Chronic pain in children and adolescents is common; approximately 5% of children and adolescents report chronic pain along with moderate to high pain-related disability. Chronic pain is a subjective experience and can best be explained by a bio-psycho-social approach, which suggests reciprocal relations between different levels of this multidimensional phenomenon. The different dimensions of chronic pain need to be considered for a comprehensive assessment. Due to the subjective nature of pain, the child’s self-report is usually considered the best available and most valid estimate of the pain experience. A reliable and multidimensional assessment is an indispensable requirement for treatment planning. To date, questionnaires in German language are available to assess a wide range of relevant parameters in pediatric chronic pain. However, so far, no validated self-report tool exists to assess sensory and affective pain perception in children. These two parameters are of relevance since they describe aspects of the biological as well as the psychological dimension of chronic pain. Furthermore, a comprehensive diagnostic approach combining parameters from the three dimensions of chronic pain does not yet exist for children and adolescents. Such a comprehensive approach could be used for sample descriptions and standardized comparisons across different populations; it could serve as an approach for treatment planning or to classify outcome. This doctoral thesis is aimed at further developing the available diagnostic measures for older children and adolescents with chronic pain based on the above mentioned gaps in pediatric pain assessment. Research was performed on three patient samples. Sample 1 includes data from a prospective assessment at the German Pediatric Pain Centre from August 2008 to March 2009 (N(1)=139). Sample 2 includes retrospective data from patients who were treated at the German Pediatric Pain Centre from July 2005 to June 2010 (N(2)=1242). Sample 3 consists of pediatric pain patients who started an intensive interdisciplinary inpatient treatment between November 2009 and July 2011 (N(3)=83). In a first study, a tool to assess sensory and affective pain perception, the Pain Perception Scale for Adolescents, was adapted and validated in an adolescent clinical sample (Sample 1). The Pain Perception Scale for Adolescents allows pain patients to provide a valid and reliable self-report of parameters for both the biological and psychological dimensions of pain. In a second study, this tool was applied to a further sample of adolescents with migraine and tension-type headache (subsample of Sample 2). It was demonstrated that, contrary to the official headache classification guidelines, the sensory pain perception in this sample did not differentiate between migraine and tension-type headache. To develop a multidimensional assessment approach, in a third study, an adult classification system (Chronic Pain Grading) was applied to a sample of pediatric pain patients (Sample 2). This approach proved useful as a valid measure for a brief operationalization of pain problem severity, including pain intensity and pain-related disability only, and as an outcome measure. However, it displayed major shortcomings with regards to treatment stratification. To further develop an approach for treatment stratification and treatment planning, a fourth study focused on developing a new multidimensional approach for subgroup classification (subsample of Sample 2). The stability of subgroups was demonstrated in a cross-validation with an independent sample (Sample 1). Furthermore, the identified subgroups displayed distinct treatment outcomes after a standardized treatment program (Sample 3). In conclusion, this doctoral thesis offers an addition to diagnostic measures for older children and adolescents with chronic pain by adding the Pain Perception Scale for Adolescents and by proving the validity of the Chronic Pain Grading for the application in this patient group. These tools allow a valid description of adolescents’ subjective pain experience. Results from this doctoral thesis also indicate that the findings from adults cannot be readily transferred to children and adolescents. The final output of this doctoral thesis is a bio-psycho-social classification approach that identifies subgroups of adolescents with chronic pain with treatment relevant differences. This is a first step toward the development of subgroup-specific treatment.

Syftet med uppsatsen var att undersöka socialarbetares erfarenheter av att arbeta som professionell med fysisk funktionsnedsättning. Metoden som användes var kvalitativ där semistrukturerade djupintervjuer fördes med respondenter vars upplevelser analyserades och tolkades utifrån två teoretiska inriktningar, nämligen Stigmateorin och den sociala modellen. Resultatet visade att respondenterna hade erfarenhet av både hinder och möjligheter i form av strukturella tillgänglighetsmässiga faktorer eller individmässiga faktorer, såsom attityder och fördomar som inverkade i deras yrkesutövning som socionomer. Den slutsats som dras utifrån analysen är att förhållningssätt till funktionsnedsättning och hur arbetsförhet uppfattas av arbetsgivare inverkar i hur arbetsförmåga bedöms och relateras till i interaktion och arbetsplatsutformning. Det sociala arbetet som profession rör sig i ett varierat områdesspan där socionomer med fysiska funktionsnedsättningar kan bidra till representativitet och unika erfarenheter i en inkluderande arbetskultur. Arbetskontexten är därför av vikt när det gäller att beakta de villkor som professionella med fysiska funktionsnedsättningar utmanas av. / The purpose of this thesis was to investigate active social workers with physical disabilities about their experiences of obstacles and opportunities in their profession. The method used was qualitative where semi-structured, in-depth interviews were conducted with respondents whose experiences were analysed and interpreted based on two theoretical orientations, namely the Stigma theory and the social model. The results showed that the respondents had experiences of both obstacles and opportunities in the form of structural accessibility factors or individual factors such as attitudes and prejudices that influenced their professional practice as social workers. The conclusion drawn from the analysis is that attitudes towards disabilities and how employers perceive work ability affect how work ability is assessed and related in interaction and workplace design. Social work as a profession moves in a varied range of areas where social workers with physical disabilities can contribute to representativeness and unique experiences in an inclusive work culture. The work context is therefore important when it comes to considering the conditions that professionals with physical disabilities are challenged by.

