Bibliotek

The importance of involving family members in the care of individuals with schizophrenia or other psychotic illnesses has received increasing attention within psychiatric healthcare services. However, several studies suggest that family members often experience a lack of involvement. Furthermore, research indicates that family members' experience of the professional's approach has bearing on whether they feel involved or not. Thus, the aims of this study were to investigate the level of importance that the family members of individuals with schizophrenia or other psychotic illnesses ascribe to the professionals' approach, the level of agreement between their experiences and what they consider as important, and aspects they consider to be important with regards to contact with professionals. Seventy family members from various parts of Sweden participated. Data were collected by the Family Involvement and Alienation Questionnaire and open-ended questions. The median level and quartiles were used to describe the distribution, and percentage agreement was analysed. Open-ended questions were analysed by qualitative content analysis. The results reveal that the majority of the participants consider Openness, Confirmation, and Cooperation as important aspects of a professional's approach. Continuity emerged as an additional aspect. The results show a low level of agreement between the participants' experience and what they consider as important.

Abstract [en]
OBJECTIVE: The aim of the study was to explore how family members experienced the use of a diary when a relative does not survive the stay in the intensive care unit (ICU).

METHOD: A qualitative method with a hermeneutic approach was used. Nine participants who read/wrote eight diaries in total were interviewed. The collected data were analysed using a hermeneutic technique inspired by Geanellos.

FINDINGS: The analysis revealed an overall theme 'the diary was experienced as a bridge connecting the past with the future', which was a metaphor referring to the temporal aspect where there was the period with the diary up until the patient's death and then the postbereavement period. The diary contributed to both a rational and emotional understanding of the death of the patient and disclosed glimmers of light that still existed before the illness deteriorated. Further, the diary bridged the space between family members themselves and between family and nursing staff. It helped to maintain a feeling of togetherness and engagement in the care of the patient which family members found comforting.

CONCLUSION: Family members of nonsurvivors had a need to have the ICU time explained and expressed. The diary might work as a form of 'survival kit' to gain coherence and understanding; to meet their needs during the hospital stay; and, finally, to act as a bereavement support by processing the death of the patient.

Abstract [en]
OBJECTIVE: The aim of the study was to explore how family members experienced the use of a diary when a relative does not survive the stay in the intensive care unit (ICU).

METHOD: A qualitative method with a hermeneutic approach was used. Nine participants who read/wrote eight diaries in total were interviewed. The collected data were analysed using a hermeneutic technique inspired by Geanellos.

FINDINGS: The analysis revealed an overall theme 'the diary was experienced as a bridge connecting the past with the future', which was a metaphor referring to the temporal aspect where there was the period with the diary up until the patient's death and then the postbereavement period. The diary contributed to both a rational and emotional understanding of the death of the patient and disclosed glimmers of light that still existed before the illness deteriorated. Further, the diary bridged the space between family members themselves and between family and nursing staff. It helped to maintain a feeling of togetherness and engagement in the care of the patient which family members found comforting.

CONCLUSION: Family members of nonsurvivors had a need to have the ICU time explained and expressed. The diary might work as a form of 'survival kit' to gain coherence and understanding; to meet their needs during the hospital stay; and, finally, to act as a bereavement support by processing the death of the patient.

The aim of this article is to reveal how family members act, react and reason when their elderly relative considers relocation to a residential home. Since family members are usually involved in the logistics of their elderly relative's relocation, yet simultaneously expected not to influence the decision, the focus is on how family members experience participation in the relocation process in a Swedish context. 17 family members are included in 27 open, semi-structured interviews and follow-up contacts. Prominent features in the findings are firstly the family members' ambition to tone down their personal opinions, even though in their minds their personal preferences are clear, and secondly, the family members' ambivalence about continuity and change in their everyday lives. Family members are found to apply the adapting, the representing, or the avoiding strategy, indirectly also influencing their interaction with the care manager. Siblings applied the adapting strategy, spouses the representing strategy, while family members in the younger generation at times switched between the strategies.

Abstract:
Purpose: This article explores experiences of the acute-care environment as a setting for end-of-life (EoL) care from the perspective of family members of a dying person. Method: We used participant-produced photographs in conjunction with follow-up interviews with nine family members to persons at the EoL, cared for in two acute-care settings. Results: The interpretive description analysis process resulted in three constructed themes-Aesthetic and unaesthetic impressions, Space for privacy and social relationships, and Need for guidance in crucial times. Aspects of importance in the physical setting related to aesthetics, particularly in regard to sensory experience, and to a need for enough privacy to facilitate the maintenance of social relationships. Interactions between the world of family members and that of professionals were described as intrinsically related to guidance about both the material and immaterial environment at crucial times. Conclusion: The care environment, already recognized to have an impact in relation to patients, is concluded to also affect the participating family members in this study in a variety of ways.

Finch discusses the nature of family life, especially concepts of duty, responsibility and obligation and how these factors operate in family and kin relationships.

OBJECTIVES:
This study evaluated client-level outcomes among an entire statewide group of Family Preservation and Family Support (FPFS) programs funded under PL 103-66.
METHOD:
A total of 1,601 clients (primarily low income, moderate to high risk with no current involvement in the child protection system) were assessed and followed over time for future child maltreatment events reported to Child Protective Services. The study compared program completers with program dropouts, compared recipients of more lengthy full-service programs with recipients of one-time services, and examined the effects of program duration, intensity, service site (center-based vs. home based) and service model/content. Effects were modeled using survival analysis and variable-exposure Poisson hierarchical models, controlling for initial client risk levels and removing failure events because of surveillance bias. Changes in lifestyle, economic and risk factors were also examined.
RESULTS:
A total of 198 (12.2%) participants had at least one defined failure event over a median follow-up period of 1.6 years. Controlling for risk and receipt of outside services, program completers did not differ from program dropouts or from recipients of one-time services, and there was no relationship between program intensity or duration and outcomes. Program types designed to help families meet basic concrete needs and programs using mentoring approaches were found to be more effective than parenting and child development oriented programming, and center-based services were found to be more effective than home-based services, especially among higher risk parents.
CONCLUSIONS:
The findings did not support the effectiveness of these services in preventing future maltreatment cases, and raised questions about a number of common family support assumptions regarding the superiority of home-visiting based and parent training services. A number of possible reasons for this are explored.

Receiving a diagnosis of an autism spectrum disorder often elicits strong emotional reactions from parents of the diagnosed child. Follow-up services and continued support for these families is a necessary component to help families adapt and meet their and their children's needs. This pilot study measured the effects of a six-session, co-facilitated, support group on the advocacy skills and self-efficacy of parents coping with a child's diagnosis. Statistically significant increases in the average mean scores for the three subscales of the Family Empowerment Scale were found. Implications for practice and research are discussed. Adapted from the source document.

Background

Attention is currently focused on family care of stroke survivors, but the effectiveness of support services is unclear. We did a single-blind, randomised, controlled trial to assess the impact of family support on stroke patients and their carers.

Methods

Patients with acute stroke admitted to hospitals in Oxford, UK, were assigned family support or normal care within 6 weeks of stroke. After 6 months, we assessed, for carers, knowledge about stroke, Frenchay activities index, general health questionnaire-28 scores, caregiver strain index, Dartmouth co-op charts, short form 36 (SF-36), and satisfaction scores, and, for patients, knowledge about stroke and use of services, Barthel index, Rivermead mobility index, Frenchay activities index, London handicap scale, hospital anxiety and depression scales, Dartmouth co-op charts, and satisfaction.

Findings

323 patients and 267 carers were followed up. Carers in the intervention group had significantly better Frenchay activities indices (p=0·03), SF-36 scores (energy p=0·02, mental health p=0·004, pain p=0·03, physical function p=0·025, and general health perception p=0·02), quality of life on the Dartmouth co-op chart (p=0·01), and satisfaction with understanding of stroke (82 vs 71%, p=0·04) than those in the control group. Patients' knowledge about stroke, disability, handicap, quality of life, and satisfaction with services and understanding of stroke did not differ between groups. Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge (44 vs 56%, p=0·04), but use of other services was similar.

Interpretation

Family support significantly increased social activities and improved quality of life for carers, with no significant effects on patients.

Socialstyrelsens och Statens folkhälsoinstituts rapport ger en aktuell och översiktlig bild av hälsoutvecklingen och dess bestämningsfaktorer. Den visar bland annat att bland kvinnor och män 35-44 år har risken att få stroke ökat med 21 respektive 15 procent sedan 1995

Folkhälsorapport 2009 visar bland annat att risken att dö i hjärtinfarkt och stroke har minskat väsentligt, medan dödligheten i bröstcancer däremot har minskat endast marginellt, och dödligheten i lungcancer fortfarande ökar bland kvinnor, medan den sjunker bland män. Psykisk ohälsa är vanligt hos yngre kvinnor; självmordsförsöken ökar.

Abstract [en]

OBJECTIVES: Demographic change has led to an increase of older people in need of long-term care in nearly all European countries. Informal carers primarily provide the care and support needed by dependent people. The supply and willingness of individuals to act as carers are critical to sustain informal care resources as part of the home health care provision. This paper describes a longitudinal study of informal care in six European countries and reports analyses that determine those factors predicting the outcomes of family care over a one-year period.

METHODS: Analyses are based on data from the EUROFAMCARE project, a longitudinal survey study of family carers of older people with baseline data collection in 2004 and follow-up data collection a year later in six European countries (Germany, Greece, Italy, Poland, Sweden, and the United Kingdom), N = 3,348. Descriptive statistics of the sample characteristics are reported. Binary logistic random-intercept regressions were computed, predicting the outcome of change of the care dyad's status at follow-up.

RESULTS: Where care is provided by a more distant family member or by a friend or neighbour, the care-recipient is significantly more likely to be cared for by someone else (OR 1.62) or to be in residential care (OR 3.37) after one year. The same holds true if the care-recipient has memory problems with a dementia diagnosis (OR 1.79/OR 1.84). Higher dependency (OR 1.22) and behavioural problems (OR 1.76) in the care-recipient also lead to a change of care dyad status. Country of residence explained a relatively small amount of variance (8%) in whether a care-recipient was cared for by someone else after one year, but explained a substantial amount of variance (52%) in whether a care-recipient was in residential care. Particularly in Sweden, care-recipients are much more likely to be cared for by another family or professional carer or to be in residential care, whereas in Greece the status of the care dyad is much less likely to change.

DISCUSSION: The majority of family carers continued to provide care to their respective older relatives over a one-year period, despite often high levels of functional, cognitive and behavioural problems in the care-recipient. Those family carers could benefit most from appropriate support. The carer/care-recipient relationship plays an important role in whether or not a family care dyad remains intact over a one-year period. The support of health and social care services should be particularly targeted toward those care dyads where there is no partner or spouse acting as carer, or no extended family network that might absorb the caring role when required. Distant relatives, friends or acquaintances who are acting as carers might need substantial intervention if their caregiving role is to be maintained.

OBJECTIVES: Demographic change has led to an increase of older people in need of long-term care in nearly all European countries. Informal carers primarily provide the care and support needed by dependent people. The supply and willingness of individuals to act as carers are critical to sustain informal care resources as part of the home health care provision. This paper describes a longitudinal study of informal care in six European countries and reports analyses that determine those factors predicting the outcomes of family care over a one-year period. METHODS: Analyses are based on data from the EUROFAMCARE project, a longitudinal survey study of family carers of older people with baseline data collection in 2004 and follow-up data collection a year later in six European countries
(Germany, Greece, Italy, Poland, Sweden, and the United Kingdom), N = 3,348. Descriptive statistics of the sample characteristics are reported. Binary logistic random-intercept regressions were computed, predicting the outcome of change of the care dyad's status at follow-up. RESULTS: Where care is provided by a more distant family member or by a friend or neighbour, the care-recipient is significantly more likely to be cared for by someone else (OR 1.62) or to be in residential care (OR 3.37) after one year. The same holds true if the care-recipient has memory problems with a dementia
diagnosis (OR 1.79/OR 1.84). Higher dependency (OR 1.22) and behavioural problems
(OR 1.76) in the care-recipient also lead to a change of care dyad status. Country of residence explained a relatively small amount of variance (8%) in whether a care-recipient was cared for by someone else after one year, but explained a substantial amount of variance (52%) in whether a care-recipient was in residential care. Particularly in Sweden, care-recipients are much more likely
to be cared for by another family or professional carer or to be in residential care, whereas in Greece the status of the care dyad is much less likely to change. DISCUSSION: The majority of family carers continued to provide care to their respective older relatives over a one-year period, despite often high levels of functional, cognitive and behavioural problems in the care-recipient. Those family carers could benefit most from appropriate support. The carer/care-recipient relationship plays an important role in whether or not a family care dyad remains intact over a one-year period. The support of health and social care services should be particularly targeted toward those care dyads where there is no partner or spouse acting as carer, or no extended family network that might absorb the caring role when required. Distant relatives, friends or acquaintances who are acting as carers might need substantial intervention if their caregiving role is to be maintained.

Doktorsavhandling

Aim: To explore forensic care in EDs for victims of violence and their family members from the perspectives of ED department heads, ED nurses, and a family member of a victim of violence. Methods: Study I consisted of a questionnaire to all heads of EDs in Sweden, data were analyzed with descriptive statistics. Study II consisted of a similar questionnaire which also included the instrument Families' Importance in Nursing Care-Nurses' Attitudes. It was sent to all nurses at 28 EDs and data were analyzed using descriptive statistics, multiple linear and ordinal regression analysis. Study III comprised of individual interviews with twelve nurses from seven EDs and data were analyzed with content analysis. Study IV was a single case study with two interviews with a family member of a victim of violence. Data were analyzed with a Gadamer-inspired hermeneutic approach. Results: ED preparedness for forensic care varied and was often limited to women and children. Nurses played a key role, but most of them had no training for this task and felt uncertain (I, II, III). Creating a caring encounter was the main challenge for providing forensic care and nurses perceived hindering factors to overcome this challenge (III). Family members were rarely included in forensic care and nurses perceived that family members were offered little help (I-III). Having ED documents that included family members, was associated with a more positive attitude to family members, which in turn was associated with involving them in care (II). For the family member, perfunctory encounters and caring alliances had a major impact and the experience reframed life (IV). Conclusion: Lack of preparedness in EDs to care for all types of victims of violence and differences between individual nurses may prohibit the provision of equal care. Hindering factors for a caring encounter can result in forensic care being unaddressed, which may limit possibilities for alleviated suffering and legal justice. Family members were rarely included in forensic care, but caring encounters can be crucial for the family member in the aftermath of violence

BACKGROUND: In European countries, knowledge about availability and utilization
of support for informal caregivers caring for older persons (≥65 years) with
dementia (PwD) is lacking. To be able to evaluate and develop the dementia
support system for informal caregivers to PwD, a survey of European support
systems and professionals involved is needed. The aim of this study was to
explore support for informal caregivers to PwD in European countries. We
investigated the availability and utilization of support in each of the
participating countries, and the professional care providers involved, through
the dementia disease.
METHODS: A mapping system was used in 2010-2011 to gather information about
estimations of availability, utilization, and professional providers of support
to informal caregivers caring for PwD. Data collected was representing each
country as a whole.
RESULTS: There was high availability of counselling, caregiver support, and
education from the diagnosis to the intermediate stage, with a decrease in the
late to end of life stage. Utilization was low, although there was a small
increase in the intermediate stage. Day care and respite care were highly
available in the diagnosis to the intermediate stage, with a decrease in the late
to end of life stage, but both types of care were utilized by few or no
caregivers through any of the disease stages. Professionals specialized in
dementia (Bachelor to Master's degree) provided counselling and education,
whereas caregiver support for informal caregivers and day care, respite care, and
respite care at home were provided by professionals with education ranging from
upper secondary schooling to a Master's degree.
CONCLUSIONS: Counselling, caregiver support, and education were highly available
in European countries from diagnosis to the intermediate stage of the dementia
disease, decreasing in the late/end of life stages but were rarely utilized.
Countries with care systems based on national guidelines for dementia care seem
to be more aware of the importance of professionals specialized in dementia care
when providing support to informal caregivers. Mapping the systems of support for
informal caregivers of PwD is a valuable tool for evaluating existing systems,
internationally, nationally and locally for policy making.

Foster children's family relationships have been one of the themes in a longitudinal study, starting with a disadvantaged group of children, 0–4 years of age when taken into care and placed in a children's home in Sweden. Seven rounds of data collection were carried out; the last two when the children were young adults. This article is about those 20 children in the study group who, in addition to temporary residential care at an early age, have experiences from foster care, either for the remainder of their childhood or before or after a period of reunion. Placement history is put in relation to family relationships, i.e. relationships to birth family and foster family. The categorisation in secure and insecure relationships or attachment patterns is based on interviews with the young adults, with a retrospect of previous relationships. The connection between placement history and family relationship is not obvious in this high-risk group. However, inclusive attitudes from the foster family towards the child's family promote continuity and a sense of security, also in periods of reunion or re-placement, and facilitate foster children's hard work in coming to terms with their family background and finding their own way.

Den här boken handlar om framgångsrika amerikanska och europeiska preventionsprogram. De har i utvärderingar visat sig minska ungdomars problembeteenden och främja barns sociala utveckling. I boken ges många exempel på välfungerande preventionsprogram som involverar familj, skola och närsamhälle. En bok för socialarbetare, psykologer och folkhälsoplanerare och andra med intresse för förebyggande arbete. Boken har tillkommit på initiativ av IMS, Institutet för utveckling av metoder i socialt arbete.

Den här boken handlar om framgångsrika amerikanska och europeiska preventionsprogram. De har i utvärderingar visat sig minska ungdomars problembeteenden och främja barns sociala utveckling. I boken ges många exempel på välfungerande preventionsprogram som involverar familj, skola och närsamhälle. En bok för socialarbetare, psykologer och folkhälsoplanerare och andra med intresse för förebyggande arbete. Boken har tillkommit på initiativ av IMS, Institutet för utveckling av metoder i socialt arbete.

Den här boken handlar om framgångsrika amerikanska och europeiska preventionsprogram. De har i utvärderingar visat sig minska ungdomars problembeteenden och främja barns sociala utveckling. I boken ges många exempel på välfungerande preventionsprogram som involverar familj, skola och närsamhälle. En bok för socialarbetare, psykologer och folkhälsoplanerare och andra med intresse för förebyggande arbete. Boken har tillkommit på initiativ av IMS, Institutet för utveckling av metoder i socialt arbete.

Objectives:
The objective was to investigate the performance aspect of participation, operationalized as the frequency of occurrence of family activities and child presence in these activities for children with profound intellectual and multiple disabilities (PIMD) and children with typical development (TD). The focus was also on how family and child characteristics are related to the frequency of occurrence of family activities. This is part of a larger research project investigating facilitating factors for participation in children with PIMD.
Methods:
A descriptive, comparative study was performed using a questionnaire developed for the purpose.
Results:
In the families with a child with PIMD, the majority of activities occurred less often than in families with children with TD. In both groups, relationships were found between the frequency of occurrence of family activities and total family income, as well as the educational level of the parents. For children with PIMD, motor ability, cognition, health, and behaviour, were related to frequency of occurrence. Moreover, the presence of the children in the activities differed in the two groups; the children with PIMD were present in the activities less often.
Discussion:
Considering a long-term perspective, low occurrence of family activities and child presence may affect child development and everyday functioning. Knowledge about factors related to the occurrence of family activities and child presence in them, as well as an understanding of its causes, can promote the provision of everyday natural learning opportunities for children with PIMD.

Despite widespread recognition of the risks that parental drug use pose to children, few resources are available to help such children. Using a developmental intervention approach, the authors designed and tested a model curriculum for use with groups of latency-aged children in schools located in communities where drug use is pervasive. In implementing this curriculum, the authors documented the need that children affected by family drug use have for workable strategies and skills for coping with aversive environments. The responsiveness of group participants to structure, predictability, and affirmation in the groups was remarkable. Measurable changes occurred in classroom behavior and feelings of self-worth. Obstacles to implementing and testing such an intervention are discussed.

In 1990 we advanced the hypothesis that frightened and frightening (FR) parental behavior would prove to be linked to both unresolved (U) adult attachment status as identified in the Adult Attachment Interview and to infant disorganized/disoriented (D) attachment as assessed in the Ainsworth Strange Situation. Here, we present a coding system for identifying and scoring the intensity of the three primary forms of FR behavior (frightened, threatening, and dissociative) as well as three subsidiary forms. We review why each primary form may induce fear of the parent (the infant's primary "haven of safety"), placing the infant in a disorganizing approach-flight paradox. We suggest that, being linked to the parent's own unintegrated traumatic experiences (often loss or maltreatment), FR behaviors themselves are often guided by parental fright, and parallel the three "classic" mammalian responses to fright: flight, attack, and freezing behavior. Recent studies of U to FR, as well as FR to D relations are presented, including findings regarding AMBIANCE/FR+. Links between dissociation, FR, U, and D are explored. Parallel processing and working memory are discussed as they relate to these phenomena.

The 2011 John Bowlby Memorial Conference, 'From Broken Attachments to Earned Security - The Role of Empathy in Therapeutic Change', focussed on what needs to take place to facilitate empathy and attunement and ultimately the achievement of earned security. The confernce posed the challenge of how to re-establish a secure sense of self, mutuality, and the capacity for inter/intra-subjectivity when difficulties in empathy and attunement exist as a result of relational trauma. This can be between parent and child, within adult relationships, between client and therapist, or in organisational contexts.

The outstanding collection of papers in this volume make a significant contribution to the field of attachment and our understanding of how child rearing affects each aspect of our lives, from the interpersonal to the organisational and societal. Each paper moves beyond the academic and theoretical to provide answers to the many difficult questions raised at the conference.

The practical, sometimes step-by-step explanation of the use of empathy in one-to-one clinical work, in health service organisations or society generally, offer a positive and hopeful way forward. All of the presenters faced up to the challenges of repairing or reversing the impact of derailed attachments and the toxic impact of trauma, offering a realistic but hopeful route to improved relating and healthier attachments.

This publication will be a valuable resource for students, seasoned practitioners, and health service professionals alike who want to enhance their understanding of empathy and attachment in this demanding field.

Subject areas covered by your book in order of importance and key subject area:

- causes of insecure attachments

- impact of relational trauma

- how to re-establish a secure sense of self

- working one to one and in organisational settings

Families with parental affective disorder participated in a large-scale longitudinal study which involved participation in a standardized, short-term, psychoeducational preventive intervention. These families were followed for at least 3 years. An analysis of clinical material from the first 12 families to complete the intervention identified specific healing principles that contributed to positive changes in behavior and attitude. The healing elements of the intervention included demystification of the illness, modulation of shame and guilt, increase in the capacity for perspective taking, and development of a hopeful perspective and belief in one's own competence. Therapeutic effectiveness evolved in a process that linked cognitive information and presented depression as an illness that could be understood with the acknowledgement of family members' individual and collective experience. In this way, families developed a shared understanding of the illness that was useful over time. This article discusses the ways in which the healing principles promoted changes in family members' behavior and attitude, which, in turn, enhanced resiliency in children.

In this paper, we aim to review the growing body of research on the psychosocial well-being of refugee children. We start with an overview of the chronological models for the refugee experience that conceptualize the process of forced migration as a long-term adverse context of cumulating risk factors, functioning as a pervasive threat to refugee children's mental health. Next, we briefly summarize the literature on refugee children's mental health as the starting point for a critical reflection on the dominance of the symptom-focused, trauma-centred approach which characterises much of refugee research. Drawing from this, we argue for the pertinence of research on refugee children's mental health from a family perspective. Finally, we propose a model for the refugee family experience, which integrates multiple individual, family and cultural processes, and we organise existing findings on refugee families in relation to six domains of the refugee family life. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

In this paper, we aim to review the growing body of research on the psychosocial well-being of refugee children. We start with an overview of the chronological models for the refugee experience that conceptualize the process of forced migration as a long-term adverse context of cumulating risk factors, functioning as a pervasive threat to refugee children's mental health. Next, we briefly summarize the literature on refugee children's mental health as the starting point for a critical reflection on the dominance of the symptom-focused, trauma-centred approach which characterises much of refugee research. Drawing from this, we argue for the pertinence of research on refugee children's mental health from a family perspective. Finally, we propose a model for the refugee family experience, which integrates multiple individual, family and cultural processes, and we organise existing findings on refugee families in relation to six domains of the refugee family life. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Vilken människosyn och vilka värderingar ligger till grund för socialtjänstens verksamhet, och hur har de påverkat uppbyggnaden av dagens socialtjänst? Kan sociala insatser huvudsakligen beskrivas som myndighetsutövning, där även tvång kan komma i fråga, eller kan de ses som en verksamhet med respekt för den enskildes vilja och integritet? Under socialvårdens utveckling från fattigvård till socialtjänst har två utomparlamentariska grupper utifrån olika ideologiska utgångspunkter haft stor betydelse för socialvårdslagarnas innehåll och utformning. Centralförbundet för socialt arbete (CSA) verkade som initiativtagare och pådrivare när de första lagarna stiftades vid förra sekelskiftet. Samarbetskommittén för socialvårdens målfrågor, som bildades i slutet av 1960-talet, hade möjlighet att påverka Socialtjänstlagens slutliga utformning.

Boken innehåller en skildring av den tidigare socialvården och beskriver hur de två grupperna agerade för att få gehör för sina idéer. Särskild uppmärksamhet ägnas Samarbetskommittén och dess framgångar och misslyckanden under den 14 år långa lagstiftningsprocessen, som i det turbulenta slutskedet med många regeringsskiften och skiftande ideologier särskilt kom att handla om tvångsvården av vuxna missbrukare.

Boken vänder sig främst till studerande och verksamma inom socialt arbete, men bör även vara av intresse för närliggande ämnesområden inom samhällsvetenskap och historia.

Denna grundbok i familjeterapi ger en bred introduktion till familjeterapins historia, dess grundläggande idéer och de viktigaste familjeterapeutiska modellerna.
Boken behandlar bl a:
• familjeterapins historia från 1950-talet till våra dagar,
• det teoretiska fundamentet för familjeterapi, inklusive en introduktion till systemteori, livscykelteori och kommunikationsteori,
• de viktigaste familjeterapeutiska modellerna, med fokus på deras teoretiska bas och praktiska användning.
Boken är avsedd för grundläggande högskole- och universitetsutbildning i psykologi, socialt arbete, vård och omsorg. Den är av intresse för alla som arbetar med familjer: psykologer, socionomer, vårdpersonal och präster.

Den 23 november 1995 bemyndigade regeringen det statsråd som har till uppgift att föredra ärenden om det offentliga skolväsendet och fristående skolor att tillkalla en kommitté (U 1995:14) med uppdrag att utreda hur ansvaret för utbildning och omvårdnad i anslutning till utbildning av funktionshindrade elever skall fördelas mellan stat, kommun och landsting samt vem som skall finansiera verksamheten

Hur upplever och hanterar vuxna personer med stora rörelsehinder sin situation och sig själva? Hur hanterar funktionshindrade sina kontakter med vårdbyråkratin och med allmänheten? Hur påverkas självbild och livssyn av att leva med stora rörelsehinder? Det bärande temat i Funktionshinder och strategival är en kritik av den medikalisering som beskriver och formar funktionshindrade människors tillvaro; sjukförklaringen, omyndigförklaringen samt dikotomin i starka och svaga. Boken vänder sig emot ett utbrett grundantagande om funktionshindrade människors tragedi och speglar både ett inifrån- och ett utifrånperspektiv så att både de läsare som lever med funktionshinder och de som möter funktionshindrade kan känna igen sig.
Boken vänder sig till universitets- och högskolestuderande inom beteendevetenskap, vård, medicin och sociala områden samt yrkesverksamma som kommer i kontakt med människor med omfattande funktionshinder. Den kan med stor behållning också läsas av personer med funktionshinder och deras anhöriga.

Psykiatrireformen trädde i kraft 1995. Reformen syftade till att förbättra livssituationen för personer med psykiska funktionshinder och öka deras möjligheter till gemenskap och delaktighet i samhället. Reformen omfattar främst personer som bedöms ha långvariga och allvarliga funktionsnedsättningar p.g.a. en psykisk sjukdom och som är i behov av stöd-, vård- och rehabiliteringsinsatser för att få en bättre livssituation. De åtgärder som föreslogs i propositionen skulle inriktas på att ge ett mer effektivt och samordnat samhällsstöd till målgruppen. Kommunernas ansvar förtydligades när det gäller att planera och samordna de insatser som personer med psykiska funktionshinder behövde. Förtydligas gjorde också kommunernas ansvar för att utveckla boendeformer och verksamheter för sysselsättning.

Regeringen konstaterade dock 2003 att det fortfarande finns brister i den psykiatriska vården och den sociala omsorgen. I oktober 2003 tillkallade därför regeringen (dir. 2003:133) en nationell psykiatrisamordnare med uppgift att se över väsentliga frågor inom vård, social omsorg och rehabilitering av psykiskt sjuka och personer med psykiska funktionshinder.

Socialstyrelsens utvärdering av psykiatrireformen (1999) visade att den hade fått en god start men ännu inte "satt sig". Det ansågs dock viktigt att reformarbetet fortsatte på bred front både lokalt och nationellt. I utvärderingen konstaterades vidare att det behövdes en aktiv, tydlig och sammanhållen tillsyn för att stödja en god verksamhetsutveckling.

Inom ramen för det Nationella programmet för tillsyn över socialtjänsten togs 2001 ett första steg till en utveckling av tillsynen i denna riktning. Länsstyrelserna och Socialstyrelsen beslutade då att kraftsamla sina resurser i en gemensam tillsyn över kommunernas insatser för personer med psykiska funktionshinder. Även kommunernas ansvar för hälso- och sjukvård har ingått i tillsynen. Kraftsamlingen har genomförts i form av ett tillsynsprojekt under åren 2002–2004. Samtliga tjugoen länsstyrelser har deltagit, dock i olika omfattning. Fyra delgranskningar har genomförts:

Tillsyn av samtliga kommuners planering av verksamheten för personer med psykiska funktionshinder på ledningsnivå, våren 2002.
Tillsyn av socialtjänstens arbete med enskilda personer med psykiska funktionshinder i ett urval av kommuner, 2002–2003.
Tillsyn av kvalitet och innehåll i verksamheter för boende och sysselsättning i ett urval av kommuner, 2002–2003.
Uppföljning av den första delundersökningen på några problemområden, hösten 2004.
För att åstadkomma en kraftsamling krävs även en samverkan mellan den sociala tillsynens aktörer och tillsynen över kommunernas hälso- och sjukvård. För det senare svarar Socialstyrelsens sex regionala tillsynsenheter. Även kommunernas ansvar för viss hälso- och sjukvård ingår därför i tillsynen.

Projektet har haft expertstöd från Socialpsykiatriskt kunskapscentrum i Västerbotten. En referensgrupp till tillsynsprojektet med representanter från Riksförbundet för Social och Mental Hälsa (RSMH) och Schizofreniförbundet har följt tillsynen och deltagit i såväl planeringen av tillsynsprojektet som i analysen av resultatet.

Tillsynsfrågor
De områden som granskats i tillsynen utgår från kommunernas ansvar för personer med psykiska funktionshinder. Huvudfrågan i tillsynen har varit: Är verksamheten så beskaffad att tillräckligt goda förutsättningar skapas för att personer med psykiska funktionshinder "får möjlighet att delta i samhällets gemenskap och att leva som andra" (5 kap. 7 § SoL)? Fyra huvudfrågor har ansetts vara centrala för tillsynen. De är:

Tar kommunerna sitt ansvar för att skaffa sig kännedom om personer med psykiska funktionshinder och nå de personer som har behov av socialtjänstens insatser?
Tar kommunerna sitt ansvar att styra och planera sin verksamhet för personer med psykiska funktionshinder?
Tar kommunerna sitt ansvar att tillhandahålla ett varierat utbud av insatser med god kvalitet?
Tar kommunerna sitt ansvar för att enskilda personer med psykiska funktionshinder får ett behovsstyrt, samordnat och rättssäkert stöd?

Kommunerna har i socialtjänstlagen ett uttalat ansvar för att genom stöd och avlösning underlätta för närstående som vårdar långvarigt sjuka, äldre och personer med funktionshinder. Syftet med denna rapport var att belysa de anhörigas upplevelse av de insatser som kommunerna har att erbjuda. 6 anhörigvårdare från olika kommuner i Jönköpings län har intervjuats. 4 av de intervjuade har på eget initiativ tagit en första kontakt med kommunen. övriga fick hjälp av personal i samband med sjukhusvistelse med förmedling av den första kontakten. Kontakterna har lett till ökade stödinsatser. Anhörigvårdarna är nöjda med stödet. Stödformer som avlösning, kontakter och träffar/studiecirklar upplevs som betydelsefulla.

