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In developing new forms for society-based support for mental health service users, authorities implemented a service in Sweden, called Personligt ombud (PO), with the assignment to support service users exercising their rights. The aim of this article is to describe what service users find to be significant features of their working relationships with their PO. Using a phenomenological approach, 23 users were interviewed sharing their experiences of their PO. The results show that service users describe their relationships with the PO as a 'professional friendship'. The friendship-like feature refers to reciprocity in sharing life experiences and forming a trustful relationship in which professional assistance can be offered, promoting well-being and recovery. Conclusions are that the PO provides a service that calls for re-interpretation of professional and user roles, where both give and receive. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study describes the meaning of the lived experiences of adults with intellectual disabilities in a Swedish institutional care setting. Background. Despite the general intention of the Swedish law to give care and support for adults with intellectual disabilities in small settings in the community, large institutional care settings exist in Sweden. It is also known that adults with intellectual disabilities have more influence over their care and support when living in small settings than in large institutions. There is a dearth research in regard to studies that focus on how adults with intellectual disabilities experiences their everyday life in such settings. Design. A qualitative design was used to gain a deeper understanding of the lived experiences of adults with intellectual disabilities in an institutional care setting in Sweden. Methods. Fieldwork from September 2006 to June 2009 in an institutional care setting including participant observation and in-depth interviews with 12 residents was used. Verbatim-transcribed text was analysed using a phenomenological reflective lifeworld approach. Results. The essential picture of the phenomenon was experienced 'as a meaningful and meaningless existence' and was reflected in residents' descriptions of their everyday life in the setting. It was characterised by the constituents: ambiguous dependency, social interactions and everyday life in a restricted area. Conclusion. The results reveal the importance of paying close attention to what adults with intellectual disabilities have to say about their everyday life when living in an institutional care setting. For caring practices of people with intellectual disabilities, it is scarcely satisfactory that residents experience an ambivalent dependency and of having to live in a restricted area. Relevance to clinical practice. The results of this study contribute to better insight and deeper knowledge of the lived experiences of adults with intellectual disabilities, enabling the staff and management to further enhance the well-being for residents. In addition, the findings provide feedback to staff, managers and researchers working in the intellectual disabilities field. [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]

This article shows, firstly, one way in which discrimination in discourse, that is, discrimination performed through the use of language, can be studied with the help of a set of concepts: exclusion from discourse; negative other‐presentation; objectification; and proposals pointing towards unfavourable treatment. The concept of othering is also used. Secondly, an empirical study of the discursive treatment of people labelled ‘mentally deficient’ in interwar Sweden is presented. The parliamentary debate on a new sterilisation law, encyclopaedic entries and medical descriptions are focused. The results reveal that the group in question was blatantly discriminated against, by means of all of the forms of discursive discrimination mentioned, and was also othered. It is suggested that the set of concepts could be useful for comparative studies of discursive treatment of people categorised as ‘mentally deficient’ in other countries during the same period and for studies of possible contemporary discrimination. [ABSTRACT FROM AUTHOR]

Background The role of gender has been a neglected issue in research on intellectual disability (ID). People with ID are generally treated as a homogenous group that are largely categorized by their level of ID. This study compared living conditions of women and men with ID and related the results to similarities and differences among the general population in corresponding age groups. Methods Persons with ID born in Uppsala County between 1959 and 1974 constituted the study sample. Information on the living conditions of 110 persons with ID was collected using questionnaires completed by relatives and staff. Information on living conditions of the general population was obtained through national welfare statistics conducted by Statistics Sweden (SCB). Results In both samples corresponding diversities were revealed for type of employment/daily activities, where women worked in traditional female job sectors and men were occupied with traditional male jobs. Women and men with ID participated to about the same extent in recreational and cultural activities and on only four of the 19 activities listed in the questionnaire (visits to the cinema and library, reading books and practising hobbies alone) significant differences were observed. Among women and men in the general population, we found gender-related differences in 13 of the activities listed. However, with the exception of women more frequently visiting the library and reading books, the two samples demonstrated no corresponding gender-related differences. For the remaining six domains (finances, family and social relations, housing, transport, community participation and personal safety), no differences were noted between women and men with ID. This finding contrasted sharply with the differences found between women and men in the general population. Conclusions Surprisingly, the comparison yielded few differences in living conditions between women and men with ID compared with those found in women and men of the general population. This finding suggests that people with ID were treated as gender-neutral persons rather than as women and men with individual preferences and needs. Thus, it appears that having ID is a more important determinant than gender regarding living conditions for women and men with ID. [ABSTRACT FROM AUTHOR]

