Research suggests a correlation between high levels of stress and burnout, and low levels of self- efficacy, in school and habilitation professionals. These findings are also prominent in practitioners in Applied Behavior Analysis (ABA) such as teachers, psychologists and Board-Certified Behavior Analysts (BCBAs). This current study aimed to examine the levels in self-reported stress, burnout, and self-efficacy reported in the Ohio State Teacher Efficacy Scale (OSTES), in a Swedish-speaking sample consisting of sixty-seven participants based in school settings, and twenty-five participants based in habilitation settings. All participants were divided into two subgroups: one group who have stated participation in formal post-graduate ABA-training (n = 31), and a group without formal ABA training (n = 61). The hypotheses formulated from previous research were: 1) Teacher Efficacy levels are higher in professionals with ABA-training; 2) Stress-levels are lower in professionals with ABA- training; 3) Burnout levels are lower in professionals with ABA-training; 4) Stress-levels are lower in professionals working in habilitation settings; 5) Burnout levels are lower in professionals working in habilitation settings. Analyzes showed that stress correlated highly positive with burnout, and that teacher efficacy had a negative correlation with stress and burnout. Furthermore, no differences in stress and burnout levels were found between participants from school and habilitation, but the levels in Self-reported Stress and Self-reported Burnout were lower in the ABA group, which therefore confirmed the predictions. Reported OSTES-levels were higher in the ABA-group, but at non- significant levels (except in the sub-item “Efficacy for instructional strategies” where significant levels were found). The conclusion was that educators high in teacher efficacy may be less likely to suffer from stress and burnout, than low-efficacy educators. To address the growing problem of stress-related diseases among Swedish school and habilitation staff, the current teacher efficacy-levels in these occupations must be further highlighted. / Forskning tyder på en korrelation mellan höga nivåer av stress och utbrändhet, och låga nivåer av self- efficacy hos personal i skola och habilitering. Dessa forskningsresultat är också framträdande gällande utövare av tillämpad beteendeanalys (TBA), såsom lärare, psykologer och certifierade beteendeanalytiker (BCBA). Den aktuella studien syftade till att undersöka nivåerna i självrapporterad stress, utbrändhet och self-efficacy baserat på Teacher efficacy-skalan Ohio State Teacher Efficacy Scale (OSTES), gällande ett urval av svensktalande deltagare bestående av sextiosju personer som arbetar inom skolan och tjugofem personer som arbetar inom habiliteringen. Samtliga deltagare delades in i två undergrupper: en grupp som tidigare genomfört en formell TBA-utbildning (n = 31) och en grupp utan formell TBA-utbildning (n = 61). Hypoteserna utifrån tidigare forskning var: 1) Teacher efficacy-nivåerna är högre hos yrkesverksamma med TBA-utbildning; 2) Stressnivåerna är lägre hos professionella med TBA-utbildning; 3) Utbrändhetsnivåerna är lägre hos professionella med TBA-utbildning; 4) Stressnivåerna är lägre hos yrkesverksamma som arbetar inom habiliteringsyrken; 5) Utbrändhetsnivåerna är lägre hos professionella som arbetar inom habiliteringsyrken. Analyserna visade att stress korrelerade mycket positivt med utbrändhet och att Teacher efficacy-nivåerna hade en negativ korrelation med stress och utbrändhet. Vidare hittades inga skillnader i stress- och utbrändhetsnivåerna mellan deltagare från skola och habilitering, men nivåerna i självrapporterad stress och självrapporterad utbrändhet var lägre i TBA-gruppen, vilket därför bekräftade denna förutsägelse. Nivåerna erhållna i OSTES-skalan var högre i TBA-gruppen, men på icke-signifikanta nivåer (förutom i underkategorin “Efficacy for instructional strategies” där signifikanta nivåer hittades). Slutsatsen var att lärare med hög Teacher efficacy kan vara mindre benägna att drabbas av stress och utbrändhet än lärare med låg Teacher efficacy. För att ta itu med det växande problemet med stressrelaterade sjukdomar bland svensk skol- och habiliteringspersonal måste de aktuella nivåerna av Teacher efficacy i dessa yrken belysas ytterligare.

Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue. Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake. Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity. Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.

