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Augmentative and alternative communication (AAC) is recommended to be included in communication interventions directed at children/youth with severe/profound intellectual and multiple disabilities (S/PIMD). Even so, the evidence base for AAC practices with children with S/PIMD is limited. Also, little is known about how frequently AAC is implemented with this target group, which AAC tools and methods are applied, and the related clinical reasoning of speech-language pathologists (SLPs). This study aimed to explore SLPs’ beliefs, clinical reasoning and practices in relation to AAC implementation with children/youth with S/PIMD. In this sequential, mixed-methods study, 90 SLPs working with children with disabilities within habilitation services in Sweden participated in an online survey. The survey answers were statistically analysed. Subsequently, focus group data were collected from seven SLPs and analysed using thematic analysis. Despite AAC being highly prioritized, SLPs found it challenging and complex to implement with this target group. A wide variety of AAC methods and tools were considered and implemented. Clinical decision-making was a balancing act between competing considerations and was mainly guided by the SLPs’ individual, clinical experiences. The resources, engagement and wishes of the social network surrounding the child were considered crucial for clinical decision-making on AAC. Implications for research and practice are discussed.Implications for rehabilitationSpeech-language pathologists (SLPs) seemingly find a wide variety of Augmentative and Alternative Communication (AAC), ranging from unaided methods to assistive technology of various complexity, to be potentially suitable for children/youth with severe/profound intellectual and multiple disabilities (S/PIMD).The motivation and preferences of the social network surrounding the child with S/PIMD seem to influence SLPs’ clinical decision-making on AAC to a high degree. Sometimes this may be considered an even more important factor than the abilities of the child.SLPs’ clinical decision-making on AAC for children/youth is guided by their individual, clinical experience to a high degree.An increase in family oriented AAC intervention research targeting individuals with S/PIMD could potentially strengthen the association between research and the current, experience-based clinical practice. Speech-language pathologists (SLPs) seemingly find a wide variety of Augmentative and Alternative Communication (AAC), ranging from unaided methods to assistive technology of various complexity, to be potentially suitable for children/youth with severe/profound intellectual and multiple disabilities (S/PIMD). The motivation and preferences of the social network surrounding the child with S/PIMD seem to influence SLPs’ clinical decision-making on AAC to a high degree. Sometimes this may be considered an even more important factor than the abilities of the child. SLPs’ clinical decision-making on AAC for children/youth is guided by their individual, clinical experience to a high degree. An increase in family oriented AAC intervention research targeting individuals with S/PIMD could potentially strengthen the association between research and the current, experience-based clinical practice.

The aim of this study was to describe behavioral strengths and difficulties in relation to intellectual function and age in boys with DMD. In a cross-sectional design, 70 boys with DMD were tested at 5, 8, 11, and 14 years of age (mean age 10y 5 m). Parental ratings of behavioral strengths and difficulties were studied in relation to age, intellectual function, motor function, and family socioeconomic status (SES). Results show a significant relation between behavioral strengths and difficulties and age with parents rating increasingly more difficulties (slightly higher, higher and very high) from 5 years (11.1%) to 9 years (30.8%) and 11 years (78.9%) of age and then fewer difficulties at 14 years (50%) of age. Working Memory Index (WMI) explained significant variance in SDQ-Total-Score (17.5%) and SDQ-Impact-Score (11.2%). WMI together with upper motor function explained 19.5% variance in SDQ-Hyperactivity and 19.7% in SDQ-Peer-Problems. Age and SES explained an 18.9% variance in SDQ-Emotional-Problems. Age is an important factor when analyzing behavioral strengths and difficulties for boys with DMD. The development of boys with DMD needs to be understood in the context of expected developmental trajectory as well as in the decline of psychical functioning. Our study supports that age, cognition, motor function, and family SES all contribute to how behavioral strengths and difficulties evolves in boys with DMD.

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

Atmospheric concentrations of carbon dioxide (CO2) and ozone (O3) have steadily increased since the industrial revolution. CO2 and O3 directly affect plant physiology, CO2 being an essential substrate for photosynthesis, while O3 is an oxidative agent causing damage to plant tissues. Due to strong concerns for future food security, effects on crop production are of particular interest. Wheat is a major food crop globally, being the second most important energy source. Accordingly, the overall aim of this thesis was to explore the general effects of elevated CO2 and O3 on wheat crops. CO2 and O3 impacts on wheat crops were systematically reviewed, using meta-analysis to estimate average effects, and deriving response functions to assess the effect size in relation to the concentration of either CO2 or O3. The underlying effects of O3 on grain nutrients was further explored in three experimental studies. Wheat yield increased by 25% on average under elevated CO2, but there was no further yield stimulation above 600 ppm. Elevated CO2 decreased grain protein concentration by 8% on average, but the effect was overestimated in pot grown plants. There was also a CO2-induced reduction in concentration of other grain nutrients, where CO2 effects on Fe and S were strongly correlated to the effects on protein but showed no relationship with grain yield stimulation. O3-induced reductions in wheat grain yield was shown to be mainly due to a decrease in grain mass, while grain number was only reduced to a small extent. Grain starch concentration was significantly reduced under O3 exposure, making starch yield the wheat yield variable most strongly affected by O3. O3 enhanced concentrations but strongly reduced the yield of important wheat grain nutrients such as protein, P, Mg, K, Ca, Zn and Mg. Both concentration and yield of Cd were reduced by O3. A comparison among our most important staple crops showed that O3 promoted a larger protein yield loss in soybean compared to rice and wheat. O3 reduced harvest index (HI) for most nutrient elements, but also for Cd, while the total element pool in aboveground biomass was unaffected (except for P). Consequently, the O3-induced reduction in grain element yield can be explained by lower remobilization rates rather than reduced uptake. There was a strong correlation of element HI when comparing sites and cultivars, indicating that it is primarily element specific and not strongly dependent on growing environment and genotypic differences. An experiment testing the interaction between O3, heat and drought stress showed that O3 effects on light saturated photosynthesis, grain mass and several grain nutrient concentrations were reduced under drought. Grain concentrations of protein, Ca and Zn were closely linked to grain yield regardless of O3, heat and drought stress. The significant impacts on wheat yield and grain quality suggest that there is a need to incorporate the influence of both CO2 and O3 in assessments of current and future global food security, but also account for the modifying effect of soil moisture.

