Since the closing of total institutions in Sweden people with severe mental problems have access to places in the society in a completely different way. Prior international studies indicate that so called therapeutic landscapes can contribute to the recovery of people with severe mental problems. The aim of this study is to examine if this can be applied in a Swedish context. What places can be included in a therapeutic landscape and what about these places can influence recovery? Qualitative semi-structured interviews were conducted with seven adults with severe mental problems, followed by a thematic analysis. The result indicates that places offered by the Swedish social services, in public places and in nature can be included in a therapeutic landscape. The places can evoke a feeling of affinity, offer a change of scenery and enable activities and relationships that can contribute to recovery. Social work plays an important part in offering access to different places, as well as creating them, and can therefore contribute to a recovery process. However, people with severe mental problems are also social agents that actively can influence their own recovery and thereby strengthen their sense of self.

This study examines the connection between curriculum, transition, and employment for individuals with moderate to severe disabilities. Employment for individuals with moderate to severe disabilities remains historically low. Results pointed to a need for increased coherence among transition planning, secondary school curriculum foci, and employers. Many factors influence successful post school employment outcomes for individuals with disabilities. These factors include expectations of the individual and family, individual adaptive behaviors, skill level and lack of knowledge by potential employers of individuals with disabilities. This study sought to understand the following questions: a) in what ways are curricular approaches, transition services, and employer requirements for individuals with moderate to severe intellectual disabilities interconnected? b) What factors affect employment for individuals with moderate to severe disabilities? c) In what ways do curricular approaches and transition services impact post school outcomes for individuals with moderate to severe ID? Connecting curriculum and transition directly to the needs of employers is imperative in understanding the effects both have on post school employment outcomes for individuals with disabilities.

Carta al editor / Revisión por pares

Negative attitudes and stigma associated with mental illness have a profound impact on individuals who experience them. Researchers have defined stigma as the attribution of a deviant characteristic to members of a particular group. Persons with severe and persistent mental illness (SPMI) face many difficulties that impact their full participation in social life. Although attitudinal reactions to individuals with SPMI have improved considerably over the last few decades, there are still areas for improvement. Limited research has been conducted to evaluate attitudes and stigma associated with individuals with SPMI among human service professionals-in-training (HSPs). For this study HSPs were defined as individuals entering into social service, mental health, and substance abuse professions. Further, there have only been a few published studies in attitude research that utilized randomized vignettes portraying individuals with two different mental health diagnoses. Data collection occurred in counselor education and similar programs at many universities. A total of 79 participants (20 males and 58 females) took part in this study. Recruitment efforts reached HSPs at 27 universities throughout the contiguous United States. For this study, participants were asked to respond to self-report surveys and to one of two written vignettes to quantify their attitudes toward the individuals depicted in them. The two vignettes described an individual with a mental illness and differed in the diagnosis attributed to the individual: schizophrenia spectrum disorder in one vignette and generalized anxiety disorder in the other vignette. Results indicated that although there were slight mean differences between the two groups of participants, the differences were not statically significant, t (77) = 0.63, p =53. The Attribution Questionnaire-27 (AQ-27; Corrigan, 2012) gathered overall attitudes towards mental illness. The Mental Health Provider Stigma Inventory (MHPSI; Kennedy, Abell, & Mennicke, 2014) was used to collect data on attitudes, behaviors, and social pressure impacting stigma towards individuals who have SPMI. Data collected with these two scales yielded evidence to indicate that participants held stigmatizing attitudes towards individuals with SPMI. Data gathered suggested that graduate students in rehabilitation counselor education programs expressed fewer stigmatizing attitudes than students from other programs. This result was seen across both measures. Data were collected on frequency of contact with persons with mental illness to evaluate the association between contact frequency and knowledge of mental illness and negative attitudes. Demographic data gathered included gender, age, professional training, and number of years of work experience in a counseling-related role. Further, a hierarchical multiple regression was used to determine which order of predictors were statistically significant to the outcome measure. Prior literature suggest that prior contact and familiarity scores playing a more important role in predicting the outcome variable (AQ-27) then the demographic information. The first model was statistically significant F(6,72) =3.64, p= .003 and explained 23% of the variance in the dependent variable (AQ-27 total scores). After the input of these demographic factors the second step included LOF and SADP- PCF-R scores. After entry of the second step the overall variance was 28%. The second model was statically significant F(8,70) = 3.39 p = 002 and explained an additional 4% variance in the model. In the final adjusted model, four out of the seven predictor variables were statistically significant. A small pilot study consisting of rehabilitation counseling professionals was used to develop the methodologies for this study. The primary limitation of the primary study was the sample size. Further details of the methodology used and limitations of this particular study will be described in subsequent chapters. Implications of this study and suggested future research are proposed.

