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.

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 wave field in the Baltic Sea has been modelled for a two-year period with the spectral wave model HYPAS. There is a large seasonal variation in the field and a minor annual one, both reflect the wind variation in the area. Since the Baltic Sea is fetch limited, the dominant wind direction is important for the maximum wave heights.</p><p>By studying the modelled wave energy density in combination with bottom type maps, the effect of the wave field on the sediment surface is examined. Up to half the bottoms in the Baltic Sea are affected ~25% of the time. A statistical relation between wave energy density and bottom types is found for the Gulf of Riga, but in the rest of the area the sediment maps were to coarse. It is, due to this, not possible to say if the result is valid for the whole area or if it is site specific.</p><p>During resuspension events the remineralisation is increased since deposited organic material is reintroduced into the watermass and there exposed to higher levels of oxygen. This process could act as an increased regional source of nitrogen in nutrient budgets and thus influence the conditions for nitrogen fixation and perhaps explain some of the geographical differences in the nitrogen fixation rates.</p>

The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation. The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society. A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services. Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services. The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments. These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration.

För att anhöriga och personer med afasi ska kunna etablera en fungerande vardag harkunskap om och förståelse för afasi visat sig viktig. I tidigare studier har anhöriga tillpersoner med afasi visat sig sakna relevant kunskap om och förståelse för afasi som debehöver för att etablera en fungerande vardag. Logopediska insatser som är riktadedirekt till anhöriga är relativt ovanliga i Sverige. Syftet med denna studie är att utifråndata från litteratur och intervjuer utforma frågor, så kallade item, som på ett tillförlitligtsätt kan mäta kunskap om och förståelse för afasi hos anhöriga till personer med afasi.Tre fokusgrupper bestående av anhöriga till personer med afasi, personer med afasi ochlogopeder användes för insamlande av intervjudata. Intervjudatan analyserades genomkvalitativ innehållsanalys. Från analysen framställdes sju kategorier med tillhörandeunderkategorier. Kategorierna låg till grund för utformningen av item. Sammanlagt har140 stycken item utformats. Dessa item var av två typer; item bestående av en 6-gradigLikert-skala och item av typen Multiple Choice. Vidare indelades item beroende påvilka svar som kan erhållas . Item med önskvärda svar( typ A) och situations- ochindividberoende item (typ B) som syftar till att ligga till grund för samtal mellananhörig till person med afasi och logoped.. De kategorier och item som studienresulterat i uppvisar samstämmighet med tidigare studier som fokuserat på anhöriga tillpersoner med afasi. Samstämmigheten tyder på att de item som inkluderas i ett framtidaformulär har möjlighet att kunna mäta av kunskap och förståelse hos anhöriga tillpersoner med afasi. För att framtagna item ska kunna resultera i det tilltänkta formuläretkrävs ytterligare validering, reliabilitetstestning och urval. / Previous studies have shown that significant others to persons with aphasia are in needof increased knowledge and understanding of aphasia. The knowledge andunderstanding for aphasia has shown to be crucial to significant others in terms ofpsychosocial well-being and to be able to establish a satisfying everyday life. PresentSpeech-language pathologist services in Sweden tend to have limited involvement ofsignificant others to persons with aphasia. This study aims to design a number ofquestions, items, which will be able to measure the knowledge and understanding ofaphasia for significant others of persons with aphasia. The items result from literaturestudies and semi-structured interviews with significant others to persons with aphasia,persons with aphasia and speech-language pathologists. Transcripts from interviews areanalyzed through content analysis. The study results in 140 items presented in sevencategories, each with a number of sub-categories. Two types of items are designed:items in the form of a 6-point Likert Scale and items in the form of Multiple Choice.The items are also divided depending on whether the answer is knowledgde-based (typeA) or to be used as material for discussion (type B). The categories and items from thisstudy are consistent with previous research. To transform the items into a completequestionnaire, further validation, testing of reliability and selection is needed.

