Yes / In many countries, routine data relating to growth of infants are collected as a means of tracking health and illness up to school age. These have potential to be used in research. For health monitoring and research, data should be accurate and reliable. This study aimed to determine the agreement between length/height and weight measurements from routine infant records and researcher-collected data. Methods Height/length and weight at ages 6, 12 and 24 months from the longitudinal UK birth cohort (born in Bradford; n=836–1280) were compared with routine data collected by health visitors within 2 months of the research data (n=104–573 for different comparisons). Data were age adjusted and compared using Bland Altman plots. Results There was agreement between data sources, albeit weaker for height than for weight. Routine data tended to underestimate length/height at 6 months (0.5 cm (95% CI −4.0 to 4.9)) and overestimate it at 12 (−0.3 cm (95% CI −0.5 to 4.0)) and 24 months (0.3 cm (95% CI −4.0 to 3.4)). Routine data slightly overestimated weight at all three ages (range −0.04 kg (95% CI −1.2 to 0.9) to −0.04 (95% CI −0.7 to 0.6)). Limits of agreement were wide, particularly for height. Differences were generally random, although routine data tended to underestimate length in taller infants and underestimate weight in lighter infants. Conclusions Routine data can provide an accurate and feasible method of data collection for research, though wide limits of agreement between data sources may be observed. Differences could be due to methodological issues; but may relate to variability in clinical practice. Continued provision of appropriate training and assessment is essential for health professionals responsible for collecting routine data.

Abstract Granlöf V, Water scarcity and insufficient water qaulity in Indonesia. Wound care implications as expressed in Nurses’ basic hygiene routines. A Minor field study Degree project in Bachelors program in Nursing 15 hp, Malmö University the Faculty of Health and Society. 2024                                                                        Background: Global warming is affecting the natural resources of clean water all over the world. Sweden’s water resources and quality are currently affected. The nurse is obliged to Adapt basic infection control practices to the available resources to conduct safe care. This Minor field study conducted in Indonesia intends to fill knowledge gaps regarding how to perform safe care in settings with limited access to clean water. The author approaches the subject convinced that Indonesian nurses possess proven experience about how to prevent water-related complications by adapting the basic hygiene routine to water scarcity. Aim: The purpose of this Minor field study is to investigate how basic hygiene routine is described by nurses who perform nursing care with limited access to clean water. Method: Empirical Minor Field Study with qualitative design. Results: The study’s themes focus on Basic hygiene routine, proven experiences in clinic the  practice and water acess and quality. Conclutions: The study result shows that a Nurse has to be aware of the differences and adapt to local guidelines in order to conduct safe care. It has been shown that common concepts and terms in Nursing theory are fluid and takes different forms just like water does.

The participant is a 61-year-old woman, diagnosed with a generalized anxiety disorder and profound intellectual disability who was referred to a behavior-disorders clinic, to increase cooperation with routine dental procedures. I used a behavioral treatment package consisting of stimulus fading, differential reinforcement, and extinction to establish tolerance of, and cooperation with, routine dental procedures. Results showed that cooperative responding varied throughout the progression of teaching the prerequisite steps (sitting in a chair, sitting in a variety of chairs, then working on sitting in the dental chair). However, by the end of the study, the participant engaged in the behavior of open mouth for 30 s and tolerated/cooperated with the experimenter using a plastic visual inspection tool for 30 s. Further research should evaluate the effectiveness of a similar treatment package to develop a more streamlined and systematic framework to improve compliance and tolerance.

