No / Aim: To develop a culturally sensitive occupation-based health promotion intervention for older Hispanic adults who live alone. Methods: We used a mixed method design for the content validation of the intervention and the Ecological Validity Model (EVM) to culturally center the intervention. In the quantitative phase, aging experts as well as community members from two activity centers for the elderly in Puerto Rico completed a content validity ratio exercise. In the qualitative phase, we conducted three focus groups with these participants. Data analysis included content validity ratio and a directed content analysis. Results: This resulted in a working version of the intervention protocol addressing the eight dimensions of the EVM. Conclusions: The EVM can be used to culturally center preventive interventions to other ethnic minority groups to augment the external validity and cultural competence of interventions. Future research must test the feasibility of this new intervention. / This publication was supported by National Institute of Health (NIH), National Institute of Minority Health and Health Disparities (NIMHD), Clinical Research Education and Career Development (CRECD) [R25RR017589] in collaboration with Puerto Rico Clinical and Translational Research Consortium (PRCTRC) [8U54 MD 007587-03] and the National Center for Research Resources (NCRR) [8U54RR026139-01A1]. The second author was supported by the National Institute of Drug Abuse (NIDA) (1K02DA035122-01A1). Its content is solely the responsibility of the authors and do not necessarily represent the official views of the NIH, NIMHD, or NCRR.

Trycksår orsakar lidande för patienter och höga kostnader för sjukvården. För att förhindra uppkomst av trycksår är det viktigt att identifiera patienter med ökad risk för trycksår samt att aktivt arbeta med preventiva omvårdnadsåtgärder. Ett strukturerat arbetssätt kan göras utifrån kvalitetsregistret Senior Alerts rekommendationer. Senior Alert är inriktat på förebyggande vård av äldre över 65 år och i registret registreras bland annat risk för trycksår, planerade åtgärder samt sjuksköterskans utvärdering av de insatta åtgärderna. Syftet med studien var att kartlägga täckningsgrad, utförda riskbedömningar och planerade åtgärder avseende risk för trycksår i kvalitetsregistret Senior Alert. Datainsamling innefattade alla patienter, 75 år eller äldre, på en medicinklinik i västra Sverige, som under år 2013 riskbedömts och registrerats med risk för trycksår. Materialet beskrevs kvantitativt. Resultatet visade att täckningsgraden i Senior Alert var 61,8% och att av de riskbedömda patienterna bedömdes 22,7% ha risk att utveckla trycksår. I genomsnitt planerades för 5,84 (±2,72) åtgärder per patient. Mest frekvent var åtgärder inom nutrition. Det fanns en svag korrelation mellan antal planerade åtgärder och Modifierad Norton-poäng (MNS-poäng). Resultatet visar att fortsatt arbete för att öka täckningsgrad krävs samt att mer individanpassade åtgärder behövs. / Pressure ulcers are common and cause both suffering for patients and high costs for the health care services. To prevent the occurrence of pressure ulcers, it is important to find patients at risk and do the preventive care. This can be done based on The National Registry Senior Alert which focus is on preventive care of elderly over 65 years. The registry includes measurements of the risk of pressure ulcers, planned actions and evaluation of the inserted measures. The purpose of this study was to examine the coverage and what preventive actions that was planned and registered in Senior Alert. A data collection was performed during 2013 and included all patients 75 years or older, at a medical clinic, in western Sweden, recorded with increased risk of developing pressure ulcers. The material was analyzed quantitatively. The results showed that the coverage of registration was 61.8% and that 22.7 % had increased risk for developing pressure ulcers. On average 5.84 (± 2.72 ) actions were planned per patient. Most frequent actions were in nutrition. There was a weak correlation between the number of planned actions and Modified Norton-score (MNS-score). The results of this study showed that further work to increase the coverage is required and that more individualized measures are needed.

Tidigare forskning visar på att ett effektivt sätt att minimera ungdomskriminalitet är att arbeta förebyggande. Syftet med studien var därför att undersöka vilka preventiva insatser som används för att motverka att ungdomar involveras i gängkriminalitet. Studien genomfördes utifrån en kvalitativ ansats med hjälp av semistrukturerade intervjuer. Urvalet bestod av sex stycken professionella inom socialtjänsten som hade erfarenhet av att arbeta med ungdomar i kriminella nätverk. För att tolka studiens resultat användes systemteori och teorin om sociala band. Med hjälp av tematisk analys har studiens material analyserats och behandlats. Resultatet visade att det preventiva arbetet med ungdomar är komplext och behöver utgå ifrån både ett individ- och helhetsperspektiv. För att identifiera och motverka gängkriminalitet bland unga behöver socialarbetare även ha kunskap om risk- och skyddsfaktorer samt främja relationsskapandet i arbetet. Slutsatsen som drogs var att det preventiva arbetet behöver prioriteras i samhället och att forskningen om preventiva insatser behöver utvecklas. / Previous research indicates that preventive interventions is an effective way to reduce gangrelated crimes. The purpose of the study was to investigate which preventive measures are used to prevent juvenile delinquency. The study was conducted with a qualitative approach with the help of semi-structured interviews with six social workers. All with experience of working with juvenile delinquency. The theoretical framework for this study was systems theory and social bond theory. With a thematic analysis, the collected data and results were analysed. Results showed that preventive work with adolescents is complex and needs to have an individual and holistic approach. In order to identify and counter juvenile delinquency, social workers also need to have knowledge of risk and safety factors, and promote a relationship-grounded practice. The conclusion was that preventive work needs to be more prioritised in society and that research on preventive measures needs to be developed.

Background: Depression is considered the worldwide leading cause of illness and disability in young people and an urgent public health issue. Within the field of public health it is of interest to deepen the understanding of determinants of depressive symptoms (DS) that are possible to address on a political or an organizational level. Also, it is of great importance to find methods to prevent depression in adolescents. To address these issues, the present thesis had two Aims: I) To study determinants of DS in adolescents, and II) to, by means of a non-randomized pragmatic trial evaluation, investigate the effectiveness a cognitive-behavioral intervention (DISA) in a real-world setting in relation to determinants of DS in adolescent girls. This was addressed by asking a) Which determinants on individual, psychosocial and structural levels are associated with DS in adolescents? (Paper I); b) What are the directional pathways between sexual harassment (SH) and DS? (Paper II); c) Which features characterize students who were assigned to a cognitive-behavioral intervention regarding levels of DS, psychosocial aspects and socioeconomic status of the respondents as well as of schools? (Paper III); d) Does DISA have an effect on DS in girls aged 14-16? (Paper IV); and e) Are there differences between the DISA participants and non-participants in the effects of psychosocial and structural determinants on DS? (Paper IV). Method: Data was collected in January 2010, 2011, and 2012, by means of a self-administered, electronic questionnaire in school. Students aged 14-16 in all nine public and one independent high school in a municipality in northern Sweden participated in the study (~1,000-1,200 students depending on the wave). All studies had DS as the single outcome variable. Individual level determinants were self-esteem and self-efficacy. Psychosocial determinants were parental/peer/teacher support; school demands; sexual harassment; and bullying. Structural determinants were family material affluence; parental foreign background, parental employment status; disrupted family, and personal relative affluence. Logistic regression was employed for research question a) (Paper I). Structural equation (SEM) cross-lag models were modeled for research question b) (Paper II). The Mann-Whitney U statistic was employed for research question c) (Paper III). SEM was used for research questions d-e) (Paper IV). Results: Determinants on individual, psychosocial and structural levels were independently associated with depressive symptoms in both genders. Self-efficacy, low teacher support, bullying victimization, and low personal relative affluence was associated with elevated levels of DS in both genders (Paper I). In girls, low parental support, high school demands, and sexual