<p>The aim of this study is to illuminate images and discourses, in which media describe people with disabilities. The purpose of the study will be fulfilled, by answering the following questions: Is it possible to discern categories of how people with disabilities are described in the media and is it possible to find associations to handicap models? We have chosen to focus on how media describe people with physical impairments and have made a content analyses of articles, based on the theoretic aim of this study, social constructionism, handicap models and earlier research. Underlying the analyses, are six articles from two Swedish news papers. The results of our research are divided in three categories: assumptions which are taken for granted, hidden meanings and contradicted categories. To sum up the results, we have found several categories in Media’s description of people with disabilities, and in the articles we have also found associations to handicap models. One of the assumptions which are taken for granted is that the disability/impairment defines the person. Hidden meanings are found which indicates, that people with disabilities doesn’t share the same social position as other groups. The articles used in this study are characterised by contradicted categories, the most common is where deviations are compared with what is considered to be normal, by the prevailing discourses. The articles also show associations to the social and the individual model.</p><p> </p>

Avhandlingen handlar om prospektivt minne (PM) hos personer med utvecklingsstörning. PM syftar på att formulera intentioner och genomföra dessa någon gång i framtiden, antingen inom en definierad tidsram eller i samband med en specifik händelse. Frågeställningar: 1. Finns det en kvalitativ och kvantitativ skillnad mellan prospektivt minne hos personer med utvecklingsstörning och en kontrollgrupp? (Artikel I – II) 2. Hur ser sambandet mellan prospektivt minne, arbetsminne och episodiskt minne ut hos personer med utvecklingsstörning och, skiljer sig detta åt jämfört med kontrollgruppen? (Artikel II) 3. Vilka förutsättningar vid inkodning och hågkomst är kompatibla? (Artikel III) 4. På vilket sätt kan svag association mellan olika delar av information bidra till prospektiva minnesfel? (Artikel IV) 5. Går det att särskilja en hög- respektive lågpresterande grupp personer med utvecklingsstörning med avseende på prospektiv minnesprestation? (Artikel II) Personer med utvecklingsstörning begår fler prospektiva minnesfel än personer i kontrollgruppen. Motsvarande gruppskillnad finns inte för självskattat minne. Prospektiv minnesprestation är bättre med bilder jämfört med ord som prospektiva ledtrådar, mest tydligt för personer med utvecklingsstörning. Arbetsminneskapacitet visade ett samband med både prospektivt minne och antalet falska minnen i kognitivt krävande situationer, till exempel, situationer med flera parallella prospektiva minnesuppgifter. Falska minnen och prospektivt minne hade ett samband hos personer med utvecklingsstörning. Att felaktigt känna igen bilder med bara delvis bekanta delar och att känna igen prospektiva ledtrådar utan att komma ihåg själva intentionen hade ett samband hos personer med utvecklingsstörning. Personer med utvecklingsstörning var också sämre än kontrollgruppen på att upprepa tidsintervall. Detta kan till exempel bero på bristande episodiskt minne och begränsade strategier för att lösa den här typen av uppgifter. Resultaten diskuteras i relation till träning av prospektivt minne och val av hjälpmedel. / This thesis deals with prospective memory (PM) in individuals with intellectual disability. The term refers to planning and executing actions that cannot be performed immediately and have to be stored in memory and retrieved either within a specified timeframe or to be associated with a specific event. Following research questions were explored: 1. Does prospective memory performance in the intellectual disability group differ quantitatively and qualitatively compared to a control group of individuals without intellectual disability? (Paper I – II) 2. What are the relations between prospective memory, working memory and episodic memory in individuals with intellectual disability, and how are these relations different from the relations found in individuals without intellectual disability? (Paper II) 3. What conditions constitute compatibility between encoding and retrieval of prospective memory tasks? (Paper III) 4. In what way might weak binding contribute to PM failure? (Paper IV) 5. Is it possible to identify high and low PM-performing groups of individuals with intellectual disability? (Paper II) The results of the studies demonstrated that individuals with intellectual disability commit more PM errors than individuals in the control group, despite similarities in self-rated memory. Pictures as PM cues improved PM performance in comparison to words in both groups. This may be important primarily for recognition of the PM cue, particularly in the intellectual disability group. As to working memory capacity, it also shows a relation to both PM performance and binding performance in cognitively demanding situations (e.g., tasks with multiple parallel PM tasks). Furthermore, it was found that binding is related to PM performance in the intellectual disability group as there is a relationship between feature errors and recognition of cues, though not retrieving the correct intention. Finally, time reproduction was found to be weak in the intellectual disability group compared to the control group. This may be due to, for example, weak episodic memory and limited strategies for solving this type of task. These findings are discussed in relation to PM training and PM aids.

