One in nine North American women will be diagnosed with breast cancer in their lifetime and most will receive chemotherapy as part of their treatment. Although advances in treatment have increased survivorship, some research suggests chemotherapy results in cognitive deficits in a subset of recipients, a condition known as chemo-fog, thereby compromising quality of life. However, inconsistencies in methodology and neuropsychological assessment have complicated comparison of findings. The first objective of this thesis was to review the methodological issues with an emphasis on the quantitative techniques typically employed. A comparison of group and individual based analyses found negligible effects for both univariate and multivariate approaches while individual based analyses identified severe declines in function in a subset of participants. A standardized-regression based (SRB) approach was recommended as the method of choice. Furthermore, it was recommended that the number of tests be limited since comprehensive batteries can complicate identification due to increased risk of misclassification. Therefore, the second goal of the thesis was to evaluate the sensitivity of a reduced battery to the declines associated with chemo-fog. A comprehensive neuropsychological battery comprising 23 tests was compared to a subset of nine tests. SRB analyses demonstrated that a more selective battery was equally useful and may be appropriate for identification of chemo-fog. Given the variability in the composition of neuropsychological test batteries, the final aim of this thesis was to compare the structure of the theoretical cognitive domains with ones identified through exploratory factor analyses (principle axis factoring) to evaluate the convergence between the two. The results demonstrated there is statistical support for the conceptual framework that underlies the composition of the domains. The contributions of this thesis include providing methodological guidelines for those conducting future research in this area to ensure that results are comparable across studies and are meaningful, and evaluating the utility of a screening battery to facilitate identification of chemo-fog. In addition, it was demonstrated that despite the lack of professional guidelines informing the selection and construction of neuropsychological test batteries, there is statistical evidence to support the practice of grouping tests into domains based on theoretical grounds.

One in nine North American women will be diagnosed with breast cancer in their lifetime and most will receive chemotherapy as part of their treatment. Although advances in treatment have increased survivorship, some research suggests chemotherapy results in cognitive deficits in a subset of recipients, a condition known as chemo-fog, thereby compromising quality of life. However, inconsistencies in methodology and neuropsychological assessment have complicated comparison of findings. The first objective of this thesis was to review the methodological issues with an emphasis on the quantitative techniques typically employed. A comparison of group and individual based analyses found negligible effects for both univariate and multivariate approaches while individual based analyses identified severe declines in function in a subset of participants. A standardized-regression based (SRB) approach was recommended as the method of choice. Furthermore, it was recommended that the number of tests be limited since comprehensive batteries can complicate identification due to increased risk of misclassification. Therefore, the second goal of the thesis was to evaluate the sensitivity of a reduced battery to the declines associated with chemo-fog. A comprehensive neuropsychological battery comprising 23 tests was compared to a subset of nine tests. SRB analyses demonstrated that a more selective battery was equally useful and may be appropriate for identification of chemo-fog. Given the variability in the composition of neuropsychological test batteries, the final aim of this thesis was to compare the structure of the theoretical cognitive domains with ones identified through exploratory factor analyses (principle axis factoring) to evaluate the convergence between the two. The results demonstrated there is statistical support for the conceptual framework that underlies the composition of the domains. The contributions of this thesis include providing methodological guidelines for those conducting future research in this area to ensure that results are comparable across studies and are meaningful, and evaluating the utility of a screening battery to facilitate identification of chemo-fog. In addition, it was demonstrated that despite the lack of professional guidelines informing the selection and construction of neuropsychological test batteries, there is statistical evidence to support the practice of grouping tests into domains based on theoretical grounds.

