish and the Finnish laws and in the statutes. The tools were an argumentation analysis, which is a form of qualitative text analysis method, combined with a hermeneutic scientific position. We have investigated the arguments that try to justify compulsory care and the care time that has been expressed in the laws and the statutes. The next step has been to analyse the text on the basis of an argumentation analysis and the theories. The theoretical starting point has been Michel Foucault's concept of power and discipline, the paternalistic and utilitarian values and four ethical perspectives. Important conclusions are that Sweden’s arguments for applying compulsory care are to inhibit, in particular the young abusers, from destroying their lives. The care time, on maximum 6 months, is justified with the arguments that motivation for continued voluntary treatment will be provoked. The arguments in Finland has focused on removing the abuser from the society during an acute stage of the abuse, where the abuser’s life or somebody else’s life in the abusers environment is in danger, this can take place for maximum 30 days. Our results have pointed out that Sweden has a more paternalistic view to the compulsory care of abusers than Finland.</p>

The Swedish and the Finnish compulsory care legislation that regards abusers differ in several ways. The arguments for compulsory care and for the time which one will receive compulsory care are dissimilar. The aim of this thesis is to describe and analyse which arguments for compulsory care and the length of the care time that has been expressed in the Swedish and the Finnish laws and in the statutes. The tools were an argumentation analysis, which is a form of qualitative text analysis method, combined with a hermeneutic scientific position. We have investigated the arguments that try to justify compulsory care and the care time that has been expressed in the laws and the statutes. The next step has been to analyse the text on the basis of an argumentation analysis and the theories. The theoretical starting point has been Michel Foucault's concept of power and discipline, the paternalistic and utilitarian values and four ethical perspectives. Important conclusions are that Sweden’s arguments for applying compulsory care are to inhibit, in particular the young abusers, from destroying their lives. The care time, on maximum 6 months, is justified with the arguments that motivation for continued voluntary treatment will be provoked. The arguments in Finland has focused on removing the abuser from the society during an acute stage of the abuse, where the abuser’s life or somebody else’s life in the abusers environment is in danger, this can take place for maximum 30 days. Our results have pointed out that Sweden has a more paternalistic view to the compulsory care of abusers than Finland.

Darbo tikslas – įvertinti terapinio profilio slaugytojų darbo laiko sąnaudų ryšį su pacientų savarankiškumu. Uždaviniai: 1. Išanalizuoti terapinio profilio slaugytojų darbo laiko sąnaudas pagal priežiūros kategorijas ir slaugytojo veiklų grupes. 2. Nustatyti terapinio profilio pacientų savarankiškumo lygmenį. 3. Išanalizuoti terapinio profilio slaugytojų darbo laiko sąnaudas, atsižvelgiant į pacientų savarankiškumo lygmenį. Tyrimo metodika. Tyrimas atliktas VšĮ Vilkaviškio ligoninės trijuose terapinio profilio skyriuose (vidaus ligų, neurologijos, slaugos ir palaikomojo gydymo). Tyrimo trukmė - 3,5 mėn. Naudotas tiesioginis laiko ir slaugytojo veiksmų stebėjimo metodas (angl. time-and-motion studies). Iš viso atlikta 72 stebėjimai, kurie sudarė 777,2 val. slaugytojų darbo laiko sąnaudų. Pacientų savarankiškumas vertintas anketa. Rezultatai: Terapinio profilio slaugytojų didžiausios darbo laiko sąnaudos dienos (46,6 proc.) ir nakties (28,3 proc.) pamainoje skirtos tiesioginei pacientų priežiūrai. Mažiausia dalis slaugytojų darbo laiko praleista netiesioginei pacientų priežiūrai. Terapinio profilio skyriuose didžioji dalis pacientų (40,1 proc.) buvo savarankiški, 22,3 priklausomi ir 16 proc. - visiškai priklausomi. Slaugytojai per dvi darbo pamainas (dienos ir nakties), pusę savo darbo laiko skyrė visiškai priklausomiems pacientams slaugyti ir prižiūrėti, ketvirtadalį laiko - priklausomiems pacientams ir mažiausiai, t.y. 14 proc. - savarankiškiems pacientams. Išvados: 1... [toliau žr. visą tekstą] / Purpose – to evaluate the relationship between time spent caring a patient by nurses on a medical unit and the patients‘ levels of independence. Objectives: 1. Analyze time spent caring for a patient by nurses on a medical unit according to care categories and nurses activity groups. 