Kommunerna har i socialtjänstlagen ett uttalat ansvar för att genom stöd och avlösning underlätta för närstående som vårdar långvarigt sjuka, äldre och personer med funktionshinder. Syftet med denna rapport var att belysa de anhörigas upplevelse av de insatser som kommunerna har att erbjuda. 6 anhörigvårdare från olika kommuner i Jönköpings län har intervjuats. 4 av de intervjuade har på eget initiativ tagit en första kontakt med kommunen. Övriga fick hjälp av personal i samband med sjukhusvistelse med förmedling av den första kontakten. Kontakterna har lett till ökade stödinsatser. Anhörigvårdarna är nöjda med stödet. Stödformer som avlösning, kontakter och träffar/studiecirklar upplevs som betydelsefulla.

En studie i två delar rörande målgruppen barn med grava rh – kontaktanvändare: Del 1: Inventering och beskrivning av dynamiska kommunikationsprogram och styrsätt (bl.a. MindMouse/CyberLink), del 2: Kommande interventionsstudie.

Projektet har en egen hemsida www.kommed.nu där du kan läsa mer. Där finns bl a rapporter och en mängd annan intressant information att hämta.

Projektansvariga: Gerd Zachrisson DART och Bitte Rydeman, DAKO i Halland.

Medel: 2-årigt projekt med stöd från HI - "IT i praktiken"

Nationellt kompetenscentrum anhöriga, Nka, har fått i uppdrag av Socialdepartementet
att utveckla ett nationellt kunskapsstöd till föräldrar och anhöriga till barn och ungdomar med flerfunktionsnedsättningar. Syftet med kunskapsstödet är att underlätta kunskapsinhämtning, erfarenhetsutbyte och nätverkskontakter för anhöriga

För de allra flesta händer det inte. Men varje år mister fler än 3 000 barn och ungdomar en förälder eller ett syskon. Då är det viktigt att ha bra kompisar. Men hur ska en bra kompis vara när något så svårt händer? Finns det saker man helst inte ska göra eller säga? Törs man fråga om dödsfallet? Kan man vara precis som vanligt och skratta och skoja? I den här boken får du träffa några barn och ungdomar som förlorat en nära anhörig. Hur var deras kompisar då? Vad var bra och vad var kanske inte lika bra? Du får också träffa några kompisar.

Barn till föräldrar med psykisk ohälsa är en eftersatt grupp. Syfet med denna studie är att studera pedagogers utveckling som kompletterande anknytningsperson i relation till en tre årig fortbildning.Fortbildnigen ägde rum samtidigt som pedagogerna arbetade och innehöll teorier om barns utveckling, nämligen anknytningsteori, Affektteori samt Sterns teori om barns självutveckling.En narrativ metod användes och narrativen analyserades i relation till fortbildningens innehåll, teorier om pedagogers lärande och teorier om tidig utveckling.
Resultatet diskuteras utifrån pedagogers arbete med utsatta barn i förskolan, lärarutbildningens innehåll och fortbildning samt samverkan.

Vid habiliteringen i Alingsås har man arbetat med syskongrupper
sedan 1997. På olika sätt hade man då fått upp ögonen för
syskonens behov, dels genom alltmer ökande förfrågningar från
föräldrar om syskongrupper dels genom personalens egen
ökande kunskap och erfarenhet av syskon.

ADHD – uppmärksamhetsstörningar och impulsivitet/hyperaktivitet (attention deficit hyperactivity disorder) – bedöms vara ett av de mest studerade tillstånden inom medicinen. Man har beräknat att ungefär tre till sex procent av alla barn i skolåldern har ADHD. Det är ca två till tre gånger vanligare med ADHD hos pojkar än flickor. Huvudsymtomen vid ADHD är uppmärksamhetsstörning, impulsivitet och hyperaktivitet/överaktivitet. Barn med ADHD har svårt att vänta, att kontrollera känslor och humör. Många har ett oförutsägbart beteende. Flertalet har problem med att planera
och organisera sin tillvaro – har brister i vad som kallas hjärnans exekutiva funktioner. En betydande andel barn med ADHD har svårigheter i samspelet med andra. De kan ha svårt att finna meningsfulla fritidsaktiviteter. Det är mycket vanligt att barn och ungdomar med ADHD är ängsliga, osäkra och saknar tilltro till sin förmåga. Många misslyckanden ökar risken för uppgivenhet, oro och depression.

Vårdtiden blir kortare om patienter med affektiv sjukdom och deras närstående erbjuds utbildning. Det visar resultat av en undersökning vid Affektivt centrum i Norra Stockholms psykiatri, S:t Göran, vid jämförelse av vårdkonsumtion hos patienter före och efter deltagande i ett utbildningsprogram.

Deltagarnas subjektiva tillfredsställelse med utbildningen var hög. Många i såväl patient- som närståendegruppen uppgav att de kunde använda kunskaper från utbildningen till att hantera sjukdomen.

Ett kort-tids-boende är förbundet med föreställningen att behoven inte bara är omfattande, utan också övergående och kortvariga. Så är det i princip. I realiteten tycks många korttidsvistelser handla om att man inte vet hur det förhåller sig med behoven – om de är övergående eller inte. Av den anledningen tenderar korttidsboendet att vara både en väntplats och en vändplats. En plats för väntan, såväl aktivt som passivt, på att flytta till särskilt boende och en plats varifrån den enskilde vänder hemåt igen – en vändplats.

Ett korttidsboende har således många och skiftande funktioner och kan se ut lite hur som helst. Det kan vara alltifrån insprängda platser till relativt smalt specialiserade enheter, därav benämningen kameleont.

Denna rapport har kommit till på uppdrag dels från Södermalms stadsdelsförvaltning,
dels Äldreförvaltningen i Stockholms stad. Bakgrunden
är önskemålet från såväl Södermalms stadsdelsnämnd som stadens
äldrenämnd att se vilken roll korttidsvården har och kan ha, och om de
prioriteringar som skett under 2000-talet gagnat de äldre. Korttidsplats,
som är det begrepp Socialstyrelsen rekommenderar, har olika funktioner,
och inkluderar korttidsvård efter sjukhusvistelse, växelvård, avlastning
av anhörig och vård i livets slutskede.
På uppdrag av Södermalms stadsdelsförvaltning har en randomiserad
studie genomförts där de som ansökte om korttidsplats men fick avslag
lottades så att hälften, interventionsgruppen, fick korttidsplats medan
kontrollgruppen gick direkt hem med de insatser stadsdelsförvaltningen
beviljat. Denna studie utökades med ett uppdrag från Socialstyrelsen att
studera alla som skrivs ut från sluten vård under en månad till hemmet
på Södermalm. På uppdrag av Äldreförvaltningen har dessa båda studier
kompletterats med en genomgång av artiklar och rapporter om korttidsvård
samt analys av data avseende stadens korttidsvård.
De som kommer till ett korttidsboende befinner sig i en mycket skör
situation i livet. Korttidsplats för återhämtning, mobilisering och fortsatt
rehabilitering efter sjukhusvård utvecklades i hela landet efter Ädelreformen,
och har fortsatt att sedan dess öka i många kommuner. Bidragande
orsak har varit allt färre vårdplatser och kortare vårdtider i den
somatiska vården samt att fler har hemtjänst och färre bor i särskilt
boende.
Andelen äldre som erhåller korttidsplats varierar mellan landets
kommuner, liksom mellan Stockholms stadsdelar. I Göteborg hade 2008
1,4 procent av de som är 65 år och äldre korttidsplats, i Stockholm var andelen
0,25 procent.
I Stockholms stad har antalet som beviljas korttidsplats minskat sedan
2001. Det är främst korttidsvård efter sjukhusvistelse som minskat,
medan korttidsvård som anhörigstöd endast minskat marginellt. Minskningen
är tydligast för de äldre kvinnorna, under en fyraårsperiod 2007-
2010 minskade antalet kvinnor 85 år och äldre som fick korttidsplats från
186 till 82, för männen var minskningen från 116 till 88 personer.
Några skäl till att korttidsplats numera sällan erbjuds efter sjukhusvistelse
är att inte förlänga vårdkedjan och att staden inte erbjuder rehabilitering
inom korttidsvården eftersom rehabilitering i ordinärt boende är
ett landstingsansvar. Effekten kan dock bli att den äldre inte får
tillräcklig tid för att hämta krafter och träna så att hon kan klara sin
vardag bättre själv. Mycket talar för att en ytterligare tids vård för vissa
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äldre kan vara kostnadseffektiv för samhället och innebära ökad trygghet
för den äldre. Resultaten från den randomiserade studien på Södermalm
tyder bl.a. på
Interventionsgruppen förbättrade sin rörelseförmåga i genomsnitt mer än
de som skrevs ut till hemmet
Andelen som minskade sitt vårdberoende var större i interventionsgruppen
jämfört med dem som skrevs ut till hemmet
Indexvärdet för den hälsorelaterade livskvaliteten ökade för interventionsgruppen,
för dem som skrevs ut direkt till hemmet var den nästan
oförändrad (statistiskt signifikant skillnad).
Signifikant större förbättring när det gäller oro/nedstämdhet samt förmågan
att klara huvudsakliga aktiviteter bland de äldre som fick korttidsplats.

Inga skillnader i kostnad för äldreomsorg (korttidsplatsen inräknad!).
Tydlig tendens till att äldre som hade fått korttidsvård blev inlagda på
sjukhus i mindre utsträckning under ett år efter utskrivning jämfört med
de äldre som skrevs direkt ut till hemmet.
Tydlig tendens till en lägre dödsrisk under ett års tid efter utskrivning
bland äldre som hade fått korttidsvård.
Det blev således inte dyrare för interventionsgruppen, som fick korttidsplats,
än för gruppen som inte lottades att få den insatsen, däremot blev
det bättre för interventionsgruppen i flera avseenden.
En form som nästan försvunnit i Stockholms stad är korttidsplats i
väntan på plats i vård- och omsorgsboende. Detta skäl till att bevilja korttidsplats
har kritiserats bl.a. av Socialstyrelsen.
Korttidsvården har en viktig roll genom att ge anhöriga avlastning. En
förutsättning för att korttidsvården ska vara en fungerande avlastning för
den anhörige är att den har ett socialt innehåll i vardagen och att den
anhörige också uppmärksammas. Pensionat Hornskroken och Kinesen i
Stockholm är goda exempel. Korttidsboende med denna inriktning måste
fokusera både på den som vistas på korttidsplatsen och den anhörige.
Korttidsvård kan också användas som sviktplats. Det saknas statistik för
denna vårdform, varför det är svårt att bedöma i vilken utsträckning den
utnyttjas så. I Stockholms län finns möjlighet till direktinlägg på geriatrisk
klinik. Det kan finnas skäl att följa upp om korttidsplats skulle
kunna användas när behovet främst är att få vila upp, äta och återhämta
kraft genom god omvårdnad och den geriatriska platsen när det krävs mer
av medicinsk behandling och/eller rehabilitering.
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Vård i livets slutskede är i Stockholms stad ovanligt i korttidsvården.
Staden saknar korttidsenheter med palliativ inriktning. I stället erbjuds
plats på vård- och omsorgsboende, vilket inte är helt adekvat i den livsfasen.

Beskrivningarna av vardagen på korttidsboendet andas ofta innehållslöshet,
torftighet både i det sociala innehållet och i boendemiljöerna. Det
saknas alltför ofta tydliga beställningar från biståndshandläggaren vad
som är syftet med vistelsen, och genomförandeplaner som visar vad korttidsvården
ska kunna ge. För att korttidsvården ska kunna utvecklas och
få den roll den kan ha behövs tydlighet i beställningen till korttidsvården,
tydlighet i biståndsbeslutet och tydliga genomförandeplaner hos utföraren.

För att detta ska bli möjligt måste korttidsvården få mer renodlade uppdrag,
med inriktning på t.ex. svikt, rehabilitering, avlösning och vård i
livets slutskede. Det krävs mer specialisering, inte att allt blandas på
samma enhet. Viktigt är också att inte blanda personer med demenssjukdom
med dem som är kognitivt klara.

Människans liv kantas av psykiska kriser. En del utlösta av plötsliga och oväntade, svåra händelser; andra hör det normala livet till. Krisen är ofta en förutsättning för utveckling och mognad, men den kan också leda till livslång psykisk invaliditet om inte den drabbade får sakkunnig hjälp

Det är trettio år sedan den första utgåvan av Johan Cullbergs klassiska bok Kris och utveckling kom 1975. Den har lästs och uppskattats av hundratusentals svenskar - såväl av studenter som av människor som själva befinner sig i kris eller kommer i kontakt med människor i krislägen. Den har också översatts till flera andra språk.

Mycket i samhället, liksom inom psykiatrin, har förändrats. Det har inneburit att en omarbetning av boken känts angelägen, även om grundstrukturen står kvar. Kvar står också den hoppfulla synen på krisen som en hävstång för den mänskliga utvecklingen. Boken har kompletterats med ett avsnitt om katastrofpsykiatri och sena stressreaktioner av docent Tom Lundin.

Den omvälvande kunskapsutvecklingen inom krisstöd har helt förändrat synen på vad som faktiskt hjälper barn och vuxna vid svåra händelser. Debriefing rekommenderas till exempel inte längre i det akuta skedet internationell konsensus och Socialstyrelsen förordar i stället Psykologisk första hjälp.
Utifrån aktuell forskning och egna praktiska erfarenheter förklarar författarna till boken Krisstöd hur vi reagerar vid svåra händelser, från allvarliga sjukdomsbesked till större katastrofer. Med levande och konkreta exempel beskriver de hur man arbetar med Psykologisk första hjälp för att stärka människors motståndskraft. Barns och ungas reaktioner och behov ägnas extra omsorg, samt hur man som personal kan ta hand om sig själv och varandra.

Denna grundbok om krisstöd är skriven för blivande och yrkesverksamma sjuksköterskor, poliser, socionomer, psykologer, läkare, personalvetare och andra som möter människor i det akuta skedet av svåra händelser i sitt dagliga arbete eller vid större olyckor och katastrofer.

Den omvälvande kunskapsutvecklingen inom krisstöd har helt förändrat synen på vad som faktiskt hjälper barn och vuxna vid svåra händelser. Debriefing rekommenderas till exempel inte längre i det akuta skedet internationell konsensus och Socialstyrelsen förordar i stället Psykologisk första hjälp.
Utifrån aktuell forskning och egna praktiska erfarenheter förklarar författarna till boken Krisstöd hur vi reagerar vid svåra händelser, från allvarliga sjukdomsbesked till större katastrofer. Med levande och konkreta exempel beskriver de hur man arbetar med Psykologisk första hjälp för att stärka människors motståndskraft. Barns och ungas reaktioner och behov ägnas extra omsorg, samt hur man som personal kan ta hand om sig själv och varandra.

Denna grundbok om krisstöd är skriven för blivande och yrkesverksamma sjuksköterskor, poliser, socionomer, psykologer, läkare, personalvetare och andra som möter människor i det akuta skedet av svåra händelser i sitt dagliga arbete eller vid större olyckor och katastrofer.

Äldreforskning

Syftet med kunskapsunderlaget är att göra information om barn och elever med medfödda skador av alkohol lättillgänglig för pedagoger, men det kan även användas av andra, som möter barn och elever med medfödda skador av alkohol

De allmänna råden riktar sig till både kommunen och den personal som arbetar på fritidshemmet och illustrerar hur ansvarsfördelningen mellan kommun och verksamhet ser ut. Det är Skolverkets förhoppning att dessa allmänna råd med kommentarer kommer att ligga till grund för diskussioner om hur verksamheten kan bedrivas och att de ska ge ett gott stöd för att utveckla verksamheten.

De befintliga allmänna råden kan tillämpas till dess att de nya allmänna råden har beslutats.

Nationellt kompetenscentrum anhöriga, Nka, har tagit fram rapporten "Kvalitet i äldreomsorg ur ett anhörigperspektiv" på uppdrag från Socialdepartementet. Rapporten ingår i den nationella kvalitetsplanen för äldreomsorgen.
I rapporten framgår det tydligt att trygghet är själva förutsättningen för att kunna skapa bästa och mesta möjliga välbefinnande för anhöriga och äldre närstående. Andra viktiga byggstenar är tillhörighet, delaktighet och betydelsefullhet. Det finns också ett behov av kompetensutveckling – både i verksamheterna och hos de anhöriga. I kunskapssammanställningen framgår också att anhöriga och äldre närstående tenderar att bemötas och behandlas olika beroende på den utbildning, arbete och social position personen har. Detsamma gäller kön, etnisk tillhörighet, trosuppfattning, funktionsnedsättning, sexuell läggning och ålder. Rapporten tar upp en rad åtgärder för att utveckla kvaliteten i vården och omsorgen för äldre ur ett anhörigperspektiv.

Rapporten sammanställer aktuell kunskap om de äldres boende, både ordinärt (det vill säga att bo "hemma") och särskilt boende. Syftet är också att beskriva faktorer som leder till flyttning respektive kvarboende på äldre dagar

Den så kallade kvarboendeprincipen, att samhället ska möjliggöra för den enskilde att kunna bo kvar i sitt eget hem, har varit den officiella policyn i decennier. Äldre personers faktiska möjlighet att bo kvar påverkas av en mängd faktorer som hälsa, familjeförhållanden, ekonomi samt bostädernas tillgänglighet för dem med funktionsnedsättning

Rapport i Socialt arbete 130. Doktorsavhandling

The overall aim with this thesis is to describe and analyze women's and men's recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder.

Four studies have been carried. Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women's and men's meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women's and men's recovery from mental illness.

The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.

Emotional Availability among Traumatized Refugee Families
Red Cross Centre for Tortured Refugees in Stockholm, Sweden, started in 2011 a clinical
research pilot project in order to prevent second generation traumatization among children of
tortured and war-traumatized parents with complex Post-traumatic Stress Disorder, PTSD.
The project runs in co-operation with Karolinska Institutet, Department of Women's and
Children's Health, Child and Adolescent Psychiatric Unit. The aim of the project was to
explore and evaluate a treatment program based on attachment theory and trauma theory for
parents and infants, age 0-24 months.
The early relation of mother-infant is fundamental for the survival of the infant and basic for
development of a child's social, emotional and cognitive health and capacity. According to
research parents with complex, PTSD, risk to transform their symptoms to their children.
The theoretical reference is based on attachment theory and Emotional Availability Scale,
EAS, as an investigating instrument. A clinical sample according to the project criteria was
selected. Five refugee families from the Middle East with established complex PTSD diagnos
have been participated in the treatment program, consisting of psycho pedagogical family
interventions, interplay therapy and group interventions.
The preliminary results of this pilot project indicated an outstanding need for developing a
treatment program focusing on mother and child emotional availability within refugee
families as a preventive intervention. This is the first report of a three-year project, financed
by Stiftelsen Allmänna Barnhuset.

The aim of my study is to describe and understand disabled children's special way of understanding and relating to the surrounding world. The thesis is based on an empirical study of six severely disabled children, lacking language and speech, aged from nine months to five years. The children were studied by video recordings in Händelsriket, a center organised to offer them different kinds of rich stimulation. One important finding was that the children expressed a non-verbal, meaning making competence that I decided to further explore. First, I tried to interpret the children's competence in the frame of psychoanalytic and psychodynamic theories, which turned out to be difficult as these theories were based on assumptions linked to the tradition of René Descartes, making a clear difference between Cogito and body, nature and culture. In this tradition, human consciousness is based on the acquisition of language and the development of the sphere of symbols. As a consequence, the mentioned theories could not help us to understand the embodied, non-verbal competence of the disabled children. Many of these theorists also argue that their theories have little relevance for disabled children.However, the phenomenological tradition, inspired by among others Edmund Husserl, Martin Heidegger and Maurice Merleau-Ponty, was of much more help in the analysis of the disabled children's activities in Händelsriket. In the theory of the lifeworld, Husserl´s and Merleau-Ponty´s, for instance, introduces two different kinds of intentionality indicating an embodied consciousness of great relevance to the empirical findings.Another important empirical finding was that feelings, and the expression of feelings, seemed to play an important role in the children's non-verbal, meaning making competence. As a consequence of this I have decided to include a discussion of research on feelings, emotions and affects. Based on the critique of the distinction between feelings, emotions and affects in social and anthropological research, I have decided to base my analysis on the concept of feelings.In the empirical analyses I discuss the role of feelings in the disabled children's perception, consciousness, communication and interaction with other people. I found that the meaning making processes based on feelings and expression of feelings contributed to the development of the children's personal styles of understanding their life-world. It also played an important role in the thematisation of their experiences, antecipations of objects, extensions and restrictions of their experiential horizons and their mastering of challenging experiences. The feelings also played important roles in the children's communicative competence and in their interaction with other people and the development of mutual closeness, understanding and community. In short, the feelings could be understood as important constituents of the life-world of the severely disabled children, their understanding of themselves and of the surrounding world.

"Min barndom var full av slag och psykisk misshandel. Jag var alltid rädd, varje dag, varje timme, varje minut och varje sekund. Rädd för min mamma, rädd för mina klasskamrater, rädd för han som utnyttjade oss, rädd för allt. Det fanns nästan ingen trygghet att finna i min barndom.
Jo, det fanns en plats där jag kunde känna mig trygg, även om det tog tid att våga vara trygg hos mina sommarföräldrar. Deras gård var en oas. Där fann jag en trygghet under de sommarveckor jag bodde
långt bort från mamma. Där fick jag provsmaka hur det kunde vara och hur det borde vara att få vara ett litet barn. Men det var bara de där sommarveckorna. En tid som liksom bara var till låns för snart skulle jag hem till min mamma igen, tillbaka till rädslan och utsattheten. Jag ville inte åka hem till när sommaren var slut, jag grät då jag tvingades att åka till mamma igen"

I Kärlek och stålull skildrar Lisbeth Pipping på ett personligt och levande sätt sin uppväxt med en utvecklingsstörd mamma, en svårt alkoholiserad pappa och två småsystrar. Läsaren får ta del av en barndom i misär, bristande omsorg och kärlek...

As people continue to age and receive complex health care services at home, concern has arisen about the availability of family caregivers and their ability to combine employment with caregiving. This article evaluates the international research on unpaid caregivers and their labor market choices, highlighting three conclusions: first, caregivers in general are equally as likely to be in the labor force as noncaregivers; second, caregivers are more likely to work fewer hours in the labor market than noncaregivers, particularly if their caring commitments are heavy; and finally, only those heavily involved in caregiving are significantly more likely to withdraw from the labor market than noncaregivers. Policy recommendations are targeting greater access to formal care for "intensive" caregivers and developing workplace policies for employed caregivers.

As people continue to age and receive complex health care services at home, concern has arisen about the availability of family caregivers and their ability to combine employment with caregiving. This article evaluates the international research on unpaid caregivers and their labor market choices, highlighting three conclusions: first, caregivers in general are equally as likely to be in the labor force as noncaregivers; second, caregivers are more likely to work fewer hours in the labor market than noncaregivers, particularly if their caring commitments are heavy; and finally, only those heavily involved in caregiving are significantly more likely to withdraw from the labor market than noncaregivers. Policy recommendations are targeting greater access to formal care for "intensive" caregivers and developing workplace policies for employed caregivers.

Doktorsavhandling

Syftet med avhandlingen är att ur ett medborgarskaps- och kommunikativt perspektiv undersöka och problematisera funktionshindrade "brukares" självbestämmande i samtal som förs under s.k. brukarcentrerade teammöten organiserade av en vuxen- respektive en barn- och ungdomshabilitering. I mötena deltar en funktionshindrad brukare och/eller anhöriga och professionella från skilda verksamheter. Studien baseras på diskursanalys av 18 observerade och bandinspelade möten hållna av tio olika team. Analyserna visar att brukarna hade ett mer eller mindre begränsat inflytande över samtalens organisering. Inflytandet varierade med organiseringen av samtalen samt med i vilken utsträckning brukarna deltog aktivt genom att identifiera egna problem och framtida mål. Det synliggjorde en spänning mellan ett "idealt" självbestämmande och brukarnas förmåga/benägenhet att leva upp till de krav som det "ideala" självbestämmandet ställde och gav upphov till situationer i vilka dilemman mellan självbestämmande och paternalism uppstod. I analyserna av hanterandet av dessa situationer framkom att deltagarna i möten utan deltagande brukare motiverade sina åsikter och beslut rörande behandlingen av brukaren genom att referera till egna övertygelser om vad som är bäst för brukaren respektive till tolkningar av brukarens egna preferenser utifrån hennes/hans agerande i vardagslivet. I möten med deltagande brukare använde övriga deltagare diskursiva strategier som var mer eller mindre paternalistiska då de innebar att de styrde brukaren på ett sätt som det inte var säkert att brukaren själv ville. I avhandlingen diskuteras vilka möjliga strategier som skulle kunna öka brukarnas självbestämmande. Utfallet relateras också till det "samtalande" och sociala medborgarskap som brukarna i avhandlingen anses utöva samt till andra möjliga innebörder av ett socialt medborgarskapsutövande.

Funktionsnedsättningar som medför någon form av begränsningar i tillvaron utgör funktionshinder. I denna rapport redovisas levnadsförhållanden för personer med olika typer av funktionsnedsättningar. Det gäller dels ett antal medicinska sjukdomar, dels några grupper som definierats just utifrån sina funktionsbegränsningar.Rapporten är indelad i två delar där den första behandlar levnadsförhållanden för personer i normalt yrkesverksam ålder, 25-64 år, och den senare förhållanden för personer i pensionsålder, 65-84 år. I ett inledande kapitel redovisas också hur vanligt förekommande olika kombinationer av funktionsnedsättningar är. I rapporten jämförs de funktionsnedsattas förhållanden i slutet av 90-talet med förhållandena tio år tidigare, dvs. före och i slutet av ett årtionde som kännetecknades av stora problem på arbetsmarknaden och besparingar i den offentliga sektorn.

Funktionsnedsättningar som medför någon form av begränsningar i tillvaron utgör funktionshinder. I denna rapport redovisas levnadsförhållanden för personer med olika typer av funktionsnedsättningar. Det gäller dels ett antal medicinska sjukdomar, dels några grupper som definierats just utifrån sina funktionsbegränsningar.Rapporten är indelad i två delar där den första behandlar levnadsförhållanden för personer i normalt yrkesverksam ålder, 25-64 år, och den senare förhållanden för personer i pensionsålder, 65-84 år. I ett inledande kapitel redovisas också hur vanligt förekommande olika kombinationer av funktionsnedsättningar är. I rapporten jämförs de funktionsnedsattas förhållanden i slutet av 90-talet med förhållandena tio år tidigare, dvs. före och i slutet av ett årtionde som kännetecknades av stora problem på arbetsmarknaden och besparingar i den offentliga sektorn.

Funktionshindrade i välfärdssamhället handlar om funktionshindrades livsvillkor på några centrala områden: arbete och försörjning, vård, omsorg och utbildning, men också om funktionshindrades roll som samhällsmedborgare med anspråk på delaktighet och inflytande.

Bokens fokus ligger till stor del på välfärdssystemets möjligheter och begränsningar relaterade till funktionshindrades villkor. Men det finns naturligtvis en rad andra faktorer som också påverkar medborgarnas villkor som till exempel utvecklingen inom ekonomi och arbetsmarknad och inte minst de attityder och föreställningar vi har om vad det innebär att ha ett funktionshinder.

Den historiska framställningen visar på en utveckling från ett ensidigt individuellt handikappbegrepp, som betonar individens sjukdomar, skador och andra brister som konstituerande för handikappet, till ett mer relativt funktionshinderbegrepp som betonar omgivningens betydelse för om handikapp föreligger eller ej.

Boken vänder sig till studerande på universitet och högskolor, framför allt inom socialt arbete och vårdvetenskap.

Rafael Lindqvist är professor i sociologi, med inriktning funktionshinderforskning, Uppsala universitet.

As the population ages and the expected wave of baby boomers settles into old age, there is a pressing need to examine the people and institutions that care for elders and the ways in which the system will need to adapt during the next 5-10 years to accommodate the needs of the elderly and of their caregivers. This paper examines future directions in this field, identifying the major issues from two perspectives: family caregiving and professional caregiving. Despite extensive research on caregiving, more attention to a series of methodological issues is needed, as is more extensive evaluation of promising intervention models in community and institutional settings. Effective strategies to lower caregiver distress and improve the quality of care can be implemented in efficient ways that manage costs, but the argument for innovations must be made based on efficacy.

Alva har en hund Musse. Musse är inte bara en hund, Alva ser Musse som en storebror också. När Alva får höra att Musse är gammal och inte kommer att leva länge till blir Alva både ledsen och arg, hon vill att han ska leva för alltid. Det är ju honom hon har som bästa vän och som hon berättar alla hemlisa för! Alva funderar över hur det ska gå till när Musse ska dö och vad händer med honom efteråt? Alva inser till slut att han inte försviner helt. Han finns ju kvar inom henne, lite i köket och kanske även i himlen.

Kristina och Vivianne, två motpoler vars liv löper parallellt i Solgläntans korridorer när de hälsar på sina mödrar. Sida vid sida i demensens skugga söker de sig till varandra, i behov av ett outtalat stöd. Vivianne gömmer sin osynliga sorg bakom lager av glada färger och en väldigt lång halsduk. Fast besluten att alltid se det positiva i livet väljer hon att hålla fast i nuet och leva för stunden, tacksam för alla minnen hon får. Kristina försöker förtränga sitt förflutna, men hon är rädd för att glömma. Rädd att pärlhalsbandet av minnen ska gå sönder. Rädd att bli som sin mamma, som hon i hemlighet önskar livet ur. Men döden kommer aldrig i tid. Den kommer alltid för sent. Eller för tidigt. För alltid i mitt hjärta är en roman om en oväntad vänskap, som kommer att betyda så mycket mer än Kristina och Vivianne någonsin hade kunnat ana. En vänskap som kommer att sträcka sig genom både tid och rum.

Carlbeck-kommittén har till uppgift att se över utbildningen för barn, ungdomar och vuxna med utvecklingsstörning. Delbetänkandet För den jag är om utbildning och utvecklingstörning (SOU: 2003: 35), är en beskrivning och kartläggning av hur utbildningen för barn, ungdomar och vuxna ser ut i dag.

Kommitténs uppgift är att hitta vägar att stärka utbildningen för barn, ungdomar och vuxna med utvecklingstörning med det övergripande målet att åstadkomma en inkluderande skola och en inkluderande undervisning.

Skriften bygger på rapporten "Program för att förebygga psykiatrisk ohälsa hos barn – en systematisk litteraturöversikt, utgiven 2010 av SBU.

Skolverket presenterar den första nationella utvärderingen av förskolan efter reformen 1998 då förskolan fick en läroplan och blev det första steget i det samlade utbildningssystemet för barn och ungdom. Utvärderingens övergripande syfte är att belysa hur förskolan utvecklats i olika avseenden efter reformen samt att ge en lägesbeskrivning av reformens effekter. Utvärderingen visar på att förskolans utveckling innehåller både positiva och problematiska inslag. Förskolans läroplan har tagits emot positivt i kommuner och förskolor, men har man lyckats uppnå det som var en av de viktigaste målen med reformen "en likvärdig förskola"?Förskolan har dessutom i en rad avseenden närmat sig skolan, i vissa fall på bekostnad av sin särart. Barns prestationer kartläggs och bedöms i ökad omfattning, vilket strider mot grundtankarna i reformen.

Beskrivning av vilket ansvar förskrivaren har utifrån lagar, förordningar och föreskrifter. Vägledning för förskrivare och annan personal inom hjälpmedelsområdet.

Kartläggningsrapport

"Föräldraboken om ADHD" vänder sig till föräldrar som har ett barn eller en tonåring med ADHD. Grundtanken är att ökad kunskap om ADHD ska göra det lättare för föräldrarna att förstå och stödja sitt barn.

Boken är skriven av psykolog Lena Westholm. Hon arbetar på ADHD-center inom Habilitering och Hälsa i Stockholms läns landsting.I boken konstateras att föräldrar till barn eller tonåringar med ADHD måste kämpa och använda mer energi än andra föräldrar för att få tillvaron att fungera. Det ställs stora krav på tålamod, planering och konflikthantering.

Läsaren ges tips på olika sätt att lösa problem och hur det kan bli lättare att hantera vardagen. Områden som tas upp är ADHD i olika åldrar, skolgång, medicinering, fritid, mat- och sovvanor, relationer, känslor med mera.

