Background: Each year, approximately 25,000 are affected by stroke in Sweden. As a result of a stroke, the person may also suffer from various types of disabilities, including aphasia. Aphasia means impairment of communication, where the affected person has difficulties in the spoken or written language. There is a lack of knowledge regarding how people with aphasia experience their condition, both at a community level and in the health care system. Aim: The purpose of the study was to describe patients experiences of aphasia after a stroke. Method: A literature-based study based on an analysis of eight scientific articles. Results: Two main themes emerged: Negative experiences and positive experiences. The results show that people with aphasia often suffer from mental illness related to their condition. Submerged mood and depression where the most common experiences of psychological effect, which can adversely affect patient's social life and daily activities. The results also show that the support from the environment can motivate the patient to want to improve their condition and give the patient an increased well-being. Conclusion: Caregivers need an increased understanding and knowledge of experiences regarding patients with aphasia. This can contribute to preventive actions related to mental illness. The support of the environment is important for patient's recovery and the nurse can, with an increased understanding and knowledge contribute to patient's well-being and rehabilitation. / Afasi är en sekundärskada till följd av en stroke, som innebär en nedsättning av kommunikationsförmågan. Detta sker då vissa delar av hjärnan drabbas av syrebrist, vilket leder till att celler skadas eller dör. Tillståndet kan påverka patienters vardag och detta präglas av patienters upplevelser av deras tillstånd. Negativa upplevelser kan vara frustration, nedstämdhet, ångest och depression, men även upplevelser av att omgivningen är oförstående och saknar insikt i vad afasi innebär. Negativa upplevelser kan leda till att patienter isolerar sig och att de inte fullföljer sin rehabiliteringsplan. Sjuksköterskan behöver mer kunskap angående patienters upplevelser av att leva med afasi – för att kunna förebygga psykisk ohälsa.   Patienter med afasi kan dock erfara positiva upplevelser trots sitt tillstånd. Genom att acceptera sitt tillstånd, samt genom stöd från omgivning och vårdpersonal kan patienter med afasi känna tillhörighet och välbefinnande. Detta kan leda till att patienter som är drabbade av afasi upplever motivation till att fullfölja sin rehabilitering. För att effektivisera återhämtningen kan närstående bjudas in av sjuksköterskan och bli mer delaktiga i patientens kommunikativa rehabilitering, då närståendes stöd och uppmuntran är en viktig aspekt i att patienter upplever motivation till återhämtning.  Patienter med afasi upplever ett sjukdomslidande till följd av att ha insjuknat i en stroke och afasi. Upplevelser av detta leder till ett själsligt lidande för patienten. Sjuksköterskans ansvar är att lindra lidande, samt att återställa och främja hälsa inom ramen för hens kompetensområde – omvårdnad. Sjuksköterskan behöver en ökad kunskap och förståelse för den psykiska påverkan som afasi kan medföra, så att hen kan uppmärksamma symtom på och förebygga psykisk ohälsa hos patienter med afasi. Det här är en litteraturstudie, med avsikt att bidra till evidensbaserad vård med grund i kvalitativ forskning. Resultatet är baserat på kvalitativ analys av åtta vetenskapliga artiklar, som beskriver patienters upplevelser av att leva med afasi.

The expressive nature of typing has been mostly neglected in research. The possibilities of our full expressive selves are not included in typing experiences.The aim of this thesis is to explore the expressive qualities and experiences of typing and open up new opportunities and possibilities for interaction designers. To fulfil this aim, the qualities of typing itself as a medium are investigated, as well as how handwriting can be used as inspiration and guidance to investigate the potential expressive qualities of typing.The result of this investigation showed how typing possesses personal, behavioral and emotional expressions. Additionally, the investigation lead to the discovery of how typing possesses impressionable experiences. These impressions changed the feeling while typing, could make the user write in a particular way and be used as an expressive tool to another person.