It has been said that the difference between involvement and commitment is like a ham and egg breakfast – the chicken was involved but the pig was committed. To better understand teacher commitment to inclusion, this study examined the perspectives and experiences of 8 elementary teachers who had included students with significant disabilities in their general education classrooms. A questionnaire was developed to determine prior and current opinions about inclusion and participants were assigned to one of the following categories: (a) those who were optimistic about inclusion prior to their experience of including a student with a significant disability and who have remained optimistic, (b) those who were optimistic about inclusion prior to their experience but who have become sceptical as a result of their experience, (c) those who were initially sceptical about inclusion prior to their experience of including a student with a significant disability but who have become optimistic as a result of their experience with inclusion, and (d) those who were initially sceptical about inclusion and who remain sceptical. Interviews were conducted to explore the effect their experiences had on their opinions about inclusion and the factors that facilitated or hindered teacher engagement. Qualitative analysis of the data suggested that teachers who are able to include students with significant disabilities are more engaged, are generally satisfied with their experiences and have become more optimistic about inclusion and more committed to it. Implications for teacher education and professional development are discussed. / October 2005

Syftet med denna systematiska litteraturstudie är att undersöka upplevelser hos anhörigvårdare till lungcancerpatienter. Artikelsökningar har skett i Cinahl och Pubmed. Tiden för anhörigvårdaren kan se olika ut, kort och intensiv eller lång och utmattande. Upplevelser så som skräck är vanligt förekommande direkt efter lungcancerdiagnosen både för patient och vårdare. Detta för att de anhöriga ställs inför ett klart hot om en kommande förlust samt skrämmande tankar kring döden. Hälsan försämras för anhörigvårdaren under vårdtiden och vissa drabbas av depression. De social relationerna försämras, vissa upphör helt då anhörigvårdaren får en känsla av att de alltid måste vara tillgängliga för den sjuke. Vårdbördan kan vara tung och emotionellt stöd kan vara nödvändigt. Trots det väljer många att inte ta emot eller söka något stöd.Inte bara hälsan förändras under sjukdomstiden utan också mycket annat, den som tidigare haft en passiv roll i hushållet kan bli tvungen att ta en mer aktiv roll i skötseln av hem och ekonomi. Trots att anhörigvårdare ofta känner sig utanför och övergivna väljer de att inte uttrycka sina känslor när de blir tillfrågade eftersom det finns en rädsla att ta fokus från patienten.

This thesis is devoted to the detectability of an inhomogeneous region possibly embedded in a noisy environment. It presents models and algorithms using the theory of the longest significant run and percolation. We analyze the computational results based on simulation. We consider the length of the significant nodes in a chain with good continuation in a square lattice of independent nodes. Inspired by the percolation theory, we first analyze the problem in a tree based model. We give the critical probability and find the decay rate of the probability of having a significant run with length k starting at the origin. We find that the asymptotic rate of the length of the significant run can be powerfully applied in the area of image detection. Examples are detection of filamentary structures in a background of uniform random points and target tracking problems. We set the threshold for the rejection region in these problems so that the false positives diminish quickly as we have more samples. Inspired by the convex set detection, we also give a fast and near optimal algorithm to detect a possibly inhomogeneous chain with good continuation in an image of pixels with white noise. We analyze the length of the longest significant chain after thresholding each pixel and consider the statistics over all significant chains. Such a strategy significantly reduces the complexity of the algorithm. The false positives are eliminated as the number of pixels increases. This extends the existing detection method related to the detection of inhomogeneous line segment in the literature.

No description available.

Syfte: Att undersöka vilket stöd närstående haft behov av från sjuksköterskor inom akutsjukvård och intensivvård vid anhörigs sjukdom och vilket stöd sjuksköterskor trodde att närstående hade behov av. Metod: Studien genomfördes som en litteraturöversikt. Artiklar söktes i databaserna PubMed och Cinahl. I studiens resultat ingick 13 artiklar med både kvalitativ(n=7) och kvantitativ(n=6) ansats som sammanställdes under olika teman. Resultat: Redovisades i fyra teman; CCFNI, Information, Delaktighet och Bemötande. Närstående och sjuksköterskor ansåg att de mest centrala behoven innefattade information, delaktighet och bemötande. Att få rak och ärlig information och att närstående var delaktiga samt att de blev bemötta med respekt och empati visade sig vara det viktigaste från både närstående och sjuksköterskors perspektiv. Slutsats: Vid anhörigs sjukdom behöver närstående stöd framför allt i form av information, bra bemötande och att få känna sig delaktiga i vården av den anhörige. Denna uppfattning delas av sjuksköterskor inom akutsjukvård och intensivvård. Som sjuksköterska bör man tänka på att ge rak och ärlig information, låta närstående vara delaktiga i den mån de själva vill samt att alltid ge så bra bemötande som möjligt.