Computer usage today is predominantly based on graphical interaction, where the visual presentation of information is essential both for input (hand-eye coordination when using a computer mouse), and output (seeing the information on a computer screen). This can create difficulties for blind computer users, both at an individual level when interacting with a computer, and also when collaborating with other computer users. The work presented in this thesis has investigated interaction for blind computer users in three stages. First investigating access to information by making studies on an interactive audio-only game, drawing conclusions about auditory direct manipulation and auditory interface design. Second studying collaboration between blind and sighted computer users in two different contexts, leading to questioning of commonly expressed design principles regarding access to collaboration. Finally studying accessibility in a working environment, finding out how technology, the assistive device used by the blind person, communication with others and professional knowledge interplayed to create an accessible work environment. Based on these empirical studies, the main conclusion from this work is a proposal of a research perspective, Assistive interfaces as cooperative interfaces. Here, the context where the interface is going to be used is in focus, and cooperative and social dimensions of interaction are acknowledged and highlighted. The design and analysis of assistive devices should be highly sensitive to the socio-interactional environment, and not just focusing on the single individual using an assistive device. / QC 20100921

The general aim of this thesis is to describe mortality, health and living conditions in an administratively defined county population of people with intellectual disabilities born between 1959 and 1974 (N=213). The living conditions of persons with intellectual disabilities were compared with those of the general population. Moreover, the reports of relatives and staff were compared on the living conditions of people with intellectual disabilities. Information on the living conditions of persons with intellectual disabilities was provided by proxy (relative and staff) questionnaire reports and national welfare statistics conducted by Statistics Sweden (SCB). Medical examination and medical case records were used to obtain data on health and medical services. People with intellectual disabilities lived in the community and took part in numerous common recreational and cultural activities. However, the comparison with the general population indicated clear differences in living conditions, particularly regarding employment and social life. In contrast, surprisingly little variation in living conditions was found in people with intellectual disabilities, despite varying ages and a wide range of level of disabilities. In addition, gender related differences of persons with intellectual disabilities were few when compared with those found in the general population. A wide range of physical and mental health problems were identified in the group with intellectual disabilities. Although a majority of persons with intellectual disabilities had access to a family doctor and attended regular health checks, a number of needs of specialist examinations were identified indicating shortcomings in the quality of health care. Analyses indicated differences in the reports of relatives and staff on living conditions of most domains included in the questionnaire. In general, disagreement was higher on subjective than on objective items. Relative and staff responders contribute dissimilar information that is related to varying viewpoints and different types of information.

Studien behandlar bemötandet under det samordnade vårdplaneringsmötet, en vårdsituation där brukaren ofta har en utsatt position. Under dessa möten ska deltagarna gemensamt komma fram till lösningar för brukarens eftervård och situation efter utskrivning från psykiatrisk avdelning. Syftet med min studie är att beskriva och bidra med kunskap och förståelse om hur brukare med psykiska funktionshinder blir bemötta utav personal under samordnade vårdplaneringsmöten. Studien belyser frågan utifrån personalens synvinkel. Studiens empiriska data har samlats in genom kvalitativa intervjuer som utgår från olika samtalsområden, där respondenterna relativt fritt får själva berätta om sina upplevelser om bemötandet av brukare. Empirin är hämtad från en medelstor kommun i Mellansverige. Empirin har analyserats med hjälp av Habermas teori om kommunikativt handlande och teorin om samtidsdiagnosen (livsvärld och system) för djupare förståelse för de mekanismer som kan påverka bemötandet under vårdplaneringsmötet. Teorin bidrar till att förstå deltagarna under vårdplaneringsmöten har sina egna normer, värderingar och kulturer som formar och påverkar deras handlingar och bemötande, men även de lagar, regler och strategier som präglar kommun och landsting. Tidigare forskning om vårdplaneringsmöten inom en annan sektor visar att de föreskrifter i hälso- och sjukvårdslagar som tar upp vikten av delaktighet och inflytande inte efterföljs under vårdplaneringar. Resultatet visar att variationen av vårdplaneringsmötena och bemötandet beror på uppsättningen av människor som ska delta under mötena. Det finns vissa riktlinjer för vårdplaneringsmötets genomförande, men få känner till dessa, vilket gör att vårdplaneringsmötets genomförande hänger på deltagarna och personen som leder mötet. Ifall personen ifråga har en bra mötesteknik kommer brukaren till tals och blir delaktig i mötet.

