Cognition and Self-Management in Type 2 diabetes in the older person was studied using neuropsychological evaluation and self-management assessments. Type 2 diabetes is increasing in prevalence, erodes quality of life, and places significant burden on healthcare services. The condition is largely self-managed, requiring daily performance of a variety of tasks. Impaired cognition has been associated with Type 2 diabetes, particularly in those who have had diabetes for longer or are older. It is unknown whether such changes in cognition seen in Type 2 diabetes affect the ability to self-manage the condition; the few studies that have been conducted in this area have shown little consensus in focus, methodology, or results. This thesis aimed to investigate any links between cognitive impairment and diabetes self management skills in an older population with Type 2 diabetes, by determining assessment schedules for both selfmanagement and cognition in this population and searching for associations between the two. Literature review, questionnaire and focus group studies pointed towards four main components of diabetes selfmanagement; diabetes knowledge, self-efficacy, motivation, and diabetesspecific problem solving abilities. A theoretical framework emerged from this analysis; Bandura’s Social Cognitive Theory provides a context for the interaction of environment, society and cognitions in health behaviours. A systematic review found several associations between self-management skills and abilities, and global and individual areas of cognition, including links between executive function and memory, and diabetes knowledge, insulin skills, adherence to medications, missed appointments, and decreased frequency of self-care activities. A further clinical study identified several associations including visual and working memory, and reaction times, with diabetes knowledge. Future studies with larger sample sizes might revisit these associations. Clinical implications include the need for routine cognitive assessment in an older population with Type 2 diabetes; interventions might include checking medication adherence, diabetes knowledge, and referral to support groups.

This investigation addresses functions/impairments, abilities/disabilities and quality of life (QoL) in a consecutive series of non-hospitalised long-term survivors (2,5-12 years) of subarachnoid heamorrhage (SAH). The investigated parameters of functions/impairments were: motor, language, perceptual and memory functions. Abilities/disabilities studied were: activities of daily living (ADL) including both personal- and instrumental ADL, working and leisure capacities. Quality of life was assessed using a double visual analogue scale. Occurrence of depression was registered using a self-rating scale. A questionnaire focusing motor and language impairments, personal ADL, work and leisure activities was initially mailed to 324 subjects. The vast majority answered the questionnaire. Ten hospitalised subjects could not validly report their functions and abilities and were by that reason excluded. In a follow-up investigation up to 247 long-term non-hospitalised subjects were investigated by a physician and an occupational therapist. A total of 82% had at least one impairment. The majority (73%) had memory impairment and among these subjects equal proportions (about 50%) had impairments of long- and short-term memory. Forty-five percent were perceptually impaired, while motor impairment occurred for 25% and aphasia in 10%. Only a small minority (9%) were, according to self-reports, regarded as being to some extent disabled in personal ADL. The corresponding numbers of disabled in instrumental ADL, leisure and working- capacity were 52%, 48% and 40%. Depression was found in 22% - among whom the majority had minimal or mild depression. Overall QoL was judged to be unchanged or increased in 62% and, therefore, decreased in 38%. As expected impairments to a significant degree caused disabilities. None of the 5 different categories of impairments were associated with mood (depressed/not depressed) and QoL (decreased/not decreased). Occurrence