Mitt syfte med detta arbete är att reda ut begreppen ordblindhet, dyslexi och läs- och skrivsvårigheter. Jag har sedan valt att använda definition läs- och skrivsvårigheter. I arbetet har jag undersökt hur pass väl teori stämmer överens med praktik, med tyngdpunkt på dessa orsaker, symptom, diagnos och åtgärder. Det är idag ganska oklart om vilka faktorer som är bidragande orsaker till läs- och skrivsvårigheter. Forskarna är osäkra på om läs- och skrivsvårigheter kan vara ärftligt betingat. Dock vet man säkert att miljön är en starkt påverkande faktor. Mina studier, såväl i teorin som i praktiken visar däremot på att symptomen för läs- och skrivsvårigheter är tydliga. Dessutom är åtgärder i form av hjälp från speciallärare en viktig del för att individen med läs- och skrivsvårigheter skall få det stöd som han/hon behöver för att lyckas i sitt fortsatta skolarbete.

Alkoholkonsum beginnt häufig bereits im Jugendalter. Allerdings fehlen bisher Erkenntnisse darüber, ob, wie häufig und aufgrund welcher Merkmale Jugendlichen und junge Erwachsene auch bereits klinisch definierte Mißbrauchs- und Abhängigkeitsdiagnosen entwickeln. In der vorliegenden Arbeit werden Ergebnisse einer repräsentativen Untersuchung an 3021 Jugendlichen im Alter von 14-24 Jahren vorgestellt. Neben der Prävalenz von Alkoholmißbrauch und -abhängigkeit nach DSM-IV werden Daten zur Häufigkeit und Menge des Alkoholkonsums berichtet sowie erste Symptome beschrieben. 9,7% der befragten Jugendlichen erhielten aufgrund von DSM-IV-Kriterien eine Mißbrauchsdiagnose, 6,2% eine Abhängigkeitsdiagnose. Bei männlichen Jugendlichen war die Prävalenz wesentlich höher als bei weiblichen. Die Prävalenz war in den älteren Geburtskohorten höher. Als erstes Missbrauchssymptom trat am häufigsten "Gebrauch mit körperlicher Gefährdung" (91,9%), als erstes Abhängigkeitssymptom "Toleranzentwicklung" (34,3%) auf. Erste diagnostische Kriterien einer Alkoholstörung traten zumeist deutlich vor dem 18. Lebensjahr auf. Diese Daten unterstreichen, daß Alkoholmißbrauch und -abhängigkeit bereits im Jugend- und frühen Erwachsenenalter häufig sind. / Alcohol use frequently begins in adolescence. However, only few studies have reported the prevalence of alcohol abuse disorders in adolescents. This paper reports results from a representative study in a sample of 3021 adolescents, aged 14-24 years. The Prevalence of alcohol abuse and dependence according to DSM-IV criteria, as well as the prevalence, frequency and quantity of alcohol abuse and a description of the first occuring symptoms, are presented here. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Males were more likely to report an alcohol disorder than females, and the prevalence also increased in the older age cohorts. The most frequent initial symptoms were "hazardous use" (91.9%) for abuse and "tolerance" (34.3%) for dependence. First symptoms have been shown to occur long before the age of 18. These results show that even in adolescents and young adults alcohol abuse and dependence are frequent disorders.

