| 1. |
- Lundin, Margareta
(författare)
-
Aspects on Image Quality in Radiologic Evaluation of the Urinary Tract
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The focus of this document is on image quality as one of the factors fundamental for the diagnostic process. With the rising number of procedures and the trend towards more complicated examinations, urinary tract investigations was chosen in this work as a good clinical model for evaluation of the factors influencing image quality and of the ways of evaluating image quality.In paper I, a method is described for optimisation during the introduction of a new imaging system, with a focus on the maintenance of image quality relative to the older already optimised system. Image quality was assessed using the image criteria of the European guidelines for IVU with visual grading analysis. Equivalent image quality in image pairs was achieved at 30% of the dose. The CDRAD contrast-detail phantom makes it possible to find dose levels that give equal image quality using different imaging systems.In paper II, the influence of bowel purgation on image quality in urography is questioned. The aim of this study was to compare bowel purgation and two other preparation methods; dietary restrictions and no preparation at all. Image quality was assessed according to European Commission criteria for excretory urography. The effectiveness of bowel purgation and the amount of residual gas were scored separately. The results of our study show that the preparation methods are of equal value and further use of bowel purgation before excretory urography cannot be justified.In paper III, the image quality of the non-enhanced series is compared to a virtual noncontrast series obtained using two generations of dual-energy CT scanners and taking CT of the urinary tract as a model. The image quality of the VNC images was rated inferior to the single-energy variant for both scanners, the OR range being 11.5–67.3 for the Definition and 2.1–2.8 for the Definition Flash. Visual noise and overall quality were regarded as better with Flash than with Definition. Image quality of VNC images obtained with the new generation of DECT is still slightly inferior compared to native images.In paper IV, the accuracy of measurement of renal calculi in a dual-energy, virtual, nonenhanced-image series is compared to actual stone size and a single-energy image series in the phantom study. This study shows that detection of small stones is not reliable, despite better image quality, with the new DECT and that small stones will be missed with VNC imaging. With larger stones, the inherent measurement error with CT is magnified with VNC imaging.
|
|
| 2. |
- Dimopoulou, Angeliki, 1975-
(författare)
-
CT with 3D-Image Reconstructions in Preoperative Planning
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Computed tomography is one of the most evolving fields of modern radiology. The current CT applications permit among other things angiography, 3D image reconstructions, material decomposition and tissue characterization. CT is an important tool in the assessment of specific patient populations prior to an invasive or surgical procedure. The aim of this dissertation was to demonstrate the decisive role of CT with 3D-image reconstructions in haemodialysis patients scheduled to undergo fistulography, in patients undergoing surgical breast reconstructions with a perforator flap and in patients with complicated renal calculi scheduled to undergo percutaneous nephrolithotomy.CT Angiography with 3D image reconstructions was performed in 31 patients with failing arteriovenous fistulas and grafts, illustrating the vascular anatomy in a comprehensive manner in 93.5% of the evaluated segments and demonstrating a sensitivity of 95% compared to fistulography.In 59 mastectomy patients scheduled to undergo reconstructive breast surgery with a deep inferior epigastric perforator flap, the preoperative planning with CT Angiography with 3D image reconstructions of the anterior abdominal wall providing details of its vascular supply, reduced surgery time significantly (p< 0.001) and resulted in fewer complications.Dual Energy CT Urography with advanced image reconstructions in 31 patients with complicated renal calculi scheduled to undergo PNL, resulted in a new method of material characterisation (depicting renal calculi within excreted contrast) and in the possibility of reducing radiation dose by 28% by omitting the nonenhanced scanning phase. Detailed analysis of the changes renal calculi undergo when virtually reconstructed was performed and a comparison of renal calculi number, volume, height and attenuation between virtual nonenhanced and true nonenhanced images was undertaken. All parameters were significantly underestimated in the virtual nonenhanced images.CT with 3D-reconstructions is more than just “flashy images”. It is crucial in preoperative planning, optimizes various procedures and can reduce radiation dose.