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

Data from experiments where field-grown wheat was exposed to ozone were collated in order to compare the effects in Europe, Asia and North America using dose-response regression. In addition to grain yield, average grain mass and harvest index were included to reflect the influence of ozone on the crop growth pattern. In order to include as many experiments as possible, daytime average ozone concentration was used as the ozone exposure index, but AOT40, estimated from average ozone concentrations, was also used to compare the performance of the two exposure metrics. The response to ozone differed significantly between the continents only for grain yield when using AOT40 as the exposure index. North American wheat was less sensitive than European and Asian that responded similarly. The variation in responses across all three continents was smallest for harvest index, followed by grain mass and grain yield. The highly consistent effect on harvest index shows that not only effects on biomass accumulation, but also on the partitioning of biomass, are important for the ozone-induced grain yield loss in wheat. The average duration of daily ozone exposure was longer in European experiments compared to North American and Asian. It cannot be excluded that this contributed to the indicated higher ozone sensitivity in European wheat in relation to North American. The main conclusions from this study are that on the average the response of wheat to ozone was lower for the older North American experiments and that the ozone response of the growth pattern reflected by grain mass and harvest index did not differ between continents.

Elevated CO2 (eCO2 ) generally promotes increased grain yield (GY) and decreased grain protein concentration (GPC), but the extent to which these effects depend on the magnitude of fertilization remains unclear. We collected data on the eCO2 responses of GY, GPC and grain protein yield and their relationships with nitrogen (N) application rates across experimental data covering 11 field grown wheat (Triticum aestivum) cultivars studied in eight countries on four continents. The eCO2 -induced stimulation of GY increased with N application rates up to ~200 kg/ha. At higher N application, stimulation of GY by eCO2 stagnated or even declined. This was valid both when the yield stimulation was expressed as the total effect and using per ppm CO2 scaling. GPC was decreased by on average 7% under eCO2 and the magnitude of this effect did not depend on N application rate. The net effect of responses on GY and protein concentration was that eCO2 typically increased and decreased grain protein yield at N application rates below and above ~100 kg/ha respectively. We conclude that a negative effect on wheat GPC seems inevitable under eCO2 and that substantial N application rates may be required to sustain wheat protein yields in a world with rising CO2 .

A central topic of recent research in ground-level ozone (O3) effects on plants is the shift from exposure based on concentrations to a physiologically more realistic approach based on O3 uptake. Critical test of the evidence for the benefits of the latter approach is of utmost importance for the development of O3 risk assessment. We explored the variability in O3 sensitivity in the wheat response function used for risk assessment by the Convention on Long-Range Transport of Air Pollution (LRTAP). The variation in O3 sensitivity among individual experiments was a factor of six larger when using the concentration-based index AOT40 compared to stomatal O3 uptake based Phytotoxic Ozone Dose (POD). Thus, consideration of environmental variables affecting stomatal conductance, such as solar radiation, air humidity and temperature, explained a substantial part of the variation in O3 response among experiments regardless of cultivar differences. Response-functions based on daytime O3 concentrations for the experiments of the POD response function was compared with the corresponding response function including available global data for O3 effects on field grown wheat yield. On average, there was no difference in O3 sensitivity between the two data sets, although the variation in response was substantially larger for global data. We conclude that POD represents a strong improvement over AOT40. The strength and representativeness of the POD approach highlighted is significant for the development and application of models used for risk assessment of ozone impact on crops.

Crops grown under elevated CO2 (eCO2) typically exhibit enhanced yields but at the same time decreased nutritional quality. The latter effect has often been explained as a growth dilution phenomenon, but this cannot be the only process involved since crop nutrient concentrations are decreased also when production is unaffected by eCO2. We review the current knowledge on eCO2 effects on crop nutritional quality with focus on the current understanding of the possible mechanisms and processes causing these effects. Emphasis is on crop nitrogen (N) and protein concentrations but effects on other nutrients and how they compare with those on N are also covered.

