This study was designed to further understand the psychosocial functioning of youth with chronic health conditions or physical disabilities, their need for and use of mental health services, and possible barriers to receiving needed services. Previous research has suggested these youth experience poorer psychosocial functioning compared to peers without special health care needs, and they also underutilize needed mental health services. A mixed-methods design was implemented consisting of a quantitative parent survey and a qualitative semistructured interview with young adults with special health care needs. Children demonstrating poorer psychosocial adjustment in this study experienced more problems related to social functioning than psychopathology (e.g., depression, anxiety). Over half of the youth had accessed mental health services with the majority utilizing community-based outpatient services. Identified barriers to accessing needed mental health services included difficulty finding professionals with experience in working with youth with special health care needs and lack of financial coverage.

This study sought to better understand the experiences of individuals with a chronic health condition utilizing telemedicine during the first twelve months of the COVID-19 pandemic. To do this, an online survey was advertised in two private Facebook support groups for individuals with adrenal insufficiency; a chronic health condition that requires frequent communication with healthcare providers. The survey consisted primarily of closed-response questions which examined the demographic data of respondents, their access to healthcare providers, their comfort levels accessing healthcare providers, and the number of times individuals sought healthcare during the first twelve months of the COVID-19 pandemic to try and predict their preference for telemedicine and in-person healthcare visits going forward. Additionally, the survey included open-response questions which allowed for respondents to describe their experience utilizing telemedicine during the first twelve months of the COVID-19 pandemic. Most respondents described their use of telemedicine as being positive but have indicated there are some health circumstances in which telemedicine may not be the best option for them. Additionally, findings indicate that individual's comfort level in visiting their healthcare providers in-person during that first year of the COVID-19 pandemic is a significant predictor of an individual's preference for telehealth. This gives future studies a starting point to investigate the driving social and health factors that shape an individual's perception of risk influencing their level of comfort and predicting their preference of telemedicine or in-person visits for their non-emergency healthcare needs.

