Social workers are on a daily basis faced with difficult decisions in assessing risk of harm to children. The process requires appropriate competencies, and relevant and validated methods to ensure legal compliance. Risk assessments, knowledge of risk and protective factors, and the interplay between these factors, have been the focus in the development of procedures within social child and youth care since the implementation of Barns Behov i Centrum (BBIC) in 2006. Ahead of the revision of BBIC 2015, the evidence base was strengthened further, and the risk- need- and responsivity principles were introduced to support analysis and assessment processes.Taking a bio-ecological perspective, the purpose of this study has been to examine types of risk and protective factors identified in investigations of girls and boys aged 13-17 years, and how these are weighed in the social secretary's analysis and assessment of the child's needs according to the risk- need- and responsivity principles.The study is based on a thematic analysis of 30 decision-making documents according to BBIC, and the findings of the analysis are further illustrated with descriptive statistics.The findings highlight that analyses and assessments lack a holistic perspective of the development of children vis-à-vis parental abilities and other factors in the family and environment, and that a predominant proportion of identified risk- and protective factors are attributed to the youth in question. The findings also show that the risk- need- and responsivity principles are not drawn upon in analyses and assessments as intended.Conclusions: • Investigations of the youths’ needs have been conducted with a narrow focus on the child's development in the BBIC triangle, which means that the assessment ofneeds is constructed on the basis that the youths’ primarily are responsible for their own situation. • In the absence of a thorough implementation of the revised BBIC, a separate praxis with regard to the principles of risk- needs- and responsivity seems to have emerged, which in turn may hinder legal compliance in the assessment of childrens’ needs.

In der chirurgischen Therapie von Schilddrüsenerkrankungen bestehen weiterhin kontroverse Diskussionen hinsichtlich der adäquaten Operationstechnik bei bilateralen Resektionen. Rezidiv- und Komplikationsvermeidung stellen hohe Anforderungen an die Schilddrüsenchirurgie. Darüberhinaus bestehen weltweit divergierende Meinungen über Risikofaktoren für die spezifischen Operationskomplikationen, die postoperative Rekurrensparese und Hypokalzämie. In der chirurgischen Abteilung der Universitätsklinik Charité, Campus Virchow-Klinikum wurden im Rahmen einer prospektiven Schilddrüsenstudie 2728 Patientendaten aus den Jahren 1985-1999 erhoben und statistisch ausgewertet. Anhand der multivariaten Regressionsanalyse wurde gezielt nach Risikofaktoren für spezifische Operationskomplikationen gesucht. Das individuell indizierte chirurgische Vorgehen basiert auf dem operativen Standard, der neben überdurchschnittlich häufig angewandten ausgedehnten Resektionsverfahren ein Operieren in exakter Mikrodissektionstechnik mit Darstellung und Schonung der anatomischen Leitstrukturen beinhält. Bei den spezifischen Komplikationen waren 4,3% transiente und 0,4% permanente Rekurrensparesen sowie 19,5% transiente und 0,9% permanente Hypokalzämien zu verzeichnen. Die multivariate Analyse wurde sowohl für das Gesamtpatientengut als auch nur für Patienten mit benignen Schilddrüsenerkrankungen durchgeführt. Für die erste Gruppe ergab die Thorakotomie einen Risikofaktor für eine postoperative Rekurrensparese und Frauen, Strumen mit retrosternalem Anteil sowie Near Total-Operationsverfahren waren jeweils Risikofaktoren für eine postoperative Hypokalzämie. Für die zweite, benigne Patientengruppe stellten beidseitig voroperierte Patienten ein signifikantes Risiko für eine Rekurrensparese und Morbus Basedow-Patienten, Patienten mit sehr grossen Schilddrüsen (WHO III Struma, Schilddrüsen mit retrosternalem Anteil) sowie Near Total-Verfahren jeweils ein Risikofaktor hinsichtlich einer postoperativen, überwiegend transienten