There is limited knowledge of cognitive outcome extending beyond 5 years after childhood traumatic brain injury, CTBI. The main objectives of this thesis were to investigate cognitive outcome at 6-14 years after CTBI, and to evaluate if advancements in the neurosurgical care, starting 1992, did influence long-term outcome and early epidemiology. An additional aim was to study the relationship between early brain injury parameters and early functional outcome. Study 1 evaluated cognitive progress during 14 years after CTBI, over three neuropsychological assessments in 8 patients with serious CTBI. Study 2 used patient records to investigate early epidemiology, received rehabilitation and medical follow up in two clinical cohorts, n=82 and n=46, treated neurosurgically for CTBI before and after 1992. An exploratory cluster analysis was applied to analyse the relation between early brain injury severity parameters and early functional outcome. In Study 3, participants in the two cohorts, n=18 and n=23, treated neurosurgically for CTBI before and after 1992, were subject to an extensive neuropsychological assessment, 13 and 6 years after injury, respectively. Assessment results of the two cohorts were compared with each other and with controls. Data were analysed with multivariate analyses of variance. Results and discussion. There were significant long-term cognitive deficits of similar magnitude and character in the two cohorts with CTBI, treated before and after the advancements in neurosurgical care. At 6-14 years after injury, long-term deficits in verbal intellectual and executive functions were found, and were discussed in terms of their late maturation and a decreased executive control over verbal memory-functions after CTBI. Visuospatial functions had a slightly better long-term recovery. The amount of rehabilitation received was equally low in both cohorts. The length of time spent in intensive care and the duration of care in the respirator may have a stronger relationship to early outcome than does a single measure of level of consciousness at admission. Main conclusions are that cognitive deficits are apparent at long-term follow up, 6-13 years after neurosurgically treated CTBI, even after advancements in the neurosurgical care in Sweden. Measures of verbal IQ, verbal memory and executive functions were especially low while visuospatial intellectual functions appear to have a better long-term recovery.

Gender and appearance affect our judgments regarding an individual’s personality, profession, and morality, and create a reference frame within which to act toward that person. The main question of the present thesis is whether these kinds of stereotypical conceptions have implications for the judicial process: how professionals within the judicial process evaluate and judge a defendant, and how and what eyewitnesses remember. Expressed in other words: Is justice blind or do gender and appearances affect the treatment we receive in a judicial process?

The main purpose of the present thesis was to study the effects of gender and attractiveness on evaluations of defendants accused of crimes of varying seriousness and type. The second theme was to study under what circumstances these effects are particularly strong; emotionality, retention interval, as well as gender and profession of evaluators, were controlled for.

Study 1 aimed at investigating “pure” gender and attractiveness effects, with psychology students as participants. Study II added the variable of emotionality, as well as six groups of evaluators. Emotionality was studied by including emotional photographs of crime victim injury as well as two levels of vividness in the written description the evaluator was to read. The evaluators were professionals working within the judicial process in Sweden–judges, jury members, counsels for the defence, prosecutors, and police officers–as well as law students. Study 1 showed that a male defendant was evaluated more negatively than a female. Study II showed two main tendencies: (i) “same-sex penalty effect”: Sentencing evaluators (judges, jurors) evaluated a defendant of their own gender more harshly than one of the opposite gender; (ii) “male penalty effect”: Nonsentencing evaluators (police officers, counsels for the defence, prosecutors, and law students) evaluated and judged a male defendant more harshly than a female. Study III focused on exploring effects of violence (emotionality) and retention interval in the context of gender differences to investigate under which circumstances gender differences might be especially strengthened. Violence was manipulated using two acts: one neutral (walking in a store) and one violent (robbing the same store). Retention interval was of two lengths: 10 minutes and 1-3 weeks. Results revealed a gender-stereotype-enhancement effect, in which the evaluator evaluated the male defendant more harshly with the longer retention interval as well as in the violent act condition. The results of the present studies may have practical implications for the functioning of the judicial process; on the eyewitness hearing level (Study III) as well as on the evidence evaluation-, guilt-, and punishment assessment levels (Studies I and II).