Background: Health-Related Quality of Life (HRQOL) can be negatively affected in patients living with arrhythmias and many patients experience a pronounced symptom burden. The arrhythmia can cause both uncertainty and limitations, including interference with work, reluctance to perform and plan for leisure activities and leading to self-imposed restrictions in daily life situations. There are patients striving to find strategies to manage the arrhythmia and for some this can become the focus in their lives. Treatment options are often a choice between pharmaceuticals and radiofrequency ablation (RFA) where RFA is an option for many arrhythmia-patients to be cured. In the care of arrhythmia-patients it is of great importance to combine objective examinations with patient-reported outcomes (PROs) to achieve patient’s own experiences of treatment efficacy and arrhythmias interference in daily life situations. Aims: The overall aims of this thesis were to assess symptom burden and HRQOL in patients with arrhythmias and to develop and validate an arrhythmia-specific questionnaire, suitable for most arrhythmia-patients. Design and Methods: Studies I and II were single-centre studies including patients referred for RFA, with two different arrhythmia diagnoses. Assessments of patient-reported outcomes (PROs) concerning HRQOL were performed using two questionnaires, SF-36 and EQ-5D (I-II). Further, patients were asked some disease-specific questions (I). Study I describes assessments before the RFA treatment and Study II the follow-up assessments at three and twelve months after RFA. Patients’ scoring of HRQOL was compared to age and gender matched reference groups before and after RFA (I-II). Studies III and IV describe the development and validation of a disease-specific questionnaire ASTA (Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia) assessing symptom burden and HRQOL. Studies III and IV were multicentre studies. Patients planned for DC-conversion, AF patients seeking emergency care and those with different forms of arrhythmias referred for RFA were included. Results: Patients scored significantly lower HRQOL in seven of SF-36’s eight scales compared to the age and gender matched reference groups before RFA treatment. Frequent arrhythmia attacks had a great negative impact on HRQOL, and female gender and older age were factors contributing to worse HRQOL (I). Treatment with RFA restored the patients’ HRQOL. Most positive effects were seen at three months follow-up. One year after treatment patients and the matched reference group scored their HRQOL to a similar level, assessed with SF-36 and EQ-5D index (II). The validated ASTA questionnaire was found to have good psychometric properties. Construct validity was confirmed with sufficient levels of item-total correlations in the ASTA symptom burden scale and HRQOL scales. The dimensionality of the ASTA HRQOL scale was established with confirmatory factor analysis, supporting a physical and a mental subscale. The internal consistency, demonstrated with Cronbach’s alpha (α), was satisfactory for the ASTA symptom burden scale and the ASTA HRQOL scales, varying from α 0.79 to α 0.91 (III-IV). Conclusions and clinical implications: The studies in this thesis confirmed how negatively affected the arrhythmia-patients can be with a pronounced symptom burden and impaired HRQOL. Treatment with RFA was demonstrated to restore the patients HRQOL to an equal level of that of the matched reference group. PROs are important to take into consideration in the care of arrhythmia-patients, to achieve the patients’ subjective experiences of their daily life situation. To the best of our knowledge ASTA is the first arrhythmia-specific questionnaire assessing symptom burden and HRQOL, suitable for most arrhythmia forms. The newly validated ASTA questionnaire can be an important contribution to assessment of PROs in arrhythmia-patients.

No description available.

This thesis addresses two interpretative questions concerning the philosophy of Friedrich Nietzsche. The first is to ascertain the primary objection that Nietzsche has to a morality that he describes as decadent. The conclusion reached is that Nietzsche’s objection to decadent morality is based on the harm it does to a class of “higher” individuals who have valuable work to perform in achieving a desirable future for humanity. The second question is to determine the manner in which Nietzsche’s own values are to be understood based on the skepticism he expresses concerning the objectivity of value. The conclusion reached is that Nietzsche’s values are objects of the same analysis he applies to human values generally. The values Nietzsche endorses, including the valuing of “higher” individuals, are to be understood as symptoms of a particular physiology and its relationship to living.

No description available.

Uppsatsen behandlar och belyser problemen som uppstår ur föräldrars upplevelse av socialsekreterares maktmissbruk i myndighetsutövning. Studiens syfte var att med hjälp av en fenomenologisk ansats och sju halvstrukturerade kvalitativa intervjuer, utforska ovan nämnda upplevelse och dess eventuella följder hos föräldrar till barn som har befunnit/befinner sig i den svenska sociala barnavården. Analysen visade att upplevelsen uttrycktes i form av kraftiga känslor av negativt slag såsom förtvivlan, ilska, vanmakt, hjälplöshet o.s.v. Därmed följde psykiska -, fysiska -/ psykosomatiska - och psykosociala besvär som tenderade att eskalera i ärendets olika faser. Konklusionen blev att upplevelsen av socialsekreterares maktmissbruk i myndighetsutövning påverkade samtliga aspekter i föräldrarnas liv, främst negativt. Detta frambringade destruktiva följder som i sin tur förvärrades med en fortsatt upplevelse av maktmissbruk, där undantaget var de psykosociala följderna som i ett fall tenderade att minska i samband med att ärendet avslutades.

