Barn med Down syndrom har ofta återkommande hörselproblem som exempelvis vaxpropp och sekretorisk mediaotit. Vanligt förekommande hörselnedsättning bland dessa barn är en fluktuerande konduktiv hörselnedsättning. Den utvecklingsstörning som syndromet orsakar kan leda till att barnen ej kan medverka aktivt vid konventionella hörselmätningar. Metoder för hörselutredning av små barn och barn som ej kan medverka adekvat är BRA, OAE och tympanometri. Syftet med arbetet är att belysa resultaten från BRA, OAE och tympanometri hos barn med DS. Vidare syftar studien till att belysa tänkbara habiliterande insatser för att bibehålla eller förbättra hörseln hos barn med Down syndrom. Som metod används systematisk litteraturstudie. Resultatet från föreliggande studie visar att mätresultat skiljer sig mellan barn med Down syndrom och barn utan Down syndrom. Strukturella avvikelser i hörselsystemet hos barn med Down syndrom påverkar resultaten från dessa mätningar. Det är därför av vikt att resultaten tolkas utifrån kunskaper om hur olika faktorer i hörselsystemet orsakade av syndromet kan påverka resultaten. Barn med DS behöver regelbundna och återkommande hörselhabiliterande insatser för att förebygga konduktiva hörselnedsättningar.

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Sammanfattning Bakgrund Ett välfungerande samarbete mellan vårdpersonal och tolk är en förutsättning för en jämlik och rättssäker vård. Området logopedi är utmanande för tolkar eftersom översättningen ofta blir en del av den kliniska bedömningen. Tidigare studier har visat att utmaningar i ett logoped-tolk samarbete innefattar otydlig rollfördelning, tidsbrist och avsaknad av rutiner. Det har även framkommit osäkerheter kring hur exakt översättningen blir när tolken medlar. Dessvärre saknas svenska studier som kartlägger vad som skulle krävas för att uppnå ett optimalt samarbete mellan tolk och logoped i Sverige. Syfte Syftet med föreliggande studie var att synliggöra logopedens erfarenheter, känslor och attityder till tolksamarbete. Författarnas förhoppning var att lyfta fram såväl framgångsfaktorer som utmaningar och kartlägga logopedens syn på vad som krävs för ett optimalt samarbete. Metod Huvudsaklig metod utgjordes av två fokusgruppsintervjuer. Utifrån de fynd som framkom från intervjuerna utformades en webbenkät. Syftet med webbenkäten var att undersöka ifall de åsikter som framkommit under fokusgruppsintervjuerna delades av andra logopederrunt om i landet. Sammanlagt medverkade 79 deltagare, varav 9 i fokusgrupperna. Resultat De främsta utmaningarna som identifierades i studien var tidsbrist, att få tag på tolkar med tillräcklig kompetens, brister rutinerna samt osäkerheter kring hur precis översättningen blir. Samtidigt beskrevs tolksamarbeten som både underlättande och positivt av många deltagare. För att skapa ett så gynnsamt samarbete som möjligt föreslår studiens deltagare tydligare riktlinjer, tillgång till fler tolkar med erfarenheter av logopedsamarbete, samt att det ska finnas färdiga instruktioner och dokument att förbereda tolken med. Lättare tillgång till utbildade och auktoriserade tolkar uttrycktes även från flertal deltagare. Slutsats Svenska logopeder beskriver samarbetet med tolk som viktigt, givande och ytterstnödvändigt, men samtidigt även som svårt och tidskrävande. Många uttrycker oro inför hur tillförlitlig och högkvalitativ patientbesöken blir när tolk är involverad. Logopederna i denna studie påpekar flera förbättringsförslag vad gäller tillvägagångssätt samt rutiner och riktlinjer som skulle kunna höja kvaliteten på samarbetet mellan logoped och tolk. Ytterligare studier krävs för att undersöka hur förbättringsförslagen ska implementeras iden logopediska verksamheten.