Wheat efficiently remobilize and allocate a large fraction of aboveground biomass and nutrients into their grains during maturation. This senescence process has been streamlined through crop breeding, which lead to increasing harvest index (HI) for biomass. With field data from two ozone exposure experiments, we derived HI for 13 elements, both nutrients and non-essential, to determine how efficiently they are allocated into the wheat grain in two different agro-ecological environments (Sweden and China) and under different ozone exposure regimes. Element HI ranged from 10 to 90 %, with highest rates for P, N and Zn (90 %, 80 % and 70 %, respectively), while HI was low for the non-mobile elements Ba, Sr and Ca (

Background The Wellbeing in Special Education Questionnaire was developed to assess subjective wellbeing in young persons with intellectual and developmental disabilities (ID/DD) as this perspective is rarely included in research. The present study explored how ID/DD and gender are related to self-reported wellbeing among adolescents. Method Students with (n = 110) or without (n = 110) ID/DD, aged 12–16 years, completed the Wellbeing in Special Education Questionnaire. Analyses of the effects of gender and disability status on peer relations and conflict, mental health, mental ill-health, school environment and family relations were carried out. Results The experiences of the school environment and of positive mental health aspects did not differ between students with and without ID/DD, but those with ID/DD reported more mental health problems and less positive experiences of peer relations and family. Generally, boys reported more positive experiences of school and less mental health problems than girls. Conclusions Including the subjective perspective of young persons with ID/DD through self-reports can provide essential information about wellbeing that cannot be gained from proxy ratings. The results suggest both differences and similarities in self-reported wellbeing between boys and girls with and without ID/DD and potentially also in how they perceived the concepts measured.

Men and women with a hereditary genetic disease are faced with different options when they wish to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focused on men and women’s psychological experiences of PGD three years after applying for PGD. Nineteen women and seventeen men (i.e. seventeen couples and two women) participated. The interviews were analysed by thematic method. It is better to have tried was identified as a master theme, under which came three underlying sub-themes, which had the following headings: Practical experience of PGD, Psychological experience of PGD and Goals of PGD. The results show that men and women three years after PGD are still psychologically affected by their experience. The men and women raised concerns that their relationship had been affected, both positively and negatively, and feelings of anxiety and depression still remained. Healthcare services should recognize the heterogeneous nature of the group being studied and therefore the need for counselling can arise at different times and in relation to different areas, regardless of the outcome of the PGD.

Elevated carbon dioxide (eCO2) is well known to stimulate plant photosynthesis and growth. Elevated carbon dioxide&rsquo, s effects on crop yields are of particular interest due to concerns for future food security. We compiled experimental data where field-grown wheat (Triticum aestivum Linnaeus) was exposed to different CO2 concentrations. Yield and yield components were analyzed by meta-analysis to estimate average effects, and response functions derived to assess effect size in relation to CO2 concentration. Grain yield increased by 26% under eCO2 (average ambient concentration of 372 ppm and elevated 605 ppm), mainly due to the increase in grain number. The response function for grain yield with CO2 concentration strongly suggests a non-linear response, where yield stimulation levels off at ~600 ppm. This was supported by the meta-analysis, which did not indicate any significant difference in yield stimulation in wheat grown at 456&ndash, 600 ppm compared to 601&ndash, 750 ppm. Yield response to eCO2 was independent of fumigation technique and rooting environment, but clearly related to site productivity, where relative CO2 yield stimulation was stronger in low productive systems. The non-linear yield response, saturating at a relatively modest elevation of CO2, was of large importance for crop modelling and assessments of future food production under rising CO2.

Few studies have explored the subjective mental health of adolescents with intellectual disabilities, while proxy ratings indicate an overrepresentation of mental health problems. The present study reports on the design and an initial empirical evaluation of the Well-being in Special Education Questionnaire (WellSEQ). Questions, response scales, and an application for tablet PCs were developed in cooperation with students and teachers in special education schools. One hundred and thirteen students (age 12–16) and their parents and teachers participated. Positive results in terms of test-retest reliability, internal consistency of scales, and response rates were obtained. Level of reading appeared to affect the students’ understanding of items. Teachers’ and parents’ ratings on the WellSEQ correlated well with established measures. Correlations between proxy ratings and students’ reports varied. The questionnaire and technology of WellSEQ may enable students with IDD to participate independently in...

Background: Previous studies have shown that women planning for in vitro fertilisation (IVF) show more distress than do men. Most studies about distress and pre-implantation genetic diagnosis (PGD) are based on women’s experiences. Little is known about what are the risk factors for men and women to experience anxiety or depression when planning for PGD.Objective: The first aim was to investigate presence of symptoms of depression and anxiety in men (n = 17) and women (n = 19) planning for PGD and compare this to men (n = 23) and women (n = 24) who were planning their first IVF. The second aim was to investigate if specified risk factors could predict the presence of anxiety and depression in the PGD group.Method: Anxiety and depression were measured with the questionnaire, the Hospital Anxiety and Depressions Scale (HADS). The Swedish version of the short Sense of Coherence scale was used to measure individuals’ sense of coherence. An index was created for six risk factors tested in the PGD group...

