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Background: Due to the increasing ageing population worldwide, humanity is facing global demographic challenges. For many people, their later years are often lived with changed functioning and the need for support in daily living activities. Assistive technology and welfare technology (AT/WT) constitute a partial solution to the demographic challenges. Objectives: The purpose of this literature review is to identify the policy features, such as decision models and guidance for the provision of AT/WT as reported in the current scientific literature. Methods: A literature review with a deductive approach using the structure of the Global Cooperation on Assistive Technology (GATE) model was conducted. The data were searched from the databases: PubMed, Cinahl Plus, and the Web of Science, resulting in nine included articles. Results: The findings are presented according to the structure of the eight domains from the GATE model— policy, assessment, procurement, technology, environment, usability, sustainability and rights— which are further grouped into categories exploring the variations in every domain. Conclusion: The review reveals a nascent and growing interest in the area; however, evidence-based decision models and other guidance on AT/WT are lacking. Recent scholarships and policy reforms can form the basis of stronger guidance to organise complex AT/WT systems, but further and future research is needed.

This study evaluates a multifactorial school-based intervention with the aim of decreasing cardiometabolic risk factors by means of a healthy lifestyle, primarily with daily physical activity and healthy food during school hours, at an upper secondary school for students with intellectual disabilities. The outcome is measured in terms of cardiometabolic risk factors and cardiovascular fitness, both known to increase the risk of future cardiovascular disease, type 2 diabetes and cancer. Two years of intervention resulted in a positive trend in several measured cardiometabolic risk factors, with no increase in fat mass. Cardiovascular fitness levels were unchanged. We conclude that a healthy school environment can contribute to a deceleration of both fat mass gain and loss of cardiovascular fitness.

The aim of the pilot study was to explore the re­actions of individuals with dementia to an interactive robotic cat and their relatives’ and professional caregivers’ experiences regarding its usability, function, and effects. Method The pilot study had an inter­vention, mixed-methods design¹ and was conduct­ed in two stages. A quantitative single-case study² including individuals with demen­tia, and a qualitative interview study³, including rela­tives and professional caregivers, were conducted. JustoCat® is an inter­active robotic pet developed using reminiscence therapy as a frame­work⁴. The development of JustoCat is based on promising work with the robotic seal, PARO^5,6. However, the inventors of JustoCat assumed that a seal would not appeal in reminiscence therapy, a robotic cat was supposed appeal to individuals’ memories of cats. There was also the idea of downscaled, advanced tech­nology based on the hypothesis of a robotic cat’s functional reliability and lower cost. The construction of JustoCat (e.g., easy-to-change fur facilitating personalized use, wash­able fur) was developed following Swedish hygiene routines required in nursing homes and hospital set­tings. Results & Discussion In the Western world, the majority of individuals with dementia spend the last part of their lives in nursing homes or dementia care homes. Some individuals with dementia could increase their well-being with different thera­pies, for example massage, singing, music or by the company of pets. The current pilot study of four individuals with dementia and their relatives and professional caregivers showed interesting results. First, living with severe dementia is a situa­tion with ups and downs concerning quality of life and agitated behavior, as presented in the single-case study design. Second, the analysis of the interviews shows the positive effects of the robotic cat providing stimu­lation, comfort, and peace to indi­viduals living with dementia. Third, professional caregivers and relatives found the robotic cat to be a useful, reliable, and multifunctional tool in their relationships with the partici­pants⁶.

The current study aimed to explore (a) reactions of individuals with dementia to an interactive robotic cat and their relatives’ and professional caregivers’ experiences, and (b) to measure usability in developing the care/treatment of individuals with dementia using interactive robotic pets. An intervention design in a pilot study using mixed methods was conducted in two stages: a quantitative single-case study (n = 4) and a qualitative interview study (n = 14). Results indicated less agitated behavior and better quality of life for individuals with dementia. Interviews showed positive effects by providing increased interaction, communication, stimulation, relaxation, peace, and comfort to individuals with dementia. The tested interactive robotic cat was also considered easy to use. There is an increased need for alternative/complementary forms of care to meet an increasing number of individuals with dementia. For some individuals with dementia, an interactive robot, such as a robotic cat, can increase well-being and quality of life.

