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Objective: Observed and predicted increases in the global burden of disease caused by major depressive disorder (MDD) highlight the need for psychometrically robust multi-dimensional measures to use for clinical and research purposes. Reynolds Adolescent Depression Scale second edition (RADS-2) is an internationally well-validated scale measuring different dimensions of adolescent depression. The Swedish version has previously only been evaluated in a normative sample. Methods: We collected data from patients in child and adolescent psychiatry and primary care and performed: (1) Confirmatory factor analysis (CFA) to evaluate the established four-factor structure, (2) Analyses of reliability and measurement invariance, (3) Analyses of convergent and discriminant validity using the Montgomery–Asberg Depression Rating Scale, the depression subscales of the Beck Youth Inventories and the Revised Child Anxiety and Depression Scale, as well as the Patient Reported Outcome Measurements Information System, peer-relationships and physical activity item banks. Results: Recruited participants (n = 536, 129 male and 407 female, mean age 16.45 years, SD = 2.47, range 12 − 22 years) had a variety of psychiatric diagnoses. We found support for the four-factor structure and acceptable to good reliability for the subscale and total scores. Convergent and discriminant validity were good. Measurement invariance was demonstrated for age, sex, and between the present sample and a previously published normative sample. The RADS-2-scores were significantly higher in the present sample than in the normative sample. In this clinical study, the Swedish RADS-2 demonstrated good validity and acceptable to good reliability. Our findings support the use of RADS-2 in Swedish clinical and research contexts.

Background: Due to the sharp global increase in prevalence of adolescent major depressive disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, we need internationally validated tools for multi-dimensional assessment. Reynolds Adolescent Depression Scale second edition (RADS-2) measures dysphoric mood, anhedonia/negative affect, negative self-evaluation and somatic complaints and is widely used internationally, but not yet available in Swedish. Aim: The aim of this study is to test the psychometric characteristics of the Swedish version of RADS-2 in a normative sample. Material and method: Data was gathered from junior and high school students in Northern Sweden (N = 637). We performed: 1. Confirmatory factor analysis to examine the 4-factor structure proposed by Reynolds, 2. Measurement invariance analysis for sex (girls, boys) and age group (12-15 years, 16-20 years). 3. Reliability testing and 4. Tests for concurrent, discriminant and convergent validity using Beck's Youth Inventories of Emotional and Social Impairment Depression and Anger subscales, the Patient Reported Outcome Measurements Information System, Anxiety and Friends subscales and the World Health Organization Wellness Index. Results: The sample consisted of n = 637 students (n = 389 girls and n = 248 boys), mean age 15.73 (SD = 1.76); 12-20 years. The 4-factor structure was confirmed, as well as measurement invariance for sex and age group. Reliability was acceptable to excellent for all subscales and RADS-2 total scale. Concurrent, convergent and discriminant validity was good. Conclusion: The Swedish version of RADS-2 showed acceptable reliability and validity in a Swedish normative sample.

Background: Studies of time trends of adolescent self-reported mental health suggest an increase of mental health symptoms globally. Unfortunately, several studies within the field have methodological problems, such as short time-period between measurements and different mental health measures over time. When estimating mental health through self-report measures, the measures need to be both valid and reliable. Reports from the Swedish National Board of Health and Welfare have shown that several self-report scales used in Child- and Adolescent Psychiatry lack validation in Swedish, and some are direct translations of adult self-report scales without proper age- adaption. Aims: This thesis aims to add to previous knowledge regarding time trends of self-reported mental health among Swedish youth and to validate internationally used reliable self-report measures for use in Sweden. Methods: In Study I, we investigated changes in self-reported mental health symptoms, both internalized and externalized, in two samples: The first sample in 1981 and the second in 2014, both samples including all grade 9 students of Luleå. The same composite self-report measures were used at both time points. In study II we translated and validated the Reynolds Adolescent Depression Scale second edition (RADS-2) with classical test theory. In study III, eight pediatric Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks were translated to Swedish and culturally adapted using the Functional Assessment of Chronic Illness Therapy (FACIT) methodology. Study IV describes the item response theory (IRT) validation of two item banks, the PROMIS Pediatric Bank v2.0 – Anxiety and the PROMIS Pediatric Bank v2.0 - Depressive Symptoms, in a school- and Child- and Adolescent Psychiatry patient sample. Results: Study I: There has been an increase in internalizing symptoms, especially among girls. Externalizing symptoms have decreased, especially among boys, and in 2014 compared t, 2021-11-18: Planerad disputation 19 november uppskjuten. Nytt datum ej fastställt. 2021-11-23: Nytt datum för disputation beslutat.

