博士(社会福祉学) / Doctor of Philosophy in Social Welfare / 同志社大学 / Doshisha University

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The purpose of the present study was to gain more knowledge about single individuals with specific premarital risk factors for later marital problems (e.g. neuroticism or low emotional readiness, family-of-origin dysfunction, poor communication skills, and hostile conflict resolution style). The sample (N=39) completed the RELATionship Evaluation (RELATE) and were selected for the study based on the presence of one or more risk factors. Participants were contacted via email and asked to complete an online version of the Relationship Follow-up Questionnaire (RFQ) to determine their knowledge or awareness of their risk factor(s) after taking RELATE, their motivation for premarital interventions after taking RELATE, their perceived roadblocks or barriers hindering participation in premarital interventions, and their post-RELATE marriage preparation behaviors including their post-RELATE relationship breakups. The results showed that the RELATE increased an at-risk individual's knowledge or awareness of risk factors, increased their motivation for premarital interventions, and had little to no effect on the break-up of relationships. At-risk individuals reported the major roadblocks or barriers to participation in premarital interventions as being time, money, being uninformed, and the perceived distance/inconvenience of interventions. At-risk individuals' post-RELATE behaviors included discussing the RELATE results with their partner and friends and utilizing books and articles related to marriage. They did not report utilizing individual or couples counseling. Practitioners can use this information to make premarital interventions more appealing to at-risk individuals and encourage the use of the RELATE to increase participation in premarital interventions and help prevent later marital problems.

Currently, the SEP laboratory has developed a system to automatically generate PDF reports summarizing the results of evaluation tests. This system works well in production but has several limitations. In fact, the use of OriginPro software is an obstacle because of the need for a paid license and hence its use is often limited to researchers and therefore not accessible by coaches and athletes. This means that coaches and athletes cannot access the results directly and must always go through the researchers to obtain the PDF report. Moreover, the PDF report is fixed and not dynamic, i.e. once it is generated, it is not possible to interact with it nor to obtain additional information than the ones presented in the report. Thus, this project aims at developing a web interface to visualize the results of the evaluation tests to improve the follow-up of the French elite athletes and coaches, in order to allow them to access in a simpler and faster way the test results but also to offer them new insights and information. Therefore, a prototype of a web interface integrating results dashboards for 22 out of the 28 different evaluation tests, was developed. This prototype was then evaluated on its usability and user experience in order to obtain subjective but also quantitative evaluations. Finally, it was shown that the use of such an interface is of great interest for athletes and coaches. Indeed, it would save them a lot of time compared to the current process of submitting test reports and there would be a real added value with the dynamic aspect of the interface, and this could be integrated into their daily practices in order to individualize the training, capitalize on the data collection, as well as to follow their athletes longitudinally. / För närvarande har SEP-laboratoriet utvecklat ett system för att automatiskt generera PDF-rapporter som sammanfattar resultaten av utvärderingstesterna. Detta system fungerar bra i produktionen men har flera begränsningar. Användningen av OriginPro-programvaran är i själva verket ett hinder eftersom det krävs en betald licens och därför är användningen ofta begränsad till forskare och därför inte tillgänglig för tränare och idrottare. Detta innebär att tränare och idrottare inte kan få tillgång till resultaten direkt utan alltid måste gå via forskarna för att få PDF-rapporten. PDF-rapporten är dessutom fast och inte dynamisk, dvs. när den väl är genererad är det inte möjligt att interagera med den eller att få ytterligare information än den som presenteras i rapporten. Detta projekt syftar därför till att utveckla ett webbgränssnitt för att visualisera resultaten av utvärderingstesterna för att förbättra uppföljningen av franska elitidrottare och tränare, för att ge dem tillgång till testresultaten på ett enklare och snabbare sätt, men också för att ge dem nya insikter och information. Därför utvecklades en prototyp av ett webbgränssnitt som integrerar resultatinstrumentpaneler för 22 av de 28 olika utvärderingstesterna. Prototypen utvärderades sedan med avseende på användbarhet och användarupplevelse för att få subjektiva men också kvantitativa utvärderingar. Slutligen visade det sig att användningen av ett sådant gränssnitt är av stort intresse för idrottare och tränare. Det skulle spara dem mycket tid jämfört med den nuvarande processen med att skicka in testrapporter och det skulle finnas ett verkligt mervärde med den dynamiska aspekten av gränssnittet, och detta skulle kunna integreras i deras dagliga praxis för att individualisera träningen, dra nytta av datainsamlingen och för att följa sina idrottsmän i ett längre perspektiv.

