The Impact of Upcoming Treatments in Huntington's Disease: Resource Capacity Limitations and Access to Care Implications.

BACKGROUND The most advanced disease-modifying therapies (DMTs) in development for Huntington's disease (HD) require intrathecal (IT) administration, which may create or exacerbate bottlenecks in resource capacity. OBJECTIVE To understand the readiness of healthcare systems for intrathecally administered HD DMTs in terms of resource capacity dynamics and implications for patients' access to treatment. METHODS Forty HD centres across 12 countries were included. Qualitative and quantitative data on current capacity in HD centres and anticipated capacity needs following availability of a DMT were gathered via interviews with healthcare professionals (HCPs). Data modelling was used to estimate the current capacity gap in HD centres. RESULTS From interviews with 218 HCPs, 25% of HD centres are estimated to have the three components required for IT administration (proceduralists, nurses and facilities). On average, 114 patients per centre per year are anticipated to receive intrathecally administered DMTs in the future. At current capacity, six of the sampled centres are estimated to be able to deliver DMTs to all the anticipated patients based on current resources. The estimated waiting time for IT administration at current capacity will average 60 months (5 years) by the second year after DMT availability. CONCLUSION Additional resources are needed in HD centres for future DMTs to be accessible to all anticipated patients. Timely collaboration by the HD community will be needed to address capacity gaps. Healthcare policymakers and payers will need to address costs and navigate challenges arising from country- or region-specific healthcare delivery schemes

Trädgård och rumsliga upplevelser

Arbetet behandlar rumslighet i trädgården och utgår ifrån Norberg-Schulz (2003) essä om fenomenet plats. Essän beskriver arkitekturens fenomenologi, och studien visar att synsättet ofta avspeglas i trädgårdslitteraturen. Fenomenologin menar att vi inte kan fånga en beskrivning av det verkliga fenomenet utan bara människans upplevelse av fenomenet. Det är så vi också gärna beskriver trädgård, genom att dela med oss av vår upplevelse av trädgården. Platsens struktur delas upp i rum, som är den tredimensionella organisationen av platsens element och karaktär, som är den allmänna atmosfären hos platsen. Vidare beror den sökta karaktären hos trädgårdsrummet på de aktiviteter som ska utföras inom trädgårdsrummet och begreppet funktionsplan utvecklas. Trädgårdens träd, buskar och gräs jämförs med husets tak, väggar och golv. Karaktären hos ett trädgårdsrum bestäms av hur de element som utgör gränserna är utformade och avslutningsvis ges några exempel på växter som kan skapa en viss önskad karaktär

Arbetsterapeuters insatser inom arbetslivsinriktad rehabilitering - en kvalitativ intervjustudie

För att hjälpa personer med funktionshinder som är arbetslösa och/eller sjukskrivna tillbaka ut i arbetslivet arbetar Arbetsförmedlingen (AF) med arbetslivsinriktad rehabilitering. Syftet med studien var att beskriva arbetsterapeuters insatser med arbetslivsinriktad rehabilitering. För att studera det intervjuades sju arbetsterapeuter, verksamma inom arbetslivsinriktad rehabilitering. Utifrån studiens syfte utvecklades en intervjuguide. Intervjuerna analyserades enligt Graneheim och Lundmans system för innehållsanalys och ledde fram till fyra teman ”Arbetsterapeuters roll vid arbetslivsinriktad rehabilitering”, ”Arbetsterapeuters insatser och arbetsuppgifter”, ”Arbetsterapeuters utvärderingar av resultaten vid rehabilitering” och ”Arbetsterapeuters beskrivning av mål inom arbetslivsinriktad rehabilitering”. Resultatet visade att arbetsterapeuterna främst arbetade med att klargöra arbetsförutsättningar och att anpassa arbetssituationen för de arbetssökande. Målet de arbetade mot var att få de arbetssökande med funktionshinder i arbete. Arbetsterapeuterna beskrev vikten av att komma in tidigt i rehabiliteringsprocessen för att hjälpa och stödja personer med funktionshinder för att de fortare ska komma ut i arbete. Fem arbetsterapeuter berättade att de gjorde uppföljningar av arbetsprövningar och arbetshjälpmedel på olika vis och vid olika tidpunkter. Rehabiliteringsinsatserna avslutas om personen har fått en anställning eller står till arbetsmarknadens förfogande och kan börja söka arbete på egen hand. För att avsluta rehabiliteringen har arbetsterapeuterna avslutande samtal med den arbetssökande

Resettlement : A study to examine the democratic values of the selection of quota refugees