Bakgrund: Det saknas biomedicinsk förklaring till varför fibromyalgi uppstår, vilket gör att patienter idag främst diagnostiseras genom symtombilden som ingår i sjukdomen. Att fibromyalgi består av både fysiska och psykiska besvär och att orsaken är oklar gör att sjukdomen är svårbehandlad. Vid bemötande av denna patientgrupp är det viktigt att ha ett holistiskt synsätt. Syfte: Att belysa aktuell forskning om kvinnors upplevelser av att leva med fibromyalgi. Metod: En litteraturöversikt baserad på tretton vetenskapliga artiklar som har analyserats. Resultat: De främsta huvudsymtomen för kvinnor med fibromyalgi är smärta, trötthet, utmattning, depression, sömnstörningar samt kognitiv nedsättning. Huvudteman som framkommit i studien är En sjukdom som påverkar livet och Att kämpa med sjukvården. Vidare framkom fyra underteman som grundas på sjukdomens begränsningar, som gör att kvinnor måste omstrukturera sin livssituation för att uppnå en livskvalitet. Slutsats: En ökad förståelse för hur kvinnor upplever att leva med fibromyalgi kan bidra till en förbättrad attityd mot denna patientgrupp. Detta kan leda till att kvinnors upplevelser av sjukdomen förbättras. / Background: There is no biomedical reason why fibromyalgia occurs. Today, the patients are diagnosed mainly by the symptoms that are part of fibromyalgia. The cause of fibromyalgia is unclear, and it consists of both physical and psychological problems that make the disease difficult to treat. It is important to have a holistic approach when treating patients with fibromyalgia. Aim: To create an overview of current research of women’s experiences of living with fibromyalgia. Method: The study is designed as a study based on thirteen scientific articles which have been analyzed. Results: The main symptoms for women with fibromyalgia were pain, fatigue, exhaustion, depression, sleep disorders and cognitive impairments. The main themes that have emerged are A disease that affects the daily life and To struggle with the healthcare. Furthermore, the results show four subthemes which were based on that the limitations of the disease demand the women to restructure their life situation achieve quality of life. Conclusion: Increased knowledge and understanding of the experiences of patients living with fibromyalgia, may contribute to a better attitude and a better care for this group of patients. This may lead to improvement of women’s experiences of the disease.

It has been well established that many people will suffer with pain at the end of life, and untreated pain contributes to reduced quality of life. Many barriers contribute to this issue including a lack of knowledge in nurses who care for dying patients. Many nurses in general practice settings do not possess adequate knowledge about basic pain management principles; and the same may be true about hospice nurses despite the assumption that hospice nurses are more adept at pain management. Contributing to this problem may be the attitudes that nurses, including hospice nurses, have regarding pain and its management. This study sought to identify the knowledge levels of hospice nurses. Because attitudes may affect the delivery of effective pain management, the study also sought to determine attitudes of hospice nurses regarding pain and its management. Thirty-five hospice nurses completed two instruments: The Pain Management Principles Assessment Test measured levels of knowledge and the Nurses Pain Management Attitude Survey determined attitudes. Data was analyzed using means, standard deviations, frequencies and percentages. A correlation between knowledge level and attitude was also calculated, along with a correlation between knowledge level and certification status. The overall mean knowledge score for the nurses studied was 21.74 (72.3%), which falls below accepted standards. The mean attitude score found was 82.34, which demonstrates only slightly positive attitudes. These findings support the idea that knowledge and attitude are not synonymous and that a nurse may have a positive attitude about the management of pain, without sufficient knowledge to effectively alleviate pain. It is often said that hospice nursing is a calling, and these are the nurses who are at the forefront of pain management. This study demonstrates that slightly more positive attitudes may indicate that this group of nurses is motivated to gain a better knowledge base. This should motivate hospices and other education institutions to incorporate more specific instruction regarding pain management into their curricula. Despite some common misconceptions pain does not have to be an unavoidable part of life, and with a better knowledge base hospice nurses could more effectively deliver compassionate, expert care.