harassment victimization (SH) were also associated with elevated levels of DS. Among boys, parental migrant background was also associated with DS. Among girls, both the targeting of girls with elevated DS, and the consequence of SH explained the relationship between DS and SH victimization over time. In boys, only the predating of DS explained the association between DS and SH (Paper II). Only girls were assigned to DISA during 2011 and DISA participants reported higher levels of DS and lower levels of self-esteem than the non-participants at pre-intervention, which indicates that DISA was used as a targeted intervention for girls with elevated symptoms. Also, DISA participants reported higher levels of SH victimization, less peer support, and lower personal relative affluence (Paper III). In contrast to the non-participants, DISA participants did not increase their mean scoring on DS at an eight months follow-up. However, SEM analyses showed that the effect of DISA participation on DS at follow-up was negligible (Paper IV). Conclusions: This study showed that SH victimization was an important determinant for DS in girls followed by personal relative affluence. Among boys, personal relative affluence and parental migrant background were the most important factors. SH victimization had mental health consequences in girls only. DISA was implemented as a targeted intervention rather than as selective or universal one, and did not have an effect on DS in this group of girls. Implications for further research and health promotion practice in the school setting are discussed. / Bakgrund: Depression anses vara den världsledande orsaken till sjukdom och funktionsnedsättning hos unga människor och en av de viktigaste folkhälsofrågorna gällande ungdomar. Inom folkhälsoområdet är det viktigt att fördjupa förståelsen av bestämningsfaktorer för depressiva symtom (DS) som är möjliga att ta itu med på en politisk eller organisatorisk nivå. Det är också av stort intresse att finna metoder för att förebygga depression hos ungdomar. För att adressera detta hade denna avhandling två Syften: I) Att studera bestämningsfaktorer för DS hos ungdomar 14-16 år, och II) Att genom en icke-randomiserad pragmatisk utvärderingsstudie undersöka effekten av en kognitiv beteendemodifierande intervention (DISA) så som den implementerats i praktiken i skolan i förhållande till bestämningsfaktorer för DS hos flickor. Följande frågeställningar formulerades: a) Vilka bestämningsfaktorer på individ, psykosocial och strukturell nivå är förknippade med DS hos ungdomar? (Paper I); b) I vilken riktning går sambandet mellan sexuella trakasserier (ST) och DS? (Paper II); c) Vad karaktäriserar elever som gått en kognitiv beteendemodifierande metod (DISA) avseende nivåer av DS, psykosociala aspekter och respondenternas och skolornas socioekonomiska status? (Paper III); d) Har DISA en effekt på DS hos flickor i åldern 14-16? (Paper IV); och e) Fanns det skillnader mellan DISA-deltagare och icke-deltagare avseende effekterna av psykosociala och strukturella faktorer på DS? (Paper IV). Metod: Data samlades in i januari 2010, 2011 och 2012 med hjälp av en självadministrerad, elektronisk enkät i skolan. Elever i åldrarna 14-16 i samtliga nio kommunala skolor och i en friskola i en kommun i norra Sverige deltog i studien (~1000-1200 elever beroende på datainsamlingsår). Samtliga studier hade DS som enda hälsoutfall. Individfaktorer som antogs ha samband med DS var självkänsla och upplevd förmåga att hantera problem i livet. Psykosociala faktorer var föräldra-, kamrat-, och lärarstöd; krav i skolan; sexuella trakasserier och mobbning. Strukturella faktorer var materiellt välstånd i familjen; föräldrar med utländsk bakgrund, föräldrars arbetslöshet; splittrad biologisk familj och personligt relativt välstånd. Logistisk regression användes för forskningsfråga a) (Paper I). Strukturell ekvationsmodellering (SEM) med en cross-lag design användes för forskningsfråga b) (Paper II). Mann-Whitney U test användes för forskningsfråga c) (Paper III). SEM användes för forskningsfrågorna d-e) (Paper IV). Resultat: Bestämningsfaktorer på individ-, psykosocial och strukturell nivå var associerade med DS hos båda könen. Upplevd förmåga att hantera problem i livet, lågt lärarstöd, utsatthet för mobbning, och lågt personligt relativt välstånd var associerat med förhöjda nivåer av DS för både pojkar och flickor (Paper I). Bland flickor var dessutom lågt föräldrastöd, höga krav i skolan, och utsatthet för sexuella trakasserier (ST) också associerade med förhöjda nivåer av DS och hos pojkar var även föräldrars invandrarbakgrund associerat med DS. Bland flickor förklarades sambandet mellan DS och ST både av att flickor med förhöjda DS blev utsatta för ST, och av att ST ledde till senare DS. Hos pojkar var det endast att pojkar med DS blev utsatta för ST som förklarade sambandet (Paper II). Endast flickor deltog i DISA och de rapporterade högre nivåer av DS och lägre självkänsla än de som inte deltog, vilket tyder på att DISA användes som en riktad intervention för flickor med förhöjda symtom. DISA-deltagare rapporterade även högre nivåer av utsatthet för ST, lägre kamratstöd och lägre personligt relativt välstånd (Paper III). DISA-deltagarnas genomsnittliga nivå av DS hade inte försämrats vid åttamånadersuppföljningen vilket icke-deltagarnas nivåer hade. SEM-analysen visade dock att effekten av DISA-deltagande på DS vid uppföljning var försumbar (Paper IV). Slutsatser: Denna studie visade att utsatthet för SH var en viktig faktor för DS hos flickor, följt av lågt personligt relativt välstånd. Hos pojkar var lågt personligt relativt välstånd den viktigaste bestämningsfaktorn följt av föräldrarnas invandrarbakgrund. Utsatthet för ST hade konsekvenser för psykisk ohälsa för flickor men inte för pojkar. DISA genomfördes som en riktad intervention snarare än som en selektiv eller universell intervention och hade inte en effekt på DS i denna grupp av flickor. Implikationer för fortsatt forskning samt för hälsofrämjande arbete i skolan diskuteras. / <p>Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 4 manuskript.</p><p>At the time of the doctoral defence the following papers were unpublished: paper 4 manuscript.</p>

Skolfam is a school-improving intervention for children in foster care. This study aimed to explore the experiences of those who have been working in former Skolfam teams. A qualitative case study was done, and the data was gathered through semi-structured interviews. Nine former team members from Skolfam were interviewed from seven different Swedish municipalities. Theories of implementation and collaboration were used as the theoretical framework, as well as the concept of street-level bureaucracy. The case analysis of the data showed patterns and themes connected to the implementation, application and closure of Skolfam. One of the findings regarded the difficulty of working with a manual, despite it being vital from an evidence-based perspective. In addition, the results showed that the teams had good collaboration. However, there were deficiencies in other levels of the organizations. The reasons for the closure and the consequences for the children in foster care differ as some municipalities nowadays have a new school intervention for these children, while others do not. The main conclusion of this study is that children in foster care need, and have the right to get, school improving interventions.

Magister Scientiae Dentium - MSc(Dent) / AIM:The aim of this study was to review the data available from the Department of Health(DOH), on pre-school paediatric patients treated under Dental General Anaesthesia(DGA), at public health facilities in the Western Cape (WC) in order to ascertain the type and nature of treatment provided.METHODOLOGY:This retrospective descriptive study reviewed the records on the Department of Health(DoH) Database of 16 732 pre-school patients treated under dental general anaesthesia in the period 1 January 2005 until 31 December 2007. A questionnaire was also completed telephonically with 22 dentists from the district dental health clinics.Summary descriptive statistics were calculated from data collected and comparisons were drawn between services available at the health districts and academic hospitals.RESULTS:Of the 58 255 procedures recorded for pre-school patients in the district health clinics in the Western Cape, 99.94% were for extractions provided and 0.5% for restorations.The average number of teeth extracted was 10.4 (SD ±3.9).The average rate of DGA per 1000 of the population was 1.06. Only 9% (2) of dentists at district clinics reported that pre-DGA prevention was provided and 5% (1) reported including post-DGA prevention. The Academic Hospital at Tygerberg Oral Health Centre was the only facility in the Western Cape that provided comprehensive dental treatment for pre-school patients which included restorations, extractions, pre and post DGA prevention. Red Cross Children’s Hospital provided treatment for pre-school patients under DGA that included extractions, pre- and post DGA, but no restorative treatment. CONCLUSION:The demand for DGA in pre-school patients in the WC was high. The lack of prevention associated with DGA in the public health service is the most likely reason the retreatment rate under DGA was reported by dentists as being 77%. There was an absence of protocol regarding DGA for pre-school patients in the public health service.RECOMMENDATIONS:Guidelines formulated were recommended for use in the public service for pre-school patients being treated under DGA and includes the provision of preventive interventions such as regular topical fluoride applications, oral hygiene instruction and dietary advice.