of depression was significantly associated with different aspects of disabilities. In contrast among a series of instrumental ADL-variables, leisure and working capacity, QoL was influenced negatively only by decreased ability to act sociably and, to a minor extent, by depressed mood. Judging from the extent of decreased quality of life, it appears that nearly 40% of all non-hospitalised former victims of SAH have not coped successfully with the impact of the SAH. A follow-up program aiming at optimising the coping process of SAH-victims is, therefore, outlined. / <p>S. 1-58: sammanfattning, s. 59-128: 5 uppsatser</p> / digitalisering@umu

Bakgrund och problem: Goodwill är ett komplext begrepp. Problematiken med goodwill kan förklaras genom fyra problemområden: erkännande, mätning och värdering, klassifikation samt presentation och disclusoure. IFRS 3 uppkom 2005 i syfte att minska beloppet för goodwill på företagens balansräkningar, ändå fortsätter goodwill att växa.Syfte: Syftet med studien är att erhålla en ökad förståelse för redovisningen av goodwill genom att analysera förhållandet mellan hur företagen redovisar och hur de borde redovisa goodwill. Genom att upptäcka bristerna som finns och diskutera hur redovisningen av goodwill kan förbättras erhålls en ökad förståelse för ämnet.Avgränsningar: Studien granskar goodwill som uppstår vid företagsförvärv i förhållande till disclosure. Internt upparbetad goodwill och negativ goodwill ingår inte i studien.Metod: Studien baseras på en innehållsanalys av årsredovisningar från börsnoterade företag. Metoden baseras på etisk tolkning utifrån två tillämpningsmetoder, observation av begrepp inom text samt relation mellan text, principer och individer som tillverkar texten. Genom att använda två tillämpningsmetoder fångar studien in variation och förändring. Begreppen observeras utifrån en datainsamlingsreferensram, vilken är baserad på principer, tolkning och redovisningsteknik.Resultat och slutsatser: Studien upptäcker skillnader mellan teori och standard. Studien fann att redovisningen av goodwill är förvirrande på grund av att en särskild standard för goodwill saknas. Dagens standarder godkänner subjektiva värderingar i redovisningen, tillskillnad från teorin som anser att värderingen ska vara objektiv. / Background and problem: Goodwill is a complex concept. The problem with this subject can be explained by four different areas: the recognition, measurement and valuation, classification, presentation and disclusoure. IFRS 3 occurred in 2005 in order to reduce the amount of goodwill on corporate balance sheets, still continues goodwill to grow.Purpose: The purpose of the study is to obtain a better understanding of the accounting of goodwill by analyzing the relationship between how companies account and how they should account goodwill. By discovering the deficiencies that exist and discuss how the accounting of goodwill can be improved a better understanding is obtained.Limitations: The study examines goodwill arising on acquisitions in relation to disclosure. Internally generated goodwill and negative goodwill are excluded.Method: The study is a content analysis of annual reports of listed companies. The method is based on the ethical interpretation based on two application methods, observation of the concepts in the text and the relationship between text and principles, and individuals that produce text. By applying two application methods the study captures variation and change. The concepts were observed based on a framework of data collection, which is based on the principle, interpretation and technique.Results and conclusions: The study discovered that differences existed between theory and standard. It discovered that the recognition of goodwill is confusing because a special standard for goodwill is lacking. Today's standards approves subjective valuations in the accounts, while the theory considers that the valuation should be objective.This essay is written in Swedish.