Adverse childhood experiences (ACEs) have long been linked to poor physical, mental, and behavioral outcomes in adulthood. Individuals with exposure to more types of ACEs are at greater risk of engaging in delinquent and criminal offending and also are relatedly more likely to be involved in the criminal justice system. The high prevalence of ACEs and other co-morbid risk factors in forensic populations calls for further investigation into how differential exposure to adversities influence the onset and nature of offending behaviors. Additionally, there are few studies investigating structural elements that precede offending behaviors (e.g., social and economic factors) in varied communities. Thus, the present study aims to examine the role of individual adversities and community factors on the development of nonsexual delinquent behaviors and juvenile justice involvement in a treatment sample of male adolescents. Data for the present study were derived from two sources. First, data were collected from archival records at a private nonprofit facility in rural Appalachia that provides treatment to adolescents who have engaged in sexually abusive behavior. Variables of interest include exposure to ACEs, indicators of sexual boundary problems within the home of origin (exposure to pornography by adult in home, witnessing sexual behaviors between others), and lifetime arrest history. Second, county-level secondary data were downloaded and delineated by county from the County Health Rankings & Roadmaps (CHR&R) program website, which provides publicly available data compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation. The CHR&R data has been published annually since 2010 and includes county-level markers of overall health and various factors that impact the health of counties. A standardized z-score was calculated to indicate social and economic environment compared to other counties in the state. Participants were assigned a z-score based on documented zip code of origin. To test the hypothesized model, confirmatory factor analysis was used, first examining indicators of individual adverse experiences and exposure to sexual behaviors in the home of origin. A three-factor model emerged: Factor 1 represented emotional abuse, physical abuse, and neglect; Factor 2 included indicators of household dysfunction; and Factor 3 included sexual abuse and more passive indicators of sexual boundary concerns in the home. Next, structural equation modeling revealed the association between individual experiences of adversity, county-level social/economic environment, and nonsexual delinquent behaviors with socioecological influences as a moderator. Results reveal varying relationships between exposures to adversity and arrest-related outcome variables. Additional discussion regarding findings, implications, and areas for future research will be explored.

Persons exposed to adverse childhood experiences (ACEs) are at increased risk of developing long-term negative health consequences. ACEs have a cumulative negative impact on mental health outcomes in particular. Evidence suggests that those in forensic psychiatric settings are disproportionally exposed to ACEs, lending to potentially greater complexity in the relationship between ACEs, psychiatric comorbidity, and behavioral problems. Additionally, within this population a common intervention for mental health symptomology includes pharmacology, particularly as health issues compound. As a medication regimen becomes more complex, the risk for negative consequences – including drug interactions, side effects, and even death – increases. Limited empirical research describing associations between ACEs, mental health outcomes, and polypharmacy is available. Furthermore, no published studies to date have examined these relationships in forensic inpatient mental health populations, despite the evidence that these populations are disproportionately exposed to maltreatment and household dysfunction in childhood, frequently have higher rates of physical and mental health problems, and are usually treated with multiple forms of medications in response to health and behavioral needs. To address gaps in existing research, the relationship between ACEs, mental health outcomes, and prescription practices will be examined within a forensic inpatient sample. The current study seeks to investigate the impact of ACEs on mental health outcomes and the relationship to polypharmacy practices within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101) or African American (40.1%, n=73), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). It is expected that greater experiences of childhood maltreatment and household dysfunction will result in greater negative mental health outcomes and associated behaviors. This relationship is expected to contribute to polypharmacy practices among prescribing physicians. Because high rates of polypharmacy yield a potential for increased aversive health outcomes, understanding the association between ACEs and other predictive factors and polypharmacy practice has valuable implications for the treatment and rehabilitation of persons in forensic mental health settings.

Trauma has been found to be highly prevalent and associated with many negative health and social outcomes (i.e., heart disease, higher suicide risk, high-risk behaviors) in the general population. Despite these associations, trauma detection is relatively rare in service-providing organizations. Trauma-informed care (TIC) is a proposed solution that encourages trauma detection, understanding the symptoms associated with trauma, and treating trauma while actively avoiding re-traumatization to the service user. Although research about TIC efficacy has been fairly limited, there are some promising potential benefits of the practice to the client, provider, and the population as a whole. For this study, we looked at service providers’ reported familiarity with TIC and implementation of TIC in their organization across seven timepoints. We found familiarity increased more than implementation, and we discuss potential reasons that may cause this discrepancy.

Adverse childhood experiences (ACEs) are traumatic events during a person’s early life that can influence their later mental health, physical health, and wellbeing. Internalizing symptoms such as anxiety and depression are common mental health outcomes associated with these events. Two factors, religiosity/spirituality (R/S) and mindfulness, are possible protecting factors to help lessen the effect of traumatic experiences on later mental health. This study examined whether R/S and mindfulness are protective factors in the relationship between ACEs and future internalizing symptoms. Further, this study examined whether the impact of R/S was influenced by an individual’s mindfulness (moderated moderation). Participants (N = 769, age M = 20.43, SD = 4.507) for this study were recruited through the SONA research platform at East Tennessee State University as a part of the REACH (Religion, Emotions, and Current Health) self-report survey. Results from the current study did not support either mindfulness or R/S as moderating factors for the relationship between ACEs and internalizing symptoms. However, exploratory mediation suggested mindfulness was a mediator for this relationship. This study, while it did not demonstrate the buffering capacity of study variables, provides information about the implications of ACEs in a Northeast Tennessee sample. Future research should examine new variables as potential protective factors for this relationship and more detailed information about the mediating effect of mindfulness.

