Long-term performance of instrumental activities of daily living (IADL) in young and middle-aged stroke survivors: Results from SAHLSIS outcome

Background: Although stroke prevalence is increasing and large proportions of stroke survivors are expected to live many years after stroke onset, research on the long-term consequences of stroke for instrumental activities of daily living (IADL) is limited.

Aim: To explore performance of IADL seven years post-stroke onset and identify predictors of long-term IADL performance based on commonly employed acute measures and demographic characteristics in young and middle-aged stroke survivors.

Methods: Data on stroke survivors were collected from SAHLSIS. IADL performance was assessed at 7 years using the Frenchay Activities Index (FAI). Demographic data and baseline measures were assessed as predictors of FAI outcome, using logistic regression.

Results: 237 stroke survivors with a median age of 63 at follow-up were included. Participants had predominantly suffered a mild stroke and >90% lived at home with no community services. Mean FAI was 25.7(score range 0-45), indicating reduced levels of participation in IADL. Frequency of performance of IADL was lowest for work/leisure activities. Gender, cohabitation status, initial stroke severity and baseline score on mRS were independently associated with IADL outcome.

Conclusions: Reduced levels of participation in IADL persist many years after stroke onset and indicate a need to adapt a long-term perspective on stroke rehabilitation.     

Everyday life in breast cancer survivors experiencing challenges: A qualitative study

Background: Early diagnosis and treatment of breast cancer results in an increasing number of survivors, some of whom face new challenges in their transition to daily life.

Aim: Based on these experiences, the aim of this study was to describe the everyday life in breast cancer survivors experiencing challenges.

Material and method: Eleven women recruited from a follow-up study of breast cancer patients participated in qualitative interviews about their everyday occupations seven years after ending treatment. The inductive analysis revealed ten categories that were organized into five subthemes under the two main themes ‘bodily and mental loneliness’ and ‘new center of gravity in everyday life’.

Results: Findings showed how relevant information and guidance; active support to the client and their relatives; and a balance between occupations at home and at work were important matters to handle their everyday life challenges.

Conclusion and significance: By assisting these women in finding new patterns of meaningful occupations that positively affect their everyday life, the study suggests some central elements to be included in future follow-up practice for breast cancer survivors. Approaching this goal, occupational therapists should contribute to more involvement assisting cancer survivors and their partners in finding new patterns of meaningful occupations that positively affect their everyday life.     

Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme

Background: In Sweden, less than 50% of those getting stroke in working age return to work (RTW). Effective rehabilitation programmes need to be developed and therapeutic aspects understood.

Aim: To explore and describe how persons with stroke experience their RTW process while participating in a person-centred rehabilitation programme focusing on RTW.

Materials and methods: Seven persons with mild or moderate stroke were interviewed twice during the intervention in the vocational training phase using semi-structured interviews. Data were analysed using grounded theory.

Results: Having a coordinator by their side gave support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication created a structure for the RTW process. Expressing one’s own wishes increased opportunities to influence and decide which path to follow in order to reach the goal.

Conclusion: Straightforward, open and recurring communication facilitated the possibility to adapt to the situation. These aspects increased insight and awareness which facilitated the RTW process.

Significance: The findings indicate that a precondition for a fruitful RTW process was that suitable platforms at work were created in which the actors involved could cooperate. This knowledge might also be valuable in the RTW process for people with other diagnosis.     

Rodent control in urban communities in Johannesburg,South Africa: from research to action

Introduction:

Rodents are troublesome urban pests, with potentially serious health implications. Preventive efforts require greater understanding of social contexts in which they are prevalent. This study aimed to determine rodent prevalence and identify factors associated with rodent infestations in urban residential settings.

Methods:

The Health, Environment and Development study is a longitudinal panel study conducted in five settlements across Johannesburg. Data on socio-economic status, domestic behaviour and housing quality are collected annually. Logistic regression revealed risk factors for rodent prevalence at household level.

Results:

Rodents are a major household problem in all study areas (prevalence 54%). Factors associated with increased prevalence of rats included lower income, living in informal areas, overcrowding, cracks in dwelling walls and internal damp.

Conclusion:

Socio-economic status, housing quality, domestic behaviour and environmental health services are associated with exposure to rodents in urban Johannesburg communities. This information served as a platform to launch rodent awareness campaigns at study sites.     

Sensor technology more than a support

Background: This interview study is a part of a project that evaluated sensor technology as a support in everyday activities for patients with memory impairment.

Aim: To explore patients with memory impairment and their partners’ experiences of using sensor technology in their homes.

