Who Should do What to Whom? : Occupational Groups´Views on Special Needs

The overall aim of this thesis is to increase our knowledge of different occupational groups´ views on work with children in need of special support. This is explored in four separate studies. The first study investigates the views of occupational groups in preschools and schools in one municipality. A questionnaire was handed out to all personnel (N=1297) in the municipality in 2008 (72.5 % response rate). The second study explores the views of educational leaders (N=45) in the same municipality. Questionnaire # 2 was distributed in 2009. All the educational leaders responded to the questionnaire. The third study describes the views of different occupational groups concerning special educational needs coordinators´ (SENCOs) role and work. This was highlighted by comparing responses from questionnaire #1 and # 2. Responses concerning SENCOs´ work were also added using a third questionnaire. This questionnaire was handed out in 2006 to chief education officers (N=290) in all municipalities in Sweden. The response rate was 90.3%. Finally, the fourth study presents five head teachers´ descriptions of their work with special needs issues. Study four was a follow-up study of questionnaire # 2. These head teachers were selected because of their inclusive values and because they seemed to be effective according to certain criteria. They were interviewed in January 2012. The results reveal a number of interesting findings. For example, there are both similar and different views among the occupational groups concerning work with children in need of special support. A majority of the respondents in all groups state that children´s individual deficiencies is one common reason why children need special support in preschools/schools. Differences between the occupational groups become especially visible regarding their views of SENCOs‟ work. Critical pragmatism (Cherryholmes, 1988) is applied as a theoretical point of departure. Skrtic´s (1991) critical reading and analysis of special education relative to general education is specifically used to interpret and discuss the outcome of the studies. Additionally, Abbott´s (1988) reasoning concerning the “division of expert labor” is used to discuss the occupational groups´ replies concerning “who should do what to whom”. The findings in the studies are contextualized and theoretically interpreted in the separate articles. However in the first part of this thesis (in Swedish: Kappa), the theoretical interpretations of the empirical outcome are discussed in more detail and the results are further contextualized and synthesised. Inclusion and premises for inclusive education are also discussed in more depth in the first part of the present thesis.

Biomarkers of extracellular matrix metabolism (MMP-9 and TIMP-1) and risk of stroke, myocardial infarction and cause-specific mortality : cohort study

Objective: Turnover of the extracellular matrix in all solid organs is governed mainly by a balance between the degrading matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). An altered extracellular matrix metabolism has been implicated in a variety of diseases. We investigated relations of serum levels of MMP-9 and TIMP-1 to mortality risk from an etiological perspective. Design: The prospective Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, followed from 1991–1995 for up to 18.1 years. A random population-based sample of 1,082 71-year-old men, no loss to follow-up. Endpoints were all-cause (n = 628), cardiovascular (n = 230), non-cardiovascular (n = 398) and cancer mortality (n = 178), and fatal or non-fatal myocardial infarction (n = 138) or stroke (n = 163). Results: Serum MMP-9 and TIMP-1 levels were associated with risk of all-cause mortality (Cox proportional hazard ratio [HR] per standard deviation 1.10, 95% confidence interval [CI] 1.03–1.19; and 1.11, 1.02–1.20; respectively). TIMP-1 levels were mainly related to risks of cardiovascular mortality and stroke (HR per standard deviation 1.22, 95% CI 1.09–1.37; and 1.18, 1.04–1.35; respectively). All relations except those of TIMP-1 to stroke risk were attenuated by adjustment for cardiovascular disease risk factors. Relations in a subsample without cardiovascular disease or cancer were similar to those in the total sample. Conclusion: In this community-based cohort of elderly men, serum MMP-9 and TIMP-1 levels were related to mortality risk. An altered extracellular matrix metabolism may be involved in several detrimental pathways, and circulating MMP-9 or TIMP-1 levels may be relevant markers thereof.