Introduction: Child abuse is a major problem that occurs in society. The concept of child maltreatment includes psychological and physical abuse, sexual abuse, negligence or exploitation of children leading to injury. The child health care nurse has an important role in detecting child maltreatment. Healthcare professionals are subject to the obligation to report to the social services immediately when they become aware of or suspect that a child is abused. Method: To respond to the purpose of the study, qualitative methodology has been used. Eight interviews have been conducted and then reviewed and transcribed. Content analysis has been used to review data collection.  Aim: Describe child health care nurses’ experience in suspicion that child is abused.  Result: In the interview material, five categories appeared in relation to child health nurses’ experiences. Through vigilance the child health nurse can identify signs that a child is abused. Question to identify different forms of abuse can be asked. Being the children’s spokesman was considered important for all informants. Feedback on a notified case from the relevant agencies was considered desirable.   Conclusion: The present study shows that participants feel safe to act when there are clear signs that a child is maltreated. There is a wish from the participants in the study on increased education in the subject and improved interaction between involved bodies.

Risky drinking behaviour can strongly influence the lives of individuals and families, including having negative effects on social welfare and health. The low rate of healthcare service use among people experiencing alcohol addiction is an important problem in Thai society. The overall aim of the study was to explore the barriers to alcohol treatments for people experiencing alcohol addiction. This thesis includes four qualitative studies that employed three different data collection methods. Individual interviews were used in studies I and II and were analysed with descriptive phenomenology. Focus group interviews were conducted in study III, and the Delphi method was applied in study IV. Both of the latter studies employed content analysis. Purposive sampling was applied to identify participants for the four studies, which included 13 men (study I) and 12 women (study II) experiencing alcohol addiction, 32 healthcare providers (study III) and 32 experts in the alcohol treatment field (study IV); the providers and experts were primarily nurses (study III and IV). The identified barriers at the individual level included the unawareness of alcohol addiction, gender differences in treatment and in society, the experienced stigma related to alcohol addiction and the lack of engagement in alcohol treatment. Barriers at the organizational level were related to healthcare providers’ agencies and engagement, vertical and horizontal collaborative practices within the hospital wards, and the collaboration with patients and their next of kin. Additionally, the struggle of handling the different sexes during treatment and the difficulties of using the required standard methods were described by the healthcare providers. At the structural level, the barriers were related to the patriarchal society, gender equity and the resources and funding from the Ministry of Public Health for improving the well-being and equal healthcare rights of people experiencing alcohol addiction in Thailand. In order to improve equal rights to health for people experiencing alcohol addiction in Thailand, knowledge of alcohol addiction, stigma and domestic violence related issues needs to be improved in the healthcare service system. Formal training and nurse educational programmes are needed to reach the theoretical and practical potential of nurses and of other healthcare providers working in alcohol addiction. Key words: alcohol addiction, gender perspective, lived experiences, alcohol dependency, focus- group interviews, Delphi study

No description available.

Working at an emergency department has some characteristics, which may generate stress. In this thesis, the stressors for emergency nurses were evaluated and an instrument was developed for measuring their impact. In order to gain a deeper understanding regarding the occupational stress among emergency nurses, a descriptive qualitative design with semi-structured interviews were used in two studies (I, II), one at a private and the other at a public hospital in Thailand. Three main categories of stressors were identified, related to the activity at the emergency departments, to human factors and to perceived consequences of these factors. Nurses in both private and public hospitals frequently experienced occupational stress, which influenced their psychophysiological health, and resulted in incomplete nursing care. Since no validated instrument had been published for measuring stressors in emergency nurses’ workplace, a scoping literature review was performed and a questionnaire for this purpose was developed, based on the review and the results from the interviews (I and II). The questionnaire was validated (III) and the influence of socio-economic factors were evaluated (IV). Four-hundred and five emergency nurses in Thailand completed a questionnaire containing 59 items. The responses were analyzed using 1) item generation, 2) content and face validity and test-retest reliability and 3) evaluation of the internal consistency and construct validity of the instrument. An exploratory factor analysis was performed on 200 of these responses and a confirmatory factor analysis on the remaining 205. The analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients’ and families’ actions and reactions, Technical and formal support, and Conflicts. The statistical evaluation (Cronbach’s alpha and intra-class correlation coefficient) indicated good homogeneity and stability. The type of organization, educational level and average income were associated with stressor related to Life and Death situations. Stressor related to Patients’ and families’ actions and reactions was predicted by educational level. While sociodemographic variables had no influence on stressor related to Technical and formal support and Conflicts. Future research regarding patient safety should focus on both emergency nurses’ and patients’ perspectives regarding consequences of occupational stress related to patient safety. Different perspectives may create a knowledge-base which can be used to develop guidelines or protocols aiming at reducing nurses’ stress and prevent its consequence, such as poor patient safety.