Methods and material: Five patients with memory impairment after stroke and three partners were interviewed. Individual semi-structured interviews were analyzed with qualitative content analysis.

Results: Installing sensor technology with individually prerecorded voice reminders as memory support in the home had a broad impact on patients’ and their families’ lives. These effects were both positive and negative. The sensor technology not only supported activities but also influenced the patients by changing behavior, providing a sense of security, independence and increased self-confidence. For the partners, the sensor technology eased daily life, but also gave increased responsibility for maintenance. Technical problems led to frustration and stress for the patients.

Conclusion: The results indicate that sensor technology has potential to increase opportunities for persons with memory impairment to perform and participate in activities and to unburden their partners. The results may promote an understanding of how sensor technology can be used to support persons with memory impairment in their homes.     

Occupational therapists experiences of implementing a new complex intervention in collaboration with researchers: a qualitative longitudinal study

Background: This study was conducted in the context of a randomized controlled trial where occupational therapists (OTs) in collaboration with researchers implemented a client-centred activity of daily living intervention (CADL) for persons with stroke.

Objective: The aim was to identify and describe over time the OTs’ experiences regarding the collaboration with the researcher in their role as implementers of a new complex intervention.

Method: Focus group interviews were conducted with 33 OTs, two, six and 12 months after they had participated in a five-day workshop. The interviews were analysed using a grounded theory approach.

Results: Three categories were identified: (1) Including in the scientific world, (2) Involving as an implementer of science and (3) Integrating in a partnership. One core category emerged: The implementation of client-centred intervention enabled the fusion of practice and science. An increased experience of using CADL and support from the researchers changed the OTs’ attitudes towards engaging in research from being an outsider to the scientific world to being included and then becoming a part of the research as an implementer of science.

Conclusions: To create a context built on a collaborative partnership between practitioners and researchers enabled the fusion of practice and science.     

Occupational therapists’ perceptions of habits based on their professional experiences

Background: Habits are building blocks for occupation. If they are not explicitly approached, a vital aspect of occupation may be left out. Knowledge is lacking about how habits are understood and approached in occupational therapy practice.

Aim: To explore occupational therapists’ perceptions of habits based on their professional experiences.

Material and methods: A qualitative design with a focus group methodology was used. The qualitative data analysis was based on five focus group discussions, including 34 occupational therapists.

Results: An overarching theme, ‘the complexity of habits,’ representing the occupational therapists’ perception of habits, covers the content of three categories: ‘reflecting contradictoriness,’ including different forms of ambiguity that characterize habits, ‘reflecting identity and security’, that emphasize the meaning of habits for identity and structure in everyday life, and ‘reflecting context and society’, comprising perceptions of habits related to the life situation, time and social patterns and environment.

Conclusions: The occupational therapists’ perceptions gave a picture of habits as complex systems. Based on the findings, the therapeutic modes used when approaching clients’ habits should involve more explicit attention to habits and the inclusion of the client’s entire context.     

Alexithymia is associated with low level of vitamin D in young healthy adults

Objective

Vitamin D plays an important role in brain development and functioning. Low levels of vitamin D have been described in several psychiatric and neurologic conditions including autism spectrum disorder. Alexithymia that shows high comorbidity with autism is also present in the general population as well as hypovitaminosis D.

Methods

Here we assessed the relation between alexithymia as measured by the Toronto Alexithymia Scale-20 and vitamin D level in healthy young adults.

Results

We found an inverse correlation between the levels of alexithymia and vitamin D.

Discussion

These data suggest the association between disturbed emotional processing and low levels of vitamin D to be present in young healthy subjects.     

Book Review

Changing the public health

Rcswch Unit in Health .ad Behaviourd Chutge. University of Edinburgh, John Wdey and Son, London, 1989, ISBN 0 471 91976 4.

The new public health

John Ashtw and RowYd Seymour. Open University Press, 1988. ISBN 0 335 15550 2, £6.95.

Infertility services-a desperate case

N d Pfeilu cmd Allison Qukk. Greater London Association of Community Health Councils, 1988.

A new kind of Doctor

Julian Tudor Hart. Merlin Press, 1988. ISBN 085036 299 7, £11.95 (hardback).     

Group triple P and child unintentional injury risk: a pilot study

Objective: Given the associations between externalizing behaviors and childhood unintentional injuries (CUI), this pilot study evaluated whether an empirically supported behavioral parent training program, Group Triple P, decreased risk for CUI.

