Background – People with functional impairments have unmet needs and they are not given the support and service they are entitled to. According to international studies, early measures and treatment may slow down the outbreak of mental illness and relieve its course. Aims - To elucidate and compare both somatic poor health and social needs of people with either physical or mental functional impairments in a rural district, and to explore and compare how different personnel in the primary health care service and psychiatric services are able to detect early signs of psychosis. Moreover, to find out how early signs of psychosis are detected in primary health services, and to explore the patients’ pathways to the GPs. Methods – In studies I and II, people with severe functional impairments were offered a screening health examination followed by an interview. Three vignettes were presented to personnel in the primary health care service and the psychiatric services in study III. The participants were asked to detect any signs and symptoms of psychosis in the vignettes. In studies IV and V, notes in primary health care records were studied during a period of two years and six months, respectively, before a diagnosis of psychosis was made by the general psychiatric services. Results – People with severe functional impairments had poorer health and more problems with their ADL (Activities of Daily Life), economy/work and Quality of Life than people in general. Among the groups studied, people with mental impairments had the poorest living conditions. There were no differences between the participants in study III regarding sex, age and occupation; and the participants detected the signs and symptoms in the vignettes to a high degree (75% of all signs and symptoms). In all, 152 patients (22 with schizophrenia/ schizoaffective disorders, 41 with schizophrenia preceded by other psychotic disorders and 89 with persisting psychiatric disorders) with the diagnosis of psychosis made by the general psychiatric services were included in study IV and V. There were notes in 77% of the primary health records during the two-year study period, and 70% of these notes were about psychiatric signs and symptoms, which means that the GPs detected signs and symptoms of psychosis in 2/3 of the cases. The analysis of the patients’ visiting patterns to GPs showed that many patients did not visit their “own” primary health care centre or their “own” GP. Furthermore, many patients had no contact with the primary health care service at all, and the subgroup with schizophrenia/schizoaffective disorders visited the primary health care service less frequently than the other groups. Main conclusion – People with severe functional impairments must be granted regular contacts with a GP, whose role must be: to identify and motivate the patients; to detect when there are needs for care and social needs; to function as a representative for the patients; to inform the patients about their rights and to guide them to other social or health authorities. The GPs detected early signs and symptoms of an emerging psychosis to a high degree, which would make early intervention possible. The more visits to the GPs, the more symptoms were detected, and out of all signs and symptoms with psychiatric content noted, the GPs would have suspected an emerging psychosis in almost every second patient who visited them. To detect early signs and symptoms of psychosis is difficult, and whenever in doubt, primary health care personnel must be able to consult psychiatric professionals. Otherwise we may miss the opportunity to intervene in an early phase of the illness. Additional training could also mean better understanding and earlier detection of people at risk of an emerging psychosis.

Introduction: In Sweden today a third of all those 60+ live alone and the absolute number will continue to increase because of the aging population. The aim of this thesis was to identify if the subgroup, older individuals living alone, might be more disadvantaged in regard to the four key sources to vulnerability suggested by Mechanic and Tanner (2007): Poverty and low socioeconomic status, personal functions, low social network and lack of support, and physical location. Gender differences were also investigated.   Method: Data was from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) collected in 2014. The total sample in this thesis includes 987 individuals with an age between 70-105. To estimate the current living conditions in regard to vulnerability among the subgroup, five dimensions of vulnerability were analyzed with multiple logistic and linear regressions.   Results: More disadvantages are found for those men and women living alone in all domains, except in social activity for women where living arrangement made no difference. Significant gender differences can be seen in depressive symptoms and social activity, but not for financial insecurity, mobility problems or living in a disorganized local community.   Conclusion: Men and women living alone are more disadvantaged compared to those living with a partner, according to the four key sources to vulnerability. With this deeper insight it is possible to obtain a greater understanding in where policies to support and strengthen this subgroup should be placed.

