<p><strong>Bakgrund: </strong>Risken för att drabbas av depression någon gång i livet är 50 % för kvinnor och 20 % för män. Orsaken till varför en depression utvecklas hos en del människor kan bero på olika faktorer, så som ärftlighet och av olika påfrestningar under uppväxten. <strong>Syfte:</strong> Syftet var att belysa upplevelser hos män och kvinnor som lever med depression. <strong>Metod: </strong>En systematisk litteraturstudie genomfördes och baserades på nio vetenskapliga artiklar. <strong>Resultat: </strong>Det visade sig att depression var något individuellt. Något som var återkommande i studierna var hur upplevelser och faktorer i barndomen kunde ha lett till depression och många personer upplevde ett lidande och en smärta i samband med sin depression. Det visade sig även att personer hanterade sin depression på olika sätt. <strong>Diskussion: </strong>I diskussionen lades det vikt på tre huvudfynd; att leva upp till höga krav i barndomen, att inte bli förstådd av omgivningen och skillnaden i hur män och kvinnor uttryckte sin depression. <strong>Slutsats:</strong><strong> </strong>Efterhand som depression blir allt vanligare i vårt samhälle är det av vikt för vårdpersonal att få en ökad förståelse för området för att kunna ge en god individanpassad omvårdnad.</p> / <p><strong>Background:</strong> The risk of suffering from depression at some point in life is 50% for women and 20% for men. The reason why depression develops in some people may depend on various factors, such as heredity and the various strains while growing up. <strong>Aim: </strong>The aim was to illuminate the experiences of men and women living with depression. <strong>Method: </strong>A systematic literature review was conducted and was based on nine scientific papers. <strong>Result: </strong>It was found that depression was something individually. Something that was recurring in the studies was how the experiences and factors in childhood might have led to depression and many people experienced a suffering and pain associated with their depression. It appeared also that people manage their depression differently. <strong>Discussion:</strong> The discussion was the emphasis on three key findings, to live up to high demanding in childhood, not to be understood by the environment, and the difference in how men and women expressed their depression. <strong>Conclusion:</strong> As depression becomes more and more common in our society, it is important that the personnel in healthcare gets a better understanding of the individual to provide good quality personalized care.</p>

<p>Multipel skleros är en sjukdom som påverkar kroppen på många olika sätt både fysiskt och psykiskt<strong>. </strong>Många unga drabbas och det påverkar hela livssituationen. Syftet med studien var att beskriva faktorer som påverkar livskvalité i det dagliga livet hos personer med Multipel skleros. Metoden utgjordes av en litteraturstudie där Polit och Becks (2008) åtta steg har använts. Studien är baserad på 10 kvalitativa och vetenskapliga artiklar. Artiklarna identifierades genom elektronisk sökning i databaserna CINAHL och PubMed. Betydande delar i artiklarnas resultat, som svarade på studiens syfte, markerades för att finna likheter och skillnader, dessa organiserades sedan i huvudkategorier och underkategorier. Resultatet visar att stöd kan upplevas både positivt och negativt och detta påverkar på det sättet livskvaliten. Att ha ett arbete, sociala relationer och känna en känsla av oberoende genom självständighet och kontroll är viktiga faktorer som påverkar livskvaliten.</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>The overall aim of the present thesis was three-fold. The overall aim of the present thesis was three-fold. The first was to study occupational performance in individuals with severe mental disorders and their experiences of occupational therapy, the second to study experienced burden of family caregivers and the third to test the validity and the homogeneity of assessment tools in this area. The samples consisted of individuals with severe mental disorders participating in organised occupations (n= 112), occupational therapy records (n=64), occupational therapists working in mental health care (n=7) and family caregivers of individuals with severe mental disorders (n=256). Data were collected by questionnaires, structured and narrative interviews, observations and occupational therapy records. Individuals with severe mental disorders reported problems related to leisure and work activities and the occupational therapists recorded problems concerning how to organise and structure occupational performance. Individuals functioning on a high cognitive level experienced problems related to work and productive activities. Participation in occupational therapy strengthened their confidence in their own ability. The "Experience of Occupational Performance Questionnaire" (EOPQ) was developed from data on the experiences of women participating in occupational therapy. A principal component analysis gave seven factors with acceptable homogeneity. There is a need for assessment tools to evaluate occupational therapy. The EOPQ represents an attempt to fulfil this need. Family caregivers experienced limitations of daily activities as a burden. The ability to perform daily activities was studied from three perspectives, the individuals’, the occupational therapists’, and the experienced burden of the family caregivers. These perspectives are complementary and thus necessary for planning and implementation of individually adapted occupational therapy as well as for the evaluation of outcomes.</p>

