97 research outputs found
Tre lĂŠreres erfaring med utforskende undervisning i naturfag
Denne masteroppgaven ser pÄ naturfaglÊreres erfaringer med utforskende arbeidsmÄter, samt naturfagslÊreres forstÄelse av begrepet utforskende undervisning. I arbeidet med naturfag skal elevene arbeide utforskende. De skal fÄ et innblikk i hvordan naturfaglig kunnskap blir til, samt fÄ kjennskap til naturfaglige metoder. Tidligere forskning viser at lÊrere ofte har en manglende forstÄelse av utforskende undervisning, samt at utforskende arbeidsmÄter ikke benyttes i utstrakt grad i norske klasserom.
Resultatene i denne studien viser at naturfaglĂŠrerne har utforskende arbeidsmetoder som en del av sin praksis, men at de Ăžnsker Ă„ anvende seg av utforsking i stĂžrre grad. LĂŠrerne viser ogsĂ„ en forstĂ„else av hvordan stĂžttestrukturer pĂ„virker elevenes lĂŠring. De uttrykker at det er flere faktorer som pĂ„virker deres didaktiske valg. Hvorav de viktigste er begrenset til planlegging og gjennomfĂžring av utforskende aktiviteter, samt tilgang til egnede undervisningsopplegg. LĂŠrerne ser flere positive sider med Ă„ anvende utforskende arbeidsmetoder. De trekker frem elevenes motivasjon og engasjement i faget som nĂžkkelfaktorer. I tillegg erfarer lĂŠrerne at elevene oppnĂ„r et stĂžrre lĂŠringsutbytte hvis de arbeider utforskende sammenlignet med «tradisjonell undervisning».This masterâs thesis looks at science teachersâ experience with inquiry-based science education methods, as well as science teachersâ understanding of the concept of scientific inquiry. In science, pupils shall work exploratory. They will gain insight into how science knowledge is developed, as well as gain knowledge of scientific methods. Previous research shows that teachers often lack understanding of scientific inquiry, and that inquiry based science methods are not widely used in Norwegian classrooms.
The results of this study show that science teachers have exploratory methods as part of their practice, but that they want to apply it to a greater extent. Teachers also show an understanding on how support structures affect pupilsâ learning. They express that there are several factors that influence their didactic choices. The main ones are limited to planning and carrying out the inquiry, as well as access to suitable teaching arrangements. Teachers see several positive aspects of applying scientific inquiry methods. They highlight the pupilsâ motivation and involvement in the subject as key factors. In addition, teachers find that students achieve a greater learning outcome if they work inquiry based to âtraditional teaching
Work disability and state benefit claims in early rheumatoid arthritis: the ERAN cohort
Objective. RA is an important cause of work disability. This study aimed to identify predictive factors for work disability and state benefit claims in a cohort with early RA.
Methods. The Early RA Network (ERAN) inception cohort recruited from 22 centres. At baseline, and during each annual visit, participants (n = 1235) reported employment status and benefits claims and how both were influenced by RA. Survival analysis derived adjusted hazard ratios (aHRs) and 95% CIs to predict associations between baseline factors and time until loss of employment due to RA or a state benefits claim due to RA.
Results. At baseline, 47% of participants were employed and 17% reported claiming benefits due to RA. During follow-up, loss of employment due to RA was reported by 10% (49/475) of the participants and 20% (179/905) began to claim benefits. Independent predictors of earlier work disability were bodily pain (aHR 2.45, 95% CI 1.47, 4.08, P = 0.001) and low vitality (aHR 1.84, 95% CI 1.18, 2.85, P = 0.007). Disability (aHR 1.28, 95% CI 1.02, 1.61, P = 0.033), DAS28 (aHR 1.48, 95% CI 1.05, 2.09, P = 0.026) and extra-articular disease (aHR 1.77, 95% CI 1.17, 2.70, P = 0.007) predicted earlier benefits claims.
