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Background Autologous haematopoietic stem cell transplantation (AHSCT) is increasingly used as a treatment for aggressive multiple sclerosis (MS) and has the potential to induce long-term remission and resolution of disease activity. Despite the extensive research on treatment outcome after AHSCT, the experience of living with MS after AHSCT has not been previously described in the scientific literature. The aim of this study was to explore long-term lived experience of people with MS treated with AHSCT. Methods and findings To exclude selection bias, all persons treated with AHSCT for MS at Uppsala University Hospital, Sweden, between 2004 and 2007 (n = 10), were asked to participate in the study, and all accepted. Open-ended interviews were conducted, digitally recorded, transcribed verbatim, and then subjected to qualitative content analysis with an inductive approach. Five main themes emerged from the interviews: (I) being diagnosed with MS–an unpredictable existence; (II) a new treatment–a possibility for a new life; (III) AHSCT–a transition; (IV) reclaiming life; and (V) a bright future accompanied by insecurity. AHSCT was described by the participants in terms of a second chance and an opportunity for a new life. The treatment became a transition from a state of illness to a state of health, enabling a previous profound uncertainty to wane and normality to be restored. Although participants of different age and sex were included, the main limitation of this study is the relatively small number of participants. Also, the inclusion of persons from one centre alone could restrict transferability of the results. Conclusions The results give a first insight into lived experience following a highly effective induction treatment for MS, and the experience of not having MS anymore. Underpinned by previously described outcome following AHSCT, the results of this study challenge the current view on MS as a chronic disease with no possible cure.

When someone falls ill with dementia it affects the whole family. Therefore, the aim of thisqualitative single case study was to increase understanding of one female spouse´s experiencesof living with a husband/partner diagnosed with early-onset dementia before the ageof 40 years. Two open-ended interviews with the female spouse were performed sixmonths apart and analysed for narrative structure and themes. The single case is describedin the form of a story and organised along a time line comprising four phases; «Somethingis wrong», «Becoming aware of what is wrong», «Life is restricted» and «Towards reconciliation».Healthcare professionals should meet spouses with respect, listen to them and providepractical support, thus giving them the opportunity to rest, obtain respite and time ontheir own to enable reconciliation and wellbeing.

Elucidating patients´ experiences of living with chronic progressive hereditary ataxia and the symptomatic treatment with intrathecal baclofen (ITB) is the objective of the current study. A multicenter qualitative study with four patients included due to the rare combination of hereditary ataxia and ITB therapy was designed to elucidate participants' experiences through semi-structured interviews. The transcribed text was analyzed according to content analysis guidelines. Overall we identified living in the present/ taking one day at a time as the main theme covering the following categories: 1) Uncertainty about the future as a consequence of living with a hereditary disease; The disease; 2) Impact on life as a whole, 3) Influence on personal life in terms of feeling forced to terminate employment, 4) Limiting daily activities, and 5) ITB therapy, advantages, and disadvantages. Uncertainty about the future was the category that affected participants' personal life, employment, and daily activities. The participants' experience of receiving ITB therapy was expressed in terms of improved quality of life due to better body position and movement as well as better sleep and pain relief.

Elucidating patients A experiences of living with chronic progressive hereditary ataxia and the symptomatic treatment with intrathecal baclofen (ITB) is the objective of the current study. A multicenter qualitative study with four patients included due to the rare combination of hereditary ataxia and ITB therapy was designed to elucidate participants experiences through semi-structured interviews. The transcribed text was analyzed according to content analysis guidelines. Overall we identified living in the present/taking one day at a time as the main theme covering the following categories: 1) Uncertainty about the future as a consequence of living with a hereditary disease; The disease; 2) Impact on life as a whole, 3) Influence on personal life in terms of feeling forced to terminate employment, 4) Limiting daily activities, and 5) ITB therapy, advantages, and disadvantages. Uncertainty about the future was the category that affected participants personal life, employment, and daily activities. The participants experience of receiving ITB therapy was expressed in terms of improved quality of life due to better body position and movement as well as better sleep and pain relief.