This review aimed to evaluate orthotic treatments for children and adolescents with pectus carinatum, primarily focusing on patient satisfaction with the treatment. Secondary outcomes of interest were adherence and psychological and social factors following the treatment period. A literature search was performed in the databases CINHAL, Medline, Web of Science and Scopus. Following predetermined eligibility criteria, articles were included and excluded. Next, criticala ppraisal was performed for the included articles. Following this, relevant data were extracted, analysed, and presented to aid in answering the research questions. Six articles with 402 patients were included in the final review. Patient satisfaction was good or improved following the treatment period, and the combined non-adherence rate for the included orthosis was 37.7 %. Patients adhering to the treatment protocol showed increased self-esteem and decreased interference with social activity following orthotic correction. Moreover, they displayed significantly higher patient satisfaction than patient's non-adherent to the treatment protocol. The findings were displayed and discussed in the Bio-Psycho-Social model. Due to their connection, patient satisfaction and adherence were placed together in the middle and surrounded bypsychological and social factors. The model displayed that a combination of many aspects determines patient satisfaction and adherence, demonstrating that treatment is complex and challenging. In conclusion, adherence was deemed one of the most important aspects to achieve high patient satisfaction. Moreover, due to psychological and social factors, a patient-centred approach with professional collaboration is necessary to achieve successful outcomes. To make reliable conclusions, research of higher quality with long follow-up periods including standardised patient satisfaction and adherence measures is needed.

Denna studie avsåg att bättre förstå social isolation bland unga från perspektivet av en socialarbetare genom att svara på följande frågor: Hur arbetar socialarbetare med isolerade unga, varför blir unga isolerade och slutligen vilken konsekvens social isolation får för de som är isolerade. Studien använde sig av en kvalitativ forskningsansats för att svara på dessa frågor genom att använda sig av semistrukturerade intervjuer som analyserades med kvalitativ innehållsanalys. Det empiriska materialet analyserades utifrån ett systemteoretiskt perspektiv och analys utifrån den sociala modellen. Empirin i studien kommer från sex stycken intervjuer med socialarbetare. Resultatet av studien tyder på att socialarbetare använder sig av olika verktyg för att arbeta med socialt isolerade ungdomar, samtliga tar upp relationsskapande som ett exempel. Anledningarna till att ungdomarna blir isolerade kan vara olika, gemensamma resultat var autism, depression, avsaknad av socialt sammanhang, otillräckligt stöd från föräldrar och slutligen internetanvändning. Konsekvenser för de socialt isolerade ungdomar varierar mellan ungdom till ungdom men återkommande tema var försämrad sociala färdigheter, fysisk hälsa och mental hälsa. Vår slutsats blev att social isolation är ett omfattande problem med ett flertal olika aspekter som behöver särskild hänsyn och socialarbetare arbetar ständigt med sin förståelse av situationen och utgår främst från den unge själv och i sitt arbete ändvänder de sig av relationskapande som sitt främsta verktyg. / This study sought to better understand social isolation among youths from the perspective of social workers by answering the following questions. How do social workers work with isolated youths, why do youths become isolated and finally what consequences does social isolation cause for youths. The study used a qualitative research approach to answer these questions by also using qualitative content analysis along with perspectives rooted in general systems theory and the social model. The empirical data in this study comes from six interviews with social workers along with prior research. The results of this study suggest that social workers use various tools when working with socially isolated youths, among these all six social workers mention relationship building as an example. The reasons youth socially isolate can vary, common results were autism, depression, a lack of social context, lacking support from parents and finally internet use. Personal consequences for socially isolated youths varied from youth to youth but recurring themes were weakened social skills, physical health and mental health. Our conclusion became that social isolation is a broad problem with several different aspects that need special consideration and social workers are constantly working with their understanding of the situation and proceed from the youths themselves by utilizing relationship building techniques as their primary tool.

The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

This study aimed to explore how non-governmental organisations (NGOs) in Sri Lanka define and interpret an independent life for women with physical disabilities (WWPD) in their services. Semi-structured interviews were conducted with five employees at five Sri Lankan NGOs. The material was then analysed using two theoretical models, the social and medical model on disability. The study results showed that the selected NGOs in Sri Lanka in the majority defined an independent life as difficult to achieve due to societal barriers. However, one local NGO defined WWPD as not independent due to the individual's impairment. Further results showed that NGOs in Sri Lanka provide individual, employment, education and advocacy/lobbying services to help WWPD achieve independence. Services based on the social model focus more on helping WWPD achieve independence than services based on the medical model. Nevertheless, medical model services are needed in combination with social model services for WWPD to achieve independence. International and national NGOs work with social model services more than local organisations. Further, services connect since several services are needed to achieve independence.