La téléréadaptation, tout comme d’autres champs en télésanté, est de plus en plus interpelée pour la prestation de services. Le but de ce projet de thèse est d’enrichir l’évaluation de la téléréadaptation afin que les connaissances qui en découlent puissent venir soutenir la prise de décision d’acteurs impliqués à différents niveaux en téléréadaptation. Le premier article présente une revue systématique dont l’objectif était de faire synthèse critique des études en téléréadaptation. La revue rassemble 28 études en téléréadaptation, qui confirment l’efficacité de la téléréadaptation pour diverses clientèles dans différents milieux. Certaines des études suggèrent également des bénéfices en termes de coûts, mais ces résultats demeurent préliminaires. Cette synthèse critique est utile pour soutenir la décision d’introduire la téléréadaptation pour combler un besoin. Par contre, les décideurs bénéficieraient aussi de connaissances par rapport aux changements cliniques et organisationnels qui sont associés à la téléréadaptation lorsqu’elle est introduite en milieu clinique. Les deux autres articles traitent d’une étude de cas unique qui a examiné un projet clinique de téléréadaptation dans l’est de la province de Québec, au Canada. Le cadre conceptuel qui sous-tend l’étude de cas découle de la théorie de structuration de Giddens et des modèles de structuration de la technologie, en particulier de l’interaction entre la structure, l’agent et la technologie. Les données ont été recueillies à partir de plusieurs sources (groupes de discussion, entrevues individuelles, documents officiels et observation d’enregistrements) suivi d’une analyse qualitative. Le deuxième article de la thèse porte sur le lien entre la structure, l’agent et la culture organisationnelle dans l’utilisation de la téléréadaptation. Les résultats indiquent que les différences de culture organisationnelle entre les milieux sont plus évidentes avec l’utilisation de la téléréadaptation, entraînant des situations de conflits ainsi que des occasions de changement. De plus, la culture organisationnelle joue un rôle au niveau des croyances liées à la technologie. Les résultats indiquent aussi que la téléréadaptation pourrait contribuer à changer les cultures organisationnelles. Le troisième article examine l’intégration de la téléréadaptation dans les pratiques cliniques existantes, ainsi que les nouvelles routines cliniques qu’elle permet de soutenir et la pérennisation de la téléréadaptation. Les résultats indiquent qu’il y a effectivement certaines activités de téléréadaptation qui se sont intégrées aux routines des intervenants, principalement pour les plans d’intervention interdisciplinaire, tandis que pour les consultations et le suivi des patients, l’utilisation de la téléréadaptation n’a pas été intégrée aux routines. Plusieurs facteurs en lien avec la structure et l’agent ont contraint et facilité l’intégration aux routines cliniques, dont les croyances partagées, la visibilité de la téléréadaptation, le leadership clinique et organisationnel, la disponibilité des ressources, et l’existence de liens de collaboration. La pérennité de la téléréadaptation a aussi pu être observée à partir de la généralisation des activités et le développement de nouvelles applications et collaborations en téléréadaptation, et ce, uniquement pour les activités qui s’étaient intégrées aux routines des intervenants. Les résultats démontrent donc que lorsque la téléréadaptation n’est pas intégrée aux routines cliniques, elle n’est pas utilisée. Par contre, la téléréadaptation peut démontrée certains signes de pérennité lorsque les activités, qui sont reproduites, deviennent intégrées aux routines quotidiennes des utilisateurs. Ensemble, ces études font ressortir des résultats utiles pour la mise en place de la téléréadaptation et permettent de dégager des pistes pour enrichir le champ de l’évaluation de la téléréadaptation, afin que celui-ci devienne plus pertinent et complet, et puisse mieux soutenir les prises de décision d’acteurs impliqués à différents niveaux en téléréadaptation. / Telerehabilitation, like other telehealth applications, has been increasingly used to provide health services. The goal of this thesis is to enrich the field of telerehabilitation evaluation such that it can better contribute to informed decision making of those involved in telerehabilitation at different levels. The first article is a systematic review of telerehabilitation studies and it was conducted in order to provide a critical synthesis of the current telerehabilitation literature. The revue included 28 studies of telerehabilitation, which, overall, confirmed the efficacy of telerehabilitation when used with a variety of clienteles in different settings. Some of the studies also suggest that there may be some cost benefits associated with telerehabilitation although the findings remain preliminary. Such a synthesis of the literature can contribute to some decisions regarding the pertinence of introducing telerehabilitation. However, decision makers also need information regarding the clinical and organizational changes that are associated with telerehabilitation when implemented in a clinical setting. The next two articles contain the results of a single case study that was centered on a telerehabilitation clinical project