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Given the crucial role professionals play in maintaining the well-being of people with intellectual disabilities, their views on work satisfaction are relevant to analyse. A comparative analysis that takes into account the support provided in different welfare organisations can be of certain importance. The aim is to analyse the most common aspects of professional work satisfaction in work with people with intellectual disabilities in schools, healthcare, and social services, and to apply a comparative analysis of such experience taking into account respondents' organisational affiliations. Data were collected using a digital questionnaire. Given the aim of the study, we drew on one open-ended question: 'describe aspects of your work that are most satisfactory for you'. The analysis shows that respondents associated positive work experience with seven aspects: autonomy, competence, nature of the work, collaboration, trust and recognition, work environment, and service users. Findings indicate that discretion is an important facet of work satisfaction among respondents in all three organisations. Flexibility, autonomy in decision-making, the ability to plan and act within certain institutional and legal frameworks, and the ability to prioritise among daily work assignments are empirical examples of this.

Although research on young people's identification processes on the Internet is a growing field, few studies illustrate conditions for young people with intellectual disabilities (ID). Previous studies have shown that young people with ID are worried about being marginalized, and that many in fact are lonelier than other young people. Internet and social networking sites might be of vital importance as a space for exploring alternative and less stigmatized identities. This article reports findings from individual interviews with 27 young people with ID in Sweden. The transcribed interviews were analyzed using a thematic content analysis. A prominent finding concerned the informants being well aware of both risks and opportunities using Internet and Social Networking Sites. Consequently, the more they interacted with non-disabled peers, the more they experienced negative consequences of Internet use. These circumstances rather lead to downsizing than upsizing Internet use, and less participation on Social Networking Sites. The experiences of the informants are discussed in a conceptual framework of social identity, participation, and emancipation. We recommend that social work practitioners reflect upon the ways that support can be arranged in order to empower young people with ID to participate on the Internet. [ABSTRACT FROM AUTHOR]

The Internet has become an increasingly common way for people to contact each other, to flirt, fall in love and start relationships. How does this development influence today's young people with intellectual disabilities? The article presents a picture of the Internet experiences of some young adults with intellectual disabilities and discusses how others view this usage. It is based on a qualitative study in Sweden where 10 young people with intellectual disabilities and 12 staff members were interviewed. The interviews show that young people with intellectual disabilities also use the Internet, mainly for social and romantic reasons. They view the Internet as a positive arena where they can be "like everybody else" and therefore generally present themselves without mentioning their disabilities. However, people around them tend to worry considerably and focus mainly on the risks involved in this usage of the Internet. [ABSTRACT FROM AUTHOR]

The overarching aim of this study is to explore guardianship in terms of its impact on daily lives of adults with intellectual disabilities in Sweden. Based on qualitative interviews, the article focuses on the expected and actual role of limited guardians for people with intellectual disabilities in the context of Swedish laws. Our findings show that the legal definition of limited guardianship is unclear and that this lack of clarity, among other dilemmas, creates conflict among clients, guardians, relatives, professionals and care workers. The guardian may be expected to act as an accountant, a legal advocate, or even a surrogate family member. The result is consistent with previous research in other countries on the consequences of guardianship. The current legislation on limited guardianship is in need of amendment in order to avoid legal uncertainty and ambiguity among clients and their support network. [ABSTRACT FROM AUTHOR]

Background: People with profound intellectual and multiple disabilities (PIMD) have combined severe intellectual and physical disability and need extensive health care support. They cannot communicate by spoken language and need around the clock support. The health care for people with PIMD is typically provided by a number of different health care services in collaboration with residential care staff and their managers. The quality of health care for people with PIMD are important due to their limited ability to communicate their needs. The aim of this study was to explore residential care staff and manager's experiences and views of health care services for adults with PIMD.Methods: Thirteen semi-structured interviews with residential care staff (n = 7) and managers (n = 6) were conducted and analysed using qualitative content analysis.Results: The informants expressed a variety of experiences, under the theme was Quality of health care is enhanced through residential care staff. The theme was comprised of four subthemes: (1) Individually tailored support promotes quality, (2) Accessibility requires adaptation and prioritization by healthcare providers, (3) Disability competence promotes quality and safety and (4) Complex collaboration conditions between the person with PIMD, residential care staff and disability health care.Conclusions: The residential care staff create quality of care in their role as representatives for adults with PIMD. The care situation is complex and requires adequate competence in the disability, the individual's needs and adaptations to ensure quality of health care. It is also important to build collaboration with other services that are involved in the care of people with PIMD. [ABSTRACT FROM AUTHOR]

We investigated the relationships between syndromic manifestations of defective placentation and the incidence of intellectual disability (ID) in offspring by conducting a population-based cohort study of 1,581,200 nonmalformed, live singleton infants born in Sweden between 1998 and 2014. Exposures were: 1) placental abruption, 2) preterm preeclampsia (<34 weeks of gestation), 3) preeclampsia combined with infant being small for gestational age (SGA) at birth, and 4) spontaneous preterm birth. The outcome was an ID diagnosis after 3 years of age. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for each syndrome using Cox regression and robust variances. There were 9,451 children with ID (5.5 per 10,000 child-years). ID incidence rates increased with placental abruption (HR = 2.8, 95% CI: 2.3, 3.5), preterm preeclampsia (HR = 3.7, 95% CI: 2.9, 4.7), preeclampsia combined with SGA (HR = 3.3, 95% CI: 2.6, 4.1), and spontaneous preterm birth (for 32–36 and 22–31 weeks, respectively, HR = 1.6 (95% CI: 1.4, 1.8) and 5.2 (95% CI: 4.3, 6.2)). The same pattern of results was evident in sibling-controlled analyses among 1,043,158 full siblings. The strength of associations increased with ID severity. Preterm birth only partly explained the associations of placental abruption, preeclampsia, or SGA with ID. We conclude that defective placentation is related to increased incidence of ID in the offspring. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities are often regarded as subjects of care and support, rather than citizens with the same rights as others. This article aims to describe how young adults experience and perceive attitudes, treatment and participation in terms of the application process for daily activity/sheltered employment, as well as their transition into this activity and their first years' experience of it. The study was carried out in a middle-sized municipality in Sweden. Data were collected from 14 people with mild to moderate intellectual disabilities, aged between 21 and 23 years. The interviews were supported by the use of pictograms. Qualitative content analysis was used to analyse the data. The participants stated that they wished to be listened to as adults, and to participate in decisions about daily activity/sheltered employment. They wished to be treated and accepted as individuals, not according to their disabilities. They wanted to participate, and the opportunity to do so would require an accepting environment. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities (ID) are known to have more diseases and are believed to start aging earlier than the general population. The population of older people with ID is growing, but knowledge about their use of healthcare is limited. This study aimed to explore somatic healthcare utilisation patterns among people with ID living in Sweden, in comparison with the general population from 2002 to 2012. Methods: Participants were a group of people with ID (n = 7936) aged 55 years and older in 2012, and an equal-sized, birth year and sex matched, general population sample (n = 7936). Participants were divided into age groups of 5-year intervals. Data regarding in- and outpatient care were collected from the Swedish National Patient Register. Results: In the younger age groups, the ID group had higher healthcare utilisation compared with the general population sample, with higher risks for planned and unplanned somatic in- and outpatient care, particularly for unplanned inpatient registrations. Decreasing patterns were seen with age; with lower risks in the ID group for the oldest age groups. This was most evident in planned somatic in- and outpatient care. In those with at least one registration, the ID group had a longer unplanned length of stay in the younger age groups, but fewer planned visits to physicians in somatic outpatient care compared with the control group. Conclusions: Compared with the general population, people with ID show higher healthcare utilisation in younger age groups. Healthcare utilisation decreases with age, and in old age, fewer people with ID use healthcare compared with the general population. The barriers to accessing planned healthcare for older people with ID need more investigation. [ABSTRACT FROM AUTHOR]