Two experiments were conducted to investigate how sources of information can bias the judicial process. Experiment 1 investigated the effects of photographs of victims’ injury, and of vivid verbal victim injury description, on the evaluation and sentencing of a defendant in a mock criminal trial. The participants were presented with five different crime accounts: (a) vandalism, (b) arson, (c) child abuse, (d) child molestation, and (e) homicide, all committed by male perpetrators, and were asked to evaluate the trustworthiness, culpability, aggressiveness, guilt, and other crime-relevant personality traits of the defendant, and to set imprisonment sentences. Results of Experiment 1 showed that exposure to photographs of crime victim injuries as well as vivid crime descriptions had only weak and non-significant effects on defendant evaluations, but imprisonment terms tended to be longer in the Photo condition than in the No photo condition. To further investigate the possible effects of photographic information on judicial processes for different crimes (child molestation, child abuse, homicide), Experiment 2 was conducted with legal practitioners (judges, members of Swedish juries, law students, counsels for the defence, prosecutors, police officers) as evaluators. Results showed three tendencies: (a) a ‘‘same-sex penalty effect’’: sentencing evaluators (judges, jurors) evaluated a defendant of the same gender as the evaluator, more harshly than one of the opposite gender, (b) a ‘‘male penalty effect’’: non-sentencing evaluators (police officers, counsels for the defence, prosecutors, and law students) evaluated and judged a male defendant more harshly than a female, and (c) for female non-sentencing evaluators, the male penalty effect was enhanced for the more attractive defendants. Overall, the results suggest that defendant gender, defendant appearance, evaluator gender, and evaluator profession can affect the outcome of a criminal trial.

Background: The gender gap for violent offending is narrowing in the general population. Substance abuse and mental health problems are known risk factors for criminality. While substance abuse treatment has been associated with reduced risk of re-offending, women seem less likely to engage than men. People misusing substances tend to be high users of emergency room (ER) services. Such use may be an indicator both of treatment failure for substance misuse and offending. Little is known about gender differences in this respect. Aims: This study aims to test for gender differences in re-offending, use of substance abuse treatment, and hospital ER visits among offenders referred for forensic psychiatric assessment in Sweden. Method: The study used a longitudinal retrospective design. Data on all 31 women from a 2-year (2000–2001) cohort of serious offenders referred for forensic psychiatric assessment in Stockholm county, and 31 men from the same cohort, were extracted from forensic service and national records. Selection of the men was by initial random sampling followed by matching on age and substance misuse. The two resulting samples were compared on health service use and re-offending data between release and the census date (30 April 2004). Results: There were no gender differences for violent re-offending or for engagement in planned substance abuse treatment, in spite of longer time at risk for the men. Re-offending was reduced for women but not men who did not present in the ER with physical health problems. Conclusions: Our study is limited by sample size, although it included all women referred to the specialist forensic psychiatric service over 2 years, but it does indicate that differences between men and women in this situation are likely, and worthy of further study. The only way of achieving adequate sample sizes is likely to be through multi-centre collaboration.

Research suggests that visual impressions of natural compared with urban environments facilitate recovery after psychological stress. To test whether auditory stimulation has similar effects, 40 subjects were exposed to sounds from nature or noisy environments after a stressful mental arithmetic task. Skin conductance level (SCL) was used to index sympathetic activation, and high frequency heart rate variability (HF HRV) was used to index parasympathetic activation. Although HF HRV showed no effects, SCL recovery tended to be faster during natural sound than noisy environments. These results suggest that nature sounds facilitate recovery from sympathetic activation after a psychological stressor.