The aim of this study was to gain in-depth knowledge of how persons with long-term mental illness experience their everyday situation, in order to identify potential psychosocial obstacles to a meaningful existence. The focus was on psychosocial aspects, such as contact with others and the quality of these contacts. An ethnographic design was used, in order to provide an inside perspective. Four persons with long-term mental illness participated in the study. Three open-ended interviews, at 1-week intervals, were conducted with each informant. Analysis of transcribed material consisted of naive reading and content analysis guided by the investigators' understanding of the psychiatric context. Three themes were generated: feeling lonely but being unable to establish friendships; knowledge of what to do but lacking initiative; and awareness of the need for support but not wanting to be subject to control. These themes reflect contradictions between thoughts, feelings and actions, which seem to contribute to a psychosocial disadvantage in the life of persons with long-term mental illness. [ABSTRACT FROM AUTHOR]

This study introduces how technology and humans are part of relationships that influence agency among people with disabilities. It aims to focus attention on the use of, and access to, information and communication technology (ICT), and agency among youths and adults with intellectual disabilities. The study draws on empirical research conducted with youths and adults with intellectual disabilities, as well as staff at a day centre. It shows that by drawing upon interests, previous experiences, and cooperating in ICT activities the participants’ agency changed. Also, it shows how disability is relational and how it can be influenced by ICT. An interdisciplinary approach is adopted to interpret the findings and to explore: How do people of different ages with intellectual disabilities experience the use of ICT in their everyday lives? Are people with intellectual disabilities able to influence their level of activity by using ICT? And if so, in what ways? [ABSTRACT FROM PUBLISHER]

Background Young adults today have grown up in a society where information and communication technology (ICT) support empowerment and social participation. Young adults with mild-to-moderate intellectual disability are at risk for marginalization by the digital divide. The aim was to map and describe how municipal organizations in Sweden organize support in terms of policy and strategies to enable the use of ICT in social care for adults with a mild-to-moderate intellectual disability. Methods A quantitative, cross-sectional survey including all municipalities in Sweden (n = 290) was conducted (response rate: 51%, n = 147). Descriptive statistics were used. Results Findings indicate a lack of organizational support for staff as well as for young adults with mild-to-moderate intellectual disability. Conclusion Municipalities request more knowledge about strategies for making ICT available. Despite the lack of comprehensive strategies for ICT, some Swedish municipalities have taken the initiative in this area. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the reasons for, and incidence of, tooth mortality over a 10-year period in mentally retarded adults receiving regular dental care. The number of teeth present in 115 individuals (mean age in 1984 was 41.0, range 19-83 years) was registered in 1984 and 1994. The reasons for tooth mortality, medication utilization, frequency of dental care visits and cooperation during dental treatment were registered and related to tooth loss. The average incidence of tooth mortality was 3.72 teeth during the 10-year period. The mean number of dental care visits per year was 6.6. Most of the 428 teeth (58%) were lost due to periodontal disease. The preventive dental care given was not sufficient to arrest oral diseases. The data indicate, however, that achievement of cooperation in dental care situations not only makes dental treatment possible, but also leads to a decreased incidence of tooth mortality. [ABSTRACT FROM AUTHOR]

Aim: This study examined medical and psychosocial risk factors in children born to women with addiction problems during pregnancy and the children's needs for extra medical and psychosocial resources.Methods: Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women with addictions to the Maternity and Child Healthcare Resource Team. We investigated the medical records of 127 children (51% girls) whose mothers were referred to the Resource Team from 2009 to 2015. Additional data were obtained from local child healthcare services (CHS), which provide routine paediatric care.Results: More than three-quarters (76%) of the children had prenatal exposure to alcohol and drugs, and 17% were born with withdrawal symptoms. The mothers had a high rate of psychiatric diagnoses (38%) and were more likely to smoke after delivery and less likely to breastfeed than the general population. However, adherence to the CHS programme was generally high. Additional visits to the nurse, referrals to specialists, collaboration meetings and reports of concerns to social services decreased when the children began attending ordinary CHS centres.Conclusion: Children born to women with addictions during pregnancy faced a high risk of developmental problems and should be offered additional CHS resources to minimise negative long-term consequences. [ABSTRACT FROM AUTHOR]

Background: People with psychiatric disability have been found to have a poorer quality of life (QOL) compared to the general population, and QOL is an important outcome from psychosocial rehabilitation. Aims: This study aimed at comparing users of two approaches to psychosocial rehabilitation in Sweden, community‐based mental health day centres (DCs) and clubhouses, regarding QOL. A further aim was to investigate predictors of QOL. Methods: People regularly attending DCs (n = 128) or clubhouses (n = 57) completed questionnaires at baseline and a 9‐month follow‐up about socio‐demographics, QOL, self‐esteem, social network, satisfaction with daily occupations, satisfaction with services and the unit's organisation. Results: Quality of life remained stable over time in both groups. QOL at follow‐up was associated with baseline self‐esteem, social network, satisfaction with daily occupations and QOL at baseline. The strongest indicator of a higher QOL at follow‐up was attending a clubhouse programme followed by having scored high on QOL at baseline. Conclusion: Both approaches were suited for supporting their users in maintaining QOL. Visiting clubhouses seems, however, advantageous for QOL in a longer‐term perspective. Although this study contributed some new knowledge, research should further address which circumstances are associated with maintaining stability in QOL. [ABSTRACT FROM AUTHOR]