Hypokalzämie dar. Eine solide Interpretation der gewonnen Ergebnisse erlaubt die Schlussfolgerung bei Beachtung einer kleinen Gruppe von Risikopatienten, dass unter Berücksichtigung klarer Standards für Indikation und Operationsverfahren Schilddrüseneingriffe heutzutage sehr sicher und effektiv durchzuführen sind. / The surgical therapy of thyroid diseases gives reason for controverse discussion concearning the appropriate surgical technique by bilateral resection. The avoidance of recurrent goiter and surgical complications is a great demand for thyroid surgery. In addition to that exist worldwide diverge opinions about riskfactors for the specific complications after thyroid operations, recurrent laryngeal nerve palsy and hypocalcaemia. In the department of surgery, universityhospital Charité, campus Virchow-Klinikum, Berlin, Germany were 2728 patientfacts collected and statistically evaluated within a prospective study from 1985-1999. By means of the multivariate logistic regression analysis riskfactors for the specific surgical complications were searched. The individually indicated surgical procedure based upon standardized surgery, that contains beside numerous extended resections than average also the exact mikrodissection technique with preparation and preservation of all important anatomical structures. These study showed 4,3% transient and 0,4% permanent recurrent laryngeal nerve palsies as well as 19,5% transient and 0,9% permanent hypocalcaemiae. The whole number of patients and the patients with benign thyroid diseases were analysed through multivariat logistic regression separately. So, for the first group thoracotomy proved to be a riskfactor for recurrent nerve palsy just as femal patients, retrosternal goiter and near total resections showed to be riskfactors for hypocalcaemia. For the second, the benign group bilateral reoperation for recurrent goiter revealed to be riskfactor for recurrent nerve palsy. Graves´~disease, very large goiter (WHO III and retrosternal goiter) and near total resection showed to be a riskfaktor for a hypocalcaemia (mainly transient). A solid interpretation of the achieved results allows the conclusion by attention to a small group of riskpatients, that today thyroid surgery can be performed very safely and effectively when standards for indication and surgical techniques are considered.

Bakgrund: Ohälsosamma levnadsvanor är ett folkhälsoproblem och står för en femtedel av den totala sjukdomsbördan i Sverige. Var annan kvinna och var tredje man i åldrarna 16-84 år rapporterar att de inte har några ohälsosamma levnadsvanor. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). De flesta distriktssköterskor och sjuksköterskor i den svenska primärvården tycker att det är viktigt att arbeta med patienternas levnadsvanor, de tycker även att arbetet behöver utvecklas (Kardakis, Weinehall, Jerdén, Nyström & Johansson, 2013). Syfte: Att undersöka i vilken utsträckning distriktssköterskor och sjuksköterskor arbetar med rådgivning om levnadsvanor till patienter i primärvården. Syftet är också att undersöka hur de skulle vilja arbeta, vilken kunskap de tycker sig ha och om de anser att de behöver ytterligare kunskap om rådgivning kring levnadsvanor. Metod: En totalundersökning gjordes där samtliga distriktssköterskor och sjuksköterskor verksamma inom primärvårdens vårdcentraler i föreliggande landsting inkluderades i studien. Data samlades in med hjälp av en webbenkät. Resultat: Resultatet visade att de flesta respondenterna ansåg att arbetet med levnadsvanor var mycket eller ganska viktigt och att de flesta arbetade med rådgivning om levnadsvanor i ganska stor utsträckning. Det fanns inga signifikanta skillnader mellan specialistutbildade och grundutbildande sjuksköterskor. Slutsats: Distriktssköterskor och sjuksköterskor i primärvården i föreliggande landsting anser att arbetet med rådgivning om levnadsvanor är mycket viktigt. De arbetar också mycket med detta och anser sig ha kunskaper inom området, men de vill ändå arbeta mer med rådgivning om levnadsvanor och utveckla sin kompetens.  