The aims of this study were to explore the intended meaning of the terms "occupation", "activity", "doing", and "task" used in international occupational therapy literature and from this perspective explore which Swedish terms best capture these meanings. A literature review of occupational therapy-related journals was performed to gain a basic understanding of the term occupation and related terms. In addition, a semantic review was used: English and Swedish dictionaries were reviewed to explore the semantic meaning of the English terms "occupation", "activity", "doing", and "task", and the Swedish terms "aktivitet", "syssla/sysselsättning", "görande", and "uppgift". A comparison was also performed by searching for parallels between the results of the literature review, the semantic definitions of the English and Swedish terms and the comprehensive meaning of the Swedish terms aktivitet and syssla/sysselsättning. An overarching idea of the concept of occupation was found in the literature review and for the purposes of this study we have identified this as Occupation for survival. From this overarching idea, three themes were identified: The feature of occupation, Impact of occupation and Occupation an occupational therapy concept. Each theme could be subdivided into sub-themes. The Swedish term aktivitet was found to have more power, strength, and spirit connected to the synonyms found in the semantic analysis than to those connected with the Swedish term syssla/sysselsättning. According to the findings in this study we found that the term "aktivitet" is the best comparable term in Swedish to the English term "occupation".

This study is the second in a series of studies carried out in Sweden concerning the dimensions of the concept occupation. The specific aim of this study was to explore new and confirm previously found dimensions of the concept of occupation in the context of occupational therapy. Occupational therapy students, a few weeks from their completion of studies, were asked to write down spontaneously what they personally considered to be occupation. Forty-two women and three men, aged between 25 and 33 years, participated. Grounded theory with the constant comparative method was used to analyse the data. A coding scheme of 40 codes was used to compare new data with previously found data concerning the concept of occupation as described by occupational therapy students. Six new codes concerning occupation expanded the dimensions of the concept. Five of those were found within the doing and context dimensions. These codes defined occupation as something that depends on who is performing the occupation and where the occupation is performed. Thus, occupation is not a permanent state but also very much depends on subjective experience. Additional studies with experienced occupational therapists have been planned to further expand these findings and aim to give a stronger foundation to the concept of occupation built on empirical grounds.

Occupational therapy interventions should always be preceded by a needs assessment on which a basis for an intervention and a follow-up evaluation can be formed. The assessment should also be performed systematically using instruments designed for the specific purpose. In occupational therapy, all assessments shall aim for occupation and occupational performance.

The aim of the study was to elucidate selection criteria for need of rehabilitation/occupational therapy, and to state criteria for participation in occupational therapy, among persons with long-term and/or recurrent pain causing activity limitations or restricting participation in daily life. The study involved 914 persons aged 18-58 years who answered a postal questionnaire concerning demography, pain, occupations in daily life, work, treatments and health care staff visited. The direct method in logistic regression analysis was used to test two models: (1) need of rehabilitation/occupational therapy and (2) participation in occupational therapy. The results for the first model revealed the selection criteria (1) 'feelings of irresolution', (2) 'gnawing/searing pain' and (3) 'use of technical aids'. The odds for need of rehabilitation/occupational therapy were higher for women than for men. The criteria derived from the second model, participation in occupational therapy, were whether (1) the participants had 'used tricks and/or compensated ways to perform tasks', (2) the participants had 'pain in shoulders' and (3) 'changes had been made at work due to health conditions'.