Demenssjukdom innebär en progressiv nedsättning i kognitiva funktioner som språk, minne och exekutiva funktioner. I takt med det progredierande sjukdomsförloppet ökar kommunikationssvårigheterna hos personer med demens, vilket kan leda till försämrad livskvalitet. Gruppaktiviteter och kognitiv stimulans anses gynna livskvalitén hos personer med demens. Samtalsstöd som är baserade på reminiscensterapi kan underlätta för personer med demens att delta i samtal. Informations- och kommunikationsteknik har visat positiva resultat i relation till kommunikation vid demenssjukdom. Personer med demens har i tidigare studier uppvisat svårigheter avseende initiativtagande i kommunikativa situationer, vilket motiverar föreliggande studie.   Föreliggande studie syftade till att bidra med kunskap gällande om och hur personer med demens under gruppsamtal tar kommunikativa initiativ genom att ställa frågor. Fyra personer med demenssjukdom rekryterades på ett demensboende. Gruppsessionerna utgjordes av åtta samtalstillfällen, fyra med CIRCUS och fyra med icke-teknologiskt samtalsstöd. Materialet omfattade totalt 6 timmar 39 minuter och 50 sekunder. Analysen bestod av en kartläggning av interaktionsfenomenen inkluderande frågor, ämnesinitierande frågor och samtalsutvecklande frågor. Samtalsföreteelserna fintranskriberades och analyserades utifrån samtalsanalytiska principer. Intervjuer genomfördes för att kartlägga deltagarnas upplevelser av samtalssessionerna.   Resultatet visade att personer med demenssjukdom under gruppsamtal med CIRCUS och icketeknologiskt samtalsstöd aktivt tar kommunikativa initiativ i form av frågor i interaktionen med varandra. Det underlättade för personerna med demens att föra samtal med mer personligt innehåll och självständigt delta i samtalen då CIRCUS användes. Deltagarna uppskattade samtalssessionerna och att samtala utifrån de personliga fotografierna, men också den sociala interaktionen som uppstod i samtalen kring fotografierna från det gemensamma boendet. Till skillnad från tidigare studier indikerar föreliggande studie att personer med demens självständigt kan ta kommunikativa initiativ under gruppsamtal. Föreliggande studie indikerar även att både generiskt och personligt reminiscensmaterial kan utgöra ett stöd för personer med demens att självständigt delta i gruppsamtal. Det finns begränsad forskning om hur personer med demens tar kommunikativa initiativ i form av frågor i social interaktion varför ett behov av vidare forskning föreligger. Föreliggande studie indikerar att CIRCUS har god potential att användas som gruppintervention för personer med demens för att stimulera till samtal om deras liv och personliga erfarenheter, vilket skulle kunna främja livskvaliteten hos personer med demens. / Dementia means a progressive deficit in cognitive functions such as language, memory and executive functions. As the disease progresses the communication difficulties for people with dementia increases, which can lead to impaired quality of life. Group activities and cognitive stimulation is beneficial to the quality of life for people with dementia. Conversation support based on reminiscence therapy can help people with dementia to participate in conversations. Information and communication technology have shown positive results in relation to communication in dementia. In previous studies, people with dementia have shown difficulties regarding initiation in communicative situations, which justifies the present study. The present study aimed to contribute with knowledge regarding whether and how people with dementia take communicative initiatives by asking questions during group conversations. Four people with dementia were recruited in a dementia residence. The group sessions consisted of eight conversation sessions, four with CIRCUS and four with non-technological conversation support. The material consisted of a total of 6 hours 39 minutes and 50 seconds. The analysis consisted of a mapping of the interactional phenomena which consisted of including questions, topic-initiating questions and conversation-elaborating questions. The conversation phenomena were transcribed and analysed on the basis of conversation analytic principles. Interviews were conducted to map the participants' experiences of the conversation sessions. The results showed that people with dementia actively take communicative initiatives in the form of questions in the interaction with each other during group conversations with CIRCUS and with non-technological conversation support. The sessions with CIRCUS made it easier for people with dementia to hold conversations with more personal content and to independently participate in the conversations. The participants appreciated the conversation sessions and to talk based on the personal photographs, but also the social interaction that arose in the conversations about the photographs from the common accommodation. Unlike previous studies, the present study indicates that people with dementia independently can take communicative initiatives during group conversations. The present study indicates that both generic and personal reminiscence material can support people with dementia to independently participate in group discussions. There is limited research on how people with dementia take communicative initiatives in the form of questions in social interaction, why a need for further research exists. The present study indicates that CIRCUS has good potential to be used as a group intervention for people with dementia to stimulate conversation about people with dementia's life and personal experiences, which could promote the quality of life for people with dementia.