Background: The Residential Environment Impact Scale (REIS) is an assessment and consulting instrument designed to examine the impact of the residential environment on its residents and to develop recommendations for adapting this environment. Since REIS is new for occupational therapists in Sweden it is important to evaluate its utilization potential. Aim: The aim was to examine the utility of the Swedish version of the Residential Environment Impact Scale (REIS-S) for adults living in residential settings. Material and methods: Twenty-two occupational therapists conducted 28 REIS-S assessments in residential settings including 92 older persons and persons with disabilities. In total, 44 questionnaires were answered before and after conduction of the assessment. The data was analyzed using qualitative methods of analysis. Results: The REIS-S showed both positive and negative dimensions of utility among occupational therapists working in residential settings. It provided support for making recommendations and contributed to effective assessments but was found time-consuming. The clinical relevance with REIS-S was positive since it met the needs expressed by the occupational therapists. Conclusions: REIS-S seems promising according to utility in Swedish residential settings for adults. However, psychometrically testing is required for further establishing the utilization of the instrument. [ABSTRACT FROM AUTHOR]

In a Swedish sample of persons eligible for disability services and aged 55 years or older in 2012, persons (n = 601) with autism spectrum disorder diagnoses registered in specialist care were identified. Register data concerning diagnoses of other psychiatric disorders, psychiatric care, and psychiatric medication were reviewed. More than 60% had been in contact with psychiatric care. The majority had no intellectual disability (ID) diagnosis recorded during the study period. Apart from ID, affective disorders, anxiety and psychotic disorders were most commonly registered; alcohol/substance abuse disorders were uncommon. Psychotropic drug prescriptions were very common, especially in the ID group. Professionals need awareness of this vulnerable group; studies concerning their life circumstances and service requirements should be conducted. [ABSTRACT FROM AUTHOR]

The major aim of the present study was to explore what people with psychiatric disabilities, living in two different types of housing, consider to be the best and the worst in their housing situation. A secondary aim was to explore to what extent additional questions to a questionnaire with a free‐response format can provide complementary information to the previous knowledge in the field. The content analysis revealed that the physical attributes were of great significance for the residents in ordinary housing, while both psychosocial aspects and physical attributes were important for those living in supported housing. When providing good housing solutions for people with psychiatric disabilities, attention needs to be given to these aspects by politicians, policymakers as well as by nursing staff. [ABSTRACT FROM AUTHOR]

International student exchange is an opportunity to discover and learn from practice in other countries but few students sign up. This article describes two European Union Erasmus Intensive Programmes that gave learning disability nurses from England and Scotland, special teachers from Sweden and Romania, and special educators from Norway, the opportunity to participate in international and multidisciplinary classroom learning about health, employment and educational services for people with learning disabilities. A module on this will be delivered online in the future. [ABSTRACT FROM AUTHOR]

Abstract: There is a need for various types of interventions when meeting needs of clients with psychiatric disabilities and complementary interventions may also influence their well‐being. The Culture and Health project, based on complementary interventions with 270 clients, was created in a county in Sweden for clients with psychiatric disabilities and for professionals to carry out the interventions. The aim of this study was to investigate the professionals’ expectations regarding the project and their clients’ possibilities for participating, and to investigate the professionals’ experiences of the project after its completion. Focus group data with a total of 30 professionals participating were collected. A qualitative content analysis revealed four categories of the professionals’ expectations before entering the project: “Clients’ own possibilities and limitations for their development and independence”, “Professionals’ possibilities for supporting the clients”, “Societal prerequisites”, and “Expectations of a new way of working”. Furthermore, the analysis regarding professionals’ experiences after working with the project revealed three categories: “Adopting the challenges”, “Having ways of working that function – prerequisites and possibilities”, and “Meeting the future – an ambition to continue”. Conclusion: Working in the Culture and Health project together with the clients in group‐based activities was perceived as beneficial, although challenges arose. When implementing cultural activities, support from stakeholder organisations is needed. [ABSTRACT FROM AUTHOR]

The prevalence of autism in children with blindness is much higher than in the general population. There are many challenges regarding the school situation for children with this complex dual disability. This study explored challenges and successful strategies in school for a sample of six Swedish children with blindness and autism, with and without intellectual disability, through qualitative interviews with students, teachers and parents. All students displayed executive functioning deficits, and the teaching situation entailed several challenges. Our research points to the importance of adopting evidence-based practices for ASD, but adapted according to the students lack of vision. For this to be possible, close collaboration between teachers, parents and specialists in the field of visual impairment and autism is necessary. [ABSTRACT FROM AUTHOR]

Identifies the dimensions and progression of the interaction between bilingual/monolingual caregivers and bilingual demented Finnish immigrants using the Erikson theory of `eight stages of man.' Phenomenological-hermeneutic analysis of their interaction; Statistical analysis to compare communication in relation to support in patients' integrity.