The overall aim of this thesis was to describe (1) needs for occupational therapy among persons with self-perceived activity limitations and/or participation restrictions due to long-term/recurrent pain, and (2) treatment interventions in occupational therapy to meet demonstrated needs. The Liss’ model for assessing health care needs was used as a structural scheme. A randomly selected sample (n=10,000) from the Swedish general population aged 18-58 years was the foundation for the study population with and without pain. In addition, occupational therapists were included (n=109). Data collection was made by postal questionnaires. The results showed a prevalence of 26 % and an incidence rate of 0.07. Demographic characteristics of the sample were female gender, ages 40-58 years and fewer years of education than those without pain. Pain in shoulders/lower back of searing/aching/gnawing character was the most frequently reported. A majority of the respondents reported affective/emo-tional effects of pain mainly of depressive character and they had previously been on sick leave due to pain. Women reported higher frequencies of self-perceived activity limitations/ participation restrictions due to pain, more difficulties with intermediate ADL, perceived higher job demands and had longer sick leave than men. Men perceived poorer social support than did women. Needs for occupational therapy were reported mainly as a consequence of activity and temporal imbalance. High health care consumers reported higher frequencies of needs/problems than did low health care consumers. The main goals and interventions suggested by occupational therapists to meet the needs in pain management focused on increased knowledge of handling daily occupations with the purpose to reduce pain, maintain competence/improve performance of home maintenance, reduce consequences of pain and increase knowledge how to handle effects of pain.

AIMS: The aim of the work presented here was to explore differences between pet owners and non-pet-owners concerning aspects of health, physical/leisure activities, work and socio-demographics. METHODS: The study was based on nationally representative data from the Swedish population (n = 43,589). Associations between pet ownership and background variables were investigated using logistic regression analysis. RESULTS: A total of 39,995 respondents were included in the analysis (non-pet-owners = 25,006; pet owners = 14,989). Pet ownership was associated with both positive and negative aspects of health, physical/leisure activities and socio-demographics. Pet owners had better general health but suffered more from mental health problems than non-pet-owners. Their leisure activities involved a greater interest in nature life and/or gardening than those of non-pet-owners. The logistic regression analysis showed that people who were self-employed, in the age range 35 to 49, of female sex, and suffering from pain in the head, neck and shoulders were more likely to own a pet than others. People physically active at a level sufficient to have a positive effect on their health more often owned a pet than people who were less active. CONCLUSIONS: Pet owners differ from non-pet-owners in aspects of socio-demographics, health, physical/leisure activities and work situation. This study, based on a general regional population in Sweden, showed differences of both a positive and a negative kind between non-pet-owners and pet owners concerning aspects of health, physical and leisure activities, and work situation.

The aim of this study was to describe the prevalence of pet ownership in adolescents in Sweden and establish whether any gender, age or health-related differences exist between those who own pets and those who do not. In addition, the study aimed to explore the relationships between species of pet, age, gender, and other socio-demographic variables and the perceived importance of pets. Three age groups (13–14 years-old, 15–16 years-old, and 17–18 years-old) of adolescents, resident in a single county in Sweden, were surveyed using the questionnaire “Liv och Hälsa Ung” (“Youth Life and Health”). A total of 8,709 respondents were included in the analysis (pet owners = 5,793; non-pet owners = 2,916). Associations between importance of the pet and demographic variables and general self-rated health were investigated using logistic regression analysis. The prevalence of pet owners in the sample was 65%, and the most common types of pets were, in descending order of popularity, cats, dogs, rodents, fish/reptiles, and horses. Most of the pet owners said their pets were very or quite important to them, for the three age groups (73.1–88.6%). In general, pets were more important for the female respondents. Importance was dependent on type of pet, with male and female dog owners and female horse owners rating their pets as more important than the owners of other species of pet. Respondents who did not own a pet were more physically active than their pet- owning peers. Pet owners with the best self-rated health also attributed the greatest importance to their pet. However, adolescents with pets reported more psychological problems and somatic health aspects than those who did not own pets. This finding calls for further studies to be conducted, with designs allowing causal conclusions to be drawn.