Severe weather outbreaks are violent weather events that can cause major damage and injury. Unfortunately, forecast models can mistakenly predict the intensity of these events. Frequently, the prediction of outbreaks is inaccurate with regards to their intensity, hindering the efforts of forecasters to confidently inform the public about intensity risks. This research aims to improve outbreak intensity forecasting using severe weather parameters and an outbreak ranking index to predict outbreak intensity. Areal coverage values of gridded severe weather diagnostic variables, computed from the North American Regional Reanalysis (NARR) database for outbreaks spanning 1979 to 2013, will be used as predictors in an artificial intelligence modeling ensemble to predict outbreak intensity. NARR fields will be dynamically downscaled to a National Severe Storms Laboratory-defined WRF 4-km North American domain on which areal coverages will be computed. The research will result in a model that will predict verification information on the model performance.

SAMMANFATTNING  Bakgrund: Sjuksköterskor och forskare som arbetar med forskning inom psykiatri har ett ansvar att ta del av patienters erfarenheter i samband med deltagande. Syftet med denna studie har därför varit att undersöka uppfattningar om att delta i forskning och skillnader i uppfattningar och rapporterad hälsa hos patienter med schizofreni, depression och frisk kontrollgrupp. Samt undersöka samband mellan uppfattningar om deltagande och rapporterad hälsa hos de tre grupperna.  Metod: En tvärsnittsstudie med data från 175 forskningsdeltagare med diagnoserna schizofreni, depression samt friska kontrollpersoner. Forskningspersonerna har deltagit i fem olika psykiatriska studier som genomförts mellan åren 2014 och 2022. Deltagarna har i slutet av studierna de deltagit i svarat på frågor om hur de uppfattat att delta, samt sin rapporterade hälsa i slutet av forskningsdeltagandet.  Resultat: Friska kontrollpersoner skattade signifikant högre i tillfredställelse med att delta i forskning och rapporterad hälsa än patienter med schizofreni och depression. Ingen signifikant skillnad mellan patienter med schizofreni och depression i forskningsdeltagande påvisades generellt. Dock skattade patienter med schizofreni signifikant lägre i förtroende jämfört med övriga två grupper. Patienter med depression skattade signifikant lägre i jämförelse med övriga två grupperna i positiva aspekter och rapporterad hälsa. En signifikant överensstämmelse mellan positiva uppfattningar och rapporterad hälsa påvisades hos patienter med depression.  Slutsats: Sjukdomsgraden och stigmatisering kan påverka förtroende och glädje att delta i psykiatrisk forskning hos patienter med schizofreni och depression och. Detta är något som behöver tas i beaktande vid utformningen av nya studier, i bemötande och informationsöverföring till patienterna. För att på djupet fånga upplevelse av deltagande efterfrågas fler studier med kvalitativa inslag. / ABSTRACT Background: Nurses and researchers conducting psychiatric research have a responsibility to avoid objectifying the participant and to consider patients' experiences in connection with participation. Therefore, the aim of this study was to investigate perceptions and differences in perceptions and reported health among patients with schizophrenia, depression, and a healthy control group. It also aimed to examine the correlation between perceptions of participation and reported health in the three groups.  Method: A cross-sectional study with data from 175 research participants with diagnoses of schizophrenia, depression, and healthy control individuals. The research participants participated in five different psychiatric studies conducted between the years 2014 and 2022. At the end of the studies, the participants answered questions about their perceptions of participation, and their reported health at the end of their research participation.  Results: Healthy control individuals rated significantly higher satisfaction with participation in research and reported health than patients with schizophrenia and depression. No significant difference in research participation was shown generally between patients with schizophrenia and depression. However, patients with schizophrenia rated significantly lower in confidence compared to the other two groups. Patients with depression rated significantly lower compared to the other two groups in positive aspects and reported health. A significant correlation between positive perceptions and reported health was shown in patients with depression.  Conclusion: Disease severity and stigma can affect confidence and enjoyment in participating in psychiatric research among patients with schizophrenia and depression. This is something that needs to be considered when designing new studies, in the approach and information transfer to patients. To deeply capture the experience of participation, more studies with qualitative aspects are requested.

Indiana University-Purdue University Indianapolis (IUPUI) / There is a lack of existing research that investigates the feasibility of using consumers to evaluate the fidelity of evidence-based practices, including supported employment which is an intervention that helps people with severe mental illnesses to obtain competitive employment. Fidelity refers to the extent that the SE program adheres to the Individual Placement and Support (IPS) model of supported employment. The present study was a concordance study that investigated whether or not consumers’ self reports of IPS fidelity information agreed with administrative charts and employment specialists. Additionally, it was hypothesized that consumers’ program satisfaction ratings would be positively correlated with their self reported IPS fidelity scores. An additional purpose of this study was to examine what types of supported employment fidelity items consumers were able to report on. Participants included a volunteer sample of 30 consumers and 5 employment specialists from one IPS program in Indiana. Consumers in the IPS program were interviewed by telephone using a survey that included questions related to their program’s fidelity as well as their satisfaction with the program. Questions were based off of items from the IPS Fidelity Scale and were categorized into the following subscales: work incentives counseling, job search, engagement, organization, staffing, and job support. Similar questions were asked in an employment specialist survey and a chart review. All three sources (consumers, charts, and employment specialists) indicated high IPS fidelity responses on the researcher developed surveys. However, there was a low level of agreement between the sources at both the subscale level and item level. Although there was an overall low level of agreement between sources, there were several items that had a moderate or higher degree of agreement. Additionally, the present study did find a positive correlation between the consumer fidelity score percentage and consumer IPS program satisfaction ratings, supporting the researcher’s hypothesis. Among the items that consumers had difficulty answering were several tapping program level policies such as zero exclusion. Reasons for the discrepancy in agreement between sources as well as clinical implications of the findings are discussed.