Methods: Parents of 19 children ages 2–8 referred by their child’s primary care physician for child externalizing behavior problems completed measures of child injury risk pre- and post-Triple P.

Results: Child injury risk and disruptive behavior problems decreased significantly.

Conclusions: Overall, our findings indicate that teaching behavior management and parenting skills to parents has the potential to decrease injury risk in their children, despite this not being an explicit target of intervention.     

Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.

Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.

Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.

Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.

Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.

Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.     

Comparison of nutritional status indicators according to feeding methods in patients with acute stroke

Background

Feeding methods for patients with acute stroke differ based on their ability to swallow; therefore, it is necessary to determine whether these methods deliver enough nourishment to these patients. Although nutrition could affect recovery from acute stroke, it is often overlooked. Indicators of nutritional status are important for the nutritional assessment of patients.

Purpose

The purpose of this study was to compare changes in nutritional indicators with various feeding methods in patients with acute stroke.

Methods

Data on 261 patients with acute stroke who were admitted to a stroke unit in 2010 and met the inclusion criteria of the study were retrospectively analyzed. For comparative analysis, we investigated the participants' National Institutes of Health Stroke Scale score, feeding methods using the Modified Gugging Swallowing Screen, and indicators of nutritional status, such as body mass index, pre-albumin level, albumin level, total lymphocyte count, and total protein level. All nutritional indicators were compared at the time of admission to the stroke unit and at 7 days after admission.

Results

At the time of admission, indicators of nutritional status were within normal ranges in all feeding groups (tube, dysphagia, and general diet). At 7 days after admission, pre-albumin (P = 0.003), albumin (P = 0.001), and total protein (P = 0.000) values in the tube feeding group were below the normal range, and the pre-albumin value and total lymphocyte count were below the normal range in the dysphagia diet group (P = 0.027). The values for all nutritional indicators were within normal limits in the general diet group.

Conclusions

Indicators of nutritional status change according to the swallowing ability of patients with acute stroke. At 7 days after admission to the stroke unit, patients with severe dysphagia had higher levels of indicators of malnutrition. Health care providers should consider whether the feeding method of each patient with stroke provides suitable nourishment. Additionally, it is important to know why these indicators vary based on swallowing abilities and what these patients require for adequate nutrition.     

A community-based intervention for low-income families to reduce children’s blood lead levels between 3–9.9 μg/Dl

Introduction: In 2012, the Center for Disease Control announced children’s blood lead levels (BLLs) above 5 μg/dL should be provided assistance, as no level of lead exposure is safe.

Method: A community-based randomized controlled trial targeting children from low-income families (BLLs: 3–9.9 μg/dL) was implemented utilizing educational and environmental tactics.

Results: All groups evidenced a significant decrease in children’s BLLs and a significant increase in lead knowledge, but no main effects based on group assignment. When compared to a post-hoc passive control group, all intervention groups evidenced significant BLL reduction.

Discussion: Findings are discussed in terms of low-cost primary prevention initiatives and mechanisms explaining intervention efficacy.     

Exploring barriers to primary care for migrants in Greece in times of austerity: Perspectives of service providers

Background: Migration in Europe is increasing at an unprecedented rate. There is an urgent need to develop ‘migrant-sensitive healthcare systems’. However, there are many barriers to healthcare for migrants. Despite Greece’s recent, significant experiences of inward migration during a period of economic austerity, little is known about Greek primary care service providers’ experiences of delivering care to migrants.

Objectives: To identify service providers’ views on the barriers to migrant healthcare.

Methods: Qualitative study involving six participatory learning and action (PLA) focus group sessions with nine service providers. Data generation was informed by normalization process theory (NPT). Thematic analysis was applied to identify barriers to efficient migrant healthcare.

Results: Three main provider and system-related barriers emerged: (a) emphasis on major challenges in healthcare provision, (b) low perceived control and effectiveness to support migrant healthcare, and (c) attention to impoverished local population.

Conclusion: The study identified major provider and system-related barriers in the provision of primary healthcare to migrants. It is important for the healthcare system in Greece to provide appropriate supports for communication in cross-cultural consultations for its diversifying population.     

Enjoyable company in sharing stroke experiences; - lifestyle groups after stroke

Background: Even people with mild to moderate stroke will experience changes in their abilities to perform everyday occupations. Group interventions may be appropriate in late-stage rehabilitation. The aim of this study was to explore how the participants involved themselves in person-centered lifestyle groups after stroke in Norway.

Method: Semi-structured interviews were performed with six older adults with mild-to-moderate stroke who had participated in lifestyle groups over a period of nine months. The interviews were analyzed using qualitative content analysis.