The aim of this study was to describe the prevalence of creative activities in occupational therapy in Sweden and how often Swedish occupational therapists use creative activities as a means of intervention. A web-mail survey was sent to 2975 Swedish occupational therapists working in health care at regional, county council or primary health care level, and those working in vocational rehabilitation. A total of 1867 (63%) answered the questionnaire and showed that 44% did use creative activities as a means of intervention and most often by practitioners working in psychiatric health care. The most commonly used form of creative activity was arts and crafts followed by gardening. This web-mail survey was based on a limited amount of items regarding creative activities. Further research should focus on in-depth inquiries about how occupational therapists and their patients perceive the use of creative activities as a means of treatment in occupational therapy. Copyright (c) 2012 John Wiley & Sons, Ltd.

The aim of this study was to continue the process of exploring and understanding the concept of occupation in a Swedish occupational therapy context and from an expert perspective. Thirteen eligible occupational therapists active in Sweden, all academically skilled and who had published articles concerning the concept of occupation or activity, were invited to take part in the study. Eight were willing to participate representing different parts of Sweden. A three-round Delphi study was conducted in which the participants reflected on 46 statements derived from a core category and five categories concerning the concept of occupation, extracted from previous studies in this project. The participants gave 124 comments on 44 of the 46 statements. Results revealed new statements, mainly concerning the intentional aspect of occupation and occupation in a structural hierarchy. Comments also contributed with rephrased statements promoting clarity. A total of 54 statements were then ranked on a four-point Likert scale of which 47 reached consensus among participants. Seven statements were not supported to a level of consensus. Four of them dealt with how and if values and individual judgements influence what are viewed as occupations. To continue the developing process, studies in occupational therapy praxis have to be performed.

A core assumption in occupational therapy is that occupation enhances health. This study is one of a series of planned studies carried out in Sweden, with the overall aim to develop a theory, based on empirical grounds, concerning the dimensions of occupation that may be useful in occupational therapy. The specific aim for this study is to examine the dimensions of occupation as generally understood among novice occupational therapy students. Grounded Theory was the chosen method. Data were collected among occupational therapy students. The students wrote down spontaneously what they considered to be included in activity. A preliminary core category "The what, why, and how of occupation" and five other categories emerged from the analysis: (1) The doing and context of occupation; (2) Motive for occupation; (3) Time and place for occupation; (4) Type of participation; and (5) Outcome of occupation. Relationships between the categories were established between the Motive for occupation and Outcome of occupation, which constitute a kind of prerequisite for occupation. The three remaining categories: The doing and context of occupation, Time and place for occupation, and Type of participation established a form for occupation. In conclusion, the study results illuminated the richness of the concept of occupation and support the core assumption in occupational therapy that occupation enhances health.

Needs assessment may be helpful in establishing health care priorities, especially when community financial resources are reduced and the need and demand for health services are increasing. As the starting point of empirical studies concerning needs assessment of rehabilitation and occupational therapy, this study aimed to establish the prevalence of self-perceived activity limitation and/or participation restrictions due to long-term or recurrent pain. The study sample (n = 10000) was taken at random from the Swedish population aged 18-58 years. After three reminders, the response rate to a postal questionnaire was 77.1%, by mail or to a telephone answering machine. The main results indicated prevalence frequencies of 26%, showing the actual state of self-perceived activity limitation and/or participation restrictions due to long-term and/or recurrent pain. Differences were found between genders, among almost all age-classes and between persons who had pain currently and those who had had pain previously. Suggested indicators from the study result were women born between 1940 and 1949 with long-term pain and previous pain.

When community financial resources are reduced and need and demand for health services are increasing, needs assessment inrehabilitation/occupational therapy (OT) becomes an issue of priority. The aims of this study were, through an analysis of 39 relevant articles and11 textbooks: (1) to identify concept about how needs assessment should be conducted and (2) to compare these results with an analysis of how they have been conducted in practice. The review indicated four main approaches, including different elements of research: design, source, data collection, and data analysis. All the elements could be combined independently in different ways. Five of the articles explicitly studied occupational therapy and one rehabilitation. The areas most frequently assessed concerned persons with mental illness (25%) and physical disabilities (21%). Most of the studies were conducted with survey-designs (81%), the main sources being patients (57%) and key-informants (36%). In 26% of the studies, several sources were used and in 33% several methods of data collection. This multiple approach is recommended as a check that the data are reliable. The ways of collecting data most frequently used, however, were questionnaires (57%) and interviews (46%). Descriptive statistics (82%) were mostly used for analysis. The possible ways of conducting needs assessment in rehabilitation/OT were not fully used in the empirical studies. The field scarcity of articles concerning needs assessment in occupational therapy indicates that this field has evidently not yet been fully explored.