|
|
| 3. |
- Gyllensvärd, Frida, 1980-
(författare)
-
Efficient Methods for Volumetric Illumination
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Modern imaging modalities can generate three-dimensional datasets with a very high detail level. To transfer all the information to the user in an efficient way there is a need for three-dimensional visualization. In order to enhance the diagnostic capabilities the utilized methods must supply the user with fast renderings that are easy to interpret correctly.It can thus be a challenge to visualize a three-dimensional dataset in a way that allows the user to perceive depth and shapes. A number of stereoscopic solutions are available on the market but it is in many situations more practical and less expensive to use ordinary two-dimensional displays. Incorporation of advanced illumination can, however, improve the perception of depth in a rendering of a volume. Cast shadows provide the user with clues of distances and object hierarchy. Simulating realistic light conditions is, however, complex and it can be difficult to reach interactive frame rates. Approximations and clever implementations are consequently required.This thesis presents efficient methods for calculation of illumination with the objective of providing the user with high spatial and shape perception. Two main types of light conditions, a single point light source and omni-directional illumination, are considered. Global transport of light is efficiently estimated using local piecewise integration which allows a graceful speed up compared to brute force techniques. Ambient light conditions are calculated by integrating the incident light along rays within a local neighborhood around each point in the volume.Furthermore, an approach that allows the user to highlight different tissues, using luminous materials, is also available in this thesis. A multiresolution data structure is employed in all the presented methods in order to support evaluation of illumination for large scale data at interactive frame rates.
|
|
| 4. |
- Persson, Anita M., 1975-
(författare)
-
Evaluation of a Miniaturized Rotating Disk Apparatus for In Vitro Dissolution Rate Measurements in Aqueous Media : Correlation of In Vitro Dissolution Rate with Apparent Solubility
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to evaluate a newly designed and constructed miniaturized rotating disk apparatus for in vitro dissolution rate measurements of different drug substances from all of the classes in the Biopharmaceutical Classification System (BCS). The new equipment is based on a low volume flow-through cell of Plexiglas, a gold plated magnetic bar and a special designed press. The disk of drug substance (approx. 5 mg) is placed eccentrically in the bar. Rotation speeds were set with a graded magnetic stirrer. An external HPLC pump delivered a continuous flow of aqueous medium to the flow-through cell during dissolution testing. A reversed phase high-performance liquid chromatography system using diode array detection (RP-HPLC-DAD) was coupled online to the new equipment. The injections from the miniaturized rotating disk outlet into the quantifying HPLC system were controlled by a six-position switching valve. The injection volumes from the valve and the autosampler, used for the external standards, were statistically evaluated to match each other volumetrically. No analyses were longer than three minutes, using isocratic mode. A traditional USP rotating disk apparatus was used as a reference system and the two instruments were shown to be statistically dissimilar in the numerical dissolution rate values probably due to different hydrodynamics, but had approximately the same precision/repeatability. When correlating the logarithmic values of the in vitro dissolution rate (G) with the apparent solubility (S), using shake-flask methodology in the solubility studies, the two apparatuses gave the same correlation patterns. Further correlation studies were done where the media components were altered by the use of different buffer species or additives into the buffers, such as inorganic salts. Chemometric tools, e.g. orthogonal partial least squares (OPLS), were used to better evaluate the most influential factors for G and S in different media. The most significant factor for a model basic drug substance (terfenadine) was pH, followed by the ionic strength (I) and added sodium chloride in one of the media. However, the surfactants in the Fasted State Simulated Intestinal Fluid (FaSSIF-V2) were found to be insignificant for G and S in this study (using a 95% confidence interval). The new miniaturized apparatus is a promising prototype for in vitro dissolution rate measurements both for early screening purposes and in dissolution testing during drug development, but needs further instrumental improvements.