The overall aim was to examine participants' perceptions of a communication course as held for parents of children with profound intellectual and multiple disabilities. The course curriculum included responsive strategies and augmentative and alternative communication. The research questions addressed the favourability, changes in parents' or children's communication and appreciated or unappreciated course features. Twenty-two written course evaluations were analysed. The mean scores for ratings were compared with ratings in a previous study, including those of parents of children with generally milder disabilities. Comments and answers to open-ended questions were analysed using thematic analysis. Participants were slightly more satisfied with the course as compared with parents who had children with milder disabilities. The thematic analysis suggested increased parental responsiveness after the course. Perceptions of augmentative and alternative communication varied. It was unclear whether the course altered the children's communication or not. The supportive social milieu offered by the course was highly appreciated. Although generalisation beyond this course and setting is to be determined, the results suggest that parents of children with profound intellectual and multiple disabilities can appreciate a communication course and find it useful. An individual approach within the group setting and practical learning opportunities seem important. [ABSTRACT FROM AUTHOR]

Parents of children with a mild intellectual disability experience more distress and require more support than other parents. The aim was to investigate the perceived family needs of parents of children with an MID and to investigate the relationship between parents’ perceived self-efficacy in their parental role and in collaborating with professionals as well as with their perceived needs for support. Interviews were based on questionnaires to the parents of 38 children. The results revealed that parents perceived need for information, respite, and venues in which to meet other parents in similar situations. The informational needs were related to parental self-efficacy and obtaining support. A lower need for information was related to higher perceived control over services. In conclusion, it appears that professionals need to work to strengthen parents’ ability to ask for support and to express the needs. Well-informed parents will develop stronger parental self-efficacy and perceived control over services. [ABSTRACT FROM PUBLISHER]

One goal with the UN Convention on the Rights of Persons with Disabilities is ensuring that persons with disabilities have the right to support in reaching and acting upon decisions. The aim of this pilot study was to explore how adults with intellectual disability describe their experiences of receiving support and being represented by a limited guardian. Two overall themes emerged from eight qualitative individual semistructured interviews: Indispensable and valuable support and Mismanagement of the assignment. Our findings showed that limited guardianship is more complex than it may initially seem due to overlaps between protecting rights, ensuring support for the person, and managing financial matters. Mutual trust and the guardian's ability to listen and be open to the client's changing needs reduced the risk of the client being misrepresented or receiving insufficient support. To support assisted decision-making, limited guardians must develop their pedagogical skills and gain knowledge about intellectual disability. [ABSTRACT FROM AUTHOR]

Background: Different types of staff support individuals with intellectual disability (ID) in their daily life, in schools, leisure activities and in special accommodations. This study aimed to gain a deeper understanding of experiences and perceptions regarding sexual and reproductive health and rights (SRHR) among staff. Methods: Data were collected in mid-Sweden in four focus groups with altogether 20 participants, 18 women and 2 men aged between 18 and 65 years. They had different professions and worked among youth and adults with ID aged 18–40 years in schools, accommodations and with leisure activities. Their working experience varied from 3 years to more than 20 years. Interviews were audio recorded, transcribed and analysed with content analysis. Results: The participants generally described positive attitudes towards sexuality for people with ID, both among themselves and in society. However, many situations such as ensuring privacy, balancing between waiting and acting, issues around contraception and reproduction were difficult to address and participants had hesitations about childbearing. They described different strategies such as showing respect, enhancing self-esteem and decision making ability and using interprofessional support to cope with frustrating situations. They lacked a clear mandate from managers as well as written guidelines and policies. They requested education and support from peers, supervisors and other professionals. Conclusion: Participants in the study were generally open-minded and accepting towards sexuality among young people with ID. They thought it was difficult to deal with reproduction/parenthood and felt unprepared and frustrated in certain situations. The participants requested a clear mandate from managers, organizational guidelines, more education and inter-professional support. We believe these findings can inform the development of policy and support the implementation of SRHR related guidelines to support staff working with young people with ID. [ABSTRACT FROM AUTHOR]

Reading difficulties are linked to several disadvantages in the general population. Less is known about correlates of reading difficulties in individuals with intellectual and severe developmental disabilities (IDD). Vocabulary and word reading were assessed in 112 adolescents with IDD, recruited from Special needs comprehensive schools in Sweden (grundsärskolor in Swedish). Proxy-ratings of mental health were collected from teachers and parents for a subset of the participants. Relationships between all measures were investigated. Reading and vocabulary were poorly developed in both groups and significantly associated. While mental health problems were common, there were no significant associations with word reading or with vocabulary knowledge. Thus, the study did not confirm an association between reading difficulties and mental health problems in adolescents with IDD. Still, the frequency of mental health problems and the low reading abilities point to the need for further intervention for adolescents with IDD. [ABSTRACT FROM AUTHOR]