We investigated the effects of ozone (O3) on seed protein accumulation in soybean, rice, and wheat based on existing literature. We identified 30, 10, and 32 datasets meeting the requirements for soybean, rice, and wheat, respectively. Data for each crop were combined in response regressions for seed protein concentration, seed protein yield, and seed yield. Although seed yield in rice was less sensitive to O3 than in wheat, there was a significant positive effect of O3 on the seed protein concentration of the same magnitude in both crops. Soybean, an N-fixing high-protein crop, responded differently. Even though the effect on seed yield was similar to wheat, there was no indication of any effect of O3 on seed protein concentration in soybean. The negative influence of O3 on seed protein yield was statistically significant for soybean and wheat. The effect was larger for soybean (slope of response function: −0.58% per ppb O3) than for wheat (slope: −0.44% per ppb) and especially compared to rice (slope: −0.08% per ppb). The different response of protein concentration in soybean, likely to be associated with adverse O3 effects on N fixation, has large implications for global protein production because of the much higher absolute protein concentration in soybean.

Global Change Biology Published by John Wiley & Sons Ltd Increasing both crop productivity and the tolerance of crops to abiotic and biotic stresses is a major challenge for global food security in our rapidly changing climate. For the first time, we show how the spatial variation and severity of tropospheric ozone effects on yield compare with effects of other stresses on a global scale, and discuss mitigating actions against the negative effects of ozone. We show that the sensitivity to ozone declines in the order soybean > wheat > maize > rice, with genotypic variation in response being most pronounced for soybean and rice. Based on stomatal uptake, we estimate that ozone (mean of 2010–2012) reduces global yield annually by 12.4%, 7.1%, 4.4% and 6.1% for soybean, wheat, rice and maize, respectively (the “ozone yield gaps”), adding up to 227 Tg of lost yield. Our modelling shows that the highest ozone-induced production losses for soybean are in North and South America whilst for wheat they are in India and China, for rice in parts of India, Bangladesh, China and Indonesia, and for maize in China and the United States. Crucially, we also show that the same areas are often also at risk of high losses from pests and diseases, heat stress and to a lesser extent aridity and nutrient stress. In a solution-focussed analysis of these results, we provide a crop ideotype with tolerance of multiple stresses (including ozone) and describe how ozone effects could be included in crop breeding programmes. We also discuss altered crop management approaches that could be applied to reduce ozone impacts in the shorter term. Given the severity of ozone effects on staple food crops in areas of the world that are also challenged by other stresses, we recommend increased attention to the benefits that could be gained from addressing the ozone yield gap.

Introduction of high-performing crop cultivars and crop/soil water management practices that increase the stomatal uptake of carbon dioxide and photosynthesis will be instrumental in realizing the United Nations Sustainable Development Goal (SDG) of achieving food security. To date, however, global assessments of how to increase crop yield have failed to consider the negative effects of tropospheric ozone, a gaseous pollutant that enters the leaf stomatal pores of plants along with carbon dioxide, and is increasing in concentration globally, particularly in rapidly developing countries. Earlier studies have simply estimated that the largest effects are in the areas with the highest ozone concentrations. Using a modelling method that accounts for the effects of soil moisture deficit and meteorological factors on the stomatal uptake of ozone, we show for the first time that ozone impacts on wheat yield are particularly large in humid rain-fed and irrigated areas of major wheat-producing countries (e.g. United States, France, India, China and Russia). Averaged over 2010-2012, we estimate that ozone reduces wheat yields by a mean 9.9% in the northern hemisphere and 6.2% in the southern hemisphere, corresponding to some 85 Tg (million tonnes) of lost grain. Total production losses in developing countries receiving Official Development Assistance are 50% higher than those in developed countries, potentially reducing the possibility of achieving UN SDG2. Crucially, our analysis shows that ozone could reduce the potential yield benefits of increasing irrigation usage in response to climate change because added irrigation increases the uptake and subsequent negative effects of the pollutant. We show that mitigation of air pollution in a changing climate could play a vital role in achieving the above-mentioned UN SDG, while also contributing to other SDGs related to human health and well-being, ecosystems and climate change.

The concept of mindfulness has attracted a growing body of research within behavioural medicine over the last decade. Mindfulness-based cognitive therapy (MBCT) has been developed to prevent relapse among people who suffer recurrent depression. Studies show impressive results, with a decrease in the risk of relapse of up to 50%. However, primary care patients’ own experiences and MBCT’s effectiveness as a relapse program and aid to their ability to deal with everyday life remain relatively unexplored. The aim of the study, therefore, was to examine how primary care patients with recurrent depression perceive the usefulness of MBCT in preventing relapse. Nineteen patients who had participated in a MBCT program for recurrent depression within a primary care setting were interviewed 12 months after treatment. Qualitative thematic analysis was used to identify, analyse, and report patterns in the interviews. Analysis suggests two overarching themes, “Strategies for remission” and “Personal development”. This study brings new information about what participants in MBCT classes describe as the most useful interventions for relapse prevention. The formal and informal meditation exercises focused on the body and the breath were described as the most important strategies for remission and the mindfulness practice gave the participants an enhanced self-knowledge that helped them to better deal with everyday stress and interpersonal functioning. The findings also indicate that traditional cognitive behavioural interventions, such as behaviour activation and establishing a maintenance plan, might not be as essential to relapse prevention as formerly thought.