|
|
| 5. |
- Berglund, Martin, 1985-
(författare)
-
Miniature Plasma Sources for High-Precision Molecular Spectroscopy in Planetary Exploration
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The prospect of finding life outside Earth has fascinated mankind for ages, and new technology continuously pushes the boundary of how remote and how obscure evidence we can find. Employing smaller, or completely new, types of landers and robots, and equipping them with miniature instruments would indeed revolutionize exploration of other planets and moons.In this thesis, microsystems technology is used to create a miniature high-precision isotope-resolving molecular spectrometer utilizing the optogalvanic effect. The heart of the instrument, as well as this thesis, is a microplasma source.The plasma source is a split-ring resonator, chosen for its simplicity, pressure range and easily accessible plasma, and modified to fit the challenging application, e.g., by the adding of an additional ground plane for improved electromagnetic shielding, and the integration of microscopic plasma probes to extract the pristine optogalvanic signal.Plasma sources of this kind have been manufactured in both printed circuit board and alumina, the latter for its chemical inertness and for compatibility with other devices in a total analysis system. From previous studies, classical optogalvanic spectroscopy (OGS), although being very sensitive, is known to suffer from stability and reproducibility issues. In this thesis several studies were conducted to investigate and improve these shortcomings, and to improve the signal-to-noise ratio. Moreover, extensive work was put into understanding the underlying physics of the technique.The plasma sources developed here, are the first ever miniature devices to be used in OGS, and exhibits several benefits compared to traditional solutions. Furthermore, it has been confirmed that OGS scales well with miniaturization. For example, the signal strength does not decrease as the volume is reduced like in regular absorption spectroscopy. Moreover, the stability and reproducibility are greatly increased, in some cases as much as by two orders of magnitude, compared with recent studies made on a classical OGS setup. The signal-to-noise ratio has also been greatly improved, e.g., by enclosing the sample cell and by biasing the plasma. Another benefit of a miniature sample cell is the miniscule amount of sample it requires, which can be important in many applications where only small amounts of sample are available.To conclude: With this work, an important step toward a miniature, yet highly performing, instrument for detection of extraterrestrial life, has been taken.
|
|
| 6. |
- Bresell, Anders, 1978-
(författare)
-
Characterization of protein families, sequence patterns, and functional annotations in large data sets
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bioinformatics involves storing, analyzing and making predictions on massive amounts of protein and nucleotide sequence data. The thesis consists of six papers and is focused on proteins. It describes the utilization of bioinformatics techniques to characterize protein families and to detect patterns in gene expression and in polypeptide occurrences. Two protein families were bioinformatically characterized - the membrane associated proteins in eicosanoid and glutathione metabolism (MAPEG) and the Tripartite motif (TRIM) protein families.In the study of the MAPEG super-family, application of different bioinformatic methods made it possible to characterize many new members leading to a doubling of the family size. Furthermore, the MAPEG members were subdivided into families. Remarkably, in six families with previously predominantly mammalian members, fish representatives were also now detected, which dated the origin of these families back to the Cambrium ”species explosion”, thus earlier than previously anticipated. Sequence comparisons made it possible to define diagnostic sequence patterns that can be used in genome annotations. Upon publication of several MAPEG structures, these patterns were confirmed to be part of the active sites.In the TRIM study, the bioinformatic analyses made it possible to subdivide the proteins into three subtypes and to characterize a large number of members. In addition, the analyses showed crucial structural dependencies between the RING and the B-box domains of the TRIM memberRo52. The linker region between the two domains, denoted RBL, is knownto be disease associated. Now, an amphipathic helix was found to be acharacteristic feature of the RBL region, which also was used to divide the family into three subtypes.The ontology annotation treebrowser (OAT) tool was developed to detect functional similarities or common concepts in long lists of proteins or genes, typically generated from proteomics or microarray experiments. OAT was the first annotation browser to include both Gene Ontology (GO) and Medical Subject Headings (MeSH) into the same framework. The complementarity of these two ontologies was demonstrated. OAT was used in the TRIM study to detect differences in functional annotations between the subtypes.In the oligopeptide study, we investigated pentapeptide patterns that were over- or under-represented in the current de facto standard database of protein knowledge and a set of completed genomes, compared to what could be expected from amino acid compositions. We found three predominant categories of patterns: (i) patterns originating from frequently occurring families, e.g. respiratory chain-associated proteins and translation machinery proteins; (ii) proteins with structurally and/or functionally favored patterns; (iii) multicopy species-specific retrotransposons, only found in the genome set. Such patterns may influence amino acid residue based prediction algorithms. These findings in the oligopeptide study were utilized for development of a new method that detects translated introns in unverified protein predictions, which are available in great numbers due to the many completed and ongoing genome projects.A new comprehensive database of protein sequences from completed genomes was developed, denoted genomeLKPG. This database was of central importance in the MAPEG, TRIM and oligopeptide studies. The new sequence database has also been proven useful in several other studies.