Considering an individual’s day-to-day variability of activity-travel patterns will provide a more complete description of how an individual behaves to adapt the changing constraints and resources on different days. Without this day-to-day variability understanding, the individual’s behaviour would not be fully grasped and any suggested policy, planning and development would not completely achieve their desired objectives. The day-to-day behaviour is a subject to an interaction between individual’s needs and time-space constraints. The availability of ‘external’ resources (e.g., disposable income, built environment accessibility, and access to different travel mode/s) gives more opportunities for some individuals to participate in certain activities and/or trips than others. The constraints do not only consider budget and time constraints, but also include how an individual associates with other individuals and materials, and complies with any given authorities’ rules and regulations. The needs-constraints interaction also unveils some endogeneities which may not be captured by microeconomic and attitude theories. Failing to understand these interactions will underestimate the individual’s complex decision making process for performing certain behaviour. The constraints are not solely about physical constraints and instrumental factors, such as travel mode availability, time and cost. It is also influenced by individual’s non-instrumental variables, such as motivation, volition and habits. Currently there is a lack of knowledge how these non-instrumental variables are interacting and influencing the constraints to shape the individual’s travel behaviour. The implementation of certain activity-travel policy which only focuses in giving more opportunities to an individual within time and space resources without considering an individual’s attitude and/or habit may not be well accepted and followed by member of public. Moreover, the integration also reveals how an individual puts different priority on different potential activities based on the how an individual allocates/does not allocate time in engaging certain activities when having strong commitment and intention. In addition, including an individual’s health condition in the analysis may help in coordinating certain public health related policy with activity-travel policy. This thesis includes six papers which investigated the factors described above. The first three papers investigated how activity participation and built environment variables which can represent individuals’ constraints explain the day-to-day variability of individuals’ behaviours. Furthermore, the fourth and fifth paper explored the interaction between individuals’ time-use and activity participation, subjective characteristics and health factors. Lastly, the sixth paper examined how the time-space constraints and health condition explain the degree of variability in individuals’ multi-facet and multi-dimensional activity-travel patterns using sequential alignment method. / Genom att ta hänsyn till den dagliga variationen i en individs aktivitets- och resemönster erhålls en mer komplett bild av hur denna beter sig för att anpassa sig till ändrade begränsningar och resurser under olika dagar. Utan förståelse för denna dagliga variation kan inte individens beteende helt förstås och de föreslagna policyåtgärderna, planering eller utveckling skulle inte helt uppnå sina önskade mål. Det dagliga beteendet är föremål för en interaktion mellan å ena sidan individens behov och å andra sidan begränsningar i tid och rum. Tillgång till ”externa” resurser (exempelvis disponibel inkomst eller tillgång till olika färdmedel) påverkar möjligheterna för individer att delta i aktiviteter och/eller resor. Begränsningarna gäller inte bara monetär budget eller tid, utan inkluderar även exempelvis fysisk miljö, regler och förordningar samt hur en individ kan associera med andra individer. Växelverkan mellan behov och begränsningar belyser och klargör även endogenitet som inte självklart kan fångas av mikroekonomiska och attitydteorier. Att inte ta hänsyn till dessa interaktioner kan vara att underskatta individens komplexa beslutfattandeprocess. Tid- och rumsbegränsningarna handlar uteslutande om fysiska begränsningar och instrumentella faktorer, såsom färdmedelstillgänglighet, färdtid och färdkostnad. Individens beteende påverkas även av enskilda icke-instrumentella variabler, såsom motivation, vilja och vanor. Vi har idag bristande kunskap om hur dessa icke-instrumentella variabler interagerar med och påverkar begränsningar för att forma individens resebeteende. Genomförandet av viss aktivitets- och resepolicyåtgärder som bara fokuserar på att ge fler möjligheter till en individ inom tid- och rumsresurser, utan att också ta hänsyn individens attityder och/eller vana, kan försvåra allmänhetens acceptans.  Vidare, genom att inkludera en persons hälsotillstånd i analysen kan vi få ökade insikter hur vi kan samordna hälsorelaterade policyåtgärder med aktivitets- och resepolicyåtgärder. Denna avhandling innehåller sex artiklar som undersöker de faktorer som beskrivs ovan. De tre första artiklarna undersöker dels hur begränsningarna enligt ovan förklarar den dagliga variationen av en individs aktivitetsmönster och aktivitetsrum, dels samspelet mellan en aktivitets varaktighet, den erforderliga restiden och aktivitetsrummet. De fjärde och femte artiklarna undersöker samspelet mellan individens tid- och rumsbegränsningar, subjektiva egenskaper och hälsobegränsningar. Slutligen, i den sjätte artikeln undersöks med hjälp av en metod för sekventiell gruppering (sequential alignment) hur tidsbegränsning, rumsbegränsning och hälsotillståndet förklarar variationen i individers mångfacetterade och flerdimensionella aktivitets- och resemönster. / <p>QC 20151210</p>

The purpose of this research was to develop and test an instrument to measure or quantify the construct of inner strength. Inner strength was synthesized into a theory based on twelve years of qualitative data from direct participant quotes, defined by Roux et al. (2002) as a central human resource that promotes well-being and healing. The inner strength questionnaire (ISQ) has undergone extensive psychometric evaluation which resulted in several versions. The third version had 37-items and was believed to have four subscales that mirrored the theoretical themes that emerged through the qualitative data. The sample was composed of 281 women with a variety of chronic health conditions including breast cancer, multiple sclerosis, diabetes, and heart disease. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to assess the structure of the ISQ. Internal consistency was used to assess the reliability of each hypothesized subscale and the entire ISQ. Convergent and discriminant validity, were analyzed using the multitrait-multimethod by Campbell and Fiske (1959). For convergent validity, the entire instrument and each of the subscales was correlated with similar theoretical subscales of the Mastery of Stress Instrument (Younger, 1993). For discriminant validity, the Center for Epidemiological Studies in Depression (CESD) was correlated with the entire ISQ. Both the EFA and CFA revealed a four factor model. The four factors were labeled 1) mental, 2) connectedness, 3) knowing and searching, 4) physical. The reliability for all items on the ISQ was 0.91. The reliabilities for each of the subscales were 0.85 for mental, 0.96 for connectedness, 0.85 for knowing and searching, and 0.83 for physical. The multitrait-multimethod matrix revealed correlation coefficients for the relationship between the ISQ and MSI to be 0.55 and a correlation coefficient of -0.19 between the ISQ and the CESD.A four factor model is supported by the statistical data. Through face-to-face interviewing and input from content expert reviewers, ten items were eliminated from the 37-item (version 3) instrument to form a new version of the instrument. The new instrument supports the metasynthesis generated by Roux (2002) except for the fifth theme, entitled "new normal", which was found to be a consequence of having inner strength, not a component of inner strength.