Where is the Person in Symptom Cluster Research? The Experience of Symptom Clusters in Patients with Advanced Lung Cancer This thesis describes a three-year qualitative study which aimed to explore the experience of symptom clusters in patients with advanced lung cancer. The study employed a patient-focused approach utilising Interpretative Phenomenological Analysis (IPA) (Smith et al. 2009a). This methodology (IPA), informed by a contextual constructionist stance, was selected to explore the experience of symptom clusters, for its focus on the lived experience, the context and meanings which surround such experiences and its idiographic approach. Ten patients (a sample size which is the upper limit of the number of participants advocated for studies employing IPA (Smith et al. 2009b;Reid et al. 2005;Smith and Osborn 2004)) with advanced lung cancer took part in the study and data were collected using unstructured, in-depth interviews at two time points: on recruitment and three to five weeks later. Data were analysed using Interpretative Phenomenological Analysis, within the framework advocated by Smith and Osborn (2003). The study generated interesting and significant findings. The experience of symptom clusters in patients with advanced lung cancer was characterised by two super-ordinate themes: ‘The lived experience of symptom clusters and the role of context and meaning’ and ‘Symptom clusters and loss of sense of self’. The super-ordinate theme of ‘The lived experience of symptom clusters and the role of context and meaning’ in the first instance, illustrates that the participants in this study were experiencing symptom clusters and providing detail on the components, nature and patterning of the symptom clusters reported, particularly the way that one or two salient symptoms were commonly highlighted from all the other symptoms experienced. This super-ordinate theme also demonstrates the core role that context and meaning play in the lived experience of symptom clusters, with many of the participants in this study framing their experiences of symptom clusters within a fear of death, stigma and loss of sense of self. The second super-ordinate theme informing this thesis is ‘Symptom clusters and loss of sense of self’. This super-ordinate theme illustrates the impact of symptom clusters on the participants’ lives, and how this, in turn, impacted on their sense of self in a number of different ways. For some, their sense of self was compromised by the concurrent symptoms that they were experiencing, as they prevented them from undertaking roles and activities that they were accustomed to in the past. This super-ordinate theme also highlights the role of the body relative to the self, and describes how the participants’ sense of self was transiently lost during periods when they experienced symptom clusters of high severity. The findings presented also demonstrate the knock-on effect of loss of sense of self experienced, with the participants feeling like they were a burden due to their incapacitation, and at times hiding the multiple symptoms that they were experiencing, in a bid to protect their loved ones from their illness. In light of the loss of sense of self experienced, this super-ordinate theme also demonstrates how the participants employed various strategies in a bid to try and maintain a coherent and valued sense of self. The findings presented illustrate how the use of IPA facilitated the collection of data that provided an in-depth understanding of the complexity of the experience of symptom clusters in patients with advanced lung cancer, adding a unique contribution to this body of knowledge. The results of this study highlight the limitations of definitions that currently underpin the study of symptom clusters in patients with cancer and the current empirical base to date, particularly the way that they do not acknowledge the core role that context and meaning play in the lived experience of this phenomenon. This lack of recognition of these core elements of the patient experience of symptom clusters poses the risk of this body of research producing data that have limited relevance to the patient and therefore clinical practice. It is therefore proposed that the study of symptom clusters in patients with cancer needs to move away from the reductionist approach which currently dominates and to broaden its scope, to one that acknowledges the complexity of the experience of symptom clusters, the core role that context and meaning play in such experiences, and contributions that patient experience can make in advancing this important and emerging body of research.