Results: The participants involved themselves in the lifestyle groups in a variety of ways by creating enjoyable company in sharing stroke experiences, sharing knowledgeable interest, pushing and forcing each other forward and reflecting on self-worth. Through doing group activities together, they created various ways of being, belonging and becoming, addressing development of strategies for regaining self-belief and a sense of autonomy, and for adapting to everyday life post-stroke.

Conclusion: The participants were active contributors in the groups and pushed each other and themselves regarding involvement in meaningful occupations. This active participation seemed to bring the participants’ resources into focus and contrasted with the frequent negative perceptions of people post-stroke as ‘victims’.     

Relational interaction in occupational therapy: Conversation analysis of positive feedback

Background: The therapeutic relationship is an important factor for good therapy outcomes. The primary mediator of a beneficial therapy relationship is clinician–client interaction. However, few studies identify the observable interactional attributes of good quality relational interactions, e.g. offering the client positive feedback.

Objective: The present paper aims to expand current understanding of relational interaction by analyzing the real-time interactional practices therapists use for offering positive feedback, an important value in occupational therapy.

Methods: The analysis is based on the conversation analysis of 15 video-recorded occupational therapy encounters in psychiatric outpatient clinics.

Results: Two types of positive feedback were identified. In aligning feedback, therapists encouraged and complimented clients’ positive perspectives on their own achievements in adopting certain behaviour, encouraging and supporting their progress. In redirecting feedback, therapists shifted the perspective from clients’ negative experiences to their positive experiences. This shift was interactionally successful if they laid the foundation for the shift in perspective and attuned their expressions to the clients’ emotional states.

Conclusions: Occupational therapists routinely provide their clients with positive feedback. Awareness of the interactional attributes related to positive feedback is critically important for successful relational interaction.     

Racial discrimination,racial/ethnic segregation,and health behaviors in the CARDIA study

Objective

Racial discrimination has been associated with unhealthy behaviors, but the mechanisms responsible for these associations are not understood and may be related to residential racial segregation. We investigated associations between self-reported racial discrimination and health behaviors before and after controlling for individual- and neighborhood-level characteristics; and potential effect modification of these associations by segregation.

Design

We used data from the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study for 1169 African-Americans and 1322 whites. To assess racial discrimination, we used a four category variable to capture the extent and persistence of self-reported discrimination between examination at years 7 (1992–1993) and 15 (2000–2001). We assessed smoking status, alcohol consumption, and physical activity at year 20 (2005–2006). Segregation was examined as the racial/ethnic composition at the Census tract level.

Results

Discrimination was more common in African-Americans (89.1%) than in whites (40.0%). Living in areas with high percentage of blacks was associated with less reports of discrimination in African-Americans but more reports in whites. After adjustment for selected characteristics including individual- and neighborhood-level socioeconomic conditions and segregation, we found significant positive associations of discrimination with smoking and alcohol consumption in African-Americans and with smoking in whites. African-Americans experiencing moderate or high discrimination were more physically active than those reporting no discrimination. Whites reporting some discrimination were also more physically active than those reporting no discrimination. We observed no interactions between discrimination and segregation measures in African-Americans or whites for any of the three health behaviors.

Conclusions

Racial discrimination may impact individuals' adoption of healthy and unhealthy behaviors independent of racial/ethnic segregation. These behaviors may help individuals buffer or reduce the stress of discrimination.     

How children with cerebral palsy master bimanual activities from a parental perspective

Background: During childhood, children learn the daily life activities they want and need to do. Children with unilateral spastic cerebral palsy often have difficulties performing activities requiring two hands.

Aim: To describe parental reasoning on how children with unilateral spastic cerebral palsy learn to master the performance of bimanual activities in everyday life.

Material and methods: Sixteen parents participated in focus groups, a qualitative research approach with its own methodological criteria and research methods.

Results: One overall theme emerged from the analysis: ‘Finding harmony between pleasure and effort is the key to learning’. This overall theme arose as a synthesis of four themes: ‘awakening of the inner drive’, ‘trying on one’s own’, ‘enabling things to work’ and ‘it must be worth the effort´. The parents described when an activity woke their children´s inner drive to perform. Their children also strived to develop their own way to perform an activity, sometimes with the support of others, still, some activities were not possible to learn.

Conclusions: Occupational therapists and others in the children’s environment have an important mission to support the children to find their own harmony between pleasure and effort and their individual key to success in learning bimanual everyday activities.