Föräldrautbildning erbjuds idag bl.a. inom förskola/skola, socialtjänst liksom hälso- och sjukvård. Lärandet kan beskrivas ur olika perspektiv. Om barnet är det primära brukar man tala om Parent Education, när fokus ligger på familjen som helhet talar man om Parent Training och när det är föräldrarna som står i centrum för utbildningsinsatsen säger man ofta Parent Support. En viktig tanke är att få tillstånd ett bra samarbete mellan föräldrar och personal. Det är nödvändigt för att skapa större delaktighet och ett bättre lärande för föräldrar.

I denna samanställning av befintlig forskning framkommer att några områden är mer studerade än andra. Ett antal studier har undersökt föräldraförmåga och föräldrakompetens. I dag vet man ganska väl vad som kan fungera och vad som kan brista i föräldrarnas förmåga att ta hand om sina barn. Resultat från olika studier visar att träning och utbildning kan förbättra föräldrarnas förmåga. En förutsättning för detta är dock att utbildningen är kontinuerlig såväl över tid som i kontakten med de professionella. Befintliga studier inkluderar oftare mödrar än fäder vilket innebär att det finns mer kunskap om mödrarna. Endast ett fåtal studier har undersökt fäderna och männen i kvinnornas liv.

Vidare finns det ett fåtal studier som fokuserar barnet i de familjer där föräldrarna har en utvecklingstörning. Den forskning som finns visar dock att barnen utgör en riskgrupp. Riskfaktorerna varierar delvis beroende på barnets ålder, men även beroende på om barnet har en utvecklingsstörning. Det rapporteras att det finns risk för att barnen försummas vilket kan ta sig uttryck i bristande omvårdnad, att barnen inte får näringsriktig kost, bristande säkerhet i hemmet och bristande hygien. Det finns även risk för att barnen utsätts för misshandel. Studier visar en ökad risk för att barn med utvecklingsstörning utsätts för misshandel och/eller sexuella övergrepp jämfört med andra barn, oavsett om föräldrarna har en utvecklingsstörning eller inte.

Det rapporteras att barn som har föräldrar med utvecklingsstörning kan ha svårigheter med språklig och kognitiv utveckling. Dessutom förekommer det att barnen har beteendeproblem och emotionella svårigheter och det är vanligare att barnen har psykiska svårigheter, framför allt depressioner, än andra barn. Förekomsten av svårigheter samt barnens utsatthet kan påverka barnens förmåga att senare i livet fungera som föräldrar.
Hur livet gestaltar sig för de barn som har vuxit upp med föräldrar som har en utvecklingstörning finns det liten kunskap om. I en dansk studie har forskarna funnit att kvinnorna lever ett mer utsatt liv än männen. I en studie från England finns det resultat som visar att de "vuxna barnen" som själva har en utvecklingsstörning har ett mer fungerande liv jämfört med de "vuxna barn" som är normalbegåvade.

Familjernas möten med det offentliga har studerats ur ett antal olika perspektiv, såväl barnens, föräldrarnas, närståendes som professionellas. I mötet mellan familj och professionella rapporteras att det är av stor betydelse att professionella är väl förtrogna med familjens behov, att de samordnar sina insatser, att det inte är för många inblandade och att man samverkar med familjen och tar hänsyn till familjemedlemmarnas behov.

När det gäller hälsobefrämjande faktorer i familjer där föräldrarna har en utvecklingsstörning finns det resultat som visar på betydelsen av såväl informella som formella nätverk. Forskare har funnit att det är olika karaktär på stödet från det formella respektive det informella nätverket. Det informella nätverket bidrar med praktisk hjälp i vardagslivet. Det formella nätverket bidrar med sakkunskap om viktiga funktioner i samhället, kunskap om interaktion mellan föräldrar och barn samt stöd för att föräldrarna skall utveckla sin kompetens.

Flertalet studier påpekar vikten av att kartlägga föräldrarnas och familjernas levnadsomständigheter för att kunna genomföra relevanta insatser. En rad olika mer eller mindre framgångsrika insatser som prövats i familjerna har rapporterats. Som framgångsfaktorer omnämns att stödet ska utformas efter barnens och föräldrarnas behov, att det är kontinuerligt och att det genomförs under en längre tid. För att insatser skall ge god effekt bör de vara anpassade till familjens omgivning, de bör vara prestationsbaserade och omfatta förebilder, praktisk feedback, beröm och belöningar. Forskare menar även att insatserna skall utformas så att det blir möjligt för föräldrar att utvecklas utifrån sina förutsättningar.

Syfte med föreliggande studie var att identifiera centrala kategorier och dimensioner som beskriver: "Föräldrars, till schizofrena barn, erfarenhet av kontakten med psykiatrisk vård". Beskrivningen bygger på föräldrars erfarenhet - behov, upplevelser och önskemål, av kontakten i samband med barns sjukdom. Barn är i studien är inte ett åldersrelaterat begrepp utan beskriver förhållandet till föräldern. Den metod studien bygger på är inspirerad av "Grounded theory" och har genomförts med ostrukturerade intervjuer. Fyra intervjuer med föräldrar till barn med en psykossjukdom har analyserats. Två män och fyra kvinnor ingår i studien, de representerar erfarenhet av kontakt av psykiatrisk vård från tre sjukvårsområden inom Stockholms läns landsting och kontakten omfattar 5-16 år. Resultatet visar såväl positiv som negativ erfarenhet av kontakten. De behov i kontakten som framträder är - behov av samarbete med psykiatrisk vård, - behov av att bli omhändertagna och - behov av kontakt med människor i samma situation. De upplevelser i kontakten som framkommer är - upplevelser av samarbete, - upplevelser av bristande samarbete - upplevelser av att bli omhändertagna. - upplevelser av dåligt bemötande, upplevelser av att bli skuldbelagda och - upplevelser av bristande kontinuitet i vården. De önskemål på kontakten som framkommer är - önskemål om samarbete, - önskemål om metoder för gott omhändertagande, - önskemål om behandlingsinriktning, - önskemål om att ej bli skuldbelagda, - önskemål om anhörigutbildning och önskemål om samarbete med IFS -Intresseföreningen för schizofreni eller andra psykotiska sjukdomar.

InledningUnder många år har Föräldrautbildningen/anhörigutbildningen vid Forum Funktionshinder engagerat socionomBerit Rauschsom föreläsare för föräldrar på temat "Det finns en framtid –men vad gör man av allt det som känns tungt?". Berit har också lett kurser i konsultativt förhållningssätt som riktat sig till paramedicinsk personal inom Habilitering & Hälsa och handlett personal. Berit är själv förälder till en idag vuxen dotter med funktionsnedsättning. Utifrån sina erfarenheter såg Berit ett behov av att fördjupa kunskapen om föräldrars situation genom föräldraintervjuer för att sedan kunna använda den kunskapen som underlag för diskussion och kompetensutveckling för personalen inom Habilitering & Hälsa.Frågan om en studie diskuteradesinom ledningsgruppen för Utvecklingsforum och i FoU-rådet vid flera tillfällen. Några synpunkter som framkom var att Fokus bör ligga på riskfaktorer och kritiska punkter. Hur identifierar man dem? Hur fångar man upp? I diskussion med verksamhetschef och Utvecklingsforum kom vi överens med Berit Rausch om att genomföra projektet Föräldraröster. BakgrundBerit Rausch, initiativtagare till projektet Föräldraröster, har mångårig erfarenhet av såväl föräldragrupper som handledning av personal inom bland annat Habilitering &Hälsa. Föräldrar som får ett barn med funktionsnedsättning genomgår eninre process som till stora delar påminner om en sorgeprocessnär man utsätts för en förlust av något slag.Även i handledningssituationer blir denna process aktuell när situationer som personal har att handskas medska diskuteras. Sjukgymnaster, logopeder, arbetsterapeuter etc saknar utbildning i psykosocialt arbete.Isamtal med nyckelpersoner inom Habilitering &Hälsa har framkommit att organisationenhar intresse av att titta närmare på vad det är som gör att vissa föräldrar kommer vidare i sin process efter att ha fått ett barn med funktions-nedsättning, medan andra "fastnar" i någon av krisens faser, förnekelse, ilska eller sorg. Frågeställningen ska ses i relation till habiliteringens utbud och arbetssätt samt förhållningssätt och bemötande av personer i kris.Vi såg det också som oerhört viktigt att förmedla den unika kunskap och kompetens som föräldrar har, till all personal inom Habilitering & Hälsa.
SyfteAtt utforska vilka kritiska punkter som föräldrar beskriver för hur de tagit sig vidare/"fastnat"ochhur föräldrar utifrån sin unika situation ser på Habilitering & Hälsas utbud, insatser, förhållningssätt och bemötande.ProjektmålAtt fördjupa kunskapen om riskfaktorer,kritiska punkter och föräldrars behov av stöd i olika faser. Att presentera resultatet av intervjuernai en sammanfattande rapport. Att inspirera till kompetensutveckling hos personal när det gäller bemötande och till anpassning av habiliteringens insatser.MetodBerit Rausch har gjort en kvalitativstudie bestående av djupintervjuer med 10 föräldrapar utifrån ett semi-strukturerat frågeformulär.Anhörigutbildningen vid Forum Funktionshinder mejlade 338 föräldrar som hade anmält sig till anhörigutbildningar under hösten 2010 och ställde frågan om de var intresserade av att bli intervjuade av Berit Rausch. 36 föräldrar/föräldrapar svarade att det var intresserade. Tillsammans med Berit valdes 11 föräldrar/föräldrapar ut för intervju. Urvalet gjordes utifrån ålder och diagnos för att i möjligaste mån få en så stor spridning som möjligt.10 familjer intervjuades.ProjektorganisationProjektgruppens medlemmar har bestått av Eva Norberg, informationschef (projektägare tom januari 2012) Barbro Lagander, verksamhetschef VO Stockholm (projektägare from februari 2012), Marie Bökman, konsulent vid Forum (projektledare), Kristina Eklund, konsulent vid Forum och Barbro Sjöström Miljand, enhetschef Kris-och samtalsmottagningen, Länscenter. ProjektresultatProjektet har bidragit medett skriftligt material som beskriver riskfaktorer och olika sätt att handskas med sin livssituation, vilket kan bidra till ökad förståelsen för föräldrars olika sätt att skapa en fungerande vardag. Föräldraröster kan användas i personalutbildningen och utveckling av metoder för föräldrastöd.

Det finns idag mycket kunskap om barn med neuropsykiatriska funktionsnedsättningar (NPF) som uppmärksamhetsstörning med hyperaktivitet (Attention-Deficit/Hyperactivity Disorder ADHD) och autismspektrumtillstånd (AST). Det finns också en del kännedom om vilka konsekvenser barnens svårigheter får för individ och samhälle. Det är konstaterat att ADHD och AST kvarstår i vuxen ålder, även om symtombilden och problematiken kan te sig annorlunda. Kunskapen om föräldraskap hos vuxna med ADHD eller AST är dock begränsad. Syftet med denna studie var att på ett systematiskt sätt sammanställa kunskap om barn och föräldrar när föräldrar har konstaterad ADHD, ADHD-symtom eller AST samt evidens för metoder som syftar till att ge stöd i föräldraskapet. Tre frågeställningar har styrt arbetet:
1. Vad vet man om hur barnet och föräldraskapet påverkas när förälder/rar har
konstaterad ADHD?
2. Vad vet man om hur barnet och föräldraskapet påverkas när förälder/rar har
konstaterad AST/Aspergers syndrom?
3. Vilka evidensbaserade metoder prövade på dessa målgrupper finns som kan
påverka föräldraskapet och barnet/en?

När man möter en mamma eller pappa berättar de kanske om sitt barn. Men är barnen deras? I många andra sammanhang talas det om våra barn: skolan, sjukvården, föreningar gör också anspråk på att äga barnen. Världen kring handikappade barn sätter förhållandet på sin spets: där finns en myriad av yrken och institutioner, som hävdar att de både vet mer och vet bäst.
Experternas kunskaper är eftersökta samtidigt skall de uppvisa en måttfull och balanserad expertis; föräldrarnas kompetens skall erkännas enligt de föräldrar som intervjuas i boken. Föräldrarna till döva, hjärnskadade, diabetessjuka barn och barn med andra handikapp ger sin bild av mötet med sjukvården, daghemmet och skolan: en bild som är drastisk och dramatisk och skildrar dilemman, strider samt konkurrensen mellan med såväl professionella som andra föräldrar. Författaren hävdar emellertid att denna bild kan översättas till de flesta moderna föräldraskap: här ges den i en kondenserad och tillspetsad form.

Genom svaren på de frågor som ställs om familjen är utredare och behandlare i missbruks- och beroendevården ibland de enda som känner till att barnen lever i en familj med missbruk. De behöver uppmärksamma barns och ungas situation, så att deras rättigheter, behov av information, råd och stöd tillgodoses.

Syftet med skriften är att underlätta för personal inom missbruks- och beroendevården att ta upp föräldraskap och samtala med föräldern om barns situation i utredning eller behandling. Den förespråkar ingen särskild modell eller metod i arbetet, utan tar upp förhållningssätt och innehåll i samtal om föräldraskap. Den tar även upp samarbetet med socialtjänstens barn- och ungdomsvård. Skriften riktar sig till utredare och behandlare inom socialtjänsten, hälso- och sjukvården samt övrig missbruks- och beroendevård, och kan också vara av intresse för socialtjänstens barn- och ungdomsvård. Den utgår ifrån situationen vid alkoholmissbruk eller -beroende, men kan i väsentliga delar också vara relevant vid föräldrars missbruk av narkotika eller läkemedel.

Familjecentralens verksamhetsidé för öppna förskolan på familjecentraler – formulerat som en hypotes - har utvärderats steg för steg genom samla in data på sammanlagd sex familjecentraler för att pröva hållbarheten i hypotesen. Utvärderingen visar på ett föräldraskapande bland småbarnsföräldrar genom att de lär sig om barn och föräldraskap, får möjlighet att utöka sitt sociala kontaktnät och att bara vara i en trygg omgivning där socialt stöd finns till hands. De får tillsammans med andra känna sig 'good enough' som en vanlig förälder med ett normalt barn. Professionell följsamhet utmärker personalens arbetssätt. De bedömer den "mognadsgrad" som föräldern befinner sig i för att söka stöd och anpassar sitt förhållningssätt till föräldern genom fysiskt avstånd och djup i samtalet. På så vis kan pedagogiska, sociala och psykologiska mekanismer triggas igång och förklara de resultat som föräldrar upplever för dem själva och deras barn. Artikeln avslutas med en omformulerad hypotes om öppna förskolors verksamhet på familjecentraler

Internet kan ge bra stöd i föräldrarollen visar ny studie från Statens folkhälsoinstitut. Delrapport från uppdraget om föräldrastöd. Under utredningstiden har flera delrapporter tagits fram. Delrapporterna är "Föräldrastöd i Sverige år 2002", "Verklig gemenskap i en virtuell värld?", "Stöd till föräldrar för att främja barns och ungdomars psykiska hälsa" och slutrapporten "Nya verktyg för föräldrar".

Förändrad tillämpning av offentlig äldreomsorg – ett hot mot målsättningen om demokrati och jämställdhet Artikeln handlar om några effekter av den förändrade inriktningen på det offentliga ansvaret för äldreomsorgen och det är anhöriga till hjälpbehövande äldre som står i fokus.

I Gabriellas liv finns mycket mörker. Det finns händelser som kastar skuggor ... där mardrömmar kan gömma sig och minne kan lura.Men i det mörka finns också små stänk av ljus. Gabriella behöver hjälp att låta ljuset växa. Hjälp att resa tillbaka in i skuggan, städa ur och låta solkatterna dansa.
I den här boken har Elisabeth Hagborg samlat många års yrkeserfarenhet av vad det kan innebära att växa upp i ett dysfunktionellt hem och tillsammans med illustratören Tove Hennix skapat en bok om Gabriella.

Natur och Kultur. 2001.Inbunden med skyddsomslag, 410 sidor, 23,5x15,5cm. 700 gram. Nära nyskick, anteckningar på pärmens insida.Jay och Robert Neugeboren växte upp i en judisk familj i New York under komplicerade och kaotiska emotionella förhållanden. Jay blev framgångsrik skönlitterär författare - Robert drabbades av svår psykisk sjukdom och skulle komma att åka in och ut på mentalsjukhus i fyra decennier. Han skulle underkastas alla tänkbara slags behandlingar - många med svåra biverkningar - men utan att få någon verklig hjälp. Galenskap och återhämtning är Jays bok om den fyra år yngre brodern och den psykiatriska vårdapparatens fullständiga misslyckanden att ge denne en anständig vård. Men det är framför allt en bok om hopp. Neugeborens budskap är att även svåra psykiska sjukdomar som schizofreni i hög grad är behandlingsbara. De kanske inte går att bota helt med det finns hjälp för dessa människor och hopp om återhämtning. Detta kan ske med hjälp av bra medicinsk behandling, adekvat psykoterapi men framför allt genom ett personlig engagemang hos personerna i den sjukes omgivning. Neugeboren berättar också om många spännande och dramatiska möten med andra människor som lärt sig att leva fullvärdiga liv trots svår psykisk sjukdom

Socialstyrelsen har på regeringens uppdrag tillsammans med Skolverket och Specialpedagogiska institutet analyserat förutsättningarna för att samordna de individuella planer som ett barn, en ungdom och en vuxen person med funktionshinder kan ha. Med funktionshinder menas det komplexa sambandet mellan förekomst av en sjukdom, skada eller liknande och begränsad aktivitet och delaktighet. Särskild uppmärksamhet har ägnats åt vad som behöver förändras i regelverken.

Den huvudsakliga frågeställningen har varit vad som hindrar och stödjer gemensam individuell planering i regelverk, hos organisationer och hos aktörer (det senare avser personalen som är anställd i de berörda verksamheterna). Ytterligare en frågeställning har varit om gemensam planering kan innebära några negativa konsekvenser för den enskilde.

Förutsättningarna för samordnad och gemensam planering har analyserats på tre nivåer: individnivå, organisationsnivå och nationell nivå. Kunskapen om de två förstnämnda nivåerna bygger på skriftlig och muntlig information från brukarföreträdare, personal, verksamhetsansvariga och myndighetsföreträdare i Sverige och i Norge. På den tredje nivån, som berör rapportens huvudresultat, har kunskap inhämtats genom granskning av de bestämmelser om individuella planer som finns i lagar, förordningar eller i för sammanhanget relevanta förarbeten och myndighetsföreskrifter. Ett antal analysfaktorer har använts som stöd för granskningen. De lagstiftningsområden som valts ut för granskning är socialtjänst, hälso- och sjukvård och skollagsreglerade verksamheter samt integration, socialförsäkring och arbetsmarknad. Förutsättningarna för gemensam planering har analyserats utifrån sambandet mellan de tre nivåerna. Rapportens bilaga visar en översikt av bristande överensstämmelser mellan de berörda regelverken.

Parenting a child with autism may differentially affect mothers and fathers. Existing studies of mother–father differences often ignore the interdependence of data within families. We investigated gender differences within-families using multilevel linear modeling. Mothers and fathers of children with autism (161 couples) reported on their own well-being, and their child's functioning. Mothers reported higher levels of distress compared with fathers, and child behavior problems predicted psychological distress for both mothers and fathers. We found little evidence of child functioning variables affecting mothers and fathers differently. Gender differences in the impact of child autism on parents appear to be robust. More family systems research is required to fully understand these gender differences and the implications for family support. (PsycINFO Database Record (c) 2013 APA, all rights reserved)(journal abstract)

BACKGROUND AND AIMS: The aim of the one-year follow-up was to evaluate formal care and the situation of informal caregivers from a gender perspective. METHODS: The present study targeted elderly persons (n = 147) living in their own homes 12 months after acute stroke, 94 women and 53 men. The median age of the women was 81 years and the men 80 years. RESULTS: A statistically significant gender difference was seen in living conditions. Eighty percent of the women were living alone compared with 28% of the men (CI 48-56%). The informal care given far exceeded that provided by the community: 65% of these elderly people had some kind of informal care and 44% received formal care from the community. There was a gender difference in daily informal personal care, 24% of men and 16% of women (CI 2-18%), and in daily informal household assistance (CI 15-43%). Formal care was provided by the community significantly more frequently to women (56%) than men (23%) (CI 21-45%). The women more frequently had community-based help with house-cleaning (CI 23-39%) and they also more frequently received help with personal care (CI 1-10%). CONCLUSIONS: This study showed statistically significant gender differences in the use of informal and formal care. Elderly caregivers' situations must be given greater attention, since informal care to stroke survivors represents a far greater burden than the care that is provided by the community. Most of the caregivers were elderly women, and preventive intervention measures should be developed in order to enable them to manage their everyday lives.

En särskild utredare tillkallas med uppgift att beskriva och analysera de problem som finns i dag vid samverkan mellan landstingens hälso- och sjukvård och kommunernas vård och omsorg på områden där det finns behov och intresse av att samverka. Utredaren skall vidare lämna förslag till lösningar som förbättrar möjligheterna till samverkan mellan kommuner och landsting på dessa områden.

This book provides a synthesis of research findings in normal language development as well as a practical approach to the evaluation and treatment of children with language disorders. Its 21 chapters are divided into six topical sections: language description, normal language development, deviant language development, goals of language learning based on normal development, correlates of language disorders, and facilitating language learning. Each chapter concludes with a summary and a list of suggested readings. The book includes appendixes that set forth conventions for transcription of child language recordings and video recorded data, present definitions of language content categories, and list instruments for assessing language and language-related behaviors. An extensive bibliography of related resources and author and subject indexes are also provided. (GW)

In monkeys, the rostral part of ventral premotor cortex (area F5) contains neurons that discharge, both when the monkey grasps or manipulates objects and when it observes the experimenter making similar actions. These neurons (mirror neurons) appear to represent a system that matches observed events to similar, internally generated actions, and in this way forms a link between the observer and the actor. Transcranial magnetic stimulation and positron emission tomography (PET) experiments suggest that a mirror system for gesture recognition also exists in humans and includes Broca's area. We propose here that such an observation/execution matching system provides a necessary bridge from'doing' to'communicating',as the link between actor and observer becomes a link between the sender and the receiver of each message.

text och illustrationer: Elisabet Alphonce

barn/ungdom

En berättelse om hur en förälder kan vara när hon drabbats av depression.

Is early preventive intervention effective in enhancing parental sensitivity and infant attachment security, and if so, what type of intervention is most successful? Seventy studies were traced, producing 88 intervention effects on sensitivity (n = 7,636) and/or attachment (n = 1,503). Randomized interventions appeared rather effective in changing insensitive parenting (d = 0.33) and infant attachment insecurity (d = 0.20). The most effective interventions used a moderate number of sessions and a clear-cut behavioral focus in families with, as well as without, multiple problems. Interventions that were more effective in enhancing parental sensitivity were also more effective in enhancing attachment security, which supports the notion of a causal role of sensitivity in shaping attachment.

För personer med flerfunktionsnedsättning är livet ofta skört och anhöriga tvingas förhålla sig till tankar om döden på ett mer påtagligt sätt än de flesta andra. I denna skrift har vi på Nationellt kompetenscentrum anhöriga (Nka) samlat berättelser från familjer, yrkesverksamma och specialister med olika erfarenheter avseende detta ämne och sammanställt det i fem kapitel. Nka är ett nationellt kunskapscentrum för anhörigfrågor och anhörigstöd, vars huvudsakliga uppgift är att vara ett expertstöd till kommuner, regioner och enskilda utförare. I uppdraget ingår också att ge kunskapsstöd direkt till föräldrar och andra anhöriga till personer med flerfunktionsnedsättning. Verksamheten startade i januari 2008 och bedrivs på uppdrag av Socialdepartementet via Socialstyrelsen.
Vi hoppas att berättelserna ska bidra till att samtal om livet och döden för personer med flerfunktionsnedsättning ska få en mer naturlig plats inom familjen och dess omgivning, samt i mötet med vården, omsorgen och det övriga samhället.

Statistiken beskriver levnadsförhållanden för olika grupper i befolkningen 16 år och äldre i olika avseenden: boende, ekonomi, hälsa, fritid, medborgerliga aktiviteter, sociala relationer, sysselsättning och arbetsmiljö, trygghet och säkerhet.

Akademisk avhandling

Denna studie syftar till att via utformandet av en teoretisk modell nå ökad förståelse för hur människan erfar lidandet. Studien, som har en hermeneutisk ansats, fokuserar lidandet som drama och kamp, vilka beskrivs som lidandets form och substans.
Data insamlades genom samtal med informanter från två kontext. Den ena informantgruppen som utgjordes av nio personer med drogrelaterade problem valdes med utgångspunkt i ett antagande om att missbruket härrör från ett livslidande. De övriga informanterna (nio stycken) söktes inom ett till det yttre kontrasterande kontext, de hjärtopererade patienternas. De texter dessa samtal genererade tolkades sedan med utgångspunkt i en hermeneutisk ansats, som hämtat metodologisk inspiration av Ricoeur och Helenius. Tolkningen ägde rum i flera steg och det meningsbärande söktes genom naiv tolkning, analys av textens struktur samt genom ett sökande efter alternativa tolkningar. Tolkningsprocessen resulterade en uppsättning teser vilka relaterades till undersökningens teoretiska perspektiv samt till en begreppsanalys av 'kamp'.
Den teoretiska modellen tar fasta på lidandets kamp som en kamp mellan värdighet och skam, lust och olust. Denna kamp kan gestaltas i lidandets drama där människan på olika sätt söker lindring i lidandet. Detta kan ske genom att man försöker besegra lidandet, avtäcka det eller försonas med det. Ytterligare ett sätt att söka lindring är att ge upp lidandets kamp och resignera. I den teoretiska modellen gestaltas även hur människan kan förhålla sig till kampen på olika sätt beroende på vilket perspektiv hon har inför framtiden. Då människan uppfattar att framtiden präglas av ett hot om avskurenhet och död förhåller hon sig till livet på ett sådant sätt att lidandet dominerar. Om uppfattningen om framtiden präglas av liv och gemenskap kan hon förhålla sig till kampen som hälsa.
När lidandet blir outhärdligt förlorar människan sin förankring i tiden. I och med att människan isoleras i nuet kan lidandet bemästras och begränsas till en konkret situation. För att en rörelse i hälsoprocesserna skall äga rum måste människan emellertid relatera till tiden. Relationen till en annan människa och skapandet av en lidandeberättelse innebär en möjlighet till förankring i tiden och därmed också till helande.

Stroke medför en plötslig och påtaglig förändring av livet för den drabbade och för anhöriga. Efter sjukhusvistelsen för-sätts de i en ny livssituation och ställs in-för många nya problem. Eftersom antalet personer som lever efter genomgången stroke ökar, på grund av förbättrad över-levnad, medför det ökade insatser inom vårdens olika grenar, främst kommunala insatser men också ökade krav och för-väntningar på att anhöriga ställer upp som vårdare.Syftet var att öka kunskapen om stroke-patienters och deras anhörigas situation efter utskrivning från sjukhus. Studie-populationen bestod av 390 konsekutiva strokepatienter, 65 år eller äldre, samt anhöriga som gett hjälp och stöd åt pa-tienten.Den prognostiska förmågan hos sjukhus-personal, avseende patientens framtida hälsotillstånd, hjälpbehov samt boende-form, var signifikant bättre än slumpen. Personalen tenderade att vara alltför optimistisk i sina bedömningar. De fakto-rer som påverkade prognosens korrekthet var aktivitetsgrad och ensamboende före insjuknandet samt påverkad kognitiv för-måga och hjälpbehov vid utskrivningen. God uppfattning om prognosen är viktig såväl för patienter och anhöriga som för vårdpersonalen, bland annat i samband med utskrivningsplanering från sjukhuset.Risken för återinsjuknande och död mins-kade kraftigt från cirka 14% tidigt i efter-förloppet till en stabil nivå på 2-5% efter ett halvår. Cirka 2-3% av patienterna fick sjukhusvård vid ett givet tillfälle under det första året. Motsvarande vårdutnyttjande inom primärvården var 10% och i den kommunala äldreomsorgen 65%. Den kommunala vården svarade således för den största vårdinsatsen efter utskriv-ningen.De vanligaste intervjubaserade hälso-problemen under det första året gällde perception, rörlighet och sömn, medan de vanligaste journalbaserade problemen var smärta, inkontinens samt problem med andning och cirkulation. Kognitions-, rörlighets- och trötthetsproblem tende-rade att samvariera, vilket kan utnyttjas för att identifiera svårfångade problem. Nästan samtliga patienter rapporterade problem någon gång under året men få vid ett givet tillfälle. De faktorer som bestämde storleken av anhörigas insatser var patientens kogni-tiva förmåga, släktskap, given kommunal äldrevård, samt patientens kön. De an-hörigas upplevda börda ökade med den givna hjälpinsatsen, om kommunal äldre-vård getts, släktskap, låg kognitiv förmå-ga och patientens ålder. Både informell och formell vård ökade. Slutligen fanns det en påtaglig parallellitet avseende ång-est och depression samt livskvalitet, som innebar att ju mer ansträngd patientens situation var, desto värre var situationen för den anhörige

Det finns i Sverige idag över 100 000 personer vilka överlevt insjuknande i stroke (blodpropp eller blödning i hjärnan). Varje år inträffar ca 20 000 ? 25 000 nyinsjuknanden och ca 5 000 - 10 000 återinsjuknanden i stroke. Vanliga symtom både vid det akuta insjuknandet, och senare efter genomgången akutsjukvård och rehabilite-ring, är förlamningar, talrubbningar, sväljningsproblem, kommunikationsproblem, störd rumsuppfattning, svårigheter att uppfatta och tolka sina sinnen och balansrubbningar. Dödligheten ligger på ca 15-20 % de första veckorna efter insjuknandet. Ungefär en tredjedel av patienterna har relativt lindriga eller övergående symtom, men av de överlevande har 35-40 % funktionshinder av stor betydelse för det dagliga livet. Stroke är den vanligaste orsaken till funktionshinder hos vuxna, vilket innebär sämre förmåga att kunna utföra vardagliga aktiviteter, som förflyttning, hygien, att äta, osv.

Substance use disorders among college students are not well understood, and the present study examined the relationship of two environmental factors to alcohol and drug use problems in 616 (316 women) college students. Participants completed measures assessing substance use problems, life events, and substance use among peers. Alcohol use problems were significantly associated with higher drug use problems and regular use of illicit drugs among friends. Drug use problems were significantly associated with male gender, higher alcohol use problems, regular use of alcohol and drugs among friends, illicit drug use among romantic partners, and higher numbers of negative life events. Results extend previous research and suggest that college students who experience multiple negative life events and/or affiliate with substance using friends and romantic partners may be at risk for developing a substance use problem.

Nursing research has been performed during the last 20-30 years, about the next of kin's vulnerability. Despite this, the health care system has had difficulties to integrate the next of kin in a way that gives support. The overall aim of the thesis was to describe and further explore the life situation of the next of kin to persons who are long-term ill, disabled, and/or older, and in need of care. Method: Multiple methods were used. Study I had a descriptive design, 44 next of kin of patients with multiple sclerosis were interviewed, latent content analysis was used for the analysis. Study II had a mixed method approach; the descriptive core study was analyzed with directed content analysis. The supplementary study with descriptive, correlative design was analyzed with descriptive and correlative statistics. Forty-four next of kin of patients with multiple sclerosis were interviewed; thereafter 37 of them answered a questionnaire about Quality of Life. Study III had a descriptive, explorative design. Twelve next of kin of older persons were interviewed with repeated informal conversational interviews, analyzed with latent content analysis. Study IV was cross-sectional with a descriptive, correlative design. Eighty-four next of kin of persons who were long-term ill, disabled, and/or older answered two questionnaires about Burden and Quality of Life that were analyzed with descriptive and correlative statistics. Results and Conclusions: Next of kin described a balance/imbalance in their relations to others and a high burden, but in general a good Quality of Life. Some next of kin also experienced chronic sorrow. Significant correlations were found between interpersonal relations and Quality of Life as a whole. Love and obligations were two anchor points on a continuum, describing the next of kin's relationship to the ill/disabled person. The relationship with the health care personnel was described through cooperation and obligations. Good communication was seen as the key to balance the relationship with others. One possibility to achieve symmetrical communications is to adapt the Partnership Model, as a tool for creating good relationships. Honest and specific communication between the health care personnel, the next of kin, and the care receiver are necessary.