The purposes of this study were to describe the needs for occupational therapy among people of working age with long-term pain, and to describe treatment interventions based on these assessments. Occupational therapists working in primary health care and/or with special interest in pain management (n=109) assessed 113 people aged 18-58 years with long-term pain with the Occupational Therapy Needs Assessment--Pain (OTNA--P) questionnaire. The occupational therapists recommended treatment interventions where appropriate. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and stress management' and behavioural' interventions. Significant correlations were found between the assessed needs and the suggested interventions. The results of this study could assist in developing guidelines for practitioners working in occupational therapy pain management programmes. It is recommended that further research is done on the effectiveness of occupational therapy interventions with patients with long-term pain.

PURPOSE: The purpose of the study was to elicit the actual state of self-perceived experience of long-term and/or recurrent pain and its effects as reported by women and men with disabilities due to pain, in order to determine criteria for assessing the need for measures in rehabilitation/occupational therapy. METHODS: The study used a comparative design with a sample randomized from the Swedish population aged 18-58 years (n = 10,000). The inclusion criterion was that the respondents had or had had pain causing activity limitation or restricting participation in daily life. A special questionnaire including items concerning demography, pain, coping, occupations in daily life, work, treatments, care institutions and hospital/care staff visited, was posted to 1,849 persons and was answered by 1,448 respondents (study group n = 1,305, control group n= 117). Results: Gender differences were found in the overall prevalence of pain, women reporting more frequent episodes of pain than men did. Differences were also found in pain variables, in daily occupations, days of sick-leave and work variables. Women completed more varied treatment than men. The incidence rate of long-term/recurrent pain in the population studied was 0.07. Conclusions: As a conclusion from this study, three essential components are suggested for use when assessing the need for rehabilitation/occupational therapy: (1) shoulder/arm or lower back pain of aching, tensed and/or searing character, particularly among women; (2) emotional/affective pain effects causing restlessness and depression, particularly among women; and (3) limitations in daily occupations assessed by FSQ and the demand/control/support model with results falling within the warning zones plus long sick-leave periods.

Dispersed ethnic populations believe their health to be worse than the ethnic majority group in Sweden. Most studies in rehabilitation exclude dispersed ethnic populations who can not read or speak the national language although this group seems to be in need of rehabilitation to a larger extent than privileged majority groups. The aim of the study was to examine the experience of living with musculoskeletal pain and experience of health care among dispersed ethnic populations of Muslim women. The method used was inspired by Grounded Theory in this study. Interviews were made with five first-generation Muslim immigrant women who had come to Sweden via Iraq as refugees. Two interviews were performed with interpreters. A preliminary core category ‘The magnitude of reciprocity’ based on three categories emerged from the analysis: (1) Impact of pain, (2) Managing pain and (3) Facing health care. Chronic pain limited the informants physically and emotionally, as well as impacting on their everyday life. Informants managed their pain primarily through medicine and physical activity, which gave at least temporary relief. Health care providers were perceived as doing their best but experiences of bad meetings were also witnessed. The factors important in achieving a good meeting in this study appeared to be; time, dialogue, honesty and understanding. Communication skills, feelings of being taken seriously and a sense of security were additional factors. Not being properly examined, or offered optimal treatment, not being believed or understood, were all seen as signs of dismissal within health care. The limitations of this study are primarily concerned with language difficulties resulting in various shortcomings. Reciprocal recognition and support connected to the specific life experiences of women that come with forced resettlement from the Muslim world to the European diaspora is a vital part of a holistic approach to pain management.