Det är angeläget att finna metoder för att förebygga psykisk ohälsa hos barn. Det finns tecken på att psykisk ohälsa hos barn kan ha ökat under de senaste decennierna och strukturerade insatser för att komma till rätta med problemen blir allt vanligare såväl inom kommunal verksamhet som inom hälso- och sjukvård. Interventionen utgörs av så kallade program som är standardiserade och finns beskrivna i manual eller motsvarande. Här sammanfattas det vetenskapliga underlaget för två typer av program: dels de som främst syftar till att förebygga utagerande beteenden hos barn och ungdomar, dels de som i första hand syftar till att förebygga inåtvända problem som ångest, depression och självskadebeteende. Program som har en allmänt hälsobefrämjande effekt, t ex för att förebygga drogmissbruk och våldshandlingar ingår följaktligen inte. Programmen är avsedda att ha effekt, inte bara direkt efter att programmet har avslutats utan även i framtiden. Rapporten har tagits fram på förfrågan av Kungliga Vetenskapsakademien och UPP-centrum (Utvecklingscentrum för barns psykiska hälsa) vid Socialstyrelsen. Båda har efterfrågat en systematisk litteraturöversikt för att klarlägga nyttan med att använda program för att förebygga psykisk ohälsa hos barn. Slutsatser:

- Av 33 bedömda standardiserade och strukturerade insatser (program) som syftar till att förebygga psykisk ohälsa hos barn har sju ett begränsat vetenskapligt stöd i den internationella litteraturen. Det är föräldrastödsprogrammen Incredible Years och Triple P, familjestödsprogrammet Family Check-Up samt skolprogrammen Good Behavior Game, Coping Power, Coping with Stress och FRIENDS. Effekterna är med få undantag små. Studierna är utförda i andra länder. Eftersom effekterna sannolikt varierar med sociala och kulturella sammanhang är det oklart i vilken utsträckning som programmen kan överföras till Sverige med bibehållen effekt. Programmen kan också behöva anpassas så att de överensstämmer med svenska värderingar och syn på barns rätt.

- I Sverige används ett hundratal olika program för att förebygga psykisk ohälsa hos barn, i huvudsak av utagerande typ. Inget av dem har utvärderats i Sverige i randomiserade studier med minst sex månaders uppföljning. Programmen De otroliga åren (översatt från Incredible Years), Triple P och Family Check-Up har enligt internationella studier begränsat vetenskapligt stöd för förebyggande effekt. Programmen KOMET, COPE, SET, StegVis, Beardslees familjeintervention, Connect och DISA har undersökts i minst en kontrollerad studie vardera men har inte tillräckligt vetenskapligt stöd för förebyggande effekt. Övriga program som används i Sverige är inte vetenskapligt utprövade som preventionsprogram.

- Program som bygger på att ungdomar med utagerande problem träffas i grupp kan öka risken för normbrytande beteenden. Andra negativa effekter för såväl program för utagerande som för inåtvända problem är tänkbara men ofullständigt belysta.

- Det behövs randomiserade studier som undersöker om de program som används har förebyggande effekt i svenska populationer och inte medför risker. Det behövs också hälsoekonomiska studier som undersöker om programmen är kostnadseffektiva.

Studiens övergripande syfte var att undersöka arbetsförhållanden som är förknippade med ackumulering av stress och bristande återhämtning och att studera hur återhämtning är relaterat till hälsoaspekter. Studiegruppen var anställda inom förskola, hemtjänst och socialtjänst och kom från två relativt stora kommuner (n = 193). Återhämtning eller brist på återhämtning antogs vara en betydelsefull förmedlande länk mellan arbetsvillkor och hälsa/ohälsa och sjukfrånvaro. Datainsamling skedde genom en enkät och den totala svarsfrekvensen var 79 %. En klusteranalys gav tre kluster "Återhämtade“ och “Ej återhämtade“ är yttergrupper, som omfattar 36 respektive 25 procent av totalgruppen medan mellangruppen utgjorde 39 procent. Gruppen ej återhämtade får ses som en riskgrupp för ohälsa. Gruppen uppvisar hela kedjan av riskfaktorer - problematiska arbetsvillkor på vilka de svarar med ökad ansträngning och kompenserande strategier. Trots betydligt högre ohälsorapportering har de inte högre sjukfrånvaro, vilket sannolikt hör samman med att de ersätter sjukfrånvaro med sjuknärvaro. I socialtjänsten är det hela 43 procent som tillhör den ej återhämtade gruppen. Regressionsanalyser med kontroll för bakgrundsvariabler visar att den icke återhämtade gruppen hade en signifikant högre relativ risk för sämre självskattad hälsa än personer i den återhämtade gruppen. Ännu kraftigare riskökningar fanns för de fem symtom som därutöver analyserades. Avslutningsvis diskuteras praktiska slutsatser och nya forskningsfrågor.