implemented in the eastern part of the province of Quebec, in Canada. A conceptual model was developed to guide this study, and it was based on Giddens’ Theory of Structuration and on models of technology structuration, in particular drawing upon the notion of the interaction between structure, agent and technology. Data was collected from several sources (focus groups, interviews, official documents and observation of recordings) and was analyzed using a qualitative analysis approach. The second article in this thesis examined the relationship between structure, agent and organizational culture with respect to telerehabilitation use. The results indicate that differences in organizational culture between the centres are more visible when telerehabilitation is used, which can in some cases lead to conflicts, while in other cases create opportunities for change. In addition, organizational culture also played a role in shared beliefs linked to the technology. Lastly, the results suggest that telerehabilitation could be used to bring about changes in organizational culture. The third article examined how telerehabilitation became integrated into existing clinical practices, how it contributed to the development of new routines and explored the sustainability of telerehabilitation. The results indicate that some activities, namely interdisciplinary care plans were integrated into clinical routines, while consultations and patient follow-up were not. Several factors related to the structure and agent were found to facilitate or hinder the integration of telerehabilitation into routine practices, including shared beliefs, the visibility of telerehabilitation activities, the clinical and organizational leadership, the availability of resources and the existence of collaborations. Sustainability was also observed when telerehabilitation use became more generalized and novel applications were developed, although this was only found to occur for activities which had integrated into routine practice. The results therefore suggest that when telerehabilitation is not integrated into routine practices, it will not be used, but that, on the other hand, telerehabilitation may be sustainable for activities which are repeated and then integrated into routine day-to-day clinical activities. Together, these studies put forth findings which can be useful when implementing new telerehabilitation programs. They also help elucidate directions for future research in order to enrich the field of telerehabilitation evaluation so that it may become more pertinent and comprehensive to support decision-makers involved at all levels of telerehabilitation.

La téléréadaptation, tout comme d’autres champs en télésanté, est de plus en plus interpelée pour la prestation de services. Le but de ce projet de thèse est d’enrichir l’évaluation de la téléréadaptation afin que les connaissances qui en découlent puissent venir soutenir la prise de décision d’acteurs impliqués à différents niveaux en téléréadaptation. Le premier article présente une revue systématique dont l’objectif était de faire synthèse critique des études en téléréadaptation. La revue rassemble 28 études en téléréadaptation, qui confirment l’efficacité de la téléréadaptation pour diverses clientèles dans différents milieux. Certaines des études suggèrent également des bénéfices en termes de coûts, mais ces résultats demeurent préliminaires. Cette synthèse critique est utile pour soutenir la décision d’introduire la téléréadaptation pour combler un besoin. Par contre, les décideurs bénéficieraient aussi de connaissances par rapport aux changements cliniques et organisationnels qui sont associés à la téléréadaptation lorsqu’elle est introduite en milieu clinique. Les deux autres articles traitent d’une étude de cas unique qui a examiné un projet clinique de téléréadaptation dans l’est de la province de Québec, au Canada. Le cadre conceptuel qui sous-tend l’étude de cas découle de la théorie de structuration de Giddens et des modèles de structuration de la technologie, en particulier de l’interaction entre la structure, l’agent et la technologie. Les données ont été recueillies à partir de plusieurs sources (groupes de discussion, entrevues individuelles, documents officiels et observation d’enregistrements) suivi d’une analyse qualitative. Le deuxième article de la thèse porte sur le lien entre la structure, l’agent et la culture organisationnelle dans l’utilisation de la téléréadaptation. Les résultats indiquent que les différences de culture organisationnelle entre les milieux sont plus évidentes avec l’utilisation de la téléréadaptation, entraînant des situations de conflits ainsi que des occasions de changement. De plus, la culture organisationnelle joue un rôle au niveau des croyances liées à la technologie. Les résultats indiquent aussi que la téléréadaptation pourrait contribuer à changer les cultures organisationnelles. Le troisième article examine l’intégration de la téléréadaptation dans les pratiques cliniques existantes, ainsi que les nouvelles routines cliniques qu’elle permet de soutenir et la pérennisation de la téléréadaptation. Les résultats indiquent qu’il y a effectivement certaines activités de téléréadaptation qui se sont intégrées aux routines des intervenants, principalement pour les plans d’intervention