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Organisation of health care for families with young children with autism in a multiethnic community in Gothenburg, Sweden In a project in a multiethnic district in Gothenburg a local collaborative model with a multiprofessional team for families with young children with autism has been running for three years. The model allows assessments and intervention planning close to the family's local environment. The project has revealed that the time from identification of problems to assessment and intervention has been considerably shortened compared to the situation before the local collaborative model was started.

A complete registration of all deceased patients at intensive care units in the Southern Health region of Sweden has shown that 3,114 patients died during the five years from 1999 to 2003. Only 174 cases (5.6 per cent) were classified as potential organ donors according to the definition of total brain infarction (brain death) without medical contra-indications against organ donation. Consent for organ donation was given in slightly more than half of these cases. In 42 per cent of the cases relatives were not aware of the attitude of the deceased, and in 40 per cent of these cases they used their right of veto against organ donation. Corresponding registration, as part of the computerised system for quality assurance for intensive care (PASIVA), may become a national and complete quality assurance for organ donation in Sweden.

The importance of the family in eating disorders has been the subject of a great deal of speculation ever since anorexia nervosa was first described some 130 years ago. Given the importance of the family in child and adolescent development, it also has great bearing on how young people learn to deal with food. But the research is inconclusive as to the family's precise role in the development of an eating disorder. There is no support in the literature on which to base a comprehensive understanding of the family setting in which a member develops an eating disorder; this also applies to anorexia nervosa cases. When groups of families afflicted with different psychiatric disorders are compared, it seems that families in which bulimia nervosa occurs tend to be more dysfunctional than families afflicted with anorexia nervosa. It also seems that families afflicted with anorexia nervosa function better than families afflicted by other psychiatric disorders. In this article the research on family functioning in relation to anorexia nervosa and bulimia nervosa is reviewed and its relevance discussed.

The incidence of AML in Sweden is 5.4/100,000, i.e. 300 persons a year. About 70% of the patients die from their disease. In a retrospective study of medical journals of 106 patients with AML, who had died 1995-1997 in five selected hospitals in Sweden, the last week in life was studied. Sixty-six women and 40 men (age 19-84, mean 67) were included and 658 days of care were documented. The cause of death, the place of death, the type of care and clinical problems and symptoms were registered. We found bleeding (44%), infection (71%), pain (76%) and respiratory (59%) and psychological (64%) problems. Next of kin were often present and during the last week in life 3/4 of the patients had palliative care focusing on symptom relief and quality of life for the patients and his/her family.

The dystonias are movement disorders with sustained muscle contractions causing twisting movements or abnormal postures. A patient survey sent to 268 members of the Swedish Dystonia Patient Association was returned by 221 (82%). Most of the patients (81%) were women and the most common form was cervical dystonia (spasmodic torticollis). Median age at onset was 41.6 years. The time from onset of symptoms to correct diagnosis was on average 6 years. 21% had relatives with movement derangements. Injection with Botulinum toxin and physical therapy were ranked as the most effective treatments. Many patients expressed a need for more physical therapy as well as a desire to meet the same physician each time and to receive more intensive psychological support.

The current Swedish transplant act (1995:831), which in contrast to the former law covers the procurement of tissues came into force on July 1, 1996. Eleven doctors and nurses were interviewed concerning their experiences of discussing tissue donation with bereaved relatives. The interviews revealed that breaking news about a patient's death was considered a routine matter, whereas discussing donation with relatives was regarded a difficult and unpleasant task. In general, the medical staff was not sufficiently familiar with the new law, and reported the lack of routines and guidelines in these matters as a problem. Many of the doctors felt they needed more psychological support and more opportunities to discuss ethical questions; the nurses asked for more information about donation and transplantation, and about ethics. In conclusion, there is a need for training in the communication skills involved in approaching bereaved relatives on the subject of tissue donation. There is also a need for a better understanding of the importance of providing psychological support to medical staff on the part of chiefs and health care authorities.

In a prospective, randomized intervention study, 36 children with diabetes mellitus type I were followed, the aim being to study if a family psychosocial intervention at diagnosis could improve glycemic control and minimise hospital admissions. The control group was treated initially in a hospital ward, while the whole family of the children in the study group received therapeutic and social support in an out-hospital training apartment. In the study group only, both parents reported a significant improvement of the family climate. An increased risk for poor glycemic control was recorded in children living in one-parent families and in families where the father had a low level of education. Younger age, a single-parent family and poor glycemic control were factors associated with more days of rehospitalization. The divorce rate in the whole group was at least as high as in the normal population but, surprisingly, maternal dysfunction was associated with lower levels of HbA1c. The conclusion is that the social family background is a most important factor for the glycemic control and need for hospital readmission of the diabetic child.