For several decades, evolutionary and social learning theories have been explanatory frameworks to explicate gender differences in overt behaviors and the prevalence, etiology, and maintenance of mental health problems. To further explore relations among gender, overt behaviors, and depression severity, this study used a daily diary methodology to examine gender differences within thirteen behavioral domains and whether differntial frequency of overt behaviors and environmental reward mediated the relationship between gender and depression severity. Overall, females engaged in a significantly greater breadth of behavioral domains and reported a higher level of environmental reward. Females reported spending more time in the domains of health/hygiene, spiritual activities, and eating with others. In contrast, males spent a greater duration of time in the domains of physical activity, sexual activity, and hobbies and recreational experiences. In relation to males, females found social activities, passive/sedentary behaviors, eating with others, and engagement in “other” activities to be more rewarding. Gender had a significant direct effect on depression severity, with females reporting increased depression. This effect was attenuated by the mediator (total environmental reward) such that to the extent that females exhibited increased environmental reward, the gender effect on depression was reduced. These data support behavioral models of depression and have clinical relevance as highlighted in the context of behavioral activation interventions for depression.

This thesis aims to explore the importance of proximity and mobility, respectively, for individuals’ accessibility, as well as the relationship between these two key spatial dimensions of accessibility in the context of everyday life. The thesis is based upon three empirical research papers which focus on accessibility-related preferences, actual accessibility conditions, and travel patterns. Focus is directed towards the spatial relationships between individuals’ residential location vis-à-vis the location of a selection of different amenities including work, education, service and leisure functions as well as social relations. The analyses are based on a wide range of quantitative data, including questionnaire surveys as well as official register data for the Swedish population.      The first paper shows that residential proximity to amenities was most valued by individuals in the case of social relations and basic daily activities. The level of satisfaction with current accessibility conditions was generally high, with the exception of social relations where the findings suggest the existence of a ‘proximity deficit’. The second paper shows that observed average distances to most amenities have decreased over time (1995–2005). Concerning service amenities, the increases in proximity over the period were primarily due to a restructuring of the localization patterns within the service sector. A comparison of potential accessibility conditions and actual travel patterns revealed that people tend to travel farther than to the nearest amenity options, presumably to a large extent because of selective individual preferences, which may downplay the importance of distance in destination choice. The third paper shows that although the numerical supply of amenities within different spatial ranges has a significant influence on how far individuals travel for service errands, supply size alone is not sufficient for explaining travel length. The findings also suggest that although people tend to utilize the supply of amenities available locally, they are also willing to extend their travel distance in order to reach the amenity supply available within the region. Thus, even when there is a local supply, a rich regional supply may induce longer trips.      A juxtaposition of the findings of the three empirical studies suggests the existence of an ‘accessibility paradox’ with several facets. First, although people express an affinity for residential proximity to many amenities, this is not necessarily reflected in actual destination choices, since minimization of travel distance is apparently not always a key criterion. This is also suggested by the conclusion that the spatial structure of the amenity supply alone accounts for only a relatively small part of the explanation of travel length, which is influenced by many other factors. In addition, actual travel distances show an increasing trend over time despite the concurrent reductions in potential distances. Second, the development over time indicates that the proximity deficit regarding social relations may be increasing in the sense that average distances have increased to many of the amenities considered important to have nearby, for instance adult children, but have decreased to those where proximity is not considered particularly important. Third, there is a discrepancy between the observed trend towards increased proximity to many amenities and much of the general discourse on accessibility, which tends to emphasize deteriorating conditions.