Background: Maternal diabetes has been associated with a risk of neurodevelopmental disorders (NDDs) in offspring, though the common co-occurrence of autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD) and intellectual disability (ID) is rarely considered, nor is the potential for confounding by shared familial factors (e.g. genetics).Methods: This population-based cohort study used data from Psychiatry Sweden, a linkage of Swedish national registers, to follow 2 369 680 individuals born from 1987 to 2010. We used population-averaged logit models to examine the association between exposure to maternal type 1 diabetes mellitus (T1DM), pre-gestational type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM), and odds of NDDs in offspring. Subgroup analysis was then performed to investigate the timings of GDM diagnosis during pregnancy and its effect on the odds of NDDs in offspring. We compared these results to models considering paternal lifetime T1DM and T2DM as exposures.Results: Overall, 45 678 individuals (1.93%) were diagnosed with ASD, 20 823 (0.88%) with ID and 102 018 (4.31%) with ADHD. All types of maternal diabetes were associated with odds of NDDs, with T2DM most strongly associated with any diagnosis of ASD (odds ratioadjusted 1.37, 95% confidence interval 1.03-1.84), ID (2.09, 1.53-2.87) and ADHD (1.43, 1.16-1.77). Considering common co-morbid groups, the associations were strongest between maternal diabetes and diagnostic combinations that included ID. Paternal T1DM and T2DM diagnoses were also associated with offspring NDDs, but these associations were weaker than those with maternal diabetes. Diagnosis of GDM between 27 and 30 weeks of gestation was generally associated with the greatest risk of NDDs in offspring, with the strongest associations for outcomes that included ID.Conclusion: The association of maternal diabetes with NDDs in offspring varies depending on the co-morbid presentation of the NDDs, with the greatest odds associated with outcomes that included ID. Results of paternal-comparison studies suggest that the above associations are likely to be partly confounded by shared familial factors, such as genetic liability. [ABSTRACT FROM AUTHOR]

The majority of studies related to the needs of individuals with psychiatric disabilities focus on their meeting with, and use of, the traditional mental health system. Environmentally relative conceptions of disability have only shown limited success in expanding the views of the field of community psychiatry to include social and organizational contexts. Swedish disability policy emphasizes the individual's ability to participate in community life and may therefore be said to reflect a social approach to disability, in contrast to an exclusively medical perspective that focuses on deficits and the individual's need for psychiatrically defined services. In this study, inventories of need for people with psychiatric disabilities, a legislated responsibility of the social service system in Sweden, were completed for three municipalities. Results indicated that these individuals resist psychiatrically defined categories as they seek supports based on their own experience of need in the community. [ABSTRACT FROM AUTHOR]

There is limited knowledge about young persons with intellectual disability who are Not in Employment, Education or Daily activity (NEED) in Sweden. The aim of the study was to explore the post-upper secondary school situation for persons with intellectual disability not involved in traditional occupations. A national database containing 2955 persons, representing 24.1% of the total (N = 12,269) was used. The results revealed a heterogeneous group where financial support was common and few made use of disability services. Gender, municipality, programme type, financial support and disability services were significantly associated with not having an occupation as opposed to being in employment, education or daily activity. Time was a central factor, as the early years after upper secondary school appear to be an important period for changing NEED status. This is the first large scale study to describe these persons not involved in traditional occupations in Sweden and further research is required. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus and hypertension are risk factors for cardiovascular disease, which is the most common cause of death in the world. People with intellectual disability (ID) have been reported to have high rates of both these disorders. The aim of this study was to describe and compare prevalence ratios of diabetes mellitus and hypertension between older adults with ID and their age peers in the general population, and to describe and compare treatment patterns in these two groups.Methods: This is a Swedish register-based study, in which we established a cohort of people aged 55+ years and who had received support for those with ID in 2012 (n = 7936). We also established a same-sized referent cohort from the general population matched by sex and year of birth. Information on diagnoses of diabetes mellitus and hypertension, and prescription of drugs for these disorders, were collected from national registers for the period 2006-2012. The two cohorts were compared using generalized linear models (GLM).Results: People with ID were 20% more likely than the general population to have a diagnosis of diabetes mellitus, and 26% more likely to have prescription of drugs for diabetes mellitus. People in the general population were 81% more likely to have a diagnosis of hypertension, and 9% more likely to have a prescription of drugs for hypertension. Among those with diabetes, ID was associated with higher occurrence of prescription of insulin combination drugs and sulfonylureas, but lower occurrence of prescription of dipeptidyl peptidase (DPP) 4-inhibitors and exenatide/liraglutide. Among those with hypertension, ID was associated with higher occurrence of prescription of diuretics, but lower occurrence of prescription of calcium channel blockers and angiotensin II antagonists.Conclusions: Treatment regimens among people with ID tended to include older types of medication compared with what was prescribed in the general population. To ensure that this is medically appropriate and not due to failure to update the treatment regimen, it is important to investigate if the people with ID and diabetes mellitus or hypertension are subjected to the same regular drug reviews that are recommended for older adults in general. [ABSTRACT FROM AUTHOR]

