Influence of childhood traumatic brain injury (TBI) on cognitive recovery and subsequent development is poorly understood. In this longitudinal study we used cluster analysis to explore acute stage individual profiles of injury age and cognition in 118 children with traumatic brain injury. Repeated measures of cognitive function were conducted at 30 months, indicating recovery, and 10 years post-injury, indicating development. Nine clusters were identified. Recovery was evident in three clusters, two of them with low functioning profiles. Developmental gains occurred for three clusters and an acute profile of higher freedom from distractibility (FFD) and lower processing speed (PS) was related to positive differences. One cluster, average low functioning and especially low verbal comprehension, demonstrated a slower development than peers. This suggests that developmental change after TBI in childhood takes place on a continuum, with both chance of long-term catching up, and risk of poor development. An acute profile of higher FFD and lower PS seemed to reflect injury consequences and were followed by developmental gains. These results challenge previous findings, and warrant further investigation.

The purpose of this study is to determine the actual occurrences of flexible working conditions and to demonstrate an instrument for their assessment. Flexibility is discussed as a concept and defined in terms of deregulation of work, and a corresponding increase in self-government and ambiguity. Using empirical data from a national survey of the Swedish labor force, the results show that almost half (47%) of the jobs on the Swedish labor market can be characterized as low, or even unregulated. This means that almost half of the Swedish work force is subjected to working conditions involving a nonnegligible requirement for self-government.

An acoustic environment contains sounds from various sound sources, some generally perceived as wanted, others as unwanted. This thesis examines the effects of wanted and unwanted sounds in acoustic environments, with regard to masking, stress recovery, and speech intelligibility.

In urban settings, masking of unwanted sounds by sounds from water structures has been suggested as a way to improve the acoustic environment. However, Study I showed that the unwanted (road traffic) sound was better at masking the wanted (water) sound than vice versa, thus indicating that masking of unwanted sounds with sounds from water structures may prove difficult. Also, predictions by a partial loudness model of the auditory periphery overestimated the effect of masking, indicating that centrally located informational masking processes contribute to the effect. Some environments have also been shown to impair stress recovery; however studies using only auditory stimuli is lacking. Study II showed that a wanted (nature) sound improve stress recovery compared to unwanted (road traffic, ambient) sounds. This suggests that the acoustic environment influences stress recovery and that wanted sounds may facilitate stress recovery compared to unwanted sounds. An additional effect of unwanted sounds is impeded speech communication, commonly measured with speech intelligibility models. Study III showed that speech intelligibility starts to be negatively affected when the unwanted (aircraft sound) masker have equal or higher sound pressure level as the speech sound. Three models of speech intelligibility (speech intelligibility index, partial loudness and signal–to–noise ratio) predicted this effect well, with a slight disadvantage for the signal–to–noise ratio model. Together, Study I and III suggests that the partial loudness model is useful for determining effects of wanted and unwanted sounds in outdoor acoustic environments where variations in sound pressure level are large. But, in environments with large variations in other sound characteristics, models containing predictions of central processes would likely produce better results.

The thesis concludes that wanted and unwanted characteristics of sounds in acoustic environments affect masking, stress recovery, and speech intelligibility, and that auditory perception models can predict these effects.

Objective

The role of genetics for predicting the response to cognitive behavior therapy (CBT) for social anxiety disorder (SAD) has only been studied in one previous investigation. The serotonin transporter (5-HTTLPR), the catechol-o-methyltransferase (COMT) val158met, and the tryptophan hydroxylase-2 (TPH2) G-703Tpolymorphisms are implicated in the regulation of amygdala reactivity and fear extinction and therefore might be of relevance for CBT outcome. The aim of the present study was to investigate if these three gene variants predicted response to CBT in a large sample of SAD patients.

Method

Participants were recruited from two separate randomized controlled CBT trials (trial 1: n = 112, trial 2: n = 202). Genotyping were performed on DNA extracted from blood or saliva samples. Effects were analyzed at follow-up (6 or 12 months after treatment) for both groups and for each group separately at post-treatment. The main outcome measure was the Liebowitz Social Anxiety Scale Self-Report.