Monitoring (tracking and surveillance) of children's behavior is considered an essential parenting skill. Numerous studies show that well monitored youths are less involved in delinquency and other norm-breaking behaviors, and scholars conclude that parents should track their children more carefully. We have questioned that conclusion. We point out that monitoring measures typically assess parents' knowledge, but not its source, and parents could derive knowledge from their children's free disclosure of information as well as their own active surveillance efforts. In our study of 14-year-olds in central Sweden and their parents, parental knowledge came mainly from child disclosure, and child disclosure was the source of knowledge that was most closely linked to broad and narrow measures of delinquency (norm-breaking and police contact). Parents' control efforts were related to good adjustment only after the child's feelings of being controlled, which were linked to poor adjustment, were partialled-out. These results held for both children's and parents' reports, for both sexes, and independent of whether the children were exhibiting problem behavior or not. We conclude that tracking and surveillance is not the best prescription for parental behavior, and a new prescription must rest on an understanding of the factors that determine child disclosure. As adolescents spend increasing amounts of time away from home, parental trust should become important, but little is known about how trust develops. We propose that parental trust is based on knowledge, primarily. We have pitted three types of knowledge about the child against each other in the prediction of parental trust--knowledge of: feelings and concerns, past delinquency, and daily activities. Results showed that knowledge of daily activities was more important than knowledge of past delinquency. In further analyses, knowledge of daily activities that came from the child's spontaneous disclosure was most closely linked to parents' trust. These findings add support to our reinterpretation of parental "monitoring" as parental knowledge that mainly comes from spontaneous child disclosure. Additionally, the role of parental trust for dysfunctional family relations was examined, and it was found that the relations between the child's delinquency and family dysfunction were mediated by parental trust. Finally, even though there was substantial agreement between parents and children about parents' trust in the child, the individual's unique perspectives were important. Family dysfunction from the child's perspective was based on whether they believed that their parents trusted them, and parents' perceptions of family dysfunction were based on their trust in the child.

This article presents evidence of the importance of multidisciplinary assessment of students with learning disabilities. Multidisciplinary collaboration between different professions provides a more complete picture of each person's unique requirements, thereby facilitating more appropriate teaching. A critical attitude toward diagnosing students with learning disabilities may result in exaggeration of psychosocial problems, thereby running the risk that genuine learning disabilities, neurological problems or other disorders are being overlooked.

Neuropsychiatric problems (Asperger syndrome, ADHD, reading and writing disorders) affect 6-10 per cent of all children in Sweden. Many of these disorders are never diagnosed. As a consequence, secondary behaviour problems and impaired family relations often follow. A study of 60 families with at least one child affected by one of the above mentioned disorders shows that quality of life can be increased and problems reduced if parents and children are informed of the child's disabilities and the child receives a special education programme. Families who do not receive this special treatment more often apply for medical care from other (more expensive) sources. Quite often do they find this treatment unsatisfactory.

From the perspective of contemporary neurobiology, genetics and developmental psychology, the traditional psychiatric diagnostic system DSM-IV is out of date. It is based on a 19th century medical model of disease with an untenable dualistic view of brain, mind and body, a mechanistic concept of causality, and retification of diagnoses. This makes DSM inadequate for the clinical child psychiatrist who needs a holistic view of the child, its family and social environment.

In a series of 83 patients undergoing coronary artery bypass grafting for angina, perceived QOL (quality of life) was rated by the patients and their spouses, preoperatively and at two and 12 months postoperatively, using the SWED-QUAL instrument. One year after surgery, QOL had improved to a level which might be expected of a normal population comparable in age and gender distribution. Good correlation existed between patient and spouse ratings, especially on physical measures.

All 151 patients registered at a palliative home care facility in Sollentuna from its inception in 1995 to the end of 1997 were studied to identify factors contributing to the patients' possibility of dying at home. Of those registered, 117 had died by the end 1997, 69 at home, 40 at a hospice, seven at emergency facilities, and one abroad. Comparison of those who died at a hospice and those who died at home showed no significant differences to exist between the two subgroups in age, gender, diagnosis, stage of disease, degree of symptom control, or treatment given. Psychosocial factors were the most important determinants of whether the patients died at home. The availability of psychological support for family members, and access to a hospital bed when they needed to relax, were also important factors, as were patient and family consent to home care.