Bone bruise lesions (BBL) are documented on MRIs diagnosing acute knee ligament injury (AKLI). Recent evidence has indicated that a majority of patients that sustain an AKLI, especially anterior cruciate ligament (ACL) knee injury, will develop post-traumatic osteoarthritis (PTOA) 10-20 years following injury. It has been proposed that the initial damage sustained to the articular cartilage overlying BBL causes a cascade of events that may result in PTOA. Researchers have proposed a modification to treatment protocols for more severe BBL, or have stressed the need for the development of protective therapies to protect the articular cartilage. However, there are limited tools available to evaluate the clinical outcome of articular cartilage overlying BBL. Furthermore, damage to the cartilage overlying BBL may be different according to differing BBL severities. Therefore, the use of a cartilage degradation biomarker, serum cartilage oligomeric matrix protein (sCOMP) and the use of a BBL severity classification system may be useful to determine if differences exist between patients with and without BBL, and with differing BBL severities. The purpose of this dissertation was to investigate the utility of sCOMP as a biomarker for acute articular cartilage damage. The purposes of these studies were to determine the inter and intraday reliability of this marker, to document sCOMP longitudinally in collegiate athletes and following AKLI, and to determine if differences in sCOMP and self-reported pain and function exist for patients with and without BBL, and differing BBL following AKLI. The results of these studies indicated sCOMP measures had strong inter and intraday reliability. Additionally, exercise does seem to influence sCOMP levels; however, these elevations may not be clinically meaningful. Furthermore, sCOMP levels were not different between patients with BBL and without, and between differing BBL severities. The results of these studies support the use of a BBL severity classification for future research studies in order to further elucidate the outcomes of these lesions.

The purpose of this study was to determine the construct validity of self-reported historical walking, running, and jogging (WRJ) activity. The criterion measure was concurrent performance on a maximal treadmill test. Subjects completed a medical exam and treadmill test between the years 1976 and 1985, and completed a follow-up questionnaire in 1986. Questionnaire included an item that assessed WRJ for each year from 1976 through 1985. Data analysis included Spearman correlations, partial correlations, ANOVA, and ANCOVA. Results indicated self-reported historical WRJ can be assessed with reasonable validity when compared with concurrently measured treadmill performance, and there is no decay in the accuracy of this reporting for up to ten years in the past.

This study was predicated on the belief that a father brings something unique to the family, thus, making irreplaceable contributions to the life of a child. Fathers are unique in that they provide something different from mothers. They are irreplaceable because when they are absent, children are said to suffer emotionally, intellectually, socially, and behaviorally. The contributions of fathers to a child's well being cannot be fully replaced by better programming, ensuring child support programs, or even by well-intentioned mentoring programs. A review of literature relevant to delinquency and adolescent behavioral and academic success revealed that there may be a correlation between a male role-model and the teaching of self-control and socially appropriate behaviors. Indeed, much of what the large body of research pertaining to fatherhood reveals is that, compared to children raised in two-parent homes, children who grow up without their fathers have significantly worse outcomes, on average, on almost every measure of well being (Horn, 2002). In addition, an understanding of the factors that may influence delinquent behaviors, in particular within the family unit, can better equip parents and educators to support those who may be exhibiting the beginning signs of delinquent behavior. This study was designed to determine the influence of, or correlation between, juvenile delinquency and the presence or absence of a father-figure in a child's life. Responses made on the Delinquency Check List between two sample sets, delinquent and non-delinquent adolescents, were examined. The study attempted to determine if delinquent activity among adolescents was differentiated by the absence or presence of a father-figure in a child's life. This study also investigated the frequency and severity of delinquent activities between adolescents in the determined sample groups.

