Orientador: Wilza Carla Spiri / Resumo: Objetivo: Compreender o significado do uso dos sistemas de classificação de pacientes como ferramenta gerencial para os gestores de enfermagem psiquiátrica e avaliar as características psicométricas do Sistema de Classificação de Pacientes Psiquiátricos – versão 2. Método: Estudo multimétodo sendo o delineamento qualitativo para a compreensão do significado, coleta de dados por meio de entrevistas semiestruturadas áudio gravadas e referencial metodológico da Análise de Conteúdo, já o delineamento de estudo metodológico foi utilizado para avaliar as características psicométricas através da Técnica Delphi com análise estatística. Participaram 10 gerentes de enfermagem de instituições psiquiátricas do Estado de São Paulo e 60 juízes especialistas. Utilizou-se o software NVivo para auxílio na análise das entrevistas e opiniões dos juízes e o software R Core Team para a análise estatística. A coleta de dados foi realizada entre agosto/2016 e maio/2017. Resultados: Quanto aos gerentes, a amostra constituiu-se de nove mulheres e um homem, com 14 anos de experiência em saúde mental e que estavam há quase sete anos no referido cargo na atual instituição. O ambiente do cuidado psiquiátrico emergiu como tema geral cercado por quatro subtemas: modelo atual de tomada de decisão, modelo ideal de tomada de decisão, dimensionamento de enfermagem, legislação profissional e de saúde mental. Apenas metade dos gerentes utilizaram um sistema de classificação de pacientes como ferramenta gerencial... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To understand the meaning of using patient classification systems as a managerial tool for psychiatric nursing managers and to evaluate the psychometric characteristics of the Psychiatric Patient Classification System - version 2. Method: Multi-method study used or qualitative quality design of the meaning, data collection through recorded semi-structured audio interviews and methodological references of Content Analysis, already outlining methodological studies used to evaluate how psychometric characteristics applied by the Delphi Technique with Statistical Analysis. Participated 10 managers of psychiatric nursing institutions in the State of São Paulo and 60 expert judges. The N-Vivo software was used to aid in the analysis of interviews and judges' opinions and the R Core Team software for statistical analysis. Data collection was carried out between August 2016 and May 2017. Results: As for the managers, a sample composed of nine women and one man, with 14 years of experience in mental health and who were almost seven years without a load at the current institution. The emerging psychiatric care environment as the general theme surrounded by four sub-themes: current decision model, ideal decision model, nursing dimension, professional legislation and mental health. Only half of the managers used a patient classification system as a management tool and as practices are still used without empiricism. As for the panel of judges, a sample composed of 14 documents,... (Complete abstract click electronic access below) / Doutor

Hintergrund: Das Informationsbedürfnis zählt zu den wichtigsten Bedürfnissen von Melanom-Patienten (MP). Diesem zu entsprechen und Patienten adäquat über ihren gesundheitlichen Zustand zu informieren, ist daher auch eine der wichtigsten supportiven Maßnahmen der Krebstherapie. Über die eigene Situation konkret Bescheid zu wissen, trägt dazu bei, Angst zu reduzieren, das persönliche Krankheitskontrollgefühl zu erhöhen sowie die Erkrankung besser bewältigen zu können. In Konsequenz ist die Zufriedenheit und Lebensqualität bei Krebspatienten höher, die sich gut aufgeklärt fühlen. Dennoch bleibt das Informationsbedürfnis häufig auch unerfüllt. Primäre Informationsquelle für Krebspatienten in Deutschland ist das persönliche Gespräch mit dem Arzt oder der Ärztin. Ist die Zeit für Arzt-Patienten- Gespräche jedoch knapp und/oder werden viele (medizinische) Informationen auf einmal vermittelt, ist es möglich, dass sich die Patienten überfordert und anschließend nicht angemessen informiert fühlen. Krebs- und so auch MP, nutzen verschiedene weitere Informationsquellen um Informationsdefizite auszugleichen. Trotz der steigenden Bedeutung des Internets, variieren Nutzung und Präferenzen