2. Determine patients‘ independence levels on a medical unit. 3. Analyze time spent caring for patients according to independence levels by nurses on a medical unit. Methods. The study was completed at Vilkaviškis Hospital, in three medical units (internal medicine, neurology and nursing and hospice care) The length of the study was 3.5 months. Data was gathered through time and motion observation. Seventy-two observations yielded 777.2 hours of observed nursing time. Patient independence was evaluated using a questionnaire. Results: On medical units, the majority of nursing time during the day (46,6%) and night (28,3%) shifts is dedicated to direct patient care. The least amount of nursing time is spent in indirect patient care. On the medical units, a large number of patients (40,1%) were independent, 22,3% needed partial care and 16%. required total care. Nurses during two shifts (day and night) spent half their time providing total care to patients, a quarter of their time providing partial care and the least amount of time, i.e., 14%, providing care to independent patients. Conclusions: 1. Almost half of the nursing shift is spent in direct patient care; much time was spent administering... [to full text]

Puisque de plus en plus d’enfants sont exposés à la séparation de leurs parents, plusieurs d’entre eux doivent partager leur temps entre les logements et la supervision de leur mère et leur père. Qu’on nomme cette réalité « garde », « résidence » ou « temps parental », elle complique grandement la description et la mesure des structures familiales dans lesquelles évoluent les enfants. Dans ce contexte, la thèse comporte deux objectifs principaux. Le premier consiste à préciser l’évolution historique des différents concepts légaux et sociologiques en jeu et à montrer comment le flou terminologique entourant la garde entraîne des problèmes lors de la mesure des arrangements résidentiels des enfants. Pour exposer la problématique, je tente de déterminer la prévalence de la double résidence égalitaire en faisant une évaluation critique des sources de données disponibles au Québec et au Canada. En fin de compte, en raison des lacunes de ces diverses sources et de leurs résultats parfois divergents, il s’avère pratiquement impossible de répondre à la question : « Combien d’enfants vivent en garde partagée (ou en double résidence) ? ». Le second objectif, qui occupe la majeure partie de la thèse, vise à illustrer le caractère dynamique des arrangements de temps parental, un aspect souvent ignoré dans la littérature scientifique. À partir des données des treize premiers passages de l’Étude longitudinale du développement des enfants du Québec (ÉLDEQ) (n=2120), je distingue quatre arrangements de temps parental postséparation : 1) la résidence maternelle (avec peu ou pas de contacts père-enfant) ; 2) la résidence maternelle (avec contacts père-enfant réguliers) ; 3) la double résidence ; 4) la résidence paternelle. En ordonnant les informations disponibles à différents points dans le temps pour un même enfant, j’ai pu reconstituer des trajectoires de temps parental complètes. Les analyses réalisées sur ces trajectoires sont rapportées dans deux articles. Je m’intéresse, dans le premier article, aux caractéristiques familiales liées à l’établissement d’un arrangement donné au moment de la séparation ainsi qu’à la durée de cet arrangement. J’y montre par exemple que la part du temps parental assumée par le père au moment de la séparation est positivement associée au niveau de scolarité des parents, au travail à temps plein des mères et au sentiment de plaisir parental des pères. On y constate aussi que les arrangements initiaux ne sont pas tous aussi durables les uns que les autres. Même si les facteurs associés à cette durée sont plus difficiles à discerner, le niveau de scolarité des parents semble être important dans le processus. Dans le second article, je construis des tables de survie multiétats afin de résumer les trajectoires de temps parental de la perspective d’un enfant « moyen ». Je cherche entre autres à déterminer combien de temps les enfants passent dans chacun des quatre arrangements définis plus tôt et à identifier les facteurs sociodémographiques associés à cette répartition. J’y conclus que le temps passé en double résidence par un enfant moyen est faible, mais qu’il augmente avec le niveau de scolarité des deux parents. La double résidence est cependant une composante centrale de la paternité postrupture. Malgré une grande fluidité dans les trajectoires de temps parental, l’arrangement établi au moment de la séparation demeure un bon prédicteur de l’expérience parentale ultérieure. Les enfants initialement en double résidence, par exemple, perdent rarement contact avec leur père au cours des cinq années qui suivent la séparation, et ce, même si plusieurs d’entre eux finiront par habiter principalement avec leur mère. / As more children are exposed to the separation of their parents, many of them have to share their time between the homes and the supervision of their mother and father. Whether this reality is referred to as “custody”, “residence” or “parenting time”, it greatly complicates the description and measurement of the family structures in which children evolve. In this context, the