School nurses meet obese children in their everyday work. Although school nurses acknowledge the importance of getting hold of school children's obesity, they seem to lack strategies enabling them to handle the delicacy of the problem. The aim of this study was to describe how school nurses perceive their work with obese children with support of an action plan. Qualitative in-depth interviews were performed with six school nurses working in a municipality, where an action plan for the work with obese school-age children had been implemented. The transcribed data was analysed by a manifest content analysis. The results showed that the informants perceived having a key role in the obesity work, which they experienced as meaningful, but full of pitfalls. They found themselves suitable for the task, but perceived lacking deeper knowledge about specific modes of work such as motivational conversation. As the task was considered delicate, there were great demands for guidelines, education and cooperation. The action plan served as support for maintaining professional confidence throughout the process, but there was room for improvements.

 Objective: Lack of referral guidelines can cause delayed or even nonexistent rehabilitation for chronic pain patients. Indicators signalling the need for interventions could counteract this delay for pain rehabilitation and thereby prevent deteriorating patient health. This study aimed to explore the indicators of need for pain rehabilitation using a multidisciplinary expert panel working with pain rehabilitation. 

Methods: A three-round Delphi study was conducted with a multidisciplinary expert panel (n=23), each representing one pain rehabilitation unit in Sweden. The expert panel produced indicators, which were then ranked using a four-point Likert scale. 

Results: Twenty multifaceted indicators for pain rehabilitation were identified. A major part concerned patient problems with activity level, catastrophizing, coping, existential problems, fear avoidance, high pain rating, medication, mental health, motivation, no pain relief, pain spread/increase, psychosocial problems combined with activity problems, psychosocial problems, recovery, and reduced physical function. Furthermore, indicators concerned demographic factors, sick leave, situation in primary health care, and work. Finally, tacit knowledge was pointed out as an indicator. The results support previous research but also bring out less quantifiable indicators, such as relying on tacit knowledge while assessing a patient’s need for rehabilitation.

Conclusion: The indicators for pain rehabilitation were comprehensive, pointing out that needs assessment is complex. Despite reaching consensus on 19 out of 20 indicators, further research is needed to deepen knowledge in this area and to secure a fair assessment of a patient’s need for pain rehabilitation.

Aim.  This paper reports a study that aimed to advance the understanding of needs related to chronic pain management by describing these needs as they are experienced by people living with chronic pain.

Methods.  Data during 2008 were collected by interviews with ten Swedish adults living with musculoskeletal chronic pain and analysed using thematic content analysis.

Findings.  Three themes were found: Need to handle the painful body and the eager mind, need for transformation of self-image, and need for affirmation through communion and enjoyment. The first theme describes how the body and mind are in conflict with each other and how participants constantly have to weigh the consequences of their actions. The second highlights the need to let go of a former self and to discover a new self. The third illustrates the participants’ needs for social engagement and for performance of valued occupations that provide hope and support.

Conclusions.  Findings show that participants experience internal needs, and they also have needs that can only be met through interaction with the surrounding context. Furthermore, findings show that some of the experienced needs can create inner conflict because they can be contradictory.

Relevance to clinical practice.  Findings from this study provide health care professionals with information about how patients with chronic pain experience needs. In turn, this can constitute a base that to enable evaluation of how closely the patients’ experiences of need correspond to the interventions that health care in general provides this group of patients. Patients should be supported to manage their possibly incompatible needs and to prioritise occupations that generate energy and satisfaction.

