Frihet i en ask? Unga tjejers upplevelser av p-piller och kontakten med ungdomsmottagningen i Trollhättan, Vänersborg och Uddevalla

Killar, tjejer, kärlek och sex. Det finns många saker att upptäcka i tonåren. Förutom egna sexuella preferenser måste man också hitta rätt i preventivmedelsdjungeln, och snårigast är buskaget för tjejer. I en serie i tre delar utforskar vi unga kvinnors upplevelser av preventivmedel. Och hur är det egentligen att besöka ungdomsmottagningen för första gången? I den första delen får vi träffa Klara som berättar om en turbulent tid efter att hon fått sina första p-piller. Hon är en av de 223 tjejer från Trollhättan, Vänersborg och Uddevalla som svarat på frågor om p-piller och kontakten med ungdomsmottagningen. Just kontakten med ungdomsmottagningen behandlas i den andra delen i serien. Dit går tjejer för att få råd när det är dags att välja preventivmedel, som i dag är fler än någonsin. Undersökningen visade bland annat att alla inte får 4 information om alternativ till p-piller. Sofie från Vänersborg var en av dem. Efter sitt första försök på ungdomsmottagningen gick hon därifrån med ett recept på p-piller, trots att hon egentligen kanske hade velat testa något annat. I den tredje delen får vi höra unga tjejer berätta om konstiga frågor som dykt upp vid besöket på ungdomsmottagningen. Hanna från Uddevalla fick en kalldusch när barnmorskan frågade vilka sexställningar hon brukade använda. Det ingår visserligen i barnmorskans roll att utvärdera sexuellt risktagande men kan frågorna gå för långt

Lex Sarah : Vad händer sen?

This paper aims to find out what lex Sarah is and how the process looks like when it comes to the investigation, from reporting to registration to the IVO, the inspection of health and social care. Who investigates, the objective of the lex Sarah and how many cases of reports that comes to registration from the year between 2010-2014. Which legal consequences it can be for an employee who has been notified is investigated also. Previous research only deals with freedom of speech, criticism and the complaint goes to the asset, and because of that, this paper focuses on individual cases where employees ' perception of a lex Sarah-registration gives a psychosocial approach. The paper is limited to a municipality where statistics are retrieved and a comparison at a national level is performed. Furthermore, two interviews conducted with a socially responsible Coordinator (SAS)who is the responsible lex Sarah-investigators in the municipality and a Union representative person who can provide a possible picture of how people who have been in a lex Sarah-case, feel about that and also persons who have been suspended from their jobs because of the investigation, experienced the situations. It´s clear that people who ends up in situations like this is feeling very sad and gets in chock when they get a message that says they are involved in a lex Sarah-reporting

Inter-communal cooperation and democracy : A case study about local government- and associations of local authority representatives view on cooperation

Municipalities today are facing several major challenges in the near future, which has led to that questions about how municipalities should handle these challenges are more frequently raised. Inter-communal cooperation has been highlighted as the given answer to these problems and challenges, but as the phenomenon is becoming more common the impact inter-communal cooperation have on matters such as democracy are increasingly raised. As a result of the increasing participation in inter-communal cooperation local democracy is facing a number of problems of legitimacy because of the uncertainty regarding accountability and communal inhabitants rights to influence. It is in this problem area the present essay is based. The aim of the study is to gain an understanding of how local government- and association of local authorities representatives view inter-communal cooperation and democracy, which in concrete terms means both examining what motives to inter-communal cooperation are highlighted by the representatives, and whether democratic values are discussed in relation to inter-communal cooperation and if so, in what ways? The study is conducted as a qualitative case study of an association of local authorities. The method used is semi-structured interviews that are carried out with representatives of the association of local authorities in question and one of its member-municipalities. As a complement to the interview study a smaller document study is also conducted. The results of the study show that the forces that are highlighted by the local government- and association of local authorities representatives are mainly linked to aspects such as efficiency and economy. Furthermore, democratic aspects, even though they often occurs in discussions about cooperation, are almost exclusively about the municipalities own opportunity to influence and rarely on the democratic values accountability and representativeness. The conclusions that can be drawn from the study is that local government- and association of local authorities representatives does not view inter-communal cooperation as problematic from a democratic perspective; in some cases they are not even aware that the problem exists

Kommunalförbund och den kommunala likställighetsprincipen : En utredning om i vilken omfattning likställighetsprincipen ska tillämpas på kommunalförbund