OBJECTIVE: Parents with epilepsy can be concerned about the consequences of epilepsy affecting their children. The aim of this paper is to describe aspects of what it means being a parent having epilepsy, focusing the parents' perspectives and their thoughts on having children. METHODS: Fourteen adults aged 18-35 years with epilepsy and subjective memory decline took part in focus-group interviews. The interviews were conducted according to a semi-structured guideline. Material containing aspects of parenthood was extracted from the original interviews and a secondary analysis was done according to a content-analysis guideline. Interviews with two parents for the Swedish book Leva med epilepsi [To live with epilepsy] by AM Landtblom (Stockholm: Bilda ide; 2009) were analyzed according to the same method. RESULTS: Four themes emerged: (1) a persistent feeling of insecurity, since a seizure can occur at any time and the child could be hurt; (2) a feeling of inadequacy - of not being able to take full responsibility for one's child; (3) acknowledgment that one's children are forced to take more responsibility than other children do; and (4) a feeling of guilt - of not being able to fulfill one's expectations of being the parent one would like to be. CONCLUSION: The parents with epilepsy are deeply concerned about how epilepsy affects the lives of their children. These parents are always aware that a seizure may occur and reflect on how this can affect their child. They try to foresee possible dangerous situations and prevent them. These parents were sad that they could not always take full responsibility for their child and could not live up to their own expectations of parenthood. Supportive programs may be of importance since fear for the safety of the child increases the psychosocial burden of epilepsy. There were also a few parents who did not acknowledge the safety issue of their child - the authors believe that it is important to identify these parents and provid

Objective: Parents with epilepsy can be concerned about the consequences of epilepsy affecting their children. The aim of this paper is to describe aspects of what it means being a parent having epilepsy, focusing the parents perspectives and their thoughts on having children. Methods: Fourteen adults aged 18-35 years with epilepsy and subjective memory decline took part in focus-group interviews. The interviews were conducted according to a semi-structured guideline. Material containing aspects of parenthood was extracted from the original interviews and a secondary analysis was done according to a content-analysis guideline. Interviews with two parents for the Swedish book Leva med epilepsi [To live with epilepsy] by AM Landtblom (Stockholm: Bilda ide; 2009) were analyzed according to the same method. Results: Four themes emerged: (1) a persistent feeling of insecurity, since a seizure can occur at any time and the child could be hurt; (2) a feeling of inadequacy - of not being able to take full responsibility for ones child; (3) acknowledgment that ones children are forced to take more responsibility than other children do; and (4) a feeling of guilt - of not being able to fulfill ones expectations of being the parent one would like to be. Conclusion: The parents with epilepsy are deeply concerned about how epilepsy affects the lives of their children. These parents are always aware that a seizure may occur and reflect on how this can affect their child. They try to foresee possible dangerous situations and prevent them. These parents were sad that they could not always take full responsibility for their child and could not live up to their own expectations of parenthood. Supportive programs may be of importance since fear for the safety of the child increases the psychosocial burden of epilepsy. There were also a few parents who did not acknowledge the safety issue of their child - the authors believe that it is important to identify these parents and provide ex, Funding Agencies|Cyberonics; Eisai; GlaxoSmithKline; Grunenthal; UCB

In Sweden, reforms in health and social care for older people were impplemented in 1992 (Ädelreformen) and provided older people with the opportunity to be cared for in their own homes, under the responsibility of the local municipality. Most of the older people choose to live in their own home or in sheltered housing, a so-called special housing, for rest of their lives and are able to recieve extensive nursing care, including palliative care. Thus, palliative care has shifted from care at hospitals to care in own homes or special housing, which has increased the demands placed on nursing staff. The aim of this study was to elucidate the meanings the nursing staff expressed as regards caring for older persons in special housing in a palliative stage. Qualitative interviews with eight assistant nurses were performed. The inter-views were recorded, transcribed verbatim and analysed using qualitative content analysis. To care for an old person in the palliative stage means "Caring for a friend", "Creating a calm and peaceful death", "Giving support to relatives" and "Alternating between feelings of powerlessness and satisfaction". When an old person died, the assistant nurse mourned him or her as the would a friend. Amongst the colleguages, the assistant nurses experienced a sense of security, which meant openness and the courage to discuss and reflect upon their feelings, both during the care and after the death. Despite this there was a need for more time to grieve after the death.