Unicompartmental knee replacement (UKR) is the principal alternative to total knee replacement (TKR) in the treatment of end-stage knee osteoarthritis. It involves less tissue resection, resulting in lower rates of morbidity and faster recoveries compared to TKR. However, UKR has a significantly higher revision rate compared to TKR. As a result, whilst over a third of patients are eligible for UKR, only around 8% receive it. A comprehensive comparison of matched patients undergoing TKR and UKR was undertaken using a large dataset from the National Joint Registry for England and Wales (NJR). Failure rates (revision, reoperation, complications and mortality), length of stay and patient-reported outcomes (PROMs) were studied. Whilst patients undergoing TKR had lower reoperation and revision rates, they had higher rates of morbidity and mortality, longer hospital stays, and inferior PROMs compared to UKR. The main reason for revision in UKR was loosening. In view of the high revision rate in UKR, NJR data was studied to identify modifiable risk factors for failure in UKR. Important patient factors were identified including age, gender and pre-operative function. Surgeons with a higher UKR caseload had significantly lower revision rates and superior patient-reported outcomes. Increasing usage (offering UKR to a greater proportion of knee replacement patients) appears to be a viable method of increasing caseload and therefore of improving results. Surgeons with optimal usage (around 50% of patients, using appropriate implants) achieved revision/reoperation rates similar to matched patients undergoing TKR. Two clinical studies were conducted to establish whether the use of cementless fixation would improve fixation and reduce the revision rate of UKR. Cementless UKR was demonstrated to be safe and reliable, with PROMs similar or superior to those demonstrated in cemented UKR. Patients with suboptimal cementless fixation were examined and pre-disposing technical factors were identified. Finally, using NJR data, the effect of the introduction of cementless UKR on overall outcomes was examined. The number of cementless cases was small, and no significant effect on implant survival was demonstrated. However, patients undergoing cementless UKR demonstrated superior PROMs. These studies demonstrate that UKR has numerous advantages over TKR in terms of morbidity, mortality and PROMs. If surgeons perform high volumes of UKR (achievable by increasing their UKR usage), these advantages can be attained without the large difference in revision rates previously demonstrated. Cementless UKR is safe and provides superior fixation and outcomes in the hands of high-volume surgeons. Further work is needed to quantify the revision rate of cementless UKR, and to assess its results in the hands of less experienced surgeons.

The Oxford Knee Score (OKS) is a popular single summary questionnaire developed to measure the effect of knee replacement surgery from the patients' perspective. There has been a recent interest in the use of the OKS in populations of patients and in roles it has not been originally developed for. To date, no evidence has been provided about the measurement properties of the OKS when it is used outside the context or purpose for which it was originally designed. The general aim of this thesis is to investigate the measurement properties of the OKS when used in extended roles: a) within the population for which the OKS was originally intended and developed for (knee replacement) and, b) when applied on a different population, viz. patients undergoing non-operative treatment for knee osteoarthritis (OA). Four existing large-scale databases of patients undergoing knee replacement surgery and a database obtained from a prospective study on patients undergoing non-surgical management for knee OA were analyzed. The results demonstrate that: 1) it is possible to extract separate information on pain and functional disability from the OKS in a meaningful way (in the form of subscales). 2) For the first time, anchor-based Minimal Important Change (MIC) of 9 points and Minimal Important Difference (MID) of 5 points were established for joint replacement surgery. 3) The OKS demonstrated satisfactory evidence reliability, validity, responsiveness, and interpretability, when used in patients who are undergoing non-operative management for their knee OA. 4) Further evidence of validity was demonstrated by fitting the OKS to the Rasch model. 5) Lastly, it was demonstrated that thresholds can be applied on the OKS to distinguish between patients who consider their knee problem to be severe enough to warrant joint replacement surgery versus patients who do not. This supports the potential use of the OKS in decision making aids for secondary care referral. Overall the thesis provides critical evidence, not previously existing, to support the continued use, and extended use, of the OKS in orthopaedic medicine.

Currently there is extensive literature on evidence-based practices (EBP) for students with autism spectrum disorder (ASD). However, there is limited research on whether or not these practices are implemented in the classroom by teachers serving students with ASD. Special education teachers are responsible for the learning outcomes of students across a range of ages and disabilities. This study investigated teachers' self-reported use of EBP and what factors influence implementation. Participants included 129 special education teachers in Texas public schools. Data utilizing descriptive statistics and logistic regression was conducted to determine what factors (i.e., education, employment, teaching experience and training methods) predicted implementation of a particular practice. Although 67% of teachers reported using EBPs, teachers' employment and training experiences did not predict the implementation of a particular practice. Information from this study can be used to enhance professional development for teachers serving students with ASD.

