Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

<p>After repeated criticism of the social services about how they manage family care, the National Board of Health and Welfare decided to solve the problem by importing a model used in England (Integrated children's system). This was translated into Swedish conditions and named BBIC (Barns behov i centrum = Child’s needs at the center). Our study aims to investigate whether BBIC will contribute to more and more extensive follow-ups of children placed than before, with a focus on the child's best. This has been studied through qualitative interviews with six social workers who work with children investigations. The results indicate that follow-up is becoming more wide when BBIC is used, the social welfare worker needs to see the child several times to obtain all the information that BBIC documents require. The result also indicates that the social workers use different BBIC documents when they do follow-ups. There are also other parts of the follow-up in which social welfare workers work different, for example how often they visit the child between the statutory reassessments.</p>

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 192-203). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Studien är en fenomenologisk studie som belyser lärares uppfattning om sin litteraturundervisning på mellanstadiet. Syftet är att genom enkäter och intervjuer ta reda på vilka arbetssätt som lärare använder vid läsning, hur arbetet med litteratur följs upp, hur användandet av litteratur skiljer sig mellan de olika årskurserna samt hur läraren motiverar sina arbetssätt som de använder vid litteraturundervisning. Arbetssätt som lärare använder vid läsning är enskild läsning, högläsning, elev läser för läraren, elev läser för elev, läsgrupp, elev läser för klassen samt läsläxa. De uppföljande arbetssätt som lärarna använder i störst utsträckning är helklassdiskussioner, uppgifter kopplade till det lästa och litteratursamtal. Lärarna uppfattar att det som skiljer sig mellan årskurserna är att eleverna mer och mer övertar ansvaret för sitt lärande. Det uppföljande arbetet med litteratur inleds vanligtvis med helklassdiskussioner som sedan övergår till att i allt högre grad ske i grupp och senare även mer individuellt. Lärarna motiverar genomgående och återkommande sina arbetsmetoder genom att betona läsupplevelsen: de vill på olika sätt främja läsglädjen hos eleverna och söker olika vägar att nå dit.

Elever ska ges ledning och stimulans i undervisningen för att kunna utveckla kunskaper i enlighet med utbildningens mål. Historieundervisningen ska således utformas så att hänsyn tas till elevers olika behov och förutsättningar. Om denna ledning och stimulans inte är tillräcklig kan det bli aktuellt med stödinsatser i form av extra anpassningar. Studiens syfte är därför att undersöka hur lärare i årskurs 4–6 använder och utvecklar stödinsatser i form av extra anpassningar i historieundervisningen för att möta den variation av olikheter som finns i en elevgrupp. Då det i studien är av intresse att undersöka lärares resonemang, erfarenheter och beskrivningar av begreppet extra anpassningar i historieundervisningen har en kvalitativ forskningsansats valts och fem lärare har intervjuats. Syftet uppfylls genom att det redovisas hur lärarna tillämpar extra anpassningar i historieundervisningen och hur de utformar denna stödinsats i samverkan. Vidare beskrivs hur uppföljning och utvärdering görs för att utveckla arbetet med extra anpassningar i historieundervisningen. En specialpedagogisk analysram med utgångspunkt i det relationella perspektivet samt det kommunikativa och relationsinriktade perspektivet, KoRP, har använts i analysen och tolkningen av det insamlade empiriska materialet. Resultatet visar att det finns ett behov av att tydliggöra skillnaden mellan ledning och stimulans, extra anpassningar och särskilt stöd. Det framkommer också att lärares inställning till arbetet med extra anpassningar påverkar både hur stödinsatsen utformas och dess kvalité. I resultatet synliggörs det även att handledning från specialpedagoger och speciallärare är viktigt för att lärare ska kunna skapa adekvata extra anpassningar men också att det finns explicita rutiner om hur detta arbete ska följas upp och utvärderas / Students should be given guidance and stimulation in the instruction to be able to develop knowledge accordingly to the aims of the education. The history instruction should consider students’ different needs and abilities. If the guidance and stimulation is not sufficient, the teacher must form additional adjustments. The purpose of this study is therefore to investigate how teachers in grade 4-6 make use of and develop additional adjustments in history instruction to meet students' differences. Since teachers reasoning, experiences and descriptions of additional adjustments are interesting to investigate, a qualitative method has been chosen and five teachers in grade 4 to 6 have participated in the study. The purpose of the study has been answered by how teachers apply additional adjustments in history instruction and how they collaborate when forming these adjustments. Furthermore, it describes how teachers follow up and evaluate the additional adjustments to develop their history instruction. This interview study has its point of departure in the relational perspective and the communicative relational perspective (KoRP). Therefore, the analysis and the interpretation of the collected empirical evidence have been reviewed with a special education point of view. The result shows that the differences between guidance and stimulation, additional adjustments and special support need to be distinguished. It also discloses that teachers’ attitudes towards additional adjustments affects how the adjustments are formed but also what quality they have. A conclusion that is drawn is that guidance from special educators is important if teachers should be able to form adequate additional adjustments. It is also important that there are clear routines of how this work should be followed up and evaluated.