thesis has two main objectives. The first is to clarify the historical evolution of the various legal and sociological concepts involved and to show how the terminological confusion surrounding child custody raises problems when trying to measure children’s living arrangements. In particular, I try to determine the prevalence of egalitarian dual residence by critically assessing the various data sources available in Quebec and Canada. In the end, because of the shortcomings of these various sources and their sometimes divergent results, it is virtually impossible to answer the question: “How many children live in shared physical custody (or dual residence) ?” The second objective, which comprises most of the thesis, aims to illustrate the dynamic nature of parenting-time arrangements, an element often overlooked in the scientific literature. With data from the first thirteen waves of the Quebec Longitudinal Study of Child Development (QLSCD) (n = 2120), I distinguish four postseparation parenting-time arrangements: 1) mother residence (with little or no father-child contact); 2) mother residence (with regular father-child contact); 3) dual residence; 4) father residence. By ordering the information available at different time points for each child, I was able to reconstruct complete parenting-time trajectories. The analyzes carried out on these trajectories are reported in two articles. In the first article, I look at family characteristics related to the establishment of specific arrangements at separation and at the duration of this arrangement. For instance, I show that the share of parenting time assumed by fathers following separation is positively associated with parents’ education level, mothers’ full-time employment and father’s feeling of parental enjoyment. The article also shows that initial arrangements are not all as durable as each other. Although the factors associated with this duration are difficult to identify, the parents’ level of education appears to be play an important role. In the last article, I build multistate life tables in order to summarize parenting-time trajectories from the perspective of an average child. I try to determine, inter alia, how much time children spend in each of the four arrangements defined earlier and what sociodemographic factors are associated with this distribution of time. I show that time spent in dual residence by an average child is low, but that it increases with the education level of both parents. Dual residence is, however, a central component of postseparation fatherhood. Despite great fluidity in parenting-time trajectories, arrangements established at separation remain good predictors of the subsequent parenting experience. Children initially in dual residence, for instance, seldom lose contact with their father during the first five years following separation even if many of them eventually end up living mainly with their mother.

Introduction: The quality of neonatal care is mainly determined by long-term neurodevelopmental outcome. The neurodevelopment of preterm infants is related to postnatal head growth and depends on medical interventions such as nutritional support. Head circumference (HC) is currently used as a two-dimensional measure of head growth. Since head deformities are frequently found in preterm infants, HC may not always adequately reflect head growth. Laser aided head shape digitizers offer semiautomatic acquisition of HC and cranial volume (CrV) and could thus be useful in describing head size more precisely. Aims: 1) To evaluate reproducibility of a 3D digital capture system in newborns. 2) To compare manual and digital HC measurements in a neonatal cohort. 3) To determine correlation of HC and CrV and predictive value of HC. Methods: Within a twelve-month period data of head scans with a laser shape digitizer were analysed. Repeated measures were used for method evaluation. Manually and digitally acquired HC was compared. Regression analysis of HC and CrV was performed. Results: Interobserver reliability was excellent for HC (bias-0.005%, 95% Limits of Agreement (LoA) −0.39–0.39%) and CrV (bias1.5%, 95%LoA-0.8–3.6%). Method comparison data was acquired from 282 infants. It revealed interchangeability of the methods (bias-0.45%; 95%LoA-4.55–3.65%) and no significant systematic or proportional differences. HC and CrV correlated (r2 = 0.859, p<0.001), performance of HC predicting CrV was poor (RSD ±24 ml). Correlation was worse in infants with lower postmenstrual age (r2 = 0.745) compared to older infants (r2 = 0.843). Discussion: The current practice of measuring HC for describing head growth in preterm infants could be misleading since it does not represent a 3D approach. CrV can vary substantially in infants of equal HC. The 3D laser scanner represents a new and promising method to provide reproducible data of CrV and HC. Since it does not provide data on cerebral structures, additional imaging is required.