der Informationsquellen mit Patientensubgruppen – so u.a. mit dem Alter, dem Bildungsstatus, dem sozio-ökonomischen Status, der Nationalität und dem generellen Bedarf nach umfassender Aufklärung über den eigenen Gesundheits- und Behandlungsstand. Analog variieren Inhalte und Umfang der Informationsbedürfnisse von MP u.a. mit dem Geschlecht, dem Alter, dem Stadium im Verlauf der Tumorerkrankung und der Erkrankungsschwere. An Primärdaten aus Deutschland fehlt es jedoch bislang. Zudem werden auch die spezifischen Bedürfnisse von MP mit Metastasen in der Literatur nur unzureichend abgedeckt. Um die Informationsbereitstellung und -versorgung von MP in Deutschland optimieren sowie bedarfsgerechter gestalten zu können, ist es grundlegend deren Informationsbedarf und Informationsverhalten zu kennen. Fragestellung: Ziel der vorliegenden Untersuchung war es, a) die Informationsbedürfnisse von MP in Deutschland (und deren Subgruppen) sowie b) die durch sie bevorzugten Informationsquellen explorativ zu ermitteln. Es sollten Ansatzpunkte für Optimierungen bei der Informationsversorgung, insbesondere im Hinblick auf mediale Neu- oder Weiterentwicklungen aufgezeigt werden. Methodik: Zwischen Juli und Oktober 2016 wurde an insgesamt 27 zertifizierten deutschen Hauttumorzentren eine multizentrische (Querschnitts-)Befragung unter MP durchgeführt. MP konnten daran teilnehmen, wenn sie mindestens 18 Jahre alt und der deutschen Sprache mächtig waren. Patienten, die während des Befragungszeitraums eines der Hauttumorzentren besuchten, wurden konsekutiv zur Teilnahme eingeladen. Für die Befragung wurde ein eigens entwickelter, standardisierter Papierfragebogen genutzt, der kollektiv mit Patienten deutscher Hautkrebsselbsthilfegruppen, medizinischem sowie Sozialwissenschaftlichem Personal entwickelt wurde. Ein Pretest der präfinalen Version erfolgte mit zwanzig MP am Hauttumorzentrum Dresden. Die Auswertung der Daten erfolgte mittels SPSS (Version 23). Um Subgruppenunterschiede bei den Informationsbedürfnissen sowie dem Informationsverhalten zu ermitteln, wurde für kategoriale Variablen der Chi² Unabhängigkeitstest und für metrische Variablen der nichtparametrische U-Test nach Mann-Whitney bzw. der Kruskal-Wallis-Test angewandt. Die binär logistische Regression wurde angewandt, um Prädiktoren für a) die Präsenz unerfüllter Informationsbedürfnisse, b) die Zufriedenheit mit dem eigenen Informationsstand sowie c) die Präferenzen verschiedener medialer Informationsquellen (Internet, Broschüren, TV/Videos, Journale/Magazine) zu ermitteln. Die statistische Signifikanz für alle Tests wurde für p < 0.05 festgelegt. Ergebnisse: Insgesamt 542 Melanom-Patienten nahmen an der Befragung teil. Die Daten von 529 Patienten (Response-Rate: 54%) konnten ausgewertet werden. Von den Teilnehmern waren 56% männlich, 61% älter als 55 Jahre, 67% waren von Metastasen betroffen (klinisches Stadium III oder IV), 49% erhielten zum Befragungszeitpunkt eine medizinische Behandlung und 47% befanden sich in der Nachsorge. 14% der MP wurden stationär und 83% ambulant betreut. Informationsbedarf: 69% der Befragten gaben an, sich generell so viele Informationen wie möglich über ihre Erkrankung und deren Behandlung zu wünschen und 78% gaben an sehr oder eher zufrieden mit dem eigenen Informationsstand zu sein. Gleichzeitig äußerten 55% der Befragten jedoch auch, weiteren Informationsbedarf zu haben. Am wenigsten fühlten sich die MP über psychosoziale Unterstützungsmöglichkeiten (24-31% kaum oder gar nicht) informiert. Am häufigsten (von jeweils 35%) wurden sich mehr Informationen zum voraussichtlichen Krankheitsverlauf, Behandlungsoptionen und Heilungschancen gewünscht. Den höchsten Informationsbedarf gaben MP mit Tumorprogression an. Außerdem berichteten MP < 55 Jahren signifikant häufiger als ältere MP (63% vs. 50%; p = .003) weiteren Informationsbedarf zu verschiedenen Aspekten der Erkrankung, ebenso wie MP die sich aktuell in Behandlung befanden im Vergleich zu Nachsorgepatienten (63% vs. 47%; p < .001). Die binäre Regressionsanalyse ergab u.a., dass die Wahrscheinlichkeit unerfüllte Informationsbedürfnisse zu haben bei MP, die sich generell viele Informationen wünschten, um 2.4 Mal höher war als bei denen, die sich durch viele Informationen eher überfordert fühlten. Subguppenunterschiede zeigten sich zudem bei den inhaltlichen Präferenzen, so z.B. wünschten sich Frauen und MP < 55 Jahren häufiger Informationen zu psychologischer Unterstützung als Männer (28% vs. 15%; p < .001) und MP ≥ 55 Jahre (25% vs. 17%; p = .038). Informationsverhalten: 81% der Befragten nutzten am häufigsten das persönliche Gespräch mit dem Arzt/der Ärztin um sich über ihre Erkrankung zu informieren. 