Os transtornos de ansiedade (TAs) estão entre os principais problemas que acometem crianças e adolescentes, podendo atingir uma prevalência de até 24,9% ao longo da vida. A eficácia do tratamento de TAs na infância e na adolescência tem sido demonstrada em estudos de curto prazo de terapia cognitivo-comportamental (TCC), mas ainda são poucos os estudos que avaliam a eficácia da terapia de longo prazo. Portanto, a presente pesquisa tem por objetivo realizar uma revisão sistemática de estudos de seguimento sobre TCC com crianças e adolescentes com TAs (artigo 1) e verificar a resposta a longo prazo da terapia cognitivocomportamental em grupo (TCCG) em relação à intensidade dos sintomas de ansiedade e depressão e à qualidade de vida (artigo 2). Para a realização do primeiro artigo (revisão sistemática), foram consultadas as bases de dados Pubmed e Isi Web of Science. Foram considerados como critérios de inclusão: estudos de coorte após TCC para TAs na infância e na adolescência. Foram excluídos os estudos com período de seguimento inferior a um ano. Para a apresentação dos achados dos estudos, foram considerados os resultados significativos (p<0,05). Em relação ao método utilizado na elaboração do segundo artigo (seguimento não controlado), a pesquisa envolveu 20 adolescentes que realizaram 14 sessões de TCCG para TAs e foram reavaliados após 2 anos do término da intervenção. Para avaliar os desfechos, utilizaram-se os instrumentos antes da TCCG, no final (4 meses) e após 2 anos: Autorrelato para Transtornos Relacionados à Ansiedade na Infância (SCARED-C); Inventário de Depressão Infantil (CDI); Impressão Clínica Global (CGI); Escala de Funcionamento Global (CGAS) e Qualidade de Vida de Jovens (YQOL). O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegra (nº 110181). Os adolescentes e seus responsáveis assinaram o termo de consentimento livre e esclarecido (TCLE). Como resultado da revisão sistemática, obteve-se um total de 10 artigos que preencheram os critérios de inclusão. O período de seguimento variou entre 12 meses a 13 anos e, em geral, os resultados indicaram a manutenção dos ganhos com a TCC de curto prazo. No entanto, os estudos apresentaram limitações, principalmente em relação ao método, como ausência de grupo controle e perdas de seguimento. No estudo de seguimento, um total de 19 (95%) adolescentes com média de idade de 12,3 (DP=1,0) anos foi avaliado. Houve redução significativa (p<0,001) da gravidade dos sintomas (CGI) e melhora do funcionamento global (CGAS) em comparação com a avaliação inicial. A qualidade de vida geral no seguimento melhorou significativamente (p=0,041) em comparação com a avaliação inicial e final da 7 TCCG. Os sintomas específicos de ansiedade e depressão não apresentaram mudanças significativas (p=0,071 e p=0,206, respectivamente). Os resultados do trabalho sugerem a manutenção dos benefícios da TCC de longo prazo e encorajam a sua utilização entre adolescentes com TAs. / Anxiety disorders (ADs) are among the most prevalent conditions affecting children and adolescents with a lifetime prevalence of up to 24.9%. The efficacy of treatment for ADs in childhood and adolescence has been demonstrated in short-term studies of cognitivebehavioral therapy (CBT), but few studies have investigated the long-term effects of this treatment. Therefore, the present study aimed to systematically review follow-up studies of CBT in children and adolescents with ADs (article 1) and explore the long-term effects of group cognitive-behavioral therapy (GCBT) on quality of life and symptoms of anxiety and depression (article 2). The systematic review was based on a search of the PubMed and ISI Web of Science databases. Articles reporting cohort studies of CBT for ADs in childhood and adolescence were included in the review. Studies with follow-up periods of less than one year were excluded. Results were considered significant at p < 0.05. The second article consisted of an uncontrolled follow-up study involving 20 adolescents who underwent 14 sessions of GCBT for ADs and were assessed at three time points (before and after treatment, and two years after the end of treatment) with the following instruments: Screen for Child Anxiety Related Emotional Disorders, child (SCARED-C); Children's Depression Inventory (CDI); Clinical Global Impression (CGI); Children’s Global Assessment Scale (CGAS) and Youth Quality of Life (YQOL). The study was approved by the Hospital de Clínicas de Porto Alegre Research Ethics Committee (protocol number 110181). Participants and guardians provided written informed consent prior to participation. Ten articles were included in the systematic review. Follow-up periods ranged from 12 months to 13 years, with most studies indicating that the effects of short-term CBT remained stable over time. However, the studies presented a series of methodological limitations, such as lack of control groups and follow-up losses. In the present follow-up study, a total of 19 (95%) adolescents with mean age 12.3 (SD=1.0) years were assessed. There were significant reductions (p<0.001) in symptom severity (CGI) and improvements in global functioning (CGAS) over the course of the study. General quality of life improved significantly at follow-up (p=0.041) as compared to assessments immediately before and after GCBT. There were no significant differences in anxiety and depression symptoms (p=0.071 and p=0.206, respectively). Results of the present studies indicate that the benefits of CBT are maintained over time, and that this method is suitable for the treatment of ADs in adolescents.

