En France, la vaccination repose principalement sur l’action des médecins généralistes (MG). L’augmentation de l’opinion défavorable du public envers la vaccination, associée au constat d’une couverture vaccinale insuffisante, démontre l’importance de prendre en compte les attitudes et perceptions des MG vis-à-vis de la vaccination. Les objectifs de ce travail de thèse étaient d’évaluer les connaissances, perceptions, attitudes, et pratiques des MG français vis-à-vis de certains vaccins, pour lesquels la couverture vaccinale est sub-optimale et/ou pour lesquelles des polémiques existent. En 2014, une vague d’enquêtes par questionnaire téléphonique a été mise en place auprès de 1582 MG français pour mieux connaître leurs comportements, attitudes et pratiques vaccinales. Plusieurs résultats ont mis en évidence l’hétérogénéité des pratiques et des perceptions des MG concernant la vaccination. Tout d’abord, nous avons mis en évidence que les MG avaient une attitude discordante entre leurs pratiques vaccinales pour leurs propres enfants et leurs recommandations vaccinales pour leurs patients. Ensuite, nous avons étudié la perception par les MG des polémiques vaccinales concernant les effets indésirables des vaccins. Cependant, les MG interrogés étaient soit sensibles aux polémiques, soit les rejetaient, sans que cela soit associé au caractère fondé ou non de la polémique. Puis nous avons étudié les recommandations des MG pour la vaccination à méningocoque C, qui étaient très insuffisantes dans notre étude, ce qui participe à la couverture vaccinale basse de ce vaccin. Le manque de communication autour de ce vaccin pourrait être imputé en partie à une campagne de vaccination insuffisante. Par la suite, nous avons étudié la décision des MG face à un enfant devant être vacciné, mais présentant une infection mineure fébrile. Une majorité des MG a préféré reporter cette vaccination, la fièvre étant le facteur influençant le plus cette décision. Les recommandations officielles françaises ne permettent pas de définir clairement l’attitude à adopter dans cette situation. Enfin, nous avons décrit les outils plébiscités par les MG pour améliorer leur pratique vaccinale au quotidien. Certains de ces outils existent mais semblent manquer de visibilité. En conclusion, les MG ne peuvent améliorer leurs pratiques qu’avec une formation spécifique à la vaccination, des outils identifiés et disponibles, et un soutien des pouvoirs publics qui s’engagent avec des recommandations claires / In France, vaccination relies mainly on general practitioners (GPs). The increase in the public's unfavourable opinion on vaccination, associated with the insufficient vaccination coverage, demonstrates the importance of taking into account the attitudes and perceptions of GPs regarding vaccination. The objectives were to assess the knowledge, perceptions, attitudes, and practices of French GPs regarding vaccines with insufficient vaccination coverage and / or for which controversies exist. In 2014, a telephone survey questionnaire was conducted on 1582 French GPs to learn more about their behaviours, attitudes and vaccine practices. Our results have highlighted the heterogeneity of GPs’ practices and perceptions regarding vaccination. First, we found that GPs reported discordances between their vaccine practices for their own children and their vaccine recommendations for their patients. Then, we studied the GPs’ perception of the vaccine polemics concerning adverse effects of some vaccines. However, the interviewed GPs were either sensitive to the polemics or rejected them, without being associated with the well-founded nature of the controversy. Then we looked at GPs’ recommendations for meningococcal C vaccination to their patients, which were very low in our study. These low recommendations contributes to the low vaccine coverage of this vaccine. The lack of communication about this vaccine could be partly attributed to an insufficient vaccination campaign. Subsequently, we examined GPs’ decision facing a child to be vaccinated, but presenting an uncomplicated common cold. A majority of GPs decided to postpone this vaccination, with fever being the most important factor influencing this decision. The French official recommendations do not define clearly the attitude to be adopted in this situation. Finally, we described the tools that GPs would find useful to improve their daily immunization practice. Some of these tools exist but seem to lack visibility. In conclusion, GPs can only improve their practices with specific immunization training, identified and available tools, and with the support of public authorities who commit themselves with clear recommendations