Tropospheric ozone is known to adversely affect crops and other vegetation. Most studies have focussed on the effects of elevated ozone levels vs. present ambient. We investigated the effect of present ambient surface ozone (O3) concentrations vs. preindustrial on a range of agronomically important response variables in field-grown wheat, using results from 33 experiments (representing 9 countries, 3 continents, 17 cultivars plus one set of 4 cultivars) having both charcoal filtered (CF) and non-filtered (NF) air treatments. Average filtration efficiency was 62%, reducing the O3 concentration from 35.6 ± 10.6 SD ppb in NF to 13.7 ± 8.8 SD ppb in CF. Average CF concentrations were in the range of levels believed to represent pre-industrial conditions, while NF concentrations were 7% lower than in the ambient air at plant height on the experimental sites. NF had significant (p

Inefficient use of fertilizers by crops increases the risk of nutrient leaching from agro-ecosystems, resulting in economic loss and environmental contamination. We investigated how ground-level ozone affects the efficiency by which wheat used applied nitrogen (N) fertilizer to produce grain protein (NEP, N efficiency with respect to protein yield) and grain yield (NEY, N efficiency with respect to grain yield) across a large number of open-top chamber field experiments. Our results show significant negative ozone effects on NEP and NEY, both for a larger data set obtained from data mining (21 experiments, 70 treatments), and a subset of data for which stomatal ozone flux estimates were available (7 experiments, 22 treatments). For one experiment, we report new data on N content of different above-ground plant fractions as well as grain K and P content. Our analysis of the combined dataset demonstrates that the grain yield return for a certain investment in N fertilizer is reduced by ozone. Results from the experiment with more detailed data further show that translocation of accumulated N from straw and leaves to grains is significantly and negatively affected by ozone, and that ozone decreases fertilizer efficiency also for K and P. As a result of lower N fertilization efficiency, ozone causes a risk of increased N losses from agroecosystems, e.g. through nitrate leaching and nitrous oxide emissions, a hitherto neglected negative effect of ozone. This impact of ozone on the N cycle implies that society is facing a dilemma where it either (i) accepts increased N pollution and counteracts ozone-induced yield reductions by increasing fertilization or (ii) counteracts N pollution under elevated ozone by reducing fertilization, accepting further yield loss adding to the direct effect of ozone on yield.

Background As most mental health studies of school-aged children with intellectual and developmental disabilities (IDD) are based on proxy ratings, the subjective views of these young persons are rarely explored. The present study explores experiences of well-being, mental ill-health, family, school, and peer relations in students in special education. Methods Ten students in special education, aged 13-16 years, answered the Wellbeing in Special Education Questionnaire (WellSEQ) and participated in semi-structured interviews. Data were analyzed using a mixed methods phenomenological research approach. Results The general agreement between questionnaire responses and interview accounts appears to be good, and the students emphasized mainly positive emotions and good mental health. Students described their school environment and family relations as inclusive contexts experienced as both protective and restrictive. Conclusion Using well-adapted research instruments enables students with IDD to communicate subjective experiences of well-being and how it relates to aspects of their everyday environment.

Air pollution levels (NO2, PAHs, O3) were investigated, before (BLE) and after (ALE) leaf emergence, in the urban landscape of Gothenburg, Sweden. The aims were to study the 1) spatial and temporal variation in pollution levels between urban green areas, 2) effect of urban vegetation on air pollution levels at the same distance from a major emission source (traffic route), 3) improvement of urban air quality in urban parks compared to adjacent sites near traffic, 4) correlation between air pollution and noise in a park. O3 varied little over the urban landscape. NO2 varied strongly and was higher in situations strongly influenced by traffic. Four PAH variables were included: total PAH, total particle-bound PAH, the quantitatively important gaseous phenanthrene and the highly toxic particle-bound benzo(a)pyrene. The variation of PAHs was similar to NO2, but for certain PAHs the difference between highly and less polluted sites was larger than for NO2. At a vegetated site, NO2 and particulate PAH levels were lower than at a non-vegetated site at a certain distance from a busy traffic route. This effect was significantly larger ALE compared to BLE for NO2, indicating green leaf area to be highly significant factor for air quality improvement. For particulate PAHs, the effect was similar BLE and ALE, indicating that tree bark and branches also could be an important factor in reducing air pollution. Parks represented considerably cleaner local environments (park effect), which is likely to be a consequence of both a dilution (distance effect) and deposition. Noise and air pollution (NO2 and PAH) levels were strongly correlated. Comparison of noise levels BLE and ALE also showed that the presence of leaves significantly reduced noise levels. Our results are evidence that urban green spaces are beneficial for urban environmental quality, which is important to consider in urban planning.

Elevated carbon dioxide (eCO2) stimulates wheat grain yield, but simultaneously reduces protein/nitrogen (N) concentration. Also, other essential nutrients are subject to change. This study is a synthesis of wheat experiments with eCO2, estimating the effects on N, minerals (B, Ca, Cd, Fe, K, Mg, Mn, Na, P, S, Zn), and starch. The analysis was performed by (i) deriving response functions to assess the gradual change in element concentration with increasing CO2 concentration, (ii) meta-analysis to test the average magnitude and significance of observed effects, and (iii) relating CO2 effects on minerals to effects on N and grain yield. Responses ranged from zero to strong negative effects of eCO2 on mineral concentration, with the largest reductions for the nutritionally important elements of N, Fe, S, Zn, and Mg. Together with the positive but small and non-significant effect on starch concentration, the large variation in effects suggests that CO2-induced responses cannot be explained only by a simple dilution model. To explain the observed pattern, uptake and transport mechanisms may have to be considered, along with the link of different elements to N uptake. Our study shows that eCO2 has a significant effect on wheat grain stoichiometry, with implications for human nutrition in a world of rising CO2.