Os transtornos de ansiedade (TAs) estão entre os principais problemas que acometem crianças e adolescentes, podendo atingir uma prevalência de até 24,9% ao longo da vida. A eficácia do tratamento de TAs na infância e na adolescência tem sido demonstrada em estudos de curto prazo de terapia cognitivo-comportamental (TCC), mas ainda são poucos os estudos que avaliam a eficácia da terapia de longo prazo. Portanto, a presente pesquisa tem por objetivo realizar uma revisão sistemática de estudos de seguimento sobre TCC com crianças e adolescentes com TAs (artigo 1) e verificar a resposta a longo prazo da terapia cognitivocomportamental em grupo (TCCG) em relação à intensidade dos sintomas de ansiedade e depressão e à qualidade de vida (artigo 2). Para a realização do primeiro artigo (revisão sistemática), foram consultadas as bases de dados Pubmed e Isi Web of Science. Foram considerados como critérios de inclusão: estudos de coorte após TCC para TAs na infância e na adolescência. Foram excluídos os estudos com período de seguimento inferior a um ano. Para a apresentação dos achados dos estudos, foram considerados os resultados significativos (p<0,05). Em relação ao método utilizado na elaboração do segundo artigo (seguimento não controlado), a pesquisa envolveu 20 adolescentes que realizaram 14 sessões de TCCG para TAs e foram reavaliados após 2 anos do término da intervenção. Para avaliar os desfechos, utilizaram-se os instrumentos antes da TCCG, no final (4 meses) e após 2 anos: Autorrelato para Transtornos Relacionados à Ansiedade na Infância (SCARED-C); Inventário de Depressão Infantil (CDI); Impressão Clínica Global (CGI); Escala de Funcionamento Global (CGAS) e Qualidade de Vida de Jovens (YQOL). O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegra (nº 110181). Os adolescentes e seus responsáveis assinaram o termo de consentimento livre e esclarecido (TCLE). Como resultado da revisão sistemática, obteve-se um total de 10 artigos que preencheram os critérios de inclusão. O período de seguimento variou entre 12 meses a 13 anos e, em geral, os resultados indicaram a manutenção dos ganhos com a TCC de curto prazo. No entanto, os estudos apresentaram limitações, principalmente em relação ao método, como ausência de grupo controle e perdas de seguimento. No estudo de seguimento, um total de 19 (95%) adolescentes com média de idade de 12,3 (DP=1,0) anos foi avaliado. Houve redução significativa (p<0,001) da gravidade dos sintomas (CGI) e melhora do funcionamento global (CGAS) em comparação com a avaliação inicial. A qualidade de vida geral no seguimento melhorou significativamente (p=0,041) em comparação com a avaliação inicial e final da 7 TCCG. Os sintomas específicos de ansiedade e depressão não apresentaram mudanças significativas (p=0,071 e p=0,206, respectivamente). Os resultados do trabalho sugerem a manutenção dos benefícios da TCC de longo prazo e encorajam a sua utilização entre adolescentes com TAs. / Anxiety disorders (ADs) are among the most prevalent conditions affecting children and adolescents with a lifetime prevalence of up to 24.9%. The efficacy of treatment for ADs in childhood and adolescence has been demonstrated in short-term studies of cognitivebehavioral therapy (CBT), but few studies have investigated the long-term effects of this treatment. Therefore, the present study aimed to systematically review follow-up studies of CBT in children and adolescents with ADs (article 1) and explore the long-term effects of group cognitive-behavioral therapy (GCBT) on quality of life and symptoms of anxiety and depression (article 2). The systematic review was based on a search of the PubMed and ISI Web of Science databases. Articles reporting cohort studies of CBT for ADs in childhood and adolescence were included in the review. Studies with follow-up periods of less than one year were excluded. Results were considered significant at p < 0.05. The second article consisted of an uncontrolled follow-up study involving 20 adolescents who underwent 14 sessions of GCBT for ADs and were assessed at three time points (before and after treatment, and two years after the end of treatment) with the following instruments: Screen for Child Anxiety Related Emotional Disorders, child (SCARED-C); Children's Depression Inventory (CDI); Clinical Global Impression (CGI); Children’s Global Assessment Scale (CGAS) and Youth Quality of Life (YQOL). The study was approved by the Hospital de Clínicas de Porto Alegre Research Ethics Committee (protocol number 110181). Participants and guardians provided written informed consent prior to participation. Ten articles were included in the systematic review. Follow-up periods ranged from 12 months to 13 years, with most studies indicating that the effects of short-term CBT remained stable over time. However, the studies presented a series of methodological limitations, such as lack of control groups and follow-up losses. In the present follow-up study, a total of 19 (95%) adolescents with mean age 12.3 (SD=1.0) years were assessed. There were significant reductions (p<0.001) in symptom severity (CGI) and improvements in global functioning (CGAS) over the course of the study. General quality of life improved significantly at follow-up (p=0.041) as compared to assessments immediately before and after GCBT. There were no significant differences in anxiety and depression symptoms (p=0.071 and p=0.206, respectively). Results of the present studies indicate that the benefits of CBT are maintained over time, and that this method is suitable for the treatment of ADs in adolescents.