Helena Gauffin,1 Gullvi Flensner,2 Anne-Marie Landtblom1,3 1Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; 2Department of Nursing, Health and Culture, University West, Trollhättan, Sweden; 3Department of Neuroscience, Uppsala University, Uppsala, Sweden Objective: Parents with epilepsy can be concerned about the consequences of epilepsy affecting their children. The aim of this paper is to describe aspects of what it means being a parent having epilepsy, focusing the parents’ perspectives and their thoughts on having children.Methods: Fourteen adults aged 18–35 years with epilepsy and subjective memory decline took part in focus-group interviews. The interviews were conducted according to a semi-structured guideline. Material containing aspects of parenthood was extracted from the original interviews and a secondary analysis was done according to a content-analysis guideline. Interviews with two parents for the Swedish book Leva med epilepsi [To live with epilepsy] by AM Landtblom (Stockholm: Bilda ide; 2009) were analyzed according to the same method.Results: Four themes emerged: (1) a persistent feeling of insecurity, since a seizure can occur at any time and the child could be hurt; (2) a feeling of inadequacy – of not being able to take full responsibility for one’s child; (3) acknowledgment that one’s children are forced to take more responsibility than other children do; and (4) a feeling of guilt – of not being able to fulfill one’s expectations of being the parent one would like to be.Conclusion: The parents with epilepsy are deeply concerned about how epilepsy affects the lives of their children. These parents are always aware that a seizure may occur and reflect on how this can affect their child. They try to foresee possible dangerous situations and prevent them. These parents were sad tha

BACKGROUND: The aim was to explore the thalamo-striato-cortical theory of central fatigue in multiple sclerosis (MS) patients with self-reported fatigue. If the theory correctly predicted fatigue based on disruptions of the thalamo-striato-cortical network, we expected altered brain activation in this network in MS participants while performing a complex cognitive task that challenged fatigue. METHODS: MS participants with self-reported fatigue were examined by functional magnetic resonance imaging (fMRI) during the performance of a complex working memory task. In this task, cognitive effort was challenged by a parametric design, which modeled the cerebral responses at increasing cognitive demands. In order to explore the theory of central fatigue in MS we also analyzed the cerebral responses by adding perceived fatigue scores as covariates in the analysis and by calculating the functional connectivity between regions in the thalamo-striatocortical network. The main findings were that MS participants elicited altered brain responses in the thalamo-striato-cortical network, and that brain activation in the left posterior parietal cortex and the right substantia nigra was positively correlated to perceived fatigue ratings. MS participants had stronger cortical-to-cortical and subcortical-to-subcortical connections, whereas they had weaker cortical-to-subcortical connections. CONCLUSIONS: The findings of the present study indicate that the thalamo-striato-cortical network is involved in the pathophysiology of fatigue in MS, and provide support for the theory of central fatigue. However, due to the limited number of participants and the somewhat heterogeneous sample of MS participants, these results have to be regarded as tentative, though they might serve as a basis for future studies.

BACKGROUND: Among individuals diagnosed with the chronic neurologic disease, multiple sclerosis (MS), a majority suffers from fatigue, which strongly influences their every-day-life. The aim of this study was to investigate work capacity and health-related quality of life (HRQoL) in a group of MS patients and also to investigate if work capacity and HRQoL could be predicted by background factors, fatigue, heat sensitivity, cognitive dysfunction, emotional distress or degree of disability. METHODS: A descriptive, cross-sectional, designed survey was undertaken A questionnaire was sent to 323 individuals diagnosed with MS, aged between 20 and 65 years, with physical disability on the expanded disability status score (EDSS) in the interval 0 ≥ EDSS ≤ 6.5, living in Östergötland county in eastern Sweden. Questions on background factors, occupation and work, together with the health-related quality of life short form instrument (SF-36), the fatigue severity scale (FSS), the perceived deficit questionnaire (PDQ) and the hospital anxiety depression scale (HAD) were posed. Associations between variables were analyzed using Pearson's and Spearman's correlations. Differences between groups were tested using the Chi-square test, the Mann Whitney U-test, and the Student's t-test. Predictive factors were analyzed using multiple linear and multiple logistic regression analysis. RESULTS: Of those who completed the questionnaire (n = 257, 79.6%), 59.8% were working. Work capacity was found significantly more among men (p < 0.005), those with a higher level of education (p < 0.001), those reporting less fatigue (p < 0.001), and those having no heat sensitivity (p = 0.004). For work capacity, significant predictors were low physical disability (EDSS), low fatigue, higher level of education, male sex and lower age. Those with work capacity showed significantly higher HRQoL than those who had no work capacity (p < 0.001). Levels of fatigue, cognition and emotional distress

