This study aims to explore parents and treatment personnels experiences of the Marte meo methodat a family treatment home. Three retrospective interviews were made with parents whoexperienced Marte meo treatment, as well as four interviews with treatment personnel. The purposeof the Marte meo method is to develop the interaction between parent and child. Previous resultsfrom studies show that treatment with the Marte meo method could provide positive effects to theparent child relationship. The results in this study have been analyzed by using parts of attachmenttheory, the salutogenic perspective and the term intersubjectivity. The parents in this study all statethat Marte meo treatment strengthened them in their role as a parent. The treatment personnel statethat they have seen positive changes in families living at the family treatment home whoparticipated in Marte meo treatment.

The two principal elements comprising this thesis are 1) a description of the development of a theory concerning schizophrenic psychosis and 2) an attempt to develop a treatment strategy based on this theory. The theory was developed by Palle Villemoes on the basis of the French psychoanalyst Lacan's work and may be described as an ego-structuring psychotherapy with its foundation in the castration complex. The psychosis is seen as a consequence of the child's inability, for various reasons, to a apt itself to symbolic castration - i e disappointment and frustration over not constantly having its own way, and over being required to subordinate itself to universal principles and authorities. The psychotic person has not subordinated under symbolic is castration but continues to exist in the original symbiotic relation with the imagined pre-oedipal mother, When the pressures of the teenage and early adult years make themselves felt, such an ego-weak person is unable to withstand and deal with them and develops a psychotic relation to her/his surroundings, The- treatment strategy described in this thesis, was developed by the author and colleagues at the treatment centre Norrgården in Härnösand. It is a milieu therapyoriented treatment during which the patient optimally passes through three phases. During the first - narcissistic - phase the aim is that the patient's contact person develop such a relationship with her/him that "idolization" of the contact person occurs. This idolization is achieved by means of interest on the part of the contactperson, and a non-polarized attitude. The contact person shows interest in the patient and in her/his situation, life-story and interests. The non-polarized attitude means that little or no importance is attached to differences, particularly those due to gender and power position. The contact person avoids provoking the patient in areas about which she/he is sensitive. When a balanced, conflict-free relationship with the patient bas been achieved, treatment moves into a so- called working phase. Now the establishing of her/ his own history in the patient takes over from the idolization built up in the course of the close relationship. The patient is to become the subject of her/his own life-story, to achieve which patient and contact person go through the story together. If all goes well the patient passes through the castration complex and is able to find a realistic place for her himself in the story, the culture, and the society that has to be lived in with all its relations towards other people. The patient now begins to view her/himself, with both possibilities and limitations, more and more realistically. She/he also begins to show interest in the future and in plans for a life after treatment. In the final phase, progressively more responsibility for decisions is left to the patient. The aim of this phase of the treatment is to consolidate the narcissism of the patient's own ego. She/he must be released from the symbiotic dyad with the contact person who now leaves it to the patient to make choices and decisions and to be aware of the passage of time. The thesis discusses the development of the theory in a dialectic relation to the practical experiences of treatment work during the earliest years at Norrgården. A central place in the thesis is occupied by 11 case descriptions of the first patients who completed the treatment at Norrgården. / digitalisering@umu

Chronic heart failure (HF) is a condition that affects more than 900,000 people in the UK. Mortality rates associated with the condition are high, with nearly 20% of patients dying within one year of diagnosis. Continuous monitoring and risk stratification can help identify patients at risk of deterioration and may consequently improve patients' likelihood of survival. Current repeated-measure risk stratification techniques for HF patients often rely on subjective perception of symptoms, such as breathlessness, and markers of fluid retention in the body (e.g. weight). Despite the common use of such markers, studies have shown that they offer limited effectiveness in predicting HF-related events. This thesis set out to identify and evaluate new markers for repeated-measure risk stratification of HF patients. It started with an exploration of traditional HF measurements, including weight, blood pressure, heart rate and symptom scores, and aimed to improve the performance of these measurements using a data-driven approach. A multi-variate model was developed from data acquired during a randomised controlled trial of remotely-monitored HF patients. The rare occurrence of HF-related adverse events during the trial required the developement of a careful methodology. This methodology helped identify the markers with most predictive ability, which achieved moderate performance at identifying patients at risk of HF-related adverse events, clearly outperforming commonly-used thresholds. Subsequently, this thesis explored the potential value of additional, accelerometer-derived physical activity (PA) and sleep markers. For this purpose, the ability of accelerometer-derived markers to differentiate between individuals with and without HF was evaluated. It was found that markers that summarise the frequency and duration of different PA intensities performed best at differentiating between the two groups and may therefore be most suitable for future use in repeated-measure applications. As part of the analysis of accelerometer-derived HF markers, a gap in the methodology of automated accelerometer processing was identified, namely the need for self-reported sleep-onset and wake-up information. As a result, Chapter 5 of this thesis describes the development and evaluation of a data-driven solution for this problem. In summary, this thesis explored both traditional and new, accelerometer-derived markers for the early detection of HF deterioration. It utilised sound methodology to overcome limitations faced by sparse and unbalanced datasets and filled a methodological gap in the processing of signals from wrist-worn accelerometers.

