Attendance at Neonatal Follow-up (NFU) programs is crucial for parents to gain access to timely diagnostic expertise, psychosocial support, and referral to needed services for their infants. Although NFU programs are considered beneficial, up to 50% of parents do not attend these programs with their infants. Non-attending infants have poorer outcomes (e.g., higher rates of disabilities and less access to required services) as compared to attenders. The purpose was to determine factors that predicted attendance at NFU. Naturally occurring attendance was monitored and maternal-infant factors including predisposing, enabling, and needs factors were investigated, guided by the Socio-Behavioral Model of Health Services Use. A prospective two-phase multi-site descriptive cohort study was conducted in 3 Canadian Neonatal Intensive Care Units that refer to 2 NFU programs. In Phase 1, standardized questionnaires were completed by 357 mothers (66% response rate) prior to their infant’s (N= 400 infants) NICU discharge. In Phase 2, attendance patterns at NFU were followed for 12 months. Higher maternal stress at the time of the infant’s NICU hospitalization was predictive of attendance at NFU. Parenting alone, more worry about maternal alcohol or drug use, and greater distance to NFU were predictive of non-attendance at NFU. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months. Two distinct attendance patterns emerged: no or minimal attendance (18.5%) and attendance at all or the majority of scheduled appointments (81.5%). The most frequent point of withdrawal from NFU occurred between NICU discharge and the first scheduled appointment; followed by drop-out following the first NFU appointment. These results provide new insight into patterns of attendance and the maternal-infant factors that characterize attenders/non-attenders at NFU and serve as the critical first step in developing interventions targeted at improving attendance, infant outcomes, and reporting of developmental sequelae.

Miljöcertifieringssystemen PEFC och FSC ställer krav på uppföljning och revision för att säkerställa att kraven och kvalitén uppnås. Studiens syfte var att belysa de skogliga maskinentreprenörerna och förvaltarnas/virkesinköparnas erfarenheter av arbete med uppföljning inom miljöcertifierat skogsbruk. Materialet insamlades genom telefonintervjuer och analyserades med kvalitativ innehållsanalys, vilket ledde fram till resultatet. Uppföljningen och traktdirektivet har en viktig roll för att nå miljöcertifieringarnas krav. Dialog och delaktighet mellan de olika yrkesgrupperna var viktig, enligt respondenterna, för att miljöcertifieringen ska nå en hög kvalité och för att skapa engagemang och vilja att förbättra arbetet. / The environmental certification systems PEFC and FSC require follow-up and auditing to ensure that the requirements are followed and that quality is achieved. The purpose of this study was to illuminate the experience of machine entrepreneurs, forestry managers and timber buyers of work with evaluation of environmental certified forestry. Data was gathered through telephone interviews and was analysed using qualitative content analysis. Evaluation and contract directives have an important role in achieving environmental certification requirements. Dialogue and co-operation between the different groups is important, according to respondents, for environmental certifications to achieve high quality and to create commitment and desire to improve the work.

Este estudio presenta los resultados de una investigación llevada a cabo en un contexto escolar con adolescentes que cumplían criterios diagnósticos para el subtipo generalizado de fobia social (FSG en adelante) (DSM-IV-TR; APA, 2000). La muestra estuvo compuesta por 78 adolescentes con una edad media de 15.27 Años (DT=0.92; Rango: 14-18 años). Los sujetos fueron clasificados y asignados a tres condiciones experimentales de tratamiento en función de una nueva propuesta de subdivisión y operacionalización de la FSG: levemente, moderadamente y gravemente generalizada. Las tres condiciones experimentales recibieron el paquete multicomponente denominado "Intervención en Adolescentes con Fobia Social". Los resultados mostraron la eficacia del tratamiento tanto a corto como a largo plazo (12 meses) en las tres condiciones experimentales. Respecto a las comparaciones intergrupo, no se hallaron diferencias entre los tres grupos ni en las pruebas de significación estadística ni en las de significación clínica (dejar de cumplir criterios diagnósticos de fobia social). Sin embargo, los valores de los tamaños del efecto indicaron una relación directamente proporcional entre eficacia del tratamiento y gravedad del subtipo: FSGG>FSMG>FSLG. En resumen, los datos obtenidos avalan la significación estadística y clínica de esta intervención en la fobia social adolescente, independientemente de la gravedad supuesta a cada subgrupo del subtipo generalizado de fobia social. / This study displays the results of a research in a school-based setting with adolescents who fulfilled diagnostic criteria for the generalized subtype of social phobia (GSP) (DSM-IV-TR; APA, 2000). The sample consisted of 78 adolescents with a mean age of 15.27 years (SD=0.92; Age range: 14-18 years). Participants were classified and assigned to three experimental conditions of treatment based on a new proposal of subdivision and operacionalization of GSP: mild, moderate, and severe. The three experimental conditions received a multicomponent package labelled "Intervention in Adolescents with Social Phobia". Results showed the effectiveness of this intervention as well in short as in long-term follow-ups (12 months) in the three experimental groups. Regarding the intergroup comparisons, there were not differences among the three conditions either in the statistical significance tests or in the clinic one (not fulfilling the diagnostic criteria for social phobia). However, the values of the effect sizes indicated a directly proportional relationship between effectiveness of our treatment and severity of the subtypes: FSGG> FSMG> FSLG. In summary, the collected data supports the effectiveness of "IAFS", independently of the severity supposed to each subtype of GSP.