ACCESSIBLE SUMMARY: • All patients cared for in Forensic Psychiatric Care (FPC) have some kind of psychiatric disorder and most of them have committed one or more criminal acts. In addition, several of the patients have alcohol and drug problems. • During the stay in institutional FPC, one part of the rehabilitation program is to prepare the patient for non-institutional FPC. However, several patients fail with the rehabilitation. • This study focuses important aspects that influence the patients' ability to manage their rehabilitation through admission to non-institutional FPC, viewed from different caregivers' perspective. • The transition is influenced by a well-planned care plan, together with a suitable non-institutional dwelling and a tailored occupation. A major barrier for successful admission was whether the patients managed their own finances or not. Other important areas were having a well-functioning and trusting social network and a good relationship with a contact person. ABSTRACT: All patients cared for in forensic psychiatric care (FPC) have some kind of psychiatric disorder and most of them have committed one or more criminal acts. One part of the patient's rehabilitation is the transition from institutional to non-institutional FPC, but a number of patients do not succeed. The aim of this study was to elucidate different caregivers' experiences of aspects that influence the patients' ability to manage this rehabilitation. A qualitative approach was chosen. Data were collected by interviews in two focus groups, each group comprising of six caregivers representing both institutional and non-institutional FPC. The transcribed interviews were analysed using a qualitative content analysis. Important aspects influencing the patients' transition described were a well-planned care plan, together with a suitable non-institutional dwelling and a tailored occupation. Other important areas were having a well-functioning and trusting social network and a go

Background: Many individuals diagnosed with Multiple Sclerosis (MS) are sensitive to increased body temperature, which has been recognized as correlating with the symptom of fatigue. The need to explore this association has been highlighted. The aim of this study was to investigate the occurrence of heat sensitivity and its relations to disease course, disability, common MS-related symptoms and ongoing immunosuppressive treatments among individuals 65 years of age or younger diagnosed with MS. Methods: A cross-sectional designed survey was undertaken. A questionnaire was sent to MS-patients with an Expanded Disability Status Score (EDSS) in the interval of 0-6.5 and who were between 20 and 65 years of age, living in an eastern region of Sweden (n = 334). Besides occurrence of heat sensitivity (Yes/No) and corresponding questions, the Fatigue Severity Scale (FSS), the MS-related symptom checklist and the Perceived Deficit Questionnaire (PDQ) were included. Data were analysed in relation to data level using Chi-square, Mann Whitney U-test, and Students t-test. Pearsons and Spearmans correlations were calculated. In the logistic regression analyses (enter) dichotomized MS-symptoms were used as dependent variables, and EDSS, disease-course, time since onset, heat-sensitivity, age and sex (female/male) were independent variables. In the linear regression analyses, enter, mean FSS and summarized PDQ were entered as dependent variables and EDSS, disease-course, time since onset, heat sensitivity, age and sex (female/male) were independent variables. Results: Of the responding patients (n = 256), 58% reported heat sensitivity. The regression analyses revealed heat sensitivity as a significant factor relating not only to fatigue (p andlt; 0.001), but also to several other common MS symptoms such as pain (p andlt; 0.001), concentration difficulties (p andlt; 0.001), and urination urgency (p = 0.009). Conclusions: Heat sensitivity in MS patients is a key symptom that is highly, Original Publication: Gullvi Flensner, Anna-Christina Ek, Olle Soderhamn and Anne-Marie Landtblom, Sensitivity to heat in MS patients: a factor strongly influencing symptomology - an explorative survey, 2011, BMC NEUROLOGY, (11), 27. http://dx.doi.org/10.1186/1471-2377-11-27 Licensee: BioMed Central http://www.biomedcentral.com

Despite recent advances in therapy and diagnosis, fatigue remains a mayor challenge in multiple sclerosis (MS). To further the understanding of the neural underpinnings of fatigue, we undertook a study using functional magnetic resonance imaging (fMRI) to investigate neural networks that may be affected by MS-related fatigue. Twelve MS patients and 12 age- and sex matched controls were administered the Fatigue Impact Scale (FIS) to assess clinically significant fatigue, and underwent a neuropsychological examination. The participants performed a working memory task (Daneman’s ‘Reading Span’ task) while being monitored by means of a 1.5 T Philips Achieva MR scanner. We have previously shown that this task triggers an executive network comprising frontal and parietal areas typically involved in working memory. In addition, the task engages a core network involving the anterior insula and the anterior cingulate cortex. This latter network may be implicated in allocation of mental resources and monitoring of the present state of the individual. There were two main findings. MS participants evidenced less activation than controls in the anterior cingulate and the left parietal cortex (Brodmann area 7) and more activation in left hemisphere language areas as well as the anterior insula. The second main finding was that clinical ratings of fatigue were strongly correlated with activity in wide areas of the core network, as well as posterior language areas. We take this finding to indicate that fatigue is related to compensatory involvement of the core network, and that excess activity in the core network possibly could be used as an objective marker of fatigue in MS.