Results

At long-term follow-up, there was no effect of any genotype, or gene × gene interactions, on treatment response. In the subsamples, there was time by genotype interaction effects indicating an influence of the TPH2 G-703T-polymorphism on CBT short-term response, however the direction of the effect was not consistent across trials.

Conclusions

None of the three gene variants, 5-HTTLPR, COMTval158met and TPH2 G-703T, was associated with long-term response to CBT for SAD.

Internetbaserad KBT ger tillgång till fungerande behandling för psykisk ohälsa på patientens villkor. Metoden har utvecklats i snabb takt genom utbredda forskningsinsatser, där Sverige kan betraktas som världsledande inom området.

Internetbehandling med KBT ger en grundlig genomgång av behandlingsarbetet med betoning på praktiska aspekter och tillämpningen i olika verksamheter. Särskilt fokus ligger på att skapa ett fungerande behandlingsupplägg, praktiska förberedelser, behandlarens roll och viktiga terapeutfärdigheter samt hur vanliga svårigheter hanteras. Läsaren får också en teoretisk orientering, kunskap om befintligt forskningsstöd och vilka fördelar metoden har för patienter, behandlare och verksamheter. Fallexempel, checklistor och annat praktiskt material gör boken till ett mycket användbart hjälpmedel.

Under de senaste 15 åren har en intensiv forskning bedrivits kring internetbaserad psykologisk behandling och svenska forskare har i hög grad deltagit i utvecklingen. Här ger Gerhard Andersson och Per Carlbring, båda professorer i klinisk psykologi, en introduktion till internetbaserad psykologisk behandling och en bild av kunskapsläget just nu.

The Internet has become a part of most people’s lives in many parts of the world. Since the late 1990s there has been an intensive research activity in which psychological treatments, such as cognitive behavior therapy (CBT), have been found to be effective when delivered via the Internet. Most research studies indicate that the effects are larger when some form of guidance is provided from a therapist, and unguided treatments tend to lead to more dropout and smaller effects. Guided Internet treatments often consists of book length text materials, but can also include other components such as audio files and video clips. Homework assignment is often included and feedback is given for completed homework. Guided Internet-based CBT (iCBT) has been found to work for problems such as depression, panic-, social anxiety-, and generalized anxiety disorders. There are many research trials in which participants have been recruited via media, and there has been less research conducted in representative clinical settings. Most research has been conducted on adults and in university settings with nationwide recruitment. There is a need for treatments and studies on older adults, children and adolescents. In conclusion, dissemination of the research findings on guided iCBT to regular clinical settings is warranted.

Background

Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in the treatment of mild to moderate depression, but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up.

Method

Participants with mild to moderate depression were recruited from the general population and randomized to either guided ICBT (n=33) or to live group treatment (n=36). Measures were completed before and after the intervention to assess depression, anxiety, and quality of life. Follow-ups were conducted at one-year and three-year after the treatment had ended.

Results

Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis. Results on the self-rated version of the Montgomery–Åsberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT, and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up. Within-group effect sizes for the ICBT condition at post-treatment showed a Cohen′s d=1.46, with a similar large effect at 3-year follow-up,d=1.78. For the group CBT the corresponding within-group effects were d=0.99 and d=1.34, respectively.

Limitations

The study was small with two active treatments and there was no placebo or credible control condition.

Conclusions

Guided ICBT is at least as effective as group-based CBT and long-term effects can be sustained up to 3 years after treatment.

Lars-Göran Öst is one of the most eminent clinical researchers in the field of cognitive behaviour therapy (CBT) and a founder of CBT in Sweden. He has recently retired from his position as professor in clinical psychology at Stockholm University, Sweden. In this paper, we sketch a brief description of the body of work by Öst. Examples of his innovative and pioneering new treatment methods include the one-session treatment for specific phobias, as well as applied relaxation for a range of anxiety disorders and health conditions. While Öst remains active in the field, he has contributed significantly to the development and dissemination of CBT in Sweden as well as in the world.