Depression in adolescents and young adults is an increasing global health concern. Available treatments are not sufficiently effective and relapse rates remain high. The novel group-treatment program “Training for Awareness, Resilience and Action” (TARA) targets specific mechanisms based on neuroscientific findings in adolescent depression. TARA is framed within the National Institute of Mental Health's Research Domain Criteria and has documented feasibility and preliminary efficacy in the treatment of adolescent depression. Since neurodevelopment continues well into the mid-twenties, age-adapted treatments are warranted also for young adults. Patients 15–22 years old, with either major depressive disorder (MDD) or persistent depressive disorder (PDD) according to the DSM-IV/5 or a rating >40 on the clinician rating scale Children's Depression Rating Scale—Revised (CDRS-R), will be recruited from specialized Child and Adolescent Psychiatry and local Youth-Clinics and randomized to either TARA or standard treatment, including but not limited to antidepressant medication and/or psychotherapy. Outcome measures will be obtained before randomization (T0), after 3 months of treatment (T1) and at 6-months- (T2) and 24-months- (T3) follow-up. Additionally, dose-response measures will be obtained weekly in the TARA-arm and measures for mediation-analysis will be obtained halfway through treatment (T0.5). Primary outcome measure is Reynolds Adolescent Depression Scale (RADS-2) score at T1. Secondary outcome measures include RADS-2 score at T2, Multidimensional Anxiety Scale for Children at T1 and T2, and CDRS-R at T1. Additional outcome measures include self-report measures of depression-associated symptoms, systemic bio-indicators of depression from blood and hair, heartrate variability, brain magnetic resonance imaging, as well as three-axial accelerometry for sleep-objectivization. Qualitative data will be gathered to reach a more comprehensive understanding of the fact

Background: In 2007, the World Bank issued the first green bond in the world together with SEB. The first green corporate bond was issued by Vasakronan in 2013 and thereafter the market has expanded. Green bonds have the same financial characteristics as traditional bonds, the difference lies in the fact that the bond proceeds from green bonds must finance environmentally or climate friendly projects. The green bonds should give investors and issuers incentives to implement sustainable investments or projects. Aim: The purpose of the thesis is to describe and explain investors' motives and incentives for buying green bonds. Completion: The thesis is based on a qualitative method and eight interviews have been conducted. The interviewed persons represent investors. In order to shed light on the nature of green bonds and the market, a literature study has been designed. Conclusion: Prominent motives and driving forces for all investors are the demand from customers, the opportunity to show a sustainable profile and that green bonds often have the same financial characteristics as traditional bonds., Bakgrund: År 2007 emitterade Världsbanken den första gröna obligationen i världen tillsammans med SEB. Den första gröna företagsobligationen emitterades av Vasakronan år 2013 och därefter har marknaden expanderat. Gröna obligationer har samma finansiella egenskaper som traditionella obligationer, dock ligger skillnaden i att obligationslikviden från gröna obligationer ska finansiera miljö- eller klimatvänliga projekt. De gröna obligationerna ska uppmuntra investerare och emittenter att genomföra hållbara investeringar eller projekt. Syfte: Uppsatsens syfte är att beskriva och förklara investerares motiv och drivkrafter till att köpa gröna obligationer. Genomförande: Uppsatsen baseras på en kvalitativ metod och åtta intervjuer har genomförts. De intervjuade personerna representerar investerare. För att belysa gröna obligationers och marknadens karaktärsdrag har en litteraturstudie utformats. Slutsats: Framträdande motiv och drivkrafter för samtliga investerare är efterfrågan från kunder, möjligheten att visa upp en hållbar profil och att gröna obligationer har ofta samma finansiella egenskaper som traditionella obligationer.