Elevated carbon dioxide (eCO2) stimulates wheat grain yield, but simultaneously reduces protein/nitrogen (N) concentration. Also, other essential nutrients are subject to change. This study is a synthesis of wheat experiments with eCO2, estimating the effects on N, minerals (B, Ca, Cd, Fe, K, Mg, Mn, Na, P, S, Zn), and starch. The analysis was performed by (i) deriving response functions to assess the gradual change in element concentration with increasing CO2 concentration, (ii) meta-analysis to test the average magnitude and significance of observed effects, and (iii) relating CO2 effects on minerals to effects on N and grain yield. Responses ranged from zero to strong negative effects of eCO2 on mineral concentration, with the largest reductions for the nutritionally important elements of N, Fe, S, Zn, and Mg. Together with the positive but small and non-significant effect on starch concentration, the large variation in effects suggests that CO2-induced responses cannot be explained only by a simple dilution model. To explain the observed pattern, uptake and transport mechanisms may have to be considered, along with the link of different elements to N uptake. Our study shows that eCO2 has a significant effect on wheat grain stoichiometry, with implications for human nutrition in a world of rising CO2.

Background: Previous qualitative studies have shown that the decision to undergo Pre-implantation Genetic Diagnosis (PGD) is a demanding situation that increases psychological burden and activates moral beliefs and cognitive assessments. Most studies are based on women’s experiences. Studies about the choice are mostly done in a hypothetical setting. Objective: The aim of this study was to investigate psychological aspects, the influence of the healthcare system and ethical considerations in relation to men and women’s decision to undergo PGD. Method: Nineteen couples (19 women and 17 men) all planning and eligible for PGD in Sweden were interviewed. Data were analysed with a thematic approach. Results: The analysis lead to the formation of a master theme, labelled Choosing. In addition, three subthemes emerged – In relation to myself, In relation to the child, and In relation to the society – and nine underlying categories. No differences were found between men and women concerning emotional depth or cog...

International research indicates that children with disabilities are more exposed to negative parenting than their non-disabled peers. The mechanisms behind this increased risk are likely operating at the levels of the individual child, the family and the broader social context. The present study investigated harsh parenting practices using self-report data from Swedish parents of children with disabilities (30 mothers and 14 fathers) and control parents (145 mothers and 25 fathers). Sweden provides an interesting context for the current research since it has outlawed physical punishment of children, displays comparatively small gaps in socio-economic circumstances and has implemented an extensive welfare system addressing the needs of children with disabilities and their families. There was no difference in harsh parenting practices between parents of children with disabilities and control parents. However, more fathers of children with disabilities than control fathers admitted use of violence at least ...

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.

Semi-structured interviews were conducted with six parents of children with intellectual disabilities, in the Western region of Sweden. The aim of the study was to explore and to gain a deeper understanding of parents’ experiences of received support for them and their children with intellectual disabilities. We focused particularly on their experiences of the availability, accessibility, and the quality of services. Parents in this study were unsure about what the diagnosis meant specifically for their child as well as for their whole family. Moreover, the parents experienced great difficulty in obtaining information about available services, which resulted in feelings of helplessness to some. Parents also reported that although services are available, they were not easily accessible. Lastly, parents felt that the quality of care and support were to some extent inadequate, as no attention was paid by professionals to their actual needs or wishes.

The aim of this study was to develop and evaluate an instrument - the Responsive Augmentative and Alternative Communication Style (RAACS) scale Version 2 - to assess the communicative style of parents as they interact with their children using augmentative and alternative communication (AAC). This scale was used to analyze play interactions between 43 parents and 28 children with different diagnoses (including Down syndrome, autism, cerebral palsy, and intellectual disability), aged between 12 and 60 months. Parent-child interactions were observed both before and after parent participation in ComAlong, a training course on using responsive communication and AAC to support interaction with children. Based on an analysis of the results, Version 3 of the RAACS scale was developed and is recommended for future use. Analyses of Version 3 showed acceptable inter- and intra-coder reliability, and excellent internal consistency.

Aim Children with congenital heart defects (CHD) who suffer from cognitive impairments and school difficulties need to be identified as early as possible in order to set appropriate interventions in place that may enhance the school situation and quality of life for these children. Identifying children and adolescents at risk for cognitive difficulties requires specific screening tools. This study assessed such a tool – Pediatric Quality of Life Inventory Cardiac Module subscale: Cognitive Problems – to investigate whether proxy reported and self-reported cognitive problems were associated with measured intellectual functioning in children and adolescents with CHD treated with surgery or by catheter interventions. Method The sample consisted of 184 children/adolescents aged 3, 5, 9, and 15 years. The severity of the CHD diagnoses was categorized into three groups (mild, moderate, or severe) for all age groups. For all the age groups, we collected proxy ratings of cognitive problems, and for the 5-, 9-, and 15-year-olds, we also collected self-reported cognitive problems. Intellectual functioning was measured with the Wechsler intelligence scales. The control variables were socioeconomic status and severity of diagnosis. Results A strong association was found between the parent’s ratings of cognitive problems and the children’s and adolescents’ results on the Wechsler scales. This association was present for all ages, including the 3-year-olds. As for the self-reports, an association was only found between the 15-year-olds self-report of cognitive problems and their results on the Wechsler scales. Conclusion To identify children with cognitive problems as early as at the age of 3 years, parent-rated Pediatrics Quality of Life subscale: Cognitive Problems can be used as a screening tool. For 15-year-olds, the self-report ratings can be used as a screening tool. We also suggest a cutoff score of 80 for both the 15-year olds as well as the proxy reports. If the score falls below 80 the child should be formally evaluated using standardized cognitive test.