Head and neck cancer is a heterogeneous group of tumours, of which certain subgroups such as cancer of the mobile tongue frequently are associated with a relatively poor prognosis due to the high risk of regional failure and mortality rates that haven’t improved in a significant way over the last 3 decades, despite advancements in both diagnostics and treatment. Today we lack means to assess the biological aggressiveness of each individual tumour, which varies largely. Treatment comprises of surgery with additional radiotherapy and medical therapies in more advanced tumours. The focus in this thesis is on molecular biomarker expression in head and neck cancer and especially in association with radiotherapy. Increased knowledge paves the way to a more individualized cancer treatment aiming for better outcome and less overtreatment and sequelae. The aims of this thesis was: To map the effects of radiotherapy in both tumour and adjacent tissue for the possible markers hyaluronan, EGFR and mast cells. To investigate whether the expression of hyaluronan in the epithelium and connective tissue stroma and EGFR in the tumour correlates with the risk for developing cervical metastasis in N0 patients, and to find out whether the 3-year tumour-specific survival rates correlates with the expression of HA in the epithelium and EGFR in the tumour. To establish an animal model for radiation-induced mucositis and to use that model to examine the pattern of invading inflammatory cells. To investigate whether the expression of podoplanin in tongue cancer correlates with the risk for cervical metastasis and to determine whether the total amount of lymph vessels in the diagnostic biopsy has any impact on the clinical outcome. To investigate the differences in the metabolome of tongue cancer cell lines with different radiosensitivity. The most important findings of this thesis were: The expression of EGFR and hyaluronan hade the same pattern of expression in both tumour and adjacent tissues before radiotherapy. The expression of EGFR was increased in the epithelium of the adjacent tissue close to the tumour after radiotherapy. The intensity of the staining of hyaluronan was correlated to the 3-year survival rates in patients with tongue cancer. An experimental model for radiation-induced oral mucositis in rat was established and in this model a temporal pattern of macrophage invasion with two different subtypes of macrophages was found. There were no correlation between the expression of podoplanin in the tumour tissue and the cervical metastasis rate in patients with tongue cancer, but the younger patients were more likely to have a higher expression of podoplanin in their tumour than elder patients. Tongue cancer cell lines with different radiosensitivity respond to irradiation with different patterns of metabolic expressions.

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It is well-known that many people like to listen to music when they are running,something that is not always available for people with hearing aids [1].The experience of music is not often taken into account when people have lostparts of their hearing, but music is in many ways important for the well-being[2]. In this project has an application been developed, to make certain audioparameters accessible for adjustments according to the users individual hearing.The parameters chosen were latency, compression, balance and loudness. Theseparameters have been chosen with the argument that they have big impact onthe experience of the music. As an example there might be latency betweenthe hearing aids between the left and the right hearing. Very often people withhearing aids have different hearing at the left and the right ear, therefore thebalance was chosen as a parameter. Compression were chosen with respect tothe fact that hearing loss often leads to less capability to hear frequencies indifferent frequencies areas. Loudness was chosen due to that it is a subjectiveparameter, that will have different impact on different individuals. The parametershave been chosen with a hypothesis that they may affect the hearingexperience for different individuals. The result show that the participants changed audio settings, each of theaudio parameters to different values and appreciated the function to changethese parameters. The participants said that the application developed in thisproject, improved their music experience and they said that they would appreciateto use an application like this, to get more value of listening to music. Theapplication was well designed and easy to use during a sport session.

Syftet med studien var att utifrån specifika frågeställningar systematiskt granska vetenskapliga studier av audiologisk grupprehabilitering. I studien undersöktes själva definitionen av audiologisk grupprehabilitering, hur olika variabler påverkar resultatet, hur utvärderingen bör ske samt hur den förhåller sig till de uppställda målen.     Den metod som tillämpats är litteraturstudie. För litteratursökningen till denna studie användes databaserna PubMed och Cinahl. Vissa artiklar söktes även från vetenskapliga studiers referenslistor samt tips från handledare.       Resultaten från de olika studierna visar att nytta med rehabilitering varierar då många aspekter spelar in och påverkar utgången av rehabiliteringsinsatsen. Rehabiliteringen bör ses som en patientcentrerad problemlösande process för att nå alla individers önskemål. När patienten själv är mer aktiv i utvärderingen ökar möjligheten att uppnå målen gällande grupprehabilitering. Hänsyn måste tas till varje enskild individs sociala bakgrund för att skapa ett audiologiskt rehabiliteringsprogram som möter deras krav vid lyssnande och kommunikation. Individens livsstil, kommunikationsvanor, krav och egenheter interagerar med fysiska begrepp såsom graden och formen på hörselnedsättningen.    Audiologisk grupprehabilitering är en åtgärd för att förbättra eller lindra problem vid hörselnedsättning och de olika studierna visar på varierande resultat. Grupprehabiliteringens mål skall möta patientens behov. För att nå dit behövs utvärderingsmetoder som är personcentrerade och problemlösande. Användandet av öppna frågeformulär är ett sätt att nå det kriteriet. / The purpose with this study was to systematically examine scientific studies of audiologic group rehabilitation. The definition of audiological rehabilitation was explored, different variables that influence the result and how the outcome measures should be done and its relationship with the goals of audiologic rehabilitation.    The method used was a literature study. Pubmed and Cinahl were used for the search of literature. Some articles were searched from scientific studies reference lists and also advice from the supervisor.   The result from the different studies shows that the effect of rehabilitation varies as there are many aspects that have an affect on the outcome measure. Rehabilitation should be seen as a patient centered problem solving process in order to reach the goals of all the individuals. When the patient is more active in the outcome measure procedure the goals also comply with the group rehabilitation. Consideration must be taken to social background of each and every individual in order to create an audiological rehabilitation program that meets their hearing and communication requirements.  The lifestyle, communication habits and singularity of the individual interact with physical conceptions as well as the grade and shape of the hearing impairment.   Audiological group rehabilitation is a mean to improve or relieve problems due to hearing impairment and the different studies show that the result varies. The goals of group rehabilitation should meet the need of the patient. In doing so there is a need of outcome measures that are person centered and problem solving. Using open questionnaires is a method to reach that criterion. / <p>Examensarbete inom audionomprogrammet, Göteborgs universitet. </p>

