<p>There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively. </p><p>Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery <i>and</i> proper management of sick-listing (II). </p><p>Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV).</p><p>Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended.</p>

Utvecklingen av nya metoder för att studera hjärnans struktur och funktion har lett till ny förståelse om kognition. Inom kognitiv neurovetenskap studeras sambandet mellan hjärnan och tänkandet, där inlärning ingår. Hur inlärning fungerar är väsentligt för att utbildning tillgodogörs. Denna litteraturstudie är baserad på delar av den kognitiva neurovetenskapen som berör olika aspekter av vad skolan och lärare kan ha nytta av för att främja elevers inlärning. Hjärnans olika funktioner kan ofta kopplas till olika regioner i hjärnan, och hippocampus samt främre hjärnbarken är två viktiga regioner för både minnesbildning samt framplockning av minnen. Främre hjärnbarken är dessutom den del av hjärnan där de exekutiva funktionerna som har stor betydelse för inlärning är lokaliserade. En viktig förutsättning för inlärning är att hjärnan är plastisk, den kan förändras både strukturellt och biokemiskt. Hjärnan är plastisk hela livet, men fram tills 25-årsåldern då hjärnan fortfarande utvecklas sker större förändringar, vilket har betydelse för såväl inlärning som beteende. Stress kan genom bland annat synaptisk plasticitet påverka inlärning på ett negativt sätt över tid, samtidigt som det även direkt hämmar vår förmåga både att lära oss och att minnas. Till exempel kan stress hämma våra exekutiva funktioner, varav arbetsminnet är en sådan funktion som är betydande för inlärning. Många ungdomar idag lider av psykisk ohälsa, och upplevelser av negativa emotioner bidrar till att hjärnan och kroppen upplever stress. För att öka elevers uppmärksamhet är det därför viktigt med ett klassrum där det är lugnt och alla känner sig trygga. Elevers uppmärksamhet och inlärning kan även påverkas genom motivation, som i hjärnan är lokaliserat i en del av belöningssystemet. Det är även förmågan att lära sig genom återkoppling, som är ett effektivt sätt att skapa inlärning. Hjärnan lär sig genom att associera ny information till tidigare lagrad kunskap, vilket är bra att tänka på framförallt när ny kunskap ska presenteras. Bra sömn och fysisk aktivitet är två faktorer som är viktiga för minnesbildningen men som kan kännas svåra att påverka som lärare, samtidigt som det inte är helt omöjligt. Även mindfulness kan implementeras och bidra till både bättre välmående och inlärning. Den kognitiva neurovetenskapen kan på flera sätt tillämpas i skolan för att främja elevers inlärning.

Kan motivation till att lära sig gå att se genom avbildningar av hjärnan? Finns det någraneurobiologiska stöd för att det dessutom skulle kunna påverka minnesbildning? Tidigareforskning har visat att aktivering av belöningssystemet och ökade nivåer av signalsubstansendopamin kan gynna minnesbildning. I denna översiktsartikel behandlas studier som berörmotivation ur olika psykologiska aspekter och hur det påverkar det deklarativalångtidsminnet. Olika hjärnavbildningsmetoder där dopaminerga regioner och hippocampushar varit centrala, tillsammans med olika inlärningsuppgifter och psykologiska tester talar föratt motivation är en viktig faktor för inlärning. Dessutom visar flera av studierna att positivåterkoppling har en bättre effekt på inlärning jämfört med negativ återkoppling.

Syftet med detta arbete är att presentera de olika utmaningar som elever med neuropsykiatriska funktionsnedsättningar ställer på Sveriges utbildningsystem och i synnerhet när det handlar om att undervisa dem i moderna språk. Studiens frågeställning är hur lärarna i moderna språk undervisar elever med olika typer av inlärningssvårigheter. Vad säger neurovetenskapen, svenska skollagen och finns det didaktiska metoder för att hantera dessa barn på bästa sätt? Studien, fokuserad på lärarna i moderna språk, har genomförts för att undersöka hur dessa upplever sitt arbete med elever med neuropsykiatriska funktionsnedsättningar. Metoden som använts i examensarbetet är en kvalitativ undersökningsform och tekniken för att samla information är intervjuer. Vi konstaterar olika slutsatser efter studiens resultat som alla pekar på en rad brister: ingen tillgång av lärare inom specialpedagogik för att hantera elever med specialbehov; ingen tillgång till specialmaterial; ingen tid att förbereda/söka specialmateriel/skapa anpassningar; inget stöd från skolledning/specialpedagog; inget ämnesdidaktiskt stöd för språkundervisning. Slutligen har olika lösningar föreslagits.