One in nine North American women will be diagnosed with breast cancer in their lifetime and most will receive chemotherapy as part of their treatment. Although advances in treatment have increased survivorship, some research suggests chemotherapy results in cognitive deficits in a subset of recipients, a condition known as chemo-fog, thereby compromising quality of life. However, inconsistencies in methodology and neuropsychological assessment have complicated comparison of findings. The first objective of this thesis was to review the methodological issues with an emphasis on the quantitative techniques typically employed. A comparison of group and individual based analyses found negligible effects for both univariate and multivariate approaches while individual based analyses identified severe declines in function in a subset of participants. A standardized-regression based (SRB) approach was recommended as the method of choice. Furthermore, it was recommended that the number of tests be limited since comprehensive batteries can complicate identification due to increased risk of misclassification. Therefore, the second goal of the thesis was to evaluate the sensitivity of a reduced battery to the declines associated with chemo-fog. A comprehensive neuropsychological battery comprising 23 tests was compared to a subset of nine tests. SRB analyses demonstrated that a more selective battery was equally useful and may be appropriate for identification of chemo-fog. Given the variability in the composition of neuropsychological test batteries, the final aim of this thesis was to compare the structure of the theoretical cognitive domains with ones identified through exploratory factor analyses (principle axis factoring) to evaluate the convergence between the two. The results demonstrated there is statistical support for the conceptual framework that underlies the composition of the domains. The contributions of this thesis include providing methodological guidelines for those conducting future research in this area to ensure that results are comparable across studies and are meaningful, and evaluating the utility of a screening battery to facilitate identification of chemo-fog. In addition, it was demonstrated that despite the lack of professional guidelines informing the selection and construction of neuropsychological test batteries, there is statistical evidence to support the practice of grouping tests into domains based on theoretical grounds.

One in nine North American women will be diagnosed with breast cancer in their lifetime and most will receive chemotherapy as part of their treatment. Although advances in treatment have increased survivorship, some research suggests chemotherapy results in cognitive deficits in a subset of recipients, a condition known as chemo-fog, thereby compromising quality of life. However, inconsistencies in methodology and neuropsychological assessment have complicated comparison of findings. The first objective of this thesis was to review the methodological issues with an emphasis on the quantitative techniques typically employed. A comparison of group and individual based analyses found negligible effects for both univariate and multivariate approaches while individual based analyses identified severe declines in function in a subset of participants. A standardized-regression based (SRB) approach was recommended as the method of choice. Furthermore, it was recommended that the number of tests be limited since comprehensive batteries can complicate identification due to increased risk of misclassification. Therefore, the second goal of the thesis was to evaluate the sensitivity of a reduced battery to the declines associated with chemo-fog. A comprehensive neuropsychological battery comprising 23 tests was compared to a subset of nine tests. SRB analyses demonstrated that a more selective battery was equally useful and may be appropriate for identification of chemo-fog. Given the variability in the composition of neuropsychological test batteries, the final aim of this thesis was to compare the structure of the theoretical cognitive domains with ones identified through exploratory factor analyses (principle axis factoring) to evaluate the convergence between the two. The results demonstrated there is statistical support for the conceptual framework that underlies the composition of the domains. The contributions of this thesis include providing methodological guidelines for those conducting future research in this area to ensure that results are comparable across studies and are meaningful, and evaluating the utility of a screening battery to facilitate identification of chemo-fog. In addition, it was demonstrated that despite the lack of professional guidelines informing the selection and construction of neuropsychological test batteries, there is statistical evidence to support the practice of grouping tests into domains based on theoretical grounds.

Anderberg, Mats & Dahlberg, Mikael (2009). Strukturerade intervjuer inom missbruksvården – som en grund för kunskapsutveckling (Structured interviews in substance abuse treatment - as a foundation for the development of knowledge).   In the discussion on knowledge development in social work, structured interviews have attracted an increasing amount of attention. The aim of this thesis is to examine and analyze how structured interviews can serve as a basis in the compilation and development of knowledge for practice and research in addiction treatment. More precisely, it means a problematization of the methodological issues that are of central importance in studying treatment outcomes, in which structured interviews form the basis. The methodological aspects in focus here are scientific concepts such as reliability, validity and specific factors in the evaluation of treatment interventions. A further objective is to outline a model for analysis when compiling and evaluating treatment outcome. The five empirical studies have been conducted in their natural context, in organisations in which structured interviews with clients are carried out as an everyday routine and used for e.g. treatment planning. The structured interview DOK (a Swedish abbreviation for Documentation of clients) is used as a basis and an example for the empirical studies in this thesis. The validation studies show that the DOK interview generally attains a good level of reliability and validity, but also contains a small number of variables that do not live up to the requirements which may be imposed. Deficiencies in operationalization and question construction seem to have a large impact. Another conclusion is that it is possible to carry out validation studies, where each variable is examined separately and evaluated with the aid of both sound methodological starting points and relevant statistical theory. Another of the central questions, the thesis addresses, is how structured interviews can be used as a basis for evaluation of treatment. The two studies which highlight this issue show that it is obvious that structured interviews are suitable for such a purpose, through its standardized form and multi-dimensional nature. Validation of structured interviews or evaluation of social interventions should not be reduced to single numbers or values. The multidimensional nature of the structured interview shall also be reflected in the results and analysis. The thesis presents an analysis model for evaluating treatment outcome in relation to two empirical examples and foregoing theoretical starting points. Our view is that structured interviews can provide a link between practice and research and thus contribute to the development of knowledge in social work and substance abuse treatment.