Conclusion. Work disability and benefits claims due to RA were predicted by different baseline factors. Pain and low vitality predicted work disability. Baseline disability, extra-articular disease manifestations and disease activity predicted new benefits claims due to RA. Future research on interventions targeting these factors could investigate job retention and financial independence
Pregnancy Related Health Care Needs in Refugees : A Current Three Center Experience in Europe
Immigration into Europe has reached an all-time high. Provision of coordinated healthcare, especially to refugee women that are at increased risk for adverse pregnancy outcomes, is a challenge for receiving health care systems. Methods: We assessed pregnancy rates and associated primary healthcare needs in three refugee cohorts in Northern Germany during the current crisis. Results: Out of n = 2911 refugees, 18.0% were women of reproductive age, and 9.1% of these were pregnant. Pregnancy was associated with a significant, 3.7-fold increase in primary health care utilization. Language barrier and cultural customs impeded healthcare to some refugee pregnant women. The most common complaints were demand for pregnancy checkup without specific symptoms (48.6%), followed by abdominal pain or urinary tract infections (in 11.4% of cases each). In 4.2% of pregnancies, severe complications such as syphilis or suicide attempts occurred. Discussion: We present data on pregnancy rates and pregnancy associated medical need in three current refugee cohorts upon arrival in Germany. Healthcare providers should be particularly aware of the requirements of pregnant migrants and should adapt primary caretaking strategies accordingly
Development and first assessment of a questionnaire for health care utilization and costs for cardiac patients
<p>Abstract</p> <p>Background</p> <p>The valid and reliable measurement of health service utilization, productivity losses and consequently total disease-related costs is a prerequisite for health services research and for health economic analysis. Although administrative data sources are usually considered to be the most accurate, their use is limited as some components of utilization are not systematically captured and, especially in decentralized health care systems, no single source exists for comprehensive utilization and cost data. The aim of this study was to develop and test a questionnaire for the measurement of disease-related costs for patients after an acute cardiac event (ACE).</p> <p>Methods</p> <p>To design the questionnaire, the literature was searched for contributions to the assessment of utilization of health care resources by patient-administered questionnaires. Based on these findings, we developed a retrospective questionnaire appropriate for the measurement of disease-related costs over a period of 3 months in ACE patients. Items were generated by reviewing existing guidelines and by interviewing medical specialists and patients. In this study, the questionnaire was tested on 106 patients, aging 35â65 who were admitted for rehabilitation after ACE. It was compared with prospectively measured data; selected items were compared with administrative data from sickness funds.</p> <p>Results</p> <p>The questionnaire was accepted well (response rate = 88%), and respondents completed the questionnaire in an average time of 27 minutes. Concordance between retrospective and prospective data showed an intraclass correlation (ICC) ranging between 0.57 (cost of medical intake) and 0.9 (hospital days) with the other main items (physician visits, days off work, medication) clustering around 0.7. Comparison between self-reported and administrative data for days off work and hospitalized days were possible for n = 48. Respective ICCs ranged between 0.92 and 0.94, although differences in mean levels were observed.</p> <p>Conclusion</p> <p>The questionnaire was accepted favorably and correlated well with alternative measurement approaches. This first assessment showed promising characteristics of this questionnaire in different aspects of validity for patients with ACE. However, additional research and more extensive tests in other patient groups would be worthwhile.</p
Rheumatoid Arthritis is an Autoimmune Disease Triggered by Proteus Urinary Tract Infection
Rheumatoid arthritis (RA) is a chronic and disabling polyarthritic disease, which affects mainly women in middle and old age
Sick leave and work disability in patients with early arthritis
We studied the occurrence of sick leave and work disability, the presence of workplace adaptations and the usage of professional guidance related to working problems in patients with early arthritis. Inclusion criteria were arthritis symptoms of less than 2Â years duration and a paid job at the time of diagnosis. Assessments were done in connection with an early arthritis clinic (EAC) at entry into the cohort and 12Â months thereafter by means of a questionnaire comprising questions on sick leave (absenteeism from work reported to the employer), work disability (receiving a full or partial work disability pension), unemployment, work adaptations and professional guidance related to working problems. Fifty-seven of the 69 participants (83%) had an arthritis symptom duration of <6Â months. The number of patients with sick leave due to arthritis in the past 12Â months decreased from 28 (41%) at study entry to 18 (26%) after 12Â months of follow-up. The number of patients receiving a work disability pension increased from 5 (7%) at study entry to 13 (19%) after 12Â months of follow-up (10 partial and 3 full). Sick leave in the 12Â months before study entry appeared to be the most important predictor of the institution or increase in a work disability pension (odds ratio, 16.1; 95%CI, 1.8â142.8). Between study entry and follow-up, the number of patients with workplace adaptations increased from 20 (29%) to 28 (42%), whereas the number of patients receiving vocational guidance decreased from 48 (70%) to 36 (52%). In patients with early arthritis and a paid job, arthritis-related sick leave was common and occurred in part before patients entered the EAC and a diagnosis was made. About 20% of the patients became permanently work disabled, with partial work disability being more common than full work disability. Considerable proportions of patients received workplace adaptations and professional guidance with working problems
An experienced physiotherapist prescribing and administering corticosteroid and local anaesthetic injections to the shoulder in an Australian orthopaedic service, a non-inferiority randomised controlled trial and economic analysis: study protocol for a randomised controlled trial
Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for the treatment of rheumatoid arthritis not previously treated with disease-modifying antirheumatic drugs and after the failure of conventional disease-modifying antirheumatic drugs only: systematic review and economic evaluation.
OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increasing disability, reduced quality of life and substantial costs (as a result of both intervention acquisition and hospitalisation). The objective was to assess the clinical effectiveness and cost-effectiveness of seven biologic disease-modifying antirheumatic drugs (bDMARDs) compared with each other and conventional disease-modifying antirheumatic drugs (cDMARDs). The decision problem was divided into those patients who were cDMARD naive and those who were cDMARD experienced; whether a patient had severe or moderate to severe disease; and whether or not an individual could tolerate methotrexate (MTX). DATA SOURCES: The following databases were searched: MEDLINE from 1948 to July 2013; EMBASE from 1980 to July 2013; Cochrane Database of Systematic Reviews from 1996 to May 2013; Cochrane Central Register of Controlled Trials from 1898 to May 2013; Health Technology Assessment Database from 1995 to May 2013; Database of Abstracts of Reviews of Effects from 1995 to May 2013; Cumulative Index to Nursing and Allied Health Literature from 1982 to April 2013; and TOXLINE from 1840 to July 2013. Studies were eligible for inclusion if they evaluated the impact of a bDMARD used within licensed indications on an outcome of interest compared against an appropriate comparator in one of the stated population subgroups within a randomised controlled trial (RCT). Outcomes of interest included American College of Rheumatology (ACR) scores and European League Against Rheumatism (EULAR) response. Interrogation of Early Rheumatoid Arthritis Study (ERAS) data was undertaken to assess the Health Assessment Questionnaire (HAQ) progression while on cDMARDs. METHODS: Network meta-analyses (NMAs) were undertaken for patients who were cDMARD naive and for those who were cDMARD experienced. These were undertaken separately for EULAR and ACR data. Sensitivity analyses were undertaken to explore the impact of including RCTs with a small proportion of bDMARD experienced patients and where MTX exposure was deemed insufficient. A mathematical model was constructed to simulate the experiences of hypothetical patients. The model was based on EULAR response as this is commonly used in clinical practice in England. Observational databases, published literature and NMA results were used to populate the model. The outcome measure was cost per quality-adjusted life-year (QALY) gained. RESULTS: Sixty RCTs met the review inclusion criteria for clinical effectiveness, 38 of these trials provided ACR and/or EULAR response data for the NMA. Fourteen additional trials contributed data to sensitivity analyses. There was uncertainty in the relative effectiveness of the interventions. It was not clear whether or not formal ranking of interventions would result in clinically meaningful differences. Results from the analysis of ERAS data indicated that historical assumptions regarding HAQ progression had been pessimistic. The typical incremental cost per QALY of bDMARDs compared with cDMARDs alone for those with severe RA is >âÂŁ40,000. This increases for those who cannot tolerate MTX (ÂŁ50,000) and is >âÂŁ60,000 per QALY when bDMARDs were used prior to cDMARDs. Values for individuals with moderate to severe RA were higher than those with severe RA. Results produced using EULAR and ACR data were similar. The key parameter that affected the results is the assumed HAQ progression while on cDMARDs. When historic assumptions were used typical incremental cost per QALY values fell to ÂŁ38,000 for those with severe disease who could tolerate MTX. CONCLUSIONS: bDMARDs appear to have cost per QALY values greater than the thresholds stated by the National Institute for Health and Care Excellence for interventions to be cost-effective. Future research priorities include: the evaluation of the long-term HAQ trajectory while on cDMARDs; the relationship between HAQ direct medical costs; and whether or not bDMARDs could be stopped once a patient has achieved a stated target (e.g. remission). STUDY REGISTRATION: This study is registered as PROSPERO CRD42012003386. FUNDING: The National Institute for Health Research Health Technology Assessment programme
Tre lĂŠreres erfaring med utforskende undervisning i naturfag
Denne masteroppgaven ser pÄ naturfaglÊreres erfaringer med utforskende arbeidsmÄter, samt naturfagslÊreres forstÄelse av begrepet utforskende undervisning. I arbeidet med naturfag skal elevene arbeide utforskende. De skal fÄ et innblikk i hvordan naturfaglig kunnskap blir til, samt fÄ kjennskap til naturfaglige metoder. Tidligere forskning viser at lÊrere ofte har en manglende forstÄelse av utforskende undervisning, samt at utforskende arbeidsmÄter ikke benyttes i utstrakt grad i norske klasserom.
Resultatene i denne studien viser at naturfaglÊrerne har utforskende arbeidsmetoder som en del av sin praksis, men at de Þnsker Ä anvende seg av utforsking i stÞrre grad. LÊrerne viser ogsÄ en forstÄelse av hvordan stÞttestrukturer pÄvirker elevenes lÊring. De uttrykker at det er flere faktorer som pÄvirker deres didaktiske valg. Hvorav de viktigste er begrenset til planlegging og gjennomfÞring av utforskende aktiviteter, samt tilgang til egnede undervisningsopplegg. LÊrerne ser flere positive sider med Ä anvende utforskende arbeidsmetoder. De trekker frem elevenes motivasjon og engasjement i faget som nÞkkelfaktorer. I tillegg erfarer lÊrerne at elevene oppnÄr et stÞrre lÊringsutbytte hvis de arbeider utforskende sammenlignet med «tradisjonell undervisning»
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