Denna studie har undersökt hur kommuner i Stockholms län följer upp det systematiska kvalitetsarbetet vid de privata skolföretag som kommunen har avtal med för att erbjuda kommunal vuxenutbildning till sina kommuninvånare. Studien önskade att samla in en så heltäckande bild som möjligt gällande vilka arbetssätt som användes i denna uppföljning samt undersöka på vilket sätt uppföljningen kan bidra till ett förbättringsarbete. Datainsamlingsmetoden som valdes var enkäter, dessa skickades till rektorer på kommunerna och till rektorer på privata skolföretag. Enkäten som var riktad mot kommuner skickades ut till 22 rektorer som tillsammans representerade Stockholms läns 26 kommuner. Enkäten som var riktad mot skolor skickades ut till 39 rektorer som representerar de 39 privata skolföretag som har avtal med en eller flera av Stockholms läns kommuner. Svarsfrekvensen för respondenter från kommun blev 46,1% och respondenter från skola blev 28,2%. Den totala svarsfrekvensen landade på 35,3%.  Resultatet visade att de arbetssätt som användes var bland annat: ·         Kontinuerlig kontakt med skolorna under terminen ·         Fysiska besök på skolorna ·         Samla in elevers synpunkter ·         Läsa skolornas årsrapporter ·         Begära in olika typer av dokumentation ·         Begära in handlingsplaner när brister upptäcks ·         Skapande av forum för dialog och erfarenhetsbyte Resultatet visade att sätt där uppföljningen kunde leda till utvecklig var bland annat att: ·         Brister upptäcks ·         Uppföljningen underlättar dialog och vidare samarbete ·         Stöd gällande lag och förordning ·         Goda exempel kunde lyftas Resultat och analys visade dock att det fanns en viss diskrepans mellan svaren hos kommunrepresentanter och skolrepresentanter. Kommunrepresentanterna ansåg i högre utsträckning att uppföljningen var utformad i syfte att utveckla utbildningen tillsammans med skolan, att den dokumentation som begärdes in användes i ett utvecklingsarbete samt att arbetet har ett fokus på både kvalitetssäkring och kvalitetsutveckling medan skolrepresentanterna inte upplevde detsamma i lika stor utsträckning. / This study has examined how municipalities in Stockholm County follow up the systematic quality work at the private school companies with which the municipality has an agreement to offer municipal adult education for its municipal residents.  The data collection method chosen was questionnaires sent to principals in the municipalities and to principals of private school companies. The questionnaire, which was aimed at municipalities, was sent to 22 principals who together represented all the municipalities in Stockholm County. The questionnaire, which was aimed at schools, was sent out to 39 principals representing private school companies that have agreements with one or more municipalities in Stockholm. The response rate for respondents from the municipalities was 46,1% and respondents from school was 28,2%. The total response rate ended up at 35,3%.  The results showed that the methods used by the municipalities included: ·         continuous contact with the schools during the semester  ·         physical visits to the schools ·         collecting student views ·         reading annual reports ·         requesting different types of documentation ·         requesting action plans when deficiencies are discovered ·         creation of forums for dialogue and exchange of experience The results showed ways in which the follow-up could lead to development:  ·         discovering deficiencies ·         the follow-up facilitates dialogue and further cooperation ·         support for current law and regulations ·         good examples could be highlighted.  The results and the analysis showed, however, that there was a certain discrepancy between the answers of municipal representatives and school representatives. The municipal representatives considered to a greater extent that the follow-up was designed with the aim of improving the education together with the school, that the documentation requested was used in a development work and that the follow-up has a focus on both quality assurance and quality improvement while the school representatives did not fully experienced it in the same way. / <p>2022-06-05</p>

Although axillary artery injury occurs frequently with dislocations of the shoulder and fractures of the clavicle, it is rarely associated with fractures of the proximal humerus. If the axillary artery is damaged, prompt recognition and treatment are necessary to salvage the involved extremity.