Asthma and allergies have increased considerably during the past 40-50 years. Along with this increase, a heightened awareness regarding different neuro-developmental disorders such as autism spectrum disorder has occurred and it has been proposed that such disorders are also on the increase. It has been suggested that environmental factors, especially in the indoor environments, may be associated with the increase in these disorder, especially among children, who spend more than 90% of their time indoors. The aim of this thesis has been to investigate certain environmental factors in homes and their impact on children’s health, in terms of asthma, rhinitis, eczema as well as autism spectrum disorders, and to identify certain methodological difficulties in epidemiological investigations. We found that the mean incidence rate per year for doctor diagnosed asthma was in the range of 0.6-2.4% and for incidence of rhinitis 1.1-3.7%. The incidence rate of eczema ever was 2.7%. These results showed that when using a cohort established after birth the estimated incidence rates are strongly dependent of how the baseline population’s health and how the studied health outcome at follow up is defined. Our results showed that the associations between parental reported moisture problems in the home and asthma in children that were revealed in cross-sectional analyses decreased or disappeared when longitudinal data were used on the same data set. Our results therefore indicate that associations between parental reported moisture problems and asthma from cross-sectional questionnaire studies should be interpreted with caution due to the risk for reporting bias. Our results show that children who were living in homes with PVC-flooring in the bedroom in early childhood were more likely to develop asthma during the following 5-year period when compared with children living in homes without such flooring material. A similar association could be seen for children with autism spectrum disorder, where PVC-flooring in early childhood was associated with more reports of autism spectrum disorder five years later. These results indicate that building materials including suspected endocrine disrupting chemicals such as phthalates might be of importance for the development of these chronic diseases. Further studies are needed to explore the early life exposure and the mechanisms and contribution of phthalates for the development of chronic diseases. / Appendix A (en undersökning) och Appendix B (en undersökning)finns i den tryckta versionen av avhandlingen