In this study, the authors compared guided Internet-delivered self-help with one-session exposure treatment (OST) in a sample of snake phobic patients. A total of 30 patients were included following a screening on the Internet and a structured clinical interview. The Internet treatment consisted of four weekly text modules which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The OST was delivered in a three-hour session following a brief orientation session. The main outcome was the behavioural approach test (BAT), and as secondary measures questionnaires measuring anxiety symptoms and depression were used. Results showed that the groups did not differ at post-treatment or follow-up, with the exception of a significant interaction for the BAT in favour of the OST. At post-treatment, 61.5% of the Internet group and 84.6% of the OST group achieved a clinically significant improvement on the BAT. At follow-up, the corresponding figures were 90% for the Internet group and 100% for the OST group (completer sample). Within-group effect sizes for the Snake Phobia Questionnaire were large (d = 1.63 and d = 2.31 for the Internet and OST groups, respectively, at post-treatment). It is concluded that guided Internet-delivered exposure treatment is a potential treatment option in the treatment of snake phobia, but that OST probably is better.

Poor subjective health has been associated with higher levels of inflammatory cytokines. We investigated whether such an association would apply to women of the general population. Levels of cytokines, affect and subjective health were assessed in 347 women of the general population aged 45 to 90 years. Higher levels of interleukin-6 were associated with poor subjective health, especially in participants over 65 years of age. Positive affect was a more robust determinant of subjective health than negative affect. The presence of low-grade inflammation and absence of positive affect, rather than presence of negative affect, may be important determinants of subjective health.

The capacity to form olfactory images has received less attention than the formation of visual and auditory images. The evidence in favor of such ability is also inconsistent. This thesis explored some of the characteristics of olfactory imagery through three empirical studies. Study I investigated the effects of blocking spontaneous sniffing during olfactory imagery. The results indicated that the prevention of spontaneous sniffing reduced olfactory but not visual imagery capacity. Study II studied the relation between olfactory awareness (as indexed by olfactory dreams, olfactory imagery, and olfactory interest) and olfactory functions (i.e., odor threshold, episodic odor memory, and odor identification). The main findings were that compared to low, high olfactory awareness was associated with better episodic odor memory and identification, but not with higher olfactory sensitivity. Study III investigated the neural correlates of odor evoked autobiographical memories (OEAMs) as (a) a function of cue modality (i.e., odors and their verbal referents), and (b) a function of memory remoteness. The results from Study III showed that OEAMs activated regions generally associated with autobiographical memory. In addition, verbally cued OEAMs were associated with activity linked to olfactory imagery. Odor cues activated the limbic and temporal polar regions more than verbal cues; a result that may explain the phenomenological differences found between the cued memories. Moreover, OEAMs from the first decade of life were associated with higher activity in the secondary olfactory cortex, whereas memories from young adulthood were related to areas linked to semantic memory processing. Taken together these studies favor the notion of a human capacity to form olfactory images. 

Behavioral evidence indicates that odor evoked autobiographical memories (OEAMs) are older, more emotional, less thought of and induce stronger time traveling characteristics than autobiographical memories (AMs) evoked by other modalities. The main aim of this study was to explore the neural correlates of AMs evoked by odors as a function of retrieval cue. Participants were screened for specific OEAMs and later presented with the odor cue and its verbal referent in an fMRI paradigm. Because the same OEAM was retrieved across both cue formats (odor and word), potential cue dependent brain activations were investigated. The overall results showed that odor and word cued OEAMs activated regions typically associated with recollection of autobiographical information. Although no odors were presented, a verbal cuing of the OEAMs activated areas associated with olfactory perception (e.g., piriform cortex). However, relative to word cuing, an odor cuing of OEAMs resulted in more activity in MTL regions such as the parahippocampus, and areas involved in visual vividness (e.g., occipital gyrus and precuneus). Furthermore, odor cues activated areas related to emotional processing, such as limbic and tempopolar regions significantly more. In contrast, word cues relative to odor cues recruited a more widespread and bilateral prefrontal activity. Hippocampus activity did not vary as function of the remoteness of the memory, but recollection of OEAMs from the 1^st vs the 2^nd decade of life showed specific activation in the right OFC, whereas the 2^nd reflected a higher activation in the left inferior frontal gyrus.