Mondialement, plus de 200 millions de femmes et de filles vivent avec une mutilation génitale féminine/excision (MGF/E) (OMS, 2016). Les mouvements d’immigration impliquent la présence d'un nombre grandissant de femmes et de filles de pays où les MGF/E sont pratiqués dans des pays où le personnel médical et infirmier se doit de se questionner sur la façon d’aborder ce sujet d'une manière sensible et respectueuse ainsi que d'élaborer et de mettre en place des actions et lignes directrices pour assurer un suivi. Le but du mémoire-practicum est de circonscrire les pratiques médicales et infirmières, en contexte obstétrical d’un CHU, dans une perspective d’identification et d’assurer un suivi auprès de femmes ayant vécu une MGF/E. Les éléments clés concernant l’identification de la présence d’une MGF/E et d’assurer un suivi de qualité proposés dans le modèle d’Evans et al. (2019) ont servi d’assise pour ce mémoire-practicum. Une recension des écrits sur la scène internationale (n=30) ainsi qu'une revue de dossiers médicaux (n=46) ont fait émerger la difficulté de documenter cette pratique. Plus spécifiquement, des limites dans les dossiers médicaux étaient évidentes quant aux mentions concernant l’identification de la présence d’une MGF/E chez une femme d’une part et pour assurer un suivi adapté aux besoins, en contexte obstétrical, d’autre part. Les résultats confirment un besoin de formation spécifique aux expériences vécues par les femmes ainsi que l’élaboration de protocoles de soins pour soutenir la pratique médicale et infirmière et permettre une collaboration intersectorielle, notamment auprès d’organismes communautaires (Evans et al., 2019). / Globally, more than 200 million women and girls are living with female genital mutilation/cutting (FGM/C) (WHO, 2016). Immigration movements involve the presence of increasing numbers of women and girls from countries where FGM/C is practiced in countries where medical and nursing personnel need to reflect upon how to address this topic in a sensitive and respectful manner as well as develop and implement actions and guidelines for follow-up. The purpose of this report is to describe medical and nursing practices in the obstetrical context of a university hospital to identify and provide a follow up to women who have undergone FGM/C. The key elements of identifying the presence of FGM/C and ensuring quality follow-up proposed in the Evans et al. (2019) model inspired the work throughout in this report. An international literature review (n=30) as well as a medical record review (n=46) highlighted the difficulty of documenting this practice. More specifically, limitations in the medical records were evident with respect to the identification of the presence of FGM/C on the one hand, as well as ensuring coherent and sensitive follow-up in an obstetrical context, on the other. The results confirm a need for more training specific to women's experiences as well as the development of care protocols to support medical and nursing practice (Evans et al., 2019). The contribution of intersectoral collaboration, namely community-based organizations was highlighted.