Background: Sweden has closed all institutions and imposed legislation to ensure service and support for individuals with intellectual disability (ID). Understanding mortality among older individuals with ID is essential to inform development of health promotion and disease control strategies. We investigated patterns and risk of mortality among older adults with ID in Sweden.Methods: This retrospective cohort study compared older adults aged 55 years and older with ID with a control population. Participants were followed during 2002-2015 or death, and censored if they moved out of Sweden. Individuals with ID were identified from two national registers: one covering all specialist health-care visits (out-patient visits and hospitalisation) and the other covering people accessing social/support services. Individuals with ID (n = 15,289) were matched with a control population by sex, birth year, and year of first hospitalisation/out-patient visit/access to LSS services. Cause-of-death data were recorded using International Classification of Diseases, Tenth Revision. Cox proportional hazards regression were conducted to assess if overall and cause-specific mortality rate among individuals with ID was higher than in the Swedish population.Results: The overall mortality rate among individuals with ID was 2483 per 100,000 people compared with 810 in the control population. Among those who died, more individuals with ID were younger than 75 years and unmarried. Leading causes of death among individuals with ID were circulatory diseases (34%), respiratory diseases (17%) and neoplasms (15%). Leading causes of death in a sub-sample with Down syndrome (DS) were respiratory diseases (37%), circulatory diseases (26%) and mental/behavioural disorders (11%). Epilepsy and pneumonitis were more common among individuals with ID than controls. Alzheimer's disease was common in the control population and individuals with DS, but not among those with ID when DS was excluded. Individuals with ID had a higher overall mortality risk (hazard ratio [HR] 4.1, 95% confidence interval [CI] 4.0-4.3) and respiratory disease death risk (HR 12.5, 95% CI 10.9-14.2) than controls.Conclusion: Older adults with ID in Sweden carry a higher mortality risk compared with the general population, mainly attributable to respiratory, nervous and circulatory diseases. Care for this group, particularly during the terminal stage of illness, needs to be tailored based on understanding of their main health problem. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore barriers and facilitators in the implementation of a health course for adults with mild or moderate intellectual disabilities. An inductive qualitative design was used. Data were collected from a health course conducted in 16 study groups with 83 participants in Stockholm, Sweden by unstructured observations in course sessions, a group discussion with course leaders and evaluation notes from the course leaders. The data were analysed by qualitative content analysis. Four categories were identified: (i) ‘individual characteristics’, implying various needs, (ii) ‘pedagogical strategies’ used to meet those needs, (iii) ‘interaction within the course’, dealing with active and less active participation and (iv) ‘structures’, including learning climate and organizing. The overarching theme ‘creating an individualized supportive context’ describes the challenge of educating people with intellectual disabilities towards an empowered and well informed decision making regarding their own health. Therefore, there is a need for support not only within the course but also from the social and physical environment as well. [ABSTRACT FROM AUTHOR]

This article analyses a theatre, Olla, which has actors with intellectual disabilities. Using qualitative methods the aims are to analyse how Olla relates to institutional environments and to analyse the social meaning of acting. The results are based on two empirical research projects using three qualitative methods: participant observation; open, non-structured qualitative interviews with both the leaders and the actors; and research circles with the actors. The results were analysed from a neo-institutional and a sub-cultural perspective. The results show that, at an organizational level, Olla is connected to the two different logics, which generate a certain ambivalence in relation to the surrounding environment. Legitimacy is rooted in a duality between process and product, art and therapy. However, the process at hand creates cultural meaning, where the emphasis is on the identification and celebration of difference. By sharing the same cultural belonging and by expressing this in relation to the public, the actors have developed confidence and strength with emancipatory significance. It has given them an instrument with which to deal with their experiences of ambivalence to their environment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine and describe the ideas, that is, a mental construction of perceived reality and values, which are expressed in the Swedish Disability Act and its Government Bill. By means of text analysis, four concepts of reality and values have been identified: (1) Citizenship and justice, (2) The collective and integration, (3) The individual and autonomy, and (4) Decentralization and power shifts. The study also shows that social rights and social citizenship have been strengthened via legislation for individuals with comprehensive disabilities. It is also demonstrated that there is considerable room in the legislation for conflicts between the two concepts and values of collective/integration and the individual/autonomy. It can also be observed that there is a considerable risk that citizens are not treated in a similar manner as regards the interpretation and application of the Disability Act, which may lead to lack of legal security. [ABSTRACT FROM AUTHOR]

This article aims to explore ways in which members of staff in group homes for people with intellectual disability experience participation, and what participation means for older people with intellectual disability. Qualitative interviews were performed with 15 members of staff at group homes in Sweden. The findings of this study are illustrated by considering two interacting themes and six subthemes. These involve staff experiences of the meaning of participation and factors which facilitate or inhibit it. The meaning of participation was expressed as doing and feeling. Staff described that participation for older people with intellectual disability was influenced by the individual characteristics of the residents, such as the relationship between age and disability. They also expressed the view that participation was influenced by organizational and physical contextual factors such as economics, time and space as well as the social environment. The latter included staff knowledge and skills, family and peers. [ABSTRACT FROM PUBLISHER]

This article discusses voluntary childlessness and reaching adulthood in Sweden, focusing on childfree women and men with intellectual disabilities (IDs). The article is based on interviews with 19 childfree individuals, four of whom had IDs. It focuses on motives for voluntary childlessness, with three types of motives being mentioned only by the interviewees with IDs; namely the difficulties of parenthood and of building relations with children, the risk of heredity and the maliciousness of children. The interviews have been analysed with relevance to power axes of gender, age and abilities, and these three motives may be seen as results of the interviewees' ascribed position as intellectually disabled and of the segregation in society between able and disabled individuals. The article also includes a discussion about how to achieve ‘adult status’ when parenthood is ruled out. Other issues in everyday life seem more important than parenthood, according to the individuals with IDs. [ABSTRACT FROM AUTHOR]

Focuses on the services for mentally handicapped in Sweden. Similarity of care in the country to Great Britain; Importance of community team in the services of mentally handicapped; Aim towards normalization of the mentally handicapped.

In Sweden several recent prostitution-related offences where the victims were women with intellectual disabilities (IDs) have created problems for criminal investigators and prosecutors. Based on court documents and interviews with police, prosecutors and social workers, and drawing upon Christie's notion of the ‘ideal victim’, four legal cases were analysed. Obtaining solid witness accounts from the victims was usually difficult. Several had a personal relationship with the defendant and were initially reluctant to provide a proper witness statement. Different types of psychological, social, and cognitive support had to be arranged to facilitate the process. As the analysis shows, there is a clear need to improve the skills and methods of professionals working within the legal system to ensure that the rights of individuals with IDs are properly met within the justice system, and that the quality of the police's work with them can stand up to scrutiny. [ABSTRACT FROM PUBLISHER]

Examines the criminality of noninstitutionalized mentally retarded (NIMR) men and women in a Swedish cohort. Information about the participants of the study; Criminal records that were collected for all the participants; Patterns of early precursors that reflect the composite variables of childhood problems used in the study; Prevalence of criminality and types of offense.