Globally, postpartum care is a neglected area in the continuum of maternal and newborn services. Facilitation interventions focusing on addressing local problems report positive results in improving the health of mothers and newborns in low-resource settings.  The aim of this thesis was to investigate a facilitation intervention to improve postpartum care at government-owned health institutions in a low-resource suburb of Dar es Salaam, Tanzania. A before-and-after study design was used to describe and evaluate the intervention in this thesis. Data were collected using mixed methods in the intervention group and the control group, before and after the intervention and were used for making comparisons.   The baseline studies showed that postpartum care practices were next to non-existent at the institutions, that most healthcare providers had high levels of knowledge, positive attitudes towards postpartum care and declared themselves ready to engage in its improvement. Mothers coming with their newborns for immunisation were satisfied with the services.  The intervention to improve postpartum care involved healthcare providers in six geographical clusters, each including 3–6 institutions, with one facilitator for each cluster. Using a participatory approach, they facilitated colleagues in identifying and addressing the provision of postpartum care at institutions. Data were collected among healthcare providers, facilitators and mothers using: focus group discussions; questionnaires; observations; and interviews, and by making field notes, written at each institution.  In the intervention, facilitators and healthcare providers used four strategies to improve postpartum care:increasing awareness and knowledge on postpartum care of healthcare providers and mothers; mobilising professional and material resources; improving care routines, communication and documentation; and promoting an empowering and collaborative work style.  The endline evaluation showed that postpartum care was conducted in the intervention group with some care items performed for 80% of observed mothers. The quality grading, which involved nine experts and was based on national guidelines, showed that none of the healthcare providers reached the level of good quality of care. In the comparison group, postpartum care continued to be next to non-existent. The healthcare providers’ knowledge increased in both groups but to a higher extent in the intervention group. The t-test indicated a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference in differences for knowledge was 1.3. The attitudes showed no major difference between baseline and endline in the intervention and comparison groups.  This facilitation intervention was an acceptable and applicable approach and indicates promising results in improving the quality of postpartum care and in increasing mothers’ attendance.

Abstrakt Syfte Kritiskt studera fysiologiska mekanismer som föreslagits för överträningsprocessen. Metod Systematisk litteraturstudie enligt SBU:s riktlinjer och formulär. Inklusions- och exklusionskriterier togs fram inför litteratursökning. Titel och abstrakt lästes och prövades mot exklusion-inklusionskriterier. Inkluderade artiklar laddades ner och relevansgranskades. Artiklar som klarade granskning evidensgraderades enligt SBU:s mallar. Resultat Tillskott av kolhydrater verkar skjuta upp symptom som associerats med överansträngning (vilket är ett kortsiktigt överträningsliknande tillstånd som kan övergå i överträning) men kunde inte förhindra att överansträngning utvecklades. Akut uthållighetsträning ger reduktion av 5-HT 2A receptorer (serotoninreceptorer). Hos atleter med överträningssyndrom verkar känsligheten hos 5-HT2A receptorer öka. Perioder av akut intensifierad träning framkallar nedreglering av immunförsvarets aktivitet samt uppreglering av Cytokin IL-6 vilket associerades med trötthet och generellt obehag, även symptom av depression. IL-1β och TNFα associerades med depression, sömnrubbningar och trötthet. Övertränade atleter visade sig ha en nedsatt antioxidativ förmåga vilket verkar grundläggas under speciellt tuffa träningsperioder. Slutsats Överansträngning, och i förlängningen överträning, verkar bero på återkommande och ihållande (utan tillräcklig återhämtning) förhöjt energibehov vilket får IL-6 att utsöndras för att stimulera levern att frisätta glukos. IL-6 ihop med TNF-α och IL-1β samt IL-10 utsöndring signaleras till hjärnan vilket möjligen påverkar serotoninsignalering till postsynapser vilket kan påverka motivationen och leda till känslor av trötthet och depressiva symptom. Homeostas rubbas och återgår inte till baslinjevärden vilket leder till, först akut och sedan kronisk stress där psykisk ohälsa och förlorad prestationsförmåga är de tydligaste symptomen. / Abstract Purpose Critical study of the physiological mechanisms proposed for overtraining process. Method Systematic literature study according to SBU's guidelines and formularies. Inclusion- and exclusion criteria were developed for the literature search. The title and abstract of each article was read and tested against exclusion-inclusion criteria. Included articles were downloaded and relevance was reviewed. Articles that passed the examination were evidence graded according to the SBU templates. Results Supplements of carbohydrates seems to postpone the symptoms associated with overreaching, but could not prevent overreaching development. Acute endurance training reduces the 5-HT2A receptors (Serotonin Receptors) sensitivity. In athletes with overtraining syndrome it appears that the sensitivity of the 5-HT 2A receptors increases. Periods of acute intensive exercise induces down-regulation of immune activity and upregulation of cytokine IL-6 which was associated with fatigue and general discomfort, including symptoms of depression. IL-1β and TNF were associated with depression, sleep disorders and fatigue. Overtrained athletes where found to have a reduced antioxidant capacity, which seems to be founded under particularly tough training periods. Conclusion Overreaching, and eventually overtraining, seems to be due to recurrent and persistent (without sufficient recovery) increased metabolic energy demand causing IL-6 to be secreted to stimulate the liver to release glucose. IL-6 in conjunction with TNF-α and IL-1β and IL-10 secretion is signaled to the brain and will possibly affect serotonin signaling to postsynapses which can affect motivation and lead to feelings of fatigue and depressive symptoms. Homeostasis is disrupted and does not return to baseline values, leading to, first acute and then chronic stress where mental illness and the loss of performance is the most visible symptoms.