Context – The prevalence of problem substance use is a global concern, particularly for adolescents due to their ongoing developmental changes. Amongst other contributory factors, parenting styles adopted by parents and caregivers can either; increase the risks of their children developing substance misuse problems or prevent its onset. Knowledge about the needs and experiences of the caregivers of adolescents who misuse substances is limited and greatly under-researched. Brief interventions (BIs) have been identified as an effective means of tackling this problem-type behaviour among adolescents, including ‘Teen Intervene', which was developed in the US. This evidence-based intervention included a parent component which has been found to further enhance the interventions' positive outcomes. Rationale – In light of the unique caregiver structures in South Africa, the general neglect of their needs in the South African literature with regards to interventions and the high prevalence of adolescent substance misuse in the Western Cape, exploring these needs within the country's context is warranted and necessary. Design and data collection – This was a qualitative study and data for the study was collected in two main phases: through focus group discussions to identify caregivers needs and to explore perceptions of the intervention; and post-intervention interviews with caregivers and adolescents at a 1-month follow-up session. Findings – Template analysis revealed six main themes: 1) Access to knowledge about substance misuse; 2) Parenting skills; 3) Sources of emotional support; 4) Empowerment for female caregivers; 5) Financial concerns; and 6) Alternative solutions to adolescent's involvement in the justice system. Caregivers also reported various feelings that are a direct result of their experiences. Discussion – Caregivers have distinct needs that require designated responses, however, some of these needs can be addressed through their inclusion in treatment interventions for adolescents who misuse substances.

Background: It has been proven to be a challenge for physiotherapists to utilize evidence within their practice. Conducting evidence-based care is a requirement for providing good care and a requirement in the legitimation for Swedish physiotherapists. Aim: To explore physiotherapists experiences of their possibilities and challenges in implementing prevailing evidence in their practice. Method: A qualitative method was applied with a semi-structured interview guide. A choice of convenience sampling was made with 5 physiotherapists from a region in Sweden with the aim of getting as wide a sample as possible. The analysis of the data was done through a qualitative content analysis. Results: Physiotherapists felt that the challenges were based on their work environment and that the Swedish care structure  measures quantity over quality. Other contributing challenging factors mentioned where lack of time, low interest from managers, lack of training and difficulties in understanding and evaluating the different parts of the evidence model. Opportunities that were raised were the mutual learning among colleagues in the workplace and that research is easily accessible with today's technology. Conclusion: This study shows that in order for physiotherapists to feel that they have good opportunities to implement evidence, one needs to try to eliminate the various challenges that arise within their work environment. This can enable organizations in which physiotherapists work to gain an understanding of what needs to be focused on and improved in order for physiotherapists to be able to implement evidence-based care and therefore increase the quality of care for patients. / Bakgrund: Det har visat sig vara en utmaning för fysioterapeuter att använda sig av evidens inom sitt verksamhetsområde. Att bedriva en evidensbaserad vård är en nödvändighet för att bedriva en god vård och ett krav i legitimationen för svenska fysioterapeuter. Syfte: Att utforska fysioterapeuters upplevelser av sina möjligheter och utmaningar med att implementera rådande evidens inom sitt verksamhetsområde. Metod: En kvalitativ metod tillämpades med en semistrukturerad intervjuguide. Ett bekvämlighetsval användes där 5 fysioterapeuter valdes från en region i Sverige och med syfte att få så brett urval som möjligt. Analysen av data gjordes genom en kvalitativ innehållsanalys. Resultat: Fysioterapeuterna upplevde att utmaningarna främst grundade sig i deras arbetsmiljö och att den svenska vårdstrukturen är mer uppbyggd för att mäta kvantitet och inte kvalité. Andra nämnda bidragande utmanande faktorer var tidsbrist, lågt intresse från chefer, brist på utbildning och svårigheter med att förstå och värdera evidensmodellens olika delar. Möjligheter som togs upp var det gemensamma lärandet bland kollegor på arbetsplatsen och att forskningen är lättillgänglig med dagens teknik. Konklusion: Den här studien visar att om fysioterapeuter ska uppleva att de har goda möjligheter att implementera evidens så behöver man försöka eliminera de olika utmaningar som finns inom deras arbetsmiljö. Detta kan möjliggöra att organisationer som fysioterapeuter jobbar inom kan få en förståelse för vad man behöver fokusera på och förbättra för att fysioterapeuter ska kunna implementera en evidensbaserad vård och därmed öka vårdkvalitén för patienter.

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Magister Curationis - MCur / The re-engineering of the healthcare landscape requires Higher Educational Institutions (HEI) to employ teaching and learning approaches that would produce graduates, who could respond to the transformative initiatives within the healthcare system. Graduates are required to become involved in a service-learning project, as part of their learning experience, within the Masters of Nursing in Advanced Psychiatric Nursing programme. Their learning and teaching activity is intended to prepare them to become competent advanced psychiatric nurse specialists, who are able to address social transformation.