Bakgrund. Denna magisteruppsats från specialistsjuksköterskeprogrammet i akutsjukvård är en pilotstudie som görs på uppdrag av Centrum för Interprofessionell Samverkan och sambruk inom Akut vård (CISA). Allvarlig händelse är en händelse där resurser behöver omfördelas, ledas och användas på ett särskilt sätt. Internationella erfarenheter visar att beredskap inför allvarlig händelse är ett förbättringsområde. Nationella erfarenheter pekar på kommunikation samt introduktion av nyanställda som områden för utveckling. Vid allvarlig händelse engageras flera olika verksamheter som måste samverka, något som tidigare erfarenheter och forskningsresultat har visat vara svårt. Övning kan förbereda personal i att hantera olika händelser, samt förbättra samverkan vid verklig händelse. Digital simuleringsövning bidrar med ett effektivt sätt att lära sig genom att utförandet sker i en säker miljö. Syftet med pilotstudien är att kartlägga genomförandet och upplevelsen av övningar inför allvarlig händelse inom larmkedjan i ett län i södra Sverige. Metod. Den valda designen var tvärsnittsstudie. Datainsamlingen utfördes genom en enkätundersökning. Urvalet skedde med hjälp av CISA:s styrgrupp genom bekvämlighetsurval. Totalt 108 respondenter svarade, av dessa exkluderades nio på grund ut av totalt eller partiellt (>30%) bortfall. Analys av deskriptiv och analytisk statistik skedde i SPSS version 25. En tematisk innehållsanalys utfördes på fritext svaren. Resultat/Slutsats. Deltagarna som arbetar inom larmkedjan övar i olika omfattning baserat på vilken verksamhet de tillhör samt om de har en ledningsroll eller ej. Verksamheterna samövar inför allvarlig händelse men tenderar att samöva prehospitalt alternativt intrahospitalt. En övervägande majoritet upplever att det övas för sällan. Övningarna upplevs generellt som meningsfulla av deltagarna. Realism, mängdträning samt tid till övning identifieras som förbättringsområden. Mer forskning behövs inom området. Förslagsvis med lika stora grupper av representanter från verksamheterna för att kunna dra säkrare slutsatser kring resultatet samt därmed gynna den enskilda patienten genom att öka samhällets beredskap inför allvarlig händelse. / Background. This master thesis from the nurse specialist program in emergency care is a pilot study conducted on assignment of Center for interprofessional collaboration and artel within emergency care (CISA). Major accidents or disasters are events where resources need to be redistributed, lead, and used in a specific manner. International experience shows that preparedness for major accidents or disaster is an area in need of improvement. National experiences point out communication and introduction of new employees as areas of improvement. A major accident or disaster involves multiple functions, that within this extreme situation need to cooperate, something that past experiences have shown to be difficult. Exercise can prepare personnel in dealing with different situations, as well as improve cooperation in real events. Digital simulation exercises contribute as an effective way to learn in a safe environment. Aim of the study was to map how exercises for major accidents are implemented and experienced within the emergency response system in a county in southern Sweden. Method. The chosen design was a cross-sectional study. The data collection was conducted through a survey study. The sample was collected with the help of CISA’s control group through convenience sample. The study got a total of 108 participants, of these participants nine were excluded because of total or partial (>30%) non-completion. Analysis of descriptive and analytic statistics was carried out in SPSS v.25. A thematic content analysis was conducted on the free text answers. Results/Conclusion The participants that work within the emergency response system exercise to different extents based on which unit within