Immigrant mental patients attending the psychiatric clinic of Väster&arirg;s Central Hospital in Central Sweden were compared with Swedish patients at the samt clinic as regards to diagnosis, expressed problems, amount of care, and social characteristics. Propensity to seek public psychiatric treatment was tower than among Swedes. It was the higher the greater the geographical and cultural distance between Sweden and their country of origin is: immigrants from Northern and Western Europe attended the clinic to a lesser degree than those from Southern and Eastern Europe. Compared with native Swedes immigrant patients were more often diagnosed as paranoid, hysterical, hypochondriacal or neurastenic. Depression was less common than in the native population. Immigrants had fewer problems at work and in human relations, but more somatic symptoms (East- and South-Europeans) or problems with alcohol (Finns). Patients who had migrated at a young age had the most severe problems. Immigrant mental patients were better integrated to the society through work and family than indigeneous patients. Migration status seems so stressinducing that even otherwise socially integrated persons fall mentally ill. With the help of a factor analysis four types of immigrant mental patients could be distinguished according to their main problem area: patients suffering from (1) adjustment problems, (2) human relations and psychotic problems vs. somatic symptoms, (3) political and work problems, and (4) alcohol and housing problems. The frequency of these problems was analyzed according to sex, ethnicity and duration of stay in Sweden. [ABSTRACT FROM AUTHOR]

The quality of meal-oriented support for people with intellectual disabilities is important for their health. The aim of the present study was to explore the experiences of meal-oriented support and diet counselling for adults with intellectual disabilities living in supported housing, from the perspective of housing staff and mothers. Five focus group interviews, including nine supporting staff members and nine mothers, were conducted. The interviews were analyzed using systematic text condensation. Five themes appeared; Extensive needs of the individual, Staff skills determine the food intake, Informal caregivers make up for shortage of support, Effective collaboration with a registered dietitian is needed and Responsibility of the organization state that professionalization of staff is needed. Lacking resources, such as time and nutritional knowledge, insufficient considerations of individual needs, and high staff turnover influence the meal-orientated services negatively. This study brings to the fore, staff working practices and the complexity of providing meal-oriented support for people with intellectual disabilities. Staff need skills to perform individually tailored support. This is best accomplished through effective collaboration between housing staff and relatives underpinned by knowledge from a registered dietitian. The working practices must be structured at the organizational level of the services.

This article reflects some potential possibilities and risks that have been created during the changes in disability policies and general social welfare systems in Sweden over the last year. New ways of life have developed among young people with intellectual disabilities. The paper is based on data from semi-structured interviews with people, who through their profession have wide contact with this group, and from participating observations and interviews with 23 young persons with intellectual disabilities, aged 19–30 years. Three main categories of young people may be distinguished in these subjects: the “cared for and represented”; the “commuters”; and the “outsiders”. For each of these groups, life patterns and contact with service providers will be described and analysed, and strategies and consequences discussed. [ABSTRACT FROM AUTHOR]

The article reports on the selection of Sweden as the host of the Special Olympics World Winter Games in 2021.

One goal of disability policies in Sweden and other countries is to ensure that people with disabilities are afforded an equal level of daily life participation as other citizens. However, few studies have examined this in adults with profound intellectual disabilities (PID) or profound intellectual and multiple disabilities (PIMD). This study used a phenomenographic approach to interview managers and staff at a social care organisation in a medium-sized Swedish municipality. It aimed to elucidate and describe conceptions of participation to highlight conceptual variations. Divergent conceptualisations were found, reflecting a lack of organisational consensus about the meaning of participation. Trying to fulfil policy goals of daily life participation for adults with PID or PIMD without a common understanding of the meaning of participation is difficult, so people at all levels of an organisation need to have a shared understanding and definition of it. [ABSTRACT FROM AUTHOR]

Robotic animals are increasingly discussed as a solution to challenges connected to the aging population and limited resources in care. While previous research focuses on the robots' effect on the patients' well-being, there is a general lack of knowledge regarding the hands-on experience of caregivers' use of robots. Therefore, the aim of the study is to explore the competences that caregivers draw upon when facilitating interaction between residents and robots. The study was conducted through ethnographic observations and interviews with caregivers at dementia care homes in Sweden. The notion of 'competence' is understood as knowledge about the ways of working and social norms that are valued within a community of practice, which members develop through engagement in the community. The findings show that caregivers' use of robotic animals as caregiving tools rests on embodied, social, and ethical competences. [ABSTRACT FROM AUTHOR]

In many countries, self-employment has become a common strategy for achieving inclusion in the labour market. Studies show that the occurrence of self-employment depends not only on individual motives, but also on existing policies and support. In Sweden, labour market measures to include people with disabilities are primarily organized to achieve inclusion through traditional forms of employment, though one tool offered by the Swedish Public Employment Service is Support to Start a Business. One part of this support is exclusive to people with disabilities. Although the Swedish Public Employment Service is responsible for this specific support, they collaborate with both external state-funded and non-profit actors who assess applicants' business ideas. Drawing on the methodological approach of institutional ethnography, this article explores how the in-house frontline workers and external actors describe their professional roles, how they make decisions and what the chain of action looks like at multiple sites. Nine representatives from the various organizations that people can meet with when trying to start and run their own business have taken part in semistructured interviews. The analysis identifies different institutional practices that overlap when people with disabilities apply for support to start their own business: one focusing on the efficient allocation of resources, and the other on the individual's social and financial welfare by protecting the individuals these organizations meet with from risks connected to economy and health. These two practices reflect a long-standing conflict between control and support in objectives within both labour market policy and social work. This support of self-employment for people with disabilities is organized by actors who traditionally have not been studied in research on social work. [ABSTRACT FROM AUTHOR]

Background: Citizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden. Methods: The respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study. Results: Five of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved. Conclusion: WHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses. [ABSTRACT FROM AUTHOR]