The present study is an investigation of a daily activity centre (DA). The overall aim was to build a grounded theory that could explain why this particular DA deviated from the norms of Swedish group homes and DAs described in previous studies. These studies have suggested that the staff stuck to old routines, such as letting the participants fold laundry, set the table and clean the table. These routines did little to nothing to promote the skills necessary for participation in the society, such as reading and writing. Furthermore, I used visual ethnographic methods and interviews to capture the activities at the DA. My analysis showed how the staff and the participants at the DA were engaged in reading and writing activities, such as publishing articles, comics, broadcasting radio and web-TV. The main conclusion is that four factors facilitated participation: new technologies, IT competence, a culture of self-responsibility and autonomy/control. [ABSTRACT FROM AUTHOR]

Background: Restrictive measures (RM) are prevalent in services for people with intellectual disabilities. This study investigates managerial awareness of RM and the nature of organisational supports required to reduce their use. Method: A survey asked front‐line managers and staff what (RM) were used, their purpose, impact and importance (10‐item Likert scales) and what organisational changes were required (free text). Responses were analysed using descriptive methods and content analysis. Results: Managers reported a lower use of RM, compared with staff. According to managers, RM were mainly used to keep service users from harm, their use having a significant impact. Opportunities to change practices were limited by a lack of resources and organisational support. Conclusion: Front‐line managers seem to lack the capacity to address the use of RM due to organisational drift; limited manager time and opportunity to allocate resources; inadequate environments; and lack of skilled staff, knowledge and relevant professional input. [ABSTRACT FROM AUTHOR]

Knowledge about people with intellectual disability (ID) and their connections to the labor market is scarce. The aim of this study was to describe and analyze the entry into and representation in the Swedish labor market for people with ID, discussed with a special focus on the gender perspective. This study included 2,745 individuals (30% women and 70% men) who graduated from Swedish upper secondary schools for pupils with intellectual disability (USSID) in the 2000s, and who were defined as employees in 2011. Graduation data from 2001 to 2011 were analyzed in relation to employment data from 2011 and adjusted for gender, graduation year, and educational program. Results show that men who attended a national USSID program and graduated between 2001 and 2006 were the most likely group to have a job. The authors conclude that the gender differences in the Swedish labor market are more clearly pronounced among women and men with ID in relation to employment rate, wage levels, and professions than in the general population. Education, welfare-services, and interventions specifically targeted to meet the needs of people with ID have to develop in more gender-sensitive ways. [ABSTRACT FROM AUTHOR]

The article presents a study which explored the intersecting meanings of age, intellectual disability (ID), gender and sexuality used by different professionals. Topics discussed include findings on individuals with ID, the emergence of a change of behaviour among individuals with ID as a means of avoiding risk-taking behaviours, and power relations between groups with and without ID.

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]

Background There might be a need for support for families where the mother has an intellectual disability, in order to counteract the effects of potential parental inadequacy and other detrimental aspects of the family situation. The purpose of this study was to describe how professionals characterized such support and the collaboration required. Materials and methods Focus group interviews involving 29 professionals were conducted and analysed using content analysis. Results Five themes were identified: The roles and activities of the professionals involved; ways in which needs of support are identified; problems in identifying mothers with an intellectual disability; how professionals coordinate their support and work together; and the dilemma concerning legislative actions. Conclusions By identifying both fruitful and problematic aspects of professional support, the findings may be used to enhance future support. More efficient chains of information and improved inter-sector collaboration between professions may further enhance the support practices. [ABSTRACT FROM AUTHOR]

BackgroundMany people ageing with intellectual disabilities (ID) age in place in group homes. Participation is a central concept in support and service to people with ID, but age is often a determining factor for participation among this group. Choice and control are dimensions of participation.AimThe aim of this article is to explore how choice and control in the everyday life of people ageing with ID is expressed and performed in the group home’s semi-private spaces.Material and methodsParticipant observations and interviews with residents and staff were conducted in four different group homes in Sweden that had older residents.ResultsFour categories were found that can be understood as aspects of choice and control in the group home’s semi-private spaces in the everyday life of people ageing with ID. These categories included aspects such as space and object, time and routines, privacy, and a person-centred approach.Conclusion and significancePeople ageing with ID are vulnerable when it comes to maintaining choice and control in various situations in the home’s semi-private spaces. It is argued that occupational therapists should include this occupational arena in their evaluations and interventions for people ageing with ID. [ABSTRACT FROM PUBLISHER]