The current study investigated the effectiveness of a Literacy Based Intervention (LBI) on English Language Learners (ELLs) with Specific Language Impairment (SLI). Specifically this report focuses on the effects of LBI on vocabulary skills (e.g. naming and defining). Nineteen ELLs (ages 74 to 104 months) participated in the intervention study, which lasted eight weeks and consisted of 50-minute sessions, three times a week. The LBI focused on rich vocabulary instruction of words that were from storybook readings. Vocabulary naming and definition probes were used to assess vocabulary progress. Results revealed that vocabulary increases did not occur until the second half of the intervention (e.g. week six or seven). LBI shows promise to be successful for increasing vocabulary skills in ELLs with SLI. / text

There is a documented need for appropriate language assessment measures for Spanish-English bilingual school-age children in the United States. The Bilingual English Spanish Assessment- Middle Extension (BESA-ME), the Test of Narrative Language (TNL), and the Test of Narrative Language- Spanish experimental version (Spanish TNL) were administered to 129 children ranging in age from 7;0 to 8;11. Convergence between the measures was examined. The results indicated a strong correlation between measures, as well as significant correlation between each measure and children’s ability level (i.e. classification as typically developing or with language impairment). These results present the BESA-ME and the TNL in Spanish and English as promising tools to assess language impairment in a population that traditionally has been a challenge to evaluate. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Η γνωστική έκπτωση εμφανίζεται στο 40-70% των ασθενών με ΠΣ, επηρεάζει σημαντικά την ποιότητα ζωής τους και έχει συσχετισθεί τόσο με τη σωματική αναπηρία, όσο και με διάφορες απεικονιστικές παραμέτρους, όπως ο συνολικός όγκος βλαβών και δείκτες ατροφίας του εγκεφάλου. Μέθοδοι: Στην παρούσα μελέτη συμμετείχαν 80 ασθενείς με ΠΣ (50 με υποτροπιάζουσα-RRMS, 30 με δευτεροπαθώς προϊούσα-SPMS). Κατεγράφησαν δημογραφικά δεδομένα και η κλίμακα αναπηρίας EDSS. Παράλληλα, έγινε νευροψυχολογική εκτίμηση με το υπολογιστικό πρόγραμμα CNS-VS καθώς και με τη δοκιμασία οπτικονοητικής ιχνηλάτησης (TMT A και Β) και λεκτικής ροής. Μελετήθηκε η επίδραση στην καθημερινή λειτουργικότητα των ασθενών (κλίμακα IADL, ικανότητα για εργασία) και υπολογίσθηκε ο συνολικός όγκος βλαβών, η ατροφία μεσολοβίου, ατροφία θαλάμων και η διάταση της 3ης κοιλίας. Χρησιμοποιήθηκε επίσης ομάδα 31 υγιών μαρτύρων για τις νευροψυχολογικές δοκιμασίες και ξεχωριστή ομάδα 51 υγιών μαρτύρων για τα απεικονιστικά δεδομένα. Αποτελέσματα: Παρατηρήθηκε έκπτωση των γνωστικών λειτουργιών στο 38% των ασθενών με RRMS και στο 80% των ασθενών με SPMS. Οι ασθενείς μας, εμφάνισαν συχνότερα χαμηλές επιδόσεις στο χρόνο αντίδρασης (83,33% SPMS/ 58% RRMS), στη δοκιμασία TMT Β (76,67% SPMS/ 34% RRMS), στην ψυχοκινητική ταχύτητα (66,67% SPMS/ 20% RRMS), στη δοκιμασία TMT Α (63,33% SPMS/ 34% RRMS), στη δοκιμασία φωνολογικής λεκτικής ροής (50% SPMS/ 30% RRMS) και στη μνήμη (40% SPMS/ 16% RRMS). Στους ασθενείς με RRMS, η γνωστική έκπτωση εμφάνισε ασθενή συσχέτιση τόσο με τη σωματική αναπηρία, όσο και με τη διάρκεια της νόσου και το συνολικό όγκο βλαβών (p<.05). Αντίθετα, ισχυρή συσχέτιση παρατηρήθηκε μεταξύ της γνωστικής έκπτωσης και των δεικτών ατροφίας του εγκεφάλου (p<.001) Παράλληλα, η κλίμακα IADL εμφάνισε ισχυρή συσχέτιση με τη μνήμη, την ψυχοκινητική ταχύτητα, την ταχύτητα επεξεργασίας και με όλους τους δείκτες ατροφίας (p<.001). Στους ασθενείς με SPMS ανευρέθη ασθενή συσχέτιση μεταξύ γνωστικής έκπτωσης και πάχους 3ης κοιλίας (p<.05). Στο σύνολο των ασθενών με ΠΣ, συνυπολογίζοντας ως συμμεταβλητές την ηλικία, το φύλο, τα έτη εκπαίδευσης και τη διάρκεια της νόσου, η χαμηλή ψυχοκινητική ταχύτητα και οι χαμηλές επιδόσεις στη δοκιμασία TMT B αποτελούν τους πλέον ευαίσθητους δείκτες πρόβλεψης αυξημένης σωματικής αναπηρίας (p=.004 για ψυχοκινητική ταχύτητα και p=.007 για TMTB) και έκπτωσης καθημερινής λειτουργικότητας (p=.001 για ψυχοκινητική ταχύτητα), ενώ η έκπτωση της σύνθετης μνήμης (p=.002) και η χαμηλή επίδοση στη δοκιμασία TMT Β (p=.004) αποτελούν τους πλέον ευαίσθητους προγνωστικούς δείκτες της