The aim of this study is to investigate the dossier and delegation selections’ pros and cons and examine how the Swedish Migration Agency, in collaboration with UNHCR, work to ensure impartiality and efficiency. The study is based on two theories: the main one is Lennart Lundquist’s theory of democratic and economic values, which we combine with Michael Lipsky’s theory of “street-level bureaucrats” with the bottom-up perspective. By interviewing six people, differently involved in the selection of quota refugees - experts as well as administrators and managers - we arrive at the result that there are both positive and negative parts of the selections and both methods are needed. Democratic and economic values make the foremost sense and we have found that the Swedish Migration Agency works in a way to find a balance between them. This study provides practical knowledge concerning challenges the people working within this area might meet and how they work to solve them. Hopefully, it will inspire people to do more research within this area of interests for a more effective, democratic and equitable selection of quota refugees in the future

Resettlement : A study to examine the democratic values of the selection of quota refugees

The aim of this study is to investigate the dossier and delegation selections’ pros and cons and examine how the Swedish Migration Agency, in collaboration with UNHCR, work to ensure impartiality and efficiency. The study is based on two theories: the main one is Lennart Lundquist’s theory of democratic and economic values, which we combine with Michael Lipsky’s theory of “street-level bureaucrats” with the bottom-up perspective. By interviewing six people, differently involved in the selection of quota refugees - experts as well as administrators and managers - we arrive at the result that there are both positive and negative parts of the selections and both methods are needed. Democratic and economic values make the foremost sense and we have found that the Swedish Migration Agency works in a way to find a balance between them. This study provides practical knowledge concerning challenges the people working within this area might meet and how they work to solve them. Hopefully, it will inspire people to do more research within this area of interests for a more effective, democratic and equitable selection of quota refugees in the future

Goal achievement process in secondary school : Teachers´ intentions, actions and students´ reactions

Syftet med studien var  att  kartlägga, belysa och förstå  hur måluppfyllelseprocessen fungerar på en gymnasieskola med yrkesförberedande program. Med  måluppfyllelse-process  menar vi alla aktiviteter där lärare  tolkar  och  förmedlar  kursmål, bedömer prestationer samt förmedlar denna bedömning. Vidare är syftet att studera  elevernas delaktighet i och reaktion på denna process.  Studien genomfördes med en kvalitativ ansats med faktaintervjuer och fokusgrupps-intervjuer.  Vi har tagit utgångspunkt i Vygotskijs teori om den proximala utvecklingszonen och begreppen formativ och summativ bedömning.  Enligt lärarna får en elev ett femtiotal återkopplingar per läsår. Här skiljer sig elevernas uppfattning betydligt då de bedömer att de får två till tio återkopplingar.   Lärarnas intention enligt studien är att åstadkomma utveckling, men eleverna uppfattar åter-kopplingen i termer av slutgiltiga betyg och ibland fördömanden. Eleverna tyckte att det var roligt och motiverande med positiv återkoppling.  De slutsatser vi dragit av studien är att processen bör bli iterativ istället för en envägs-kommunikation, eleven måste utgå från sina egna mål och lärarens roll borde vara att matcha eleven mot dessa. Utrymme för reflektion utifrån återkopplingen måste tillföras och eleven bör få utbildning i måluppfyllelseprocessen för att kunna vara aktiv i denna process.The purpose of this study was to identify, highlight and understand how the  goal achievement process works at a secondary school with vocational programs.  We identify the goal achievement process as all activities i.e. teacher communication, interpreting of course goals, assessing performance and convey this assessment. The purpose was also to study student participation in the process and reactions to teacher activities.  The study was conducted with a qualitative approach with fact interviews and focus group interviews as tools to collect data. We based our analysis on Vygotsky's theory of the proximal development zone and the concepts of formative and summative assess-ment.  According to teachers, a student gets some fifty feedbacks per academic year. This differs significantly  two to ten. intentions according to the study are to achieve development, but students' understandings of the feedback are in terms of final scores and sometimes condemnations. The students thought it was encouraging and motivating with positive feedback.   The conclusions we drew from the study are that the process should be iterative rather than a one-way communication, students must set their own goals and the teacher's role should be to match students towards them. Time for reflection on the feedback need to be given in the process and students should be trained in the goal achievement process to be able to take active part

Thyroid hormones and adult interpersonal violence among women with borderline personality disorder