The aim of this study was to investigate why musical instruments are not used more freely and frequently during activities as recess or at the after-school centres. A survey was executed among primary school staff in Piteå municipality, Sweden. The survey addressed past experience of musical activities, interest in music as well as individual extent of musical education. Participants were further asked to give a recollection of the accessibility of musical instruments in their workplace and eventually to reflect upon how satisfied they were with current accessibilities and work procedures considering the use of musical instruments. The outcome of the survey shows that there is a high accessibility of musical instruments in the primary school organization of Piteå municipality and that elementary teachers, as well as after-school centre teachers, often have formal musical education in their professional training. Despite these seemingly good conditions regarding musical practice, music is still treated differently from other topics and school activities. This could indicate that there are other elements, apart from actual musical competence, that are the source of these misconceptions and insecurities concerning musical instruments. One such element could be the individual experience of musical training and views on musical competence mediated within former teacher-student relations. Other elements include discourse and social structures within the teaching community, connected to views in larger society on culture and musicality, that could be the real cause of musical instruments not being used outside of musical classes. This study raises the question of what is to be prioritized in the school system. Should music teachers still be the only ones “allowed” to play instruments? Or should school staff put aside their own opinions and insecurities so that children may have a rich learning experience in music which further promotes development and progress? / Denna studie började med observationen att musikinstrument, även om de finns tillgängliga i skolans lokaler, inte används i någon större utsträckning utanför de lektioner som hålls av musiklärare. Syftet med den här studien är att förstå varför musikinstrument inte används mer ofta, och mer fritt, inom de verksamheter inom skolan som skulle kunna ha utrymme för det, såsom under rasterna eller fritidshemmens aktiviteter. En enkätundersökning har genomförts med lågstadielärare, musiklärare och fritidspedagoger i Piteå kommun. Deltagarna fick svara på frågor om deras tidigare erfarenheter av musikaliska aktiviteter, deras intresse för musik samt omfattningen av individuell musikalisk utbildning. De blev vidare ombedda att uppskatta tillgången till musikinstrument på deras arbetsplats och fick slutligen reflektera över hur nöjda de var med verksamhetens förutsättningar för musicerande och musikskapande aktiviteter. Utfallet av enkätundersökningen visar att det finns en hög tillgänglighet av musikinstrument i grundskolans lokaler inom Piteå kommun samt att lärare och fritidspedagoger ofta har tagit del av viss akademisk musikutbildning i sin pedagogiska utbildning. Trots dessa goda förutsättningar för musikaliska aktiviteter och musikskapande är musik fortfarande, som ämne och aktivitet sett, annorlunda betraktat jämfört med andra ämnen och aktiviteter inom skolans verksamhet. Musikinstrument, vilka skulle kunna ses som viktiga verktyg för lärande, ses istället som exklusiv utrustning som bara får användas av den som redan behärskar musik som konstform - såsom musiklärare eller kulturskolelärare. Studien väcker frågan om vad som ska prioriteras i verksamheten. Ska musiklärare fortsätta vara de enda som “får” använda och spela på musikinstrument? Eller är det dags att lärare och fritidspedagoger lägger diskursen och osäkerheten åsido så att barnen kan få tillgång till en rikedom av erfarenheter av musik som vidare främjar lärande och utveckling?

