ETNA3, a clinical randomized study assessing three cognitive-oriented therapies in dementia: Rationale and general design

Despite the popularity of cognitive-oriented therapies in dementia, very few data gathered from scientific literature provide a clear demonstration of the genuine efficacy of these techniques. Most of the results published have issued from studies suffering from important methodological limitations such as: absence of control group to compare clinical courses, very small size of study samples, absence of group randomization, absence of blind assessment of efficacy criteria or absence of long-term efficacy assessment. Randomized clinical trials are rare or even absent for some techniques and generally report more modest benefits. In this context, the ETNA3 study has been implemented. The ETNA3 study is a French nationwide prospective simple-blinded randomized clinical trial conducted to evaluate the impact of cognitive training, reminiscence therapy and an individualized cognitive rehabilitation program on the progression rate of dementia. The study was conducted in 653 outpatients with mild to moderate Alzheimer's disease followed up for 2 years (MMSE score 16 and 26). The main objective was to determine whether any or several of these non-pharmacological treatments could delay the severe stage of dementia during a 2-year follow-up compared to a usual care group without non-pharmacological treatment. The secondary outcomes assessed cognitive abilities, functional abilities in activities of daily living, behavioral disturbance, apathy, quality of life, depression, caregiver's burden and resource utilization. This article presents the rationale and methodology of the study.     

Coordination of a complex welfare system case: rehabilitation entity in Finland

The main purpose of this article is to analyse the institutional and political structures of the Finnish rehabilitation entity and the governmental efforts to improve the governance of the rehabilitation policy. Rehabilitation in Finland is a complex welfare system which has undergone several coordination attempts during the last two decades. The centrality of the coordination of this welfare system is obvious. Based on the content analysis of three Government's rehabilitation reports from 1994 to 2002 and their background papers, this article provides two main findings. First, the rehabilitation entity seems to be based on different funding strategies, different governing and different coordination models between the rehabilitation subsystems. Second, the governance discourse in the reports seems to be unchanging with a predominantly hierarchical mode. The article concludes with a discussion on the challenges to coordinate this kind of a complex welfare system as an entity and also how to overcome those challenges. Copyright © 2010 John Wiley & Sons, Ltd.     

意大利辅助用具免费供给残疾人体系(英文)

Aids are only one of the instruments with which the disabled person can often reach a good level of autonomy,he can improve his conditions of life and prevent the aggravating of his situation.Aids serve also to facilitate care on the part of the family.The rights confirmed by Law 104 can also be achieved through the use of aids.The Italian state has planned a system of care with regards to aids so that some of them can be purchased with different tax concessions but essential aids,those necessary for the reaching of autonomy goals and prevention defined by an individual rehabilitative project,are supplied free of charge.In Italy essential aids are part therefore of a rehabilitation plan that is identified for each person with disabilities by a team made up of different professionals.     

Comparison of an individual systematic interview method and the oral health impact profile. Responsiveness and ability of describing treatment effect of oral rehabilitation

Summary The Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL‐DW) has shown potential for generating information and measuring Oral Health–Related Quality of Life (OHRQoL) in oral rehabilitation. The Oral Health Impact Profile‐49 (OHIP‐49) has been widely used in population studies. The purpose of this study was to compare the responsiveness and ability of the SEIQoL‐DW and the OHIP‐49 to qualitatively describe the change following oral rehabilitation. Twenty‐two participants treated with fixed or removable prosthesis were interviewed before and after treatment using the SEIQoL‐DW and the OHIP‐49 questionnaire. The participants rated the subjective perception of change and answered two global oral rating questions. A clinical examination was performed to identify dental status variables. No significant difference was found between pre‐ and post‐treatment SEIQoL‐DW scores. A significant difference between pre‐ and post‐treatment OHIP‐49 scores was found. The SEIQoL‐DW and OHIP‐49 change scores was significantly correlated. The dental status variables such as number of teeth, number of teeth replaced, number of occluding units, type of treatment, extractions and removable dental prosthesis (RDP) before treatment did not influence the change scores. The effect size was low for the SEIQoL‐DW (0·15) and moderate for the OHIP‐49 (0·60). Improvement in subjective perception of change was related to both improvement and deterioration in change scores. More aspects were mentioned in the SEIQoL‐DW compared to the OHIP‐49. Based on the change in overall score and effect size, the SEIQoL‐DW showed a weaker responsiveness than the OHIP‐49. The SEIQoL‐DW, however, described the change more detailed than the OHIP‐49.     

Treating Indigenous Australians with Alcohol/Drug Problems: Assessing Quality of Life

This study investigated the quality of life (QoL) of clients in an Indigenous Australian residential alcohol and drug treatment center. Qualitative and quantitative data were collected from a random sample of Indigenous clients utilizing the Self Evaluated Individual Quality of Life–Direct Weight tool. The findings from this study provide support for the inclusion of QoL as important in understanding the recovery process from substance misuse. A discrepancy was found between the self-reported aspirations of clients and the focus of the treatment provided, and recommendations were provided for inclusion of new areas in the education provided to the clients of this service.     

Audiologist-patient communication profiles in hearing rehabilitation appointments

ObjectiveTo profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients’ decisions to pursue hearing aids.MethodsSixty-three initial hearing assessment appointments were filmed and audiologist-patient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted.ResultsTwo distinct audiologist-patient communication profiles were identified during both the history taking phase (46 = biopsychosocial profile, 15 = psychosocial profile) and diagnosis and management planning phase (45 = expanded biomedical profile, 11 = narrowly biomedical profile). Longer appointments were significantly more likely to be associated with an expanded biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients’ decisions to pursue hearing aids.ConclusionInitial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction.Practice implicationsFindings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients.