Compulsive hoarding is characterized by difficulty discarding unneeded items and the accumulation of items within living spaces and is associated with significant functional impairment and distress. Along with the negative impact on the individual, previous reports have indicated that compulsive hoarding is not only impairing and substantially burdensome for family members, but also linked to disruptions in family functioning. The present study utilized a path model analysis to examine the associations between an array of hoarding variables hypothesized to impact family functioning and parent-adult child relationships in 199 adult children of hoarders. Results revealed that family functioning mediated the relationship between hoarding severity and parent-adult child relationship. Decreased insight into hoarding symptoms was directly associated with decreased quality of parent-adult child relationships, which was mediated by family functioning. Increased family accommodation was significantly associated with increased impairment (work, social, family domains) in adult children of hoarders. Clinical implications and future directions in research are discussed.

No description available.

[Truncated abstract] Some children with Specific Language Impairment (SLI) show poor performance on behavioural tasks designed to measure rapid auditory processing, such as the Repetition Test developed by Tallal and colleagues. Stemming from concerns about whether this task reflects higher-order, cognitive variables, this thesis sought to determine whether the performance deficits SLI children show were evident at the neurophysiological level, with minimal cognitive influences, such as attention, using paradigms designed to elicit the mismatch negativity (MMN) and late discriminative negativity (LDN). In the first two studies, a MMN paradigm, equivalent to the Repetition Test, was trialled with a group of 8 adults. In this paired paradigm, the second tone of a pair of pure tones ascending in frequency ('low'-'high') was occasionally replaced with a 'low' tone. The aim was to determine a 'long' and 'short' intra-pair interval (IPI) with which MMN was generated utilizing this paradigm and that were congruent with the Repetition Test findings (i.e., a long IPI at which SLI were able to perform the task, and a short IPI at which SLI children's performance was selectively impaired). In Study One, MMN to a within-pair frequency change was generated with the 30 ms IPI, but not the 700 ms IPI. The grouping parameters of the temporal window of integration (TWI) and temporal distinctiveness were considered less than optimal for the grouping of the pairs presented at 700 ms IPI for the pre-attentive system to register the within-pair frequency change. ... The frequency difference limens (DLs) of the SLI group were significantly higher than a group of 18 normally developing age- and intelligence-matched peers, but there was no significant difference between the groups in their performance on a control intensity discrimination task. The iii SLI group also showed poorer reading skills, yet frequency discrimination was related to oral language ability only. In the final study, MMN was measured to examine the pre-attentive neurophysiological basis of the SLI group's frequency discrimination deficit. Two frequency deviants that were just above each group's 75% DL on the frequency discrimination task were employed in a simple frequency change paradigm: 40 Hz difference for the control group, and 80 Hz difference for the SLI group. MMN and LDN were elicited in the group of 15 normally developing children to their 40 Hz suprathreshold frequency difference and to the 80 Hz difference. A significant MMN was not observed in the group of 13 SLI children to the 40 Hz difference, which was below their threshold level. However, despite discrimination at the behavioural level, MMN did not reach significance in the SLI group to their 80 Hz suprathreshold frequency difference, yet LDN was observed. MMN was larger in both groups for the 80 Hz difference. Furthermore, MMN and LDN amplitude to the suprathreshold deviants were predictive of both frequency and intensity DLs. These results suggested that SLI children have a pre-attentive neurophysiologically mediated insensitivity to small frequency differences, and that MMN (and LDN) to suprathreshold frequency deviants is a sensitive indicator of group discrimination differences and brain-behaviour relationships in children with and without SLI.

Obstructive Sleep Apnoea (OSA) is a disease characterised by repetitive upper airway obstructions which are manifest by desaturation and arousal from sleep. It has been known for many years that this interruption to the normal architecture of sleep may present to the clinician as excessive daytime somnolence often with a complaint of difficulties with concentration and short term memory. Previous work had demonstrated a relationship between variables of cognitive dysfunction in patients with obstructive sleep apnoea, however, little was known about which components of the syndrome contributed to this outcome and whether specific clinical thresholds of sleep disordered breathing could be defined for the development of cognitive dysfunction. In the context of this body of work cognitive dysfunction is defined as: a level of cognitive performance below normal derived values for a given cognitive test, when the subjects performance is controlled for age, sex and level of education.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