Det är tydligt att distriktssköterskor och sjuksköterskor i primärvården är en underutnyttjad resurs i arbetet med levnadsvanor. / Background: Unhealthy lifestyle behaviour is a public health problem, accounting for a fifth of the total burden of disease in Sweden. Every second woman and every third man aged 16-84 years report that they do not have any unhealthy lifestyle behaviours. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). Most district nurses and registered nurses in Swedish primary health care think it is important to work with lifestyle behaviours, they also think there is need for improvement (Kardakis, Weinehall, Jerdén, Nystrom & Johansson, 2013). Aim: To examine the extent to which district nurses and nurses are working with counseling patients on lifestyle behaviours in primary health care. The aim is also to examine how they would like to work, what knowledge they think they have and if they feel they need additional knowledge of counseling on lifestyle behaviours. Method: A comprehensive survey was made in which all district nurses and registered nurses working in primary health care centers in the present county were included in the study. Data were collected using an online survey. Results: The results showed that most respondents felt that the work with lifestyle behaviours was very or quite important. Most of the respondents were working quite widely with counseling on lifestyle behaviours. There were no significant differences between nurses with specialist education and registered nurses. Conclusion: District nurses and registered nurses in primary health care in this county believe that counseling on lifestyle behavior is very important. They also work a lot with this and claim to have knowledge about lifestyle behaviours. Still they want to work more with counseling on lifestyle behaviours and develop their skills. It is clear that district nurses and registered nurses in primary health care is an underutilized resource in the work with lifestyle behaviours.

O objetivo neste estudo foi avaliar a relação entre o uso de psicoativos, envolvimento em bullying e problemas relacionados em adolescentes escolares. Trata-se de estudo de corte transversal com abordagem quantitativa. Desenvolvido com 1.192 adolescentes, matriculados do 6º ao 9º ano, de escolas públicas e privadas de um município do sul de Minas Gerais. Seguiram-se neste estudo os aspectos éticos preconizados. Os instrumentos utilizados foram: questionário de caracterização da amostra, Drug Use Screening Inventory e a Escala de Violência Escolar - versão estudantes. Constatou-se que houve predomínio de adolescentes do sexo feminino, com média de idade de 12,9 anos (desvio-padrão=1,3), variando entre 11 e 15 anos, de cor branca, que cursavam o 6º ano do ensino fundamental II, residiam em casa própria, católicos, moravam com pai e mãe, tinham relacionamento familiar classificado como muito bom, frequentavam festas de uma a duas vezes por semana, de escolas públicas e localizadas na zona urbana. Da amostra, 33,1% dos estudantes consumiram algum tipo de droga; 18,3%, drogas ilícitas; 23,8%, álcool; e 5%, tabaco. Quanto ao envolvimento em bullying, 26,4% foram classificados como autores; 33,4%, vítimas; e 10,3%, alvo/autor do fenômeno. O Sistema Familiar e a Saúde foram os problemas mais evidentes na vida dos adolescentes. O uso de drogas foi associado à idade (14 e 15 anos), religião (ateu), bom relacionamento familiar, morar com amigos/instituições, frequentar festa (uma vez ao mês, de uma a duas vezes por semana, e de três a quatro vezes por semana). O consumo de álcool e cocaína foram associados à autoria de bullying, ser vítima e usar algum tipo de droga (exceto álcool e tabaco), enquanto ser alvo/autor foi relacionado à maconha. Adolescentes com características como: ter idade (12 anos), ser ateu e morar em zona urbana aumentam as razões de chances para ser vítima; ter 15 anos e morar na zona urbana, para ser alvo/autor e ter idade de 13 anos para autor de bullying. Adolescentes que foram alvo/autores de bullying apresentaram maiores problemas de comportamento quando comparados aos adolescentes não envolvidos no fenômeno. Os dados fornecem subsídios para tomada de decisão em ações