|
|
| 7. |
- De Geer, Jakob, 1970-
(författare)
-
On the use of computed tomography in cardiac imaging
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundCardiac Computed Tomography Angiography (CCTA) is becoming increasingly useful in the work‐up of coronary artery disease (CAD). Several potential methods for increasing the diagnostic yield of cardiac CT are available.Purpose Study I: To investigate whether the use of a 2‐D, non‐linear adaptive noise reduction filter can improve CCTA image quality.Study II: To evaluate the variation in adenosine stress dynamic CT perfusion (CTP) blood flow as compared to stress 99mTc SPECT. Secondly, to compare the perfusion results from manual and automatic myocardial CTP segmentation.Study III: To evaluate the accuracy of non‐invasive, CCTA‐derived Fractional Flow Reserve (cFFR).Study IV: To evaluate the prognostic value of CCTA in terms of major adverse cardiac events (MACE).Materials and methodsStudy I: Single images from 36 consecutive CCTA exams performed with two different dose levels were used. Image quality in full dose, low‐dose and noise‐reduced low‐dose images was graded using visual grading analysis. Image noise was measured.Study II: CTP and SPECT were performed in 17 patients, and the variation in per AHA‐segment blood flow was evaluated and compared. CTP results from manual and automated image segmentation were compared.Study III: CCTA datasets from 21 patients were processed using cFFR software and the results compared to the corresponding invasively measured FFR (invFFR).Study IV: 1205 consecutive patients with chest pain of unknown origin underwent CCTA. Baseline data and data on subsequent MACE were retrieved from relevant registries. Survival, hazard ratios and the three‐year incidence of cardiac events and readmissions were calculated.Results Study I: There was significant improvement in perceived image quality for all criteria when the filter was applied, and a significant decrease in image noise.Study II: The correlation coefficients for CTP vs. SPECT were 0.38 and 0.41 (p<0.001, for manual and automated segmentation respectively. Mean per patient CTP blood flow in normal segments varied between 94‐183 ml/100 ml tissue/min for manual segmentation, and 104‐196 ml/100 ml tissue/min for automated segmentation. The Spearman rank correlation coefficient for manual vs. automated segmentation CTP was ρ = 0.88 (p<0.001) and the Intraclass Correlation Coefficient (ICC) was 0.93 (p<0.001).Study III: The Spearman rank correlation coefficient for cFFR vs. invFFR was ρ = 0.77 (p<0.001) and the ICC was 0.73 (p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value for significant stenosis (FFR<0.80, per vessel) were 0.83, 0.76, 0.56 and 0.93 respectively.Study IV: The hazard ratio for non‐obstructive CAD vs. normal coronary arteries was 5.13 (95% C.I 1.03‐25.43, p<0.05), and 151.40 (95% C.I 37.03‐619.08, p<0.001) for obstructive CAD vs. normal coronary arteries. The three‐year incidence of MACE was 1.1% for patients with normal vessels on CCTA, 2.5% for patients with non‐obstructive CAD and 42.7% for patients with obstructive CAD (p<0.001).Conclusions:Study I: Image quality and noise levels of low dose images were significantly improved with the filter, even though the improvement was small compared to the image quality of the corresponding diastolic full‐dose images.Study II: Correlation between dynamic CTP and SPECT was positive but weak. There were large variations in CTP blood flow in normal segments on SPECT, rendering the definition of an absolute cut‐off value for normal vs. ischemic myocardium difficult. Manual and automatic segmentation were equally useful.Study III: The correlation between cFFR and invFFR was good, indicating that noninvasively estimated cFFR performs on a similar level as invasively measure FFR. Study IV: The long‐term risk for MACE was very low in patients without obstructive CAD on CCTA, though there seemed to be a substantial increase in the risk for MACE even in patients with non‐obstructive CAD as compared to normal coronary arteries. In addition, even patients with normal coronary arteries or non‐obstructive CAD continued to have a substantial number of readmissions for chest pain or angina pectoris.
|
|
| 8. |
- Fraser, Magdalena
(författare)
-
People of the Dolmens and Stone Cists : An archaeogenetic Investigation of Megalithic Graves from the Neolithic Period on Gotland
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The study of ancient genomics of pre-historic human remains has in recent years offered unprecedented knowledge regarding pre-historic migration and population structure on the European continent which has fundamentally altered the current views in the archaeological community. However, the merging of the two fields, archaeology and genetics, is still in its infancy and much work is still needed in order for these fields to integrate. In this thesis I explore how genetic analyses, in combination with contextual radiocarbon dating and isotopic analyses for diet and mobility can be used to investigate demographic events on a local and regional level. This is done through the investigation of people buried in five previously excavated megalithic tombs on the Island of Gotland dated to the Neolithic period. I present the genomic population structure and archaeological background for the pre-historic European reference data and show how this is used to investigate population continuity, demographic shifts, cultural duality, and admixture for local and regional contexts. I present new data and explore the Strontium-baseline for the Gotland biosphere which is used for the mobility analyses. I show that mitochondrial haplogroup data is especially useful in combination with isotopic data, and radiocarbon dating for investigation of demographic shifts on a larger scale. I also show that genomic data gives unique insights into the individuals’ life history which, together with the established demographic background allows for fine scale investigation of population demographic events within and between different archaeological contexts. Finally I show that the different Neolithic contexts on Gotland to a large extent involves immigration of new groups to the island, and that the contextual breaks seen in the archaeological record during the Neolithic period are connected with cultural and population demographic shifts. This dissertation demonstrates that genomic analyses, in combination with archaeology and isotopic analyses, as well as contextual osteological analyses and radiocarbon dating, present unique insights into the life history of the actual people who lived the lives we try to understand.