the emergency response system they belong to as well as if they have a management role in case of a major accident or not. The units corporate for major accidents but tend to co-exercise either prehospitally or intrahospitally. A clear majority of the participants agree that they practise too rarely. The exercises are generally seen as meaningful by the participants. Realism, amount of training and time for practice are identified as areas of improvement. More research is needed within the area, as a suggestion with equal sized groups of representatives from the different units, to be able to draw more certain conclusions from the result and thereby favor the individual patient, by increasing the readiness for major accidents or disasters in society. / Projekt Tabletop

We consider a longitudinal system in which transitions between the states are governed by a discrete time finite state space stochastic process X. Our aim, using aggregated sample survey data of the form typically collected by official statistical agencies, is to undertake model based inference for the underlying process X. We will develop inferential techniques for continuing sample surveys of two distinct types. First, longitudinal surveys in which the same individuals are sampled in each cycle of the survey. Second, cross-sectional surveys which sample the same population in successive cycles but with no attempt to track particular individuals from one cycle to the next. Some of the basic results have appeared in Davis et al (2001) and Davis et al (2002).¶ Longitudinal surveys provide data in the form of transition frequencies between the states of X. In Chapter Two we develop a method for modelling and estimating the one-step transition probabilities in the case where X is a non-homogeneous Markov chain and transition frequencies are observed at unit time intervals. However, due to their expense, longitudinal surveys are typically conducted at widely, and sometimes irregularly, spaced time points. That is, the observable frequencies pertain to multi-step transitions. Continuing to assume the Markov property for X, in Chapter Three, we show that these multi-step transition frequencies can be stochastically interpolated to provide accurate estimates of the one-step transition probabilities of the underlying process. These estimates for a unit time increment can be used to calculate estimates of expected future occupation time, conditional on an individual’s state at initial point of observation, in the different states of X.¶ For reasons of cost, most statistical collections run by official agencies are cross-sectional sample surveys. The data observed from an on-going survey of this type are marginal frequencies in the states of X at a sequence of time points. In Chapter Four we develop a model based technique for estimating the marginal probabilities of X using data of this form. Note that, in contrast to the longitudinal case, the Markov assumption does not simplify inference based on marginal frequencies. The marginal probability estimates enable estimation of future occupation times (in each of the states of X) for an individual of unspecified initial state. However, in the applications of the technique that we discuss (see Sections 4.4 and 4.5) the estimated occupation times will be conditional on both gender and initial age of individuals.¶ The longitudinal data envisaged in Chapter Two is that obtained from the surveillance of the same sample in each cycle of an on-going survey. In practice, to preserve data quality it is necessary to control respondent burden using sample rotation. This is usually achieved using a mechanism known as rotation group sampling. In Chapter Five we consider the particular form of rotation group sampling used by the Australian Bureau of Statistics in their Monthly Labour Force Survey (from which official estimates of labour force participation rates are produced). We show that our approach to estimating the one-step transition probabilities of X from transition frequencies observed at incremental time intervals, developed in Chapter Two, can be modified to deal with data collected under this sample rotation scheme. Furthermore, we show that valid inference is possible even when the Markov property does not hold for the underlying process.