I takt med att urbaniseringen fortgår och demografiska förändringar i form av en allt mer åldrande befolkning har kommuner i större utsträckning än tidigare valt att börja samverka över kommungränser för att möta dessa utmaningar.En av de vanligaste formerna för samverkan är kommunalförbund. När ett kommunalförbund bildas får de egen bestämmanderätt inom ramen för dess förbundsordning, kommunallagen (1990:900) samt även annan lagstiftning som kan gälla för dess verksamhet. Bestämmelser om kommunalförbund återfinns i kommunallagen sedan slutet av 90-talet, dessförinnan reglerades de i kommunalförbundslagen (1985:894). Anledningen till att bestämmelserna om kommunalförbund integrerades i kommunallagen var för att tydliggöra vilka av kommunallagens regler som gällde även kommunalförbund. Fortfarande kvarstår dock vissa otydligheter kring vad som faktiskt gäller för samverkansformen. I lagstiftningen framgår t.ex. inte om de kommunalrättsliga grundprinciperna ska tillämpas eller ej.Det övergripande syftet med denna uppsats är att utreda i vilken omfattning en av dessa principer, den kommunala likställighetsprincipen, ska tillämpas på kommunalförbund. Eftersom likställighetsprincipen är en av de principer som blir aktuell när kommuner agerar inom ramen för sin kompetens, måste det först fastställas om de kompetensbegränsande principerna ska tillämpas på kommunalförbund. Den kompetensbegränsande princip som valts ut för att synliggöra detta är lokaliseringsprincipen. För att besvara syftet redogörs vidare dels för den rättsliga regleringen för kommunalförbund och i vilken utsträckning kommunalförbund ska likställas med en kommun. Dels redogörs även för vilka förutsättningar som måste vara uppfyllda för att likställighetsprincipen ska bli tillämplig och i vilken utsträckning ett kommunalförbund uppfyller dessa.Slutsatserna av uppsatsen är att kommunalförbund, rent organisatoriskt, kan likställas med en kommun eftersom de uppfyller de kriterier som ställs för att en offentligrättslig association ska klassas som en kommun. Vidare fastställs att lokaliseringsprincipen är tillämplig på kommunalförbund och att samverkansformen även uppfyller förutsättningarna som krävs för att tillämpningen av den kommunala likställighetsprincipen ska bli aktuell. Detta innebär därmed att den kommunala likställighetsprincipen ska tillämpas på kommunalförbund

Vad kan elever lära om ett ämne? : En fallstudie om de budskap som kan förmedlas genom lärarens och organisationens förhållningssätt

As we have been actively involved in various teaching programmes for many years, we wanted to enquire how the students and teachers understood their school and compare it to how we experienced it.  Do the students fully understand the knowledge they are receiving and can they learn from it? Do the teachers believe what they are teaching is understood by the students? What is the underlining knowledge of social practices in the school, which can inspire students in different ways? The aim of the study, as the title suggests, is to convey and describe the various methods practiced in a specific social practice. Our project is a quality study.  We have used observation, specific intense individual and group interviews. In the result, arrives a different message through what there is possible for the students to learn about the matter. These messages are visible in the different attitudes the teacher, the school and the organisation have vis-à-vis the matter. In the discussion, we have focussed on what has arrived in the result around the teacher's and the organisation's attitudes. How can these attitudes influence the students' attitude to the matter and how will one work in order to become aware about the messages that are sent

Therapist-Guided Internet-Delivered Cognitive Behavioral Therapy vs Internet-Delivered Supportive Therapy for Children and Adolescents With Social Anxiety Disorder : A Randomized Clinical Trial

IMPORTANCE Social anxiety disorder (SAD) is a prevalent childhood-onset disorder associated with lifelong adversity and high costs for the individual and society at large. Cognitive behavioral therapy (CBT) is an established evidence-based treatment for SAD, but its availability is limited. OBJECTIVE To assess the efficacy and cost-effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (ICBT) for SAD in youths vs an active comparator, internet-delivered supportive therapy (ISUPPORT). DESIGN, SETTING, AND PARTICIPANTS This single-masked, superiority randomized clinical trial enrolled participants at a clinical research unit integrated within the child and adolescent mental health services in Stockholm, Sweden, from September 1, 2017, to October 31, 2018. The final participant reached the 3-month follow-up (primary end point) in May 2019. Children and adolescents 10 to 17 years of age with a principal diagnosis of SAD and their parents were included in the study. INTERVENTIONS ICBT and ISUPPORT, both including 10 online modules, 5 separate parental modules, and 3 video call sessions with a therapist. MAIN OUTCOMES AND MEASURES The Clinician Severity Rating (CSR), derived from the Anxiety Disorder Interview Schedule, rated by masked assessors 3 months after the end of treatment. The CSR ranges from 0 to 8, with scores of 4 or higher indicating caseness. Secondary outcomes included masked assessor-rated diagnostic status of SAD and global functioning, child- and parent-reported social anxiety and depressive symptoms, and health-related costs. RESULTS Of the 307 youths assessed for eligibility, 103 were randomized to 10 weeks of therapist-guided ICBT (n = 51) or therapist-guided ISUPPORT (n = 52) for SAD. The sample consisted of 103 youths (mean [SD] age, 14.1 [2.1] years; 79 [77%] female). Internet-delivered cognitive behavioral therapy was significantly more efficacious than ISUPPORT in reducing the severity of SAD symptoms. Mean (SD) CSR scores for ICBT at baseline and at the 3-month follow-up were 5.06 (0.95) and 3.96 (1.46), respectively, compared with 4.94 (0.94) and 4.48 (1.30) for ISUPPORT. There was a significant between-group effect size of d = 0.67 (95% CI, 0.21-1.12) at the 3-month follow-up. Similarly, all of the secondary outcome measures demonstrated significant differences with small to large effect sizes, except for child-rated quality of life (nonsignificant). The cost-effectiveness analyses indicated cost savings associated with ICBT compared with ISUPPORT, with the main drivers of the savings being lower medication costs (z = 2.38, P = .02) and increased school productivity (z = 1.99, P = .047) in the ICBT group. There was 1 suicide attempt in the ISUPPORT group; no other serious adverse events occurred in either group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, internet-delivered cognitive behavioral therapy was an efficacious and cost-effective intervention for children and adolescents with SAD. Implementation in clinical practice could markedly increase the availability of effective interventions for SAD.Funding Agencies|Swedish Research Council for Health, Working Life, and WelfareSwedish Research CouncilSwedish Research Council for Health Working Life &amp; Welfare (Forte) [Forte 2014-4052]; Region Stockholm [2017-0605, HNSV 14099]</p