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

La présente thèse poursuit l'objectif général de mieux comprendre l'expérience de la transplantation d'organe de la perspective de dyades comprenant un donneur et un receveur d'une donation vivante de rein. Pour ce faire, nous proposons une exploration en profondeur de la trajectoire de transplantation et des enjeux relationnels des donneurs et des receveurs. Un second objectif, qui s'est développé au cours de la recherche, est de contribuer à une meilleure compréhension des enjeux entourant la recherche qualitative impliquant des dyades. Cette thèse est présentée sous la forme de trois articles. Le premier article vise, par le biais de la méthode du méta-résumé, à dresser un portrait le plus complet possible du processus de donation tel qu'il avait été examiné à ce jour par les écrits empiriques qualitatifs disponibles, et à mettre en lumière les aspects qui avaient encore peu été appréhendés par les chercheurs, notamment l'importance de considérer conjointement au sein d'une même recherche des donneurs et des receveurs d'une donation vivante de rein. Le deuxième article a pour but d'explorer en profondeur l'expérience vécue pour des dyades de donneurs et de receveurs en contexte de donation vivante de rein, et en particulier la trajectoire de transplantation ainsi que les enjeux relationnels. Des entrevues qualitatives ont été menées auprès de cinq dyades (donc cinq donneurs et cinq receveurs). L'analyse phénoménologique interprétative des données recueillies propose un portrait de la trajectoire de transplantation, soit (a) l'expérience de la maladie du receveur, (b) l'expérience d'offrir et d'accepter un rein, (c) la période des tests, (d) la transplantation d'organe à proprement parler et finalement (e) la période post-transplantation. Un apport particulièrement significatif de l'analyse et de l'interprétation de nos données est la mise en relief que le processus de transplantation est mieux compris lorsque l'on considère le contexte social et interpersonnel plus large dans lequel évolue chaque dyade donneur-receveur, et en ce sens, la décision de donner ou d'accepter un rein peut être appréhendée comme un prolongement du rôle social auquel la personne adhère par rapport à autrui dans sa vie quotidienne. Le troisième article, qui a émergé des leçons acquises en réalisant la recherche effectuée dans l'article précédent, vise à décrire et discuter des défis éthiques et des impacts des décisions méthodologiques dans le cadre de recherches qualitatives impliquant des dyades de personnes se connaissant. Sur la base de nos propres défis empiriques et des écrits scientifiques disponibles, des réflexions et recommandations sont suggérées à différents stades d'un processus typique de recherche qualitative, soit (a) le recrutement, (b) le consentement à participer, (c) la collecte de données, (d) la validation des transcriptions par les participants, (e) l'analyse de données, et (f) la dissémination des résultats. Une réflexion en amont des enjeux entourant ces étapes est susceptible de faciliter l'entreprise de recherches qualitatives impliquant des dyades. En conclusion, les résultats de notre analyse soulignent l'importance du rôle social et du contexte interpersonnel plus large dans lequel évoluent les donneurs et les receveurs dans la façon dont ils parviennent à donner une signification à leur expérience. Enfin, si la recherche qualitative impliquant des dyades est en émergence, des défis éthiques et des décisions méthodologiques rigoureuses doivent être considérés en amont. / The global objective of this thesis is to help develop a better understanding of how living kidney transplantation donors and recipients experience the donation process as an interactive dyad. To address this objective, we suggest an in-depth exploration of the transplant trajectory and of the relational issues at play between donors and recipients in the context of a living kidney donation. A secondary objective, which developed along the way, is to contribute to a better understanding of how to conduct qualitative research with dyads. This thesis is comprised of three articles. The first article is a meta-summary that aimed at aggregating results pertaining to both donors and recipients of a living kidney donation to offer a complete picture of the donation process and to highlight avenues that warrant further research, namely looking at both donors and recipients as an interactive dyad within the same study. The objective of the second article was to provide a better understanding of how living kidney transplantation donors and recipients experience the donation process as an interactive dyad, and in particular the transplant trajectory and the relational issues involved. In-depth qualitative interviews were conducted with five dyads (five donors and five recipients). An interpretative phenomenological analysis of the data suggests that the transplant process can be naturally broken down into five phases of the transplant process: (a) the experience of the disease, (b) the experience of offering and accepting a kidney, (c) the screening period, (d) the surgery, and (e) the post-transplantation period. We found that for each donor-recipient dyad, the transplantation process reflects the unique larger social and interpersonal context within which the dyad evolves, and in this sense, the decision to donate or accept a kidney becomes a reflection of the social role one adheres to with respect to another being in everyday life. The third article emerged from the lessons we learned in conducting the research described in the second article and describes both the ethical challenges and methodological decisions involved in conducting qualitative research with dyads who have shared a common experience. Based on our experience and on the available literature, we offer reflections and recommendations that follow the typical chronology of the research process: (a) recruitment, (b) consent to participation, (c) data collection, (d) transcript validation by participants, (e) data analysis, and (f) result dissemination. Reflecting ahead upon issues at each of these stages is likely to be beneficial in conducting rigorous qualitative research involving dyads. In conclusion, our results underline the importance of the unique larger social and interpersonal context within which dyads evolve and achieve a sense of meaning with respect to their own experience of the donation process. Last, as qualitative research involving dyads continues to evolve, ethical challenges and rigorous methodological decisions should be reflected upon ahead of time.