Background Studies suggest that children with congenital heart defects (CHD) are at risk for adverse intellectual functioning. However, factors related to lower intellectual functioning in this group are largely unknown. This study describes intellectual functioning in children with CHD in relation to severity of the heart defect, the child’s age, and the socioeconomic status of the family (SES). Methods Two hundred twenty-eight children treated with surgery or by catheter technique were tested using the Wechsler intelligence scales to determine full scale IQ (FSIQ). FSIQ was then analyzed in relation to age (3-, 5-, 9-, and 15-year olds), severity of the diagnosis (mild, moderate, and severe), and SES (low, medium, and high). The median age was 70 months (5.8 years) with a range of 162 months [30 months (2.5 years) to 192 months (16.0 years)]. Results The total mean score on FSIQ was 100.8 (SD = 14.5). Children with severe CHD had significantly lower FSIQ than children with mild and moderate CHD, and 9- and 15-year olds had significantly lower FSIQ compared to the 3-year olds. Children from families with low SES had significantly lower FSIQ than children from medium SES and high SES families. No interaction between severity of diagnosis, age, and SES was found for FSIQ. Conclusion Eighty-three percent of the children with CHD performed at or above average with respect to FSIQ. SES and severity of diagnosis had significant main effects on FSIQ. These factors should be considered when planning interventions and follow-up programs for children with CHD.

Background Research on parents of children with intellectual disability (ID) has identified a range of risk and protective factors for parental well-being. In family research, the association between marital quality and depression is a vital field of investigation. Still little research has addressed how aspects of the couple relationship affect the adaptation of parents of children with ID. The present study examined predictive links between couple relationship factors (marital quality and coparenting quality) and individual well-being. Methods Data were obtained through self-report questionnaires completed by parents of children with ID (mothers, n = 58; and fathers, n = 46) and control children (mothers, n = 178; and fathers, n = 141). To test the hypothesis that couple relationship factors predicted individual well-being, multiple regression analyses were performed controlling for the following risk factors identified by previous research: child self-injury/stereotypic behaviour, parenting stress, and economic risk. Results Marital quality predicted concurrent well-being, and coparenting quality predicted prospective well-being. Mothers of children with ID reported lower well-being than other parents. Conclusions There is a continued need for investigation of the details of the links between couple relationship and individual well-being in parents of children with ID. Couple relationship factors should be given consideration in clinical interventions.

Background: Despite previous efforts to understand temperament in children with intellectual disability (ID), and how child temperament may affect parents, the approach has so far been unidimensional. Child temperament has been considered in relation to diagnosis, with the inherent risk of overlooking individual variation of children's temperament profiles within diagnostic groups. The aim of the present study was to identify temperamental profiles of children with ID, and investigate how these may affect parents in terms of positive and negative impacts. Method: Parent-rated temperament in children with ID was explored through a person-oriented approach (cluster analysis). Children with ID (N = 49) and typically developing (TD) children (N = 82) aged between 4 and 6 years were clustered separately. Results: Variation in temperament profiles was more prominent among children with ID than in TD children. Out of the three clusters found in the ID group, the disruptive, and passive/withdrawn clusters were distinctly different from clusters found in the TD group in terms of temperament, while the cluster active and outgoing was similar in shape and level of temperament ratings of TD children. Children within the disruptive cluster were described to have more negative and less positive impacts on mothers compared to children within the other clusters in the ID group. Conclusions: Mothers who describe their children as having disruptive temperament may be at particular risk for experiencing higher parenting stress as they report that the child has higher negative and lower positive impacts than other parents describe. The absence of a relationship between child temperament profile and positive or negative impact on fathers may indicate that fathers are less affected by child temperament. However, this relationship needs to be further explored. (C) 2011 Elsevier Ltd. All rights reserved.

Background Much research has been devoted to the emotional burdens of having a child with intellectual disability (ID),but very little of this has focused on the burdens imposed by negative public attitudes towards disability.Adjustment has primarily been thought of as adjustment to the actual disability rather than adjustment to attitudes or prejudices towards disability. Aim The aim of the present study was to study expectations of and reactions to disability and normality experienced by parents of children with ID in their everyday life in Sweden. Research questions Do the parents relate to the tragedy discourse and,if so,how? Do parents relate to other expectations and disability discourses and,if so,how? What subject positions do the discourses offer? Method The analysis was based on 17 semi-structured interviews with nine fathers and eight mothers of nine children with different IDs.The children were newly diagnosed and were from 6 months to 5 years of age. Results Four discourses (tragedy and the lived experience,tragedy and the outsider perspective, the clinical gaze and the super-parent ideal) and subject positions relating to these discourses are discussed. Discussion The results of this study show that parents of young children with disabilities relate to a wide range of social processes and practices,which could be thought to affect their emotional well-being and parental identity negatively.