Aim and Objectives: To increase the understanding of next of kin's life situation in the context of supporting persons who are long term ill, disabled and/or older by describing their experienced burden and quality of life and also the relationship between QoL, burden and socioeconomic variables.

Methods: Cross-sectional, descriptive and correlative design. Eighty-four next of kin answered two questionnaires: the Caregiver Burden Scale and the Subjective Quality of Life.

Results: Next of kin experienced a high burden in their life situation although they, at the same time, experienced a good quality of life. In the results gender differences were found. Females next of kin to a higher extent were disappointed, more emotionally involved, and they also estimated their economic situation as more unsatisfactory than the males next of kin.

Conclusion: Healthcare personnel meet next of kin, persons in need of care, within all healthcare and social care in society.Therefore it is important to have a general knowledge and ability to understand the next of kin's life situation, thus making it possible to focus the nursing interventions on individual support regardless of the care receiver's diagnosis.

BACKGROUND:
The purpose of this study was to analyse whether the parallel life situation between stroke patients and their informal caregivers (dyads) shown in cross-sectional studies prevails also in a longitudinal perspective.
METHODS:
A total of 377 Swedish stroke patients, aged ≥ 65 years, and their 268 informal caregivers were followed from hospital admission and one year on. Analyses were based on patient interviews, functional ability (MMSE) score, Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD) score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity score. Similar information was obtained by postal questionnaires from informal caregivers, also including information on the nature and amount of assistance provided and on Caregiver Burden (CB) score.
RESULTS:
Before index admission informal caregivers provided care on average 5 h per week and after discharge 11 h per week (P < 0.0001). Support volume was associated with patient sex (more for men), low patient's functional ability, low received municipal social service support, closeness of patient-caregiver relation, and short distance to patient's home. Significant positive associations within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score (P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patient's age, sex, functional ability, and patient-caregiver relationship. CB score increased with amount of informal caregiver support, patient's age, and with low functional ability and low amount of municipal social service support. All these associations were constant across time.
CONCLUSIONS:
There was an association within the dyads regarding anxiety score, NHP score, and activity score. CB score was generally high.

BACKGROUND: The purpose of this study was to analyse whether the parallel life
situation between stroke patients and their informal caregivers (dyads) shown in
cross-sectional studies prevails also in a longitudinal perspective.
METHODS: A total of 377 Swedish stroke patients, aged ≥ 65 years, and their 268
informal caregivers were followed from hospital admission and one year on.
Analyses were based on patient interviews, functional ability (MMSE) score,
Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD)
score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity
score. Similar information was obtained by postal questionnaires from informal
caregivers, also including information on the nature and amount of assistance
provided and on Caregiver Burden (CB) score.
RESULTS: Before index admission informal caregivers provided care on average 5 h
per week and after discharge 11 h per week (P < 0.0001). Support volume was
associated with patient sex (more for men), low patient's functional ability, low
received municipal social service support, closeness of patient-caregiver
relation, and short distance to patient's home. Significant positive associations
within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score
(P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patient's
age, sex, functional ability, and patient-caregiver relationship. CB score
increased with amount of informal caregiver support, patient's age, and with low
functional ability and low amount of municipal social service support. All these
associations were constant across time.
CONCLUSIONS: There was an association within the dyads regarding anxiety score,
NHP score, and activity score. CB score was generally high.

The purpose of this paper is to reflect on carers' experiences of being involved in the development of a web-based support programme for carers of people with heart failure (CPwHF), and discuss the challenges related to their involvement in the development process. The focus was on the different phases in the project as well as the methodological challenges and opportunities that occurred in the user group sessions conducted.

Design/methodology/approach
This research adopt an explorative design studying a co-design process to develop an information and communication technology based support programme for and with CPwHF. Habermas' concepts of lifeworld and system are used as a theoretical framework to analyse the co-design process employed in the study.

Findings
Reflecting on the co-design approach adopted, the findings highlight the methodological challenges that arise with carer involvement and the possible tensions that occur between researchers' ambitions to include users in the design process, and the goal of developing a product or service, in the different phases of the design process.

Originality/value
Findings highlight that there is a tension between the system and lifeworld in the co-design process which are not totally compatible. The paper highlights that there is a need to develop flexible and reflexive human-centred design methodologies, able to meet carers' needs and ideas, and at the same time balance this with proposed research outcomes.

In this chapter, we describe the development and evaluation of the Family Bereavement Program (FBP), a theoretically derived intervention program for children who have experienced parental death. We first present a discussion of risk and protective factors for parentally bereaved children and discuss these within a general theoretical framework of resilience following adversity. We then discuss the modifiable risk and protective factors that were targeted for change in the FBP and the theoretical model underlying the program. Finally, we present evidence from the evaluation of the FBP, including assessment of mediators and moderators of program effects at posttest and short-term follow-up and findings from preliminary analyses at the 6-year follow-up. This research on a theoretically based intervention for bereaved children follows a similar program of research we have conducted with children from divorced families, and we discuss ways in which the findings with bereaved children replicate, and in some cases diverge from, findings regarding children in divorced families.

Purpose: This theoretical article outlines the deliberate process of applying a qualitative data analysis method rooted in Friedemann's Framework of Systemic Organization through the study of a web-based education and support intervention for stroke caregiving families. Methods: Directed by Friedemann's framework, the analytic method involved developing, refining, and using a coding rubric to explore interactive patterns between caregivers and care recipients from this 3-month feasibility study using this education and support intervention. Specifically, data were gathered from the intervention's web-based discussion component between caregivers and the nurse specialist, as well as from telephone caregiver interviews. Findings and Conclusions: A theoretical framework guided the process of developing and refining this coding rubric for the purpose of organizing data; but, more importantly, guided the investigators' thought processes, allowing them to extract rich information from the data set, as well as synthesize this information to generate a broad understanding of the caring situation.

This article analyses informal caregiving and volunteering in organizations over 17 years in Sweden, with a focus on links between these two forms of unpaid activities. The discussion is based on results from a national survey that was repeated four times in the period 1992–2009. Links were found between the different types of activities. In all four studies a substantial group of the population was involved both in informal caregiving and volunteering. This group of 'active citizens' are commonly also engaged in informal social networks. This 'double active' group had increased over time and they provide a substantial amount of hours of involvement. Patterns outlined in this article demonstrate that unpaid activities represent a multifaceted phenomenon, and that the boundaries between informal caregiving and volunteering as forms of engagement may be more fluid than has previously been acknowledged. The results challenge the literature in which informal caregiving is viewed as a major obstacle to volunteering. At the same time, however, informal caregiving in general was found to be increasing. There might be reasons to be cautious about the possible risk that too much pressure on citizens for informal caregiving might jeopardize the type of double involvement that is outlined in this article.

Denna artikel analyserar informellt omsorgsgivande och ideella insatser i frivilligorganisationer i Sverige i ett 17-årigt perspektiv. Diskussionen är baserad på resultaten från en nationell befolkningsstudie som genomförts fyra gånger 1992–2009. Resultaten visade att det fanns beröringspunkter mellan olika former av obetalda insatser. I alla fyra studier var det vanligt att vara engagerad både i informellt hjälparbete och ideella insatser. Denna grupp av 'aktiva medborgare' var vanligtvis också engagerad i informella sociala nätverk. Denna 'dubbel-aktiva' grupp har ökat över tid och de utför många timmar av engagemang per månad. Resultaten utmanar den litteratur som menar att informellt hjälparbete är ett omfattande hinder för att engagera sig i ideella insatser. En möjlig tolkning av de ganska flytande gränserna mellan informell omsorg och ideellt arbete är att välfärdens organisering i Sverige hittills har gett möjlighet för informella omsorgsgivare att ha utrymme och tid för engagemang i ideella organisationer och annat samhällsengagemang, liksom för de ideellt aktiva att utföra informellt omsorgsarbete. Det kan finnas skäl att uppmärksamma risken för att ett ökat tryck på medborgarna att utföra oavlönat arbete, framför allt av omsorgskaraktär, kan försvåra möjligheterna för denna typ av dubbla engagemang.

Traumatic brain injury can interrupt without warning the life story that any one of us is in the midst of creating. When the author's fifteen-year-old son survives a terrible car crash in spite of massive trauma to his brain, she and her family know only that his story has not ended. Their efforts, Erik's own efforts, and those of everyone who helps bring him from deep coma to new life make up a moving and inspiring story for us all, one that invites us to reconsider the very nature of "self" and selfhood.

Ruthann Knechel Johansen, who teaches literature and narrative theory, is a particularly eloquent witness to the silent space in which her son, confronted with life-shattering injury and surrounded by conflicting narratives about his viability, is somehow reborn. She describes the time of crisis and medical intervention as an hour-by-hour struggle to communicate with the medical world on the one hand and the everyday world of family and friends on the other. None of them knows how much, or even whether, they can communicate with the wounded child who is lost from himself and everything he knew. Through this experience of utter disintegration, Johansen comes to realize that self-identity is molded and sustained by stories.

As Erik regains movement and consciousness, his parents, younger sister, doctors, therapists, educators, and friends all contribute to a web of language and narrative that gradually enables his body, mind, and feelings to make sense of their reacquired functions. Like those who know and love him, the young man feels intense grief and anger for the loss of the self he was before the accident, yet he is the first to see continuity where they see only change. The story is breathtaking, because we become involved in the pain and suspense and faith that accompany every birth. Medical and rehabilitation professionals, social workers, psychotherapists, students of narrative, and anyone who has faced life's trauma will find hope in this meditation on selfhood: out of the shambles of profound brain injury and coma can arise fruitful lives and deepened relationships.

Boken samlar de kåserier och krönikor som RBU Stockholm publicerat i medlemstidningen Utsikt. Föräldrar till barn med funktionsnedsättningar kommer att känna igen sig i bokens kåserier och krönikor. Man påminns om sina egna upplevelser, skrattar med åt absurda situationer och känner ilskan mot tjänstemän och en oförstående omgivning. Svar på tal levereras!

This second edition of an important and essentially practical book is now fully updated and revised to take into account the significant developments that have been made in using symbols to support literacy. It is full of ideas and examples of the ways in which access to literacy can be enhanced through the use of symbols, based on the experience of the authors and many practitioners. Topics covered include how symbols are being used in schools, colleges and day care centers; ways in which symbols can help to enhance learning and independence; lots of new examples of good practice from practitioners; the results of the Rebus Symbol development project; how symbols fit in with the National Literacy Strategy; and how symbols can be used to make information more accessible.

Teachers in mainstream and special schools, teaching assistants, day-care workers and parents should find this book helps them understand how to use symbols to improve literacy and aid communication.

I boken Litet syskon - om att vara liten och ha en syster eller bror med sjukdom eller funktionsnedsättning är det barnen själva som berättar, det är deras röster vi hör. Barnen är mellan två och sex år och har syskon med autism, cancer, cystisk fibros, epilepsi, hjärtfel, muskelsjukdom, rörelsehinder, synskada och utvecklingsstörning.

I boken visar Christina Renlund många sätt som barn kan uttrycka sig på, många konkreta verktyg som är användbara för att hjälpa barn att berätta. Och barn behöver prata - i första hand i sin familj men det behöver även finnas konkreta arbetssätt för hur man pratar med barn om sjukdom/funktionsnedsättning inom förskola och vård.

Christina Renlund är leg. psykolog och psykoterapeut med mångårig erfarenhet av arbete med barn och unga med kronisk sjukdom/funktionsnedsättning och deras familjer. Hon har tidigare skrivit boken Doktorn kunde inte riktigt laga mig - barn om sjukdom och funktionshinder och om hur vi kan hjälpa.

Peter Brusén berättar i boken om sin kamp mot smärtan, sorgen och hur en svår kris kunde vändas till ett nytt oberoende liv. Författaren är chef för Socialstyrelsens handikappenhet och har före olyckan bland annat utvärderat handikappreformen. Olyckan har gett honom ett unikt "dubbelseende" som expert och idag också som en person med ett svårt funktionshinder. Han skildrar möten med vården, rehabiliteringen, handikappomsorgen och försäkringskassan. Boken ger kunskaper om bland annat behovsbedömning, handläggning och hur attityder påverkar dina handlingar.
Professor Johan Cullberg har skrivit bokens förord och Handikappombudsmannen Lars Lööw en avslutning.
Boken vänder sig till alla som arbetar inom vård, rehabilitering, handikappomsorg eller som i egenskap av politiker, handläggare eller chef möter människor med svåra funktionshinder. Men boken vänder sig i lika hög grad till alla som själv har ett funktionshinder eller är anhörig.

Boken ingår som en del i ett Arvsfondsprojekt som genomförs av Bräcke Diakoni tillsammans med patientföreningarna SÖF, Svenska Ödemförbundet, LymfS, Lymf- och lipödemföreningen i Stockholms län samt NKA, Nationellt kompetenscentrum för anhöriga.

Förhoppningen med projektet är att behandling av lipödem ska bli erkänd som en rättighet när diagnosen är ställd för den enskilda kvinnan. Då behövs kunskap överallt i vården och den plattform som också framställs i projektet kommer att finnas kvar som en kunskapskälla både för personal som vill erbjuda behandling samt för anhöriga och kvinnor som själva har lipödem.

En blandning av fakta, filosofi och poesi. Enkelt med få men väl vägda ord och vackra bilder berättas om början och slutet, och allt däremellan, livet. Att det är lika för allt levande, även om man är en blomma, en insekt, en fågel eller en människa, allas liv har en början och ett slut. Allt har en livtid, kort eller lång. Från 5-6 år.

This thesis is based on an empirical study carried out as a case study at a nursing home ward in the region of Stockholm. The aim of this study is to describe and analyse the conditions of ageing and dying for the old persons living in a nursing home, as well as for their relatives. Different methods were used: participant observations, informal conversations with the elderly residents, with the staff and with visiting relatives. Furthermore, twenty-one (in-depth) interviews with eighteen relatives were also conducted.From the results it became clear that the two major features embedded in the overall experience of the nursing home setting were: a sense of waiting and the presence of dying and death. For the residents a major part of daily life was marked by their dependency on others and on their bodily decline. It is argued that the institutional features contribute to reinforcing the images/pictures of bodily decline. As such, the nursing home also had a significant impact on the experiences of the relatives. The compact environment of frailty and death could arouse feelings of anxiety and worries among the relatives about their own ageing and death.Analyses of the data based on the interviews with relatives indicated a number of central patterns: accompanying each other, understanding the old person's health and needs, recreating roles, sharing the care and preparing for dying and death. These also form the theoretical structure of the thesis. A finding of the study was that the relationship between the old person and the relative underwent important changes. Not only the placement in itself but also the poor health of the old person contributed to this change. As a consequence new roles emerged within the relationship, as well as with the staff. Many relatives continued to visit and also contributed to the care even though this care work could vary and mostly was quite limited in both content and extent. One group among the relatives not only visited, but they truly shared the old person's daily life. It was found that relatives, irrespective of the caring role, try to guard and maintain the identity and dignity of the old person.Based on an analysis of the different themes/processes found in the data, four core categories emerged: time, space, body and dignity. They all constitute the existential condition that affects the lives of the old persons and their relatives in an institutional setting. They also embrace the complexity and contradictions that characterise the data. Therefore, in the concluding chapter, the spatial and temporal contradictions of the nursing home are discussed. Another issue concerned the bodily themes found in the data and how these illuminate the diverse meanings and the, sometimes, contradictory images of the body. These themes led to the conclusion that it is not death, but the bodily disintegration and unboundedness that the old persons and their relatives fear most. Finally, it is argued that the "light care work" carried out by the relatives is so much more than sporadic visits. Instead, these visits can be seen as 1) rituals contributing to a sense of continuity and coherence, 2) representations of the relationships and 3) a way in which relatives can maintain and guard the old person's identity and dignity.

This thesis is based on an empirical study carried out as a case study at a nursing home ward in the region of Stockholm. The aim of this study is to describe and analyse the conditions of ageing and dying for the old persons living in a nursing home, as well as for their relatives. Different methods were used: participant observations, informal conversations with the elderly residents, with the staff and with visiting relatives. Furthermore, twenty-one (in-depth) interviews with eighteen relatives were also conducted.From the results it became clear that the two major features embedded in the overall experience of the nursing home setting were: a sense of waiting and the presence of dying and death. For the residents a major part of daily life was marked by their dependency on others and on their bodily decline. It is argued that the institutional features contribute to reinforcing the images/pictures of bodily decline. As such, the nursing home also had a significant impact on the experiences of the relatives. The compact environment of frailty and death could arouse feelings of anxiety and worries among the relatives about their own ageing and death.Analyses of the data based on the interviews with relatives indicated a number of central patterns: accompanying each other, understanding the old person's health and needs, recreating roles, sharing the care and preparing for dying and death. These also form the theoretical structure of the thesis. A finding of the study was that the relationship between the old person and the relative underwent important changes. Not only the placement in itself but also the poor health of the old person contributed to this change. As a consequence new roles emerged within the relationship, as well as with the staff. Many relatives continued to visit and also contributed to the care even though this care work could vary and mostly was quite limited in both content and extent. One group among the relatives not only visited, but they truly shared the old person's daily life. It was found that relatives, irrespective of the caring role, try to guard and maintain the identity and dignity of the old person.Based on an analysis of the different themes/processes found in the data, four core categories emerged: time, space, body and dignity. They all constitute the existential condition that affects the lives of the old persons and their relatives in an institutional setting. They also embrace the complexity and contradictions that characterise the data. Therefore, in the concluding chapter, the spatial and temporal contradictions of the nursing home are discussed. Another issue concerned the bodily themes found in the data and how these illuminate the diverse meanings and the, sometimes, contradictory images of the body. These themes led to the conclusion that it is not death, but the bodily disintegration and unboundedness that the old persons and their relatives fear most. Finally, it is argued that the "light care work" carried out by the relatives is so much more than sporadic visits. Instead, these visits can be seen as 1) rituals contributing to a sense of continuity and coherence, 2) representations of the relationships and 3) a way in which relatives can maintain and guard the old person's identity and dignity.

Living with children with a disability is often perceived as a permanent stressor to the family and it affects all aspects of family life including the well-being of family members. Since little is known about parenting teenage daughters diagnosed with ADHD, the aim of the study was to gain a deeper understanding of the main problem involved using a grounded theory approach. Interviews were carried out with 12 parents, 11 mothers and 1 father, of teenage daughters diagnosed with ADHD. The parents´situation was conceptualized as living at the edge of one´s capability with the properties having the sole parental responsibility, fighting for professional support, being on duty around the clock and trying to solve family conflicts. Parents described how their health was negatively affected by their life situation.

Living with children with a disability is often perceived as a permanent stressor to the family and it affects all aspects of family life including the well-being of family members. Since little is known about parenting teenage daughters diagnosed with ADHD, the aim of the study was to gain a deeper understanding of the main problem involved using a grounded theory approach. Interviews were carried out with 12 parents, 11 mothers and 1 father, of teenage daughters diagnosed with ADHD. The parents´situation was conceptualized as living at the edge of one´s capability with the properties having the sole parental responsibility, fighting for professional support, being on duty around the clock and trying to solve family conflicts. Parents described how their health was negatively affected by their life situation.

Abstract:
Despite the well‐known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long‐term illness, and associations with health‐seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004–2014, an annually repeated, large sample, cross‐sectional, population‐based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non‐adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00–1.22), and non‐adherence (adjusted OR 1.22; 95% CI 1.13–1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51–1.67) and non‐adherence (adjusted OR 1.26, 95% CI 1.17–1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non‐adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health‐seeking behaviour and non‐adherence to prescribed medication.

Palliative care is an integral part of care and takes place in many settings—including the home, special accommodations, and hospitals. However, research shows that palliative care often ends with a death in the hospital due to the heavy burden on the primary caregiver. This study explores the meaning of being the primary caregiver of a close one who is terminally ill and is based on qualitative interviews with six primary caregivers of a terminally ill individual at home. The findings are discussed in the light of the theoretical concepts of liminality, lived body, and power. A potential impending risk exists of being abandoned when one is the primary caregiver to a close one who is terminally ill. This situation calls for professional caregivers to take responsibility and to respond to these, often unspoken, needs. This is particularly important concerning bodily care and the medical treatment regimen. In addition, when friends and relatives are absent, there is an ethical demand on professional caregivers to compensate for this lack and to compensate for this need. Palliative home care demands care that is person-centered—including the individual's history, family and loved ones, and individual strengths and weaknesses.

OBJECTIVE:
To investigate the relationships between characteristics of the living situation in the community and subjective quality of life and social network among community-based individuals with schizophrenia.
METHOD:
A total of 418 individuals with schizophrenia from 10 sites were interviewed with regard to quality of life, psychopathology, social network and needs for care. Characteristics of the living situation investigated were: living alone or not, living with family or not, and having an independent or a sheltered housing situation.
RESULTS:
An independent housing situation was related to a better quality of life concerning living situation and living with the family to a better quality of life concerning family relations. An independent housing situation was associated with a better social network regarding availability and adequacy of emotional relations.
CONCLUSION:
People with schizophrenia with an independent housing situation have a better quality of life associated with more favorable perceptions of independence, influence, and privacy. Their social network is better irrespective of whether they live alone or not, or with family or not

Although a considerable body of research has described the implications of parental mental illness, the perspectives of children and adolescents have rarely been addressed. In this article, I explore adolescents' experiences in everyday life, based on an action-oriented study of a Norwegian online self-help group for adolescents (aged 15 to 18) with mentally ill parents. The analysis was conducted through participant observation of the group for 2 years. The adolescents experienced a variety of difficult challenges related to their parent's mental illness: lack of information and openness; unpredictability and instability; fear; loneliness; and loss and sorrow. However, they also discussed strategies for active management of the challenges arising from the family situation. I argue that these adolescents can be understood as vulnerable as well as active participants in managing their everyday lives. I emphasize the importance of including perspectives of children and adolescents in further research so as to improve health care for families with parental mental illness.

Abstract [en]
Background: The number of partners providing informal care for their chronically ill spouse is rising, and they describe their daily life as demanding. The aim of this paper was to describe the partners' experiences of living with a person with chronic illness and how they manage everyday life.

Methods: A descriptive design with a qualitative approach was used. A purposive sample of 16 Swedish partners with a chronically ill spouse were interviewed. The interviews were recorded, transcribed, and analyzed using qualitative content analysis.

Results: Four main themes were identified: Managing challenges in daily life,' Seeking support and use own capabilities to manage life,' Appreciating the good parts of life' and Adapting to constant changes and an uncertain future'. Their experiences of support from formal care providers varied; they expressed the need for more assistance from the health care sector.

Conclusions: The partners experienced many challenges in everyday life when providing informal care for their chronically ill spouse. This affected both their physical and psychological health, as they had limited time for themselves. The partners seemed to receive more support from their informal network than from formal care providers. In handling daily life, the partners balanced demands and resources to identify possibilities to move forward and find meaning in life. This is congruent with theories by Antonovsky, and Folkman and Lazarus that describes meaningfulness and how to handle challenges in everyday life.

Background: The number of partners providing informal care for their chronically ill spouse is rising, and they describe their daily life as demanding. The aim of this paper was to describe the partners' experiences of living with a person with chronic illness and how they manage everyday life. Methods: A descriptive design with a qualitative approach was used. A purposive sample of 16 Swedish partners with a chronically ill spouse were interviewed. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. Results: Four main themes were identified: Managing challenges in daily life,' Seeking support and use own capabilities to manage life,' Appreciating the good parts of life' and Adapting to constant changes and an uncertain future'. Their experiences of support from formal care providers varied; they expressed the need for more assistance from the health care sector. Conclusions: The partners experienced many challenges in everyday life when providing informal care for their chronically ill spouse. This affected both their physical and psychological health, as they had limited time for themselves. The partners seemed to receive more support from their informal network than from formal care providers. In handling daily life, the partners balanced demands and resources to identify possibilities to move forward and find meaning in life. This is congruent with theories by Antonovsky, and Folkman and Lazarus that describes meaningfulness and how to handle challenges in everyday life.

ALS is a neurodegenerative disease without curative treatment. The knowledge of the relationship between patients and their next of kin with respect to quality of life (QoL) is deficient. The overall aim of this thesis is to describe different perspectives of QoL of patients with ALS and their next of kin, and to describe strengths and hindrances in the manageability of their daily lives. The participants were recruited from Sahlgrenska University Hospital in Gothenburg, Sweden. In the quantitative studies I–III, 35 couples participated. Fourteen patients and thirteen next of kin participated in the qualitative study (IV). Few changes were found over time in studies I and III, but in patients, there was a decreased rating in some of the physical subscales and in general health in the health-related QoL (HRQoL). The ratings in those subscales were worse in patients than in next of kin, even though next of kin also gave a decreased rating in some of the physical and mental subscales. Next of kin estimated individual QoL to be worse than patients did. No changes were found over time in anxiety, depression, or individual QoL. The ratings in discrete pairs were often similar, indicating that if one person felt bad, the other one did also. Even though the pairs gave relatively good ratings of QoL, study II showed that QoL was worse than in a subset of the general population. Study IV found a constant fluctuation between factors that facilitated and hindered the manageability for each individual person, as well as similarities and differences between patients and their next of kin. QoL was worse in our participants compared with the general population and did not change much over time. The similarities and differences between the patients and next of kin show the need to offer them physical, psychosocial, and existential support, both together and individually, to ensure the best possible QoL. The knowledge that the manageability can change from one moment to another makes it necessary to meet the individuals with a wide perspective and to support them in the situation in which they are currently living.

FEX A, FLENSNER G, EK A-C and SÖDERHAMN O. Nursing Inquiry 2011; 18: 336-347 Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.

Although parental substance misuse is now a focus of concern in child welfare practice, we know little about what it is really like for children who grow up in families where adult drug and/or alcohol use is an issue. Set against a backdrop of research links between parental substance misuse and child maltreatment, this article examines a number of studies that focus on the experiences of children and young people in this context. Emerging themes are identified which provide insight into the world of children for whom a substance is, effectively, a family member –'the elephant in the living room'– and the implications for practice, particularly in relation to children's visibility, disclosure and confidentiality, are considered. It is argued that a focus on the 'elephant' often leads to children remaining 'invisible' to those whose role it is to ensure their welfare.

Bipolar disorder has considerable consequences for the daily life and functioning of the person affected and their family. The aim of this study was to describe the experience of living with bipolar disorder from the view of the person affected and their family. A further aim was to analyze the outcomes of educational interventions for persons with the illness and their family members in outpatient mental health care. In Papers I and II, qualitative interviews were conducted with persons diagnosed with bipolar disorder (n=18) and family members (n=17) focusing on their experiences of life with the illness. In Papers III and IV the outcomes of educational interventions for those affected (n=32) and the families (n=34) were followed-up and analyzed. Paper III included a comparative group (n=15) of persons with the illness only receiving standard treatment. Data were collected using a semistructured interview (III) and self-assessment instruments (III-IV) on five occasions, starting before the intervention and ending at the two-year follow-up. Content analysis was applied to the qualitative studies, whereas descriptive and non-parametric statistical methods were used for the quantitative studies. The educational intervention was an existing health care intervention in a unit in outpatient mental health care services consisting of ten group-sessions with different topics related to living with bipolar disorder which the group discussed and reflected on. It is based on the assumption that communication, collaboration and discussion in these groups create interaction that facilitate development of knowledge about and capacity to manage living with the illness. The results of this thesis showed that the whole lives of the family and the member affected were influenced. The process of integrating the illness challenged their pre-understanding, requiring reconsideration of self among the persons affected and confirmation of the correctness of the families' experiences. Uncertainty among persons with the illness concerning their own capacity and the limited life associated with the illness influenced their view of the future. The younger adults avoided planning or hoping for the future, and without hope of improvement it sometimes felt hard to continue. The families were strongly committed to the care for the member with the illness, but felt engaged in a lonely and burdensome struggle that diminished their chances of a normal life of their own. Hope for the future, sufficient social functioning and feeling part of society was prerequisites for a manageable life for these people. The educational interventions gave them opportunity to interact and learn together with mental healthcare professional and other people within a constructive environment. The outcomes of the interventions showed that both persons with bipolar disorder and the family members increased their self-management ability as a result of their developed knowledge and their ability to meet the daily social concerns and stresses related to living with bipolar disorder improved. This thesis contributes increased knowledge concerning what it means to live with bipolar disorder in the long-term and emphasis the importance of educational interventions with a person-centred view for person affected and family members developing their capacity to manage life. The overall support from mental health care has to be further developed and designed to meet all the specific and different needs of those persons and their families. To supplement the promising outcomes of the educational interventions more research is needed concerning increased self-management under different stages of the illness and life.

Akademisk avhandling

The overall aim of this thesis was to elucidate family members' lived experiences and needs during a child's cancer trajectory and to describe how the illness and its treatment influence both individuals within the family and the family as a whole. Seventeen families with a child under the age of 13 and newly diagnosed with cancer were followed during the child's treatment trajectory by means of interviews and observations. Parents, patients and siblings seven years or older were interviewed at the time of diagnosis, during the treatment and after it was completed. Patients younger than seven were observed during their initial hospitalization. The interviews were analyzed with a hermeneutic phenomenological approach and the observations with content analysis. The results from the observations (Paper II) showed that the young children's needs during their initial hospitalization were described as a need to have the parent close by, a need to play and feel joy, a need for participation in care and treatment, a need for a good relationship with the staff and a need for physical and emotional satisfaction. The results from the interviews showed that, at time of diagnosis (Paper I) the families' lived experience was described as a broken life world and an immediate striving to survive. Their secure everyday life disappeared and was replaced by fear, chaos and loneliness. When striving to help the child and the family survive, family members endeavoured to feel hope and have a positive focus, to gain control and to feel close to other people. During treatment (Paper III) the families lived experience was described as focus on the ill child - an everyday struggle. Each day's focus was on the child and the families experienced it as a tough period which they struggled to come through. Only when the sick child's needs were satisfied, could the focus move to other parts of the family. Family members felt drained, locked up and isolated. Family life was experienced as disrupted and they struggled to retain normality and become experts. Perspectives on life changed; it was important to enjoy life and to be aware of sources of support. When treatment was completed (Paper IV) the families' lived experience was described as returning to a changed ordinary life - incorporating a trying and contradictory experience. The families felt relieved that the child's treatment was over but, at the same time they still experienced stresses and strains in life. Family members felt changed and especially the parents needed to focus on themselves in order to recover. The families wanted closeness but, from time to time, felt a loss of concern from others. The findings from this thesis can deepen the understanding of what it is like living with childhood cancer and of the needs of young children with cancer. By reflecting on the findings, paediatric oncology staff may become increasingly thoughtful and thereby better prepared to take care of family members of a child with cancer, including the sick children themselves.

Manual explains the development, standardization, applications, and profiles for the ASEBA adult forms. Also provides reliability and validity data, problem prevalence rates, scale scores, scoring instruments, and answers to common questions. 232 pages.