voltadas para prevenção a comportamentos de risco durante a adolescência / The objective of this study was to evaluate the relationship between use of psychoactive substances, involvement in bullying and related problems in school adolescents. This is a quantitative cross-sectional study. It was conducted with 1192 adolescents attending between the 6thand 9thgrade of public and private schools of a municipality in the south of Minas Gerais. The study was in accordance with ethical aspects. The following instruments were used: sample characterization questionnaire, Drug Use Screening Inventory (DUSI) and School Violence Scale - students\' version. There was a predominance of female adolescents, mean age of 12.9 years (SD = 1.3), ranging from 11 to 15 years old, white race, attending 6thgrade of primary education, living in their own homes, Catholics, living with their father and mother, a family relationship classified as very good, attending parties once or twice a week, of public schools located in the urban area.Of the sample, 33.1% used some type of drug, of which 18.3% used drugs except alcohol and tobacco, 23.8% consumed alcohol, and 5% used tobacco. Regarding involvement in bullying, 26.4% were classified as perpetrators, 33.4% were victims and 10.3% were both the victim/perpetrator of the phenomenon. The family system and health were the most evident problems in adolescents\' lives. Drug use was associated with age (14 and 15 years), religion (atheist), good family relationship, living with friends/institutions, attending parties (once a month, once or twice a week, and three to four times a week). The consumption of alcohol and cocaine were associated with being a bullying perpetrator; being a victim with the use some type of drug (except alcohol and tobacco); and being the victim/perpetrator with the use of marijuana. Adolescents with characteristics such as age of 12 years, atheist and who live in urban areas have increased odds of being a victim; being 15 years old and living in the urban area increases the odds of being a victim/perpetrator; and being 13 years old increases the odds of being a bullying perpetrator. Adolescents who were victims/perpetrators of bullying presented greater behavior problems compared to adolescents not involved in the phenomenon. These data provide support for decision-making in actions aimed at preventing risky behaviors during adolescence

O objetivo neste estudo foi avaliar a relação entre o uso de psicoativos, envolvimento em bullying e problemas relacionados em adolescentes escolares. Trata-se de estudo de corte transversal com abordagem quantitativa. Desenvolvido com 1.192 adolescentes, matriculados do 6º ao 9º ano, de escolas públicas e privadas de um município do sul de Minas Gerais. Seguiram-se neste estudo os aspectos éticos preconizados. Os instrumentos utilizados foram: questionário de caracterização da amostra, Drug Use Screening Inventory e a Escala de Violência Escolar - versão estudantes. Constatou-se que houve predomínio de adolescentes do sexo feminino, com média de idade de 12,9 anos (desvio-padrão=1,3), variando entre 11 e 15 anos, de cor branca, que cursavam o 6º ano do ensino fundamental II, residiam em casa própria, católicos, moravam com pai e mãe, tinham relacionamento familiar classificado como muito bom, frequentavam festas de uma a duas vezes por semana, de escolas públicas e localizadas na zona urbana. Da amostra, 33,1% dos estudantes consumiram algum tipo de droga; 18,3%, drogas ilícitas; 23,8%, álcool; e 5%, tabaco. Quanto ao envolvimento em bullying, 26,4% foram classificados como autores; 33,4%, vítimas; e 10,3%, alvo/autor do fenômeno. O Sistema Familiar e a Saúde foram os problemas mais evidentes na vida dos adolescentes. O uso de drogas foi associado à idade (14 e 15 anos), religião (ateu), bom relacionamento familiar, morar com amigos/instituições, frequentar festa (uma vez ao mês, de uma a duas vezes por semana, e de três a quatro vezes por semana). O consumo de álcool e cocaína foram associados à autoria de bullying, ser vítima e usar algum tipo de droga (exceto álcool e tabaco), enquanto ser alvo/autor foi relacionado