Bakgrund: Konsekvenserna av att leva med långvarig smärta leder till att många patienter behöver rehabilitering. I rehabilitering ingår ofta arbetsterapi där activity pacing färdigheter lärs ut och diskuteras. Activity pacing är en flexibel strategi som används för att hantera ADL. Som begrepp har activity pacing studerats men det saknas studier som undersökt activity pacing som intervention ur ett kliniskt perspektiv hos personer med långvarig smärta. Syfte: Undersöka hur en intervention med activity pacing påverkar aktivitetsutförande, tillfredsställelse med aktivitetsutförande, behov av arbetsterapi och activity pacing färdigheter hos patienter med långvarig smärta. Metod: En grupp på 11 patienter med långvarig smärta deltog under tolv veckor i studien som hade en single-case, ABA design. De deltog alla i ett rehabiliteringsprogram vid en universitetsklinik och gick där under våren 2008 rehabiliteringskursen ”Balans i aktivitet” där activity pacing var den huvudsakliga interventionen. Primärt utfallsmått var Canadian Occupational Performance Measure. Sekundära utfallsmått var Occupational Therapy Needs Assessment Pain Patient samt frågor om activity pacing färdigheter. Data kommer att analyseras genom typisk single-case visuell inspektion och statistiska metoder. Förväntat resultat: Resultatet kommer att visa hur de olika utfallsmåtten ffa aktivitetsutförande och tillfredsställelse med aktivitetsutförandet (COPM) förändras över tid samtidigt som den arbetsterapeutiska interventionen med activity pacing har utförts. Konklusion: Studien bidrar med detaljerad kunskap om hur aktivitetsutförandet förändras över tid, när och om någon effekt uppstår och hur effekten bibehålls efter att interventionen avslutats.

This study explores occupational therapists' (OT) perceptions of indicators for occupational therapy interventions among patients with chronic pain. An exploratory design was applied to six focus groups of OTs (n = 25) for data collection. Analysis was performed using content analysis through identification of meaning units, codes, categories and themes. Limitations of occupational performance was a major theme that included participant restrictions caused by physical, emotional and environmental barriers. Five subthemes of need were identified: 1) pain behaviour that prevented engagement in activities; 2) lack of knowledge about pain mechanisms and strategies to deal with pain; 3) occupational imbalance in work, leisure and home; 4) emotional stress and depression due to pain; and 5) physical or environmental strain resulting in limitations in occupational performance. Because of the variety and the diverse trends of approaches towards interventions for patients with chronic pain that exist in different cultures and settings, this study should be replicated in other contexts to increase the transferability of the findings. Copyright (c) 2009 John Wiley & Sons, Ltd.

Abstract Adults with intellectual disabilities (IDs) have poor lifestyle-related health compared with the general population. Our aim was to study whether such differences are present already in adolescents. Aim: To compare the prevalence and severity of cardio-metabolic risk factors and cardio-vascular fitness in adolescents with and without IDs. Methods: Intellectual disability (ID) students (n = 66) and non-intellectual disability (non-ID) students from practical (non-ID-p) (n = 34) and theoretical (non-ID-t) (n = 56) programmes were recruited from three upper secondary schools. Anthropometric data, blood pressure, body composition, fasting-insulin, fasting-glucose, fasting-lipids and cardio-vascular fitness were measured. Results: Participants with and without ID differed significantly in the prevalence of cardio-metabolic risk factors with participants with ID having a higher percentage of total fat mass, wider waist circumferences (WCs), lower levels of fat-free mass (FFM), lower bone mineral density (BMD) and higher insulin and homeostasis model assessment of insulin resistance (HOMA) levels and poorer cardio-vascular fitness. The healthiest levels were found in the non-ID-t group compared to the group with ID and the group with non-ID-p in between. Conclusion: The prevalence of cardio-metabolic risk factors and poor cardio-vascular fitness was found to be high in this young population with intellectual disabilities. Measures should be taken to improve the health messages directed towards children and adolescents with intellectual disabilities.

Adolescents with intellectual disabilities (ID) have an increased prevalence of being overweight and having cardiometabolic diseases as adults, in part due to poor eating habits with an inadequate intake of vegetables. The aim of this study was to evaluate whether a multifactorial school intervention using the "Plate Model" results in improved healthy food choices with recommended ≥37.5% of vegetables. Participants with mild/moderate intellectual disabilities from an intervention school (n=27) were compared with controls (n=62) from two other upper secondary schools for students with ID. All were offered a test buffet lunch with meatballs, potatoes, sauce, and eight different vegetables presented in identical bowls. Their servings and food intake were evaluated from digital images and video films. The majority (88%) of the total group filled their plate with ≥37.5% of vegetables. The mean energy intake did not differ between the groups (576kcal (min 196-max 1444)). The intervention participants had a lower intake of fat (21% (SD 6) vs. 24% (SD 7), p=031), a higher intake of carbohydrates (57% (SD 7) vs. 53% (SD 8), p=035), less plate waste (5 (SD 10) grams vs. 25 (SD 43) grams, p=021), and more participants took only one portion (56% vs. 32%, p=039) compared with the control group. The participants from the intervention school made healthier food choices. In this setting, most adolescents with ID ate a sufficient amount of vegetables.