Fixed retainer after orthodontic treatment is an increasing retention appliance. For the mandibular incisors there are two different fixed retainers that are commonly used, either a canine-to-canine retainer bonded only to the canines or a twistflex retainer bonded to each of the mandibular incisors and canines. Increased mandibular incisor irregularity seems to be a continuous process throughout life even in untreated patients. The natural physiological changes during aging causes changes like those that occur after orthodontic treatment and the removal of retainers. There are few long-term studies that have compared patients who have had a mandibular fixed retainer with patients without retention appliance after treatment, and then compared the treated patients with untreated subjects.The overall aim of this thesis was to compare and evaluate two different mandibular fixed retainers and also to compare orthodontically treated cases with untreated long-term. This thesis is based on two studies and a PAR Index evaluation was presented in the frame story:Paper I is a retrospective longitudinal study done on dental casts and lateral head radiographs from patients who had received either a canine-to-canine retainer or a twistflex retainer after treatment. Different variables were measured, were Little’s Irregularity Index was the main outcome measure. The measurements were done at four different occasions, were the last registration was 12 years after treatment, i.e. 9 years after removal of retainer. Paper II is also a retrospective longitudinal study with three different groups, one group received a fixed mandibular retainer, one group did not receive any retention appliance after treatment and the third group was untreated subjects. Measurements were done on dental casts and lateral head radiographs at four different occasions to analyze dental and skeletal changes 12 years after treatment. Also here Little’s Irregularity Index was the main outcome measure. PAR Index evaluation is done to evaluate the stability of orthodontic treatment outcome after treatment and long-term for two different retainer groups and one non-retention group. The following conclusions were drawn: Paper I•Both the canine-to-canine retainer and the twistflex retainer can be recommended since both are equally effective during retention period.•None of the retention types prevent long-term changes of mandibular incisor irregularity or available space for the mandibular incisors after removal of the retainers.•No differences in bonding failures between the two retainers were found. Paper II•There were no differences found 12 years after treatment in Little’s Irregularity Index for the mandibular incisors between the group that had a retainer and the group that had no retainer after treatment•In the untreated group, Little’s Irregularity Index was increased over time but not to the same extent as in the treated groups. •The crowding before treatment did not explain the crowding at the last registration.•The use of mandibular retainers for two to three years does not appear to prevent long-term relapse. •If the patient wants to constrain the changes that come with natural development, then lifelong retention is needed.•The overjet and overbite were stable long-term.PAR Index evaluation•Twelve years after treatment the mean reduction in PAR score was over 70 per cent only for the groups who had a mandibular retainer after treatment. However, the non-retention group had a PAR score of 66 per cent.•There were more cases in the retention groups that were ”greatly improved and/or improved” 12 years after treatment compared to the non-retention group. After treatment between 16 and 23.3 per cent of all the cases were ”worse or not improved”. Twelve years after treatment between 36 and 43.6 per cent of the total cases were ”worse or not improved”.

Sammanfattning Syftet med studien, som grundar sig i en kvalitativ ansats, är att genom semistrukturerade intervjuer få uppfattning om vilka positiva och negativa aspekter det finns med privatisering av barn- och ungdomsvård. Dessutom grundar sig studien på att upptäcka socialarbetare upplevda skillnader i uppföljningsarbetet hos kommunalt utredda familjehem respektive konsulentstödda familjehem. Utifrån tidigare forskning framgår det att barn och vuxna är väldigt beroende av kontinuitet gällande att träffa samma socialarbetare för att uppleva situationen på ett bra sätt. Stor omsättning av socialarbetare leder till att upplevelsen med dessa inte blir lika bra och att förtroendet för socialarbetaren sjunker.   Genom tematisk analys framkom det att uppföljningen av placerade barn skiljer sig beroende på om barnet är placerat i kommunal eller privat verksamhet. I studien framkommer det att socialtjänsten besitter det yttersta ansvaret för det placerade barnet men saknar insyn i de privata aktörernas arbete. Det finns inte heller någon granskning från IVO gällande de privata verksamheterna. Detta skapar en osäkerhet om barnets behov tillgodoses på rätt sätt. / Abstract The purpose of this study is to get an idea through a qualitative method based in semi-structured interviews of which positive and negative aspects exist with the privatization of child and youth care. In addition, the study is based on discovering social workers perceived differences in the follow-up work of municipally investigated family homes and consultant-supported family homes. Previous research conclude that children and adults are very dependent on continuity in meeting the same social worker to experience the situation in a good way. A high turnover of social workers generates a bad experience and a lack of trust between the social worker and client.  Through thematic analysis, it emerged that the follow-up of placed children differs depending on whether the child is placed in a municipal or private operation. In the study it appears that the social service has the ultimate responsibility for the placed child but lacks insight into the work of the private operations. This creates uncertainty as to whether the child’s needs are being met in the right way.