Purpose – The aim of this paper is to investigate which work- and private life factors are associated with long-term health, operationalized as low sickness absence and low sickness presence. Design/methodology/approach – A representative sample of 2,297 individuals responded to a questionnaire on two occasions at an interval of one year. In total, 28 percent were classified as having good long-term health. Findings – Univariate and multivariate analyses showed that some quality-related work environment factors were rather strongly associated with long-term health. For some variables women showed a clear dose-response pattern on the three-level scale alternatives in relation to health, while men had a more asymmetric response pattern. The results are discussed in relation to the symmetry in the work environment factors, i.e. if there are different factors that explain health and illness. Practical implications – Issues concerning health and health-enhancing factors are of considerable interest to practitioners concerned with management issues, organizational structure, and rehabilitation. Originality/value – The paper shows the importance of including a positive health variable within the health research paradigm to supplement the dominance of variables focusing on illness and disease.

Our findings show that sleep deprived people appear less healthy, less attractive, and more tired compared with when they are well rested. This suggests that humans are sensitive to sleep related facial cues, with potential implications for social and clinical judgments and behaviour. Studies are warranted for understanding how these effects may affect clinical decision making and can add knowledge with direct implications in a medical context.

Over the last years, soundscape research has increased strongly and with this also the need for sharing ideas regarding methods of data collection, procedures and evaluation. We present two soundscape studies, conducted in residential areas. The measurements are based on general practice in perception psychology, psychophysics and sensory evaluation. The first study measured overall soundscape quality in order to investigate necessary actions to improve the soundscape. The second study measured if the restoration of a courtyard will meet preset objectives for soundscape improvement. We present useful soundscape metrics and indicators. We discuss our particular research procedures and their implications for soundscape research and practice. We conclude that perception psychology, psychophysics, and sensory evaluation provide the design tools necessary for soundscape improvement.

In 2008 the International Organization for Standardization (ISO) decided to put together a new expert working group ISO/TC 43/SC 1/WG 54 named “Perceptual assessment of soundscape quality”. The scope of the working group is to provide minimum specifications for soundscape studies, by proposing (a) new international standard(s) on how to measure the perceived quality of soundscapes. This work is chiefly motivated by a need to harmonise methods in soundscape research internationally in order to improve the comparability of research results across countries and over time. The standard(s) developed by this working group will primarily be intended for researchers assessing perceived soundscape quality and for public users evaluating soundscape quality in different areas. The standard(s) will include definitions, methods, measurements and reporting requirements. Examples of applications may include visitor questionnaire studies in outdoor areas intended for recreation (e.g., city parks or open green spaces), or resident questionnaire studies in residential areas, including areas with designated places of high sound quality. In the ISO terminology this is a preliminary working item, which means that there are no time restrictions until the group has put forward its first formal proposal. The working group plan to do this in 2011.

Soundscape management is urgently needed in developing countries. Take for example Lima, the capital of Peru. Because people have moved to cities to seek a better life and to work in the growing industrial sector, Lima’s population has grown rapidly since the 1960’s, to reach 8.5 million in 2007 (30 % of Peru’s population). Public transport in Lima is by road vehicles rather than by trams and trains. Apart from chemical air pollution and particulate matter, noise pollution increases intensely with the ever-increasing number of vehicles (on average 3.7 % per year). Current developments are all but sustainable, and Lima city urgently needs to implement efficient noise-abatement strategies to control noise emissions and immissions. Soundscape management would be able to provide high acoustic quality. Thus, urban planning and environmental management have to be creatively developed.