AIM OF THE STUDY The aim of this study was to explore if ICF-CY can support teachers in elementary schools in their work in promoting children’s health, development and learning. A further aim was to bring forward what teachers experience as benefits and disadvantages in using the classification.   METHOD After an introduction to ICF-CY, six elementary school teachers filled in questionnaires based on ICF-CY for 94 children. In conjunction with this, the teachers were interviewed about their experiences and perceptions of the work.   RESULTS The results show that through their work with the ICF-CY questionnaires the teachers experienced an active process of reflection and learning. They obtained new perspectives which gave them a more holistic picture of children’s situations than they had before. The teachers found the ICF-CY to be a useful instrument to support work within the school environment towards individualized education, based on the children’s possibilities. They also felt that the importance of cooperation between the persons around each child became clearer by using ICF-CY because no single individual is in possession of all the necessary information about the child’s situation, but by combining different perspectives it is possible to establish a common ground on which education and intervention can be based. At the same time, however, the teachers found the classification somewhat overly comprehensive and in some ways complicated. Therefore they felt that an introduction to the ICF-CY is essential before adopting it.   CONCLUSIONS The teachers’ experience of seeing each child’s situation more clearly after conducting a classification by using the ICF-CY questionnaires indicates that ICF-CY should be introduced to parents, teachers and other professionals working with education and intervention for children. The way in which assessment carried out with ICF-CY as an instrument affects the process of education and intervention remains to be examined. / CHILD

The aim of this study is to illuminate images and discourses, in which media describe people with disabilities. The purpose of the study will be fulfilled, by answering the following questions: Is it possible to discern categories of how people with disabilities are described in the media and is it possible to find associations to handicap models? We have chosen to focus on how media describe people with physical impairments and have made a content analyses of articles, based on the theoretic aim of this study, social constructionism, handicap models and earlier research. Underlying the analyses, are six articles from two Swedish news papers. The results of our research are divided in three categories: assumptions which are taken for granted, hidden meanings and contradicted categories. To sum up the results, we have found several categories in Media’s description of people with disabilities, and in the articles we have also found associations to handicap models. One of the assumptions which are taken for granted is that the disability/impairment defines the person. Hidden meanings are found which indicates, that people with disabilities doesn’t share the same social position as other groups. The articles used in this study are characterised by contradicted categories, the most common is where deviations are compared with what is considered to be normal, by the prevailing discourses. The articles also show associations to the social and the individual model.