58% wünschten sich von diesem jedoch auch Empfehlungen zu Informationsquellen, die sie außerhalb der Klinik nutzen können. Das Internet (63%) und Patientenbroschüren (58%) wurden am häufigsten als erst- oder zweitwichtigstes Medium für die indikationsbezogene Informationsbeschaffung angegeben. Die Angebote von Selbsthilfegruppen und Krebsberatungsstellen wurden nur durch 8 bzw. 12% jemals oder überhaupt genutzt. Als Prädiktoren für die präferierte Internetnutzung erwiesen sich das Alter < 55 Jahre, ein höherer Bildungsabschluss, ein generell hoher Informationsbedarf sowie Unwissenheit über den eigenen, aktuellen Stand der Erkrankung. Audiovisuelle Medien wurden hingegen von MP mit geringeren Bildungsabschlüssen präferiert. Schlussfolgerungen: Die Ergebnisse sensibilisieren dafür, welche Inhalte MP deutscher Hauttumorzentren primär interessieren, welche Defizite bei der Informationsversorgung aktuell bestehen und welche Inhalte für bestimmte Subgruppen wichtig sind. Diese Kenntnisse sind für die Führung von Arzt-Patienten-Gesprächen wichtig. Zum anderen liefern sie wichtige Anhaltspunkte für die inhaltliche Ausgestaltung bedarfsgerechter Informationsangebote. Die Ermittlung der wichtigsten medialen Informationsquellen ist richtungsweisend für künftige Entwicklungen im Bereich der Medien zur Informationsversorgung von MP. Den Gründen für die geringe Inanspruchnahme der Angebote von Selbsthilfegruppen und Krebsberatungsstellen durch MP sollte weiter nachgegangen werden, da beide Institutionsformen wichtige, unterstützende, supplementäre Angebote zur klinischen Versorgung darstellen.:Abkürzungen 4 1. Einführung in die Thematik 5 1.1 Wissenschaftliche Ausgangssituation 6 1.1.1 Verbreitung des Melanoms in Deutschland 6 1.1.2 Forschungsstand zu Informationsbedürfnissen von Melanom-Patienten 7 1.1.3 Forschungsstand zum Informationsverhalten von Melanom-Patienten 8 1.2 Theoretischer und wissenschaftlicher Ansatz der eigenen Arbeiten 9 1.2.1 Fragebogenentwicklung 9 1.2.2 Studiendurchführung 10 1.2.3 Datenauswertung 10 1.3 Erarbeitete wissenschaftliche Ergebnisse 11 1.3.1 Charakteristika der teilnehmenden Melanom-Patienten 11 1.3.2 Informationsstand der Patienten zu verschiedenen Aspekten ihrer Erkrankung 11 1.3.3 Zufriedenheit mit dem eigenen Informationsstand 11 1.3.4 Präsenz unerfüllter Informationsbedürfnisse 12 1.3.5 Inhaltliche Informationsbedürfnisse und -präferenzen 12 1.3.6 Nutzung verschiedener Informationsquellen 12 1.3.7 Präferenzen medialer Informationsquellen 13 1.3.8 Rolle des Arztes bzw. der Ärztin 13 1.3.9 Zufriedenheit mit erhaltenen Informationen aus verschiedenen Informationsquellen 13 2. Publikation 1: Unmet information needs of patients with melanoma in Germany 15 3. Publikation 2: Information-seeking and use of information resources among melanoma patients of German skin cancer centers 25 4. Diskussion und Ausblick 35 4.1 Limitationen 40 4.2 Ausblick 41 5. Zusammenfassung 43 6. Summary 46 7. Literatur- und Quellenverzeichnis 49 Anlagen / Background: The need for information is one of the greatest needs reported by melanoma patients (MP). Satisfying unmet information needs (UIN) is an important measure of supportive cancer care since it can reduce anxiety, improve compliance with therapy and, increase the feeling of personal control, thereby improving coping with the disease itself. Cancer patients in Germany prefer consultations with the physician to acquire information about their condition. However, the physician’s time is usually limited and sometimes many detailed medical facts are provided at once. In such cases patients may have difficulty in understanding or be unable to absorb all the information and recall them correctly. This can lead to their feeling inadequately informed. Another problem is that patients may fail to address all their concerns during medical consultations and thus some questions may remain unanswered. To compensate for information deficits, many cancer