Purpose
To obtain caregiver report of children's competencies and behavior problems in a standardized format.
Conceptual Organization
The Child Behavior Checklist/4-16 (CBCL/4-16) was the first of what has become a multi-axial
empirically based set of measures for assessing children from parent, teacher, and self-reports. In 1991,
The CBCL/4-16 was re-normed to include children up to 18 years of age (becoming CBCL/4-18), and
eight cross-informant constructs were identified to facilitate direct comparison between problem
behavior scores on the CBCL, the Teacher Report Form (TRF), and the Youth Self-Report Form (YSR)
(Achenbach, 1991). All three instruments include measurement of the following eight constructs or
syndromes: Social Withdrawal, Somatic Complaints, Anxiety/Depression, Social Problems, Thought
Problems, Attention Problems, Delinquent Behavior, and Aggressive Behavior. The CBCL is the only
measure among the three instruments that contains the Sex Problems scale (Achenbach, 1991).
In addition to focusing on a child's behavior as defined by one of the eight syndrome scales, the CBCL,
TRF, and YSR also allow the examination of two broad groupings of syndromes: Internalizing Problems
and Externalizing Problems. Internalizing Problems combines the Social Withdrawal, Somatic
Complaints, and Anxiety/Depression scales, while Externalizing problems combines the Delinquent
Behavior and Aggressive Behavior scales (Achenbach, 1991).
The three corollary instruments also contain items that assess social competence. The CBCL/4-18
contains 20 competence items grouped into 3 scales (Activities, Social, and School) (Achenbach, 1991).
Item Origin/Selection Process
Items were derived from research and consultation with professionals and parents, and revisions were
based on the findings of numerous pilot studies. For a complete description of item derivation for the
CBCL, see the Manual for the Child Behavior Checklist/4-18 and 1991 Profile (hereafter referred to as
the Manual) (Achenbach, 1991).
Materials
Manual, forms, and computerized scoring programs, available from the publisher.
Time Required
Twenty-five to thirty minutes.
Administration Method
The CBCL is designed to be completed independently by the caregiver. It requires fifth grade reading
ability. The form can also be administered orally by an interviewer who records the caregiver's answers.
There are several items for which the respondent is asked to elaborate about an endorsed behavior in
order to avoid improper scoring.
Training
Requires thorough familiarity with the Manual, especially with the cautions related to commonly
misinterpreted items (Manual, p. 13, pp. 249-250). Please see the Manual for additional information on
training and educational requirements.
Scoring
Score Types
Items are coded from 0 to 2. Instructions for hand scoring the instrument are provided in Appendix A
of the Manual.
Total scores may be computed for Social Competence, Behavior Problems, Internalizing Problems,
Externalizing Problems, and Sex Problems, plus scores for each of the 8 syndrome scales (Achenbach,
1991)
Raw scores can be converted to age-standardized scores (T scores having a mean = 50 and SD = 10) that
can be compared with scores obtained from normative samples of children within the same broad age
range. Please see the Manual for more information on CBCL scores.
Score Interpretation
For the syndrome scales, T scores less than 67 are considered in the normal range, T scores ranging from
67-70 are considered to be borderline clinical, and T scores above 70 are in the clinical range
(Achenbach, 1991) Please see the Manual for additional information on specific syndrome scales
For Total Problems, Externalizing Problems, and Internalizing Problems, T scores less than 60 are
considered in the normal range, 60-63 represent borderline scores, and scores greater than 63 are in the
clinical range (Achenbach, 1991).
Norms and/or Comparative Data
The CBCL/4-18 was normed on a sample of 2,368 non-handicapped 4 to 18 year old children. See
Manual for additional information on norms and comparative data. .
Psychometric Support
Reliability
Information on test-retest reliability and Cronbach's alphas are available from the author (Achenbach,
1991).
Validity
Evidence for content, construct, and criterion-related validity is well documented. See Chapter 6 in
Manual for additional details.

The YABCL has 107 items that describe specific behavioral and emotional problems. Parents and others rate the young adult for how true each item is now or was within the past six months using the following scale: 0 = not true (as far as you know); 1 = somewhat or sometimes true; 2 = very true or often true. In addition, 13 socially desirable items are rated, and space is also provided for responses to two open-ended items covering physical and other problems, plus anything else the respondent wants to report about the young adult. These questionnaires are designed to provide standardized descriptions of behavior, feelings, thoughts, and competencies rather than diagnoses per se. The YABCL has 109 problem items and 11 competence items that are scored on 3-step scales. Eight syndromes are derived from the items on the YABCL, including 2 designated as Internalizing (Anxious/Depressed, Withdrawn) and 3 designated as Externalizing (Aggressive, Delinquent, and Intrusive Behavior). Reliability on the YABCL averages 0.85 across syndromes and Internalizing, Externalizing, and Total Problems scales (P .001). Validity has been demonstrated by showing significantly higher scores for subjects referred for mental health services than for matched nonreferred subjects.36-38 For the 8 syndrome scales, the 95th percentile is considered the borderline clinical cutoff and the 98th percentile the clinical cutoff on the basis of a nonreferred population. For the problem scales (Internalizing, Externalizing, and Total Problems), the 83rd percentile is considered the borderline clinical cutoff and the 90th percentile the clinical cutoff.33.

How the type of representation (icons, photos of objects in context, photos of objects in isolation) displayed on a hand-held computer affected recognition performance in young adults with cognitive disabilities was examined. Participants were required to match an object displayed on the computer to one of three pictures projected onto a screen. We tested the opinion widely held by occupational therapists and special education professionals that there is an inverse relationship between cognitive ability and the required fidelity of a representation for a successful match between a representation and an external object. Despite their widespread use in most learning tools developed for persons with cognitive disabilities, our results suggest that icons are poor substitutes for realistic representations.

The Nordic countries share a tradition of universal, tax-financed eldercare services, centred on public provision. Yet Nordic eldercare has not escaped the influence of the global wave of marketisation in recent years. Marketinspired measures, such as competitive tendering and user choice models, have been introduced in all Nordic countries, and in some countries, there has been an increase of private, for-profit provision of care services. This report is the first effort to comprehensively document the process of marketisation in Sweden, Finland, Denmark and Norway. The report seeks to answer the following questions: What kinds of market reforms have been carried out in Nordic eldercare systems? What is the extent of privately provided services? How is the quality of marketised monitored? What has the impact of marketisation been on users of eldercare, on care workers and on eldercare systems? Are marketisation trends similar in the four countries, or are there major differences between them? The report also includes analyses of aspects of marketisation in Canada and the United States, where there is a longer history of markets in care. These contributions offer some perhaps salutary warnings for the Nordic countries about the risks of increasing competition and private provision in eldercare. The authors of this report, representing seven countries, are all members of the Nordic Research Network on Marketisation in Eldercare (Normacare). The report has been edited by Professor Gabrielle Meagher, University of Sydney and Professor Marta Szebehely, Stockholm University. Our hope is that the report will provide both a foundation and an inspiration for further research on change in Nordic eldercare.

This study sought to assess the association between traditional masculine gender role ideologies and sexual risk and intimate partner violence (IPV) perpetration behaviors in young men's heterosexual relationships. Sexually active men age 18–35 years attending an urban community health center in Boston were invited to join a study on men's sexual risk; participants (N=307) completed a brief self-administered survey on sexual risk (unprotected sex, forced unprotected sex, multiple sex partners) and IPV perpetration (physical, sexual and injury from/need for medical services due to IPV) behaviors, as well as demographics. Current analyses included men reporting sex with a main female partner in the past 3 months (n=283). Logistic regression analyses adjusted for demographics were used to assess significant associations between male gender role ideologies and the sexual risk and IPV perpetration behaviors. Participants were predominantly Hispanic (74.9%) and Black (21.9%); 55.5% were not born in the continental U.S.; 65% had been in the relationship for more than 1 year. Men reporting more traditional ideologies were significantly more likely to report unprotected vaginal sex in the past 3 months (ORadj = 2.3, 95% CI = 1.2–4.6) and IPV perpetration in the past year (ORadj = 2.1, 95% CI = 1.2–3.6). Findings indicate that masculine gender role ideologies are linked with young men's unprotected vaginal sex and IPV perpetration in relationships, suggesting that such ideologies may be a useful point of sexual risk reduction and IPV prevention intervention with this population.

Scand J Caring Sci; 2012; 26; 587-597 'Mastering an unpredictable everyday life after stroke'- older women's experiences of caring and living with their partners Introduction: The shift from older persons living in institutions to living in the community naturally affects both the older persons and their partners. The informal care is often taken for granted, and the research that focuses on the diversity of older female carers needs is scarce. Aim: To explore and learn from the older women how they experience their life situation and formal support as carers of their partners after stroke and to suggest clinical implications. Method: The design of the study is qualitative being based on the focus group method. Sixteen carers, median age 74 years (range 67-83), participated in four focus group discussions, which each met once for not more than 2 hours. Findings: The discussions resulted in one comprehensive theme; 'Mastering an uncertain and unpredictable everyday life'. Three subthemes emerged from the material: 'Living with another man' where the carers discussed not only the marked change in their partner's personality, but also the loss of a life-companion and their mutual intellectual contact; 'Fear of it happening again', comprising the carers' experiences of fear and confinement, of always having to be ready to help and of being trapped at home; 'Ongoing negotiation', referring to the carers' struggling and negotiating not only with their partners, but also with themselves and formal care for time to themselves. Conclusion: This study helps us to understand how these older women tried to master an uncertain and unpredictable life. Their life had changed radically; now they were always on call to help their partners and felt tied to home. The results draw attention to the carers' need for time to themselves, a greater knowledge of stroke and continuous support from formal care.

INTRODUCTION:
The shift from older persons living in institutions to living in the community naturally affects both the older persons and their partners. The informal care is often taken for granted, and the research that focuses on the diversity of older female carers needs is scarce.
AIM:
To explore and learn from the older women how they experience their life situation and formal support as carers of their partners after stroke and to suggest clinical implications.
METHOD:
The design of the study is qualitative being based on the focus group method. Sixteen carers, median age 74 years (range 67-83), participated in four focus group discussions, which each met once for not more than 2 hours.
FINDINGS:
The discussions resulted in one comprehensive theme; 'Mastering an uncertain and unpredictable everyday life'. Three subthemes emerged from the material: 'Living with another man' where the carers discussed not only the marked change in their partner's personality, but also the loss of a life-companion and their mutual intellectual contact; 'Fear of it happening again', comprising the carers' experiences of fear and confinement, of always having to be ready to help and of being trapped at home; 'Ongoing negotiation', referring to the carers' struggling and negotiating not only with their partners, but also with themselves and formal care for time to themselves.
CONCLUSION:
This study helps us to understand how these older women tried to master an uncertain and unpredictable life. Their life had changed radically; now they were always on call to help their partners and felt tied to home. The results draw attention to the carers' need for time to themselves, a greater knowledge of stroke and continuous support from formal care.

As primary caregivers of children with mental health problems, mothers face challenges that put them at risk for depression, which is rarely identified or addressed. The aims of this paper were to (a) identify mean differences among demographic, stressor, threat, and resource variables specified in a theoretical model and thought to be associated with maternal depressive symptoms and (b) determine how much variability in depressive symptoms is explained by these variables. High levels and prevalence of depressive symptoms were found within a quality of life study that these data were drawn from. Of 139 mothers participating in this study, 58% had a score of 16 or greater on the CES-D indicating moderate to high levels of depressive symptoms. Significant differences were found between mothers with higher versus lower levels of depressive symptoms for 11 of the 18 variables. Hierarchical regression was used to examine the variance explained in depressive symptoms based upon the conceptual model with 4 composite variables. Income (step 1), behavioral problems (step 2), threat appraisal (step 3), and resource appraisal (step 4) combined explained 42% of the variance.

Substantial evidence suggests that rumination is an important vulnerability factor for adolescent depression. Despite this, few studies have examined environmental risk factors that might lead to rumination and, subsequently, depression in adolescence. This study examined the hypothesis that an adverse family environment is a risk factor for rumination, such that the tendency to ruminate mediates the longitudinal association between a negative family environment and adolescent depressive symptoms. It also investigated adolescent gender as a moderator of the relationship between family environment and adolescent rumination. Participants were 163 mother–adolescent dyads. Adolescents provided self-reports of depressive symptoms and rumination across three waves of data collection (approximately at ages 12, 15, and 17 years). Family environment was measured via observational assessment of the frequency of positive and aggressive parenting behaviors during laboratory-based interactions completed by mother-adolescent dyads, collected during the first wave. A bootstrap analysis revealed a significant indirect effect of low levels of positive maternal behavior on adolescent depressive symptoms via adolescent rumination, suggesting that rumination might mediate the relationship between low levels of positive maternal behavior and depressive symptoms for girls. This study highlights the importance of positive parenting behaviors as a possible protective factor against the development of adolescent rumination and, subsequently, depressive symptoms. One effective preventive approach to improving adolescent mental health may be providing parents with psychoeducation concerning the importance of pleasant and affirming interactions with their children. (PsycINFO Database Record (c) 2013 APA, all rights reserved)(journal abstract)

Abstract
BACKGROUND:
This study examined the perceived effectiveness of a 15-week community-based program for 46 children exposed to intimate partner violence (IPV) and their mothers.
AIMS:
The primary aims were to describe the children who entered one of the existing community-based programs in terms of behavioral problems and to evaluate the impact of the program on children's general behavioral functioning as assessed by their mothers.
RESULTS:
Children's rated behavioral problems (SDQ) dropped following treatment; the effect size was in the medium range. The social impairment caused by the problems decreased as well. The effect regarding behavioral problems was not related to the degree of exposure to IPV or the mothers own changes in trauma symptoms following treatment. Results were analyzed as well at the individual level with the Reliable Change Index (RCI), which showed that the majority of children were unchanged following treatment.
CONCLUSIONS:
One implication from the study is the need for baseline screening and assessment. About half of the current sample had a clinical symptom picture indicating the need for specialized psychiatric/psychotherapeutic treatment. Furthermore, the reduction in behavioral problems was significant but many children still had high levels of behavioral problems after treatment, indicating a need of a more intense or a different type of intervention.

Children of adolescent mothers are at risk for a variety of developmental difficulties. In the present study, the effectiveness of a brief intervention program designed to support adolescent mothers' sensitivity to their infants' attachment signals was evaluated. Participants were adolescent mothers and their infants who were observed at 6, 12, and 24 months of age. The intervention conducted by clinically trained home visitors consisted of eight home visits between 6 and 12 months in which mothers were provided feedback during the replay of videotaped play interactions. At 12 months, 57% of the mother–infant dyads in the intervention group and 38% of the comparison group dyads were classified as secure in the Strange Situation. Seventy-six percent of the mothers in the intervention group maintained sensitivity from 6 to 24 months compared with 54% of the comparison mothers. Further analyses indicated that the intervention was effective primarily for mothers who were not classified as Unresolved on the Adult Attachment Interview.

Background

Improvement is needed in methods for planning and evaluating interventions designed to facilitate daily time management for children with intellectual disability, Asperger syndrome, or other developmental disorders.

Objectives

The aim of this study was to empirically investigate the hypothesized relation between children's time processing ability (TPA), daily time management, and self-rated autonomy. Such a relationship between daily time management and TPA may support the idea that TPA is important for daily time management and that children with difficulties in TPA might benefit from intervention aimed at improving daily time management.

Methods

Participants were children aged 6 to 11 years with dysfunctions such as attention-deficit/hyperactivity disorder, autism, or physical or intellectual disabilities (N = 118). TPA was measured with the instrument KaTid. All data were transformed to interval measures using applications of Rasch models and then further analysed with correlation and regression analysis.

Results

The results demonstrate a moderate significant relation between the parents' ratings of daily time management and TPA of the children, and between the self-rating of autonomy and TPA. There was also a significant relation between self-ratings of autonomy and the parents' rating of the children's daily time management. Parents' ratings of their children's daily time management explain 25% of the variation in TPA, age of the children explains 22%, while the child's self-rating of autonomy can explain 9% of the variation in TPA. The three variables together explain 38% of the variation in TPA. The results indicate the viability of the instrument for assessing TPA also in children with disabilities and that the ability measured by KaTid is relevant for daily time management.

Conclusions

TPA seems to be a factor for children's daily time management that needs to be taken into consideration when planning and evaluating interventions designed to facilitate everyday functioning for children with cognitive impairments. The findings add to the increasing knowledge base about children with time processing difficulties and contribute to better methods aimed at improving these children's daily time management. Further research is needed to examine if there are differences in TPA related to specific diagnosis or other child characteristics.

Objective: To describe measures used to evaluate the burden of caregiving experienced by caregivers of stroke patients and their clinimetric properties.
Design: A review of the literature was conducted to examine burden scales with regard to concept, feasibility, internal consistency, validity, reliability and responsiveness.
Results: The literature search resulted in 45 measures of caregiver outcomes, including 16 different measures of caregiver burden. About half of the scales were used only once and were not further described. Nearly all instruments measure the various dimensions of burden (competency, negative feelings, social relations, participation problems, physical and mental health and economic aspects), but not in the same proportions. Most measures showed good internal consistency, and validity was demonstrated for all measures except one. However, not much is known about the reliability and responsiveness of these measures.
Conclusions: No measure has proven superiority above others. Future research should focus on comparisons between existing instruments and on their reliability and responsiveness.

There is a need for psychometrically sound measures of children's participation in recreation and leisure activities, for both clinical and research purposes. This paper provides information about the construct validity of the Children's Assessment of Participation and Enjoyment (CAPE) and its companion measure, Preferences for Activities of Children (PAC). These measures are appropriate for children and youth with and without disabilities between the ages of 6 and 21 years. They provide information about six dimensions of participation (i.e. diversity, intensity, where, with whom, enjoyment and preference) and two categories of recreation and leisure activities: (i) formal and informal activities; and (ii) five types of activities (recreational, active physical, social, skill-based and self-improvement). This paper presents information about the performance of the CAPE and PAC activity type scores using data from a study involving 427 children with physical disabilities between the ages of 6 and 15 years. Intensity, enjoyment and preference scores were significantly correlated with environmental, family and child variables, in expected ways. Predictions also were supported with respect to differences in mean scores for boys vs. girls, and children in various age groups. The information substantiates the construct validity of the measures. The clinical and research utility of the measures are discussed.

Lack of conceptual clarity and measurement methods have led to underdeveloped efforts to measure experience of participation in care by next of kin to older people in nursing homes. OBJECTIVE: We sought to assess the measurement properties of items aimed at operationalizing participation in care by next of kin, applied in nursing homes. METHODS: A total of 37 items operationalizing participation were administered via a questionnaire to 364 next of kin of older people in nursing homes. Measurement properties were tested with factor analysis and Rasch model analysis. RESULTS: The response rate to the questionnaire was 81% (n = 260). Missing responses per item varied between <0.5% and 10%. The 37 items were found to be two-dimensional, and 19 were deleted based on conceptual reasoning and Rasch model analysis. One dimension measured communication and trust (nine items, reliability 0.87) while the other measured collaboration in care (nine items, reliability 0.91). Items successfully operationalized a quantitative continuum from lower to higher degrees of participation, and were found to generally fit well with the Rasch model requirements, without disordered thresholds or differential item functioning. Total scores could be calculated based on the bifactor subscale structure (reliability 0.92). Older people (≥ 65 years) reported a higher degree of communication and trust and bifactor total scores than younger people (p < 0.05 in both cases). People with a specific contact person experienced a higher degree of participation in the two subscales and the bifactor total score (p < 0.05 in all three instances). CONCLUSION: Psychometric properties revealed satisfactory support for use, in nursing home settings, of the self-reported Next of Kin Participation in Care questionnaire, with a bifactor structure. Additional research is needed to evaluate the effectiveness of the scales' abilities to identify changes after intervention.

PURPOSE:
The aim of this paper is to examine conceptual issues that challenge development of valid and useful measures of children's participation.
METHOD:
Ambiguities in the current definition of participation in the International Classification of Functioning, Disability and Health (ICF) are examined along with their implications for developing valid measures for children and youth.
RESULTS:
Developers of new measures must address three key issues that will affect the ultimate meaning of participation data obtained from these instruments: uncertain criteria to distinguish activity from participation; lack of consensus on whether measures should address objective or subjective aspects of participation or both; and appropriate choice of respondent when children are the focus. Variations in how the participation construct is operationalized challenge one's ability to develop a coherent body of knowledge about children's participation and the factors that influence it.
CONCLUSION:
Given current variations in how participation is being defined, both developers and users of measures of participation need to be explicit about the definition of participation that a particular measure represents and the inferences that can be drawn from the scores.

The aim of this study was to develop and evaluate an instrument - the Responsive Augmentative and Alternative Communication Style (RAACS) scale Version 2 - to assess the communicative style of parents as they interact with their children using augmentative and alternative communication (AAC). This scale was used to analyze play interactions between 43 parents and 28 children with different diagnoses (including Down syndrome, autism, cerebral palsy, and intellectual disability), aged between 12 and 60 months. Parent-child interactions were observed both before and after parent participation in ComAlong, a training course on using responsive communication and AAC to support interaction with children. Based on an analysis of the results, Version 3 of the RAACS scale was developed and is recommended for future use. Analyses of Version 3 showed acceptable inter- and intra-coder reliability, and excellent internal consistency.

Risk and protective factors predictive of adolescent problem behaviors such as substance abuse and delinquency are promising targets for preventive intervention. Community planners should assess and target risk and protective factors when designing prevention programs. This study describes the development, reliability, and validity of a self-report survey instrument for adolescents ages 11 to 18 that measures an array of risk and protective factors across multiple ecological domains as well as adolescent problem behaviors. The instrument can be used to assess the epidemiology of risk and protection in youth populations and to prioritize specific risk and protective factors in specific populations as targets for preventive intervention.

Att vara anhörigvårdare till en äldre närstående med inkontinens kan innebära ett tjugofyratimmars arbete och ansvar, som inte delas med någon annan. En emotionell och fysisk börda, där den egna hälsan får stå tillbaka till förmån för den närståendes väl. Dessutom innebär det för en del anhörigvårdare en instängdhet och ett minskat socialt liv. Samtidigt betraktade flera omsorgen om sin anhörige som en naturlig del och uttryckte önskan att göra det möjligt för denne att bo hemma så länge som möjligt. Det är viktigt att anhörigvårdarens situation uppmärksammas i ett tidigt skede av sjukvården och speciellt av landstinget, för att kunna möjliggöra information och stöd om problemet inkontinens, såväl som om övrig vård samt hjälp som finns att tillgå i samhället.

I relation till hälsa, självkänsla, sociala och ekonomiska resurser i ett svenskt och europeiskt perspektiv. Knowledge of factors contributing to life satisfaction among older people is needed, both in the context of those with reduced self-care capacity and among healthy older people and those providing help to others. Such knowledge may be helpful in developing primary and secondary interventions. The overall aim of this thesis was to investigate life satisfaction and its relation to factors such as physical and mental health and social and financial resources among people (60?89 years old) with and without reduced self-care capacity in six European countries, and among informal caregivers (50?89 years old) in Sweden. The aim was further to investigate the extent, need and type of support provided or desired among informal caregivers. This is part of the cross-national European Study of Adults? Wellbeing (ESAW) including six European countries N=12 478 (the Netherlands, Luxemburg, Italy, Austria, UK and Sweden). The Older Americans? Resources Schedule (OARS), Life Satisfaction Index Z (LSIZ) and Rosenberg self-esteem scale were used. Study I comprised 522 people (65?89 years old) with reduced self-care capacity, study II comprised 151 informal caregivers with a high caregiving extent, 392 with a low caregiving extent and 1258 non-caregivers from the Swedish sample. In study III 2195 people with reduced self-care countries. The data were analysed by descriptive and inferential statistics using non-parametric statistics, logistic and linear regression. Low life satisfaction (LSIZ) was related to higher age, being a woman, high degree of reduced self-care capacity, living in special accommodations, feeling lonely and poor financial resources. Feeling lonely, reduced self-care capacity, feeling worried, poor health and poor financial resources in relation to needs predicted low life satisfaction (Paper I). Frequent caregivers with a high extent of caregiving had lower LSIZ than those with less frequent caregiving and noncaregivers, while no differences were found between less frequent caregivers and non-care caregivers in LSIZ. Lower LSIZ was associated with not being employed, low social resources, not refreshed after a night's sleep, poor health, and frequent caregiving (Paper II). In paper III it was found that there were differences as well as similarities in factors predicting LSIZ in that self-esteem and overall health were important in all countries among older people with reduced self-care capacity and reduced self care capacity in three of six countries, whilst in paper IV four factors were found to be common in all ESAW countries. The factors were social resources, financial resources, feeling greatly hindered by health problems and low self-esteem. Factors of importance for life satisfaction thus seem to differ depending on the personal situation and social and political system. These differences should be taken into account when outlining and providing preventive, rehabilitative and support for these groups.

Demenssjukdomar och minnesproblematik är ett stort komplext område som berör både kommun och landsting. År 2010 publicerades Socialstyrelsens nationella riktlinjer för vård och omsorg vid demenssjukdom. Riktlinjerna ska vara till stöd och hjälp för politiker och tjänstemän för att skapa en god likvärdig personcentrerad demensvård. De ska också vara till stöd för den praktiska vården, omvårdnaden och omsorgen. Det lokala vårdprogrammet är utformat med de Nationella riktlinjerna som grund.

Syftet med detta vårdprogram är att underlätta såväl utredning, behandling som uppföljning av patient med utvecklingsstörning och misstänkt eller verifierad demenssjukdom. Det understryker vikten av individuellt anpassad vårdkedja utifrån patientens behov och förmåga

Children experiencing difficulties in their peer relations have typically been identified using external sources of information, such as teacher referrals or ratings, sociometric measures, and/or behavioral observations. There is a need to supplement these assessment procedures with self-report measures that assess the degree to which the children themselves feel satisfaction with their peer relationships. In this study, a 16-item self-report measure of loneliness and social dissatisfaction was developed. In surveying 506 third- through sixth-grade children, the measure was found to be internally reliable. More than 10% of children reported feelings of loneliness and social dissatisfaction, and children's feelings of loneliness were significantly related to their sociometric status. The relationship of loneliness and sociometric status to school achievement was also examined.

The aim of this study is to assess the impact of sudden parental bereavement on subsequent attainment of developmental competencies. This longitudinal study reports on 126 youth bereaved by sudden parental death (suicide, accident, or natural death) and 116 demographically similar nonbereaved controls assessed at 9, 21, 33, and 62 months after parental death, and at comparable times in controls. Half were female and 84.7% Caucasian. Youths and care-giving parents were assessed on psychiatric disorders, psychological characteristics, and contextual variables antecedent and subsequent to bereavement. At Month 62, at which time youth on average aged 18.4 years (SD = 3.1), participants were assessed on developmental competence using an adaptation of the Status Questionnaire, peer attachment using the Inventory of Parent and Peer Attachment, and educational aspirations using the Future Expectations Scale. The bereaved and nonbereaved groups were compared using univariate and multivariate statistics, including path analyses. On univariate analyses, bereaved youth had more difficulties at work, less well-elaborated plans for career development, lower peer attachment, and diminished educational aspirations. The effects of bereavement were most commonly mediated via its effects on offspring and caregiver functioning and family climate, even after adjusting for the impact of predeath characteristics. Outcomes were unrelated to age at the time of parental death, gender of the deceased parent, or cause of death. Children who lost a parent to sudden death evidenced lower competence in work, peer relations, career planning, and educational aspirations, primarily mediated by the impact of bereavement on child and parental functioning and on family climate.

This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.

Abstract
OBJECTIVES:
This article reports on results from a randomized experimental trial of the effects of the Family Bereavement Program (FBP) on multiple measures of grief experienced by parentally bereaved children and adolescents over a 6-year period.
METHOD:
Participants were 244 youths (ages 8-16, mean age = 11.4 years) from 156 families that had experienced the death of a parent. The sample consisted of 53% boys and 47% girls; ethnicity was 67% non-Hispanic White and 33% ethnic minority. Families were randomly assigned to the FBP (N = 135) or a literature control condition (N = 109). Two grief measures, the Texas Revised Inventory of Grief and the Intrusive Grief Thoughts Scale (IGTS) were administered at 4 times over 6 years: pretest, posttest, and 11-month and 6-year follow-ups. A 3rd measure, an adaptation of the Inventory of Traumatic Grief (ITG) was administered only at the 6-year follow-up.
RESULTS:
Compared with the control group, the FBP group showed a greater reduction in their level of problematic grief (IGTS) at posttest and 6-year follow-up and in the percentage at clinical levels of problematic grief at the posttest. The FBP also reduced scores on a dimension of the ITG, Social Detachment/Insecurity, at 6-year follow-up for 3 subgroups: those who experienced lower levels of grief at program entry, older youths, and boys.
CONCLUSION:
These are the first findings from a randomized trial with long-term follow-up of the effects of a program to reduce problematic levels of grief of parentally bereaved youths.
(c) 2010 APA, all rights reserved

OBJECTIVE:
To investigate an intensified transition concept between neurological inpatient rehabilitation and home care for long-term effects on the care situation two and a half years after stroke patients' discharge.
DESIGN:
Controlled clinical trial allocating patients to intervention group (intensified transition on ward II) or control group (standard transition on ward I); patients were allocated to whichever ward had a vacancy. The last follow-up assessment was carried out on average 31 months after discharge.
INTERVENTION:
The intensified transition concept consisted of therapeutic weekend care, bedside teaching and structured information for relatives during the second phase of the rehabilitation.
SUBJECTS:
Seventy-one patients and their family carers were included, of which one case dropped out. Therefore 70 family carers--35 individuals in each group-- were available for assessment at long-term follow-up.
DATA COLLECTION:
Family carers were asked via telephone whether the patient was still alive and if so, where he or she is living--at home or in a nursing home.
STATISTICAL METHODS:
Binary logistic regression analysis with the care situation (home care versus institutionalized care or deceased) as dependent variable.
RESULTS:
Two and a half years after discharge (T3) in the intervention group significantly fewer patients were institutionalized (2 versus 5) or deceased (4 versus 11) (P = 0.010). Multivariate analysis showed that besides a higher functional life quality at discharge and lower patient's age, the participation in the intensified transition programme is the third significant predictor for home care at T3.
CONCLUSION:
Effects of an intensified transition programme can persist over a long-term period. They can sustain home care by reducing institutionalization and mortality.

Background: Given close genetic and emotional connections between a twin pair, the death of a co-twin sibling may considerably affect the mental health of the surviving twin. However, evidence from population-based cohort studies is currently lacking. Methods: Based on the Swedish health registers, we identified 4528 exposed twins whose twin sibling died between 1973 and 2013. For comparison, 22,640 matched unexposed twins (i.e., had twin sibling but didn't experience such a loss) and 4939 full siblings of these exposed twins were included. Controlling for multiple confounders, we used Cox models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of clinical ascertained psychiatric disorders after loss of a co-twin. Results: The median age at a co-twin loss was 59 years. Compared to the unexposed twins, exposed twins were at increased risk of psychiatric disorders (HR = 1.65 [95% CI 1.48–1.83]). The association seemed stronger for loss of a monozygotic twin (HR = 2.02 [95% CI 1.56–2.61]) than loss of a dizygotic twin (HR = 1.46 [95% CI1.27–1.67]), and was evident after loss by natural causes (HR = 1.49 [95% CI 1.32–1.69]). Additionally, such risk was most pronounced during the first year after loss and when loss occurred at young age. The HR was 1.55 (95% CI 1.31–1.82) when compared exposed twins to their full siblings who also exposed to loss of a normal full sibling due to the death of the deceased twin. Conclusions: Losing a co-twin is a strong life stressor indicated by the increased subsequent risks of psychiatric disorders among the surviving twins

The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then described and basic results are reported. These indicate that, in a sample of women aged 18-65, loss of mother before the age of 17, either by death or by separation of one year or more, was associated with clinical depression in the year of interview. Loss of father by death was in no way associated with current depression, but separation from father showed a trend which, however, did not reach statistical significance. Control for other possible confounding factors did not change this patterning of results; these were further supported when psychiatric episodes earlier in adulthood were examined. Examination of the caregiving arrangements in childhood suggests that it is 'lack of care', defined in terms of neglect rather than simply hostile parental behaviour, which accounts for the raised rate of depression. Such 'lack of care' is more frequent after loss of mother than after loss of father.

Abstract
OBJECTIVE:
As part of a search for measurable attributes of an individual that might be related to the risk of alcoholism, the author's group previously compared 227 sons of alcoholics and 227 matched comparison subjects at the age of about 20 years. Forty percent of the men at high risk for alcoholism and less than 10% of the comparison subjects demonstrated a low intensity of response to alcohol challenge. This article reports the results of the follow-up of the first half of this study group almost a decade later.
METHOD:
Of the men who had been tested at about age 20, 223 were about age 30 at this evaluation, which included personal and resource-person interviews, record searches, urine toxicology screens, and blood level markers of drinking.
RESULTS:
A low level of response to alcohol at age 20 was associated with a fourfold greater likelihood of future alcoholism in both the sons of alcoholics and the comparison subjects. Fifty-six percent of the sons of alcoholics with the lesser alcohol response developed alcoholism during the subsequent decade, compared to 14% of the men in this group who had highly sensitive alcohol responses. Neither family history of alcoholism nor response to alcohol predicted any other psychiatric diagnoses over the subsequent decade, and neither was a significant predictor of any other substance use disorder.
CONCLUSIONS:
In a heavy-drinking society, a lower sensitivity to modest doses of alcohol is associated with a significant increase in the risk of future alcoholism, perhaps through increasing the chances that a person will drink more heavily and more often.

Det är angeläget att särskilt personligt stöd blir en flexibel insats som kan kompletteras dels efter individuella behov, dels efter förändrade förutsättningar beroende på teknikutveckling och annan kunskaps- och kompetensutveckling. Det är därför inte rimligt att precisera en heltäckande katalog av åtgärder som skall ingå i insatsen. Utifrån dagens erfarenhet av innehållet i råd och stöd kan dock tre delar utgöra bas i särskilt personligt stöd; Kunskapsstöd, psykosocialt stöd och särskilt kompletterande stöd.