La perte au suivi diminue grandement l’efficacité des interventions de prévention de la transmission mère-enfant du VIH en Afrique subsaharienne. Devrait-on donc choisir des traitements courts ou longs de pTME? Nous avons mené une revue systématique des études sur l’efficacité de traitements avec et sans composante anténatale et évalué l’impact de la perte au suivi sur leur efficacité. Nous avons trouvé qu’après ajustement pour la perte au suivi, les traitements avec composante anténatale ont encore une efficacité plus élevée à prévenir la TME. Les intervenants ne devraient pas craindre l’utilisation de traitements plus longs auprès de populations à risque de perte au suivi. Plus d’études sont nécessaires pour déterminer comment les interventions peuvent être adaptées au virage dans la pTME. / Loss to follow-up greatly decreases efficiency of MTCT interventions in sub-Saharan Africa. Should we therefore choose shorter pMTCT treatments over longer ones? We conducted a systematic review of studies on the efficiency of pMTCT treatments with or without an antenatal component. We found that after adjustment, treatments with an antenatal component still had a higher efficiency at decreasing MTCT despite loss to follow-up. Healthcare providers shouldn’t fear using longer treatments amongst populations at high risk of loss to follow-up. More studies are needed to determine how current interventions can be better adapted to the turnaround in pMTCT interventions.

Suite aux notifications de cas de comportements suicidaires associés aux antidépresseurs (ADs) chez les jeunes, une mise en garde réglementaire a été émise en mai 2004 au Canada, et deux guides de pratique clinique ont été publiés dans la littérature en novembre 2007. L'objectif de ce mémoire fut d'évaluer l’association entre ces interventions de communication et le suivi médical de la population pédiatrique traitée par ADs au Québec. Une étude de cohorte rétrospective (1998-2008) a été menée chez 4 576 enfants (10-14 ans) et 12 419 adolescents (15-19 ans) membres du régime public d’assurance médicaments du Québec, ayant débuté un traitement par AD. Le suivi médical dans les trois premiers mois de traitement a été mesuré par l’occurrence et la fréquence de visites médicales retrouvées dans les banques de données de la RAMQ. Les facteurs associés à un suivi conforme aux recommandations ont été évalués à partir de modèles de régression logistique multivariés. Seuls 20% des enfants ou adolescents ont eu au moins une visite de suivi à chaque mois, en conformité avec les recommandations. La probabilité de recevoir un suivi médical conforme était plus élevée lorsque le prescripteur initial était un psychiatre. L’occurrence et la fréquence des visites n’ont pas changé après la publication de la mise en garde ou des recommandations. De ce mémoire on conclut que d'autres interventions visant à optimiser le suivi médical devraient être envisagées. / Following reports of a potential association between antidepressants (ADs) and suicidal behaviour in youth, a regulatory warning was issued in Canada in May 2004, and clinical practice guidelines on recommended medical follow-up were published in the literature in November 2007. This Master's thesis aimed at assessing the association between these communication interventions and medical follow-up practices. A retrospective cohort study (1998-2008) was conducted among 4,576 children (10-14 years) and 12,419 adolescents (15-19 years) members of the Quebec public drug plan. Medical follow-up was ascertained through patterns of physician billing practices found in the RAMQ medical services databases. Study outcomes consisted of occurrence and frequency of visits in the first three months of AD treatment. Factors associated with follow-up consistent with recommendations were identified through multivariate logistic regression models. The main independent variable was exposure to each of the communication interventions. Covariates included: gender, class of AD, number of concomitant chronic diseases, psychiatric conditions, prescriber’s specialty, and potential exposure to each intervention. Only 20% of children or adolescents received at least one visit each month. The probability of receiving adequate follow-up was greater when treatment was initiated by a psychiatrist. Occurrence and frequency of visits did not change after the warning nor the publication of the recommendations. From this thesis, one may conclude that further interventions to optimize medical follow-up practices should be envisaged.