<p>Previous research and patient complaints to the Swedish Patient Support Committee shows that there is a lack of substance in the patient-nurse relationship. This may suggest that it can be difficult for health care to live up to health-care law which requires it to be of good quality, based on dignity and respect and designed so that the patient is an active participant and can make their own decisions when it comes to their health care. For a better understanding of what a dignified patient-nurse relationship is, this study aims to clarify what the patient values as good patient-nurse relationship and describe how they have experienced the patient-nurse relationship during their stay at an emergency care department. The study is a descriptive cross-sectional study with a quantitative approach, where the population consisted of patients who were cared for at an emergency care department in the County of Västmanland, Sweden during 2007. The sample consisted of 93 patients which were asked to answer a questionnaire. The results show that patients who were cared for, answered positively in terms of the patient-nurse relationship, when they felt welcome to the department (62,1 %), when they were treated with deference and respect (59,3 %) and when the nurses showed they cared (57 %). A total of 11 % of the patients experienced a violation of their integrity and a sense of powerlessness towards health care. The results confirm previous research which emphasizes the importance of paying attention to patients' needs and requests before the dissatisfaction and lack of good patient-nurse relationship has arisen. This is necessary in order to improve and develop the positive experience of caring for the patient, and thus raise the quality of care.</p> / <p>Klagomål till patientnämnden visar på att det finns brister i bemötandet vilket också styrks av tidigare forskning. Det förefaller att det kan vara svårt för sjukvården att leva upp till hälso- och sjukvårdslagen som kräver att vården ska vara av god kvalitet, grundas på respekt, värdighet och utformas så att patienten själv får vara med och ta beslut. För att bidra till mer kunskap om ett värdigt bemötande avser denna studie att belysa vad patienten värderar som ett gott bemötande.<strong> </strong>Syftet var att beskriva hur patienter värderar bemötandet och hur de beskriver att de blivit bemötta av personalen under sin vårdtid på en akutvårdsavdelning. Studien är en deskriptiv tvärsnittsstudie med en kvantitativ ansats där populationen bestod av patienter som vårdats på akutvårdsavdelningar i Landstinget Västmanland under 2007. I studien ingick 93 patienter som vid slutet av vårdtillfället tillfrågats om de ville besvara en enkät. Resultatet visar att det som patienterna skattade att de var mest nöjda med (stämmer precis) ifråga om bemötandet var det välkomnande de fick när de kom till avdelningen (62,1 %), att de blev bemötta med aktning och respekt (59,3 %) samt att vårdarna brydde sig om dem (57 %). Trots det upplevde 11 % av patienterna kränkning av integritet och vanmakt i vården. Resultatet bekräftar tidigare forskning och poängterar vikten av att uppmärksamma patientens behov och begär innan ett missnöje har uppstått. Detta för att kunna förbättra och även utveckla en positiv upplevelse av bemötande för patienten och därmed höja vårdkvaliteten.</p> / Axelina

<p>Small firms often have inadequate access to the capital necessary for sucessful management. The Swedish Government introduced in the mid-1990s allowance rules that facilitate retention of profit for sole proprietorships and partnership firms. The tax credits arising from the allowances give certain benefits as a source of financing compared to traditional forms of credits. Among the more essential benefits are that the payment for some parts of the tax credit can be put on hold almost indefinitely, or alternatively never be paid. The firms are free to use these means, and the responsibility of future payment of the postponed tax debt stays with the individual firms. The comprehensive purpose of the dissertation may be stated as to increase the understanding of small Swedish firms, especially sole proprietorships, utilizing possibilities for allowances for income smoothing and internal financing. At the beginning the dissertation describes case studies, comprising a smaller selection of microfirms. With a starting-point from the accounted and reported income-tax returns, alternative calculations are made where additional positive tax and finance effects appear possible to obtain. One purpose of these studies is to increase the insight regarding the possibilities of income smoothing and internal financing that arise from utilizing these allowances. </p><p>These studies also illuminate, to what extent and in what way they are being used in reality. Another objective of these studies is to give a more substantive insight into the technics behind the different allowances, appropriation to positive or negative interest rate allocation appropriation or dissolving of tax allocation reserve appropriation or dissolving of “expansion fund” Theories regarding the creation of resources, through building of capital, and theories on financial planning and strategy are studied. The purpose is to find support for the choice of theoretical grounded underlying independent variables that can be used in cross-sectional studies to explain the use of the possibilities of appropriations. Theories of finance that are of greatest interest, in the operationalisation of these variables, are theories that discuss the choices of different financing alternatives for small firms. The “pecking order theory”, describes the firm’s order of priority when choices of finance alternatives are made. The concept of “financial bootstrapping” expands the frame for different forms of financing choices that especially very small firms have at their disposal.