Introduction: Auditory neuropathy spectrum disorder (ANSD) is a disorder characterized by impaired temporal coding of acoustic signals due to a deficiency in neural synchrony or neural transmission. Despite variations in speech perception outcomes within both patients and studies, current evidence demonstrates that children with ANSD, who use hearing aids (HAs) or cochlear implants (CIs), generally achieve speech perception performance comparable to peers with sensorineural hearing loss (SNHL). However, limited studies have reported factors that have prognostic value for auditory intervention outcomes. The objectives of this doctoral thesis, consisting of three consecutive associated projects on children with ANSD, were (1) to determine factors with predictive value for post-intervention (CIs and/or HAs) outcomes through a retrospective study, (2) to systematically summarize and critically appraise existing evidence of the prognostic value of early auditory electrophysiologic tests and MRI findings for CI outcomes through a systematic review (SR), and (3) to systematically overview, summarize, and critically appraise evidence of CI outcomes through an umbrella review of current SRs (overview of SRs). -- Methods: For the first project, the records of 38 children with ANSD between 5 and 18 years old, 63.20% males, who used CIs (71%) and/or HAs, identified at the Children's Hospital of Eastern Ontario (CHEO) were reviewed. For the second and third projects, the SRs were guided by the PRISMA 2020 statement, and electronic databases were searched without restrictions on language, publication status, or year of publication. In the second project, studies on children with ANSD (including those with cochlear nerve deficiency [CND]), cochleovestibular nerve (CVN) abnormalities, or SNHL reporting the relevance of preoperative and/or postoperative electric compound action potential (eCAP), electric auditory brainstem response (eABR), and/or MRI results to CI outcomes were included. The methodological quality and strength of evidence were assessed using the Crowe Critical Appraisal Tool (CCAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool, respectively. In the third project, all SRs that reported CI outcomes in children with ANSD were included. The methodological quality of the selected SRs was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist, and the risk of bias in evidence was assessed using the Risk of Bias in Systematic Reviews (ROBIS) tool. -- Results: In the retrospective chart review (first project), ages at HL diagnosis and CI activation and the length of follow-up with CI/HA showed a significant relationship with open-set speech perception outcomes (i.e., the scores of Phonetically Balanced Kindergarten [PBK] test with word and phoneme speech materials and Hearing in Noise Test [HINT] in quiet and noise conditions). Using a Forward Linear Multiple Regression Model, the length of follow-up with CI/HA and bilateral amplification showed prognostic value for speech perception performance. In the second project, 25 papers were included in the review. While it was difficult to draw a firm conclusion about the eCAP findings, current evidence strongly supports the prognostic value of eABR and MRI for post-CI speech perception outcomes. According to the eight SRs selected for the third project, children with ANSD achieve CI outcomes comparable to their peers with SNHL. However, in children with postsynaptic ANSD (i.e., those with CND), cochlear nerve hypoplasia is associated with better speech recognition outcomes compared to cochlear nerve aplasia, especially in the absence of additional disabilities and/or medical comorbidities (ADs/MCs). -- Conclusion: Children with ANSD, especially those without cochlear nerve aplasia and ADs/MCs, achieve speech perception outcomes comparable to their peers with SNHL. In addition, age at HL diagnosis, age at CI activation, the length of follow-up with CI/HA, bilateral amplification, and eABR and MRI findings are associated with or have predictive value for intervention outcomes. The findings of the SRs should be interpreted with caution given the low quality of evidence and risk of bias in the studies selected for SRs.