Background The number of older residents in group homes for people with intellectual disability (ID) is increasing. This interview study was focused on how group home staff address issues of ageing and being old among people with ID. Method Twelve members of staff at 4 different group homes in Sweden were interviewed. Results Findings revealed old age as something unarticulated in the group home. Group home staff felt unprepared to meet age-related changes in residents. The study also revealed that group home staff had a one-tracked way of describing the process of ageing among people with ID, which was seemingly rooted in a medical paradigm of disability. Conclusion Based on this study's findings, we suggest that there is a need to raise issues and give guidance related to ageing and ID in disability policy documents to support the development of a formal culture that addresses old age and ID in disability services. [ABSTRACT FROM AUTHOR]

Background: Preterm birth has been linked to increased risk of autism spectrum disorders (ASD), but how this risk changes with gestational age at birth has not been well characterised, especially with regard to co-occurring intellectual disability (ID).Methods: Register-based cohort study of singleton births in 1984-2007 in Stockholm County, Sweden (N total: 480 728; n ASD: 10 025). We assessed overall and sex-specific, gestational week-specific prevalence estimates and risk ratios of ASD with and without ID.Results: Preterm and postterm births were associated with elevated risk of ASD, and the relationship between gestational age at birth and ASD with and without ID differed in males and females. Risk of ASD without ID was higher in preterm births among both sexes and decreased continuously with increasing length of gestation. Risk of ASD with ID was higher in both preterm and postterm births among both sexes, with postterm birth in females being more highly associated with ASD with ID than that in males.Conclusions: The relationship between gestational age at birth and ASD differs by the presence/absence of co-occurring ID and fetal sex. Both preterm and postterm birth are associated with increased risk of ASD. Risk of ASD is not constant within conventionally defined gestational age at birth periods. Further research on mechanism underlying these associations is needed. [ABSTRACT FROM AUTHOR]

Importance: Maternal antidepressant medication use during pregnancy has previously been associated with adverse outcomes in offspring, but to our knowledge, the association with intellectual disability (ID) has not been investigated.Objectives: To examine the association of maternal antidepressant medication use during pregnancy with ID in offspring and investigate the importance of parental mental illness for such an association.Design, Setting, and Participants: A population-based cohort study of 179 007 children born from January 1, 2006, through December 31, 2007, with complete parental information from national registers who were followed up from birth throughout 2014.Main Outcomes and Measures: We estimated relative risks (RRs) and 95% CIs of ID in children exposed during pregnancy to any antidepressant medication or specifically to selective serotonin reuptake inhibitor (SSRI) antidepressants, all other non-SSRI antidepressants, or other nonantidepressant psychotropic medications. Analyses were adjusted for potential confounders. In addition to full population analyses, we used a subsample to compare mothers who used antidepressants during pregnancy with mothers who had at least one diagnosis of depression or anxiety before childbirth but did not use antidepressants during pregnancy.Results: Of the 179 007 children included in the study (mean [SD] age at end of follow-up, 7.9 [0.6] years; 92 133 [51.5%] male and 86 874 [48.5%] female), ID was diagnosed in 37 children (0.9%) exposed to antidepressants and in 819 children (0.5%) unexposed to antidepressants. With adjustment for potential confounders, the RR of ID after antidepressant exposure was estimated at 1.33 (95% CI, 0.90-1.98) in the full population sample and 1.64 (95% CI, 0.95-2.83) in the subsample of women with depression. Results from analyses of SSRI antidepressants, non-SSRI antidepressants, and nonantidepressant psychotropic medications and analyses in the clinically relevant subsample did not deviate from the full-sample results.Conclusions and Relevance: The unadjusted RR of ID was increased in offspring born to mothers treated with antidepressants during pregnancy. After adjustment for confounding factors, however, the current study did not find evidence of an association between ID and maternal antidepressant medication use during pregnancy. Instead, the association may be attributable to a mechanism integral to other factors, such as parental age and mother's psychiatric disorder. [ABSTRACT FROM AUTHOR]

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Background: Previous research suggests that female violent offenders at risk of a prison sentence are more likely than their male counterparts to be assessed as having mental health problems of a nature or degree that would lead to a court requirement for hospital treatment.Aims/hypotheses: To test the hypothesis that there is bias towards hospital disposal of female compared with male violent offenders with mental disorder.Methods: In Sweden, the National Board of Forensic Medicine oversees all assessments of mental disorder for the criminal courts. Twenty-six Board appointed forensic psychiatrists, psychologists and social workers each independently assessed six case vignettes for fit with criteria for 'severe mental disorder', a prerequisite for hospital disposal from court. Each gender neutral vignette described a person who had been convicted of serious assault and had a major mental disorder. A gender was then assigned to each offender randomly within a block design, thus varying between sets. Participants were blind to the main aim of the study and the gender variation.Results: There was no significant association between gender of the person assessed and judgement that s/he had a 'severe mental disorder'. An offender depicted as having mental retardation was more likely to be assessed as at high risk of criminal recidivism if portrayed as female, regardless of the sex, place of work or level of experience of the assessor.Conclusion: We found no evidence of gender bias in determining appropriateness of a hospital disposal of an offender with mental disorder. The difference in assessment of recidivism according to sex of the patient was only in relation to mental retardation; further research would be needed to able to interpret this. As researchers in other countries have reported gender bias in disposals from court, our findings may provide support for a centralised forensic psychiatric assessment board and formal, on-going training. Copyright © 2015 John Wiley & Sons, Ltd. [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]