interdisciplinaire, tandis que pour les consultations et le suivi des patients, l’utilisation de la téléréadaptation n’a pas été intégrée aux routines. Plusieurs facteurs en lien avec la structure et l’agent ont contraint et facilité l’intégration aux routines cliniques, dont les croyances partagées, la visibilité de la téléréadaptation, le leadership clinique et organisationnel, la disponibilité des ressources, et l’existence de liens de collaboration. La pérennité de la téléréadaptation a aussi pu être observée à partir de la généralisation des activités et le développement de nouvelles applications et collaborations en téléréadaptation, et ce, uniquement pour les activités qui s’étaient intégrées aux routines des intervenants. Les résultats démontrent donc que lorsque la téléréadaptation n’est pas intégrée aux routines cliniques, elle n’est pas utilisée. Par contre, la téléréadaptation peut démontrée certains signes de pérennité lorsque les activités, qui sont reproduites, deviennent intégrées aux routines quotidiennes des utilisateurs. Ensemble, ces études font ressortir des résultats utiles pour la mise en place de la téléréadaptation et permettent de dégager des pistes pour enrichir le champ de l’évaluation de la téléréadaptation, afin que celui-ci devienne plus pertinent et complet, et puisse mieux soutenir les prises de décision d’acteurs impliqués à différents niveaux en téléréadaptation. / Telerehabilitation, like other telehealth applications, has been increasingly used to provide health services. The goal of this thesis is to enrich the field of telerehabilitation evaluation such that it can better contribute to informed decision making of those involved in telerehabilitation at different levels. The first article is a systematic review of telerehabilitation studies and it was conducted in order to provide a critical synthesis of the current telerehabilitation literature. The revue included 28 studies of telerehabilitation, which, overall, confirmed the efficacy of telerehabilitation when used with a variety of clienteles in different settings. Some of the studies also suggest that there may be some cost benefits associated with telerehabilitation although the findings remain preliminary. Such a synthesis of the literature can contribute to some decisions regarding the pertinence of introducing telerehabilitation. However, decision makers also need information regarding the clinical and organizational changes that are associated with telerehabilitation when implemented in a clinical setting. The next two articles contain the results of a single case study that was centered on a telerehabilitation clinical project implemented in the eastern part of the province of Quebec, in Canada. A conceptual model was developed to guide this study, and it was based on Giddens’ Theory of Structuration and on models of technology structuration, in particular drawing upon the notion of the interaction between structure, agent and technology. Data was collected from several sources (focus groups, interviews, official documents and observation of recordings) and was analyzed using a qualitative analysis approach. The second article in this thesis examined the relationship between structure, agent and organizational culture with respect to telerehabilitation use. The results indicate that differences in organizational culture between the centres are more visible when telerehabilitation is used, which can in some cases lead to conflicts, while in other cases create opportunities for change. In addition, organizational culture also played a role in shared beliefs linked to the technology. Lastly, the results suggest that telerehabilitation could be used to bring about changes in organizational culture. The third article examined how telerehabilitation became integrated into existing clinical practices, how it contributed to the development of new routines and explored the sustainability of telerehabilitation. The results indicate that some activities, namely interdisciplinary care plans were integrated into clinical routines, while consultations and patient follow-up were not. Several factors related to the structure and agent were found to facilitate or hinder the integration of telerehabilitation into routine practices, including shared beliefs, the visibility of telerehabilitation activities, the clinical and organizational leadership, the availability of resources and the existence of collaborations. Sustainability was also observed when telerehabilitation use became more generalized and novel applications were developed, although this was only found to occur for activities which had integrated into routine practice. The results therefore suggest that when telerehabilitation is not integrated into routine practices, it will not be used, but that, on the other hand, telerehabilitation may be sustainable for activities which are repeated and then integrated into routine day-to-day clinical activities. Together, these studies put forth findings which can be useful when implementing new telerehabilitation programs. They also help elucidate directions for future research in order to enrich the field of telerehabilitation evaluation so that it may become more pertinent and comprehensive to support decision-makers involved at all levels of telerehabilitation.