Sound source identification is typically the first step in a soundscape study. For comparability, a standardized sound source taxonomy and data collection methods are needed. Sound sources typically form three main categories: technological, human and natural sounds (e.g., road traffic, voices, and singing birds). These categories are meaningfully related to emotional responses to soundscapes. Technological sounds are typically judged unpleasant, natural sounds pleasant, whereas human sounds are eventful. Based on our empirical results we discuss how detailed a sound source taxonomy needs to be. We illustrate and conclude, it must state basic principles for how to categorize sound sources, and include clear examples without aiming to be exhaustive. Although standardized, related data collection methods must be flexible and allow adaption to unforeseen circumstances.

There is a need for a model that identifies underlying dimensions of soundscape perception, and which may guide measurement and improvement of soundscape quality. With the purpose to develop such a model, a listening experiment was conducted. One hundred listeners measured 50 excerpts of binaural recordings of urban outdoor soundscapes on 116 attribute scales. The average attribute scale values were subjected to principal components analysis, resulting in three components: Pleasantness, eventfulness, and familiarity, explaining 50, 18 and 6% of the total variance, respectively. The principal-component scores were correlated with physical soundscape properties, including categories of dominant sounds and acoustic variables. Soundscape excerpts dominated by technological sounds were found to be unpleasant, whereas soundscape excerpts dominated by natural sounds were pleasant, and soundscape excerpts dominated by human sounds were eventful. These relationships remained after controlling for the overall soundscape loudness (Zwicker’s N10), which shows that ‘informational’ properties are substantial contributors to the perception of soundscape. The proposed principal components model provides a framework for future soundscape research and practice. In particular, it suggests which basic dimensions are necessary to measure, how to measure them by a defined set of attribute scales, and how to promote high-quality soundscapes.

Background and aims: The association between type 2 diabetes and different forms of cognitive impairment is well established. The mechanism behind the association is however still unrevealed. We have recently reported that raised blood glucose levels were associated to impairment in episodic memory, the memory function first affected in the progress to dementia. However, patients with type 2 diabetes have not only elevated levels of blood glucose, but also increased levels of insulin because of insulin resistance. It has been suggested that insulin itself might have a negative effect on cognitive function and memory. Diabetes is associated with a long standing hyperglycaemia but also with hypertension and hyperlipideima, leading to micro and macro vascular disease. Thus, our aim was to study whether insulin affects episodic memory independently of glucose in a nondiabetic adult population.

Materials and methods: We linked and matched two large population based data sets in Sweden, the Betula study and the Västerbotten Intervention Program. We identified 364 (F/M 207/157, mean age 50.5 ±8.0 years) nondiabetic subjects, free from dementia, who had participated in the two surveys within six months. The memory test included testing of episodic memory. We transformed the results using the mean values and standard deviation from the youngest age group to compute a composite z-score (subjects’ value minus mean score in the 40-year-old group divided by SD). Fasting plasma insulin (FPI) and glucose (FPG) were analyzed with standard methods.

Results: Women had higher levels of episodic memory (mean z-score -0.06, SD 0.54) compared to men (mean z-score -0.36, SD 0.51, p<0.001). Given the sex difference in the outcome variable we stratified for sex. In a univariate linear regression both FPG (B -0.274, SE 0.068, Beta -0.271, p<0.001) and FPI (B -0.389, SE 0.131, Beta -0.204, p=0.003) were significantly associated with episodic memory in women but not in men. FPG, but not FPI, remained significantly associated with episodic memory after adjustment for hypertension, total P-cholesterol, bodymass index, educational level, depression, smoking and cardiovascular disease ( FPG: B -0.218, SE 0.070, Beta -0.220, p=0.002; FPI: B -0.232, SE 0.149, Beta -0.127, p=n.s.), when FPG and FPI were analyzed separately. Entering both FPG and FPI into the regression model did not attenuate the association between FPG and episodic memory (FPG: B -0.204, SE 0.071, Beta -0.206, p=0.005).

Conclusion: We conclude that an increase in plasma glucose, but not plasma insulin, is associated with impairment in episodic memory in women. This could be explained by a negative effect on the hippocampus caused by raised plasma glucose levels.