In the Swedish debate concerning disability issues it has been shown, as in many other countries, that the concept ‘participation’ has been used in a very vague and obscure way. For example, at an ideological level the concept often refers to ‘accessibility’. Others claim that it should be understood as ‘social integration’ or ‘inclusion’. In the International Classification of Functioning, Disability and Health (WHO) participation means ‘involvement’ in a life situation. In the literature there are several ways to approach the concept of participation. Broadly, it is used to describe a characteristic within the individual or the result of an interplay. The general aim of this thesis is to illuminate different forms of participation within the municipal upper secondary special programme for pupils with intellectual disabilities (ID). The study contains two main parts. On the one hand a semantic analysis is made for the purpose of illuminating different conceptual forms of participation. On the other hand a field study is performed. This empirical study can be described as a hermeneutically influenced field study designed to interpret participative patterns in everyday school situations. Data have been collected during a period of one school year. Several methods have been used in order to capture different kinds of patterns in the pupils’ participation in a chosen upper secondary individual program for pupils with ID. These methods involve participant observation in everyday school situations (which was recorded in field notes), interviews with pupils, staff and administrators. Rather often it is implied that a higher extent of involvement leads to a higher (or better) form of participation. My study showed something else. Several examples demonstrated how groups of pupils within the special programme setting gave up their involvement in specific activities since they wanted to show their belonging to a different community outside the school. The analysis showed that involvement, as one form of participation, is highly related to other forms of participation (for example formal and informal belonging). In one sense these pupils had a conception of how to behave in order to be accepted outside the special programme setting. Therefore it is possible to talk about the pupils in terms of different worlds of belonging. For a specific group of pupils the formal belonging to the special programme was a threat towards their self-image, which seemed to derive from another alternative world — with other ideals than are usually associated with special programmes for pupils with ID.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease. Treatment strategies emphasize early multi-professional interventions to reduce disease activity and to prevent disability, but there is a lack of knowledge on how optimal treatment can be provided to each individual patient. Aim: To elucidate how clinical manifestations of early RA are associated to disease and disability outcomes, to strive for greater potential to establish prognosis in early RA, and to facilitate implementation of decision support through analyses of the decision-making environment in chronic care. Methods: Multivariate statistics and mathematical modelling, as well as field observations and focus group interviews. Results: Decision support: A prognostic tree that predicted patients with a poor prognosis (moderate or high levels of DAS-28) at one year after diagnosis had a performance of 25% sensitivity, 90% specificity and a positive predictive value of 76%. Implementation of a decision support application at a rheumatology unit should include taking into account incentive structures, workflow and awareness, as well as informal communication structures. Prognosis: A considerable part of the variance in disease activity at one year after diagnosis could be explained by disease progression during the first three months after diagnosis. Using different types of knowledge – different expertise – prior to standardized data mining methods was found to be a promising when mining (clinical) data for new patterns that elicit new knowledge. Disease and disability: Women report more fatigue than men in early RA, although the difference is not consistently significant. Fatigue in early RA is closely and rather consistently related to disease activity, pain and activity limitation, as well as to mental health and sleep disturbance. Conclusion: A decision tree was designed to identify patients at risk of poor prognosis at one year after the diagnosis of RA. When constructing prediction rules for good or poor prognosis, including more measures of disease and disability progressions showed promise. Using different types of knowledge – different lenses of expertise – prior to standardized data mining methods was also a promising method when mining (clinical) data for new patterns that elicit new knowledge. / Introduktion: Reumatoid artrit (RA) är en kronisk inflammatorisk sjukdom. Dagens behandlingsstrategi bygger på tidiga multiprofessionella insatser för att reducera sjukdomsaktivitet och minska risken för framtida funktionshinder. Idag finns stora datamängder tillgängliga gällande medicinering och utfall vid RA. Dessa data erbjuder möjligheter att generera ny kunskap som kan användas för att forma beslutsstöd. Syfte: Att undersöka hur olika kliniska manifestationer vid tidig RA samvarierar med funktionshinder och sjukdomsaktivitet, att pröva metoder att ställa prognos vid tidig RA, och att analysera en kontext för beslutsfattande inom vård av kroniskt sjuka. Metod: Multivariat statistik och matematisk modellering, samt observationsstudier och fokusgruppsintervjuer. Resultat: Beslutsstöd: Ett beslutsträd utformades för att bestämma vilka patienter som har dålig prognos (måttlig eller hög DAS-28) ett år efter diagnos. Beslutsträdet hade 25 % sensitivitet, 90 % specificitet och ett positivt prediktivt värde på 76 %. Vid införande av beslutsstöd på en reumatologisk klinik befanns det nödvändigt att hänsyn tas till incitamentsstrukturer, arbetsflöde och samarbetsformer. Informella kommunikationsstrukturer kan också ha stort inflytande på klinisk praxis. Prognos: En betydande del av variansen i sjukdomsaktivitet ett år efter diagnos kan förklaras av sjukdomsprogression första tre månaderna efter diagnos. Att formalisera olika experters erfarenheter före standardiserade ”data mining” metoder är en lovande ansats när man letar efter mönster i (kliniska) databaser. Funktionshinder och sjukdomsaktivitet: Kvinnor rapporterar mer trötthet än män vid tidig RA, men skillnaden är inte konsistent över tid. Trötthet vid tidig RA är nära relaterat till sjukdomsaktivitet, smärta och aktivitets begränsningar, men också till mental hälsa och sömnstörningar. Slutsats: Ett beslutsträd har utformats för att predicera patienter med dålig prognos inom tidig RA. Studier av fler mått på sjukdoms- och funktionshindersprogression behövs vid konstruktion av prediktionsregler för god eller dålig prognos framledes. Att använda sig av kunskap från olika experter – olika experters glasögon – vid sökandet efter mönster i stora datamängder för att generera ny kunskap är en lovande metodik. Implementering av beslutsstöd bör göras under övervägande av incitamentsstrukturer, arbetsflöde och samarbetsformer.