Background: As dispersed ethnic populations in Swedish society expand, the healthcare system need to adapt rehabilitation services according to their needs. The experiences of trauma and forced resettlement have a continuing impact on health and musculoskeletal pain, as well as the intersecting structures that prerequisite the possibilities in the new country. To understand the specific needs of women from the Iraqi diaspora in Sweden, there is a need to elucidate the effects of pain on their everyday life. Aims: To elucidate everyday life with chronic pain from the perspective of women from the Iraqi diaspora in Sweden. Methods: Qualitative interview study according to Glaser's grounded theory. Results: The results from 11 interviews suggest that pain was associated with dependency on society as well as on family. It resulted in a struggle for sense of control, framed by faith in God, influenced by the healthcare system, and with support from family. The women's testimony of lack of continuity of care, resulting in recollection of lived traumas in every visit, is a vital sign of the unconscious power relations within health care and how representatives from health care, instead of being the ones who help the women forward, become the ones who hold them back. Conclusions: The results show the importance of challenging the normative assumptions embedded in health care and treatment for patients with chronic pain and of including the voice of "others". © 2013 the Nordic Societies of Public Health.

The purpose of this study was to develop an interview guide for use by primaryhealthcare professionals to support them in identifying the rehabilitation needs of forcedresettled women from the Middle East living with chronic pain. Previous findings togetherwith the existing literature were used as the basis for developing the interview guide in threesteps: item generation, cognitive interviews, and a pilot study. The study resulted in a16-item interview guide focusing on patients’ concerns and expectations, with considerationof pre-migration, migration, and post-migration factors that might affect their health. Withthe help of the guide, patients were also invited to identify difficulties in their daily activitiesand to take part in setting goals and planning their rehabilitation. The current interview guideprovides professional guidance to caretakers, taking a person-centered participative point ofdeparture when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staffmembers working in primary healthcare, with the aim of contributing to continuity of careand multi-professional collaboration.

Meeting patients from other countries constitutes a challenge for health care. The purpose of this study was to increase knowledge about tacit understandings of treatment in practice by determining the perceptions of chronic pain and rehabilitation directed to resettled women from the Middle East, from a variety of health care professionals within primary care. Based on the results, we find a need to support and increase knowledge among health care professionals to involve the patient and consider her beliefs, expectations, background, current life situation, and spirituality, and to involve family in rehabilitation.

Background: As dispersed ethnic populations in Swedish society expand, the healthcare system need to adapt rehabilitationservices according to their needs. The experiences of trauma and forced resettlement have a continuing impact on healthand musculoskeletal pain, as well as the intersecting structures that prerequisite the possibilities in the new country. Tounderstand the specific needs of women from the Iraqi diaspora in Sweden, there is a need to elucidate the effects of painon their everyday life. Aims: To elucidate everyday life with chronic pain from the perspective of women from the Iraqidiaspora in Sweden. Methods: Qualitative interview study according to Glaser’s grounded theory. Results: The results from11 interviews suggest that pain was associated with dependency on society as well as on family. It resulted in a strugglefor sense of control, framed by faith in God, influenced by the healthcare system, and with support from family. Thewomen’s testimony of lack of continuity of care, resulting in recollection of lived traumas in every visit, is a vital sign of theunconscious power relations within health care and how representatives from health care, instead of being the ones whohelp the women forward, become the ones who hold them back.Conclusions: The results show the importance ofchallenging the normative assumptions embedded in health care and treatment for patients with chronic painand of including the voice of “others”.