Det är viktigt att det inte utvecklas någon skarp gräns mellan dessa delar eftersom det är en styrka om den samlade kompetensen kan samverka på det sätt som bäst motsvarar individens behov. Detta gränsöverskridande arbetssätt kan även i fortsättningen medföra problem i avgränsningen av insatsen, men en efterfrågan på tydliga riktlinjer och detaljstyrning måste vägas mot de enskildas behov av individuellt anpassade åtgärder.

Förtydligandet av insatsen innebär i huvudförslaget att det inom särskilt personligt stöd skall vara möjligt att komplettera kvalitativt eller kvantitativt med åtgärder som kan betraktas ingå i habilitering och rehabilitering om dessa behov inte tillgodoses på annat sätt. Detta gäller alla de fyra delar som normalt anses ingå i habilitering och rehabilitering - medicinska, psykologiska, sociala och pedagogiska.

Alkoholfrågan är något som berör de flesta och många av oss bär på minnen och erfarenheter som vi kanske aldrig fått sätta ord på. Barns erfarenheter och upplevelser av alkohol har vi samlat i vår bok: Lyssna på barnen

Om föräldrar missbrukar, så leder detta ofta till att en väl bevarad familjehemlighet styr hela familjens liv. Genom föreläsningar och reportage berättar människor om sina egna erfarenheter.

Blå Bandet är en del av ett stort internationellt nätverk som i de flesta länder kallas Blå Korset. Våra systerorganisationer i Norge och Danmark, arbetar förutom med förebyggande arbete, också med vård och rehabilitering av missbrukare och deras familjer.

De positiva effekter som fysisk aktivitet har på
hälsa och självkänsla är idag allmänt kända. Att
vara delaktig i lek och fysiska aktiviteter har också
en viktig social betydelse för barns och ungdomars
utveckling.
Forskning visar att elever som är delaktiga i
fysiska aktiviteter i högre utsträckning utvecklar
sociala relationer och stärker sitt självförtroende,
vilket även påverkar självkänslan och självbilden
positivt. (Moser och Dudas, 1997)
Denna skrift är framtagen efter att vi i Specialpedagogiska
skolmyndigheten tillsammans med
forskare gjort en studie kring samarbetsorienterat
lärande och vägledande kamrater. Vi vet att många
elever med någon funktionsnedsättning upplever
att de inte alltid får förutsättningar att vara delaktiga
i olika aktiviteter eller i gemenskapen under
skoldagen. Särskilt tydligt har det visat sig i ämnet
idrott och hälsa.
Skolinspektionens ämnesrapport för idrott och
hälsa (2012) lyfter fram att det sällan finns tillgång
till specialpedagogiskt stöd i ämnet. Rapporten
pekar också på att idrottslärare ofta är bra på att
uppmuntra eleven men inte på att anpassa undervisningen
eller aktiviteterna. I rapporten framkommer
även att elever med funktionsnedsättning ofta inte
deltar fullt ut i undervisningen.
Med denna bakgrund ville vi titta närmare på
om man kan påverka delaktigheten mellan elever
med och utan funktionsnedsättning på idrottslektionerna.
Vi var även intresserade av att se om
det påverkade klassklimatet och engagemanget
i aktiviteterna.
Det kommer allt mer forskningsresultat som
visar positiva effekter av elevers kompetens att
samarbeta och hjälpa varandra. I vår och liknande
studier kan vi se att samarbetsorienterat lärande,
tillsammans med pedagogers medvetna förhållningssätt,
kan ge goda möjligheter att påverka
klassklimat och gemenskap. Vi vill därför dela med
oss av våra lärdomar från denna och liknade studier.
I denna skrift ger vi främst exempel från ämnet
idrott och hälsa, men vi ser också att dessa lärdomar
är överförbara på andra ämnen och områden
i skolans verksamhet.
Vi vill även lyfta fram begrepp och synsätt som
vi tror att många skolor kan ha nytta av i sitt arbete
kring att skapa en tillgänglig och inkluderande miljö.
Under hösten 2013 kommer studien att publiceras
som en vetenskaplig artikel i European Journal of
Special Needs Education. Artikeln heter Cooperative
oriented Learning in Inclusive Physical Education.
Författare till artikeln är Aija Klavina, Associate Professor
vid Academy of Sport Education i Lettland,
Kajsa Jerlinder, universitetslektor vid högskolan i
Gävle, Lars Kristén, universitetslektor vid högskolan
i Halmstad, Lena Hammar, rådgivare vid Specialpedagogiska
skolmyndigheten och Tine Soulie,
konsulent vid Handikappidrottens Videncenter
i Danmark.

Den här antologin sammanfattar kunskapsläget och bidrar med ny kunskap om arbetsfördelningen mellan kvinnor och män och de konsekvenser som denna får för deras möjligheter på arbetsmarknaden.

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För femtio år sedan rådde huvudsakligen en mycket strikt arbetsdelning mellan makar. Den rådande normen var att mannen genom förvärvsarbete bar huvudansvaret för den ekonomiska försörjningen av familjen. Om det var ekonomiskt möjligt var hustruns huvudsakliga ansvar att ta hand om hem och barn. I början av sextiotalet var således en majoritet av de gifta kvinnorna hemarbetande och skötte i det närmaste allt hushållsarbete.

Mycket har hänt sedan dess och i dag är det mycket få kvinnor i Sverige som arbetar hemma på heltid. Den normförskjutning som skett har naturligtvis påverkat både män och kvinnor, även om omvälvningen onekligen varit störst för kvinnorna.

I dag utgör de hälften av förvärvsarbetskraften och fördelningen av omsorgs- och hushållsarbetet i familjen är väsentligt mycket jämnare än den var för femtio år sedan. Samtidigt kvarstår betydande könsskillnader exempelvis i arbetstid och lön vilka i sin tur är relaterade till kvarvarande könsskillnader i fördelningen av omsorgs- och hushållsarbete.

The overall aim was to explore the family's experiences of major depression and the meaning of the illness for family life, for the ill person, the partner and the children. This thesis has a life-world perspective and is a qualitative explorative study using narrative interviews with families with parents who were identified as having major depression MD (Paper I-IV). A case study with a single family (n=3) was performed with a focus on describing what happens and how to manage the illness in a family (I). Group interviews with 7 families (n=18) were conducted to describe the ways of living with MD in families (II). Further, parents (n=8), who were identified as suffering from major depression, representing 8 families were interviewed to elucidate the meaning of depression in family life from the viewpoint of the ill parent (III). Interviews were also conducted with children and young adults (n=8), aged from 6 to 26 years, representing 6 families to elucidate the meaning of a parent's major depression in family life from the children's perspective (IV). The interview texts were analysed using qualitative methods; thematic content analysis (I-II) and phenomenological hermeneutic analysis (III-IV). The thesis shows that family members had different views and ways of interpreting and managing the family's situation when the mother was suffering from major depression (I).The families faced demanding conditions in the presence of illness which they tried to manage together. The families' situation (fatigue, loss of energy and being burdened with guilt) seemed to bring these families into stressful life situations (II). Depressed parents' suffering and dignity were revealed as being simultaneously present and complicating family life. Dignity has to be repeatedly restored for oneself and the family, and the family's dignity has to be restored in front of other outside the family circle (III). Children's sense of responsibility and loneliness were elucidated. The children's responsibility includes their striving for reciprocity, and in their loneliness is the children's yearning for reciprocity. Children compensate with a sense of responsibility for an ill parent in family life and for their lack of health. Children's family life shifts between responsibility and loneliness as they wait for reciprocity in family life to return to normal (IV). This thesis shows how a study using qualitative methods makes it possible for family members together and individually to talk about major depression as illness that is an intruder in their family life. The thesis elucidates how the depression complicates and involves the family member's life as well as the ill person's family life. All family members have their own life-world and try to balance everyday life from an individual perspective, which overshadows that managing the illness is a concern for the whole family.

Measures for children with developmental disabilities: an ICF-CY approach. Annette Majnemer, ed. Mac Keith Press, 2012. 150.00 [pound sterling]. 552pp. ISBN: 978-1-908316-45-5 I highly recommend this book: Professor Majnemer has brought together a wide range of outcome measurement experts creating a thoughtfully crafted book, essential reading for anyone selecting outcome measures for use with children and youth with developmental disabilities. The book is framed by the components.

Syftet med denna kvalitativa studie var att undersöka upplevelser av gruppbaserat föräldrastöd hos mammor med Adhd som deltagit i en universell föräldragrupp på barnhälsovårdscentral (BVC) samt i en anpassad självhjälpsgrupp (Mammagruppen). Mammagruppen bestod av fem mammor med diagnosen Adhd, en hade även Asperger syndrom. Med ett bortfall deltog fyra av dem i studien. Tre av informanterna deltog även i föräldragrupp på BVC. Deras barn var 0-2 år gamla utan uttalade problem. Datainsamling skedde genom semistrukturerade intervjuer och en induktiv tematisk analys resulterade i två huvudteman; Samhörighet och Stöd. Resultatet visar att informanternas upplevelser av Mammagruppen blev övervägande positiva och upplevelser av föräldragruppen på BVC blev övervägande negativa. Några grundläggande faktorer som bidrog till detta var huruvida de har upplevt samhörighet i grupperna samt om de har fått utrymme till att samtala om sina egna behov och känslor. Detta bidrar med unik kunskap och belyser det upplevda behovet av ett anpassat stöd. Det behövs vidare forskning innan vi kan säga att det finns skillnader.

Huruvida föräldrar med intellektuell funktionsnedsättning (psykisk utvecklingsstörning) klarar av sitt föräldraskap har alltid ifrågasatts. Den här boken vill visa på vikten av relationen mellan föräldrar och barn när man ska ge hjälp och stöd till föräldrar med kognitiva brister. Forskning rörande barn och barns utveckling har länge varit ett viktigt område inom psykologin. Man är dock inte alltid överens om föräldrars betydelse för barns psykiska utveckling. Författarna visar hur psykologiska insatser kan utformas i familjer med komplex problematik inklusive föräldrar med intellektuell funktionsnedsättning. Boken kan utgöra en referensram för att underlätta samarbetet mellan personal inom pedagogisk, social, psykologisk och medicinsk verksamhet. Boken bör med fördel även kunna användas inom utbildningar för behandlingspersonal inom psykolog- och socionomutbildningar

Riksförbundet för rörelsehindrade barn och ungdomar (RBU) vill med den här rapporten bidra till en bättre förståelse för familjer som har rörelsehindrade barn. Syftet är dels att familjer i liknande situationer skall få en insikt om att de inte är ensamma och dels att påverka politiker, tjänstemän samt vårdpersonal

Abstract [en]

We estimate how much caregiving men and women respectively do, and how much of the caregiving is done by older (65+) and younger persons, inside their household and for other households, in Spain and in Sweden. To assess this, we use self-reported hours of caregiving from two national surveys about caregiving, performed in 2014 (Spain, N = 2003; Sweden, N = 1193). Spain and Sweden have dissimilar household structures, and different social services for older (65+) persons. Caregivers, on average, provide many more hours of care in Spain than in Sweden. Women provide about 58% of all hours of caregiving, in Spain in all age groups, in Sweden only among younger caregivers. The reason is the dominance of partner caregivers among older Swedes, with older men and women providing equal hours of care. Family caregiving inside the household is more extensive in the more complex Spanish households than in Swedish households. Family care between households prevails in Sweden, where the large majority of older persons live with a partner only, or alone. This is increasingly common in Spain, although it remains at a lower level. We estimate that older persons provide between 22% and 33% of all hours of caregiving in Spain, and between 41% and 49% in Sweden. Patterns of caregiving appear to be determined mainly by demography and household structure.

In caregiving literature, it is often the female gender that has been the focus of attention,
and in particular women's unpaid labor. Studies also tend to make comparisons
between men's and women's caregiving, using men's caregiving experiences to show
not only that women face greater burdens, but also that men's needs can be disregarded.
This means that while gender analyses are not uncommon in the caregiving literature,
gender tends to be equated with womanhood. The research problem that this dissertation
addresses is therefore the gender bias that characterizes caregiving scholarship
at present and the fact that this bias is impeding us from moving the debates on
care and caregiving forward. The aim of the dissertation is twofold. Firstly, it attempts
to contribute to the rectification of the gender bias in question by focusing on men's
caregiving and answering the following research questions: What motivates men to
provide care for their elderly parents? How do adult sons experience caregiving? What
do adult sons think that care and caregiving are, i.e. what are their perspectives on
care? Secondly, this dissertation also aims to explore whether a gender-aware and
masculinity-informed perspective can be used to enhance our understanding of caregiving.
Thus, through a phenomenological analysis of interviews with 19 caregiving
adult sons and sons-in-law, this dissertation discusses how motives, experiences and
perspectives, which have so far been interpreted as unique to women, are also matters
that men talk about and consider important in caregiving. The dissertation argues
therefore that much could be gained if we were to rectify the gender bias that characterizes
the literature on family caregiving and explore caregiving men in the genderaware
and masculinity-informed way that is lacking in this literature at present. Inspired
by the debate within studies of masculinity, the dissertation argues that within
the debate on care there is a hegemony of care which has so far tended to exclude
men's perspectives on caregiving because literature on family caregiving has regarded
women as the ideal caregivers. This dissertation shows that a gender-aware and masculinity-informed
perspective on care can increase our understanding of family caregiving
and contribute to the rectification of the gender bias that care research suffers
from. Against this backdrop, it is proposed that caregiving men should not solely be
regarded as empirically interesting. This is because they are an unexploited and theoretically
profuse source of information about caregiving.
Keywords: care, family caregiving, gender, men, masculinity, motive, experience, perspective

Men's violence against women is a universal issue affecting health, human rights and gender-equality. In pregnancy, violence is a risk for both the mother and her unborn child.The overall aims were: to determine the prevalence of such violence in a Swedish pregnant population, to investigate pregnant women's attitudes to questioning about exposure to violence, and to evaluate experience gained by antenatal care midwives having routinely questioned pregnant women regarding violence.All women registered for antenatal care in Uppsala, Sweden, during 6 months were assessed regarding acts of violence. The Abuse Assessment Screen (AAS) was used twice during pregnancy and again after delivery when the women were asked an open-ended written question regarding attitudes to questioning about violence. Midwives' experiences regarding routine assessment were evaluated in focus group discussions.The AAS questions were answered by 93% (1,038) of those eligible. Physical abuse by a partner or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. Lifetime sexual abuse was reported by 8.1%. Repeated questioning increased the abuse detection rate. Abused women reported more previous ill-health, and women physically abused during pregnancy more pregnancy terminations than did non-abused women. Abuse assessment was found entirely acceptable by 80%, both acceptable and unacceptable/disagreeable by 5% and solely unacceptable/ disagreeable by 3%, while 12% were neural. Abused and non-abused women did not differ regarding disinclination to answer the abuse questions. According to the midwives the delicacy of the subject and the male partners' presence were the most prominent remaining obstacles to routine determination of violence. Routines are required to make questioning about violence an integral part of antenatal care. This would necessitate a private appointment for the woman, knowledge among care providers about the nature of men's violence, and awareness of referral options.

The overarching aim of this thesis was to describe how family members experienced everyday life with life-threatening illness close to death, with focus on self-image and identity. The thesis comprises four papers, each with a specific aim to illuminate various aspects of the phenomenon under study. The study population consisted of 29 participants; ten family caregivers and five families, including five patients with life threatening illness and their family members. Data were based on retrospective single interviews (paper I), prospective individual, couple and group interviews with the families over six to eighteen month (papers II-III). Interpretive description approach (papers I, II, IV), narrative method (paper III) and secondary analysis (paper IV) were used to analyze data. The findings show how living close to death influences everyday life at home, at several levels (papers I-IV). From the perspective of the dying person, narrations of daily situations was described by four themes related to identity and everyday life; inside and outside of me, searching for togetherness, my place in space and my death and my time. The changing body, pain, fatigue, decreased physical capacity and changed appearance, appeared to influence the dying person's need for altered knowledge and community, and as a result the patterns of interaction within the families changed. The strive for knowledge and community took place at home, an arena for identity work and the conscious search for meaning, knowledge and community; it was limited by time and inevitable death (paper III). For the family member, life close to death can mean sharing life with a changing person in a changing relationship (paper II). It may mean that everyday life needs to be modified in order for it to work (papers I-IV). New patterns of dependence and an asymmetrical relationship affect all involved (papers III-IV). Daily life close to death is about finding the space to promote the individual self-image, me-ness, at the same time as finding new ways of being a family; we-ness (paper II). Regardless of being the ill person or not, the family members we interviewed had to face impending death, which challenged earlier ways of living together (papers I-IV). From the perspective of the relatives, the everyday life of caring for the dying family member was characterized by challenged ideals, stretched limits and interdependency (paper I). Situations that challenged the caregivers' self-image were connected to intimacy, decreasing personal space and experiences such as "forbidden thoughts". The findings suggest that the bodily changes were of importance for the self-image, and that the former approach to the own body was important in the process of experiencing the body. The person living close to death was in transition to something new; being dead in the near future. One way of handling the struggles of everyday life was to seek togetherness, strive to find other persons with similar experiences while sharing thoughts and feelings. Togetherness was sought within the family, in the health care system and on the internet; a sense of togetherness was also sought with those who had already died. The other family members were also in transition as the future meant living on without the ill family member and changing their status to for example being a widow or being motherless. Identity work close to death denotes creating an access ramp into something new; a transition into the unknown. From a clinical perspective, this study emphasizes the significance of creating a climate that allows caregivers to express thoughts and feelings.

Background The impact of clinically diagnosed mental disorders on mortality in the general population has not been established.

Aims To examine mental disorders for their prediction of cause-specific mortality.

Method Mental disorders were determined using the 36-item version of the General Health Questionnaire and the Present State Examination in a nationally representative sample of 8000 adult Finns.

Results During the 17-year follow-up period 1597 deaths occurred. The presence of a mental disorder detected at baseline was associated with an elevated mortality rate. The relative risk in men was 1.6(95% confidence interval 1.3-1.8) and in women, 1.4 (95% Cl 1.2-1.6). In men and women with schizophrenia the relative risks of death during the follow-up period were 3.3 (95% Cl 2.3-4.9) and 2.3 (95% Cl 1.3-3.8) respectively, compared with the rest of the sample. In both men and women with schizophrenia the risk of dying of respiratory disease was increased, but the risk of dying of cardiovascular disease was increased only in men with neurotic depression.

Conclusions Schizophrenia and depression are associated with an elevated risk of natural and unnatural deaths.

Aims and objectives. We aimed to discover the significance of the participation of relatives in the treatment process using the principles of the Need-Adapted Approach. The study is based on joint interviews with 10 psychiatric patients, their relatives and a multiprofessional treatment team. Background. The Need-Adapted Approach was developed in Finland for difficult psychiatric problems in public sector psychiatry. The central feature of the approach is the active participation of patients and their relatives in planning the treatment and in the treatment process. It emphasises horizontal expertise and open discussions between the patient, relatives and professionals. Design. A qualitative method based on the grounded theory approach was used. Method. The main focus in the analysis was on how the informants experienced the significance of the participation of their relatives in the treatment process. Results. Seven categories and one core category were identified. Primary categories which increased safety were: (1) shared understanding, (2) a new kind of relationship opens up and (3) being able to cope with life. Secondary categories were: (4) exclusion and (5) need for a one-to-one relationship. Ambivalent categories were: (6) whom or what one can believe and (7) keeping the illness secret. One core category, safety, was identified among the categories. A theoretical model was created for clinical purposes. Conclusions. When practiced correctly, the Need-Adapted Approach makes it possible to create circumstances in psychiatric treatment where the patient and his/her relatives can experience increased safety in spite of the anxiety connected to the psychiatric difficulties. Relevance to clinical practice. Clinical workers and nursing personnel can use our findings in their practical work with psychiatric patients and their relatives. Our findings support further theoretical considerations concerning safety and can be used as guidelines for nursing personnel in their work

Abstract
BACKGROUND: Older people with multi-morbidity are major users of healthcare and are often discharged from hospital with ongoing care needs. This care is frequently provided by informal caregivers and the time immediately after discharge is challenging for caregivers with new and/or additional tasks, resulting in anxiety and stress. AIM: This study aimed to describe mental health, with particular reference to anxiety and depression and reactions to caregiving, and to investigate any associations between the two, in next of kin of older people with multi-morbidity after hospitalisation. It also aimed to explore the association between the demographic characteristics of the study group and mental health and reactions to caregiving. METHODS:
This was a cross-sectional questionnaire study using the Hospital Anxiety and Depression Scale and the Caregiver Reaction Assessment. The study group consisted of 345 next of kin of older people (65+) with multi-morbidity discharged home from 13 medical wards in Sweden. Data were analysed using descriptive and analytical statistics. To identify whether reactions to caregiving and next of kincharacteristics were associated with anxiety and depression, a univariate logistic regression analysis was performed. RESULTS: More than one quarter of respondents showed severe anxiety and nearly one in 10 had severe depressive symptoms. The frequencies of anxiety and depression increased significantly with increased negative reactions to caregiving and decreased significantly with positive reactions to caregiving. Regarding caregiving reactions, the scores were highest for the positive domain Caregiver esteem, followed by the negative domain Impact on health. Women scored significantly higher than men on Impact on health and spouses scored highest for Impact on schedule and Caregiver esteem. CONCLUSIONS: Nurses and other healthcare professionals may need to provide additional support to informal caregivers before and after discharging older people with significant care needs from hospital. This might include person-centred information, education and training.

The aim of this study was to develop a model of mental health professional (MHP) support based on the needs of families with a member suffering from severe mental illness (SMI). Twelve family members were interviewed with the focus on their needs of support by MHP, then the interviews were analyzed according to the grounded theory method. The generated model of MHP support had two core categories: the family members' process from crisis to recovery and their interaction with the MHP about mental health/illness and daily living of the person with SMI. Interaction based on ongoing contact between MHP and family members influenced the family members' process from crisis towards recovery. Four MHP strategies--being present, listening, sharing and empowering--met the family members' needs of support in the different stages of the crisis. Being present includes early contact, early information and protection by MHP at onset of illness or relapse. Listening includes assessing burden, maintaining contact and confirmation in daily living for the person with SMI. Sharing between MHP and family members includes co-ordination, open communication and security in daily living for the person with SMI. Finally, the MHP strategy empowering includes creating a context, counselling and encouraging development for the family members. The present model has a holistic approach and can be used as an overall guide for MHP support in clinical care of families of persons with SMI. For future studies, it is important to study the interaction of the family with SMI and the connection between hope, coping and empowerment.

Barnens hälsa påverkas redan tidigt i livet av föräldrarnas livsvillkor. Låg social status, brist på vänner och stress tidigt i livet leder till hälsoskillnader. Familjecentraler med en öppen förskola och förebyggande socialt arbete är en tidig insats och en lågriskstrategi som riktar sig till alla. Den har goda förutsättningar för att stärka föräldrarnas tillit och gemenskap med andra och kan bidra till att minska hälsoskillnader genom att främja barnens hälsoutveckling. Syftena med utvärderingen av de 16 familjecentralerna var att undersöka i vilken mån besökarna är representativa för befolkningen i upptagningsområdet och av vilka anledningar föräldrarna besöker öppna förskolan på familjecentralen. Jämförelse mellan befintlig befolkningsdata i upptagningsområdena och föräldrabesökares bakgrundsdata visar att familjecentralen i huvudsak når en representativ del av befolkningen. Föräldrar använder sig av familjecentralen för att få råd, utbyte av erfarenheter, barnens skull och att umgås med andra. I synnerhet för invandrare har familjecentralen stor betydelse för att komma in i det svenska samhället.

BACKGROUND:
The Snoezelen is a multisensory intervention approach that has been implemented with various populations. Due to an almost complete absence of rigorous research in this field, the confirmation of this approach as an effective therapeutic intervention is warranted.
METHOD:
To evaluate the therapeutic influence of the Snoezelen approach. Twenty-eight relevant articles relating to individual (one-to-one) Snoezelen intervention with individuals with intellectual and developmental disabilities (IDD) were reviewed. A meta-analysis regarding the significance of the reduction of maladaptive behaviour and the enhancement of adaptive behaviour was implemented. An analysis of standardised mean differences was used through the use of fixed effect models.
RESULTS:
The primary finding was that the Snoezelen approach, when applied as an individual intervention for individuals with IDD, enabled significant and large effect size in adaptive behaviours, with generalisation to the participants' daily life.
CONCLUSIONS:
Weaknesses in the examined research methodologies, the heterogeneity between research designs, the small number of available research projects, and the small number of participants in each research project, prevent a confirmation of this method as a valid therapeutic intervention at this time.

This review summarizes a growing number of methodological concerns emerging from research on child witnesses of intimate partner violence (IPV). A brief summary of various psychological, biological, and cognitive impairments associated with witnessing IPV is presented. Directions for future research in this area are explored with particular attention paid to experimental design. Advantages and disadvantages of retrospective, cross-sectional, and longitudinal designs are evaluated. Suggested improvements include the use of multiple informants, behavioral observations, and prospective, longitudinal assessment.

I en alltmer globaliserad värld får
fler möjlighet att bosätta sig i ett annat land
än det de föddes i. Som ett resultat av detta ökar andelen utlandsfödda i de flesta höginkomstländer, så även i Sverige. Den 31 december år 2006 hade 17
procent av den svenska befolkningen utländsk bakgrund, dvs. var antingen
född i något annat land än Sverige (13 procent) eller hade två utlandsfödda
föräldrar (4 procent). Av dessa var 52 000 utlandsadopterade. Därtill kommer
asylsökande och andra migranter som saknar uppehållstillstånd, som inte finns med i befolkningsstatistiken.
Många utlandsfödda har
flyttat från länder där risken att smittas av vissa
svåra och långvariga infektioner är betydligt större än i Sverige. De viktigaste
av dessa smittämnen är hepatit B och C, tuberkulos och hiv.
Migranterna tar med sig sin livsstil till det nya landet, t ex kost- , tobaksoch
alkoholvanor. Mötet med det nya landets kultur leder till att livsstilen
förändras, men lång tid efter invandringen kan in
flytande av ursprungslandets
livsstil ofta spåras i invandrares sjukdomsmönster. Så har t.ex. män med
ursprung i Medelhavsområdet en högre risk att drabbas av tobaksrelaterad
sjuklighet, som lungcancer jämfört med genomsnittsbefolkningen i Sverige,
men samtidigt har de en lägre risk att drabbas av alkoholrelaterad sjuklighet,
som levercirrhos.
Många betydande folkhälsoproblem orsakas av miljöfaktorer i samspel med
en medfödd sårbarhet, t.ex. allergiska sjukdomar och diabetes. Förekomsten
av de genetiska faktorer som orsakar denna sårbarhet skiljer sig mellan olika
befolkningar i världen och fortsätter att påverka risken för dessa sjukdomar
hos migranter även i det nya landet .
Flyktingen har ett annat utgångsläge än den som
flyttar till ett annat land
för att arbeta eller för att bilda familj. Personer som
flyr från sitt hemland har
nästan alltid levt en tid under stor stress innan de
flyr. Själva
flykten är ofta
omgärdad av umbäranden och hot, och många familjer splittras under långa
perioder. Efter ankomsten till det nya landet väntar en tid av ovisshet under
asylprocessen innan det nya livet kan ta sin början. Detta leder sammantaget
till att psykisk ohälsa är ett större problem hos nyanlända
flyktingar än hos
andra grupper av migranter,

"Jag vill ha en annan mamma, en som kan springa ..."

Kerstins fotbollslag ska spela match mot föräldrarna. Kerstins pappa, som brukar vara bäst på plan, kan inte vara med så mamma ska med i stället. Men mamma sitter ju i rullstol, hon kan ju inte spela.

Mamma kommer till matchen och rycker dessutom in som värsta hjälten.

Det här är en berättelse om att ha en förälder som inte är som alla andra, men som kan vara världsbäst ändå!

Denna danska bilderbok bygger på vikten av att prata med barn när deras förälder eller annan vuxen som barnet bor tillsammans med drabbas av psykisk ohälsa.I slutet av boken diskuterar författaren effekterna för barnen och familjen i sin helhet då någon vuxen drabbas av ångest och/eller depression och vad det gör med familjen. Vilka situationer och frågeställningar som kan uppkomma och som behöver förklaras och besvaras för att barnen ska förstå vad som sker. Boken riktar sig till barn mellan 3-10 år.
Boken går att laddda ner på www.issuu.com

På morgonen den 10 december 1996 förändrades Jill Bolte Taylors liv totalt. Den 37-åriga hjärnforskaren drabbades av en kraftig stroke då ett blodkärl brast i vänstra halvan av hjärnan. Inom loppet av några timmar försvann förmågan att tala, läsa, skriva, gå och hennes minne var i det närmaste helt utraderat.

Tiden som följde blev en berg- och dalbana mellan två verkligheter: den euforiska känslan från höger hjärnhalva som styr känslor och kreativitet, och de logiska rationella tankarna från vänstra halvan som talade om för Jill att hon var sjuk och fick henne att söka hjälp i tid.

Det tog åtta år för Jill Bolte Taylor att tillfriskna helt och hållet. Tack vare en otrolig envishet, sin kunskap om hur den mänskliga hjärnan fungerar och inte minst med stor hjälp av sin fantastiska mamma lyckades hon få tillbaka det liv hon en gång hade. Idag anser Jill att stroken var det bästa som kunde hända henne. Genom att tvingas använda sin högra hjärnhalva insåg hon att vi människor kan tillgodogöra oss de känslor av frid och välbehag som den vänstra halvan gör sitt bästa för att trycka ner.

Min stroke tar läsaren med på en fascinerande resa in i den mänskliga hjärnan. Det är både en värdefull hjälp för alla som drabbats av någon form av hjärnskada och ett känslosamt vittnesmål om att djup inre frid är möjligt att uppnå för alla människor, vid alla tillfällen. Boken har i flera veckor legat på topp 10 på New York Times bästsäljarlista för faktaböcker.

Flera tusen barn befinner sig varje år
på ett skyddat boende med sin mamma,
på flykt undan det livsfarliga våldet
hemma. Hur påverkas barnets liv av
våldet och av att tvingas bryta upp från
sin vardag? I den här rapporten lyfts
barns egna röster och erfarenheter,
tillsammans med aktuell kunskap.
Rapporten visar hur barns behov och
rättigheter många gånger blir sekundära
när barnet i praktiken blir medföljande
till sin mamma. Det blir tydligt att
rättssäkerheten måste stärkas för barn
som utsätts för våld i hemmet.

Managing the assets of older people is a common and potentially complex task of informal care with legal, financial, cultural, political and family dimensions. Older people are increasingly recognised -as having significant assets, but the family, the state, service providers and the market have competing interests in their use. Increased policy interest in self-provision and user-charges for services underline the importance of asset management in protecting the current and future health, care and accommodation choices of older people. Although 'minding the money' has generally been included as an informal care-giving task, there is limited recognition of either its growing importance and complexity or of care-givers' involvement. The focus of both policy and practice have been primarily on substitute decision-making and abuse. This paper reports an Australian national survey and semi-structured interviews that have explored the prevalence of non-professional involvement in asset management. The findings reveal the nature and extent of involvement, the tasks that informal carers take on, the management processes that they use, and that 'minding the money' is a common informal care task and mostly undertaken in the private sphere using some risky practices. Assisting informal care-givers with asset management and protecting older people from financial risks and abuse require various strategic policy and practice responses that extend beyond substitute decision-making legislation. Policies and programmes are required: to increase the awareness of the tasks, tensions and practices surrounding asset management; to improve the financial literacy of older people, their informal care-givers and service providers; to ensure access to information, advice and support services; and to develop better accountability practices.

Although the whole family is affected by a parent's palliative disease, palliative care research does not yet routinely consider patients' minor children. Children's and adolescents' psychosocial functioning may be impaired during prolonged parental disease with poor prognosis. Therefore, more and more health care providers are establishing clinical initiatives for families of palliative patients with minor children. However, the number of these family interventions, as well as their theoretical and empirical backgrounds and evidence base, has yet to be determined. The purpose of this study was to systematically review structured and published interventions for this target group, as well as empirical studies on these interventions. The evidence base and impact of interventions on families were considered. Literature published between 1980 and present focusing on psychosocial family-, child- or parent-centered interventions during palliative care was retrieved from PsycINFO®, Embase, MEDLINE®, CINAHL®, and PSYNDEX databases. Five interventions met the inclusion criteria. Programs focused on different populations, had diverse empirical and theoretical backgrounds and features, and were evaluated by studies of varying methodological quality. This systematic review illustrates the lack of well designed and elaborated intervention concepts and evaluation studies in this field, highlighting the necessity of conceptual and methodological rigor to inform clinical practice on a sustainable basis in the future.