à maconha. Adolescentes com características como: ter idade (12 anos), ser ateu e morar em zona urbana aumentam as razões de chances para ser vítima; ter 15 anos e morar na zona urbana, para ser alvo/autor e ter idade de 13 anos para autor de bullying. Adolescentes que foram alvo/autores de bullying apresentaram maiores problemas de comportamento quando comparados aos adolescentes não envolvidos no fenômeno. Os dados fornecem subsídios para tomada de decisão em ações voltadas para prevenção a comportamentos de risco durante a adolescência / The objective of this study was to evaluate the relationship between use of psychoactive substances, involvement in bullying and related problems in school adolescents. This is a quantitative cross-sectional study. It was conducted with 1192 adolescents attending between the 6thand 9thgrade of public and private schools of a municipality in the south of Minas Gerais. The study was in accordance with ethical aspects. The following instruments were used: sample characterization questionnaire, Drug Use Screening Inventory (DUSI) and School Violence Scale - students\' version. There was a predominance of female adolescents, mean age of 12.9 years (SD = 1.3), ranging from 11 to 15 years old, white race, attending 6thgrade of primary education, living in their own homes, Catholics, living with their father and mother, a family relationship classified as very good, attending parties once or twice a week, of public schools located in the urban area.Of the sample, 33.1% used some type of drug, of which 18.3% used drugs except alcohol and tobacco, 23.8% consumed alcohol, and 5% used tobacco. Regarding involvement in bullying, 26.4% were classified as perpetrators, 33.4% were victims and 10.3% were both the victim/perpetrator of the phenomenon. The family system and health were the most evident problems in adolescents\' lives. Drug use was associated with age (14 and 15 years), religion (atheist), good family relationship, living with friends/institutions, attending parties (once a month, once or twice a week, and three to four times a week). The consumption of alcohol and cocaine were associated with being a bullying perpetrator; being a victim with the use some type of drug (except alcohol and tobacco); and being the victim/perpetrator with the use of marijuana. Adolescents with characteristics such as age of 12 years, atheist and who live in urban areas have increased odds of being a victim; being 15 years old and living in the urban area increases the odds of being a victim/perpetrator; and being 13 years old increases the odds of being a bullying perpetrator. Adolescents who were victims/perpetrators of bullying presented greater behavior problems compared to adolescents not involved in the phenomenon. These data provide support for decision-making in actions aimed at preventing risky behaviors during adolescence

Introduktion: Sexuella övergrepp är ett omfattande folkhälsoproblem som för med sig stora samhällsekonomiska kostnader samtidigt som det får en rad allvarliga psykosociala hälsoproblem för offren. I Sverige är den mest utsatta gruppen unga tjejer och majoriteten av sexuella övergrepp bland unga begås av jämnåriga förövare. Trots det saknas forskning kring sexuella övergrepp bland unga jämnåriga. Studien syftar därför till att studera förekomst, bakgrundsfaktorer och hälsoaspekter av utsatthet för sexuella övergrepp av en jämnårig och undersöka om det förekommer könsskillnader gällande olika hälsoaspekter.   Metod: Studien är en tvärsnittsstudie som baseras på datamaterial som samlades in till den nationella kartläggningen ”våld mot barn 2016”, med ett deltagarantal på 4741 elever (ca 15-17 år).  