ανικανότητας των ασθενών για εργασία. Στο σύνολο των ασθενών με ΠΣ, η ατροφία των θαλάμων αποτελεί τον καλύτερο προγνωστικό δείκτη χαμηλής επίδοσης στη δοκιμασία TMT Β (p=.000) και έκπτωσης της σύνθετης μνήμης (p=.000), ενώ η ατροφία τοu μεσολοβίου αποτελεί τον πλέον ευαίσθητο δείκτη πρόβλεψης μειωμένης ψυχοκινητικής ταχύτητας (p=.000). Συμπεράσματα: Παρόλο που η έκπτωση των γνωστικών λειτουργιών είναι παρούσα από τα αρχικά στάδια της νόσου, είναι συχνότερη, πλέον έκδηλη και βαρύτερη στη χρόνια προιούσα ΠΣ. Δεν ανευρέθη διαφορετικό πρότυπο έκπτωσης γνωστικών λειτουργιών μεταξύ ασθενών με RRMS και ασθενών με SPMS. Το σφαιρικό αυτό πρότυπο, χαρακτηρίζεται από έκπτωση στην ταχύτητα επεξεργασίας πληροφοριών, ακολουθούμενο από ελλειμματικές εκτελεστικές λειτουργίες και έκπτωση της σύνθετης μνήμης. Η έκπτωση των καθημερινών δραστηριοτήτων είναι πολύ βαρύτερη στην SPMS, σε σύγκριση με την RRMS . Η επιφάνεια του μεσολοβίου και των θαλάμων αναδείχθηκαν οι πλέον ευαίσθητοι δείκτες στο διαχωρισμό των ασθενών με RRMS από SPMS. Παρατηρούμε δηλαδή, ότι παρόλο που η ατροφία είναι παρούσα από τα αρχικά στάδια της νόσου, με την πάροδο των ετών αυξάνεται σημαντικά. Η ψυχοκινητική ταχύτητα, η μνήμη και η δοκιμασία ΤΜΤ Β έχουν τη μεγαλύτερη προβλεπτική ικανότητα για την εξέλιξη της νόσου, τόσο σε επίπεδο σωματικής αναπηρίας, όσο και καθημερινής λειτουργικότητας. Οι δείκτες ατροφίας παρουσίασαν την ισχυρότερη συσχέτιση με τη γνωστική έκπτωση και την έκπτωση στην καθημερινή λειτουργικότητα. Από τους δείκτες αυτούς, η ατροφία των θαλάμων και του μεσολοβίου φαίνεται να έχουν την ικανότητα να προβλέψουν τη γνωστική έκπτωση στο σύνολο των ασθενών με ΠΣ. / Cognitive decline is present in 40%-70% of patients with MS and affects their quality of life. It has been significantly correlated with physical disability as well as with total lesion load and atrophy measures on MRI. Methods: In the present study, we evaluated 80 patients with MS (50 with RRMS, 30 with SPMS). We studied their demographic characteristics and assessed them clinically with EDSS. All patients underwent thorough Neuropsychological assessment with a computerized cognitive screening battery (CNS-VS) as well as with Trail Making Test A and B and verbal fluency task. We evaluated their everyday activities with the Instrumental Activities of Daily Living Scale, and we calculated the total lesion volume, thalamic atrophy, corpus callosum atrophy and 3rd ventricle width as apeared on the MRI. In addition, 31 healthy individuals underwent the same Neuropsychological assessment and 51 healthy individuals had brain MRI scans for comparison with our patients. Results: We found 38% of our RRMS patients and 80% of our SPMS patients to have cognitive deficits. More frequently affected measures were reaction time (83,33% SPMS/ 58% RRMS), TMT B(76,67% SPMS/ 34% RRMS), psychomotor speed (66,67% SPMS/ 20% RRMS), TMT A (63,33% SPMS/ 34% RRMS), phonological verbal fluency task (50% SPMS/ 30% RRMS) and memory (40% SPMS/ 16% RRMS). In our RRMS patients, cognitive impairment had a weak correlation with physical disability and total MR lesion load (p<.05) and a strong correlation with all atrophy measures (p<.001). Moreover, IADL were highly correlated with psychomotor speed, processing speed, memory and all MR atrophy measures (p<.001). On the other hand, our SPMS cognitively impaired patients had only a weak correlation with 3rd ventricle width (p<.05). When taking our MS patients as a single group and using as covariates age, sex, years of education and disease duration, we found that low psychomotor speed (p=.004) and poor performance on TMT B (p=.007) were the most sensitive predictors of increased physical disability, whereas psychomotor speed predicted impaired every day activities (p=.001). Employment status was predicted by impaired composite memory (p=.002) and poor performance on TMT B (p=.004). Thalamic atrophy was the most sensitive indicator for poor performance on TMT B (p=.000) and impaired memory (p=.000), while corpus callosum atrophy was the best indicator for slow psychomotor speed (p=.000). Conclusions: Although cognitive impairment is present from