Die Kopf-Hals-Region ist eine der anatomisch kompliziertesten Regionen und enthält et- wa 300 Lymphknoten, die innerhalb eines komplexen Lymphgefäßsystems miteinander in Verbindung stehen. Die meisten Plattenepithelkarzinome der oberen Luft- und Speise- wege sind potentiell heilbar, aber sie metastasieren früh in die regionalen zervikalen Lymphknoten. Der Status dieser Lymphknoten ist der signifikanteste prognostische Faktor in der Therapie der Kopf-Hals-Tumoren. Die Neck Dissection, englisch für „Halsausräu- mung“, wird auch im deutschsprachigen Raum so genannt und ist der Standard der chir- urgischen Behandlung. Die vorliegende monozentrische Studie untersucht erstmals mittels Workflowanalyse ei- ne Serie von Neck dissections (ND) im Interoperateur-Vergleich und zielt auf die quali- tätsrelevante Erfassung der Operationssystematik ab. Von Januar bis Dezember 2011 wurden an einer onkologisch ausgerichteten HNO-Univer- sitätsklinik 42 selektive NDs (SND) und modifiziert radikale NDs (MRND) bei 5 unter- schiedlichen Operateuren mit der Workflowaufnahmesoftware s.w.an-Editor systemati- siert kodiert und vergleichend ausgewertet. Die Operateure variierten in ihrer Operationserfahrung mit Neck dissections zwischen 1- 17 Jahren und führten im Untersuchungszeitraum 19-76 NDs durch. Die Gesamtpräpara- tionszeit (15min. (2-48)) korrelierte negativ mit der Anzahl der jährlich durchgeführten NDs (p<.033). Bei der Dauer der Entfernung der einzelnen Lymphknotenpakete (33min. (10-81)) ergab sich eine negative Korrelation mit der jeweiligen Erfahrung des Opera- teurs (p<.001). 63 Als bevorzugte Reihenfolge der entfernten Level zeigte sich die Chronologie: 3-2A-(2B)- 5-4-(1). Diese variierte trotz „Schule des Hauses“ signifikant. Bei SNDs ergab sich eine Korrelation (p<.038) zwischen Erfahrung und Befolgung dieser Reihenfolge. Die Summe der entfernten Lymphknoten im histopathologischen Präparat gesamt (17 (0- 29)) sowie pro Level (3,8 (0-11)) zeigte keinen signifikanten Unterschied in Abhängigkeit von Erfahrung, Anzahl der 2011 durchgeführten NDs, befolgter Chronologie und Dauer der Operation. Trotz signifikanter Unterschiede bei den Operateuren im operativen Vorgehen fanden sich keine signifikanten Unterschiede in Gesamtsumme der entnommenen Lymphknoten- zahl. Die Workflowanalyse hilft, die Operationssystematik zu erfassen und damit bei wechselnden Operateuren einen Standard zu definieren.:1.1. KOPF-HALS-TUMOREN 1.2. ÄTIOLOGIE UND RISIKOFAKTOREN 1.3. EPIDEMIOLOGIE 1.4. KLINIK 1.5. DIAGNOSTIK 1.6. HISTORISCHER ÜBERBLICK 1.6.1. ANFÄNGE DER CHIRURGIE 1.6.2. ENTWICKLUNG DER STRAHLENTHERAPIE 1.6.3. RADIKALE NECK DISSECTION 1.6.4. FUNKTIONELLE ODER MODIFIZIERT RADIKALE NECK DISSECTION 1.6.5. SELEKTIVE NECK DISSECTION 1.6.6. NOMENKLATUR DER LYMPHKNOTEN-LEVEL 1.6.7. NOMENKLATUR DER NECK DISSECTION 1.7. THERAPIE 1.7.1. STRAHLENTHERAPIE 1.7.2. NECK DISSECTION 1.7.3. CHEMOTHERAPIE 1.8. AKTUELLEENTWICKLUNGEN 1.8.1. ENTWICKLUNGEN IN DER DIAGNOSTIK 1.8.2. ENTWICKLUNGEN DES CHIRURGISCHEN VORGEHENS 1.9. KOMPLIKATIONEN 1.10. PROGNOSE 2. AUFGABENSTELLUNG 3. MATERIAL UND METHODEN 3.1. PATIENTEN 3.2. DATENERHEBUNG 3.3. EIN- UND AUSSCHLUSSKRITERIEN DER ERHOBENEN DATEN 3.4. STATISTISCHE METHODEN II 4. ERGEBNISSE 4.1. GESAMTKOLLEKTIV 4.1.1. PATIENTENGUT 4.1.2. EINTEILUNG DER OPERATION IN PHASEN 4.1.3. EINTEILUNG DER DATEN NACH KOMPLEXITÄT DER OPERATION 4.2. OPERATEURE IM VERGLEICH 4.2.1. ERFAHRUNG UND ROUTINE DER OPERATEURE 4.2.2. GESAMTDAUER DER OPERATION 4.2.3. ANZAHL DER DURCHGEFÜHRTEN ARBEITSSCHRITTE 4.2.4. KORRELATION ZWISCHEN ERFAHRUNG SOWIE ROUTINE DER OPERATEURE UND DAUER DER OPERATION 4.3. LYMPHKNOTEN IM FOKUS 4.3.1. CHRONOLOGIE DER LYMPHKNOTENENTNAHME 4.3.2. HISTOPATHOLOGIE 5. DISKUSSION 5.1. GESAMTKOLLEKTIV 5.1.1. PATIENTENGUT 5.1.2. EINTEILUNG DER OPERATION IN PHASEN 5.1.3. EINTEILUNG DER DATEN NACH KOMPLEXITÄT DER OPERATION 5.2. OPERATEURE IM VERGLEICH 5.2.1. ERFAHRUNG UND ROUTINE DER OPERATEURE 5.2.2. GESAMTDAUER DER OPERATION 5.2.3. ANZAHL DER DURCHGEFÜHRTEN ARBEITSSCHRITTE 5.2.4. KORRELATION ZWISCHEN ERFAHRUNG SOWIE ROUTINE DER OPERATEURE UND DAUER DER OPERATION 5.3. LYMPHKNOTEN IM FOKUS 5.3.1. CHRONOLOGIE DER LYMPHKNOTENENTNAHME 5.3.2. HISTOPATHOLOGIE 5.4. SCHLUSSFOLGERUNG 6. BIBLIOGRAFIE