This thesis deals with the urgent and follow-up measures in case of chlorine leak and a retrospective analysis of past cases. Chlorine is a widely used toxic gas. It is known from history as the first practically used warfare agent. Today, it is an important chemical raw material that is used widely in industry. It is also commonly transported by road and rail. It is one of the substances whose leakages occur very often. The objective of this paper is to assess the impacts of chlorine leakage on the lives and health of people and to provide an overview of urgent and follow-up measures in case of chlorine leakage in the perspective of the integrated rescue system and the general public. In addition, to locate, describe and analyze past cases. The theoretical part contains information about chlorine, the principles of behaviour of the population in case of an accident with chlorine leakage and an overview of measures undertaken at the site of chlorine leakage. Through studying available literature and resources on the Internet, overview of major chlorine leakages in the Czech Republic as well as abroad has been created. Selected events are described in detail. The practical part simulates, using computer programme called TerEx, a chlorine leakage from a water treatment plant in Písek, South Bohemia. To compare the results, several model situations were created with varying amounts of chlorine leaked at different times of accident and atmospheric conditions. A specific example is used to assess the risks to people living near the plant and to outline the urgent and follow-up measures.

The goal of this diploma thesis is to introduce urgent and follow-up precautions in case of leakage of chlorine - simulated accident of vehicle transporting chlorine. The major objective of this study is to analyse the risk of chlorine-transport for people with the aid of available simulation programme and to specify urgent and follow-up precautions. The next part of this study is to investigate the knowledgeability of people. The theoretical part of this study is systematical structured into a number of chapters and worked out on the basis of available legislative regulations, literature and internet sources. At first basic legislation of transport of dangerous substances is described, from the european, as well as national perspective. The next chapter deals with transport of dangerous substances, danger classes of these substances, their labeling in transport, as well as labeling of transport units. The following chapter is devoted to aspects of an accident in case of transporting of dangerous substances. This chapter demonstrates an accident with leakage of dangerous substance, its impact, escape of this substance and its spread. Further the sources and risks of transportation of dangerous substances and accident rate in this transport are described. The next chapter deals with the specific dangerous substance - chlorine. It is aimed at physico-chemical characters of chlorine, its history and its current utilisation, its effect on human health, on environment and first aid in case of contact. At the end urgent and follow-up precautions in case of an accident inkl. leakage of chlorine. The empirical part of this study is devoted to two basic research questions. Qualitative, as well as quantitative methods of research were used to answers these questions. The empirical part is devided into two major chapters. The primary purpose of this study is to simulate an accident of vehicle transporting chlorine with the aid of the programme TerEx and to determine its impact on people and surrounding. The first question was to analyse the potential dangerous for people and surroundings in case of an accident with chlorine. For this purpose the town České Budějovice was used. First the transport of liquid chlorine in small containers in the Czech Republic was analysed focusing on the southbohemian region and especially the regional city. Thereafter input data were entered. On the basis of obtained outputs were determined threats, that arise from the transport of dangerous chlorine and on the basis of simulation were characterized activities carried out by Integrated Rescue System using appropriate urgent and follow-up precautions. Part of this work was also the second research question - the level of knowledge of people located close to the simulated accident about this problem. This survey was aimed at the risk of chlorine, its transport and characteristics and impact on human health as well as protection against its adverse effects. For this purpose a group of second-year students of the local gymnasium located close to the place of simulated accident was chosen. The data were collected through a questionnaire, which contained a group of questions relating to this problem. The obtained data were evaluated using basic methods of elemental statistical analysis and graphic processing. Findings resulting from the analysis of transporting of chlorine and from the simulation using the programme TerEx show, that the danger to the population of České Budějovice in case of an accident with chlorine is significant. The issue of chlorine-transport and its risks is additionally complicated by insufficient regulation. Another negative factor of transporting of these substances is the complicated traffic situation in the country town. Based on the results of the questionary can be stated, that these students have average knowledge in this issue.