Purpose: The purpose of this study was to investigate if patients with multiple sclerosis (MS) and fatigue have aberrant brain activation in the anterior insular cortex (AIC) and the anterior cingulate cortex (ACC), which are regions in the brain that are suggested to be a core network for cognitive control (Cole and Schneider, 2007; Sridharan et al., 2008). Materials and Methods: Twelve patients with MS and eleven healthy controls were examined with functional Magnetic Resonance Imaging (fMRI) while performing a complex working memory task. The task was to indicate if words presented in video goggles had appeared in previously presented sentences. Axial blood oxygen level dependent (BOLD) images were analyzed with SPM8 software. Images were realigned for movement correction, normalised to standard brain template, and smoothed with 8mm Gaussian kernel. We used a parametric contrast that tapped brain activation as a function of difficulty level of the task, i.e. words presented after 1, 2, 3, or 4 consecutive sentences. Results: Healthy controls elicited more activation in the left superior parietal lobe (p<0.001 family wise error (FWE) corrected for multiple comparisons), the right caudate head (p=0.002), and ACC (p=0.004) compared to MS patients. The MS patients had more activity in the left and right inferior parietal lobe (p=0.001 and p=0.029, respectively). In addition, in a region of interest analysis the MS patients had more activation in the left dorsal and ventral AIC (p=0.011 and p=0.009, respectively). The figure shows brain activation at working memory across both healthy controls and MS. Conclusion: MS patients elicited, as predicted, aberrant activation in the AIC-ACC network in that they had activation depletion in ACC and increased activity in the left AIC. It has recently been proposed that the AIC engenders awareness and the ACC engenders volitional action (Craig, 2009). The abnormal activation in this region could therefore explain the frequen

OBJECTIVE: to describe obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth. DESIGN: a qualitative study using a phenomenological approach. Data were collected by means of interviews that were tape-recorded. SETTING: the women's homes or at a hospital in western Sweden. PARTICIPANTS: 10 women with body mass index >30, three primiparous and seven multiparous, who had given birth at a hospital in western Sweden in the period between October 2006 and September 2007 were interviewed four to six weeks after childbirth. FINDINGS: the meaning of being both obese and pregnant is living with a constant awareness of the body, and its constant exposure to the close observation and scrutiny of others. It involves negative emotions and experiences of discomfort. Feelings of discomfort increase as a result of humiliating treatment, whilst affirmative encounters alleviate discomfort and provide a sense of wellbeing. CONCLUSION AND IMPLICATIONS FOR PRACTICE: obese pregnant women are a vulnerable group because obesity is highly visible. Caregivers tend to focus on providing care to obese patients somatically, but are additionally in need of knowledge about care from the woman's point of view. Many obese women have negative experiences of health care that they have to overcome. It is necessary to individualise care for obese pregnant women, which involves taking time to give the women an opportunity to tell their own story. Caregivers have to promote health but it has to be done honestly and respectfully. In order to avoid judgemental attitudes and causing increased suffering for obese pregnant women, midwives and physicians need to be conscious of, reflect upon and verbalise their own attitudes and power., Available online 19 December 2008

Aim: To evaluate quality of websites containing health information about heart attack in the Swedish language, accessible via one common used search engine available to the general public. Background: Increasingly, information about different health problems is sought on the Internet. From a layman perspective, such information can be hard to find, to understand and to trust. Health care professionals should be able to inform and teach the individual safe ways of finding health information of good quality on the Internet, which involves assessments of the websites. Methods: In one common used search engine, the Google, one search was performed during February 2006. Seventy websites were evaluated using one or all the European Union (EU) quality criteria. Findings: No website met all the criteria, but websites found on the search engines first search pages, met the criteria in the best way. Those websites were primarily aimed at mediating health information to the general public provided by government authorities, county councils, universities and companies. Conclusions: Ethnic minority groups, and individuals with low literacy skills/or visual impairments, may have difficulties finding suitable information. The EU quality criteria need to be refined in order to better assess the quality on different kind of websites.