O principal objetivo desse trabalho foi analisar a influência das condições ambientais na higidez das larvas de engraulidídeos da plataforma continental ao largo de Santos (24o49\'S - 23o49\'S e 46o55\'W - 45o24\'W). As coletas foram realizadas em dois cruzeiros oceanográficos (setembro de 2005 e março de 2006). Verificou-se diferença nas condições hidrográficas entre as duas campanhas de coletas, sendo que em setembro de 2005 houve maior influência de descarga de águas estuarinas na plataforma, enquanto em março de 2006 houve intrusão da Água Central do Atlântico Sul. As duas situações geraram estratificação vertical e favoreceram a entrada de nutrientes no sistema, o que gera enriquecimento da zona eufótica e beneficia as cadeias tróficas locais. Para avaliar a condição de higidez das larvas, foram utilizados indicadores morfológicos (relação massa-comprimento, fator de condição, altura do corpo da larva, relação entre altura da cabeça e diâmetro do olho) e bioquímicos (quantidade de proteína e relação proteína/DNA). Os indicadores apontaram melhor condição relativa, para as larvas coletadas em março de 2006, que pode ser conseqüência da ocorrência de uma intensa estratificação vertical na coluna de água e de uma maior estabilidade gravitacional em março de 2006, proporcionando maior concentração de nutrientes e ocasionando aumento na densidade e melhora na condição das populações planctônicas. / The aim of this study was to analyze influence of environmental conditions on health of engraulidid larvae of the continental shelf off Santos (24º49´S - 23º49´S e 46º55´W - 45º24´W). Samples were collected during two oceanographic cruises (September 2005 and March 2006). Differences among hydrographic conditions were verified between surveys: in September there was a major influence of the estuarine water discharge in the inner shelf, whereas in March there was an intrusion of the South Atlantic Central Water (SACW) in the region. The two conditions generated vertical stratification and improved the pelagic food web, in which fish larvae participate. Morphological (weight-length relation, condition factor, larvae body height, head height-eye diameter relation) and biochemical (protein quantity and protein/DNA relation) indicators were used to evaluate the larvae health condition. Results showed better relative condition of larvae collected in March 2006 that can be a consequence of the intense water column vertical stratification and gravitational stability in March 2006, providing higher nutrients concentration, increasing density of organisms and improving condition of planktonic populations.