patients search and use other information resources (IR). Recent research suggests that the information-seeking behavior of cancer patients, including those with melanoma, has been changing alongside the application of modern media. However, not all cancer patients use and prefer the internet or smartphone apps to seek for information, for instance. Rather, usage and preferences of IR vary with the patient’s age, education, socioeconomic status, nationality and the general need in receiving comprehensive information about their own condition. Previous research further has shown that information and supportive care for melanoma patients has to be adapted to the stage of disease, the patients’ gender age and educational level. So far, the UIN of melanoma patients in Germany and of MP with metastases are not covered well in the literature. In order to optimize and adapt information provision to the needs of MPs in Germany, it is essential to know about their specific UIN and informationseeking behavior. Objective: The aim of the present study was therefore, to exploratively investigate a) the UIN of MP in Germany (and their subgroups), and b) to determine the IR they prefer. Starting points for the optimization of information provision in MP should be determined, in particular in terms of developments in the media. Methods: From July to October 2016, a multicenter cross-sectional survey of MP was conducted at 27 accredited German skin cancer centers. MPs were eligible for participation if they had a minimum age of 18 years and were able to understand and speak the German language. Patients attending a skin cancer center during the survey period were consecutively invited to participate. For the survey, a standardized paper questionnaire was specially devised, and was developed collectively with patients of German skin cancer self-help groups as well as medical and scientific staff. A pretest was done by twenty MP at the Dresden skin cancer center. For data analysis SPSS (version 23) was used. The Chi² test was used for categorical variables and the non-parametric U-test (Mann-Whitney) or the Kruskal-Wallis test were used for metric variables to identify subgroup differences in UIN and the information-seeking behavior. Binary logistic regression analysis was used to identify predictors of a) the presence of UIN, b) satisfaction with the MPs’ own information level, and c) the preferences of various media (internet, booklets, TV/videos, journals/magazines). Statistical significance was set at p <0.05 for all tests. Results: 542 questionnaires were returned, and the data of 529 questionnaires was analyzed, corresponding to a response rate of 54%.Of the participating MP, 56% were male, 61% aged > 55 years, 67% were affected by metastatic melanoma, and 49% received medical treatment at the time of the survey. 14% of participants were inpatients and 83% received outpatient care. Unmet information needs: In general, 69% of the MP preferred to be informed on their condition as much as possible, and 78% described themselves as rather or even very satisfied with their knowledge about their condition. However, more than half of the participants (55%) reported UIN. They most often felt poorly or not at all informed about social (31%) and psychological support (24%), and about the consequences of the disease for their private life (23%). Most MP wished more information on treatments, the course of disease and chances of cure (each for 35%). The significantly highest number of UIN was reported by MP with tumor progression. Furthermore, MP aging < 55 years as well as MPs currently receiving medical treatment reported UIN significantly more often than older MPs (63% vs. 50%, p = .003) and post-treatment MP (63% vs. 47%, p <.001). Binary regression analysis indicated that the probability of having UIN was 2.4 times higher for MPs who generally preferred as much information as possible, than for those who felt overwhelmed by too much information. Subgroup differences were also found in the content preferences, e.g. women and MP aging < 55 years more often wished information on psychological support than men (28% vs. 15%, p <.001) and MP ≥ 55 years (25% vs. 17%, p = .038). Information-seeking: 81% of the MP reported consultations with the physician as the source of information they