Purpose: To describe daily time management in adults with and without mental disability and to examine differences in the level of their daily time management; to describe the possessions and use of electronic planning devices (EPDs) in activities and how environmental factors influence the use of EPDs in adults with mental disability. Methods: In a descriptive and cross-sectional design, 32 participants using EPDs and a matched comparison group of 32 healthy adults was recruited. Time-Self rating scale measuring daily time management was adapted for adults. A study specific questionnaire was applied to collect data on five ICF environmental factors. Rasch modelling, descriptive and non-parametric statistics were applied. Results: Time-S has acceptable psychometric properties for use on adults with mental disability. People with mental disability and low level of daily time management who use advanced EPDs are more influenced by environmental factors. The study group perceived that encouragement and support from professionals as well as services influence their use of EPDs. Conclusions: Time-S can safely be used for people with mental disability. EPDs do not fully compensate the needs of the target-group. Prescribers need to give considerations to this and therefore they should be provided with more knowledge about this matter. [ABSTRACT FROM AUTHOR]

The aim of the study was to follow up inter-professional experiences of improvement work one year after a completed CII improvement program aiming at improve health care and social services for people with mental disabilities living in ordinary housing. This study was performed with a qualitative descriptive approach which employed six focus group interviews followed by a thematic analysis. The results revealed four themes; Self-awareness and insights; Behavior and actions in daily practice; Organizational cultures and subcultures; and Organizational practices, using Ken Wilbers' integral theory of four quadrants of realities as a holistic frame in the discussion. [ABSTRACT FROM PUBLISHER]

The relationship with professionals is an important factor in relation to the outcome of interventions directed to persons with severe mental problems. However, the current knowledge regarding the development of helpful relationships within Individual Placement and Support (IPS) services is limited. The aim of the study was to investigate how participants in IPS services described their relationship with their IPS coach. The article is based on interviews from a Swedish government evaluation of IPS services, thematically analyzed. The results showed that the relationship with the coach is central for the participants’ success in the service. The main theme, “something different - as a human being” highlighted that the conditions for the relationship are different within IPS as compared to traditional services. The other themes were “here and now action,” “closer to wish-fulfilment – impact on the self,” and “from role to person.” The principles of IPS parallel the results from research about helpful relationships and offers good preconditions for the occurrence of such relationships. This can represent a bridge between evidence based methods and research on helpful relationships, and should be possible to implement in the development of evidence based methods as well as of treatment as usual. [ABSTRACT FROM AUTHOR]

Objective: Prenatal exposure to elemental mercury may be a potential hazard for the offspring of female dental personnel working with dental amalgam. The aim of this study was to investigate whether potential in utero exposure to mercury might have affected the development of nervous system of the sons of Swedish female dental personnel leading to an increased risk of neurological disease or intellectual disability. Material and methods: We used national Swedish registers to investigate risks for diseases potentially related to adverse effects on neurodevelopment. Sons of female dentists (n=1690) and dental nurses (n=10,420) were compared with cohorts consisting of sons of other female healthcare personnel. Due to changes in mercury exposure in dentistry during the study period, analyses were stratified by decade of birth. Hazard ratios (HRs) were calculated using Cox proportional hazard models. Results: We found no elevated risk for neurological disease, epilepsy or intellectual disability among the sons of dental personnel during any of the decades studied. HRs for neurological disease among the dental nurse cohort were even below 1.00 during the 1970s and 1980s. A low number of events resulted in uncertainty regarding results in the dentist cohort. Conclusions: We did not find any support for the hypothesis that mercury exposure in Swedish dentistry during the 1960s, 1970s or 1980s had any effect on the incidence of neurological disease or intellectual disability among the sons of female dental personnel. Our results imply that current use of dental amalgam should not represent an elevated risk for neurological disease or intellectual disability among the offspring of dental personnel. [ABSTRACT FROM AUTHOR]