Objective: Patient education plays an important role in the management of chronic diseases that can cause disability and predictable psychosocial problems. Quality of life assessment in multiple sclerosis (MS) has confi rmed that psychosocial complications related to working life, marriage/partnership, and the family often occur. Furthermore, symptoms such as fatigue, pain, and sexual dysfunction have a great impact. We wanted to develop and implement study circles to promote the patients- abilities to meet such common problems and to provide a network where they can be autonomous and develop appropriate strategies in self-care and existential problems. Methods: Together with the MS patient organization and a study association, we have arranged study circles for patients with MS, thus providing structured information according to a pedagogic model. The patients are encouraged to work together in groups to learn about the disease and its key symptoms, to develop strategies to master these symptoms in everyday life, and to make necessary changes, ie, self-care management. The programme also contains handicap policies. Results: Fifteen study circles with a total of 105 patients started during the fi rst year. Fifteen circle leaders were approved. A focus interview showed that the patients are highly satisfi ed but also revealed some problems in interactions with health care professionals. The study circles were included in a wider project from a newly started multidisciplinary centre for health education for a variety of chronic diseases causing disability, which aims at becoming a regional interface between the health care system, patient organizations, and educational services. Conclusion: The study circles have an important role to play in the management of MS. Good organization is required to make such a project work since health care services do not normally work so closely with patient organizations and educational services. Practice implications: Study circles t

Anne-Marie Landtblom1,2, Cecilia Lang1, Gullvi Flensner3,41Motala General Hospital, Motala, Sweden; 2Department of Clinical and Experimental Medicine, Division of Neurology; 3Department of Medicine and Care, Division of Nursing Science, University of Linköping, Sweden; 4Department of Nursing, Health and Culture, University West, Trollhättan, SwedenObjective: Patient education plays an important role in the management of chronic diseases that can cause disability and predictable psychosocial problems. Quality of life assessment in multiple sclerosis (MS) has confirmed that psychosocial complications related to working life, marriage/partnership, and the family often occur. Furthermore, symptoms such as fatigue, pain, and sexual dysfunction have a great impact. We wanted to develop and implement study circles to promote the patients’ abilities to meet such common problems and to provide a network where they can be autonomous and develop appropriate strategies in self-care and existential problems.Methods: Together with the MS patient organization and a study association, we have arranged study circles for patients with MS, thus providing structured information according to a pedagogic model. The patients are encouraged to work together in groups to learn about the disease and its key symptoms, to develop strategies to master these symptoms in everyday life, and to make necessary changes, ie, self-care management. The programme also contains handicap policies.Results: Fifteen study circles with a total of 105 patients started during the first year. Fifteen circle leaders were approved. A focus interview showed that the patients are highly satisfied but also revealed some problems in interactions with health care professionals. The study circles were included in a wider project from a newly started multidisciplinary centre for health education for a variety of chronic diseases causing disability, which aims at becoming a regional interface be

Objective: Patient education plays an important role in the management of chronic diseases that can cause disability and predictable psychosocial problems. Quality of life assessment in multiple sclerosis (MS) has confirmed that psychosocial complications related to working life, marriage/partnership, and the family often occur. Furthermore, symptoms such as fatigue, pain, and sexual dysfunction have a great impact. We wanted to develop and implement study circles to promote the patients’ abilities to meet such common problems and to provide a network where they can be autonomous and develop appropriate strategies in self-care and existential problems. Methods: Together with the MS patient organization and a study association, we have arranged study circles for patients with MS, thus providing structured information according to a pedagogic model. The patients are encouraged to work together in groups to learn about the disease and its key symptoms, to develop strategies to master these symptoms in everyday life, and to make necessary changes, ie, self-care management. The programme also contains handicap policies. Results: Fifteen study circles with a total of 105 patients started during the first year. Fifteen circle leaders were approved. A focus interview showed that the patients are highly satisfied but also revealed some problems in interactions with health care professionals. The study circles were included in a wider project from a newly started multidisciplinary centre for health education for a variety of chronic diseases causing disability, which aims at becoming a regional interface between the health care system, patient organizations, and educational services. Conclusion: The study circles have an important role to play in the management of MS. Good organization is required to make such a project work since health care services do not normally work so closely with patient organizations and educational services. Practice implications: Study circles that

Increasingly people use the Internet to find health-related information. However, to obtain information of good quality there may be obstacles. The aim of this literature review was to gain knowledge about use of the Internet in developing health related knowledge. Two questions were posted: What factors can be obstacles in understanding health-related information on the Internet? What effects can health related information obtained from the Internet have for the user? In a systematic search in CINAHL and Pubmed, and a systematic review of two specific journals from the years 2000 to 2004, 14 scientific articles were found. Use of the Internet is related to the individual’s age, socio-economical factors, ethnicity, and health. Information obtained from the Internet may influence the patient-caregiver relation, as well as the individual’s sense of security and independence. There are learning needs for the individual in how to use the Internet and needs for improvement of the search-engines and websites