<p>Although consciousness has been studied since ancient time, how the brain implements consciousness is still considered a great mystery by most. This thesis investigates the neural correlates of consciousness by measuring brain activity with functional magnetic resonance imaging (fMRI) while specific contents of consciousness are defined and maintained in various experimental settings. Study 1 showed that the brain works differently when creating a new conscious percept compared to when maintaining the same percept over time. Specifically, sensory and fronto-parietal regions were activated for both conditions but with different activation patterns within these regions. This distinction between creating and maintaining a conscious percept was further supported by Study 2, which in addition showed that there are both differences and similarities in how the brain works when defining a visual compared to an auditory percept. In particular, frontal cortex was commonly activated while posterior cortical activity was modality specific. Study 3 showed that task difficulty influenced the degree of frontal and parietal cortex involvement, such that fronto-parietal activity decreased as a function of ease of identification. This is interpreted as evidence of the non-necessity of these regions for conscious perception in situations where the stimuli are distinct and apparent. Based on these results a model is proposed where sensory regions interact with controlling regions to enable conscious perception. The amount and type of required interaction depend on stimuli and task characteristics, to the extent that higher-order cortical involvement may not be required at all for easily recognizable stimuli.</p>

<p>Wilson's disease (WD), bepatolenticular degeneration, is an autosomal recessive disorder caused by mutations in the ATP7B gene, and is characterised by abnormal metabolism and deposition of copper in the liver, brain and other organs. The main aim of this thesis was to investigate the occurrence of psychopathology, as well as personality traits and neuropsychological function in Swedish patients with treated WD. The research subjects were 29 patients with confirmed WD, investigated at the Department of Internal Medicine at Uppsala University Hospital between 1996 and 2000. </p><p>The treated WD patients showed prominent psychopathology as determined by the Comprehensive Psychopathological Rating Scale. The spectrum of psychopathological symptoms is not typical of classic psychiatric syndromes, and includes symptoms from Anxiety, Depression and Obsessive-Compulsive disorders as well as Negative Symptoms. In self-assessment, the WD patients tended to underestimate the presence of psychopathological symptoms. The treated WD patients differed in their sleep pattern from the control group, as measured with the Uppsala Sleep Inventory. The spectrum of self-reported symptoms suggests an altered REM sleep function. </p><p>The treated WD patients had significant deviations in personality traits, especially in aggressivity-hostility related scales and Psychic anxiety, compared to healthy controls, as measured with the Karolinska Scales of Personality. The deviations were not related to age, age at onset or duration of WD. The treated WD patients displayed a specific profile of moderate neuropsychological impairment, as determined by the Automated Psychological Test battery. Finally, an attempt was made to search for, possible genotype-phenotype relationships in some ATP7B mutations. </p>

<p>The general aim of this work was to evaluate the outcome of specialised stroke rehabilitation and to examine the relation between both subjectively perceived and objectively assessed balance and impairments and some activity limitations. A further, integrated aim was to establish some psychometric properties and the usability of a newly developed Falls-Efficacy Scale, Swedish version (FES(S)) in stroke rehabilitation.</p><p>Seventy-three patients younger than 70 years of age with a first stroke and reduced walking ability were randomised into an intervention group (walking on a treadmill with body weight support) and a control group (walking on the ground). Time points of assessment were: on admission for rehabilitation, at discharge and 10 months after stroke. Walking training on a treadmill with body weight support and walking training on the ground were found to be equally effective in the early rehabilitation. The patients in both groups improved their walking velocity, motor function, balance, self-efficacy and ADL performance.</p><p>In a geriatric sample of 37 stroke patients examined at similar time points, significant improvements in self-efficacy, motor function, balance, ambulation and ADL occurred from admission to discharge independently of age. In comparison with observer-based balance measures, FES(S) at discharge was the most powerful predictor of ADL performance 10 months after onset of stroke.</p><p>In 30 patients with stable stroke, the overall test-retest reliability of FES(S) was found to be adequate. The internal consistency confirmed that FES(S) has an adequate homogeneity.</p><p>In a subsample of 62 patients from the original sample and in the geriatric sample, FES(S) correlated significantly with Berg’s balance scale, the Fugl-Meyer balance scale, with motor function and with gait performance. In the relatively younger group ADL (measured by the Functional Independence Measurement) correlated significantly with FES(S) on admission and at 10 months follow-up, while at discharge none of the FES(S) measures correlated significantly with ADL. In this subsample effect size statistics for detecting changes in FES(S) demonstrated very acceptable responsiveness of this scale during the early treatment period and during the total observation period</p><p>In the light of these findings assessment and treatment of self-efficacy seems relevant in stroke rehabilitation. </p>