Hintergrund: Der Einfluss von rheumatoider Arthritis auf Psyche, Lebensqualität und Alltag der Patienten ist groß. Für eine positive Langzeitprognose sind frühzeitige Diagnosestellung und Therapieeinleitung entscheidend. Diese werden maßgeblich von den strukturellen Gegebenheiten der ambulanten rheumatologischen Versorgung beeinflusst. Hier zeigen sich trotz großer Fortschritte in den letzten Jahren weiterhin Defizite. Anhand einer Patientenbefragung in Leipzig sowie ländlichen Gebieten Sachsens sollen regionale Unterschiede und eventuelle Mängel in der ambulanten Versorgung sowie deren Einfluss auf die Lebensqualität, psychische Gesundheit und Entscheidungsfindungsprozesse untersucht werden. Methoden: Aus sechs Praxen in der Stadt Leipzig und drei Praxen in Kleinstädten (Naunhof, Plauen und Hoyerswerda) wurden Patienten mit der Erstdiagnose rheumatoide Arthritis im ersten Quartal 2011 mittels Fragebögen zu psychischer Gesundheit (Hospital Anxiety and Depression Scale und Short-Form-36-Health-Survey) sowie Entscheidungsfindungsprozessen (Decision Making Preference Scale) befragt. Ein eigens entwickelter Fragebogen erhob Beschwerde- und Behandlungsdauer sowie allgemeine medizinische Daten und Medikation. Ergebnisse: 19 Land- und 38 Stadtpatienten wurden eingeschlossen. Landpatienten suchten signifikant später den Hausarzt auf (Land 15, Stadt 12 Monate, p= .023). Die hausärztliche Behandlungsdauer bis zur Überweisung zum Rheumatologen betrug auf dem Land 5,4 und in der Stadt 2,4 Monate. Bei 70% der Stadt- und 40% der Landpatienten erfolgte die Überweisung innerhalb der ersten sechs Wochen. Die Gesamtdauer von Beschwerdebeginn bis zur Überweisung zum Rheumatologen war mit 20 Monaten auf dem Land signifikant länger als in der Stadt (15 Monate, p= .043). Die Wahl der Medikation durch den Rheumatologen hing signifikant mit der Herkunft der Patienten zusammen (p= .006). Nach Erstkontakt erhielten 65% der Land- und 55% der Stadtpatienten ein DMARD. In beiden Regionen wurde überwiegend mit Glukokortikoiden behandelt (Stadt 82%, Land 71%). Auf dem Land zeigten die Patienten weniger Interesse an Mitwirkung im partizipativen Entscheidungsfindungsprozess und waren mehrheitlich bereit, sich der Meinung des Arztes auch gegen den eigenen Willen anzuschließen. In der Stadt war der Wunsch nach aktiver Teilhabe an medizinischen Entscheidungen bei jüngeren und höher gebildeten Patienten signifikant größer als bei älteren oder bildungsfernen Erkrankten. Mit 21% wiesen tendenziell mehr Landpatienten depressive Symptome auf als in der Stadt (14%). Auf dem Land bestand häufiger der Verdacht auf krankheitsassoziierte Angststörungen. Zusätzlich litten die Patienten hier signifikant stärker unter ihren Schmerzen als in der Stadt (p= .026), wobei sich kein grundsätzlicher Unterschied in der gesundheitsbezogenen Lebensqualität ergab. Schlussfolgerung: In Stadt und Land zeigen sich Defizite in der ambulanten rheumatologischen Versorgung, wobei der Grad der Unterversorgung mit der Herkunft assoziiert ist und Landpatienten signifikant länger bis zum ersten Rheumatologenkontakt brauchen. Maßgeblich verantwortlich hierfür ist die verspätete Vorstellung der Patienten beim Hausarzt ebenso wie die ungleiche Facharztverteilung in Stadt und Land. Patienten auf dem Land sind tendenziell depressiver, passiver und schmerzgeplagter, wobei sich keine grundsätzlichen Unterschiede in der gesundheitsbezogenen Lebensqualität ergeben. Die Ergebnisse spiegeln Ärztemangel und infrastrukturelle Probleme wider. Weiterer Schulungs- und Aufklärungsbedarf zur verstärkten Bildung eines öffentlichen Bewusstseins für die Erkrankung rheumatoide Arthritis wird ebenso deutlich wie die Notwendigkeit für die Bahnung schnellerer Zugangswege zu rheumatologischer Behandlung.