</p><p>The last part of the theoretical frame deals with the phenomenon of “income smoothing,” which can be translated as leveling out profits/losses. A number of financial and non-financial variables are supported by and operationalised from these financial theories e.g., return on sales, capital turnover, quick ratio and debt-to-equity ratio, respectively age, gender and line of business. Cross-sectional studies are implemented for the taxation years of 1996 and 1999, on databases that have been extracted from Statistics Sweden. The group of 87,276 sole proprietorships included in the study were required to complete tax returns and pay taxes for the business activity according to the supporting schedule, N2, information from the sole proprietorships’ income statement and balance sheet in an accounting statement that comes with the income tax return form. The possibilities of allowances are considered as dependent variables. The intention of the cross-sectional studies is to survey and describe the utilization of possible allowances, with the support of the financial and non-financial independent variables. The connection of these variables to the decision of sole proprietorships to appropriate to the tax allocation reserve is also summarized in a logistic regression model. A number of theoretically based propositions are made for the purpose of observing how the variables are connected to the chances that sole proprietorships actually appropriate to this form of allowance. Appropriation to the tax allocation reserve stands out as the most practiced form of allowance. The studies also clarify that utilization varies among different forms of allowances, but that not all firms that have the prerequisites to utilize the possibilities really do so to the full. A further utilization of the different possibilities of allowances is often conceivable. For the sole proprietorships that are not utilizing these possibilities, the allowances should be considered eligible as a contribution to internal financing and to increase access to capital.</p>

<p>General and reproductive health and reproductive outcome were described in rural women of childbearing age (15-44 years) during 1992-93 in a cross-sectional study in Zimbabwe. Through a two-stage sampling procedure twelve villages were selected at random, and 79% of the women in the villages accepted to participate (n=1213). In a structured interview women¡¯s self-reported morbidity, socio-economic conditions, use of health care and fertility regulation methods, reproductive outcome and infertility problems were assessed. The prevalence rates of anaemia, malaria and syphilis were investigated. Retrospectively, HIV serology was anonymously assessed and associations with socio-economic conditions and morbidity were analysed. </p><p>The mean age was 28 years. Family planning was currently used by 37%. Primary and secondary infertility was reported by 0.9% and 4.4%, respectively. The perinatal mortality rate for all completed pregnancies (n=3601) was 23/1000. During the latest completed pregnancy 94% had attended antenatal care and 85% had delivered in hospitals or clinics. The self-reported complications during delivery seemed to have been cared for within the health care system. </p><p>Women perceived their health as being generally good. Mean haemoglobin (Hb) was 13.5 g/dl and only 3.4% were anaemic (Hb ¡Ü11.0 g/dl). Malaria prevalence was 5.4%, but a positive malaria test was not associated with anaemia. Syphilis prevalence was 2.2%, and a positive syphilis test increased the risk of being HIV positive three-fold (OR=3.0; 95% CI: 1.4-6.2). </p><p>The prevalence of HIV was high (22%). Women aged 15-19 had the lowest prevalence (7.6%), while the highest was found in married women aged 20-29 years (30%). The differences in HIV prevalence between the villages ranged between 8.4% and 33%. HIV positive women reported no more morbidity than HIV negative women. The low morbidity found at the time of the study indicates a fairly short duration of the HIV epidemic. </p>