Bakgrund: Distriktssköterskan inom barnhälsovården ansvarar för att erbjuda alla barn att vaccineras enligt barnvaccinationsprogrammet. När ett nytt vaccin tillkommer i barnvaccinationsprogrammet är det distriktssköterskans uppgift att leda införandet och informera om evidens kring vaccinet till vårdnadshavare, så att de kan fatta beslut om vaccination till sitt barn. Distriktssköterskan har vid tidigare införanden av vaccin i barnvaccinationsprogrammet upplevt svårigheter gällande bristande stöd och information avseende vaccinet från organisationen. Syfte: Beskriva distriktssköterskans erfarenheter av att införa vaccination mot rotavirus i barnvaccinationsprogrammet inom barnhälsovården. Metod: Studien genomfördes med kvalitativ metod och induktiv ansats. Datainsamlingen genomfördes med semistrukturerade intervjuer med 13 distriktssköterskor inom barnhälsovården i Mellansverige. Analysen genomfördes med kvalitativ innehållsanalys enligt Elo och Kyngäs. Resultat: I analysen framkom två kategorier och sex subkategorier. Kategorierna var, Förutsättningar vid förändring och Förhållningssätt hos vårdnadshavare. Distriktssköterskans erfarenhet är att det krävs förberedelser och stöd från organisationen för att skapa goda förutsättningar för implementering. Distriktssköterskan behöver kunna anpassa den information som ges till vårdnadshavare eftersom de har olika förhållningssätt till vaccin och kunskap. Slutsats: Möjlighet till förberedelse främjar god implementering. Förtroende för distriktssköterskan ökar chansen att vårdnadshavaren önskar vaccinera sitt barn., Background: The district nurse in child health care is responsible for offering all children vaccines from the child vaccination program. When a new vaccine is added to the child vaccination program, the district nurse leads the implementation and communicate evidence to the guardian, so they can make decisions about vaccination for their child. In previous implementations of vaccines in the childhood vaccination program, the district nurse has experienced difficulties with insufficient support and information from the organization. Purpose: Describe the district nurse experience of introducing rotavirus vaccination into the child vaccination program in child health care. Method: The study was conducted with a qualitative method and an inductive approach, with semi-structured interviews with 13 district nurses in child health care in Central Sweden. The analysis was performed with a qualitative content analysis according to Elo and Kyngäs. Results: The study resulted in two categories Conditions for change and Approach of guardians and six subcategories. The district nurse experienced that preparation and support from the organization is required for good implementation. The guardian has different approaches and levels off knowledge regarding vaccines and the district nurse need to adapt the information. Conclusion: Opportunity for preparation promotes good implementation. The district nurse needs to be able to adapt the information given to the guardians because they have different approaches to vaccines and knowledge.

Supplement: 1Special Issue: SIMeeting Abstract: 3188

LISAN - Livssituation hos barn och ungdomar med narkolepsi

Background: Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase. Methods: This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model. Results: Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P < 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286). Conclusion: In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades.