most frequently used to acquire information about their own condition. However, 58% also wanted recommendations on sources of information that they could use outside the clinic. When asked about how important particular media were, 63% of MP awarded the internet and 58% awarded booklets as first or second most important for information-seeking. Services from self-help groups and cancer counseling centers were used by only 8% - 12% of the surveyed MP at all. Aging < 55 years, a higher education, a generally high need for information as well as unawareness about the own current condition proved to be predictors of the preferred internet use. Audiovisual media, however, were preferred by MP with lower education. Conclusions: The results raise awareness of topics that are primarily of interest for MP of German skin cancer centers, which deficits in information provision currently exist and what topics are more important to several subgroups. The findings are important to be considered during medical consultations. On the other hand, they indicate what content MPs expect to be educated about, even by media. The identification of media preferences points out what information resources will be important to MPs for information acquisition in the future, and in which area developments should be forced. Current underuse of peer support from self-help groups and cancer counseling centers by MP should be further explored and ideally remedied because both types of facility provide help in various respects and can supplement clinical care.:Abkürzungen 4 1. Einführung in die Thematik 5 1.1 Wissenschaftliche Ausgangssituation 6 1.1.1 Verbreitung des Melanoms in Deutschland 6 1.1.2 Forschungsstand zu Informationsbedürfnissen von Melanom-Patienten 7 1.1.3 Forschungsstand zum Informationsverhalten von Melanom-Patienten 8 1.2 Theoretischer und wissenschaftlicher Ansatz der eigenen Arbeiten 9 1.2.1 Fragebogenentwicklung 9 1.2.2 Studiendurchführung 10 1.2.3 Datenauswertung 10 1.3 Erarbeitete wissenschaftliche Ergebnisse 11 1.3.1 Charakteristika der teilnehmenden Melanom-Patienten 11 1.3.2 Informationsstand der Patienten zu verschiedenen Aspekten ihrer Erkrankung 11 1.3.3 Zufriedenheit mit dem eigenen Informationsstand 11 1.3.4 Präsenz unerfüllter Informationsbedürfnisse 12 1.3.5 Inhaltliche Informationsbedürfnisse und -präferenzen 12 1.3.6 Nutzung verschiedener Informationsquellen 12 1.3.7 Präferenzen medialer Informationsquellen 13 1.3.8 Rolle des Arztes bzw. der Ärztin 13 1.3.9 Zufriedenheit mit erhaltenen Informationen aus verschiedenen Informationsquellen 13 2. Publikation 1: Unmet information needs of patients with melanoma in Germany 15 3. Publikation 2: Information-seeking and use of information resources among melanoma patients of German skin cancer centers 25 4. Diskussion und Ausblick 35 4.1 Limitationen 40 4.2 Ausblick 41 5. Zusammenfassung 43 6. Summary 46 7. Literatur- und Quellenverzeichnis 49 Anlagen

For almost 30 years, the school subject Swedish as a second language (Sva) has struggled with poor goal achievement, a high proportion of unqualified teachers and a political lack of interest in multilingualism. With large flows of refugees in recent years, there is a considerable number of students in Swedish primary school who are in need of a school subject with clear assessment routines for more effective second language teaching.In order to make visible how assessment routines are used for second language development and thus enable the purpose of this qualitative study, semi-structured interviews have been conducted with seven sva-teachers at six different primary schools in a medium-sized city in northern Sweden. A conventional content analysis has been done based on the transcribed material, through coding and thematization.Based on Vygotsky's sociocultural perspective and Hattie's theory of visible learning, this descriptive study investigates how and why the interviewed Swedish teachers apply continuous assessment of students' second language development.The result shows that even if the sva-teachers in this study use the same assessment tool to make students' progression in the second language visible, it is not certain that the effect of the assessment is the same because the same assessment tool is used for different purposes by different sva-teachers.

Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that affects women’s menstrual cycles, androgen (male hormones) levels, and cysts on the ovaries. This endocrine disorder has various symptoms, with insulin resistance as a hallmark symptom. Approximately 65-70% of women with PCOS have insulin resistance and hyperinsulinemia, whether or not they are overweight, obese, or lean (Marshall & Dunaif, 2012). Many women with PCOS struggle to lose weight because their excess weight is related to nutrition, lifestyle factors, and imbalanced hormones. Understanding PCOS as a metabolic disorder with nutritional implications led to investigating the potential benefit of having registered dietitian nutritionists (RDN) as part of the healthcare team of women with PCOS. We developed a survey based on the literature on PCOS, diet/nutrition interventions, and the role of RDNs in the healthcare team of PCOS women of childbearing age. Only childbearing-age women (18–44) diagnosed with PCOS were eligible to complete the survey. The survey was designed as a needs assessment to determine if women with PCOS are routinely referred to RDNs for support; whether or not such support is beneficial; and what gaps in knowledge or misconceptions about nutrition and PCOS exist among participants. Most importantly, it was designed to examine if women understand how nutrition relates to managing their PCOS symptoms and future disease risks. The data from this survey shows the need for RDNs on the healthcare team of women with PCOS and gives us an understanding of nutrition education interventions that could be developed for future studies. Understanding how RDNs play a role in symptom management could lead to a better quality of life for women with PCOS.

Purpose. The purpose of this dissertation is to understand the state of recommended practice for sedation interruptions (SI) and to discover factors that hinder or facilitate critical care nurses’ use in practice. To garner insight about why this evidence-informed intervention is not being used as recommended to improve mechanically ventilated patient outcomes. Methods. A series of studies using a multi-methods design and guided by the Knowledge to Action Framework: study 1) a systematic review and critical appraisal examined the quality and reporting of all available guidelines and care bundles with recommendations related to SI for mechanically ventilated adults in critical care; study 2) a needs assessment included an environmental scan of the study site and gap-analysis using a retrospective chart audit to measure the nature and magnitude of the evidence-practice gap; study 3) a descriptive qualitative study used semi-structured theory-based interviews to deepen our understanding of the determinants that influence SI use in preparation for a future implementation study. Findings. Study 1 included 11 guidelines and care bundles with 15 recommendations about SI. Deficiencies in the methodological quality of the current guidelines and care bundles may impact overall credibility and applicability of the recommendations, though SI is currently recommended best-practice. Study 2 confirmed the existence of an evidence-practice gap related to SI and affirmed the need to discover barriers and drivers to best practice implementation (study 3). We identified nine facilitators and 20 barriers to SI use by nurses. Facilitators were associated with the innovation (e.g., the importance of protocols) and the potential adopters (e.g., SI are specific to the nurse's role). The barriers were associated with the potential adopters (e.g., nurses’ knowledge gaps and variable goals of SI) and the practice environment (e.g., lack of availability of extra staff and multidisciplinary rounds). Conclusion. Before adequately implementing SI and evaluating uptake by nurses, we need to address modifications to existing guidelines and recommendations, even though SI is considered best practice. A theory-informed implementation study can further activate the use of SI for mechanically ventilated adults in critical care.

<p dir="ltr">This thesis explores consumers' knowledge, perceptions, and handling practices of tree nuts through needs assessments to collect data for the development of tree nut food safety education materials.</p>

The problem in this research was to derive and prioritize program content areas and topics for a community college level printing program appropriate to the needs of the printing industry in Halifax County, Nova Scotia, Canada. This prioritized list will provide guidance during curriculum development. The needs assessment executed in this study was a Beta-type needs assessment. The methodology used in this study was a telephone interview technique utilizing a questionnaire developed on the basis of in-person interviews with key informants in the printing profession. As a result of this study, curriculum guidelines were offered for a community college level printing program. Within these guidelines, the broad content area of press operations was given the highest priority, with almost one-half (45%) of the curriculum devoted to press course offerings in press operations. The broad content area of pre-press operations was given the second highest priority, with approximately one-third (33%) of the curriculum devoted to course offerings in pre-press operations. The broad content area of postpress was given the least priority, with less that one-quarter (22%) of the curriculum devoted to course offerings in post-press operations. Curricular emphasis of specific topic areas within these broad content areas were also examined, and recommended curricular emphasis was given for these topic areas. In addition demographic information regarding the size and scope of the printing industry in Halifax County was reported. / Ed. D.