O principal objetivo desse trabalho foi analisar a influência das condições ambientais na higidez das larvas de engraulidídeos da plataforma continental ao largo de Santos (24o49\'S - 23o49\'S e 46o55\'W - 45o24\'W). As coletas foram realizadas em dois cruzeiros oceanográficos (setembro de 2005 e março de 2006). Verificou-se diferença nas condições hidrográficas entre as duas campanhas de coletas, sendo que em setembro de 2005 houve maior influência de descarga de águas estuarinas na plataforma, enquanto em março de 2006 houve intrusão da Água Central do Atlântico Sul. As duas situações geraram estratificação vertical e favoreceram a entrada de nutrientes no sistema, o que gera enriquecimento da zona eufótica e beneficia as cadeias tróficas locais. Para avaliar a condição de higidez das larvas, foram utilizados indicadores morfológicos (relação massa-comprimento, fator de condição, altura do corpo da larva, relação entre altura da cabeça e diâmetro do olho) e bioquímicos (quantidade de proteína e relação proteína/DNA). Os indicadores apontaram melhor condição relativa, para as larvas coletadas em março de 2006, que pode ser conseqüência da ocorrência de uma intensa estratificação vertical na coluna de água e de uma maior estabilidade gravitacional em março de 2006, proporcionando maior concentração de nutrientes e ocasionando aumento na densidade e melhora na condição das populações planctônicas. / The aim of this study was to analyze influence of environmental conditions on health of engraulidid larvae of the continental shelf off Santos (24º49´S - 23º49´S e 46º55´W - 45º24´W). Samples were collected during two oceanographic cruises (September 2005 and March 2006). Differences among hydrographic conditions were verified between surveys: in September there was a major influence of the estuarine water discharge in the inner shelf, whereas in March there was an intrusion of the South Atlantic Central Water (SACW) in the region. The two conditions generated vertical stratification and improved the pelagic food web, in which fish larvae participate. Morphological (weight-length relation, condition factor, larvae body height, head height-eye diameter relation) and biochemical (protein quantity and protein/DNA relation) indicators were used to evaluate the larvae health condition. Results showed better relative condition of larvae collected in March 2006 that can be a consequence of the intense water column vertical stratification and gravitational stability in March 2006, providing higher nutrients concentration, increasing density of organisms and improving condition of planktonic populations.

Baksidestext Barnmisshandel är ett omfattande folkhälsoproblem med långsiktiga negativa konsekvenser för den enskilda individen och för samhället i stort. Förebyggande insatser kan vara livsavgörande för de utsatta barnen. Denna avhandlings övergripande syfte var att öka kunskapen om barn som riskerar att fara illa i sin hemmiljö samt att identifiera utmaningar i ett förebyggande perspektiv. Två områden har studerats: (1) Våld mot barn med långvarig sjukdom/funktionsnedsättning (2) Förskolan som upptäckande och stödjande arena Gemensamt för inriktningarna är att barn med långvarig sjukdom/funktionsnedsättning och barn i förskoleåldern utgör särskilt sårbara grupper, som löper ökad risk att fara illa i sin hemmiljö. De har också unik kontakt med professionella med möjlighet att upptäcka och agera vid oro. Avhandlingen bygger på fyra delstudier; en nationell kartläggning riktad till skolelever, en intervjustudie med föräldrar samt två förskolestudier. Resultaten från studierna diskuteras utifrån identifierade utmaningar i ett förebyggande perspektiv. Utmaningarna inkluderar emotionella hinder samt behov av ett mer nyanserat och proaktivt förhållningssätt för att kunna utveckla tidiga insatser till barn och föräldrar. / The aim with this thesis was to increase the knowledge about children at risk of maltreatment and to identify challenges in a preventive perspective. Two areas have been studied; Physical abuse of children with chronic conditions/disabilities and Detection and support within the pre-school environment.  Four data sets were used: a national survey of school children (I), an in-depth interview study with parents (II) and two pre-school studies (III, IV). I-II: Chronic conditions in children increase the risk for physical abuse, but vary with socio-economic circumstances. The highest risk for physical abuse was found among children with chronic conditions born outside Sweden. The subsequent study revealed direct risk factors related to parent and child (emotional demands in precarious situations), and indirect risk factors related to parent and professional (gradual shift in responsibility and emotionally closed environment) and social norms (taboo on talking about abuse). III-IV: Preschool staff suspected child maltreatment for two percent of the preschool children. In less than half of the cases, the parents were informed and a report to social services was made in a third of the cases. The most common reason for not making a report was that the staff believed that the pre-school had sufficient resources to help the child. In the subsequent study, preschool teachers’ concerns about the child’s home environment were explored in a broader perspective over a one year period. The study showed that concern for the children’s home situation related to increased concern for several aspects of children’s health and development, increased need of special support in preschool, insufficient contact with parents, and lower parental socioeconomic status. The results are discussed according to identified challenges in a preventive perspective. These include emotional obstacles for prevention and a need for a more nuanced and proactive professional approach to enable early support to children at risk of maltreatment and their parents.