No description available.

<p>Datum för godkännande: 2017-11-17.</p>

Background: Research shows that immigrant families encounter different complexities and challenges in a new host country, such as acculturation, isolation and lack of social support. These challenges have been shown to have negative impacts on immigrant families’ mental and emotional health, family function, parenting practices and parents’ sense of competence. Parental support programmes have been shown to positively affect parental skills, strengthen the parent-child relationship, and promote the mental health of parents and children. However, universal parenting support programmes face challenges in reaching and retaining immigrant parents. In addition, there is limited knowledge on the effectiveness of parenting support programmes among immigrant Somali-born parents and their children. Aim: The overall aim of this thesis was to develop and evaluate the effectiveness of a culturally tailored parenting support programme (Ladnaan intervention) on the mental health of Somali-born parents and their children. A further aim was to explore the parents’ experience of such a support programme on their parenting practises. Methods: The thesis involved two explorative qualitative studies and one randomised controlled trial (RCT). Study I employed qualitative focus group discussions (FGDs) to explore Somali-born parents’ need for parenting support. Study II involved an RCT study in which 120 parents with children aged 11–16 years, and parents with self-perceived stress relating to their parenting were randomised to an intervention group or a wait-list control group. The Ladnaan intervention consisted of three components: societal information (two sessions), the Connect parenting programme (10 sessions), and a cultural sensitivity component. The Ladnaan intervention was delivered in the participants’ native language by group leaders of similar background and experience, and modifying the examples and role plays in the Connect programme. The primary outcome was a reduction in children’s emotional and behavioural problems as measured by the Child Behaviour Checklist 8-16. The secondary outcomes were improved mental health among parents, as assessed by the General Health Questionnaire (GHQ12); and greater sense ofparenting competence, as measured by the Parent Sense of Competence (PSOC) scale. Study III comprises a qualitative study using individual semi-structured interviews (conducted two months after the Ladnaan intervention) to explore parents’ experiences of participating in a culturally tailored parenting support programme. Results: The results in study I, shows that Somali-born parents encountered challenges in the host country, which impacted their confidence in parenting and the parent-child relationship. These challenges included insufficient knowledge of the parenting system and social obligations as a parent in the new host country. Other parental challenges in the host country included a stressful society, isolation, role changes, and parent-child power conflict. The Somali parents experienced opportunities to rethink and modify their parenting and strengthen their relationship with their children in the new country, but needed support from the local authority and others in these endeavours. In study II, the Ladnaan intervention showed that, according to the parents’ self-reports, children in the intervention group showed significantly decreased aggressive behaviour, social problems, attention problems, externalising ofbehavioural problems, and in total problems at the two-month follow-up. Moreover, parents in the intervention group showed significantly and clinically improved mental health and sense of competence in parenting at the two-month follow-up. The improved mental health of the parents could, in part, be explained by their satisfaction in parenting. In study III, parents who participated in the culturally tailored intervention programme reported that it enhanced their confidence in parenting and contributed to their ability to become emotionally aware and available for their children. The parents attributed this to the combination of societal information, the Connect programme, and the cultural sensitivity ofthe Ladnaan intervention, which were most supportive for their parenting. The culturally sensitive approach ofthe parenting programme (i.e., conducted in their native language by bicultural and bilingual group leaders) was viewed by the parents as valuable for their participation in the programme, as well as for modifying their parenting practices. Conclusion: The culturally tailored parenting support programme helped parents overcome transition challenges related to social obligation as parents in the host country, and to modify their parenting orientation and styles in the new country. Furthermore, it improved the parents’ mental health and sense of competence in parenting, as well as reduced their children’s behavioural problems. When tailoring and delivering a parenting support programme to immigrant parents it is crucial to consider their specific needs and preferences and to ensure that the programme is culturally sensitive. Such an approach is more likely to contribute to participants’ engagement, retention, and acceptance of the parenting programme; and also improve their parenting practices and strengthen parent-child relationship, leading to improvements in children’s behaviour and parents’ mental health.