Syfte: Syftet med studien var att undersöka arbetsterapeuters erfarenheter av att arbeta med fritidsaktiviteter för barn och ungdomar som lever med funktionsnedsättningar inom barn- och ungdomspsykiatrin och habiliteringen. Metod: Studien genomfördes som en kvalitativ intervjustudie. Sju semistrukturerade intervjuer utfördes via telefon och Skype med yrkesverksamma arbetsterapeuter med erfarenheter av att arbeta med barn och ungdomar med funktionsnedsättningar inom barn- och ungdomshabiliteringen (HAB) samt barn- och ungdomspsykiatrin (BUP). Vid analys av intervjuerna användes en kvalitativ innehållsanalys. Resultat: Det framgick i resultatet att fritidsaktiviteter inte är prioriterat enligt vårdriktlinjer och att det även fanns andra hindrande faktorer som begränsar arbetsterapeuterna att arbeta med fritidsaktiviteter. Det framgick även att det fanns stöttande faktorer som gör det möjligt för arbetsterapeuterna att hitta lösningar på hur de kan arbeta med fritidsaktiviteter och att de upplever att det har positiv påverkan på klienterna som väger över de annars negativa konsekvenser som kan uppstå vid brist av en meningsfull fritid. Resultatet visar att arbetsterapeuterna inkluderar fritidsaktiviteter vid kartläggningen, ger tips och råd kring fritidsaktiviteter samt har möjlighet att sätta in interventioner som kan gynna både vardagliga aktiviteter och fritidsaktiviteter. Arbetsterapeuterna upplever att klientens efterfrågan av hjälp varierar beroende på vilken diagnos klienten har. Slutsats: Arbetsterapeuterna som arbetade med fritidsaktiviteter upplevde att det hade en positiv effekt för barn- och ungdomar med funktionsnedsättning. Fritidsaktiviteter är ett område som bör inkluderas mer i arbetsterapin eftersom det främjar självständighet och delaktighet i vården men även i klienternas liv. Arbetsterapeuter besitter den kunskap som behövs för att arbeta och anpassa fritidsaktiviteter i olika miljöer och behov. / Purpose: The aim of this study was to examine occupational therapists' experience of working with leisure activities for children and adolescents who live with functional impairments in pediatric facilities in Sweden. Method: The study was conducted with a qualitative data collection method with semi-instructed interviews through phone or skype with seven occupational therapists with experience and that are working in a pediatric facility with children and adolescents who live with functional impairments. In the analysis of the interviews a qualitative content analysis was used. Result: The results showed that leisure activities are not a prioritization according to health guidelines and that there are also other factors that prevent occupational therapists from working with leisure activities. It also appears that there are supporting factors that enable occupational therapists to find solutions of how they can work with leisure activities and that their experience is that leisure activities have a positive impact on clients weighing over the otherwise negative consequences that can arise from lack of meaningful leisure. The result showed that occupational therapists include leisure activities in information gathering, provide tips and advice and have the opportunity to use intervention that benefit both activities of daily living and leisure activities. The occupational therapists find that the clients demand for help vary depending on the diagnosis the client has. Conclusion: The Occupational therapists that are working with leisure activities experience that they have a positive effect on children and adolescents with functional impairments. And that is a topic that should be included more in occupational therapy because it promotes independence and participation in care but also in the client’s life. Occupational therapists possess the knowledge needed to be able to work and adapt leisure activities in different environments and needs.

Denna studie syftade till att undersöka hur personal på grupp- och serviceboenden hanterar dilemman mellan omvårdnad och självbestämmande. Fokus låg på vilka erfarenheter personalen har av dilemman, hur de hanterar dessa samt vad som avgör hur de handlar. Datainsamlingen skedde genom sex semi-strukturerade intervjuer med personal på grupp- och serviceboenden och analyserades med tematisk analys. Resultatet visade att personalen möter många dilemman i sitt arbete där hantering av dessa utgår ifrån individens självbestämmande. Kommunikation var en betydande del av personalens sätt att hantera dessa dilemman på. Studien visade också att personalen hanterar dilemman utifrån sin egen avsikt - att främja självbestämmande och omvårdnad. Personalens handlingar påverkas av vad de moraliskt och organisatoriskt kan göra samt brukarens handlingar. / The aim of this study was to investigate how staffs at group housing and service housing manage dilemmas between nursing and self-determination. Experiences of dilemmas, how they manage these dilemmas and factors that determined their actions were explored. The data were collected through six semi-structured interviews with staffs in group housing and service housing and was analyzed using a thematic analysis. The result showed that the staff face many dilemmas, and their management of these situations is always based on self-determination. Communication was also a significant part of how they manage the dilemmas. Furthermore, the study showed that staffs deal with dilemmas based on their own intention - to promote self-determination and nursing. Their actions are based on what they can do morally and organizationally as well as the patients’ actions.

This is a qualitative study based on interviews with unit managers working by the entitlement law LSS, Act concerning Support and Service for Persons with Certain Functional Impairments. The purpose of this study is to get an understanding of how unit managers in the LSS area perceive, work with and have experience of user influence in their organizations. The implementation of previous research makes an easier understanding of what the professional role means for both the organization and the user of welfare services. The main result of the study shows that the unit managers have a significant role for the user influence and that user influence needs further development in their organizations. Unit managers work to equalize social differences and compensate for the user's care needs. User influence is therefore needed for users to be able to become as independent as possible.  The unit manager works according to organizational conditions and creates strategies while using their professional discretion. Which promotes participation and self-determination for the user and their way of life. The result fills a knowledge gap regarding the unit manager's professional role and work for and with user influence in practice within the law of LSS. The study's theoretical approach is based on the theories of human-treating organizations, social citizenship and a model that explains society views different levels of disability and the user's personal autonomy.