|
|
| 9. |
- Fuchs, Alexander, 1985-
(författare)
-
Assessment of predicting blood flow and atherosclerosis in the aorta and renal arteries
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cardiovascular diseases (CVD) are the most common cause of death in large parts of the world. Atherosclerosis (AS) has a major part in most CVDs. AS is a slowly developingdisease which is dependent on multiple factors such as genetics and life style (food, smoking, and physical activities). AS is primarily a disease of the arterial wall and develops preferentially at certain locations (such as arterial branches and in certain vessels like thecoronary arteries). The close relation between AS sites and blood flow has been well established over the years. However, due to multi-factorial causes, there exist no early prognostic tools for identifying individuals that should be treated prophylactically or followed up. The underlying hypothesis of this thesis was to determine if it is possible to use bloodflow simulations of patient-specific cases in order to identify individuals with risk for developing AS. CT scans from patients with renal artery stenosis (RAS) were used to get the affected vessels geometry. Blood flow in original and “reconstructed” arteries were simulated. Commonly used wall shear stress (WSS) related indicators of AS were studied to assess their use as risk indicators for developing AS. Divergent results indicated urgent need to assess the impact ofsimulation related factors on results. Altogether, blood flow in the following vessels was studied: The whole aorta with branches from the aortic arch and the abdominal aorta, abdominal aorta as well as the renal arteries, and separately the thoracic aorta with the three main branching arteries from the aortic arch. The impact of geometrical reconstruction, employed boundary conditions (BCs), effects of flow-rate, heart-rate and models of blood viscosity as function of local hematocrit (red blood cell, RBC, concentration) and shear-rate were studied in some detail. In addition to common WSS-related indicators, we suggested the use of endothelial activation models as a further risk indicator. The simulations data was used to extract not only the WSS-related data but also the impact of flow-rate on the extent of retrograde flow in the aorta and close to its walls. The formation of helical motion and flow instabilities (which at high flow- and heart-rate lead to turbulence) was also considered.Results:A large number of simulations (more than 100) were carried out. These simulations assessed the use of flow-rate specified BCs, pressure based BCs or so called windkessel (WK) outlet BCs that simulate effects of peripheral arterial compliance. The results showed high sensitivity of the flow to BCs. For example, the deceleration phase of the flow-rate is more prone to flow instabilities (as also expressed in terms of multiple inflection points in the streamwise velocity profile) as well as leading to retrograde flow. In contrast, the acceleration phase leads to uni-directional and more stable flow. As WSS unsteadiness was found to be pro-AS, it was important to assess the effect flow-rate deceleration, under physiological and pathological conditions. Peaks of retrograde flow occur at local temporal minima in flow-rate. WK BCs require ad-hoc adjusted parameters and are therefore useful only when fully patient specific (i.e. all information is valid for a particular patient at a particular point of time) data is available. Helical flows which are considered as atheroprotective, are formed naturally, depending primarily on the geometry (due to the bends in the thoracic aorta). Helical flow was also observed in the major aortic branches. The helical motion is weaker during flow deceleration and diastole when it may locally also change direction. Most common existing blood viscosity models are based on hematocrit and shear-rate. These models show strong variation of blood (mixture) viscosity. With strong shear-rate blood viscosity is lowest and is almost constant. The impact of blood viscosity in terms of dissipation is counter balanced by the shear-rate; At low shear-rate the blood has larger viscosity and at high shear-rate it is the opposite. This effect and due to the temporal variations in the local flow conditions the effect of blood rheology on the WSS indicators is weak. Tracking of blood components and clot-models shows that the retrograde motion and the flow near branches may have so strong curvature that centrifugal force can become important. This effect may lead to the transport of a thrombus from the descending aorta back to the branches of the aortic arch and could cause embolic stroke. The latter results confirm clinical observation of the risk of stroke due to transport of emboli from the proximal part of the descending aorta upstream to the vessels branching from the aortic arch and which lead blood to the brain.Conclusions:The main reasons for not being able to propose an early predictive tool for future developmentof AS are four-folded:i. At present, the mechanisms behind AS are not adequately understood to enable to define