No / The current systems of care for dying persons, the people caring for them, and the bereaved operate in ways that frequently lack sufficient sensitivity to their needs. We describe a new model for dying, death, and loss that adopts a public health approach. Specifically, we describe a deliberative process that resulted in a charter for a public health approach to dying, death, and loss. Modeled after the World Health Organization's 1986 Ottawa Charter, our charter includes a call to action. It has the potential to bring about significant change on local, societal, and global levels as exemplified by four projects from three countries. Public health and end-of-life services and organizations need to form partnerships with the community to develop a public health approach to dying, death, and loss. Learning from each other, they will affirm and enhance community beliefs and practices that make death part of life.

Biståndshandläggare inom äldreområdet är en profession med hög arbetsbelastning och ett komplext uppdrag att verka i skärningspunkten mellan intentionerna i en målrationell lagstiftning, kommunal budget och den enskildes behov. Genom att låta handläggare besvara en vinjettstudie, där de presenterats för Esther, undersöktes biståndshandläggare som profession utifrån ett cyniskt perspektiv, hur biståndshandläggare hanterar sin arbetssituation utifrån diskretionsteori och om egenskaper hos biståndshandläggaren påverkar utfall i handläggningsprocessen. Studien visar att Esthers ärende handläggs på olika sätt, att handläggare fokuserar på olika behov och gör olika bedömningar av hennes rätt till bistånd i form av särskilt boende enligt 4 kap. 1 § SoL. Vidare undersökning av samband mellan egenskaper hos handläggare och utfall i handläggningsprocessen påvisar inga signifikanta samband som kan förklara utfallet. Resultatet pekar på att egenskaper som ålder, erfarenhet av biståndshandläggning eller annan myndighetsutövning och socionomutbildning inte skapar en mer rättssäker handläggning. Skillnader i biståndshandläggningen tycks i stället orsakas av de strategier som biståndshandläggare använder för att klara sin vardag. / Decision makers in the field of eldercare is a profession with a high workload and a complex assignment while navigating in the intersection between the intentions of a goal-oriented legislation, a municipal budget, and the needs of the individual. By asking decision makers to answer a vignette study, where they were presented to Esther, decision makers as a profession were examined from a cynical perspective. Examining the use of strategies to handle their workload, based on theories of discretion and if characteristics of the decision maker affect outcomes in the needs assessment process. The study shows that Esther’s case was handled in different ways, that decision makers focused on different needs and made different assessment regarding her right to accommodation at a retirement home according to chapter 4 § 1 in the Social Services Act. Further examination of the relationship between characteristics of decision makers and outcomes in the needs assessment process shows no significant relationships that explains the outcome. The results indicate that characteristics such as age, experience in needs assessment and other experience of authority or a degree from higher education in social work does not create a more legally secure process. Instead, the differences in the needs assessment seems to be caused by the strategies that decision makers use to cope with their working situation.

The study examined the sexual and reproductive health needs of adolescents infected with HIV and AIDS. This was a qualitative study that involved semi-structured interviews and observation. The sampling method used was purposive and it entailed 10 adolescents (4 boys and 6 girls) who are living with HIV at Chiedza Child Care Centre in Zimbabwe. This study revealed that adolescents’ sexual and reproductive health needs are the desire to have sex, desire to have children, the need for prevention of unwanted pregnancy and care and treatment support. However, their knowledge of HIV and AIDS was inadequate. Adolescents also revealed their lack of proper information regarding their health care and treatment needs. However, adolescents illustrated an adequate knowledge of the services available for them for their health, treatment and care needs. The study recommended that there is need to strengthen the provision of information and services on adolescents’ sexual and reproductive health issues. The study also recommended that counsellors should improve their counselling skills so that they can empower adolescents living with HIV to be able to negotiate condom usage, matters of dating and handling relationships. / Sociology / M. A. (Social Behaviour Studies in HIV and AIDS)