Background: β-blockers are widely used for treating cardiac conditions and are suggested for the treatment of anxiety and aggression, although research is conflicting and limited by methodological problems. In addition, β-blockers have been associated with precipitating other psychiatric disorders and suicidal behaviour, but findings are mixed. We aimed to examine associations between β-blockers and psychiatric and behavioural outcomes in a large population-based cohort in Sweden. Methods and findings: We conducted a population-based longitudinal cohort study using Swedish nationwide high-quality healthcare, mortality, and crime registers. We included 1,400,766 individuals aged 15 years or older who had collected β-blocker prescriptions and followed them for 8 years between 2006 and 2013. We linked register data on dispensed β-blocker prescriptions with main outcomes, hospitalisations for psychiatric disorders (not including self-injurious behaviour or suicide attempts), suicidal behaviour (including deaths from suicide), and charges of violent crime. We applied within-individual Cox proportional hazards regression to compare periods on treatment with periods off treatment within each individual in order to reduce possible confounding by indication, as this model inherently adjusts for all stable confounders (e.g., genetics and health history). We also adjusted for age as a time-varying covariate. In further analyses, we adjusted by stated indications, prevalent users, cardiac severity, psychiatric and crime history, individual β-blockers, β-blocker selectivity and solubility, and use of other medications. In the cohort, 86.8% (n = 1,215,247) were 50 years and over, and 52.2% (n = 731,322) were women. During the study period, 6.9% (n = 96,801) of the β-blocker users were hospitalised for a psychiatric disorder, 0.7% (n = 9,960) presented with suicidal behaviour, and 0.7% (n = 9,405) were charged with a violent crime. There was heterogeneity in the direction of results; within-individual analyses showed that periods of β-blocker treatment were associated with reduced hazards of psychiatric hospitalisations (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), charges of violent crime (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001), and increased hazards of suicidal behaviour (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, reduced associations with psychiatric hospitalisations during β-blocker treatment were mainly driven by lower hospitalisation rates due to depressive (HR: 0.92, 95% CI: 0.89 to 0.96, p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p < 0.001). Reduced associations with violent charges remained in most sensitivity analyses, while associations with psychiatric hospitalisations and suicidal behaviour were inconsistent. Limitations include that the within-individual model does not account for confounders that could change during treatment, unless measured and adjusted for in the model. Conclusions: In this population-wide study, we found no consistent links between β-blockers and psychiatric outcomes. However, β-blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β-blockers to manage aggression and violence could be investigated further. In a population-based cohort study of 1.4 million individuals in Sweden, Dr. Yasmina Molero and colleagues investigate the associations between β-blockers and psychiatric and behavioural outcomes. Author summary: Why was this study done?: β-blockers are primarily cardiac medications that are widely used for treating anxiety and are also suggested for the management of clinical depression and aggression, although research on efficacy is conflicting and limited by small samples and methodological problems. β-blockers have been linked to an increased risk of suicidal behaviour, but findings are inconclusive. More evidence using large samples and appropriate designs is needed on real-world effects on mental health and behavioural outcomes in people taking β-blockers. What did the researchers do and find?: We examined a population-based cohort of 1,400,766 persons in Sweden who had been treated with β-blockers using a within-individual design; i.e., we compared individuals to themselves during medication and non-medication periods to account for background factors that may confound associations. Periods on β-blocker treatment were associated with an 8% lower risk of being hospitalised due to a psychiatric disorder, a 13% lower risk of being charged with a violent crime by the police, and an 8% increased risk of being treated for suicidal behaviour or suicide mortality. Reduced associations with violent charges were consistent across sensitivity analyses, while associations with suicidal behaviour and psychiatric hospitalisations varied by specific psychiatric diagnoses, past psychiatric problems, and cardiac severity. What do these findings mean?: The widespread use of β-blockers to manage anxiety is not supported in this real-world study that examined presentations of anxiety in secondary care. Studies using other designs (e.g., randomised controlled trials) are needed to better understand the role of β-blockers in the management of aggression and violence. If findings on violence are confirmed by studies that use other designs, β-blockers could be considered to manage aggression and hostility in individuals with psychiatric conditions. [ABSTRACT FROM AUTHOR]

The normative and political call for an inclusive working world as the UNCRPD explicates is not consistent with the current employment realities of people with disabilities in Germany and in the Nordic countries such as Iceland, Norway or Sweden. Only a fraction is able to find employment on the labour market, while segregated systems are expanding at the same time. We reference the 'Work 4.0' discourse with a particular focus on substitutability potentials and automation processes in the course of digitalization. These developments go hand in hand with the pluralization of employment constellations as well as progressive expansion of education and devaluation of qualifications. This article takes a critical look at these processes of change in the working world with regard to their effects on people with disabilities. The central contradictions between political, legal, and normative demands for employment realities to be organized inclusively as well current developments in the area of technology, employment, and knowledge are discussed. [ABSTRACT FROM AUTHOR]

The Structured Water Dance Intervention (SWAN) is a dance-oriented aquatic group activity directed to give opportunities for the joy of movement, relaxation, and reduced stress. This study aimed to evaluate the effects of SWAN on salivary cortisol and stress in adults with profound intellectual and multiple disabilities (PIMD). A total of 34 adults with PIMD at four habilitation centres in Sweden completed the SWAN intervention. The intervention was administered for 40 min once a week during a 12-week period. Saliva cortisol was collected in the morning and evening at baseline one week before the intervention, thrice during the intervention period, and one week after the intervention. Moreover, in connection with the SWAN sessions, the participants' level of stress was also assessed by the accompanying assistants. The results showed that salivary cortisol and participants stress decreased significantly, directly after the SWAN sessions compared with measures directly before sessions. The study demonstrates that adults with PIMD have diurnal salivary cortisol patterns consistent with those observed in adults without disability and that the SWAN reduces salivary cortisol levels and stress in people with PIMD; this justifies that SWAN could be considered in the choice of interventions to reduce stress in adults with PIMD. Trial registration: This study is registered 09/04/2019 on ClinicalTrials.gov (ID: NCT03908801). [ABSTRACT FROM AUTHOR]

Background: People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model-a person-centred activity- and recovery-oriented intervention-has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness.Methods: The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff.Discussion: This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness.Trial Registration: ClinicalTrials.gov NCT05056415. Registered on 24 September 2021. [ABSTRACT FROM AUTHOR]