Elevated T3 levels have been reported in men with antisocial behavior. The aim of the present study was to investigate the relationship between thyroid hormones and expressed adult interpersonal violence in female patients with borderline personality disorder (BPD). Furthermore, expressed adult interpersonal violence in female BPD patients was compared to healthy female controls. A total of 92 clinically euthyroid women with BPD and 57 healthy women were assessed with the Karolinska Interpersonal Violence Scales (KIVS). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays in patients. Plasma cortisol was also measured. Among females with BPD, expressed interpersonal violence as an adult showed a significant positive correlation with the T3 levels. The mean expression of interpersonal violence as an adult was significantly higher in BPD patients as compared to healthy controls. The multiple regression model indicated that two independent predictors of KIVS expressed interpersonal violence as an adult: T3 and comorbid diagnosis of alcohol abuse. Association between T3 levels and violent/aggressive behavior earlier reported exclusively in male samples may be valid also in females with BPD. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NCND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Hypothalamic pituitary thyroid axis and exposure to interpersonal violence in childhood among women with borderline personality disorder

Background: A relationship between exposure to sexual violence and thyroid hormone alterations has been observed among women with posttraumatic stress disorder (PTSD). Women with borderline personality disorder (BPD) report a high estimate of childhood trauma. Objective: The aim of the present study was to assess relationships between thyroid hormone measures and exposure to violence in childhood in women with BPD. Method: A total of 92 clinically euthyroid women with BPD (53% with comorbid PTSD) diagnosis and at least two prior suicide attempts were assessed with the Karolinska Interpersonal Violence Scales (KIVS). The KIVS contains four subscales with concrete examples of exposure to violence and expressed violent behavior in childhood (aged 6–14 years) and during adult life (15 years or older). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays. The FT3/FT4 ratio was used to estimate peripheral deiodination. Plasma cortisol was also assessed. Results: Sixty-seven percent of patients reported medium high or high level of exposure to interpersonal violence as a child. The FT3/FT4 ratio showed a significant negative correlation with exposure to violence as a child. Patients with PTSD had significantly higher plasma cortisol levels. An ad hoc analysis revealed that the correlation between KIVS exposure to interpersonal violence as a child and FT3/FT4 ratio was significant only in patients with comorbid PTSD. Altered thyroid activity, especially FT3/FT4, levels was associated with exposure to violence in childhood in women with BPD. Conclusion: Severe childhood trauma-related stress may promote lasting altered thyroid levels and/or contribute to the development of psychopathology associated with BPD traits or PTSD

Thyroid hormones and adult interpersonal violence among women with borderline personality disorder

Elevated T3 levels have been reported in men with antisocial behavior. The aim of the present study was to investigate the relationship between thyroid hormones and expressed adult interpersonal violence in female patients with borderline personality disorder (BPD). Furthermore, expressed adult interpersonal violence in female BPD patients was compared to healthy female controls. A total of 92 clinically euthyroid women with BPD and 57 healthy women were assessed with the Karolinska Interpersonal Violence Scales (KIVS). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays in patients. Plasma cortisol was also measured. Among females with BPD, expressed interpersonal violence as an adult showed a significant positive correlation with the T3 levels. The mean expression of interpersonal violence as an adult was significantly higher in BPD patients as compared to healthy controls. The multiple regression model indicated that two independent predictors of KIVS expressed interpersonal violence as an adult: T3 and comorbid diagnosis of alcohol abuse. Association between T3 levels and violent/aggressive behavior earlier reported exclusively in male samples may be valid also in females with BPD. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NCND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Hypothalamic pituitary thyroid axis and exposure to interpersonal violence in childhood among women with borderline personality disorder

A relationship between exposure to sexual violence and thyroid hormone alterations has been observed among women with posttraumatic stress disorder (PTSD). Women with borderline personality disorder (BPD) report a high estimate of childhood trauma. The aim of the present study was to assess relationships between thyroid hormone measures and exposure to violence in childhood in women with BPD. A total of 92 clinically euthyroid women with BPD (53% with comorbid PTSD) diagnosis and at least two prior suicide attempts were assessed with the Karolinska Interpersonal Violence Scales (KIVS). The KIVS contains four subscales with concrete examples of exposure to violence and expressed violent behavior in childhood (aged 6–14 years) and during adult life (15 years or older). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays. The FT3/FT4 ratio was used to estimate peripheral deiodination. Plasma cortisol was also assessed. Sixty-seven percent of patients reported medium high or high level of exposure to interpersonal violence as a child. The FT3/FT4 ratio showed a significant negative correlation with exposure to violence as a child. Patients with PTSD had significantly higher plasma cortisol levels. An ad hoc analysis revealed that the correlation between KIVS exposure to interpersonal violence as a child and FT3/FT4 ratio was significant only in patients with comorbid PTSD. Altered thyroid activity, especially FT3/FT4, levels was associated with exposure to violence in childhood in women with BPD. Severe childhood trauma-related stress may promote lasting altered thyroid levels and/or contribute to the development of psychopathology associated with BPD traits or PTSD.</p