In recent decades the public welfare sector has been subjected to major structural changes, and studies of various occupational groups within human service work have reported increased workload and a high prevalence of work-related stress. Using questionnaire data from a sample of human service workers within social work, child care and elderly care, the aim of this study was to identify different patterns of coping strategies to manage the imbalance between work demands and resources, and then to investigate their impact on outcomes in employee health and service quality. Findings: Cluster analysis identified three strategy profiles: compensatory and quality reducing, voice and support seeking and self-supporting, and the comparative analysis indicated that the compensatory and quality reducing cluster may be regarded as a risk group. Results of hierarchical regression analyses disclosed that the identified strategies affected health outcomes as well as perceived service quality. The use of compensatory and quality reducing strategies was negatively related to health and quality, although work demands, resources and background characteristics were controlled for. Applications: The results add to the research field through the identification of compensatory and quality reducing strategies not previously described in the coping literature, as well as the risks associated with them. Applied in practice, the identified strategy clusters might help distinguish risk behaviors' from more beneficial strategies. The results also point toward the importance of providing organizational structures that allow the employees to voice their opinions and critique, as well as to give and receive social support.

Förändringarna inom välfärdstjänstesektorn i Sverige har det senaste decenniet varit genomgripande. Rationaliseringar och ett decentraliserat resultat- och kostnadsansvar har i många fall medfört ökade arbetskrav, och socialsekreterares situation framstår som särskilt svår. Ansvaret att hantera obalansen mellan krav och resurser har decentraliserats till den enskilde socialsekreteraren. När resurserna inte matchar de kvalitetskrav som ställs tvingas socialsekreterarna tillämpa strategier som antingen äventyrar deras egen hälsa eller kvaliteten i arbetet.

Soundscape is an overlooked aspect of sustainable urban development and resilient cities. Particularly, soundscape is associated with urban open space quality and urban design. It concerns the acoustic environment as perceived or experienced and/or understood by people in context. It includes all sounds – positive as well as negative. Unlike current management of the acoustic environment, soundscape is not primarily about reducing sound levels below an acceptable guideline value. Rather, it is about what sounds belong to a place. From a heritage perspective it is important to ask what soundscapes present generations create and transfer to future generations. How do people want the city to sound? This relates to architecture and the urban infra structure, such as location of buildings, roads and parks, including the activities they entail. Much of what present generations create is durable and will affect many generations to come, by limiting the number of degrees of freedom at their disposal. This paper presents an early report on the Sound Cities projects that investigate how soundscapes may be consciously and expediently designed, as well as what we should mean with soundscape quality. For example, what is the relationship between soundscape and human activity in the city, or between soundscape and different kinds of sound sources? The aim of the projects is to promote sustainable urban development, quality of life, as well as health and well-being among urban residents, today and in the future. The projects include in situ questionnaires, psychoacoustic listening experiments, as well as machine learning, based on music information retrieval technology.

With the formation of the working group ISO/TC 43/SC 1/WG 54 “Perceptual Assessment of Soundscape Quality” of the International Organization for Standardization (ISO) in 2008, a debate has arisen on what soundscape quality should mean. The Swedish Soundscape-Quality Protocol defines soundscape quality operationally as a single, one-dimensional Good-Bad scale. Critics argue that this is unsatisfactory, because there is no one ideal soundscape. Rather, they argue that soundscape quality is relative to a place and the outcomes that the soundscape of that place facilitates or enables (e.g., conversation without interruption, nature appreciation or psychological restoration). In 2013, a questionnaire study will be conducted in Sheffield, UK, including about 900 users/visitors in 45 urban and peri-urban areas, divided on 9 different kinds (e.g., pedestrian areas, residential areas, parks, and plazas). The purpose is to define soundscape quality and to further develop measurement methods in this field. The results are expected to contribute to methods for 'green labelling' of soundscapes, and to support the development of the International Standard ISO 12913 on soundscape. The present paper discusses research plans and initial results.