Starting university is associated with major academic, personal and social opportunities. For many people, university entrance is also associated with increased stress and alcohol consumption. At the start of the autumn term 2002, all students entering educational programmes at two comparable middle-sized Swedish universities were invited to participate in a comparative intervention study. This included both primary and secondary interventions targeting hazardous drinking and stress. The overall aim was to improve alcohol habits and stress patterns in university freshmen at an intervention university in comparison with a control university.

A total of 2,032 (72%) freshmen responded to the baseline assessment. Half of them scored above traditional AUDIT cut-off levels for hazardous alcohol use. Factors associated with hazardous use were age below 26, male gender, family history of alcohol problems, and not being in a serious relationship. The Arnetz and Hasson Stress Questionnaire was evaluated and used to study a selection of freshmen at high riskof stress. It was easy to use and offered sufficient internal consistency and construct validity. In the freshman year, 517 students (25%) dropped out from university education. A multivariate analysis established that high stress and university setting was associated with dropout from university studies, while symptoms of depression and anxiety as well as hazardous drinking were not.

Outcome was analysed in students remaining at university at one-year follow-up. The primary interventions offered to freshmen at the intervention university reduced alcohol expectancies and mental symptoms compared with freshmen at the control university. Secondary stress interventions were effective in reducing mental symptoms and alcohol expectancies. Secondary alcohol interventions were effective in reducing AUDIT scores, alcohol expectancies, estimated blood alcohol concentrations, as well as stress and mental symptoms.

In conclusion, both primary and secondary alcohol and stress interventions have one-year effects in university freshmen and could be used in university settings.

Ann Gomér berättar sin historia om hur livet förändrades för henne och hennes familj när andra dottern Frida föddes. Frida föddes med omfattande funktionsnedsättningar och läkarna kunde inte riktigt ge henne en diagnos. Många tankar och många svårigheter, men också glädjeämnen mitt i det svåra. Hur livet blir för andra dottern Fanny beskriver Ann, men Fanny själv berättar mer i ett efterord

Den 1 januari 2010 infördes en ny bestämmelse i hälso- och sjukvårdslagen som ger hälso- och sjukvårdens verksamheter och dess personal skyldighet att särskilt beakta barnets behov av information, råd och stöd när en förälder har en psykisk sjukdom, är allvarligt somatiskt sjuk eller missbrukar. Detsamma gäller när en förälder oväntat avlider. Den nya lagstiftningen stärker barns rätt och ställer krav på att ett familjeorienterat synsätt utvecklas inom verksamheter som möter vuxna patienter inom de ovan nämnda grupperna.

Stiftelsen Allmänna Barnhuset och Socialstyrelsen har 2008 -2010 drivit ett gemensamt projekt i syfte att skaffa kunskap om vilka åtgärder som behöver vidtas för att lagen ska få avsedd effekt. Denna bok är en rapport från det arbete och vi hoppas att den kan inspirera, stimulera och visa på möjliga vägar för lokalt och regionalt utvecklingsarbete i syfte att bättre uppmärksamma barn som anhöriga.

I boken framkommer också vilka svårigheter som finns och vikten av ett gemensamt ansvarstagande av de huvudmän som möter barn i dessa situationer.

Several issues impinge on scholars and practitioners interested in adolescent bereavement. First and foremost, adolescent bereavement over the death of a family member or a friend is more prevalent than many persons recognize. Second, scholars and practitioners need models that link adolescent development with adolescent coping during bereavement. Third, models are needed (a) to assist in rethinking what "recovery from bereavement" denotes and (b) to afford criteria for assessing recovery from bereavement. The author reviews findings on bereavement during adolescent development and gives particular attention to three models that enhance our understanding of coping with the life crises bereavement presents to adolescents. One model links grief during adolescence to developmental tasks; another model presents adaptive tasks and coping skills; and the third model identifies sentiments essential for human wholeness. Findings from a variety of studies with bereaved adolescents provide data to test the usefulness of the models. The closing discussion centers on implications for working with bereaved adolescents.

Early life stress (ELS) is expected to increase reactivity of the hypothalamic-pituitary-adrenocortical (HPA) axis; however, several recent studies have shown diminished cortisol reactivity among adults and children with ELS exposure. The goal of this study was to examine cortisol activity in 10-12-year-old internationally adopted children to determine if moderate and severe ELS have different impacts on the HPA axis. Salivary cortisol and two measures of autonomic activity were collected in response to the Trier Social Stress Test for Children (TSST-C). Three groups reflecting moderate, severe, and little ELS were studied: early adopted children who came predominantly from foster care overseas (early adopted/foster care (EA/FC), n=44), later adopted children cared for predominantly in orphanages overseas (late adopted/post-institutionalized (LA/PI), n=42) and non-adopted (NA) children reared continuously by their middle- to upper-income parents in the United States (n=38). Diminished cortisol activity was noted for the EA/FC group (moderate ELS), while the LA/PI group (severe ELS) did not differ from the NA group. Overall, few children showed cortisol elevations to the TSST-C in any group. The presence/absence of severe growth delay at adoption proved to be a critical predictive factor in cortisol activity. Regardless of growth delay, however, LA/PI children exhibited higher sympathetic tone than did NA children. These results suggest that moderate ELS is associated with diminished cortisol activity; however, marked individual differences in cortisol activity among the LA/PI children suggest that child factors modify the impact of severe ELS. Lack of effects of severe ELS even for growth delayed children may reflect the restorative effects of adoption or the generally low responsiveness of this age group to the TSST-C.

Det svenska samhället har under senare delen av 1900-talet påverkats och förändrats på grund av en ökad internationell migration. År 1950 var 2,8 % av den svenska befolkningen utrikesfödd; idag utgör de utrikesfödda 12,0 % av totalbefolkningen. Om även andragenerationens migranter (de som har en eller båda föräldrar utrikesfödda) räknas med utgör första och andragenerationens migranter tillsammans 20 % av Sveriges befolkning. Tidigare studier har visat att migration kan påverka hälsa och hälsoutveckling på både positiva och negativa sätt. Ett accepterat sätt att mäta hälsa och hälsoutveckling är att studera morbiditet och mortalitet i en befolkning. Ett fåtal studier har återfunnits som har undersökt morbiditet och mortalitet bland migranter. Ingen av dessa har haft en longitudinell design och undersökt en total population av migranter i ett land. Det övergripande syftet var att beskriva och jämföra hälsa och hälsoutveckling över tid mellan svenskfödda och utrikesfödda och genom detta att studera migrationens påverkan på hälsa. De fyra i avhandlingen ingående delarbetena bygger på analys av data från Statistiska Centralbyrån och Socialstyrelsens Centrum för Epidemiologi. I databasen har ingått samtliga utrikesfödda, 16 eller äldre som fanns i Sverige 1970. Till varje utrikesfödd person finns en svensk kontroll matchad vad gäller kön, ålder, sysselsättning, yrke och bosättningslän. För 20 518 utrikesfödda personer kunde inte en kontroll skapas på grund av matchningskriterierna; dessutom exkluderades de personer som under den studerade tiden (1970?1999) hade emigrerat från Sverige. Totalt kom databasen som användes för analys att omfatta 723 948 personer, 50 % utrikesfödda och 50 % svenska kontroller. Den första delstudiens syfte var att beskriva och jämföra mortalitet mellan utrikesfödda och svenskfödda under perioden 1970?1999. Resultaten visade en generellt högre dödlighet bland utrikesfödda (OR 1,08) och en lägre medelålder vid tidpunkten för dödsfallet. Speciellt hög mortalitetsrisk återfanns bland män från Finland (OR 1,21), Danmark (OR 1,11) och Norge/Island (OR 1,07). Två ålderskohorter jämfördes, personer födda 1901?1920 respektive personer födda 1921?1944, och analysen visade en högre mortalitet för personer i den äldsta ålderskohorten. Personer som hade invandrat ?sent? till Sverige visade större skillnader i medelålder vid död än de som hade invandrat ?tidigt?; personer som kommit till Sverige under perioden 1941?1970 hade en 2,5 år lägre medelålder vid tiden för dödsfallet. Syftet för den andra delstudien var beskriva, jämföra och analysera dödsorsaksmönster bland utrikesfödda och svenskfödda under perioden 1970?1999. Studiens resultat visade ett större antal avlidna i sex olika ICD-huvuddiagnosgrupper och en lägre medelålder vid tiden för dödsfallet bland utrikesfödda. Födelselandet hade betydelse för dödsorsaksmönstret. Vid jämförelse med de svenska kontrollerna återfanns bland migranter från Danmark ett större antal avlidna i diagnosgruppen ?Neoplasm?, bland migranter från Finland och Polen var skillnaden stor i gruppen ?Diseases of the circulatory system? och personer från tidigare Jugoslavien särskilde sig mot kontrollerna framför allt med ett större antal avlidna i gruppen ?Symptoms, signs and ill-defined conditions?. Över tid fanns en tendens till en utjämning av skillnaderna i diagnosmönstret mellan utrikesfödda och svenskfödda. Då de två tidigare studierna hade visat på skillnader i mortalitet och morbiditet mellan utrikesfödda och svenskfödda kom den tredje studien att som syfte ha att beskriva, jämföra och analysera konsumtion av hälso- och sjukvård i fyra olika ICD-diagnosgrupper. Som mått på sjukvårdskonsumtion användes antal inläggningar på sjukhus, totalt antal vårddagar och vårddagar under de två sista inläggningstillfällena på sjukhus bland avlidna utrikesfödda och svenskfödda 1987?1999. Resultatet visade en tendens till mindre sjukvårdskonsumtion bland utrikesfödda, särskild vad gäller utrikesfödda män. Mindre sjukvårdskonsumtion för utrikesfödda återfanns i två av de fyra använda diagnosgrupperna (?Symptoms, signs and ill-defined conditions? och ?Injury and poisoning ?). Att vara utrikesfödd, justerat för ålder, var en oberoende bestämmande faktor för inläggning på sjukhus. Den nollhypotes som formulerats vid studiens start, att skillnader mellan utrikesfödda och svenskfödda beträffande sjukvårdkonsumtion inte fanns, kunde tillbakavisas. Det sista delarbetets syfte var att beskriva och jämföra skillnader i mortalitet i olika landsting mellan utrikesfödda och svenskfödda med en formulerad nollhypotes att inga mortalitetsskillnader fanns mellan olika landsting. Studiens resultat kunde tillbakavisa nollhypotesen, det fanns skillnader i mortalitet mellan utrikesfödda och svenskfödda framför allt i de län som kunde karaktäriseras som mera ?landsbygds?-dominerade. Landsbygdsdominerade län hade också gemensamt att deras populationer av migranter var förhållandevis små. Medelåldern vid tiden för avlidande var för män mellan 1,0?4,3 år lägre för utrikesfödda personer. Resultaten av de i avhandlingen ingående fyra olika studierna visar högre dödlighet, annorlunda sjukdomsmönster och tendens till lägre konsumtion av vård bland utrikesfödda än bland svenskfödda personer under perioden 1970?1999. Flera faktorer, såsom ekonomisk situation, arbete, arbetsmiljö, arbetslöshet, sociala nätverk och situationen före migrationen kan ha påverkat de utrikesföddas sämre hälsoläge. Den fysiska och sociala miljön och eventuella ojämlikheter i sjukvårdsresurser och tillgång till vård spelar också en viktig roll. Migrationen har haft en negativ inverkan på de utrikesföddas hälsa och är en viktig faktor att ta hänsyn till vid studier av hälsa och hälsoutveckling bland befolkningen i ett land

This study examined the relationship of caregiving roles to labor force participation using the nationally representative data from the Health and Retirement Study. The sample was composed of men and women aged 50 to 61 years (N = 5,119). Caregiving roles included caregiving for spouse, parents, and grandchildren; a summary of three caregiving roles was used to indicate multiple caregiving roles. Bivariate analysis using chi-square and t tests and binary logistic regression models were applied. Results show that women caregivers for parents and/or grandchildren were less likely to be in the labor force than non-caregivers and that caregiving responsibility was not related to labor force participation for the sample of men. Findings have implication for supporting family caregivers, especially women, to balance work and caregiving commitments.

Abstract

Background

Bereavement by spousal death and child death in adulthood has been shown to lead to an increased risk of mortality. Maternal death in infancy or parental death in early childhood may have an impact on mortality but evidence has been limited to short-term or selected causes of death. Little is known about long-term or cause-specific mortality after parental death in childhood.

Methods and Findings

This cohort study included all persons born in Denmark from 1968 to 2008 (n = 2,789,807) and in Sweden from 1973 to 2006 (n = 3,380,301), and a random sample of 89.3% of all born in Finland from 1987 to 2007 (n = 1,131,905). A total of 189,094 persons were included in the exposed cohort when they lost a parent before 18 years old. Log-linear Poisson regression was used to estimate mortality rate ratio (MRR). Parental death was associated with a 50% increased all-cause mortality (MRR = 1.50, 95% CI 1.43–1.58). The risks were increased for most specific cause groups and the highest MRRs were observed when the cause of child death and the cause of parental death were in the same category. Parental unnatural death was associated with a higher mortality risk (MRR = 1.84, 95% CI 1.71–2.00) than parental natural death (MRR = 1.33, 95% CI 1.24–1.41). The magnitude of the associations varied according to type of death and age at bereavement over different follow-up periods. The main limitation of the study is the lack of data on post-bereavement information on the quality of the parent-child relationship, lifestyles, and common physical environment.

Conclusions

Parental death in childhood or adolescence is associated with increased all-cause mortality into early adulthood. Since an increased mortality reflects both genetic susceptibility and long-term impacts of parental death on health and social well-being, our findings have implications in clinical responses and public health strategies.

Abstract:
Background Most research on parental bereavement and health have analysed health consequences of parental loss in childhood, while collateral health in adulthood has been less studied. Methods Using register-based population data from Finland, we analyse adult offspring aged 18–50 years with discrete-time hazard models that adjust for offspring and parental socioeconomic and demographic characteristics. In focus are adult children whose parents were alive and lived together at the beginning of the observation period. We compare two culturally distinct but otherwise similar ethno-linguistic groups, Finnish speakers and Swedish speakers. Results The results suggest that bereaved men have an approximately 30% higher death risk than non-bereaved men, while there is practically no difference in women. Associations between parental and child deaths are, as expected, stronger for concordant causes of death than for discordant causes of death. However, some associations for discordant causes of death remain, which may indicate causality. Among Swedish speakers, who have notably higher family stability than Finnish speakers, the death of one or both parents shows a stronger association with own mortality. Conclusions The estimated associations found are generally larger than in the neighbouring country Sweden, which may be due to a stronger obedience to traditional family values and patriarchal family roles in Finland. These findings suggest that the association between parental death and mortality in adult offspring may depend on the societal context as well as on cultural practices. These factors should be increasingly acknowledged in future studies on collateral health.

Abstract
BACKGROUND:
Little is known about the effect of parental bereavement on physical health. We investigated whether the death of a child increased mortality in parents.
METHODS:
We undertook a follow-up study based on national registers. From 1980 to 1996, we enrolled 21062 parents in Denmark who had a child who had died (exposed cohort), and 293745 controls--ie, parents whose children were alive, and whose family structure matched that of the exposed cohort. Natural deaths were defined with ICD8 codes 0000-7969 and ICD10 codes A00-R99, and unnatural deaths with codes 8000-9999 and V01-Y98. We used Cox's proportional-hazards regression models to assess the mortality rate of parents up to 18 years after bereavement.
FINDINGS:
We observed an increased overall mortality rate in mothers whose child had died (hazards ratio 1.43, 95% CI 1.24-1.64; p<0.0001). An excess mortality from natural causes (1.44, 1.15-1.78; p<0.0001) was noted in mothers only during the 10th-18th year of follow-up. Mothers had increased mortality rates from unnatural causes throughout follow-up, with the highest rate recorded during the first 3 years (3.84, 2.48-5.88; p<0.0001). Bereaved fathers had only an early excess mortality from unnatural causes (1.57, 1.06-2.32; p=0.04). Mothers who lost a child due to an unnatural death or an unexpected death had a hazard ratio of 1.72 (1.38-2.15; p=0.0040) and 1.67 (1.37-2.03; p=0.0037), respectively.
INTERPRETATION:
The death of a child is associated with an overall increased mortality from both natural and unnatural causes in mothers, and an early increased mortality from unnatural causes in fathers.

Abstract
BACKGROUND:
Growing up with one parent has become increasingly common, and seems to entail disadvantages in terms of socioeconomic circumstances and health. We aimed to investigate differences in mortality, severe morbidity, and injury between children living in households with one adult and those living in households with two adults.
METHODS:
In this population-based study, we assessed overall and cause-specific mortality between 1991 and 1998 and risk of admission between 1991 and 1999 for 65085 children with single parents and 921257 children with two parents. We estimated relative risks by Poisson regression, adjusted for factors that might be presumed to select people into single parenthood, and for other factors, mainly resulting from single parenthood, that might have affected the relation between type of parenting and risk.
FINDINGS:
Children with single parents showed increased risks of psychiatric disease, suicide or suicide attempt, injury, and addiction. After adjustment for confounding factors, such as socioeconomic status and parents' addiction or mental disease, children in single-parent households had increased risks compared with those in two-parent households for psychiatric disease in childhood (relative risk for girls 2.1 [95% CI 1.9-2.3] and boys 2.5 [2.3-2.8]), suicide attempt (girls 2.0 [1.9-2.2], boys 2.3 [2.1-2.6]), alcohol-related disease (girls 2.4 [2.2-2.7], boys 2.2 [2.0-2.4]), and narcotics-related disease (girls 3.2 [2.7-3.7], boys 4.0 [3.5-4.5]). Boys in single-parent families were more likely to develop psychiatric disease and narcotics-related disease than were girls, and they also had a raised risk of all-cause mortality.
CONCLUSIONS:
Growing up in a single-parent family has disadvantages to the health of the child. Lack of household resources plays a major part in increased risks. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, children of single parents still have increased risks of mortality, severe morbidity, and injury.

Background
Growing up with one parent has become increasingly common, and seems to entail disadvantages in terms of socioeconomic circumstances and health. We aimed to investigate differences in mortality, severe morbidity, and injury between children living in households with one adult and those living in households with two adults.

Methods
In this population-based study, we assessed overall and cause-specific mortality between 1991 and 1998 and risk of admission between 1991 and 1999 for 65 085 children with single parents and 921 257 children with two parents. We estimated relative risks by Poisson regression, adjusted for factors that might be presumed to select people into single parenthood, and for other factors, mainly resulting from single parenthood, that might have affected the relation between type of parenting and risk.

Findings
Children with single parents showed increased risks of psychiatric disease, suicide or suicide attempt, injury, and addiction. After adjustment for confounding factors, such as socioeconomic status and parents' addiction or mental disease, children in single-parent households had increased risks compared with those in two-parent households for psychiatric disease in childhood (relative risk for girls 2·1 [95% CI 1·9–2·3] and boys 2·5 [2·3–2·8]), suicide attempt (girls 2·0 [1·9–2·2], boys 2·3 [2·1–2·6]), alcohol-related disease (girls 2·4 [2·2–2·7], boys 2·2 [2·0–2·4]), and narcotics-related disease (girls 3·2 [2·7–3·7], boys 4·0 [3·5–4·5]). Boys in single-parent families were more likely to develop psychiatric disease and narcotics-related disease than were girls, and they also had a raised risk of all-cause mortality.

Conclusions
Growing up in a single-parent family has disadvantages to the health of the child. Lack of household resources plays a major part in increased risks. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, children of single parents still have increased risks of mortality, severe morbidity, and injury.

Boken handlar om tjugo unga människors uppväxtvillkor. Gemensamt för dem är att en eller båda föräldrarna varit tunga narkotikamissbrukare under deras uppväxt. Gemensamt för dem är också att de flesta upplevt ett antal separationer från föräldrar eller andra viktiga vuxna. Det är också uppenbart att de flesta av dem trots denna bakgrund har en positiv syn på livet och framtiden. Den övergripande frågan som ställs i boken är hur man kan lyckas i livet - mot alla odds.

I boken som bygger på djupintervjuer med de unga personerna, diskuteras de faktorer som kan vara avgörande för barns återhämtningsförmåga eller motståndskraft. Det här är ett till stor del outforskat område (forskningen har hittills varit inriktad på brist- eller riskfaktorer) och kan hjälpa dem som arbetar inom vård- och behandling att hitta nya metoder och förhållningssätt i arbetet med barn i missbruksfamiljer.

PURPOSE/OBJECTIVES: To describe mothers' reported methods of interacting with the mothers' school-age children about their breast cancer. DESIGN: Qualitative. SETTING/SAMPLE: 19 mothers newly diagnosed with breast cancer. Mothers received treatment for their illness in the Pacific Northwest. Mothers had at least one child between 7 and 12 years old at the time of diagnosis. METHODS: Case-intensive, in-home, semistructured interviews were audiotaped, transcribed, and inductively coded into four conceptual domains and 16 categories of behavioral strategies used by the mothers to interact with their children about the breast cancer. MAIN RESEARCH VARIABLES: Behavioral strategies used by mothers when interacting with the children about the breast cancer and when providing children with support. FINDINGS: Mothers used a number of methods to bring children into the mothers' breast cancer experience. The conceptual domains included talking about the breast cancer, explaining treatment and care, providing experiences, and doing things to help children cope. CONCLUSIONS: The dominant pattern in the interview data was for mothers to assume a teacher/educator role with the children about the cancer, not an interactive, emotive-expressive parenting role. Most mothers used technical biomedical language; did not give evidence of systematically checking on the children's understanding of what they were told; did not elicit the children's concerns; and exposed the children to emotionally laden or potentially frightening images, words, or experiences. IMPLICATIONS FOR NURSING PRACTICE: Programs and materials need to be developed that help mothers work from a model of parenting that includes developmentally appropriate language, facilitates the children's expression of questions and feelings, links the mothers with the children's understanding of the illness, and assists the children to better manage what is happening related to the breast cancer.

Semistructured interviews were conducted with 26 mothers who had one or more children(N = 36) aged 8 to 12 years when they were diagnosed with early stage breast cancer. Formal methods were used to analyze the content of the data inductively. Mothers identified times during their diagnosis and treatment that were most difficult for their children, behaviors they observed indicating that the child was having a difficult time, and factors that prevented them from helping the child during those difficult times. The data provide a partial basis for developing materials, programs, and services designed to minimize the children's distress and to enhance the effectiveness of' parenting when a mother has early stage breast cancer.

Mothers with learning difficulties1 are thought to be among the most socially isolated parents in the community. A great deal of attention has been directed to assessing their parenting abilities and teaching parenting skills, but less has been given to the support that mothers may (or may not) receive from family, friends and the service system. The present paper investigates mothers' views about the types of support which they receive and from whom they receive it. Data were derived from 70 mothers who participated in interviews using a support interview guide designed to accommodate the mothers' cognitive difficulties. The primary purpose of the interview was to explore the quantity and composition of the mothers' support networks, the frequency of contact and geographical proximity of support people, and the type of support provided. Key findings include: the central place that family members have in these mothers' lives; the importance of service providers as sources of information and advice; and the relative absence of friends and neighbours. Briefly, mothers living alone have service-centred networks, mothers living with a partner have family-centred networks with relatively dispersed family ties, and mothers living in a parent/parent-figure household have local, family-centred networks. The overall conclusion to be drawn from the present results is that these mothers do not live in a social vacuum, but many are socially isolated. The finding that so few mothers could identify supportive ties with friends and neighbours suggests that these mothers are isolated from their local communities and are potentially vulnerable if a breakdown occurs in the support provided by their families. The need for service providers to be more actively involved in linking mothers to their communities is discussed.

Since the initial publication of this breakthrough work, Motivational Interviewing (MI) has been used by countless clinicians. Theory and methods have evolved apace, reflecting new knowledge on the process of behavior change, a growing body of outcome research, and the development of new applications within and beyond the addictions field. Extensively rewritten, this revised and expanded second edition now brings MI practitioners and trainees fully up to date. William R. Miller and Stephen Rollnick explain how to work through ambivalence to facilitate change, present detailed guidelines for using their approach, and reflect on the process of learning MI. Chapters contributed by other leading experts then address such special topics as MI and the stages-of-change model, applications in medical, public health, and criminal justice settings, and using the approach with groups, couples, and adolescents.

This meta-analysis summarizes results from k = 24 studies comparing either Brief Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, or Multisystemic Therapy to either treatment-as-usual, an alternative therapy, or a control group in the treatment of adolescent substance abuse and delinquency. Additionally, the authors reviewed and applied three advanced meta-analysis methods including influence analysis, multivariate meta-analysis, and publication bias analyses. The results suggested that as a group the four family therapies had statistically significant, but modest effects as compared to treatment-as-usual (d = 0.21; k = 11) and as compared to alternative therapies (d = 0.26; k = 11). The effect of family therapy compared to control was larger (d = 0.70; k = 4) but was not statistically significant probably because of low power. There was insufficient evidence to determine whether the various models differed in their effectiveness relative to each other. Influence analyses suggested that three studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered but will be useful as this literature grows.

Objectives: Dementia increasingly diminishes the ability to communicate. We aimed to develop and evaluate a psychosocial intervention program that focuses on communication in dementia care. This was intended to enhance the quality of life (QoL) of people with dementia and to reduce the burden on their informal caregivers. Method: A training program for informal caregivers of people with dementia was developed. The training combines the expertise of geriatric psychiatry, geriatric care, and educational psychology. Caregivers acquire and deepen competencies required to improve communication in dementia care. The training was evaluated with a pre-post-control group design and time-series analyses. Twenty-four informal caregivers participated in the study. Results: The results of the study provide evidence that TANDEM training increases caregivers' use of strategies that are relevant for communication in dementia care and the care receivers' QoL. Conclusion: The results of research in this program show the relevance of including caregivers in interventions and the importance of communication for the QoL of people with dementia.

Families, applied researchers, and teachers and support providers continue to be interested in effective strategies for teaching generalized repertoires of communicative skills to learners with severe disabilities. The present study assessed the effects of a general case training procedure in establishing manding or requesting responses by three students, aged 5–10 yrs old, with severe disabilities across a range of settings and situations. The data indicated that the general case approach was successful in establishing generalized manding for all three students. The limitations of the study and the implications of these results for future research and application are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

We reviewed nine studies evaluating the use of tangible symbols in AAC interventions for 129 individuals with developmental disabilities. Studies were summarized in terms of participants, tangible symbols used, communication functions/skills targeted for intervention, intervention procedures, evaluation designs, and main findings. Tangible symbols mainly consisted of three-dimensional whole objects or partial objects. Symbols were taught as requests for preferred objects/activities in five studies with additional communication functions (e.g., naming, choice making, protesting) also taught in three studies. One study focused on naming activities. With intervention, 54% (n = 70) of the participants, who ranged from 3 to 20 years of age, learned to use tangible symbols to communicate. However, these findings must be interpreted with caution due to pre-experimental or quasi-experimental designs in five of the nine studies. Overall, tangible symbols appear promising, but additional studies are needed to establish their relative merits as a communication mode for people with developmental disabilities.

A 3-yr study on the use of tangible symbols (i.e., objects and pictures used as symbols) by 41 children (aged 3–18 yrs) with a variety of handicapping conditions was conducted to follow up on an earlier study by the authors (see record 1990-15438-001) that revealed their utility for children who are deafblind. The vast majority of participants learned to use tangible symbols, allowing them to overcome the restrictions imposed by gestural communication. A number of the participants progressed beyond tangible symbols and learned to use abstract symbol systems, including speech. A few of the participants did not learn to use tangible symbols during the time span available for intervention. Data describing the progress of participants are presented. Participants are grouped according to outcome, and the characteristics of each group are discussed in terms of the communication skills of participants as they began intervention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Recent years have brought a dramatic rise in the number of efforts to measure and monitor the status of children. Yet, despite numerous efforts and reports with 'Child indicators' in the title, the field of social child indication is fragmented and lacking a unifying taxonomy. The more ambitious the analysis and the more elaborate the statistics, the stronger the need for a common language used by all. This article tries to suggest such a taxonomy.

In the Holocaust literature, considerable attention has been given to the psychological impact of Holocaust survivors' trauma on their offspring. There is some evidence to show that parenting styles and parent-child communication regarding the Holocaust are important mechanisms through which survivors' trauma affects the psychological adjustment of their offspring. The present study extends this work to a Cambodian context in focusing on intergenerational effects of trauma stemming from the Khmer Rouge regime. Specifically, the effects of parental unresolved trauma, in terms of the mother's PTSD symptoms, on second generation Cambodian adolescents were examined. Extrapolating from the findings in the Holocaust literature on second generation effects of trauma, it was hypothesized that the severity of the mother's trauma symptoms stemming from the Khmer Rouge regime would be predictive of her child's level of psychological distress, and that this relationship would be mediated by parenting style and parent-child communication. It was also predicted that the child's level of bicultural integration would serve as a protective factor in moderating the impact of the mother's trauma such that a child with a higher level of bicultural integration would be less negatively psychologically affected.

The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology .
Anda R.F., Felitti V.J., Bremner J.D., Walker J.D., Whitfield C., Perry B.D., Dube S.R. & Giles W.H. ( 2005 ) European Archives of Psychiatry and Clinical Neuroscience , ePub, posted online 29 November 2005 .

Background Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being.

Methods After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological 'case example' of the convergence between epidemiological and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17 337 adult HMO (Health Maintenance Organization) members and assessed eight adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a 'dose–response' relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity).

Results Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression-related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score.

Conclusions The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.

Background

Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being.

Methods

After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological "case example" of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity).

Results

Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression-related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score.

Conclusions

The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.

In 2005, approximately 211,240 women in the US will be diagnosed with early stage breast cancer and an estimated 22% will be child rearing. Research reveals that both mothers and children have elevated distress attributed to the cancer; struggle with how to talk about and deal with the impact of the cancer; and both fear the mother will die. The Enhancing Connections Program (EC) was developed to reduce this cancer-related distress and morbidity. The program involves five, 1-hour educational counseling sessions delivered at 2-week intervals by specially trained clinicians. This study reports on the program's short-term impact on mothers' and children's adjustment. Thirteen households were recruited within 7.5 months of the mother's diagnosis with early stage breast cancer. Impact was evaluated within a single group design using data obtained from standardized questionnaires with established reliability and validity. Results revealed significant improvements in the mother's depressed mood, anxiety, and self-confidence to assist her child (mother report). There were also significant decreases in the child's behavioral problems (mother and father report); the child's cancer-related worries (child report); and the child's anxiety/depressed mood (mother and father report). Further evaluation is warranted within a clinical trial.

I en språkutvecklande förskolemiljö ligger fokus på barncentrerad kommunikation där det vardagliga samspelet är grunden. Olika sätt att kommunicera tillåts och uppmuntras. Barn ges möjlighet att använda alla sinnen – kroppsspråk, minspel, röstläge, intonation, beröring, blickkontakt och tecken.

Boken handlar om hur användandet av TAKK stärker kommunikationen i förskolan. TAKK innebär att låna tecken från det svenska teckenspråket och använda dessa tecken som ett alternativ och ett komplement i det kommunikativa samspelet. De viktigaste orden i meningen förstärks med tecken samtidigt som vi talar.

Författaren ger inspiration och konkreta förslag för att komma i gång att arbeta med TAKK i förskolegruppen.

Background: Family education, training, and counselling programmes have been cited as one way to complement traditional interventions for the individual with aphasia. However, the literature still represents the speech‐language pathologist as the expert in a directive role. Aims: This article describes the second phase of a research study aimed at addressing the psychosocial sequelae of aphasia by developing and studying the effects of a learner‐centred training programme for spouses of adults with chronic aphasia designed to improve conversational interaction between couples. The first phase of this research included the development of a communication‐training programme that integrated principles and strategies from speech‐language pathology and adult education (Sorin‐Peters, 2002). The second phase described in this paper included the delivery and evaluation of the programme using a qualitative case study methodology. The use of the qualitative case study methodology to study the psychosocial consequences of aphasia is described in a companion paper (Sorin‐Peters, 2004). This paper presents the results of one qualitative case study in detail to demonstrate how the qualitative case study methodology was implemented, and a summary of the cross‐case analysis for the five couples, examining the effectiveness of the programme. Methods & Procedures: Using videotaped data, the Couple Questionnaire, and a semi‐structured interview, this study examined changes in attitudes and communication behaviours in five couples immediately after conversation partner training and at 2 months follow‐up. All data were transcribed and analysed for patterns of change. Outcomes & Results: Communication outcomes included changes in conversational interaction as well as in the transaction of information in conversation for all five couples. These included positive changes in the management of conversational repair. There was more balanced control after training and the cognitive competence of the partners with aphasia was revealed following the training. In addition, different conversational genres emerged throughout the programme that could be organised hierarchically. Results indicated ways in which the adult learning principles were actualised across the five cases. Themes emerged related to the expression of emotion about aphasia, including feelings of anger, sadness, and grief, and increased acceptance of the aphasia after the training. Themes related to marital issues emerged and were intertwined with emotions and communication. Conclusions: The adult learning model approach promoted positive and comprehensive changes, and perhaps more than those achieved via existing medical‐model or psychosocial approaches. The adult learning approach to individuals with chronic aphasia extends the existing psychosocial model by acknowledging both the spouse's and person with aphasia's competence as adult learners, by viewing the person with aphasia not only as part of a social unit, including the family, but also as part of a broader system, including multiple environmental and cultural factors that interact interdependently to effect change, and by focusing on the importance of communication for the expression of emotions and the maintenance and development of marital relations. The results suggest the benefits of the expansion of the speech‐language pathologist's role with couples with aphasia to include an adult learning approach to improving conversational interaction between people with aphasia and their spouses.