Aim The aim of the present study was to examine the correlation between different types of perfectionism and perceived stress. The following issues were investigated: 1) Does dance teachers with higher levels of perfectionism also experience higher levels of stress? 2) Are there any differences between different types of perfectionism? 3) How much of the variation of perceived stress can be explained by variables such as age, experience and different types of perfectionism? Method In order to achieve the purpose of the study, a survey was conducted. The final selection consisted of 70 dance teachers with a mean age of 33.5 years. The survey content consisted of Multidimensional Perfectionism Scale (MPS; Hewitt &amp; Flett, 1991, 2004), which had 15 questions about each kind of perfectionism (SIP, AIP and SFP), and Perceived Stress Scale ((PSS-10; Cohen, S., Kamarck, T., &amp; Mermelstein, R. (1983), which consisted of 10 questions about perceived stress. The data was exported to SPSS. Then a correlation analyses, as well as a regression analysis was made. Results Strong positive relationships were seen between socially prescribed perfectionism (SPP) and perceived stress, as well as self oriented perfectionism (SOP) and perceived stress. SOP correlated with other oriented perfectionism (OOP), as well as with SPP. Higher-aged dance teachers estimated lower levels of SOP, SPP and perceived stress. SPP proved to be the strongest predictor on perceived stress. Conclusions Dance teachers with high levels of SPP and SOP seem to be more stressed. The older and more experienced the danceteachers were, the less perfectionist and stressed they were. The strongest predictor of stress was SPP. If you are interested in finding out which dance teachers (or teachers / coaches) are at greatest risk of stress, it may be important to investigate their levels of SPP. / Syfte och frågeställningar Studiens syfte var att undersöka sambandet mellan olika typer av perfektionism och stress bland danslärare i Sverige. Följande frågeställningar undersöktes: 1) Upplever mer perfektionistiska danslärare högre nivåer av stress? 2) Finns skillnader i upplevda stressnivåer mellan olika typer av perfektionism? 3) Hur stor del av variationen i upplevd stress kan förklaras av variabler som ålder, erfarenhet, och olika typer av perfektionism? Metod För att uppnå syftet med studien genomfördes en enkätundersökning. Det slutliga urvalet bestod av 70 danslärare med medelåldern 33,5 år. Enkätens innehåll bestod av Multidimensional Perfectionism Scale (MPS; Hewitt &amp; Flett, 1991, 2004)(se bilaga 4), som behandlar självinriktad (SIP)- annaninriktad (AIP)- och socialt föreskriven perfektionism (SFP) samt Perceived Stress Scale (PSS)(PSS-10; Cohen, S., Kamarck, T., &amp; Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 386-396.), med 10 frågor som behandlar upplevd stress. Datan exporterades till SPSS. Därefter gjordes en korrelationsanalys, samt en regressionsanalys. Resultat Starka positiva samband sågs mellan SFP och stress, samt SIP och upplevd stress. SIP korrelerade med AIP, samt SFP. Danslärare med högre ålder skattade lägre nivåer av SIP, SFP och upplevd stress. SFP var den starkaste prediktorn på upplevd stress. Slutsats Danslärare med höga nivåer av SFP och SIP verkar vara mer stressade. Ju äldre och mer erfarna danslärarna var, desto mindre perfektionistiska och stressade var de. Den starkaste prediktorn för stress var SFP. Är man intresserad över att ta reda på vilka danslärare (eller lärare/tränare) som löper störst risk för att bli stressade, kan det vara av stor vikt att undersöka och eventuellt förebygga deras nivåer av SFP.