Made available in DSpace on 2016-12-23T13:56:11Z (GMT). No. of bitstreams: 1 Dissertacao Elizoneth NDI pos defesa 22-09-2011 REVELAR ENCARDERNACAO.pdf: 1659201 bytes, checksum: 33ab6a3f900f4a5ae8e1f0f4164eb954 (MD5) Previous issue date: 2011-08-25 / Introdução: O tratamento da tuberculose (TB) consiste no uso da associação de medicamentos por no mínimo seis meses. É comum que o paciente seja atendido por diversas equipes multidisciplinares em diferentes níveis de atenção, o que inclui a atenção farmacêutica através do seguimento farmacoterapêutico. Com a crescente informatização é fundamental a adoção de padrões de troca de informação visando à interoperabilidade entre sistemas/serviços. Objetivos: Este trabalho tem por objetivo especificar os elementos para um software que sistematiza os dados necessários e/ou gerados no processo de atenção farmacêutica ao longo do tratamento da TB. Métodos: proposição de formulários de seguimento farmacoterapêutico e construção de um primeiro sistema computacional a partir dos mesmos; acompanhamento de 30 pacientes em tratamento de TB com adequações do formulário proposto; definição dos elementos para interoperabilidade deste software, através de revisão bibliográfica e discussão sobre padrões de troca de informação em saúde; construção de um protótipo computacional que implemente tais conceitos, produzindo documentos computacionais em conformidade com a arquitetura HL7-CDA (Health Level 7 Clinical Document Architecture). Resultados: construiu-se formulário de seguimento farmacoterapêutico para pacientes com TB, indicando o conteúdo mínimo para um resumo de alta/seguimento. Tal conteúdo, devidamente representado através de padrões de troca de informação, foi incorporado a documentos HL7-CDA gerados pelo protótipo de software. Conclusão: o protótipo desenvolvido foi capaz de gerar resumos de alta/seguimento farmacoterapêutico em conformidade com a arquitetura HL7-CDA. Dessa forma, permitir-se-á uma futura integração com sistemas computacionais de outros serviços de saúde no controle e seguimento farmacoterapêutico de pacientes com TB / Introduction: Tuberculosis (TB) treatment is a combination of medications for at least six months. Normally patients are treated by several multidisciplinary teams serving different levels of care, including patient´s pharmaceutical care through pharmacotherapy follow-up. With the increase of technology, it is essential to adopt exchanging standards of information in order to have interoperability between systems/services. Objectives: This study aims to specify data and respective standards requirements for pharmacotherapeutic follow-up data management software with focus on TB treatment. Methods: Pharmacotherapeutic follow-up forms propose an implementation of the first computer system prototype; forms test and adjustment through following the pharmacotherapy of a set of 30 TB patients; review, discussion and define respective healthcare data exchange standards required for such data in order to implement software interoperability; implementation of these concepts in a second software prototype that produces XML documents in adherence to HL7-CDA (Health Level 7 - Clinical Document Architecture). Results: a set of forms for TB patients pharmacotherapeutic follow-up, delivering the essential content of a discharge/ follow-up summary. Such content, fully represented by heathcare informations exchange standards has been translated to HL7- CDA documents generated by the prototype software. Conclusion: The prototype was able to generate "discharge/ pharmacotherapeutic follow-up" summaries in adherence to HL7-CDA architecture. Thus, it will allow systems interoperability throughout control and monitoring of TB pharmacotherapy patients