The present thesis concerns people with Usher syndrome (USH) and their health. People with USH have a congenital hearing loss of various degrees and an eye disease with a progressive course; for some, the balance is also affected. Three clinical groups have been identified 1, 2 and 3, and 13 genes have currently been identified. USH is the most common cause of deafblindness. Clinical knowledge and the limited research that exists have shown that people with deafblindness can experience difficulties in everyday life. Depression, anxiety and social withdrawal have been described. The general aim of the present thesis was to describe the health of people with USH. The empirical material employed was based on an extensive survey in which people with USH answered two questionnaires concerning health, anxiety, depression, social trust, work, health-care, financial situation, and alcohol and drug use. The focus of the present thesis is on general health, physical health and psychological health, social trust and finance. Three studies in the present theses focus on USH1, 2 and 3, respectively; finally, the fourth study provides an in-group comparison of people with USH. The results of studies I and III are compared with a crosssection of the Swedish population. The results revealed poor physical and psychological health, a lack of social trust and a strained financial situation regardless of clinical diagnosis. The discussion stresses the importance of taking a biopsychosocial approach when describing the health of people with USH, in which previous research is lacking. Additional research should focus on the mechanisms at different levels that affect people with USH and their health from a life- course perspective. Furthermore, research should include a salutogenic perspective to explore the resources and strengths of people with USH.

Background. The current understanding on caries and enamel developmental defects prevalence and frequency, caries risk, health-related quality life (HRQoL) and stress response in young children with cleft lip and/or palate (CL/P) are sparse. In this thesis these aspects were investigated in 5- and 10- year-old children with CL/P in comparison to non-cleft children in the same ages. Design. The studies in this thesis have a cross-sectional case-control design. Participants. The study group consisted of 139 children with CL/P (80 children aged 5 years and 59 aged 10 years) and 313 non-cleft controls (144 children aged 5 years and 169 aged 10 years). Method. Caries was scored according to International Caries Detection and Assessment System (ICDAS II) and developmental enamel defects were measured as presence and frequency of hypoplasia and hypomineralization. Oral hygiene was assessed using Quigley-Hein plaque index. Stimulated saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rates. Information regarding children’s oral hygiene routines, dietary habits and fluoride exposure were collected with questionnaires. Caries risk was evaluated with algorithm-based software, Cariogram while HRQoL was perceived with KIDSCREEN-52. Stress response was analyzed with cortisol concentration in saliva at three different time points using a commercial competitive radioimmunoassay. Results. Caries prevalence (36% versus 18%) and caries frequency (1.2 dmfs versus 0.9 dmfs) was significantly higher in 5-year-old children with CL/P in comparison to non-cleft controls. In 10-yearolds no significant difference was found between children with CL/P and non-cleft controls in caries prevalence (47% versus 38%) or in caries frequency (0.7 DMFS versus 0.5 DMFS). Children with CL/P had significantly higher prevalence of enamel defects, higher counts of salivary lactobacilli and less good oral hygiene. The odds of being categorized with high caries risk were elevated in children with CL/P. Children with CL/P had similar HRQoL and salivary cortisol concentrations as non-cleft controls. However, 10-year-old boys with CL/P had significantly higher cortisol concentrations in the evening than non-cleft boys. Conclusions. Preschool children with CL/P seem to have more caries in the primary dentition than non-cleft controls. Children with CL/P had increased odds of being categorized as high caries risk individuals compared to controls. Some of the contributing factors seem to be higher prevalence of enamel defects, impaired oral hygiene and elevated salivary lactobacilli. Furthermore, as measured with the help of cortisol concentrations in saliva, children with CL/P were not more stressed than noncleft controls and their HRQoL was comparable to a European norm population. It appears that regular comprehensive preventive oral care in children with CL/P is effective in preventing caries development in permanent teeth. However, children with CL/P are at risk of caries development and preventive oral care should be implemented and started earlier than today.