The recent performance of Cape Gate Sharon does not measure up to expectations. This is, to a significant extent, due to the fact that there is no effective measurement and follow-up of performance. The implementation of an effective KPI- based, performance evaluation system, within a balanced scorecard structure, should lead to material performance enhancement in Cape Gate Sharon. This, however, requires significant investment in both capital, as well as management involvement. As a pilot study, it is therefore beneficial to focus initially on the before-and-after-effects of the implementation of the KPI-based performance management within Cape Gate Sharon Wire Mills division. The primary objective of this research is to determine the effectiveness of Key Performance Indicators in the product factories of Cape Gate. The specific supportive objectives of this research are the following. • To determine if effective KPI’s are measured • To determine if the implementation of KPI’s have been done successfully • To determine what the effect of specific KPI measurement in Cape Gate is. The literature study identifies what performance measurement and management is, as well as an in-depth study into key performance indicators. A simple, logical and repeatable closed loop model within a framework is suggested for the implementation of a KPI system. For the purpose of this mini-dissertation, the research is carried out through a process of a document analysis and a data analysis. Available reports are used to determine the current performance measurement system, to determine if effective KPI’s were chosen and to determine if the implementation was done successfully. Descriptive statistics were then used to analyse actual production data in order to determine the effect that KPI’s have on production. The results of each supporting objective were used to determine the effectiveness of key performance indicators in the product factories of Cape Gate. It is concluded that an effective set of KPI’s were chosen for Cape Gate product factories, with the exception of absenteeism. The closed-loop model was implemented successfully and all the required steps were taken. The effect of KPI’s was apparent on production, utilisation and downtimes. There is insufficient evidence that an improvement was made on absenteeism and the scrap percentage. This can be contributed to infrequent and delayed measurement of the two KPI’s, and the fact that absenteeism is not part of level 2 of the KPI framework. / Thesis (M.B.A.)--North-West University, Vaal Triangle Campus, 2010.

The recent performance of Cape Gate Sharon does not measure up to expectations. This is, to a significant extent, due to the fact that there is no effective measurement and follow-up of performance. The implementation of an effective KPI- based, performance evaluation system, within a balanced scorecard structure, should lead to material performance enhancement in Cape Gate Sharon. This, however, requires significant investment in both capital, as well as management involvement. As a pilot study, it is therefore beneficial to focus initially on the before-and-after-effects of the implementation of the KPI-based performance management within Cape Gate Sharon Wire Mills division. The primary objective of this research is to determine the effectiveness of Key Performance Indicators in the product factories of Cape Gate. The specific supportive objectives of this research are the following. • To determine if effective KPI’s are measured • To determine if the implementation of KPI’s have been done successfully • To determine what the effect of specific KPI measurement in Cape Gate is. The literature study identifies what performance measurement and management is, as well as an in-depth study into key performance indicators. A simple, logical and repeatable closed loop model within a framework is suggested for the implementation of a KPI system. For the purpose of this mini-dissertation, the research is carried out through a process of a document analysis and a data analysis. Available reports are used to determine the current performance measurement system, to determine if effective KPI’s were chosen and to determine if the implementation was done successfully. Descriptive statistics were then used to analyse actual production data in order to determine the effect that KPI’s have on production. The results of each supporting objective were used to determine the effectiveness of key performance indicators in the product factories of Cape Gate. It is concluded that an effective set of KPI’s were chosen for Cape Gate product factories, with the exception of absenteeism. The closed-loop model was implemented successfully and all the required steps were taken. The effect of KPI’s was apparent on production, utilisation and downtimes. There is insufficient evidence that an improvement was made on absenteeism and the scrap percentage. This can be contributed to infrequent and delayed measurement of the two KPI’s, and the fact that absenteeism is not part of level 2 of the KPI framework. / Thesis (M.B.A.)--North-West University, Vaal Triangle Campus, 2010.

Objective: To determine whether continuity of care (COC) reduces emergency department (ED) visits and/or readmission in adolescents with psychiatric disorders. Methods: A retrospective cohort of adolescents discharged with psychiatric disorder between April 1, 2002 and March 1, 2004 was identified using hospital administrative databases. Good COC was defined as at least one aftercare contact in 30 days. Confounding by patient characteristics was adjusted for by propensity-score-matching of good and poor COC adolescents. Cox PH was used to analyze time to outcome. Results: 48.77% of adolescents had good COC. 38.39% of adolescents had ED visit or readmission in the year post-discharge. Good COC increased risk of readmission (HR = 1.38 (1.14 – 1.66)), but not of ED visits (HR = 1.14 (0.95 – 1.37)). Conclusions: COC increased risk of readmission by 38% but did not increase risk of ED visits. These findings are contextualized. Implications to adolescent mental health service delivery are discussed.

Objective: To determine whether continuity of care (COC) reduces emergency department (ED) visits and/or readmission in adolescents with psychiatric disorders. Methods: A retrospective cohort of adolescents discharged with psychiatric disorder between April 1, 2002 and March 1, 2004 was identified using hospital administrative databases. Good COC was defined as at least one aftercare contact in 30 days. Confounding by patient characteristics was adjusted for by propensity-score-matching of good and poor COC adolescents. Cox PH was used to analyze time to outcome. Results: 48.77% of adolescents had good COC. 38.39% of adolescents had ED visit or readmission in the year post-discharge. Good COC increased risk of readmission (HR = 1.38 (1.14 – 1.66)), but not of ED visits (HR = 1.14 (0.95 – 1.37)). Conclusions: COC increased risk of readmission by 38% but did not increase risk of ED visits. These findings are contextualized. Implications to adolescent mental health service delivery are discussed.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.