Abstract Ensuring of Respite Care Services in the Česká Lípa Region after Releasing of Patients from Hospital The goal of this thesis is to map the scope, the quality and further relationships of respite care in the Česká Lípa region in case of patients released from hospitals for whom a respite care is indicated, to find shortcomings of the systém and to propose optimal solutions of problems. There were two hypotheses set: H1: Sufficient respite care services are not provided to clients at weekends, H2: Consecutive respite care is not duly indicated by physicians to all clients released from hospitals who need it. The theoretical part of the thesis describes characteristics of respite care, its meaning and the process of ins development. The research was carried out trough the questioning method, using questionnaires and anasysis of documents. The other part of the thesis presents the results of performed quantitative research. These results were acquired by means of evaluation of questionnaires. The anasysis of acquired data confirmed both the supposed hypotheses. The discussion elucidates some problems related to the given theme and the conclusion of the thesis recommends some measures to improve the quality and continuity of providing the respite care services in the Česká Lípa region. The results of the thesis may inspire the existing as well as newly established respite care agencies to increase the quality of respite care.

Sammanfattning Nyckelgården är ett HVB-hem med inriktning på behandling av föräldrar och barn. Den primära anledningen till att familjer placeras är omsorgsbrist hos föräldrarna. Detta innebär vanligen föräldrarnas svårigheter att kontrollera sina egna känslor och frustrationer, vilket har lett till en oförmåga att prioritera barnens känslomässiga behov. Nyckelgården erbjuder kvalificerad behandling i förälder-barnrelationen och arbetar även med svårigheter knutna till självutveckling, social kompetens och nätverk. Syftet med vår studie var att utvärdera Nyckelgården för att arbetet där ska kunna utvecklas och förbättras. Vi har genomgående utgått från ett brukarperspektiv för att förmedla tidigare klienters upplevelse av sin vistelse på behandlingshemmet. De frågeställningar som konkretiserar vårt syfte är; Hur har tidigare klienter upplevt bemötande och möjlighet till delaktighet under sin vistelse på behandlingshemmet? Har tidigare klienter upplevt någon form av förändring i sin livssituation till följd av familjebehandlingen? Vad upplevde tidigare klienter som mest givande under behandlingstiden och vad behöver förbättras? För att uppnå syftet med studien har vi genom kvalitativ metod genomfört intervjuer med fem av Nyckelgårdens tidigare klienter. Resultatet av intervjuerna har analyserats utifrån två teorier; Aaron Antonovsky’s teori om KASAM samt John Bolwby’s anknytningsteori, vilken Kari Killén utgår ifrån i sitt resonemang om professionell-klient relationen. Utvärderingen visar att respondenterna har upplevt delaktighet under sin behandling och att detta i flertalet fall har bidragit till motivation under behandlingsprocessen. Vidare visar resultatet att personalens förmåga att lyssna och visa empati upplevs som viktigt för respondenterna. Det mest givande med behandlingen upplevdes vara att de fick verktyg i form av kunskap för att bättre hantera sin föräldraroll samt hjälp till självhjälp i sin övriga livssituation. Majoriteten av respondenterna uttryckte att de upplevt positiva förändringar till följd av Nyckelgårdens behandling i form av mer fungerande relation och bättre samspel med sina barn. Vår slutsats av resultatet är att Nyckelgården är en väl fungerande verksamhet och att personalen fortsatt bör reflektera över sin förmåga att lyssna, visa empati samt bekräfta klienter i sin föräldraroll. / Abstract Nyckelgården is a treatment home that focuses on family preservation. The primary reason for placing families is care shortage from the parents. This means that parents display difficulties controlling their emotions and frustrations, which have led to an inability to prioritize the emotional needs of the children. Nyckelgården offers qualified treatment of the parent-child relationship and also work with difficulties regarding self-development, social abilities and social networks. The aim of our study was to evaluate Nyckelgården in order to develop and evaluate their work. Throughout our evaluation we originated from a client’s perspective in order to convey former clients experience of their time spent at the treatment home. The questions of issue have been; how have former clients experienced refutation and ability to participate during their stay at the treatment home? Have former clients experienced any kind of change in their life situation related to the family treatment? What did former clients experience to be most rewarding about their stay and what is in need of improvement? In order to attain the aim of the study we have trough qualitative method performed five interviews with former clients of Nyckelgården. The result of the interviews have been analyzed with the help of two theories; Aaron Antonovsky and his theory of KASAM and John Bolwby’s theory of attachment from which Kari Killén have discussed professional- client relationships. The evaluation show that the respondents have experienced participation during their treatment and that in many cases this has led to improved motivation during the treatment process. Further, the result show that professional ́s ability to listen and display empathy proved important to the respondents. Most rewarding in relation to treatment was receiving tools in terms of knowledge to better deal with the parenting role and to experience a sense of empowerment. The majority of the respondents expressed that they experienced positive changes in relation to their treatment at Nyckelgården as well as improved interaction with their children. Our conclusion is that Nyckelgården is a well-functioning organization and that the professionals continuously should reflect on their ability to listen, display empathy and acknowledge clients in regards to their parenting role.