The purpose of this study was to evaluate the utility of the Adaptive Tasks Framework for assessing parental needs when providing primary care for their child with a chronic health condition. A qualitative descriptive methodology framed the study and two methods were employed to collect data: a secondary analysis of existing interview data from seven parents of children with chronic health conditions and interviews with four parents who were currently providing primary care for their child with a chronic health condition. The data was analyzed using content analysis, whereby interview data was explored to determine if it fit into one or more of the eight adaptive tasks categories. Parents reported needs in all of the eight adaptive tasks categories, with the need for information regarding their child's chronic health condition being the foremost concern among parents. The need for caring, empathetic, and patient health care professionals who are sympathetic to the informational needs of parents, while at the same time acknowledging their expertise, was the second need expressed by the parents in this study. Implications of these findings for nurses is that the Adaptive Tasks Framework provides a useful tool for assessing parental needs when managing their child's chronic health condition and for determining areas in which the parents may require support.

The purpose of this study was to evaluate the utility of the Adaptive Tasks Framework for assessing parental needs when providing primary care for their child with a chronic health condition. A qualitative descriptive methodology framed the study and two methods were employed to collect data: a secondary analysis of existing interview data from seven parents of children with chronic health conditions and interviews with four parents who were currently providing primary care for their child with a chronic health condition. The data was analyzed using content analysis, whereby interview data was explored to determine if it fit into one or more of the eight adaptive tasks categories. Parents reported needs in all of the eight adaptive tasks categories, with the need for information regarding their child's chronic health condition being the foremost concern among parents. The need for caring, empathetic, and patient health care professionals who are sympathetic to the informational needs of parents, while at the same time acknowledging their expertise, was the second need expressed by the parents in this study. Implications of these findings for nurses is that the Adaptive Tasks Framework provides a useful tool for assessing parental needs when managing their child's chronic health condition and for determining areas in which the parents may require support.

Longevity of cows in a large scale production technology affects the drove turnover and raising economy. Another important elements in a good raising economy are reproduction and performance. The goal of the research was to find out the health conditions of cows, their reproduction and longevity. The research took place in ZOD Kolný. Milk efficiency, reproduction, health condition and selection of animals were monitored on 330 cows from race Holštýn and Česká straka in 2006-2007. Obtained data have been processed by variance analysis and correlation analysis in Microsoft Excel programme. Dairycows were stabled in a free box stable. The basic feed ration was canned roughage with a pithy supplement. We have observed teh health condition of dairycows, causes of setting cows aside, longevity, servis period, between-calving interval and efficiency. The average data were compared in the light of lactation lactation. Obtained data were also compared with records from the Czech republic. The research has found out that in a dairycow drove with average efficiency 7 584,5 kg there have been 3583 veterinary interventions executed on 270 monitored cows, but 3322 from that have been interventions related to reproduction failures. The whole number of dairycows set aside while researching was 142. The main causes of settin cows aside were the reproduction failures(13,03%) and the lacteal gland inflamations (7,8%). The age analysis has shown that only 24,2% of cows are on 4th and higher lactation. Most cows are on the 2nd lactation (100 heads). There we could see the heads descent ply down to the 8th lactation, were there are only 3 dams. The average servis period was 167,03 days. There were over 85% of dairycows with unsatisfactory servis period (over 75 days). 58,14% of dairycows got over 120 day limit. These data in comparison with the whole czech rate, where the servis period is 125,8 days, show the servis period 41,5 days longer. The average interval lenght was 42,7 days, which is 17,3 days longer than the republic average in 2006. Economical deprivation caused by the servis period prolongation were 3921,26 Kč per cow. Altough the profit with 104 Kč spending on one day was along with average milk yield 7 548,50 Kč 39 789,55 Kč per caw per year. So if a cow with an average milk eficiency (consodering it´s lactation) would live until the 7th lactation, it will earn 289 323,30 Kč in it´s whole life.