Covid-19 innebar nya rutiner för fastighetsmäklarna med ökat krav på användning av digitalkommunikation för att möta kunder och genomföra bostadsaffärer. Eftersomfastighetsmäklarnas intäkter helt löper på försäljningsprovision kan de nya rutinerna medförakonsekvenser för mäklares ekonomiska överlevnad. Syftet med studien var därför attanalysera hur mäklare förändrat och digitaliserat sina rutiner under Covid-19 pandemin, ijämförelse med före pandemin, för att utveckla kundrelationer, genomföra bostadsaffärersamt säkra sin ekonomiska överlevnad. Studien genomfördes med hjälp av intervjuer avmäklare, tematisering och jämförelse med rutinteorin och tidigare forskning. Resultatetvisade att mäklare genomförde färre personliga möten i hemmet och mäklarkontoret. Deutvecklade rutiner för att kombinera personliga och digitala möten, upprätthöll digitalkommunikation via hemarbete, videovisningar och sociala medier. De effektiviserade ävensina digitala rutiner genom obligatorisk föranmälan till visningar, digital avtalssignering ochanvändning av en digital plattform som kallas sälj- och köpcoachen. En av slutsatserna sommanifesterades under studien var det ökade avståndet mellan mäklare och kund, vilketkompenserades genom ökad digital användning av video, digital signering samt sälj- ochköpcoachen. Denna ökade digitalisering innebar förbättrad effektivitet i mäklarnas arbete attutveckla kundrelationer, genomföra bostadsaffärer och säkra sin ekonomiska överlevnad.Mäklarna antas därför fortsätta ompröva och effektivisera sin digitala kommunikation medkunder på nya oväntade sätt i framtiden. / Covid-19 meant new routines for real estate agents with increased requirements for the use ofdigital communication to meet customers and carry out housing transactions. A real estateagents income runs entirely on sales commission, therefore could the new routines that camealong with the pandemic have negative consequences on their financial survival. The purposeof the study was therefore to analyze how real estate agents changed and digitized theirroutines during the Covid-19 pandemic, compared to before the pandemic, to developcustomer relationships, conduct housing transactions and ensure their financial survival. Thestudy was conducted through interviews with brokers, thematization and comparison withroutine theory and previous research. The results showed that brokers conducted fewerpersonal meetings in the home and in their office. They developed routines for combiningpersonal and digital meetings, maintained digital communication via homework, video viewsand social media. They also streamlined their digital routines through mandatory pre-registration for screenings, digital contract signing and use of a digital platform called thesales and buying coach. One of the conclusions that manifested during the study was theincreased distance between broker and customer due to the pandemic. However, this wascompensated by increased usage of digital video, digital signing and the sales- and buyingcoach. The increased digitalisation meant improved efficiency in the brokers&amp;#39; work to developcustomer relationships, carry out housing transactions and secure their financial survival.Brokers are therefore expected to further develop and streamline their digital communicationwith customers in new unexpected ways in the future.