Detta examensarbete handlar om hur ekosystemtjänster kan användas i planeringen och utvecklingen av urbana landskap. Ekosystemtjänster är de fördelar som vi människor får direkt och indirekt av naturen. I arbetet identifieras och utvärderas urbana ekosystemtjänster på ett kommunalt utvecklingsprojekt som ska exploateras för handel och bostäder, från öppen jordbruksmark. Människan är beroende av jordens ekosystem och de tjänster de genererar, men människan har i allt snabbare takt och i högre grad påverkat ekosystemen och cirka en tredjedel av jordens ekosystemtjänster är idag hotade eller överutnyttjade (MA 2003). En bidragande orsak till detta är den intensiva urbaniseringen och därför är det viktigt att ta hänsyn till ekosystemtjänster vid samhälls- och landskapsplanering. Arbetet undersöker om ekosystemtjänster går att använda som verktyg i planeringsprojekt samt om ett befintligt verktyg tar hänsyn till ekosystemtjänster. Urbana ekosystemtjänster skiljer sig från ekosystemtjänster i naturlandskap och det är av vikt att anpassa klassificeringssystemet till de specifika förhållandena, varför ett anpassat klassificeringssystem tas fram. Identifieringen av ekosystemtjänster på fallstudieområdet görs innan och efter exploatering. Utvärderingen av ekosystemtjänster på samma område görs med hjälp av den svenska översättningen av hållbarhetscertifieringssystemet BREEAM Communities. Resultaten jämförs och leder till diskussion om ekosystemtjänster kan inkluderas i planeringsprocessen redan idag, samt om BREEAM Communities kan användas som verktyg för att ta hänsyn till ekosystemtjänster i samhälls- och landskapsplanering., This master thesis focuses on how ecosystem services can be applied in planning and development of urban landscapes. Ecosystem services are the benefits people obtain from nature. Ecosystem services are identified and evaluated in a municipal development project, which is to be exploited for commercial and residential areas from open farmlands. Humans are dependent on the earth's ecosystems and the services they generate, but humans have an increasing impact on ecosystems and about a third of the earth's ecosystem services are todays threatened or overexploited (MA 2003). The intense urbanisation contributes to this progress. Therefore it is important to take into account ecosystem services in urban and landscape planning. This thesis investigates if ecosystem services can be used as a tool in planning and in case an existing certification tool takes into account ecosystem services. Urban ecosystem services differ from ecosystem services in rural landscapes and it is important to adapt the classification scheme to the specific context, which is why a custom classification system is presented. The identification of ecosystem services is analysed on the case study area, before and after exploitation. The evaluation of ecosystem services in the same area is carried out using the Swedish translation of the sustainability certification system BREEAM Communities. The results are compared and leads to a discussion whether ecosystem services can be included in the planning process today and if the certification tool BREEAM Communities can be used to include ecosystem services in community and landscape planning.

Kandidatuppsatsen handlar om begreppet hållbar utveckling i en historisk och samtida kontext och den sträcker sig från den globala till den lokala samhällsnivån. Arbetet är en grundläggande beskrivning av hållbarhetsbegreppet och syftet för författaren har varit att skapa en förståelse för begreppet att ta med sig in i ett framtida yrkesliv som landskapsarkitekt. Genom en internationell litteraturstudie av till stora delar rapporter och information från hemsidor ska begreppet hållbarhet förklaras. Begreppets väg från det stora till det lilla, från en global nivå till en lokal ska försöka identifieras och till sist ges exempel från det praktiska arbetet med hållbar utveckling i en svensk kommun. Den avslutande diskussionen innehåller reflektioner på informationen som kommit fram efter litteraturstudien och vägen från global till lokal nivå behandlas även här., This Bachelor thesis deals with the concept of sustainable development in a historical and contemporary context and it extends from the global to the local community level. The work is a basic description of the sustainability concept and the author’s purpose has been to create an understanding of the concept to bring in to her future life as a professional landscape architect. Through an international literature review based on reports and information from websites the concept of sustainability is explained. An attempt will be made to detect the way of sustainable development from a global to a local community level. Furthermore examples from practical work of sustainable development in a Swedish municipality will be given. The final discussion contains reflections on information obtained from the literature review and from the detected way from a global to a local level.