Introduction: This study pertains to the design of a decision aid (DA) to shed light on information and support needs in colorectal cancer screening, with the aim to explore the calling patterns to the Screening of Swedish Colons (SCREESCO) study's helpline. Methods: A cross‐sectional study was conducted with data from documented telephone calls to the SCREESCO study, including individuals, 59–60 years, randomized to colonoscopy or high sensitive faecal immunochemical test (FIT). Results: More than 2000 calls (women 58.5%; colonoscopy 59%) were analysed. Calling patterns: unsubscribing from screening, confirmation of participation, logistical concerns about the screening procedure, counselling, and FIT screening difficulties or in need of a new FIT test. Comorbidity was the most frequent reason for unsubscribing and most of the counselling calls included questions about the FIT test or the colonoscopy. Conclusion: Most of the calls to the helpline seemed to be related to individuals' lack of understanding about the organization of the screening programme and the screening procedure. Therefore, we find it important to further stress the tailoring part in our DA developing process, that is, provide limited information initially, with the possibility of access to more, if desired by the individual, still with respect to the individual's needs, health and digital literacy. Patient and Public Contribution: Individuals representing the public and invited to SCREESCO participated since we analysed their calls to the helpline. The findings will contribute to our continued work with the DA where the public will contribute and participate. [ABSTRACT FROM AUTHOR]

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Aims: To study associations between intellectual disability (ID) and sexual and violent offending among individuals subject to pre-trial forensic psychiatric assessment. To investigate sentences following pre-trial forensic psychiatric assessment in offenders with and without ID. Methods: A population-based observational study using data from pre-trial forensic psychiatric assessments in Sweden (1997–2013), the Swedish National Crime Register and several other Swedish national registers. The study population consisted of 7450 offenders (87% men, 13% women) who were subject to forensic psychiatric assessment in 1997–2013, of whom 481 (6.5%) were clinically assessed as having ID. Results: ID offenders were more likely than non-ID offenders to have a sexual crime as an index crime [26.2 v. 11.5%, adjusted odds ratio (OR) 2.7, 95% confidence interval (CI) 2.02–3.58] as well as previous convictions regarding sexual offending (10.4 v. 5.6%, adj OR 2.3, 95% CI 1.70–3.12). These associations were restricted to male offenders; sexual offending was uncommon among women. Comorbid attention-deficit hyperactivity disorder reduced the association between ID and sexual offending (adj OR 2.7 v. 3.1, p = 0.017), while comorbid autism spectrum disorder had no significant influence on the association (adj OR 2.7 v. 3.0, p = 0.059). Violent crime was equally common among ID and non-ID offenders. Offenders with ID were more likely than non-ID offenders to be sentenced to forensic psychiatric care or community sanctions and measures (such as probation, conditional sentences or fines) than to prison; however, 15% of individuals who received an ID diagnosis during the forensic psychiatric assessment were sentenced to prison. Previous criminal convictions, concurrent antisocial personality disorders and substance use disorders were associated with a higher probability of a prison sentence among offenders with ID. Conclusions: Sexual crime is overrepresented among offenders with ID compared to offenders with other mental disorders than ID in forensic psychiatric contexts. ID offenders become subject to forensic psychiatric care and forensic psychiatric services need evidence-based treatment programmes for offenders with ID. In addition, there is a need for early intervention strategies suitable for disability services and special education schools, in order to address the complex needs of individuals with ID and prevent sexual and violent offending. [ABSTRACT FROM AUTHOR]

Background: A knowledge gap exists about the risk of cancer in individuals with intellectual disability (ID). The primary aim of this study was to estimate the cancer risk among individuals with ID compared to individuals without ID.Methods and Findings: We conducted a population-based cohort study of all children live-born in Sweden between 1974 and 2013 and whose mothers were born in a Nordic country. All individuals were followed from birth until cancer diagnosis, emigration, death, or 31 December 2016 (up to age 43 years), whichever came first. Incident cancers were identified from the Swedish Cancer Register. We fitted Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) as measures of cancer risk in relation to ID after adjusting for several potential confounders. We analyzed ID by severity, as well as idiopathic ID and syndromic ID separately. We performed a sibling comparison to investigate familial confounding. The study cohort included a total of 3,531,305 individuals, including 27,956 (0.8%) individuals diagnosed with ID. Compared with the reference group (individuals without ID and without a full sibling with ID), individuals with ID were in general more likely to be male. The median follow-up time was 8.9 and 23.0 years for individuals with ID and individuals without ID, respectively. A total of 188 cancer cases were identified among individuals with ID (incidence rate [IR], 62 per 1,000 person-years), and 24,960 among individuals in the reference group (IR, 31 per 1,000 person-years). A statistically significantly increased risk was observed for any cancer (HR 1.57, 95% CI 1.35-1.82; P < 0.001), as well as for several cancer types, including cancers of the esophagus (HR 28.4, 95% CI 6.2-130.6; P < 0.001), stomach (HR 6.1, 95% CI 1.5-24.9; P = 0.013), small intestine (HR 12.0, 95% CI 2.9-50.1; P < 0.001), colon (HR 2.0, 95% CI 1.0-4.1; P = 0.045), pancreas (HR 6.0, 95% CI 1.5-24.8; P = 0.013), uterus (HR 11.7, 95% CI 1.5-90.7; P = 0.019), kidney (HR 4.4, 95% CI 2.0-9.8; P < 0.001), central nervous system (HR 2.7, 95% CI 2.0-3.7; P < 0.001), and other or unspecified sites (HR 4.8, 95% CI 1.8-12.9; P = 0.002), as well as acute lymphoid leukemia (HR 2.4, 95% CI 1.3-4.4; P = 0.003) and acute myeloid leukemia (HR 3.0, 95% CI 1.4-6.4; P = 0.004). Cancer risk was not modified by ID severity or sex but was higher for syndromic ID. The sibling comparison showed little support for familial confounding. The main study limitations were the limited statistical power for the analyses of specific cancer types, and the potential for underestimation of the studied associations (e.g., due to potential underdetection or delayed diagnosis of cancer among individuals with ID).Conclusions: In this study, we found that individuals with ID showed an increased risk of any cancer, as well as of several specific cancer types. These findings suggest that extended surveillance and early intervention for cancer among individuals with ID are warranted. [ABSTRACT FROM AUTHOR]