aset of parameters that are sensitive and specific enough to be predictive of its development.ii. The lack of accurate patient-specific data (BC:s) over the whole physiological “envelop”allows only limited number of flow simulations which may not be adequate for patientspecificpredictive purposes.iii. The shortcomings of current models with respect to material properties of blood andarterial walls (for patient-specific space- and time-variations) are lacking.iv. There is a need for better simulation data processing, i.e. tools that enable deducinggeneral predictive atherosclerotic parameters from a limited number of simulations, throughe.g. extending reduced modeling and/or deep learning.The results do show, however, that blood flow simulations may produce very useful data thatenhances understanding of clinically observed processes such as explaining helical- andretrograde flows and the transport of blood components and emboli in larger arteries.
|
|
| 10. |
- Goldin, Stephen, 1948-
(författare)
-
Living in the present with the past : mental health of Bosnian refugee children in Sweden
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The negative impact of war on child mental health has been repeatedly documented. Still, the majority of children exposed to ethnic and political violence show no signs of clinical disorder. In Western countries of exile, these findings have prompted a variety of attempts to evaluate refugee children, in the hope of identifying and offering support to those children “at risk”. This study critically examines one such attempt. The aims are fourfold: 1. to describe the range and pattern of child trauma-stress exposure and mental health reactions as captured on clinician semi-structured interview; 2. to critically compare clinician assessment with independent parent, child and teacher reports; 3. to identify factors of potential risk or protective import for child mental health; 4. to draw clinical implications: from whom and by what means can children at risk be reasonably identified? The target of our study was the entire population of Bosnian-Serbian-Croatian speaking child refugee families assigned to Umeå and surrounding municipalities during 1994-95. Fifty families, containing 90 children aged one month to 20 years, were included in the study. Assessment occurred in two phases. First, a semi-structured interview was conducted that inquired broadly as to the child’s family background, trauma-stress exposure, emotional-behavioral problems, patterns of family functioning, and future hopes. Second, standardized self-report questionnaires were administered, separately to parent and child, to provide alternative appraisal of the child’s war exposure, mental health symptoms, coping strategies, and social network. Teacher evaluation of child cognitive-social functioning as well as emotional-behavioral problems was also obtained. Clinician semi-structured interview revealed the child’s pre-war period as preponderantly good, and provided richly detailed narratives of child exposure during war and resettlement that clustered into a limited number of type-stories. Independent parent assessment captured the same broad strokes of child war exposure; but both approaches – fixed questionnaire and semi-structured interview – showed specific areas of blindness. Teenage self-report offered a disparate but equally rich account of war exposure, while that of primary school child was significantly less detailed. Nearly half of the study children (48%) were identified on clinician interview with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%), followed by posttraumatic reactions (23%) and anxiety-regressiveness (15%). Independent symptom appraisal by parent and primary school child was largely concordant with that of clinician, while teenagers made similar assessment as to who was in distress, but defined the nature of that distress differently. Teacher report stood apart, identifying fewer inward emotional problems and asserting the cognitive-social competence of the vast majority of study children. Trauma-stress exposure during both war and resettlement presented as an unequivocal risk to mental health, but accounted for only part of outcome variance. Additional factors of strong import related broadly to “living in the present”. Parent impairment of daily routines, child dissatisfaction with school and an ongoing quarrelsome relationship presented as risk factors. Protection was associated with parent maintenance of a warm family climate and of concrete physical-emotional caring, child social ties to physically present others, including teacher; and above all, a family sense of hope for the future. Results support the general robustness of our semi-structured approach. Exploring the child’s present well-being in narrative relation to past and future, our assessment captured and gave meaning to the complexity of child exposure and behavior. At the same time, independent parent and child appraisals provided an additional richness to the retelling and evaluation of child experience. Particularly the apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment.
|
|