Background: Family education, training, and counselling programmes have been cited as one way to complement traditional interventions for the individual with aphasia. However, the literature still represents the speech‐language pathologist as the expert in a directive role. Aims: This article describes the second phase of a research study aimed at addressing the psychosocial sequelae of aphasia by developing and studying the effects of a learner‐centred training programme for spouses of adults with chronic aphasia designed to improve conversational interaction between couples. The first phase of this research included the development of a communication‐training programme that integrated principles and strategies from speech‐language pathology and adult education (Sorin‐Peters, 2002). The second phase described in this paper included the delivery and evaluation of the programme using a qualitative case study methodology. The use of the qualitative case study methodology to study the psychosocial consequences of aphasia is described in a companion paper (Sorin‐Peters, 2004). This paper presents the results of one qualitative case study in detail to demonstrate how the qualitative case study methodology was implemented, and a summary of the cross‐case analysis for the five couples, examining the effectiveness of the programme. Methods & Procedures: Using videotaped data, the Couple Questionnaire, and a semi‐structured interview, this study examined changes in attitudes and communication behaviours in five couples immediately after conversation partner training and at 2 months follow‐up. All data were transcribed and analysed for patterns of change. Outcomes & Results: Communication outcomes included changes in conversational interaction as well as in the transaction of information in conversation for all five couples. These included positive changes in the management of conversational repair. There was more balanced control after training and the cognitive competence of the partners with aphasia was revealed following the training. In addition, different conversational genres emerged throughout the programme that could be organised hierarchically. Results indicated ways in which the adult learning principles were actualised across the five cases. Themes emerged related to the expression of emotion about aphasia, including feelings of anger, sadness, and grief, and increased acceptance of the aphasia after the training. Themes related to marital issues emerged and were intertwined with emotions and communication. Conclusions: The adult learning model approach promoted positive and comprehensive changes, and perhaps more than those achieved via existing medical‐model or psychosocial approaches. The adult learning approach to individuals with chronic aphasia extends the existing psychosocial model by acknowledging both the spouse's and person with aphasia's competence as adult learners, by viewing the person with aphasia not only as part of a social unit, including the family, but also as part of a broader system, including multiple environmental and cultural factors that interact interdependently to effect change, and by focusing on the importance of communication for the expression of emotions and the maintenance and development of marital relations. The results suggest the benefits of the expansion of the speech‐language pathologist's role with couples with aphasia to include an adult learning approach to improving conversational interaction between people with aphasia and their spouses.

OBJECTIVES: The aim was to describe the existential life situations of spouses
who care for persons with dementia, before and after relocation to nursing homes.
METHOD: This was a qualitative study among 11 spouses of persons with dementia,
recruited via purposeful sampling. Data were collected through interviews and
analysed with interpretive content analysis.
RESULTS: Before the relocation to nursing homes, the spouses' existential life
situations were characterized by feelings of shame and guilt, being isolated in
the home. Spouses were also exposed to psychological threats, physical violence,
and had feelings of placing one's own needs last. After the relocation, spouses
described feelings of guilt and freedom, living with grief and thoughts of death,
feelings of loneliness in the spousal relationship, and striving for acceptance
despite a lack of completion.
CONCLUSION: The existential life situation of spouses of persons with dementia is
about being in limit situations which changes when the ill person relocates to a
nursing home. This is important knowledge for health care staff to bear in mind
at nursing homes when encountering spouses.

Teknik för äldre är ett regeringsuppdrag som samordnats av Hjälpmedelsinstitutet. Det har verkat sedan 2007 med en budget om 22 miljoner kronor årligen. Teknik för äldre har stöttat utvecklingen av bra produkter och tjänster som underlättar vardagen och boendet för äldre och anhöriga. Företag, organisationer och kommuner har kunnat ansöka om ekonomiskt stöd för att driva utvecklingsprojekt. 100 projekt har fått stöd inom Teknik för äldre I (2007-2009) och 61 projekt inom teknik för äldre II (2010-2012). Bidrag om sex miljoner kronor vardera har lämnats till kommunala försöksverksamheter i Göteborgs stad, Norrköpings kommun och Västerås stad. Inom Teknik för äldre II har projekt prioriterats som bidragit till tillgängligt boende, bättre stöd till anhöriga och utveckling av äldreomsorgen med hjälp av välfärdsteknologi. Informations- och kommunikationsinsatser har också varit i fokus.

Abstract [en]
Policy makers in Sweden and other European Member States pay increasing attention as to how best support working carers; carers juggling providing unpaid family care for older family members while performing paid work. Exploring perceived benefits and challenges with web-based information and communication technologies as a means of supporting working carers' in their caregiving role, this paper draws on findings from a qualitative study. The study aimed to describe working carers' experiences of having access to the web-based family care support network 'A good place' (AGP) provided by the municipality to support those caring for an older family member. Content analysis of interviews with nine working carers revealed three themes: A support hub, connections to peers, personnel and knowledge; Experiencing ICT support as relevant in changing life circumstances; and Upholding one's personal firewall. Findings indicate that the web-based family care support network AGP is an accessible, complementary means of support. Utilising support while balancing caregiving, work obligations and responsibilities was made easier with access to AGP; enabling working carers to access information, psychosocial support and learning opportunities. In particular, it provided channels for carers to share experiences with others, to be informed, and to gain insights into medical and care issues. This reinforced working carers' sense of competence, helping them meet caregiving demands and see positive aspects in their situation. Carers' low levels of digital skills and anxieties about using computer-based support were barriers to utilising web-based support and could lead to deprioritising of this support. However, to help carers overcome these barriers and to better match web-based support to working carers' preferences and situations, web-based support must be introduced in a timely manner and must more accurately meet each working carer's unique caregiving needs.

Abstract [en]

This article presents an integrative literature review of the experience of dementia care associated with the extended palliative phase of dementia. The aim was to highlight how dementia is defined in the literature and describe what is known about the symptomatology and management of advanced dementia regarding the needs and preferences of the person with dementia and their family carer/s. There was no consistent definition of advanced dementia. The extended palliative phase was generally synonymous with end-of-life care. Advanced care planning is purported to enable professionals to work together with people with dementia and their families. A lack of understanding of palliative care among frontline practitioners was related to a dearth of educational opportunities in advanced dementia care. There are few robust concepts and theories that embrace living the best life possible during the later stages of dementia. These findings informed our subsequent work around the concept, 'Dementia Palliare'.

This article presents an experimental evaluation of the Family Bereavement Program (FBP), a 2-component group intervention for parentally bereaved children ages 8-16. The program involved separate groups for caregivers, adolescents, and children, which were designed to change potentially modifiable risk and protective factors for bereaved children. The evaluation involved random assignment of 156 families (244 children and adolescents) to the FBP or a self-study condition. Families participated in assessments at pretest, posttest, and 11-month follow-up. Results indicated that the FBP led to improved parenting, coping, and caregiver mental health and to reductions in stressful events at posttest. At follow-up, the FBP led to reduced internalizing and externalizing problems, but only for girls and those who had higher problem scores at baseline.

Abstract:
Background: Children show long-term psychological distress if family communication and illness-related information are poor during and after a parent's illness and death. Few psychosocial interventions for families with minor children living with a parent who has a life-threatening illness have been evaluated rigorously. Even fewer interventions have been family-centered. One exception is the Family Talk Intervention (FTI), which has shown promising results regarding increased illness-related knowledge and improved family communication. However, FTI has not yet been evaluated in palliative care. This study therefore aimed to explore the potential effects of FTI from the perspectives of minor children whose parent is cared for in specialized palliative home care. Methods: This pilot intervention study involves questionnaire and interview data collected from children after participation in FTI. Families were recruited from two specialized palliative home care units. To be included, families must include one parent with life-threatening illness, at least one child aged 6–19 years, and understand and speak Swedish. Twenty families with a total of 34 children participated in FTI; 23 children answered the questionnaire, and 22 were interviewed after participation. Results: The children reported that FTI increased their knowledge about their parents' illness. They said the interventionist helped them to handle school-related problems, establish professional counselling, and find strength to maintain everyday life. Children aged 8–12 reported that talking with their parents became easier after FTI, whereas communication was unchanged for teenagers and between siblings. Children also reported having been helped to prepare for the future, and that they benefitted from advice about how to maintain everyday life and minimize conflicts within the family. Conclusions: Children who participated in FTI reported that it was helpful in many ways, providing illness-related information and improving family communication when a parent has a life-threatening illness. Other potential positive effects reported by the children were that FTI facilitated their preparation for the future, decreased family conflicts, and started to build up resilience.

Purpose: This study evaluated the effectiveness of telephone groups for older, spousal caregivers of stroke survivors. Method: The 88 caregivers were mostly white females who were 70 years old on average and who had been providing care for an average of 3 years. Participants were randomized to treatment or control conditions, followed for 6 months, and assessed for depression, burden, loneliness, stress, and competence. Treatment participants engaged in an eight-session psychoeducational telephone group. Results: Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress. Control participants showed a significant increase in burden during the study; treatment participants showed a significant increase in competence.

För att stödja anhöriga med behov av extra stöd i samband med en närståendes
flytt till äldreboenden erbjöd Östermalms stadsdelsförvaltning under 2011 anhörigstöd
i form av gruppsamtal, så kallat fördjupat anhörigstöd. Målet med det
fördjupade anhörigstödet var att stödja anhöriga som gått igenom den svåra
processen att fatta beslutet om närståendes flytt. En terapeut ledde sammankomsterna
och stadsdelsförvaltningens anhörigkonsulent var behjälplig i detta arbete.
Stiftelsen Äldrecentrum fick i uppdrag av Östermalms stadsdelsförvaltning att
göra en deskriptiv studie av deltagarnas erfarenheter av att vara med i pilotprojektet
med fördjupat anhörigstöd. Syftet var att beskriva vad det fördjupade
anhörigstödet innebär samt att redogöra för deltagarnas erfarenheter. De fem
anhöriga, samtliga kvinnor, som deltog i det fördjupade anhörigstödet intervjuades.
Intervjuer genomfördes även med ledarna för gruppsammankomsterna.
Ett fördjupat anhörigstöd är terapi, där det handlar om att få verktyg för att
kanske välja en annan väg och att gå vidare. Man berör tidigare upplevelser i livet
och kopplar dessa till den anhöriges nuvarande situation. I ett fördjupat anhörigstöd
får den anhörige hjälp att bearbeta sin situation, vilket möjliggör för deltagarna
att komma ur sin kris.
Inom ramen för det fördjupade anhörigstödet genomfördes totalt tio gruppsammankomster.
Deltagarnas erfarenheter av sammankomsterna visade bland
annat att:
 Samtliga deltagare var mycket nöjda med det fördjupade anhörigstödet
Träffarna beskrevs som innehållsrika och intensiva.
 Deltagarna lyfte fram det positiva med sammankomsterna dels den goda
sammanhållningen i gruppen dels ledarnas engagemang och stöd.
 Tre av deltagarna ansåg att de hade fått ut det de hoppades på av det
fördjupade anhörigstödet, en visste inte och en deltagare sa att hon tyckte att
det var positivt att gå dit och att hon hade mått bra i stunden.
När det fördjupade anhörigstödet avslutades erbjöds deltagarna att fortsätta sina
sammankomster själva. Samtliga deltagare har också möjlighet till fortsatt kontakt
med anhörigkonsulenten.
Möjligheten för anhöriga att få hjälp att bearbeta sorg och förlust behöver uppmärksammas
i större utsträckning i det anhörigstöd som ges. Pilotprojektet
"Fördjupat anhörigstöd" är en intressant stödform som visar att behov finns av
stöd till anhöriga i en svår och utsatt situation. Stödformen behöver prövas och utvecklas
ytterligare. Ett område att få mer kunskap om är hur stort behovet av
terapi är för att stödja anhöriga. Intressant vore att prova olika terapiformer. En
annan intressant utveckling skulle vara att genomföra ett fördjupat anhörigstöd i
samverkan mellan kommun och landsting.

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.

Kunskapsstödet presenterar en modell för hur samordning av insatser för barn med funktionsnedsättning kan förbättras av kommuner och landsting. Modellen förväntas öka barns tillgång till fungerande stöd och minska föräldrars arbetsbelastning. Här ges organisatoriska och praktiska framgångsfaktorer i arbetet med att utveckla samordning.

Avhandling

Bakgrund. När människor är inkluderade i varandras liv påverkar en förändring av livssituationen hos en person även de övriga personerna som står den nära. Det innebär att när en person drabbas av ohälsa eller sjukdom påverkas även personens familj. Familjens upplevelse av den situation som uppstår i samband med ohälsa kan dessutom negativt påverka familjemedlemmarnas medvetenhet om familjens tillgängliga styrkor och resurser, vilket i sin tur kan påverka familjers kamp för att återfå och bibehålla hälsa. Traditionellt sett har vården fokuserat på att erbjuda stöd på personnivå, och främst då till patienter. De senaste decennierna har dock en tendens uppmärksammats till ökad förståelse för att hela familjen behöver inkluderas i omvårdnaden. Att anamma ett familjecentrerat förhållningssätt – det vill säga, att se och möta familjen som en enhet och som ett system – har visat sig ha flera fördelar utifrån såväl patient- och familje- som sjuksköterskeperspektiv. Detta har medfört en efterfrågan på forskning om hur familjecentrerad omvårdnad kan läras ut och implementeras i den kliniska hälso- och sjukvården. Syfte: Det övergripande syftet med avhandlingen är att belysa erfarenheter av stöd från distriktssköterskor/sjuksköterskor till familjer i ordinärt boende, samt att utvärdera implementering av familjecentrerade samtal.

Mitt masterprojekt är en bok som syftar till att stötta anhöriga till personer med förvärvad hjärnskada, där jag använder mig själv och min egen rehabilitering efter en smitningsolycka som fallstudie.

Detta material är en vägledning för samtalsledare i lärande nätverk och i
olika utbildningssituationer om AKK - Alternativ och Kompletterande
Kommunikation för barn och personer med kommunikativa funktionsnedsättningar.
Vägledningen är tänkt att fungera tillsammans med två andra dokument. Det ena är ett inspirationsmaterial benämnt Röster om kommunikation. Det andra dokumentet är en kunskapsöversikt inom området AKK.

Webbupplaga

Den här boken handlar om svensk handikappolitik, som sedan tidigt sjuttiotal är en del av den generella välfärdspolitiken. Det är ganska tyst om handikappfrågorna i dag. De är politiska, men möter inte något stort politiskt eller medialt intresse.
Boken bygger till stora delar på intervjuer med Birgitta Andersson, Barbro Carlsson, Folke Carlsson, Vilhelm Ekensteen, Bengt Lindqvist och Lennart Nolte. De har alla haft ledande positioner i handikapprörelsen och varit med och banat väg för den handikappolitik vi har i dag. Här blickar de tillbaka på det skeende de själva varit med om att utforma och ger sina tankar om varför det blev som det blev. Dessutom invervjuas några forskare om välfärdspolitik och funktionshinder.
Varför har vissa av handikapprörelsens kamper lyckats och andra inte? Varför har samhället gjort ett bra jobb på en del områden, men inte på and ra? Varför står så många fortfarande utanför arbetslivet, fast det har varit en av rörelsens viktigaste frågor i mer än ett halvt sekel? Varför är det så mycket mer intressant att diskutera vad tillgänglighet skulle kosta än att fundera på otillgänglighetens pris i ett modernt samhälle? Och varför ifrågasätts den personliga assistansen ständigt och jämt?

The aims of this thesis where the target population has been older adults suffering from osteoporosis related fractures were firstly to study the association between functional impairment due to pain, and activity expressed as walking speed (WS) and Timed Get up and-Go (TUG), and to examine the associations between functional impairment and social participation (SP) and quality of life (QoL). Secondly, to study the association between activity and SP and QoL. Thirdly, to study the effect of informal and/or formal support on SP.
In study I activity 3 years after trauma and stratified for pain was examined. For fractured, both with and without pain, higher WS was noted for subjects with the last fracture more than 3 years ago compared to subjects fractured less than 3 years ago. The median time for fractured in pain and a trauma more than 3 years ago walking 15m at a self selected speed was 14 s compared to 20 s (p = 0.04) for subjects in pain and fractured less than 3 years ago. Both fracture and pain independently explained levels of WS.
In study II the association between functional impairment and SP and QoL was investigated. QoL included Life satisfaction index A (LSI- A) and SF-12 consisting of a mental component (MCS) and a physical component (PCS). Fractured with and without pain were compared to non-fractured controls and in 12 out of 21 activities fewer fractured in pain took part compared to controls. Regarding QoL, fractured in pain scored lower for MCS, PCS and LSI-A, compared to controls.
In study III the association between WS, TUG and QoL and SP was examined. In a logistic regression model adjusting for confounders, significant associations remained between SP and WS, TUG where an increased probability of taking part increased with a faster performance.
In study IV the extent of SP due to formal and/or informal care was examined. Adjusted odds ratios for SP using non support as a reference, showed that subjects with informal support did not have a lower probability for participating while subjects with informal and/or formal support had a significant lower probability for SP.
In conclusion, fractured had a limitation in activity. For both fractured with and without pain a limitation in WS was observed up to three years after trauma suggesting that there is rehabilitation potential the first years after fracture. A health condition with fracture and a functional impairment due to pain, or a deterioration WS or TUG are associated with a restriction in SP and a lowered QoL. The results also substantiate the influence of informal support i.e. care given by relatives and friends have decisive influence to maintain SP and thereby an active lifestyle.

Examensarbete våren 2011, socionomprogrammet

Artikelnr 2007-112-1

Although a fair amount is known about young children's production of negation, little is known about their comprehension. Here, we focus on arguably the most complex basic form, denial, and how young children understand denial, when it is expressed in response to a question with gesture, single word, or sentence. One hundred twenty-six children in 3 age groups (Ms = 1 year 9 months, 2 years 0 months, and 2 years 4 months) witnessed an adult look into 1 of 2 buckets and then, in response to a question about whether the toy was in there, communicate either something positive (positive head nod, "yes," "it is in this bucket") or negative (negative head shake, "No," "It's not in this bucket"). The youngest children did not search differently in response to any of the communicative cues (nor in response to an additional cue using both gesture and single word). Children at 2 years 0 months searched at above-chance levels only in response to the negative word and negative sentence. Children at 2 years 4 months were successful with all 3 types of cues in both positive and negative modalities, with the exception of the positive sentence. Young children thus seem to understand the denial of a statement before they understand its affirmation, and they understand linguistic means of expressing denial before they understand gestural means. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

The purpose of this two-year ethnographic study was to explore the experiences of parentally bereaved young people who sought support from the Rocky Centre (a pseudonym), a childhood bereavement service in the United Kingdom. Data were generated from extended periods of participant observation and semi-structured interviews with both staff and service users. In this article we focus specifically on the interviews with 13 young people to elucidate the factors that helped them to live with parental bereavement. Of these participants, four had been recently bereaved and nine had experienced the death of a parent over ten years ago. Seven key themes emerged from the analysis of the interview data: expressing emotion, physical activity, positive adult relationship(s), area of competence, friendships/social support, having fun/humour and transcendence. These themes are discussed in turn, and implications for research and practice are addressed.

The present study examines multiple types of victimization simultaneously, their prevalence and characteristics in childhood and adolescence, and it examines the associations between victimization and poly-victimization on the one hand and single and multiple mental health and behavioral problems on the other. The sample consisted of 2,500 Swedish young adults (20-24 years) who provided detailed report of multiple types of lifetime victimization and current health and behaviors via an interview and a questionnaire. Results showed that it was more common to be victimized in adolescence than in childhood and more common to be victimized repeatedly rather than a single time, among both males and females. Males and females were victimized in noticeably different ways and partially at different places and by different perpetrators. With regard to mental health and behavioral problems, anxiety, post-traumatic stress, self-harm, and criminality were clearly overrepresented among both males and females who had experienced any type of victimization. Poly-victimization was related to single and multiple mental health and behavioral problems among both males and females. We conclude that professionals need to conduct thorough evaluations of victimization when completing mental health assessments among troubled youths, and that youth might benefit from the development of interventions for poly-victimized youth.

Meta-syntheses can enhance our knowledge regarding the impact of the environment on the participation of youth with disabilities and generate theoretical frameworks to inform policy and best practices. The purpose of this study was to describe school-aged youth with disabilities' perspectives regarding the impact of the environment and modifications on their participation. A meta-synthesis systematically integrates qualitative evidence from multiple studies. Six databases were searched and 1287 citations reviewed for inclusion by two independent raters; 15 qualitative articles were selected for inclusion. Two independent reviewers evaluated the quality of each study and coded the results section. Patterns between codes within and across articles were examined using a constant comparative approach. Environments may be more or less inclusive for youth with disabilities depending upon others' understanding of individual abilities and needs, youth involvement in decisions about accommodations, and quality of services and policies. Youth implemented strategies to negotiate environmental barriers and appraised the quality of their participation based on the extent to which they engaged alongside peers. This meta-synthesis generated a framework illustrating the relationship between the environment, modifications and participation, and provided a conceptualization of participation grounded in the lived experiences of youth with disabilities. Findings reveal gaps in current knowledge and highlight the importance of involving youth with disabilities in decision making.

OBJECTIVES:
The American Academy of Pediatrics recommends a medical home for children with special health care needs (CSHCN). In the Pediatric Alliance for Coordinated Care (PACC), 6 pediatric practices introduced interventions to operationalize the medical home for CSHCN. The intervention consisted of a designated pediatric nurse practitioner acting as case manager, a local parent consultant for each practice, the development of an individualized health plan for each patient, and continuing medical education for health care professionals. The objectives of this study were 1) to characterize CSHCN in the PACC, 2) to assess parental satisfaction with the PACC intervention, 3) to assess the impact on hospitalizations and emergency department episodes, and 4) to assess the impact on parental workdays lost and children's school days lost for CSHCN before and during the PACC intervention.
METHODS:
A total of 150 CSHCN in 6 pediatric practices in the Boston, Massachusetts, area were studied. Participants were recruited by their pediatricians on the basis of medical/developmental complexity. Physicians completed enrollment information about each child's diagnosis and severity of condition. Families completed surveys at baseline and follow-up (at 2 years), assessing their experience with health care for their children.
RESULTS:
A total of 60% of the children had >5 conditions, 41% were dependent on medical technology, and 47% were rated by their physician as having a "severe" condition. A total of 117 (78%) families provided data after the intervention. The PACC made care delivery easier, including having the same nurse to talk to (68%), getting letters of medical necessity (67%), getting resources (60%), getting telephone calls returned (61%), getting early medical care when the child is sick (61%), communicating with the child's doctor (61%), getting referrals to specialists (61%), getting prescriptions filled (56%), getting appointments (61%), setting goals for the child (52%), understanding the child's medical condition (56%), and relationship with the child's doctor (58%). Families of children who were rated "severe" were most likely to find these aspects of care "much easier" with the help of the pediatric nurse practitioner. Satisfaction with primary care delivery was high at baseline and remained high throughout the study. There was a statistically significant decrease in parents missing >20 days of work (26% at baseline; 14.1% after PACC) and in hospitalizations (58% at baseline; 43.2% after PACC). The approximate cost per child per year of the intervention was 400 dollars.
CONCLUSIONS:
The PACC medical home intervention increases parent satisfaction with pediatric primary care. Those whose needs are most severe seem to benefit most from the intervention. There are some indications of improved health as well as decreased burden of disease with the intervention in place. The PACC model allows a practice to meet many of the goals of serving as a medical home with a relatively small financial investment.

The purpose of the study was to understand the impact of chronic disability on the functional ability of older adults. Thirty older adult participants and their caregivers were asked to identify which instrumental activities of daily living (IADL) are most meaningful and how their disability affected performance. Data collected through individual analysis indicated that the most important IADL tasks were driving and managing medication. Both older adult participants and their caregivers similarly perceived the health condition as significantly affecting the performance of all of the IADLs. However, there was a difference in the perception of the prior level of functioning for managing medication (z = 2.45, p = .024) and phone use (z = 2.26, p = .014). Results arrived at, and to be discussed, were in agreement with previous research findings indicating that complex tasks of daily living, particularly driving, are significant to the older adult's quality of life.

A variety of strategies have been used to help children with autism acquire functional communication skills. The Picture Exchange Communication System (PECS) is a unique communication training program that was developed as a means of circumventing some shortcomings associatd with these strategies. A description of the steps within PECS is provided. Long-term group data have indicated that a large proportion of children started on PECS as preschoolers acquire speech. Individual and group data supporting the use of PECS are provided.

A variety of strategies have been used to help children with autism acquire functional communication skills. The Picture Exchange Communication System (PECS) is a unique communication training program that was developed as a means of circumventing some shortcomings associatd with these strategies. A description of the steps within PECS is provided. Long-term group data have indicated that a large proportion of children started on PECS as preschoolers acquire speech. Individual and group data supporting the use of PECS are provided.

IMS AND OBJECTIVES:
This study had two aims. The first aim was to compare attachment styles and traumatic childhood experiences of women with psychiatric disorders and their children to a control group. The second aim was to determine the relationship between attachment styles and traumatic childhood experiences both in mothers and their children.

BACKGROUND:
According to attachment theories, trauma in an early relationship initiates a developmental cascade in which insecure attachments may occur.

DESIGN:
A cross-sectional, descriptive study which, employed a case-control design, was performed between May 2013-March 2014.

METHODS:
This study was conducted in 63 women with psychiatric disorders and their children. The control group consisted of 63 women without any psychiatric disorders and their children. Data were collected using questionnaire forms, including the Adult Attachment Style Scale and the Childhood Trauma Questionnaire for both mothers and children. Descriptive statistics, a Pearson correlation and comparative statistics were used to analyse data.

RESULTS:
The childhood trauma scores of both the women with psychiatric disorders and their children were higher than the control group scores. Compared to the control group, the mothers with psychiatric disorders and their children were found to have less secure attachment styles. It was determined that the mothers and children with insecure attachment were more likely to have been abused.

CONCLUSION:
These results point to a relationship between trauma in childhood and attachment style. They also suggest that this relationship may undergo intergenerational transfer.

RELEVANCE TO CLINICAL PRACTICE:
This study contributes to the existing literature on the relationship between childhood traumas and attachment. Psychiatric nurses should focus not only on psychiatric disorders but also on the difficulties a patient faces regarding being a parent.

Professor Marta Szebehely och doktorand Petra Ulmanen står bakom en ny rapport om framtidens äldreomsorg. En utgångspunkt för deras rapport är att vi måste börja betrakta äldreomsorgen på ett liknande sätt som barnomsorgen. Båda dessa är viktiga för att uppnå de jämlikhets- och jämställdhetsambitioner som finns inskrivna i svensk välfärdspolitik. Bara om det finns välutbyggda och välfungerande omsorgstjänster kan både kvinnor och män i alla sociala skikt förvärvsarbeta över hela livscykeln.

I sin studie över hur den svenska äldreomsorgen har förändrats över tid har författarna analyserat SCB:s stora intervjustudier av befolkningens levnadsförhållanden samt sett på tidigare svensk och internationell forskning. Några av de viktigaste slutsatserna som författarna drar är:

Äldreomsorgen har minskat under de senaste tre decennierna. Även om hemtjänsten har ökat så har detta inte skett i en sådan grad att motsvarande minskning av äldreboenden har kompenserats.

Bortfallet av offentlig omsorg har i huvudsak ersatts av anhörigas insatser. Även om privat köpt hjälp i viss mån har ersatt den offentliga omsorgen är det i första hand de anhöriga, framförallt de medelålders döttrarna, som kompenserar för den minskade offentliga omsorgen. Detta gäller i synnerhet bland kvinnor med lägre utbildning.

Det finns ett tydligt internationellt samband mellan hur välutbyggd den offentliga äldreomsorgen är och hur många medelålders kvinnor som förvärvsarbetar. En försämrad äldreomsorg riskerar därmed att få konsekvenser för de medelålders barnen, framförallt döttrarnas, arbetsutbud.

The aim of this thesis was to investigate old people's care and quality of life during the last period of life, but also to investigate their own and next-of-kin's experience of this phase. The thesis is based on four studies using separate samples. The sample (n=1198) in study I was drawn from the care and services part of the sub-study ?Good Aging in Skåne? (GAS). The criteria for inclusion in study I were: being 75 years and older having died during the years 2001?2004 and having received public care and services at home or in special accommodation. The study sample in study II comprised 411 people being 75 years and older of whom fifty of the respondents (the study group) had died one year after data collection, the 361 survivors were considered a comparison group. In study III, 17 people aged 75 years or older, who received municipal help and/or care and had a life-threatening disease and/or received palliative care, were interviewed. In study IV 17 next-of-kin's of people aged 75 years and older who had recently died and had received help and/or care from the municipality in the last phase of life, were interviewed. Quantitative descriptive statistics, comparative statistics and logistic regression analysis, but also qualitative content analysis, were used when analysing the data. The results showed that in the last year of life, 82% of those living at home and 50% of those living in special accommodation were hospitalised. The results also showed that those living at home and those with several hospital stays more often died in hospital than those living in special accommodation and those with fewer hospitals stay. More visits to physicians in outpatient care predicted death in hospital, while living in special accommodation and PADL dependency predicted death outside hospital (Paper I). The results in paper II showed that the study group had a lower QoL than the comparison group. Factors that effected the quality of life negatively were more admissions to hospital and a larger number of health complaints. The analysis showed that factors predicting mortality were older age and more health complaints. The older persons? experience of their situation could be understood as Turning inwards to come to peace with the past, the present and approaching death while being trapped by health complaints. Six categories embraced the experience of aspects that constitute a good life in the last phase of life; Maintaining dignity, Enjoying small things, Feelings of ?being at home?, Being in the hands of others, trying to adjust, Still being important for other people and Completing life while facing death (Paper III). The next of kin's experience of this situation could be understood as Being a companion in the transition towards an inevitable death feeling of having the major responsibility and needing to be acknowledged by professionals, which included the categories: Being a companion on the path to death; Focusing on the needs of the dying person, and making adjustments to everyday life; Feeling the major responsibility, and Gaining strength from support. The results showed that older peoples? last phase of life is coloured by health complaints and frequent visits to hospital, which in turn affects their quality of life. Their own experience of this situation was being in the hands of several care providers, and trying to adjust to the situation. To provide high quality care in this phase it is important to increase the co-operation between various care providers. It also seems important for older people to have the possibility to enjoy the small things in life, being able to still be involved in the world around, and to be supported to complete life in order to achieve peace of mind. As the next-of-kin are involved in the care and are emotionally affected by the situation, their needs for support should also be acknowledged. This means they need to be seen by the professionals as well as by others around in order to retain their sense of participation, even when professional care providers are involved.

Att världens befolkning är i åldrande är känt sedan länge. Att denna ökning av äldre kommer att få konsekvenser för vård och omsorg anses vara självklart. Denna bok har som utgångspunkt att konkretisera några av de teman som ryms inom detta fält. Läsaren får inblick i arbetslivsrelaterade teman inom äldreomsorgens organisation och rekryteringsbas, anhörigskap, krisberedskap,internationella jämförelser inom äldreomsorgen, samt omsorg och etnicitet. Boken ger även insyn i hur äldre förhåller sig till samhälleliga normer och föreställningar om åldrandet. Till detta kommer till slut frågan om utvecklandet av nya professioner inom äldreområdet, vilket ska ses mot bakgrund av de delvis annorlunda behov som framtidens äldre förväntas ha.