The Swedish personal assistance system, facilitated through Swedish legislation (known as the LSS), allows children with profound intellectual and multiple disabilities (PIMD) to receive subsidized personal assistance. This assistance may be either a hired professional from outside the family or a parent paid as a personal assistant. The type of personal assistant can impact activity selection. As noted by bio-ecological systems theory, participation in 'systems' beyond the household is important for a child's cognitive and social development, including the development of children with disabilities. The authors explored whether children's personal assistant type (i.e., external or parental) is related to their presence in socially integrative activities (SIAs) versus non-socially integrative activities (NSIAs). The relationship between children's activity engagement and their personal assistant type was examined via a descriptive, comparative study based on a questionnaire. Sixty families answered, providing quantitative data about personal assistance type across 56 common family activities. Children's external assistants showed a greater presence in SIAs than children's parental assistants, who showed a greater presence in NSIAs. The level of activity engagement between personal assistant type, however, had a less direct relationship. In accordance with bio-ecological systems theory, activity selection can influence the child's cognitive and social development. Ultimately, this study suggests that external assistants partake in more SIAs than parental assistants, likely as a function of providing respite for families. This respite stems from the LSS's implicit role for external personal assistants to also serve as relief for parents. In turn, by facilitating exposure to broader systems, these external assistants can play a critical role in children's social and cognitive development. [ABSTRACT FROM AUTHOR]

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.

Background As physical activity can prevent overweight and promote general health, the aim was to investigate the amount of physical activity among adolescent and young adult women and men with intellectual disability (ID), compared to age-matched control groups without intellectual disability. A further aim was to examine whether physical activity level was associated with the body mass index (BMI). Materials and methods Fifty-two adolescent and young adult women and men with intellectual disability and 48 without intellectual disability, between the ages 16 and 20 years, BMIs ranging from 16.3 to 50.3 kg/m², were measured for number of steps taken with a pedometer for five consecutive days (Sunday-Thursday). Results The only group to meet recommendations regarding number of steps (10 000-12 000/day) was women without intellectual disability. No significant associations were found between total number of steps taken and BMI. Results The only group to meet recommendations regarding number of steps (10 000-12 000/day) was women without intellectual disability. No significant associations were found between total number of steps taken and BMI. [ABSTRACT FROM AUTHOR]

Articles 12 and 13 of the UN Convention on the Rights of Persons with Disabilities encourage modifications to member-country justice systems to ensure equal access to justice for people with disabilities. The article explores Swedish professionals' perceptions and experiences of the accessibility of the country's justice system to individuals with intellectual disability (ID) who are involved in prostitution and prostitution-like activities and have become victims of crime. Barriers to this accessibility, as well as the use of advocacy by, and cooperation between, professionals as ways to overcome them, are investigated. Thirteen open-themed, face-to-face interviews were conducted with 21 participants working for the police, public prosecutor's office, social services, and habilitation services. Participants described shortcomings in the implementation, and even lack, of access to the justice system for these individuals, including lack of clear policies and legislation that would take ID into account. Crime victims with ID, according to them, were frequently not considered as credible witnesses by the justice system and there was a need for alternative communication tools in court. Also, lack of knowledge about people with ID among other professionals was identified as a problem. The use of advocacy function and successful collaboration among relevant professionals were suggested as ways to improve accessibility. The findings indicate that the laws and directives to promote the access of people with ID to the Swedish justice system are poorly implemented in practice. To improve this access, better collaboration among professionals and more systematic use of them in an advocacy role to help and support persons with ID throughout the entire justice process are likely to be helpful. [ABSTRACT FROM AUTHOR]

This study compared the caring situation, health, self-efficacy, and stress of young (16–25) informal carers (YICs) supporting a family member with mental illness with that of YICs supporting a friend. A sample of 225 carers, assigned to a family group (n = 97) or a friend group (n = 128) completed the questionnaire. It was found that the family group experiences a lower level of support and friends experienced a lower positive value of caring. No other differences in health, general self-efficacy and stress were found. YICs endure different social situations, which is why further study of the needs of YICs, especially those supporting friends, is urgently needed. [ABSTRACT FROM AUTHOR]

In a record-linkage study in Stockholm, Sweden, the year 2011 prevalence of diagnosed autism spectrum disorders (ASD) was found to be 0.40, 1.74, 2.46, and 1.76 % among 0-5, 6-12, 13-17, and 18-27 year olds, respectively. The corresponding proportion of cases with a recorded diagnosis of intellectual disability was 17.4, 22.1, 26.1 and 29.4 %. Between 2001 and 2011, ASD prevalence increased almost 3.5 fold among children aged 2-17 years. The increase was mainly accounted for by an eightfold increase of ASD without intellectual disability (from 0.14 to 1.10 %), while the prevalence of ASD with intellectual disability increased only slightly (from 0.28 to 0.34 %). The increase in ASD prevalence is likely contributed to by extrinsic factors such as increased awareness and diagnostics. [ABSTRACT FROM AUTHOR]

Background Children with profound intellectual and multiple disabilities ( PIMD) demand intense family accommodations from birth and onwards. This study used an exploratory and qualitative study design to investigate stability and change in sustainability of daily routines and social networks of Swedish families of children with PIMD. Materials and methods Eight families participated over two years in eco-cultural family interviews and social networks interviews collected at home visits. Data were analyzed descriptively and by manifest contents analysis. Results Results showed variations in sustainability of daily routines over time across families. The sustainability was linked to fathers' involvement, couples' connectedness and emotional support. Stability and change of social networks were characterized by low overlap between the child and family networks, the children's communicative dependency and low density of able communication partners. Conclusions The results indicate that patterns of stability and change were linked both to family resources and child characteristics. [ABSTRACT FROM AUTHOR]