Whether to improve existing acoustic environments, as they are perceived or experienced and/or understood by people, in context (i.e., soundscapes), or to design future soundscapes it is central to have a prediction model that relates predictors (i.e., acoustic indicators) to outcomes (i.e., psychological variables). In the Sound Cities project it is proposed to use as outcome what Axelsson previously has termed Information Load. The purpose of the Sound Cities project is to identify what acoustic indicators may predict the information load of soundscapes. The method will be psychoacoustic experiments in which a large sample of naïve listeners will assess recordings of authentic acoustic environments with regards to information load. Acoustic signals and information-load data will be submitted to machine learning, based on music information retrieval technology. It is expected that the Sound Cities project will contribute to the underpinnings of future tools for soundscape planning and design, like soundscape maps that provide information on how people perceive the acoustic environment. This is in contrast to present noise maps, which only provide calculated sound-pressure levels from transportation and industry.

Med dagens fokus på prestation och belöning i arbetslivet är det viktigt att framhäva betydelsen av individens egna upplevelser av dessa begrepp. De kan exempelvis operationaliseras i termer av attityd till resultatbaserad lön, självbestämd lön och lönetillfredsställelse, å ena sidan, samt arbetsrelaterad självtillit, kvalitet i det egna arbetet och personligt ansvarstagande för resultat, å andra sidan. Samtidigt behöver vi veta mer om bakomliggande faktorer som påverkar individens upplevelser av prestation och belöning. Sådana bakomliggande faktorer skulle kunna utgöras av individuella skillnader relevanta för just prestation och belöning – exempelvis målorientering och utbildningsnivå. I föreliggande studie klassades respondenter in i fyra typer av målorientering – ospecificerad (OMO), prestationsbaserad (PMO), inlärningsbaserad (IMO), och prestations- och inlärningsbaserad (PIMO) samt två utbildningsnivåer (hög, låg). Tvärsnittsdata (n=626) analyserades med tvåvägs (4x2) MANOVA. Sammanfattat visade resultaten att individer klassade som IMO och PIMO var mer positiva till resultatbaserad lön, hade högre självtillit i arbetet, skattade egna prestationer högre i kvalitet samt tog större ansvar för egna resultat (gällde inte grupperna lågutbildade/PIMO och högutbildade/IMO) jämfört med individer klassade som PMO eller OMO. Effekter av utbildningsnivå observerades endast för lönetillfredsställelse och självbestämd lön där lågutbildade var mer nöjda med sin lön (gällde endast individer klassade som IMO och PIMO) medan högutbildade skulle ta ut en högre lön om de själva fick bestämma. Praktiska konsekvenser av studiens resultat samt förslag på vidare forskning diskuteras.

The present paper argues that recent research on public sector reforms offers few contributions to the body of knowledge on this topic because it adds little to the conclusions drawn during the first generation of research in this area. Although these later studies have often been context-specific and have explored the details of the process of change in some depth, it is rather difficult to compare their results or to make reasoned judgements of the comprehensiveness and centrality of the analysed change. Although most public sector reforms that affect hospitals, schools or social services are initiated and designed by national governments, individual case studies of local administrations often fail to capture the generic traits of nationwide reforms. However, public sector change cannot be approached as if it comprises collections of nominally independent local events. The present paper argues for two new approaches to the study of public sector change: (i) the systematic categorization of the different forms of governmental intervention under study and (ii) analysis of the ways in which these forms of intervention are linked and interact. Based on extensive empirical research, this paper suggests a generic classification of these forms of intervention that can be used in empirical research on comprehensive public sector change. Consequently, five interventions in public sector organizations are suggested, namely political intervention, intervention by laws and regulations, intervention by audit and inspection, intervention by management and intervention by rationalizing professional practice. The model is particularly well suited to the longitudinal analysis of complex public sector reforms. This approach provides a conceptual tool to distinguish between interventions based on different forms of knowledge and to investigate how they are linked to each other vertically and horizontally. We demonstrate the usefulness of the model by analysing two empirical examples of reforms in which a variety of interventions were imposed at the local level, through legislation as well as a spectrum of voluntary measures proposed by government agencies, by national associations for local and regional councils and by other national or regional actors.