Background: Among the instruments commonly used by occupational therapists working in the area of rehabilitation of persons with neurological disorders are evaluations of both occupation, such as activities of daily living (ADL), and body functions. While persons with neurological diagnoses typically have symptoms that represent diminished neurobehavioral functions, the resulting pattern of neurobehavioral impairments affecting ADL performance often differs among diagnostic groups. Usually, neurobehavioral impairments are evaluated in a context that is separate from and not natural for ADL task performance. The A-ONE is a unique instrument that can be used to evaluate both ADL performance (ADL scale) and, in the natural context of the ADL task performance, the underlying neurobehaviors that cause diminished ADL task performance among persons with neurological disorders (Neurobehavioral scale). The scales of the instrument are of ordinal type, and in their existing form, do not have measurement properties. Measurement properties are a requirement of evidence-based and quality assured rehabilitation services. The overall aim of this doctoral study was to further develop and validate the A-ONE. This included (a) internal validation to explore the potential for converting the ordinal scales of the instrument to interval scales, (b) examination of which of the neurobehavioral items would be most beneficial and clinically useful for constructing a new Neurobehavioral Impact (NBI) scale for evaluating persons with different neurological diagnoses, and (c) exploration of whether persons with right and left cerebrovascular accidents (RCVA, LCVA) differ in mean NBI measures.  Methods: This thesis is comprised of four studies which all contribute in different ways to the validation of the scales of the A-ONE. In the first three studies, Rasch analyses, a widely accepted modern test theory methodology, was used to examine internal validity of the scales and the reliability of the A-ONE measures. In the fourth study, ANCOVA was used to explore between group differences, and Pearson correlation coefficients were used to explore relations between person measures from the different A-ONE scales. Results: The first study of 209 persons diagnosed with CVA and dementia provided support for converting the ordinal ADL scale to an interval scale that has potential to be used to measure change in ADL performance over time. The second and third studies, including 206 and 422 persons respectively, indicated that it is possible to construct several unidimensional versions of a new NBI scale from the neurobehavioral items of the instrument, each with different item content and hierarchical item structure. Further, some of these NBI scales could be used across different diagnostic groups. When exploring differences between 215 persons with RCVA and LCVA on the NBI scale developed for CVA, results of the ANCOVA (with ADL ability as a covariate) indicated that there is no significant difference between groups in their mean NBI measures, despite known differences in patterns of neurobehavioral impairments. Conclusions: The results of this thesis indicate that the A-ONE, although developed by traditional psychometric methods for the purpose of providing useful information for intervention planning, now also has the potential to be used to measure change and compare diagnostic groups. This additional feature will likely enhance both clinical and research potential of the instrument. In order to make the results of the study accessible for clinicians, conversion tables need to be developed.

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. 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. 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. 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. 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 In the light of these findings assessment and treatment of self-efficacy seems relevant in stroke rehabilitation.

The overall aim of the present thesis was three-fold. The overall aim of the present thesis was three-fold. The first was to study occupational performance in individuals with severe mental disorders and their experiences of occupational therapy, the second to study experienced burden of family caregivers and the third to test the validity and the homogeneity of assessment tools in this area. The samples consisted of individuals with severe mental disorders participating in organised occupations (n= 112), occupational therapy records (n=64), occupational therapists working in mental health care (n=7) and family caregivers of individuals with severe mental disorders (n=256). Data were collected by questionnaires, structured and narrative interviews, observations and occupational therapy records. Individuals with severe mental disorders reported problems related to leisure and work activities and the occupational therapists recorded problems concerning how to organise and structure occupational performance. Individuals functioning on a high cognitive level experienced problems related to work and productive activities. Participation in occupational therapy strengthened their confidence in their own ability. The "Experience of Occupational Performance Questionnaire" (EOPQ) was developed from data on the experiences of women participating in occupational therapy. A principal component analysis gave seven factors with acceptable homogeneity. There is a need for assessment tools to evaluate occupational therapy. The EOPQ represents an attempt to fulfil this need. Family caregivers experienced limitations of daily activities as a burden. The ability to perform daily activities was studied from three perspectives, the individuals’, the occupational therapists’, and the experienced burden of the family caregivers. These perspectives are complementary and thus necessary for planning and implementation of individually adapted occupational therapy as well as for the evaluation of outcomes.

This study addresses the question of change in household structure and the reproduction of “life from day to day”. It is based on structuration theory, time-geography and Allan Pred’s theory of place as historically contingent process. Large households are viewed as tokens of the early modern era, and the appearance of small households can therefore be seen as signs of modernisation. But the decline in size of the average household was not dramatic, it went from 3.53 people per household in 1760 to 3.31 people in 1830. By the composition of different occupational groups in the city in 1760 and 1830, it is evident that the decline of the textile industry, the low activity in the building trades and the decrease of residential sailors – and the subsequent rise of petty trade and traditional handicrafts – gave a strong influx of traditional elements to the evolution of the household. In contrast to this there were a number of “new” or more modern elements that can be seen as precursors to the structure of daily life in the modern era. One of these was a rising number of households which were small and headed by people who earlier in history would have been household members – and not heads of households. The structure of daily life and its reproduction from day-to-day is also analysed in the study. This pattern was both affected by certain changes in the overall household structure, and by two phenomena that directly had an impact on the recreation of life from day to day. The first of these was the “food money”, a substitution of money for the right to food in the employers house, and the second was a move from the right to lodgings in the employers’ home to the need of living quarters elsewhere. Both of these phenomena acted on the “structure of daily life”, and helped to alter the focus of daily life, that is to turn it away from the productive households and put more attention on the streets and on the households that only served as reproductive units.