Long-term safety and efficacy of patisiran for hereditary transthyretin-mediated amyloidosis with polyneuropathy: 12-month results of an open-label extension study

© 2020 Elsevier Ltd. All rights reserved.Background: Hereditary transthyretin-mediated amyloidosis is a rare, inherited, progressive disease caused by mutations in the transthyretin (TTR) gene. We assessed the safety and efficacy of long-term treatment with patisiran, an RNA interference therapeutic that inhibits TTR production, in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Methods: This multicentre, open-label extension (OLE) trial enrolled patients at 43 hospitals or clinical centres in 19 countries as of Sept 24, 2018. Patients were eligible if they had completed the phase 3 APOLLO or phase 2 OLE parent studies and tolerated the study drug. Eligible patients from APOLLO (patisiran and placebo groups) and the phase 2 OLE (patisiran group) studies enrolled in this global OLE trial and received patisiran 0·3 mg/kg by intravenous infusion every 3 weeks with plans to continue to do so for up to 5 years. Efficacy assessments included measures of polyneuropathy (modified Neuropathy Impairment Score +7 [mNIS+7]), quality of life, autonomic symptoms, nutritional status, disability, ambulation status, motor function, and cardiac stress, with analysis by study groups (APOLLO-placebo, APOLLO-patisiran, phase 2 OLE patisiran) based on allocation in the parent trial. The global OLE is ongoing with no new enrolment, and current findings are based on the interim analysis of the patients who had completed 12-month efficacy assessments as of the data cutoff. Safety analyses included all patients who received one or more dose of patisiran up to the data cutoff. This study is registered with ClinicalTrials.gov, NCT02510261. Findings: Between July 13, 2015, and Aug 21, 2017, of 212 eligible patients, 211 were enrolled: 137 patients from the APOLLO-patisiran group, 49 from the APOLLO-placebo group, and 25 from the phase 2 OLE patisiran group. At the data cutoff on Sept 24, 2018, 126 (92%) of 137 patients from the APOLLO-patisiran group, 38 (78%) of 49 from the APOLLO-placebo group, and 25 (100%) of 25 from the phase 2 OLE patisiran group had completed 12-month assessments. At 12 months, improvements in mNIS+7 with patisiran were sustained from parent study baseline with treatment in the global OLE (APOLLO-patisiran mean change -4·0, 95 % CI -7·7 to -0·3; phase 2 OLE patisiran -4·7, -11·9 to 2·4). Mean mNIS+7 score improved from global OLE enrolment in the APOLLO-placebo group (mean change from global OLE enrolment -1·4, 95% CI -6·2 to 3·5). Overall, 204 (97%) of 211 patients reported adverse events, 82 (39%) reported serious adverse events, and there were 23 (11%) deaths. Serious adverse events were more frequent in the APOLLO-placebo group (28 [57%] of 49) than in the APOLLO-patisiran (48 [35%] of 137) or phase 2 OLE patisiran (six [24%] of 25) groups. The most common treatment-related adverse event was mild or moderate infusion-related reactions. The frequency of deaths in the global OLE was higher in the APOLLO-placebo group (13 [27%] of 49), who had a higher disease burden than the APOLLO-patisiran (ten [7%] of 137) and phase 2 OLE patisiran (0 of 25) groups. Interpretation: In this interim 12-month analysis of the ongoing global OLE study, patisiran appeared to maintain efficacy with an acceptable safety profile in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Continued long-term follow-up will be important for the overall assessment of safety and efficacy with patisiran.info:eu-repo/semantics/publishedVersio