Malmskillnadsgatan i Stockholm har trots sitt centrala läge mitt i Stockholm där mycket folk är i rörelse runtom, blivit synonymt med kriminella aktiviteter och blivit en gata som folk anser vara dyster och oattraktiv. Syftet med detta arbete är att undersöka hur aspekter inom den bebyggda miljön påverkar aktivitet och trygghet i gatumiljöer samt hur de påverkar människors upplevelse av gatumiljön. Fokus kommer att ligga på Malmskillnadsgatan och det upprustningsprojekt som Vasakronan, tillsammans med Stockholms stad, har utfört. För att uppfylla syftet har en fallstudie av Malmskillnadsgatan gjorts i form av dokumentanalys, platsbesök och intervjuer med brukare samt en anställd på Vasakronan. Arbetet har utgått från ett teoretiskt ramverk där kopplingen mellan bebyggd miljö, attraktivitet och aktivitet samt bebyggd miljö och trygghet har analyserats. De teorier som använts är Gehls perspektiv på attraktiva gatumiljöer. Ewing och Handys fem kvaliteter för ett aktivt gatuliv, Crime Prevention Through Environmental Design (CPTED), Broken window theory samt Routine activity theory.  Dokumentanalysen visade att en kombination av brist på utbud av aktivitet, oattraktiv och stängd arkitektur och gatans läge jämfört med omkringliggande gator bidrog till att skapa låg naturlig genomströmning och lågt flöde på gatan. Platsbesöket visade att gatan har förbättrats utifrån flera av de teorier som nämnts i det teoretiska ramverket. De tidigare stängda fasaderna har öppnats upp och införandet av aktivitet i bottenvåning, främst i form av restaurangverksamhet, har bidragit till ett större flöde. Brukarintervjuerna visade att en klar majoritet tyckte att Malmskillnadsgatan blivit mer attraktiv och trygg efter ombyggnationen, dock främst enbart vid fastigheten Hästskon 12. Flera respondenter tycker att övriga delar av gatan fortfarande är oattraktiva och otrygga och bilden av att gatan dör ut på kvällar och helger finns fortfarande kvar. Arkitekturen och införandet av restaurangverksamhet nämndes främst som faktorer som fått gatan att bli mer attraktiv. Flödet av människor som dessa skapat var den främsta orsaken till att flera av respondenterna kände sig trygga. Förslag på ytterligare förbättringar var större variation i aktivitetsutbudet, mer aktiva bottenvåningar på övriga delar av gatan samt bättre belysning. / Malmskillnadsgatan in Stockholm, despite its central location in the heart of Stockholm with a lot of people moving around, has become synonymous with criminal activities and has been perceived as a gloomy and unattractive street. This study aims to investigate how aspects of the built environment affect activity and safety in urban environments, as well as how they influence people's perception of the street environment. The focus will be on Malmskillnadsgatan and the redevelopment project carried out by Vasakronan, in collaboration with the City of Stockholm. To fulfill the purpose, a case study of Malmskillnadsgatan has been conducted through document analysis, site visits, and interviews with users and an employee of Vasakronan. The study is based on a theoretical framework that analyzes the connection between the built environment, attractiveness, and activity and between the built environment and safety. The theories used include Gehl's perspective on attractive street environments, Ewing and Handy's five qualities for vibrant street life, Crime Prevention Through Environmental Design (CPTED), the Broken Window theory, and the Routine Activity Theory. The document analysis revealed that a combination of a lack of activity offerings, unattractive and closed architecture, and the street's location compared to surrounding streets contributed to the low natural flow and low activity on the street. The site visit showed that the