Increasing numbers of older patients with cognitive impairment and disturbed behaviour are likely to present to acute care hospitals in the future. Nurses are not well disposed towards care due to safety and morale issues caused by knowledge deficits, job stress, oppressed group behaviours and ageist attitudes. Patient outcomes are often poor with multiple adverse events, long lengths of stay and levels of mortality. Disturbed behaviour may be caused by delirium, depression or other mental disorders and dementia or all. The research question addressed was “Can the instigation of a person-centred approach to care of patients with cognitive impairment and disturbed behaviour result in decreased nursing stress, improved patient care practices, outcomes and relatives’ satisfaction?” A conceptual framework incorporating the constructs of Person-Centred Care, the Integrated Structural Model of Human Behaviour and Practice Development informed the action research methods utilised. The processes of facilitation were used to undertake four action research cycles incorporating plans, actions, observations and reflections in one 25-bed acute aged care ward in a large tertiary referral hospital The first cycle involved setting up the study, recruitment of nurses and patients, gathering of baseline data and application of nonparticipant observational studies of the quality of nurse-patient interactions which served to inform the plan for interventions. The following three cycles demonstrated efforts to undertake those interventions through strategies to increase nursing empowerment and knowledge in the context of constant staff turnover and diversions that compromised support and participation. During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives’ satisfaction with care, nursing care practices involving the completion of a Communication and Care Cues form and nurses’ interactions with the patients. New care planning tools were developed that will enable ongoing activities for practice improvement. Conversely, there was a significant increase in the nurses’ stress levels when caring for hypoactive delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates. Nursing care practices were unchanged and the new care planning tools were not well utilised. Reflection on the implications and limitations of action research methods supported by practice development strategies in the dynamic, often chaotic environment experienced during the study, suggested that if there is an absence of hierarchical managerial sponsorship for such activities, then sustainable change is difficult. Therefore, it was shown that a person-centred approach to care of patients with cognitive impairment and disturbed behaviour using action research methods in this environment, can result in some enhanced nurse-patient interactions, patient care practices, outcomes and relatives’ satisfaction. However, progress is likely to be slow and time consuming. Further improvements require attention to the well-being status of the nurses through actions that generate feelings of empowerment through individual recognition, knowledge enhancement, adequate access to patient information and sufficient time to undertake their duties as equal members of the multidisciplinary team.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

<p>The main purpose of this study was to examine if, and how, persons with psychological impairments have worse living conditions than the population average. The papers intention was to investigate and describe these conditions and to analyze them based on theories of stigma, and systems theory. This paper was composed on a qualitative study in which god men have been interviewed, in addition to accomplish the purpose. This study has highlighted the four individual areas of economy, employment, housing conditions and social relations. Results have shown that people with mental disabilities tend to live in worse living conditions than the population average. The conclusion of this study is that social service should make more attention to living conditions and social problems that people with mental health difficulties have. This would enable the social worker to his authority in making correct and fair assessments, and increased opportunities to design interventions in a satisfactory manner.</p>

<p>While reading in deaf children has been the object of a number of studies, the reading abilitiesof children with mild and moderate hearing impairment and their relation to cognitiveprocessing have not received very much attention. Predictive factors of reading ability inhearing children are well known, with phonological and working memory abilities beingnecessary prerequisites for reading development. Existing studies suggest, however, thatcertain hearing-impaired children achieve a reading level comparable to that of hearingchildren in spite of impaired phonological abilities. In the present study, reading abilities anda range of cognitive processing abilities were measured in a group of hearing-impairedchildren and compared with hearing controls in equivalent school grades. Comparisons weremade at group and school-grade level, and the cognitive profile of hearing-impaired childrenat level with controls (those being within one standard deviation) was discussed. The resultssuggest that phonological abilities are important for the hearing-impaired children, but to alesser extent than for normally hearing children. The results also point towards workingmemoryabilities (particularly correct recall of phonemes in nonword repetition) as beingimportant for the possibility to compensate for impaired phonological abilities.</p> / <p>Emedan döva barns läsande har varit föremål för ett antal studier, har läsförmågan hos barnmed mild och måttlig hörselnedsättning och dennas relation till underliggande kognitiva förmågor inte fått mycket uppmärksamhet. Predicerande faktorer för läsförmågan hos hörande barn är väl kända och fonologisk förmåga och arbetsminneskapacitet utgör oumbärliga förutsättningar för läsutvecklingen. Befintliga studier antyder dock att vissa barn med mildoch måttlig hörselnedsättning uppnår en läsförmåga i nivå med hörande barns, trots nedsatt fonologisk förmåga. I föreliggande studie undersöktes läsförmågan och en rad kognitivaförmågor hos en grupp barn med mild och måttlig hörselnedsättning. Jämförelser gjordes medhörande kontroller på gruppnivå och per årskurs, och den kognitiva profilen hos de barn medhörselnedsättning som låg i nivå med kontrollerna (de som låg inom en standardavvikelse) diskuterades. Resultaten antyder att fonologiska förmågor var viktiga för läsning i sambandmed hörselnedsättning, men i mindre utsträckning än för normalhörande barn. Resultaten antyder också att arbetsminneskapacitet (framförallt korrekt fonemåtergivning vidnonordsrepetition) har betydelse för möjligheten att kompensera en nedsatt fonologiskförmåga.</p>

<p>Work has a great influence on most of individuals in society. It influences both identity as well as the structure of the day. Unemployed people are often affected in a negative way through economic and psychological problems. In order to help people with reduced work capacity back to the labour market and decrease unemployment, the Labour Market Board works with vocational rehabilitation. The aim of this study is to investigate experiences of vocational rehabilitation within the Labour Market Board among unemployed people. A qualitative method was used by which interviews were made with 11 unemployed persons who participated in an investigation as a part of vocational rehabilitation within the Labour Market Board. The result shows both positive and negative experiences of the investigation period. The identified experiences were sorted into code groups: Support, Insight, Confidence in the investigation and result, Belief in the future, Motivation, and Participation. Both the actions of the personnel and the presence of the group members influenced the experiences. The support given by the personnel and how it is experienced is of great importance for the future of the unemployed. When the investigation was pursued during a short period of time, there was a lack of confidence in the investigation and result. A suggestions for future studies is to design a questionnaire that can be used in a larger study including a large number of individuals who are participating in vocational rehabilitation within the Labour Market Board.</p>