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]

Background Hypospadias (aberrant opening of the urethra on the underside of the penis) occurs in 1 per 300 newborn boys. It has been previously unknown whether this common malformation is associated with increased psychiatric morbidity later in life. Studies of individuals with hypospadias also provide an opportunity to examine whether difference in androgen signaling is related to neurodevelopmental disorders. To elucidate the mechanisms behind a possible association, we also studied psychiatric outcomes among brothers of the hypospadias patients. Methods Registry study within a national cohort of all 9,262 males with hypospadias and their 4,936 healthy brothers born in Sweden between 1973 and 2009. Patients with hypospadias and their brothers were matched with controls by year of birth and county. The following outcomes were evaluated (1) any psychiatric (2) psychotic, (3) mood, (4) anxiety, (5) eating, and (6) personality disorders, (7) substance misuse, (8) attention-deficit hyperactivity disorder (ADHD), (9) autism spectrum disorders (ASD), (10) intellectual disability, and (11) other behavioral/emotional disorders with onset in childhood. Results Patients with hypospadias were more likely to be diagnosed with intellectual disability (OR 3.2; 95% CI 2.8-3.8), ASD (1.4; 1.2-1.7), ADHD (1.5; 1.3-1.9), and behavioral/emotional disorders (1.4; 1.2-1.6) compared with the controls. Brothers of patients with hypospadias had an increased risk of ASD (1.6; 1.3-2.1) and other behavioral/emotional disorders with onset in childhood (1.2; 0.9-1.5) in comparison to siblings of healthy individuals. A slightly higher, although not statistically significant, risk was found for intellectual disability (1.3; 1.0-1.9). No relation between other psychiatric diagnosis and hypospadias was found. Conclusions This is the first study to identify an increased risk for neurodevelopmental disorders in patients with hypospadias, as well as an increased risk for ASD in their brothers, suggesting a common familial (genetic and/or environmental) liability. [ABSTRACT FROM AUTHOR]

The Christian Church, which—due to its message of God's grace towards all mankind—should be expected to lead the way in matters of humanity, seems to be stuck in a notion of normalcy; the kind of participation known by the church usually aims at a practice involving activities that require capacities not present among persons with severe disabilities. This study is about persons with intellectual disability and their experiences of participation in the Church of Sweden. The first section discusses the concept of participation. The second section is about participation and normalcy in the Church of Sweden and includes the stories of Eric, Unni, and David who all have an intellectual disability and want to belong to the People of the Faith. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

Background Fathers' interactions with children who have intellectual disabilities (ID) or developmental delays (DD) have increased over the past few decades and may be expected to continue to increase as maternal and paternal roles, along with other gender roles, become more equal. The aim of the present study was to explore fathers' experiences of parenthood in relation to a child with ID/DD from the initial discovery of the disability to 5 years later. Methods Fathers' experiences of parenting children with ID/DD were explored in a longitudinal framework. Seven Swedish fathers of young children with ID/DD participated in a series of semi-structured interviews from 2005 to 2010, and their accounts were subjected to interpretative phenomenological analysis. Results The analysis revealed three themes: (1) An interrupted path -- no longer taking things for granted, which describes the fathers' reactions to their children's diagnosis; (2) Being a good father, which describes the fathers' overall perceptions of their parenting of a child with ID/DD; and (3) Dealing with the unexpected, which describes fathers' individual ways of integrating, managing, and living with the knowledge of their child's disability over the 5 years during which fathers were interviewed. Conclusions Fathers' individual paths need to be taken into consideration when offering psychological support to families of children with ID/DD. [ABSTRACT FROM AUTHOR]

Background: Across several research studies comparing the individual placement and support (IPS) approach to traditional vocational services, the approach has achieved employment outcomes superior to comparison conditions. However, to understand the efficacy of IPS, it is equally important to consider what is more or less effective as viewed by the IPS participants. Aim: To investigate participants' experiences of IPS participation and their experiences of receiving support from an employment specialist (ES). Method: Interviews were conducted with 17 persons with severe mental illness. The interviews were subjected to qualitative content analysis. The principles of informed consent and the voluntary nature of participation were included as ethical considerations. Results: Participation in IPS was associated with hope, meaning and an individualized support provided by the ES. The skills of the ES facilitated the relationship with the participant and the contact with the labour market. However, to make a change happen, everybody involved in IPS had to contribute. Conclusion: These findings have endorsed the guiding principles of IPS and emphasized the ES's role and skills during IPS as well as the participant's motivation. [ABSTRACT FROM AUTHOR]