street has improved according to several of the theories mentioned in the theoretical framework. The previously closed facades have opened up, and the introduction of activities on the ground floor, mainly in the form of restaurants, has contributed to increased flow. User interviews indicated that a clear majority felt that Malmskillnadsgatan had become more attractive and safer after the redevelopment, primarily in the vicinity of Hästskon 12. However, several respondents still found other parts of the street unattractive and unsafe, and the perception that the street dies out in the evenings and on weekends persists. The architecture and the introduction of restaurant activities were primarily mentioned as factors that made the street more attractive. The flow of people they created was the main reason several respondents felt safe. Suggestions for further improvements included greater variety in the range of activities, more active ground floors in other parts of the street, and better lighting.

Background: Although immunisation services are provided free at all public health facilities in South Africa, immunisation coverage remains variable and disease outbreaks still occur. The coverage rate in the Overberg district is recorded as 75.8%, below the national target of 90% (Western Cape Government Provincial Treasury 2013:2). The researcher wanted to understand what the barriers to accessing immunisation services were and how this might relate to other primary health care services. Methods: The researcher visited 22 households and interviewed nine mothers who had brought their children to Zwelihle Clinic to be immunised and nine community health workers servicing the Zwelihle community in the Overberg district, Western Cape Province. Findings: A key finding is that the data does not reflect the actual situation – children in the community either are immunised at other facilities or have left the catchment area, hence strong relationships between the facility and the community and an electronic patient tracking system become important. Findings impacting access to services include the attitude of administrative staff, waiting times and the impact of migratory communities. Recommendations are made to improve the quality of data, provide training to administrative staff, improve patient education, reduce waiting times and improve the relationship between the clinic and the community in order to better track patient migration / Health Studies / M.A. (Public Health)

In recent years, there has been an ever increasing emphasis placed on the collection and use of patient reported outcome measures (PROM) in mental health services. This emphasis stems from a culture of evidence based practice, wherein PROM are shown to improve therapeutic outcomes at the clinical level, as well as provide information for the appropriate development of services and commissioning at a national level. This study uses an online survey to explore the use of PROM by mental health staff (n=112) in various Child and Adolescent Mental Health Services across England. Attitudes toward routine outcome monitoring practices and perceived competency around PROM use were also measured. Results found that although significant numbers of staff were using PROM, the amount of data being collected falls short of policy targets. Staff’s attitudes towards the practice are shown to be ambivalent, whereas overall perceived levels of competency were reasonably good. The relationships between attitudes, competence and PROM usage are discussed and a prediction model for PROM usage is developed in light of existing psychological theory. Results showed that training played an important role in the uptake of PROM and implications for the dissemination of training programs are emphasised.