Studien presenterar beskrivande statistik som prevalenser och korsanalyser (Chi-2-test). Binära logistiska regressioner har gjorts för att analysera om utsatthet för sexuella övergrepp av jämnårig är relaterat till specifika bakgrundsfaktorer samt olika hälsoaspekter. Till sist justerades bakgrundsfaktorer och hälsoaspekter genom multivariata logistiska regressionsanalyser för att kontrollera för kön, boendesituation, funktionsnedsättning, föräldrarelaterade faktorer, födelseland och familjeekonomi. Resultat: Nästan var tredje flicka och knappt var tionde pojke har utsatts för sexuella övergrepp av en jämnårig. De bakgrundsfaktorer som är starkt relaterade till sexuella övergrepp av jämnårig är att vara flicka, ha en funktionsnedsättning, ha en förälder med egna problem och att inte bo med båda sina föräldrar. Var femte elev som hade utsatts för sexuella övergrepp av en jämnårig var samtidigt multiutsatt. De som utsatts för sexuella övergrepp av jämnåriga hade sämre utfall i alla hälsoaspekter än de som inte utsatts för det och alla hälsoaspekter var vanligare hos flickor jämfört med pojkar. Slutsats: Majoriteten av alla typer av sexuella övergrepp begås av en jämnårig samtidigt som sexuella övergrepp av jämnårig sågs ha oberoende effekt på mental hälsa. En femtedel av de som utsatts för sexuella övergrepp av jämnårig är dock multiutsatta och behöver uppmärksammas mer då tidigare forskning visat att den här gruppen är extra sårbar och drabbas av psykisk ohälsa i större utsträckning än de som inte är multiutsatta. Den här studien har bidragit med kunskap om en grupp som tidigare inte har studerats enskilt och den här nya kunskapen kan komma till användning i det våldspreventiva arbetet på alla nivåer i samhället.

Introduktion/bakgrund: Barn kan drabbas av olika sjukdomstillstånd vilket påverkar såväl deras allmänna hälsa som orala hälsa. Diabetes typ 1 är ett sjukdomstillstånd som kräver vård av god kvalitet. Alla barn är olika och personcentrerad vård som teoretisk bas kan bidra till att sätta det unika barnets behov i centrum. Syfte: Syftet med denna litteraturstudie var att beskriva riskfaktorer för orala sjukdomar hos barn med diabetes typ 1. Metod: En litteraturstudie utfördes genom att systematiskt utföra sökningar i databaserna PubMed och CINAHL. Kvalitetsgranskning med granskningsmallar från SBU utfördes i urvalsprocessen. Av totalt 766 antal artiklar inkluderades 11 artiklar. Resultat: Resultatet baseras på 11 vetenskapliga artiklar från 9 länder och redovisas med följande underrubriker; ”Oral sjukdom och okontrollerad diabetes”, ”Oral egenvård” och ”Omgivande faktorer”. Resultatet visade att kost och okontrollerad diabetes, dålig oral egenvård och bristande samhälleliga skyddsfaktorer är riskfaktorer för orala sjukdomar hos barn med diabetes typ 1. Slutsats: Denna litteraturstudie visar att det finns flera riskfaktorer för orala sjukdomar hos barn med diabetes typ 1, både på samhällelig och individuell nivå. Samhället kan bidra till ökade resurser för att öka samverkan mellan de aktuella barnen, vårdnadshavare och hälso- sjukvård, socialtjänst, tandvård och skola. På individnivå behöver vårdprocesser vara förankrade i personcentrerad vård. / Introduction/background: Children can suffer from various medical conditions which affect both their general health and oral health. Diabetes type 1 is a medical condition that requires good quality of care. All children are different and person-centred care as theoretical foundation can contribute to put every child's needs in focus. Aim: The aim of this literature study was to describe risk factors for oral diseases in children with type 1 diabetes. Method: A literature study was performed by systematically searching the databases PubMed and CINAHL. Quality review with review templates from SBU were performed in the process. Out of a total of 766 articles, 11 articles were included. Results: The result is based on 11 scientific articles from 9 countries and is reported with the following subheadings; "Oral disease and uncontrolled diabetes", "Oral self-care" and "Ambient factors". The results showed that diet and uncontrolled diabetes, bad oral self- care and lack of societal preventive factors are risk factors for oral diseases. Conclusion: This literature study shows that there are many risk factors for oral diseases in children with type 1 diabetes, at both societal and individual levels. Society can contribute to increased resources to increase professional collaboration between the children, caregivers and health care, social services, dental care and school in order to offer person-centered care.