The theme of this thesis is suicide mortality in its various aspects, seen from an international, European perspective. It questions the existence of social (structural) concomitants to suicide mortality and investigates attitudes towards and legislation concerning suicide, as well as some historical processes pertaining to their development. Paper 1 replicates an authoritative study of the "correlates of suicide" on a national level in European countries. It shows that the findings of this study do not hold 16 years later, and it presents some ideas as to why these changes have taken place. It is suggested that there are no simple social correlates to suicide on this level, and that suicide rates tend to vary according to, among other things, international cultural influences. Paper 2 investigates penal legislation relating to suicide in European countries. Three types of punishable action are found: 1) aiding suicide, 2) abetting suicide, and 3) driving somebody to suicide. A majority of European countries include some of these acts in their criminal laws. However, the laws vary very widely between countries, thereby constituting a notable exception to the common presumption of uniformity of law. The scope of the criminalization and the severity of the penalties for the crimes covary both with cultural attitudes towards suicide and with suicide rates. The results are interpreted as indicating the existence of a cultural-normative system, consisting of the cultural attitudes towards suicide, the laws regulating the actions relating to suicide and, perhaps, religion. It influences the occurrence of suicide, mainly by offering individuals cultural models of behavior. Paper 3 describes the process towards the decriminalization of suicide (in 1864) in Sweden, its causes and consequences. It is suggested that the law change took place because of a) the international ideological currents of the time (the heritage of the Enlightenment), b) the examples presented by other European countries, and c) the radical changes in people's behavior. The reform was long overdue, and thus did not have a direct effect on suicide mortality. The increase in Swedish suicide rates in the 19th century is seen as connected with certain aspects of the "modernization" process. Paper 4 addresses the prospects and problems connected with the ap-plication of Talcott Parsons's functionalist theory to suicide research, in particular when contrasting it with Durkheim's theory. It is found that the latter, despite its shortcomings, still dominates socially oriented suicide research. Parsons's theory is seen as implicating the cultural primacy of suicide mortality. Its general usability is, however, highly uncertain since many of its essential constituent parts are not well suited to the subject. A model for suicide rates, consisting of cultural (domestic and inter-national), political, social, diffusion and availability factors is presented. Taken together, the papers constitute a case for cultural (as opposed to socio-structural) research into suicide mortality. They question the repeated testing of structural variables in favor of creating cultural indicators. They suggest some new lines of research, and call for a consistently universal perspective on the problem of suicide and suicide mortality. / <p>Härtill fyra uppsatser.</p>

<p><font face="Times New Roman" size="3"><font face="Times New Roman" size="3"> <p align="left">The study made use of cross-sectional design that compared the performance of younger children (6- to 7-year-olds) with that of older children (12- to 13-year-olds) on various measures of executive function. Within this, it made use of a natural experimental design, with children exposed to alcohol<i><font face="Times New Roman" size="3"> as the experimental group and non-exposed children as the control group.</font></i></p> </font></font></p>

<p>Low back pain (LBP) is a significant problem among the nursing population worldwide. Manual lifting and shifting of heavy objects and patients are primary contributing factors. Nurses are supposed to be knowledgeable about the risk factors and preventive measures and effectively apply it into practice to prevent them from sustaining back injuries. Strategies to reducing the incidences of LBP in nurses have been previously implemented but with little outcomes. The purpose of this study was to explore the relationship between occupational risk factors and the prevalence of LBP in nurses at MOI, Tanzania. Therefore, the study examined / the prevalence of LBP amongst nurses, work-related risk factors contributing to LBP, knowledge and effectiveness of back care techniques, and barriers to effective back care techniques in clinical nurses.</p>

The study investigated three aspects related to smoking, namely, smoking behaviour, risk perception and attitudes to anti-smoking legislation. The theoretical framework of the study was the Information-Motivation-Behavioural (IMB) skills model. The study was a quantitative one, making use of a cross-sectional survey design to obtain data about the three variables of interest. Responses to statements about risk perception and attitudes to anti-smoking legislation in the questionnaire were arranged on a three-point Likert scale. The inferential statistics used were one-sample ttests and Chi-square analyses. The results showed an overall smoking prevalence of 16%, with twice as many females than males being smokers in the sample. ‘Coloured’ students in both genders had the highest smoking rate compared to all other race groups. The knowledge of the health risks of smoking were very high, however smokers had a lower perception of risk compared to non-smokers. Moreover, while there was a fair amount of support for anti-smoking legislation among smokers, smokers tended to show less support for legislation than non-smokers, especially to those parts of the legislation that affect them more directly. The results of the study indicate a clear connection between smoking behaviour and the effect it has on both risk perception as well as attitudes to anti-smoking legislation in individuals.