This research will explore how social workers in the Swedish childcare system argue about semi coercive measures, tensions between voluntariness and coercion, and their discretion for those actions. Semi coercive measures are regulated by The Care of Young Persons Act (LVU), section 22. To investigate this a qualitative method was adopted. Eight semi- structured interviews were conducted with social workers that have experience when it comes to work within social services regarding children and young people. The research utilises a thematic analysis as a means of processing the data. To analyse the results, Lipsky’s theoretical concept; Street-level bureaucracy and Foucault’s theoretical concept of power; discipline and disciplining based on panopticism and pastoral power, are used. The analysis of the results indicates that the respondent’s views of the tension between coercive and voluntary measures differ, and that there is no clear distinction. Most of the respondents considered the regulations on semi coercive measures as unnecessary while others thought they are a useful tool when implemented correctly. Moreover, social workers use similar forms of semi coercive measures but not according to section 22 LVU. Respondents use their discretion in different ways, which influences their views on whether the section is necessary or not.

Ur ett sjuksköterskeperspektiv är det viktigt att tänka på att kraven på Hälso- och sjukvård blir allt högre i en tid då det finns allt minskade resurser. Det är angeläget att utnyttja alla resurser och på ett optimalt sätt. Syftet med denna studie är att undersöka vetenskaplig litteratur med avsikt att få ökad kunskap om vilka omvårdnadsåtgärder som är effektiva för sjuksköterskor att använda sig för att förebygga tromboflebit hos vuxna patienter med behov av perifer venkateter. I denna litteraturstudie genomfördes sökningar i PubMed, CINAHL och Elin. Inkludering av studier styrdes av i förväg uppsatta kriterier och företrädesvis eftersöktes studier med kvantitativ metodansats. Data analyserades och granskades av två oberoende granskare, enligt en granskningsmall. Slutligen inkluderades och granskades 10 studier. Resultat av denna studie visar att aseptiska hygienrutiner vid inläggning av perifer venkateter, valet av instickstället och storleken på perifer venkateter samt information till patienten är grundläggande preventiva åtgärder mot tromboflebit. Risken för utveckling av tromboflebit ökar ju längre tid perifer venkateter ligger inne i kärlen, vid infusionen av läkemedel och lösningar och vid försummad omvårdnad. Kunskap, erfarenhet och professionella rutiner minskar däremot utvecklingen av tromboflebit. / From the nurse perspective it’s important to think that the claims of health and medical attendance become higher in a time when resources decrease. It is important to take advantage of all resources in the optimal way. The aim of this study is to investigate scientific literature with the purpose to increase knowledge about which nursing actions are effective for nurses to practice to prevent phlebitis among adults patient with need for peripheral venous catheterization. In this study literature searches were conducted in PubMed, CINAHL and Elin. Inclussion of studies were made with the help of criterias established beforehand and prospective quantitative studies were preferred. Data were analysed and reviewed by two independent reviewers, using a protocol. Finally 10 studies were included. The results show that aseptic hand routines, choice of insertion area, size of peripheral venous catheter and information to the patient are fundamental arrangements to prevent phlebitis. The risk for development of phlebitis increases with time in situ of catheterization, with administration of drugs and solutions and with neglected nursing care. However knowledge, experience and professional routines decrease development of phlebitis.