Background: Specific medical guidelines for health surveillance exist for people with Down syndrome (DS) since 25 years but knowledge of adherence to the guidelines is lacking. The guidelines were developed to avoid unnecessary suffering from preventable conditions. The aims of the study were to investigate 1) planned health care visits in relation to the co-morbidities described in specific medical guidelines as a measure of adherence, 2) unplanned health care visits as a measure of potentially unmet health care needs and 3) gender differences in health care utilisation among older people with DS.Methods: This register-based study includes people with DS (n = 472) from a Swedish national cohort of people with intellectual disability (n = 7936), aged 55 years or more, and with at least one support according to the disability law, in 2012. Data on inpatient and outpatient specialist health care utilisation were collected from the National Patient Register for 2002-2012.Results: A total of 3854 inpatient and outpatient specialist health care visits were recorded during the 11 years, of which 54.6% (n = 2103) were planned, 44.0% (n = 1695) unplanned and 1.4% (n = 56) lacked information. More than half of the visits, 67.0% (n = 2582) were outpatient health care thus inpatient 33% (n = 1272). Most planned visits (29.4%, n = 618) were to an ophthalmology clinic, and most unplanned visits to an internal medicine clinic (36.6%, n = 621). The most common cause for planned visits was cataract, found at least once for 32.8% in this cohort, followed by arthrosis (8.9%), epilepsy (8.9%) and dementia (6.6%). Pneumonia, pain, fractures and epilepsy each accounted for at least one unplanned visit for approximately one-fourth of the population (27.1, 26.9, 26.3 and 19.7% respectively). Men and women had similar numbers of unplanned visits. However, women were more likely to have visits for epilepsy or fractures, and men more likely for pneumonia.Conclusions: Increased awareness of existing specific medical guidelines for people with DS is vital for preventive measures. The relatively few planned health care visits according to the medical guidelines together with a high number of unplanned visits caused by conditions which potentially can be prevented suggest a need of improved adherence to medical guidelines. [ABSTRACT FROM AUTHOR]

The aim of this study was to actively integrate expertise of persons living with spina bifida, to explore conditions embedded in their everyday life. This was important because young adults with spina bifida risk not being able to fully participate in the community on equal terms and in accordance with their own preferences. Photovoice, a community-based participatory research approach, was utilized to engage participants through dialogue and photography. An exhibition was created to share results with community and stakeholders. An overarching theme that characterized the experiences of the group was, "an adaptation for us, but it works for no one". Findings are presented as: "Accessibility—a never-ending project," "Tensions of a normative view," and "Power to influence." Findings integrated everyday life metaphors photographically depicted by broken elevators, unsafe transportation, closed doors and not experiencing real opportunities of involvement. Tensions in everyday life experienced by persons living with spina bifida can inform conditions relevant and necessary to support community participation, particulary among persons living with disability. [ABSTRACT FROM AUTHOR]

Background: The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment. Methods: Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997–2013. We performed univariate analyses to compare the characteristics of individuals with (n = 537) and without ID (n = 7,905). Results: The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder. Conclusions: The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care. [ABSTRACT FROM AUTHOR]

As previous research has shown, people with disabilities often have restricted access to adulthood and its corresponding life events (including sexuality, partnership and parenthood), both in society and in popular cultural representations. This article analyzes five contemporary Swedish fiction films with protagonists with disabilities in order to consider how and in what ways they depict romantic relationships, sexuality, and reproduction as manifestations of adulthood in normative time and life course. The aim is to analyze if ableist norms related to time, adulthood, and sexuality is confirmed or challenged in these films. Four of the five films confirmed the ableist norm and used normalizing strategies to assimilate the disability position into normative life course and timeline. One of the films challenged the ableist implications of the normative timeline thus providing the possibility of crip time. Given media representations' powerful dissemination of cultural values it is of great importance to scrutinize its underlying cultural values. [ABSTRACT FROM AUTHOR]

Introduction: Person-centered care (PCC) appears particularly suitable for patients with complex diseases and in multidisciplinary care. However, previous research tends to focus on each profession and condition separately. Purpose: We studied how health care professionals (HCPs) understand PCC, and whether their clinical practice is aligned with their theoretical understanding, when starting clinical practice at a novel multidisciplinary clinic. Methods: In total, 16 semi-structured interviews with HCPs and 31 non-participatory observations of outpatient meetings and other activities at the clinic such as team meetings were conducted at a multidisciplinary, integrated outpatient clinic in Sweden. All patients had simultaneous diabetes mellitus, chronic kidney disease and established cardiovascular disease. The clinic employed a PCC approach. Data were analyzed using an inductive thematic approach. Results: Two key findings emerged. First, PCC requires a holistic view of the patient at all times during care, with everything focused on the patient. This requires that the HCPs know the patient well enough as an individual to be able to tailor the care together with them. Second, working with a PCC philosophy leads to transformed roles for HCPs in patient meetings, with more active involvement by the patient and often also their next of kin. The observations, in comparison with the interviews, showed that not all HCPs applied their views on PCC in patient meetings. Observations showed that some patient meetings were less person-centered than others, potentially due to stress or lack of time. Conclusion: PCC require HCPs to have a holistic view of the patients and a deeper understanding of their situation, as individuals. Working with PCC also leads to a more coaching, supportive role of the HCPs. [ABSTRACT FROM AUTHOR]

Social media is often seen as an arena for negotiation of power, where marginalized voices can be given influence in the public debate. This study focuses the use of Twitter for discussions related to disabilities and disability policy in Sweden. The empirical material is gathered through the hashtag (#) "funkpol", the primary hashtag used to discuss such topics. Empirical data was gathered using a scripted Google spreadsheet. Over a period of 6 months, approximately 10.000 tweets were retrieved. Our findings show nine different categories of twitterers. According to patterns visible in the study, the most active twitterers - the private twitterers - reached out to the established power (advocacy organizations, politicians and media). However, these instances did not respond as much as they were addressed - at least not directly on Twitter. The article shows how private actors are active but not picked up in the public debate. Instead, established power structures prevailed. [ABSTRACT FROM AUTHOR]

The aim of this study was to gain a deeper understanding of Swedish social workers' experience of disabled children's participation, to discover in what ways their knowledge about impairment and disability, combined with legal literacy and local context influence children's participation in formal meetings and decision making. Seven focus-group interviews were conducted with 35 municipal social workers from communities in different parts of Sweden. The phenomenological analysis resulted in the overarching theme of elusive participation, in which participation was described as difficult to grasp both in relation to what was supposed to be achieved and what it was meant to result in. Elusive participation entailed a discrepancy between policy and practice, norms and perception of normality, conflicting perspectives and needs, judgment of children's abilities. These findings underline the importance of creating safe spaces in which social workers have the opportunity for critical reflections and shared discussions about social work practice. [ABSTRACT FROM AUTHOR]