Syftet med avhandlingen är att ur ett medborgarskaps- och kommunikativt perspektiv undersöka och problematisera funktionshindrade ”brukares” självbestämmande i samtal som förs under s.k. brukarcentrerade teammöten organiserade av en vuxen- respektive en barn- och ungdomshabilitering. I mötena deltar en funktionshindrad brukare och/eller anhöriga och professionella från skilda verksamheter. Studien baseras på diskursanalys av 18 observerade och bandinspelade möten hållna av tio olika team. Analyserna visar att brukarna hade ett mer eller mindre begränsat inflytande över samtalens organisering. Inflytandet varierade med organiseringen av samtalen samt med i vilken utsträckning brukarna deltog aktivt genom att identifiera egna problem och framtida mål. Det synliggjorde en spänning mellan ett ”idealt” självbestämmande och brukarnas förmåga/benägenhet att leva upp till de krav som det ”ideala” självbestämmandet ställde och gav upphov till situationer i vilka dilemman mellan självbestämmande och paternalism uppstod. I analyserna av hanterandet av dessa situationer framkom att deltagarna i möten utan deltagande brukare motiverade sina åsikter och beslut rörande behandlingen av brukaren genom att referera till egna övertygelser om vad som är bäst för brukaren respektive till tolkningar av brukarens egna preferenser utifrån hennes/hans agerande i vardagslivet. I möten med deltagande brukare använde övriga deltagare diskursiva strategier som var mer eller mindre paternalistiska då de innebar att de styrde brukaren på ett sätt som det inte var säkert att brukaren själv ville. I avhandlingen diskuteras vilka möjliga strategier som skulle kunna öka brukarnas självbestämmande. Utfallet relateras också till det ”samtalande” och sociala medborgarskap som brukarna i avhandlingen anses utöva samt till andra möjliga innebörder av ett socialt medborgarskapsutövande. / From a citizenship and communicative perspective the aim of the dissertation is to examine and problematize the self-determination of disabled “users” during conversations taking place at “user-centred” team meetings. The meetings are organised by two habilitation centres, one for children and young people and one for adults. One disabled user and/or his/her relatives and professionals representing different institutions participate in the meetings. The study is based on discourse analysis of 18 observed and audiotaped team meetings held by ten different teams. The analyses show that the users exerted a more or less restricted influence on the organisation of the conversations. This varied with the organisation of the conversations and to the extent that the users participated actively by identifying their own problems and future goals. Hence, a certain conflict between an “ideal” type of self-determination and the users’ ability/willingness to live up to the demands that this kind of self-determination makes on them was revealed. This conflict gave rise to situations in which dilemmas between selfdetermination and paternalism appeared. By analysing how these situations were handled it was found that the participants in meetings without participating users accounted for their opinions and decisions concerning the treatment of the users by referring either to interpretations of the user’s preferences, which were based on the user’s behaviour in everyday life, or to their own beliefs of what would benefit the user. In meetings with participating users, the other participants handled the situations by steering the discussions in directions the user may not have chosen him-/herself. These discursive strategies were more or less paternalistic. In the dissertation it is discussed what other possible strategies exist that could increase the users’ self-determination. The result is also related to the “spoken” and social citizenship that the users are considered to exercise, as well as to other possible meanings of social citizenship.