<p>Stroke is the third leading cause of morbidity and mortality in the industrialized world. Subarachnoid hemorrhage (SAH), the least common form of stroke, is one of the most demanding diseases treated in neurointensive care units. Cerebral ischemia may develop rapidly, and has a major influence on outcome.To be able to save parts of the brain that are at risk for ischemic brain damage, there is a need for reliable monitoring techniques. Understanding the pathophysiology of cerebral ischemia is a prerequisite both for the correct treatment of these diseases and for the development of new monitoring techniques and treatment modalities. The main aim of this thesis was to gain insight into the mechanisms of cerebral ischemia by studying early hemodynamic and metabolic changes with positron emission tomography and neurochemical changes with microdialysis. A secondary aim was to evaluate the potential of these techniques for detecting ischemia and predicting the degree of reversibility of ischemic changes.</p><p>Early changes in cerebral blood flow (CBF) and metabolism (CMRO₂) were studied with repeated positron emission tomography in an experimental model (MCAO) of transient focal ischemia, and in SAH patients. CMRO₂ was superior to CBF in discriminating between tissue with irreversible damage and tissue with the potential for survival in the experimental model. A metabolic threshold of ischemia was found. Neurochemical changes in the ischemic regions were studied simultaneously with microdialysis. Extracellular concentrations of glucose, lactate, hypoxanthine, glutamate and glycerol were measured, and the lactate/pyruvate (LP) and lactate/glucose ratios were calculated. Changes in all the microdialysis parameters were related to the degree of ischemia (severe ischemia or penumbra). Especially the LP ratio and glycerol were found to be robust and specific markers of ischemia. In the patients, hemodynamic and metabolic changes were common, but diverse in the acute phase of SAH, and it was suggested that these changes may contribute to an increased vulnerability for secondary events and the development of secondary ischemic brain damage.</p>

<p>The subjects were 130 male prisoners in Swedish jails were examined by SCID and the diagnoses given in terms of DSM-IV. The most common mental disorder was drug abuse. On Axis II several personality disorders were diagnosed. Personality assessments were made by KSP. High scores were mainly found for e.g. impulsiveness, sensation seeking, aggression and low scores in socialisation.</p><p>MAO assays were performed in 99 male criminal offenders and in 60 non-criminal volunteers. Offenders had lower MAO activity than controls also with the confounding factor smoking under control. It is proposed that platelet MAO is linked to personality traits, which can predispose for criminality. </p><p>For testing the existence of combinations of vulnerability factors, a configuration frequency analysis (CFA) was used. The criteria which formed the basis for the subgrouping were; MAO activity below or above –0.5 SD of the mean (L and H), the presence or absence of an Axis I disorder (= drug abuse) (Y/N), the presence or absence of an Axis II disorder (Y/N), or the presence or absence of an Axis I and II disorder (Y/N). In this way eight subgroups were formed. Two significant "types" were found among the criminals: One was characterised by low platelet MAO activity, Cluster B personality diagnosis as well as Drug Abuse Disorder diagnosis (LYY); and the other by a pattern of normal platelet MAO activity, no Cluster B personality disorder, and no Drug Disorder diagnosis (HNN). Also two "antitypes", occurring less frequent than expected, were identified; LYN and LNY. Thus, the aggregation of certain risk factors in the same individual has been shown to contribute to the development of criminal behaviour.</p><p>The subgroups HNN, LYN, LNY and LYY were then analysed for a variety of criminological factors. There was a difference in mean age between the subgroups, the HNN being lowest. Economical crimes were more common at an early criminal debut and crimes involving violence at an adult debut. The HNN subgroup had a lower number of crimes and times spent in jail than the other subgroups. More than 50% of the clients in all groups had previously been sentenced to Reformatory.</p>