Acute pancreatitis is a disease which can present in a mild or severe form. In the last few years, the incidence of acute pancreatitis has been steadily rising. The treatment of severe cases is complex and nutrition is one of the key treatment factors. Enteral and parenteral nutrition are documented parts of acute phase treatment included in many guidelines. However, there is a controversy about the timing of initiation of peroral nutrition after the acute phase of severe pancreatitis has resolved. This dissertation shows the results of monocentric prospective randomized trial which compares the safety and effectivity of peroral nutrition compared to enteral nutrition in patients with severe acute pancreatitis during hospitalization as well as in long term after hospital discharge. Patients with severe acute pancreatitis were randomized into two groups - enteral nutrition versus peroral nutrition. The randomized nutrition strategy was initiated within the first 14 days of hospitalization. We monitored the length of hospital stay, tolerance of nutrition, complications, body weight and nutrition parameters. The two groups did not differ significantly in the length of hospital stay. The number of complications was similar between the groups, there was no significant difference in the rate of acute...

Students with disabilities often face difficulty throughout their lives. One of these common challenges for students with severe disabilities is they often struggle with routine skills — for example, significant time spent helping students transition to activities throughout the day. The student's performance to complete required daily school routines increased when the researcher applied the picture activity schedules. Also, one strategy to enable students with disabilities to increase independence is through assistive technology. Therefore, many studies support the use of technology-based visual supports to teach daily school routines. Teachers increasingly have started to adopt an electronic visual activity schedule (eVAS) as a means to provide clear and consistent support for students with disabilities. Although the above studies are positive, there is still a need to more fully examine the various outcomes of eVAS. Therefore, this study is to investigate the effects of using eVAS (i.e., FIRST THEN application) on the latency period that the student spends for checking the schedule independently and prompts needed to transition throughout the day. Also, the value that the teacher and student place on the use of an eVAS to teach daily life and school routines instead of using typical instruction (e.g., traditional visual schedule), and the student’s ability to generalize the use of the eVAS across instructors and materials (display). The participant was a 10-year-old male in the fifth grade with intellectual disability and autism. This study was conducted in an intermediate school in the southeastern United States. An ABAB single case design was used to investigate the effects of the app. The dependent variables (DV) included: 1) The percent of independent correct responding to the natural cue “timer went off, or the teacher said: “Time to Switch”; 2) The amount of time the participant took to respond to the natural cue and check a schedule. The independent variable (IV) was applying the system of least prompts (SLP) along with the First Then application on iPad. Both DV and IV were collected five sessions in five days, during the transition period between activities in each baseline, intervention, maintenance, and generalization phases. The second observer recorded 25% of the data collection of the inter-observer agreement and procedural fidelity. By the end of the study, the social validity survey was provided one for the teacher and another one for the participant. The result indicated a functional relation between DV and the IV. Also, the limitation and the suggestion for future research were discussed. In conclusion, this study extended the result of prior studies by emphasizing the effectiveness of using the eVAS with students to independently complete the routine skills and applying SLP to give the student the opportunity to do the task with less prompts. The study will guide teachers use of such support tool and apply the intervention in the classroom with students with disabilities.

Managed Mental Health Care (MMHC) began blanketing the United States when cost of care rose exponentially. MMHC is one avenue many employers and insurance companies have chosen to provide employees with mental health treatment at controlled costs. However, not all employers view supplying their employees with mental health treatment beneficial, as they do not know mental health problems can significantly decrease work productivity. Brown and Jones (2005) used the Social Role Scale (SR) of the Severe Outcome Questionnaire (SOQ) to estimate work productivity in employees under the assumption that the scale measures work productivity. The purpose of this study was to move closer to an estimation of the relationship between improved mental health and improved workplace functioning by examining the relationships among a self-report measure of mental health (i.e., the SR), a self-report measure of work productivity (i.e., the Work Productivity and Activity Impairment Scale [WPAI]), and objective measures of work productivity (i.e., the quality and timeliness of institutional records, supervisor ratings, and sick hours used). It was thought that understanding the relationships among these measures might assist in estimating the cost/benefit of investing in psychotherapy. Participants in this study were employees and inpatients at the Utah State Hospital. Statistical analyses indicated the SR did predict two WPAI scales (i.e., Presenteeism and Activity Impairment) for employees. Specific relationships among measures, and suggestions for future research, are discussed.