The public sectors in many developing countries have undergone major restructuring over the past decades. Earlier research suggests that such restructuring is inherently linked to feelings of ambiguity and insecurity among employees, undermining behavioral support for change, and thus, chances of change success. Using survey data from a restructured public sector organization in Pakistan, this study investigated the mediating role of commitment to change on the relationship between role ambiguity/job insecurity and behavioral support for change. The results show that role ambiguity and job insecurity were negatively related to both commitment to change and behavioral support for change. More importantly, however, the results support the notion that the negative effects of role ambiguity and job insecurity on behavioral support for change are fully mediated by individuals’ commitment to change. The study emphasizes the importance of mobilizing commitment to change in restructuring processes.

Unions frequently restructure through merger, most often in the form of absorptions involving one bigger union absorbing a smaller one. However, the individual-level effects of merger resulting in big amorphous organisations remain unclear. In this article, we highlight the role of the individual member in union absorptions, and investigate the relative importance of being a member of a large absorbing union or a small absorbed union, as well as the attitude of members towards merger in predicting post-merger member attachment. The results from longitudinal data before and after absorption showed that members’ attitude towards merger significantly predicted the members’ attachment levels after absorption—this was, however, not the case for union commitment. We also uncovered a significant interaction indicating that the effect of members’ attitude towards merger was more strongly related to perceptions of union support and instrumentality among members of the absorbed union.

Hur påverkar styrformer som kundstyrning och ekonomistyrning  arbetet i välfärdssektorn och relationerna mellan de anställda och deras kunder, det vill säga  klienter, elever eller patienter? I kapitlet beskrivs hur ett antal läkare resonerar om hur yrkesroll och arbetssätt förändrats mot bakgrund av nya styrpraktiker i sjukvården. Vi försöker överbrygga det gap som finns mellan organisationsforskning som behandlar styrning av organisationer och arbetslivsforskning som fokuserar på konsekvenser av olika förutsättningar i arbetet.

Integrating data at the macro-level, such as changes in the labour market, data at the meso-level such as phenomena in organisations and workplaces, and data at the micro-level such as individual’s working conditions and health is indeed a complex matter. A single study alone can seldom work out the problems of generalisation, hypothesis testing, and a deeper understanding of new as well as previously known occurrences and processes within the realm of complex systems.

The authors of this chapter present some experiences of integrating data at several levels. Some of these experiences emanate from the chapters presented in this book, while others are from other projects. Methodologies based on a quantitative approach as well as experiences of using qualitative methods are presented.

It has been suggested that the relation between personality and prejudice varies as a function of identity salience but previous empirical results are not conclusive. Extending previous research, we conducted an experimental study (N = 122) with pre- and post-manipulation measures of personality, and a postmanipulation measurement of prejudice, under conditions of control (no identity manipulation), personal or national identity. The results revealed no differences in the magnitude of the personality–prejudice correlations across conditions, neither for the pre- nor post-manipulation scores. Correlations based on pre- and post-manipulation variables, within each condition, did not differ significantly either. This indicates that neither prejudice nor personality variables were affected by identity salience. Thus, the study provides no support for the contention that the personality–prejudice relation varies as a function of social identity.

'Measuring the Impossible' (MtI) refers to recent innovative research activities related to the measurement of quantities and qualities that are dependent on human perception and/or interpretation. Its interdisciplinary nature interconnects various monodisciplinary research areas; physics, physiology, mental part of psychology, and (overt behavioral sciences. These four also depict the different aspects of inner and outer psychophysics. Outer psychophysics regards physiological and mental processing as a combined 'black box' within which no measurement is performed. A key question within MtI and in inner psychophysics is how to explicate the mental or psychophysiological processes taking place within the 'black box' and this is cardinal to developing new theories and methods of measurement. To accomplish this, we argue that the two traditional Bottom-Up and Top-Down approaches have to be integrated into a dual-directional Research Strategy Loop involving complex communication systems beyond the straight-forward psychophysical relationship.