the early stages of MS, it is much commoner, more pronounced and severe at the progressive stage of MS. In the present study, we were not able to find a different pattern of cognitive decline between RRMS and SPMS patients. We observed a global pattern, consisting of impairment in information processing speed, followed by executive dysfunction and memory deficits. As disease progresses, everyday activities are affected more severely. Comparison of RRMS and SPMS patients revealed statistical significant difference in the surface of corpus callosum and thalami, indicating that although atrophy is present form the early stages of the disease, it is more prominent in the progressive stage. Psychomotor speed, composite memory and TMT B are the best predictors of EDSS and every day activities impairment (IADL). All of our MR atrophy measures had a strong correlation with cognitive decline and impaired every day activities. It seems that thalamic atrophy and corpus callosum atrophy are the best predictors of cognitive decline in our MS patients.

Variability inherently present between multiple talkers can prove beneficial in the context of learning. However, the performance during learning paradigms by children with specific language impairment (SLI) remains below typically developing peers, even when multiple talkers are used. Preschool children with typically developing language (n = 17) and SLI (n = 17) participated in a talker discrimination task. Five different pairings of talkers (same male, different males, same female, different females, male + female) were used to present 50 spoken words. Children with SLI were significantly poorer in discriminating same and different male speakers compared to their typical peers. The present findings demonstrate that preschool children with SLI can experience difficulty distinguishing between talkers. Poor sensitivity to variation in talkers may contribute to poor learning in SLI for contexts where multiple talker input should benefit the learner.

In 2000, contributors to the formulation of the National Plan for Training Personnel to Serve Children with Blindness and Low Vision anticipated a severe shortage of direct service personnel as early as 2006 with an increasing negative impact on teacher numbers through the end of the decade. It is necessary to attract approximately 5,000 new teachers to the field to meet the needs of the ever-increasing population of students with visual impairments requiring specialized training.This study investigated the personality and background experiences of individuals who are attracted to work as educators with students with visual impairments. A sample of 132 teachers who had been trained at either the undergraduate or graduate level and were employed within their first five years as teachers with this specialization completed the Holland Self-Directed Search (Form CP) and a Participant Profile form to ascertain the personality types and experiences of those new to the field.The study considered three variables: (1) gender, (2) race/ethnicity, (3) teacher training level and their association with Holland personality type (RIASEC). All three variables were weak predictors of the personality type of teachers of the visually impaired as indicated by Goodman and Kruskal's tau. Results of the Holland Self-Directed Search was a stronger measure of the personality type associated with becoming a teacher of students with visual impairments. The data related to the sample revealed that 65.2% of those responding identified themselves as Social type.Teachers identified how they became aware of the field prior to making a decision to enter a teacher-training program, what their reasons were for making a decision to enter a training program to become a teacher of students with visual impairments, and which areas of their teaching experience differed from what they had expected prior to employment in the field. Limitations of the study, implications of the results for recruitment and retention of teachers of students with visual impairments, and recommendations for future research are provided.

No description available.