Mobility within the community is a necessary part of urban life for enhancing personal well-being and happiness. However, autistic individuals may not be the natural players in this context and have risks of using public transport, including getting disoriented, meltdown or shutdown, and being discriminated against in motion. This can be attributed to their difficulties in social communication and cognitive abilities brought about by autism. However, autistic individuals’ lived experience is rarely explored in the field. Thus, this study aims to examine their personal experiences and pay attention to how autism is enacted in public transport settings, and various encounters in a material environment. A two-month ethnographic study was used from the perspective of a micro-lens of a specific autistic adult individual. Through a narrative analysis of “key events” happening in the process of movements, the materiality of mobility by taking public transport for autistic individuals’ ordinary life was presented.  The findings and analysis are unfolding from three oriented dimensions. Firstly, I point out that as a material practical form of moving, encounters of the autistic participant with other passengers in a public moving space are merely a temporary gathering, shaping a relationship that avoids communication. Additionally, risks exist including information overload and being disoriented that show how autism is enacted in public transportation settings. Secondly, I suggest that as the material basis of the movements of taking public transport, the outside landscape presents the materialistic appearance of the modern city, bringing a sense of security as well as a channel for the autistic participant to learn new things, but at the same time the de-naturalization and modernity exacerbates the autistic one’s negative relation to the urban environment. Last, I demonstrate how the coercive nature of the technological objects intervenes in the originally pure tension between autistic individual and moving services, thus indirectly exposing the loss of discursive power and resources experienced by the participant.  Based on these findings, I draw on the discussions of the strategies and the built environment. From the standpoint of the former, it shows that prioritizing fast mobility has led to the neglect of actual needs for a higher standard of moving experience. This also indicates that the autistic one's resistance to movement often manifests as an attachment to the fixed and secure space of the home, forming the strategies of responsiveness and resistance. The latter suggests the ‘perspective turn’ to the social model of disability, realizing that being disabled might be a universal experience of a person, and everyone could be in a state of disability either permanently or temporarily. Therefore, optimizing the built environment of public transport not only benefits autistic individuals but also represents an investment in broader social well-being.

Magister Psychologiae - MPsych / This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 – 49 years of age being most affected. As previously mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The primary aim of this study was to compare the Beck’s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale –(the Depression component) (HADS-D) as a screening tool for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach’s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish the sociodemographic and disease profiles of the participants under study. / South Africa

<p>This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 &ndash / 49 years of age being most affected. As previously&nbsp / mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the&nbsp / progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it&nbsp / difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that&nbsp / females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on&nbsp / gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will&nbsp / only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those&nbsp / living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this&nbsp / disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The&nbsp / primary aim of this study was to compare the Beck&rsquo / s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale &ndash / (the Depression component) (HADS-D) as a screening tool&nbsp / &nbsp / for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach&rsquo / s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish&nbsp / the sociodemographic and disease profiles of the participants under study. </p>

Many Canadian children from minority status groups experience long-term academic complexities, influencing their sense of school belonging and engagement (Willms, 2003; Willms & Flanagan, 2007). Research demonstrates children with intersecting differences of race, ethnicity, language, and disability, and those in their middle years (10-13 years old), undergo heightened academic challenges (Blanchett, Klingner, & Harry, 2009; Cobbold, 2005). Within Toronto, one of the most diverse Canadian cities, this study explores the narratives of 6 middle years children with intersecting differences of race, ethnicity, language, and disabilities. The narratives highlight participants’ understandings of differences, learning, and inclusion. Specifically, what are marginalized children’s personal schooling experiences, and how may these insights support inclusive learning, teaching, and sense of belonging? Underpinned by conceptual lenses of (a) critical theory, from which stems critical pedagogy and critical multicultural education, and (b) the “new sociology of childhood” (Greene & Hogan, 2005), which includes social constructivist and participatory frames, this study employed qualitative narrative and critical discourse analysis research methods throughout 7 research sessions over a 4 month period. Accessing children’s multiple views, data collection included a “mosaic” (Clark & Moss, 2001) multi-method approach, such as semi-structured interviews with open-ended questions, writing activities, imaginative story games, photography, and drawings. The children’s narratives are re-presented as portrait narrative summaries within this paper. Surfacing findings include two predominant themes: (a) Participants’ conceptualizations of differences, race, ethnicity, language, culture, disability, and autism. Participants’ views relate to theories of denying differences, colour blindness, White discourse, and Othering; and (b) Interconnecting factors of inclusive and exclusive elements contributing to participants’ overall sense of school belonging. Additionally this theme highlights matters of meritocracy, individualization, and the “good” student. Underscoring both themes are notions of normalcy, and deficit and deficient-based discourses. Inviting student voice into educational conversations and research processes, this study demonstrates the importance of listening to voices of children with intersecting differences, as they may adeptly advance areas of inclusion and diversity.