Stress är ett växande problem i dagens samhälle, allt fler barn och ungdomar mår sämre på grund av den ökande stressnivån. Barn och ungdomar befinner sig stora delar av sin vakna tid i skolan. Inom denna arena är stress vanligt förekommande, vilket utgör vikten att arbeta mot den ökande stressnivån. Studier och rapporter visar på att den psykiska ohälsan och stress har ökat och då främst inom skolan. En lagom mängd stress gör att prestationen ökar vilket är en positiv följd av stress. Dock är nivåerna av stress höga och blir inte hanterbara för barn och ungdomar som vistas i stressiga miljöer. Syftet med studien är att undersöka förekomsten och könsfördelningen av stress bland ungdomar i Västmanlands län samt eventuella samband mellan stress och sömnbesvär respektive självskattad hälsa. För att besvara syftet användes data från Liv och hälsa ung Västmanland 2012 undersökning, vilket är en hälsoundersökning som omfattar 6675 studenter i årskurs 7 och 9 samt årskurs 2 på gymnasiet. Studiens resultat visar att stress är vanligt förekommande, där nästan en tredjedel (29.5 %) ofta eller mycket ofta känner sig stressade, vilket motsvarar drygt 2000 barn och ungdomar. Resultatet visar på samband mellan ökad stress och ökade sömnbesvär och mellan ökad stress och sämre självskattad hälsa. Som teoretisk anknytning för stress användes krav/kontroll/stöd-modellen. Coping som förklarande teori användes för att tolka sambandet mellan stress och sömnbesvär. Känsla av sammanhang (KASAM) användes för att tolka sambandet mellan stress och självskattad hälsa. / Stress is a growing problem in today's society, more and more children and adolescents are feeling bad because of the increased stress levels. Children and adolescents spend most of their time in school. Stress is one of the most common problems in this arena, which makes it crucial to work preventive against stress in schools. Studies have shown that the mental illness and stress has increased, primarily within schools. Low levels of stress enhance performance and are therefore a positive aspect of stress. However the levels of stress are high and not manageable for the children and adolescents who spend time in stressful environments. The purpose of the study was to investigate the prevalence and gender distribution of stress among adolescents in Västmanlands län, and potential relation between stress and insomnia respective self-reported health. Data from Liv och Hälsa Ung Västmanland 2012, which investigates health among students, has been used. Data includes 6675 students in grade 7 and 9 in elementary school and grade 2 in upper secondary school. The results shows that stress is a common problem, where almost a third of the participants (29.5 %) often or very often feel stressed, which corresponds to about 2000 adolescents. Results show a significant relation between stress and increased insomnia as well as between stress and self-reported health. The demand/control/support model was used as a theoretical explanation for stress. Coping as an explaining theory was used to interpret the relation between stress and insomnia. Sense of Coherence was used to explain the relation between stress and self-reported health.

Background South Africa is experiencing a massive HIV epidemic that together with the new epidemic of non-communicable diseases is directly affecting the health and wellbeing of older people. For policy makers, there is a crucial need for information on how this dual epidemic is evolving and how this may affect older people's health, mortality and health care needs. 2. Aims To better understand factors that influence the health, wellbeing and survival of older people, and their need for care in rural South Africa at a time of a growing dual epidemic of chronic diseases (non-communicable and communicable). To provide information which may assist in the planning of health services for older people. 3. Methods Applying the WHO Study on Global Ageing and Adult Health (SAGE) and a study on HIV and non-communicable diseases (NCD), we investigated the health, wellbeing and mortality of the population 50 years and older in the Agincourt sub-district in north-east South Africa which is underpinned by health and demographic surveillance. A random sample of the population 50 years and older was selected for the SAGE survey. A random sample of the population 15 years and older was selected for the HIV and NCD study. All available adults 50 plus were invited to participate in the SAGE module in the 2006 census round. We assessed self-reported health, anthropometric measures, blood pressure and HIV status using dried blood spots. Statistical analysis included simple frequencies, univariate and multivariate analysis and Cox proportional hazard models. 4. Findings The usual pattern of mortality, of increasing death rates with age, is not observed in this population, where those in their 50s have higher mortality compared to older age groups. The high prevalence of HIV in this age group (50 to 59) appears to be the main explanation for the observed pattern. Hypertension affects two thirds of this older population and, although there are no differences by gender, women are more aware of their condition. This is reflected in more women attending primary health care services. Reporting lower quality of life and greater disability are associated with higher likelihood of death. We observed gender differences in the process of ageing with women reporting higher prevalence of mortality risk factors but living longer than men, a phenomenon known as the "survival paradox".