Background Can ratings of temperament be a way of identifying young children with intellectual dis- abilities (ID) who are at risk for being experienced as difficult? We aimed to explore parents' reports of temperament in their young children with or without ID, as well as positive and negative impact of the child on parents. Method Mothers and fathers of 55 children recently diagnosed with ID and 183 age-matched typically developing (TD) children completed the EASI Temperamental Survey and two scales of the Family Impact Questionnaire measuring positive and negative impact of the child on parents. Results Parents rated children with mixed ID/DD (developmental delay) as shyer and more impulsive, and less active and sociable when compared with TD children. Children with mixed ID/DD were also reported to have more negative and less posi- tive impact on the family compared with the TD group. In subgroup analyses, children with Down syndrome and cerebral palsy/motor impairment were described as having less negative impact on parents and were described as low in negative emo- tionality. Children with autism spectrum disorder (ASD), ID/DD nos and other less common diag- noses had a similar pattern of temperament with high emotionality, shyness and impulsivity, and low activity and sociability. Parents of children with ASD and ID/DD reported the highest level of negative impact. Conclusions Temperamental characteristics such as high negative emotionality and impulsivity, which can be identified earlier than behavioural problems, could be indicators of negative impact on parents of young children with ID. Despite great variability in temperament among children with mixed ID/DD, results indicated common temperamental character- istics among children with ASD, ID/DD and other diagnosis.

The aim of the present study was to explore how a personal narrative told by a group of eight persons with aphasia differed between written and spoken language, and to compare this with findings from 10 participants in a reference group. The stories were analysed through holistic assessments made by 60 participants without experience of aphasia and through measurement of lexical and syntactic variables. The findings showed that the participants with aphasia generally received lower ratings than the reference group, but also that stories written by participants with aphasia were rated as easier to understand, more interesting, and more coherent than the group's spoken stories. Regression analysis showed that syntax could predict several of the rated variables for the stories told by the participants with aphasia. Results point to the need to include writing training in language rehabilitation in order to increase the ability for persons with aphasia to participate in communicative situations in everyday life.

We synthesized the effects of ozone on wheat quality based on 42 experiments performed in Asia, Europe and North America. Data were analysed using meta-analysis and by deriving response functions between observed effects and daytime ozone concentration. There was a strong negative effect on 1000-grain weight and weaker but significant negative effects on starch concentration and volume weight. For protein and several nutritionally important minerals (K, Mg, Ca, P, Zn, Mn, Cu) concentration was significantly increased, but yields were significantly decreased by ozone. For other minerals (Fe, S, Na) effects were not significant or results inconclusive. The concentration and yield of potentially toxic Cd were negatively affected by ozone. Some baking properties (Zeleny value, Hagberg falling number) were positively influenced by ozone. Effects were similar in different exposure systems and for spring and winter wheat. Ozone effects on quality should be considered in future assessments of food security/safety.

Background As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS) is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years) will have reduced their BMI-for-age z-score. Methods/Design The study is a randomized controlled trial, including overweight (n=160) and obese (n=80) children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1) supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2) influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of parental stress. Discussion The LOOPS project will provide valuable information on how to build effective interventions to influence an unhealthy weight development to prevent the negative long-term effects of childhood obesity. Trial registration ClinicalTrials.gov NCT00916318

Keywordsearly intervention, parental education, communication development, augmentative and alternative communication (AAC), parents' experiencesAbstractThe aim of this study was to evaluate parents and course leaders' experiences of the ComAlong early intervention course; a parental course about communication, communication development, play, responsive communication strategies and augmentative and alternative communication (AAC). ComAlong targets parents of pre-school children with extensive communication difficulties and, at times, additional disabilities. Data consisted of course evaluation surveys filled out by 86 parents (57 mothers and 29 fathers) and one grandmother and interviews of four parents and four course leaders. Overall, parents were positive about the course. This was shown in ratings of 21 statements, in written answers to seven open questions and in the interviews. The total mean value for all statements was 4.4 (max 5) and the median was 4 or 5. The means for the 20 statements varied between 3.9 and 4.8 and half of all statements had mean values of 4.5 or higher. The mean value for the course (parents’ rating of the course on a 1 to 10 scale where 10 was the best) was 8.5 (Mdn and mode = 8, SD = 1.1). On the whole, parents and course leaders were satisfied. Parents learned about communication and AAC and experienced that communication with the child had changed to the better. In particular, parents appreciated meeting respectful and competent course leaders and other parents to children with varying disabilities. Information about the course before it started was a problematic issue. These and other findings are discussed with regard to early intervention for parents of children who use augmentative and alternative communication.

The aim of the present study was to explore the variation of parents' descriptions and experiences of their child that was recently identified to have an intellectual disability (ID).The study applied interpretative phenomenological analysis and analysis of narrative style looking at content and form of parental narratives. Data was collected from nine fathers and eight mothers through semi-structured interviews within 6 months following diagnosis.Analysis revealed three factors indicating the parents' level of processing: (1) emotional expressions regarding the child - varying between limited (distanced or idealized) and balanced/affectionate; (2) experience of the disability - varying between preoccupation and acceptance; and (3) time orientation - varying in terms of flexibility and temporal focus.Although parents of children with ID describe negative emotions in relation to the child and the disability, most of these parents also describe positive emotions that seemed to balance the negative experiences.