Associations between community participation and types of places visited among persons living with and without dementia: risks perception and socio-demographic aspects

INTRODUCTION: Increasingly, literature has focused on community participation in places visited by persons living with and without dementia. Earlier research indicates that multiple factors, including socio-demographic aspects and risk perception may influence community participation. AIM AND METHODS: This cross-sectional, explorative study aims to inquire into how places visited, socio-demographic aspects and risks perception are associated with self-rated community participation for persons living with and without dementia (n = 70) in Switzerland. Data was collected through face-to-face interviews with questionnaires (ACT-OUT, MoCA, sociodemographic). First, we investigated whether the number of places visited was correlated with self-rated participation; then we added socio-demographic and risks perception factors with a bivariate analysis; and searched for a model using multinomial logistic regressions. RESULTS: For the group of participants living with dementia, risks of falling (p = .014) and of getting lost (p = .037) were significantly associated with self-rated participation. For the group of participants living without dementia, visiting places outside the home was significantly associated with self-rated participation, especially visiting places in domain D/places for recreational and physical activities (p = .005). DISCUSSION AND CONCLUSIONS: The results of exploring multiple factors and searching for a model highlights the complexity of community participation as a construct. Risks and visiting places for recreational and physical activities seem to play a role in self-rated participation. Mobile interviews might be better suited to gain in-depth understanding on community participation for persons living with dementia

Transformation des solidarités chez les étudiants de la HES-SO en ergothérapie et en travail social

Sous l’effet des migrations internationales, le paysage socioculturel de nombreux pays s’est modifié (Althaus et al., 2010). Dans ce contexte de transformation sociale, il faut s’interroger sur la manière dont les étudiants en ergothérapie et en travail social perçoivent les enjeux liés à l’accompagnement de populations hétérogènes aux plans culturel, linguistique et social. Cette recherche, financée par le Fonds national suisse de la recherche scientifique (2016-2019), vise à documenter les changements du rapport à l’Autre de ces jeunes adultes lors de leur formation initiale au sein de la Haute École Spécialisée de Suisse Occidentale (HES-SO). Les contacts durant le stage avec des individus porteurs de différences contribueraient à cette transformation. Les résultats préliminaires se basent sur des entretiens réalisés auprès de 51 étudiants en première année de formation. L’analyse thématique fait ressortir une variété d’expériences interculturelles vécues, antérieures au stage. La discussion explore les différents bagages des étudiants en lien avec la diversité

Sex-specific association of cardiovascular drug doses with adverse outcomes in atrial fibrillation.

OBJECTIVES Sex differences occur in atrial fibrillation (AF), including age at first manifestation, pathophysiology, treatment allocation, complication rates and quality of life. However, optimal doses of cardiovascular pharmacotherapy used in women with AF with or without heart failure (HF) are unclear. We investigated sex-specific associations of beta-blocker and renin-angiotensin system (RAS) inhibitor doses with cardiovascular outcomes in patients with AF or AF with concomitant HF. METHODS We used data from the prospective Basel Atrial Fibrillation and Swiss Atrial Fibrillation cohorts on patients with AF. The outcome was major adverse cardiovascular events (MACEs), including death, myocardial infarction, stroke, systemic embolisation and HF-related hospitalisation. Predictors of interest were spline (primary analysis) or quartiles (secondary analysis) of beta-blocker or RAS inhibitor dose in per cent of the maximum dose (reference), in interaction with sex. Cox models were adjusted for demographics, comorbidities and comedication. RESULTS Among 3961 patients (28% women), MACEs occurred in 1113 (28%) patients over a 5-year median follow-up. Distributions of RAS inhibitor and beta-blocker doses were similar in women and men. Cox models revealed no association between beta-blocker dose or RAS inhibitor dose and MACE. In a subgroup of patients with AF and HF, the lowest hazard of MACE was observed in women prescribed 100% of the RAS inhibitor dose. However, there was no association between RAS dose quartiles and MACE. CONCLUSIONS In this study of patients with AF, doses of beta-blockers and RAS inhibitors did not differ by sex and were not associated with MACE overall

Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort

Background: Longitudinal association studies of atrial fibrillation (AF) and cognitive functions have shown an unclear role of AF-type and often differ in methodological aspects. We therefore aim to investigate longitudinal changes in cognitive functions in association with AF-type (non-paroxysmal vs. paroxysmal) and comorbidities in the Swiss-AF cohort. Methods: Seven cognitive measures were administered up to five times between 2014 and 2022. Age-education standardized scores were calculated and association between longitudinal change in scores and baseline AF-type investigated using linear mixed-effects models. Associations between AF-type and time to cognitive drop, an observed score of at least one standard deviation below individual's age-education standardized cognitive scores at baseline, were studied using Cox proportional hazard models of each cognitive test, censoring patients at their last measurement. Models were adjusted for baseline covariates.Results2,415 AF patients (mean age 73.2 years; 1,080 paroxysmal, 1,335 non-paroxysmal AF) participated in this Swiss multicenter prospective cohort study. Mean cognitive scores increased longitudinally (median follow-up 3.97 years). Non-paroxysmal AF patients showed smaller longitudinal increases in Digit Symbol Substitution Test (DSST), Cognitive Construct Score (CoCo)and Trail Making Test part B (TMT-B) scores vs. paroxysmal AF patients. Diabetes, history of stroke/TIA and depression were associated with worse performance on all cognitive tests. No differences in time to cognitive drop were observed between AF-types in any cognitive test. Conclusion: This study indicated preserved cognitive functioning in AF patients, best explained by practice effects. Smaller practice effects were found in non-paroxysmal AF patients in the DSST, TMT-B and the CoCo and could indicate a marker of subtle cognitive decline. As diabetes, history of stroke/TIA and depression—but not AF-type—were associated with cognitive drop, more attention should be given to risk factors and underlying mechanisms of AF

Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort.

BACKGROUND Longitudinal association studies of atrial fibrillation (AF) and cognitive functions have shown an unclear role of AF-type and often differ in methodological aspects. We therefore aim to investigate longitudinal changes in cognitive functions in association with AF-type (non-paroxysmal vs. paroxysmal) and comorbidities in the Swiss-AF cohort. METHODS Seven cognitive measures were administered up to five times between 2014 and 2022. Age-education standardized scores were calculated and association between longitudinal change in scores and baseline AF-type investigated using linear mixed-effects models. Associations between AF-type and time to cognitive drop, an observed score of at least one standard deviation below individual's age-education standardized cognitive scores at baseline, were studied using Cox proportional hazard models of each cognitive test, censoring patients at their last measurement. Models were adjusted for baseline covariates. RESULTS 2,415 AF patients (mean age 73.2 years; 1,080 paroxysmal, 1,335 non-paroxysmal AF) participated in this Swiss multicenter prospective cohort study. Mean cognitive scores increased longitudinally (median follow-up 3.97 years). Non-paroxysmal AF patients showed smaller longitudinal increases in Digit Symbol Substitution Test (DSST), Cognitive Construct Score (CoCo)and Trail Making Test part B (TMT-B) scores vs. paroxysmal AF patients. Diabetes, history of stroke/TIA and depression were associated with worse performance on all cognitive tests. No differences in time to cognitive drop were observed between AF-types in any cognitive test. CONCLUSION This study indicated preserved cognitive functioning in AF patients, best explained by practice effects. Smaller practice effects were found in non-paroxysmal AF patients in the DSST, TMT-B and the CoCo and could indicate a marker of subtle cognitive decline. As diabetes, history of stroke/TIA and depression-but not AF-type-were associated with cognitive drop, more attention should be given to risk factors and underlying mechanisms of AF

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia

The changing context of Western European healthcare systems: Convergence versus divergence in nursing problematics

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.Convergence Divergence Health-care reforms Nursing problematics Cross-national research

Development of a Questionnaire to Evaluate Out-of-Home Participation for People With Dementia

OBJECTIVE. We describe the development of a questionnaire, Participation in Activities and Places Outside Home (ACT-OUT). for older adults with cognitive impairment and align it to people with mild- to moderate-stage dementia. METHOD. ACT-OUT was developed in a cross-cultural collaboration in combination with three rounds of cognitive interviews in Switzerland with 26 older adults without cognitive impairment and five older adults with dementia. Qualitative data from the interviews were analyzed using a constant comparison approach. RESULTS. The final ACT-OUT Version 1.0 consists of three parts: (1) questions targeting places older adults visit: (2) questions on aspects influencing participation , such as transportation. familiarity, and risk perception: and (3) questions on perception of self. CONCLUSION. The development of an instrument such as ACT-OUT is more a cyclical than a linear process. This study is a first step toward a more systematic evaluation of out-of-home participation among older adults with and without dementia

Le rapport à l’autre porteur d’une différence ; description de la sensibilité interculturelle des étudiants en ergothérapie de France et de Suisse

Autant en France qu'en Suisse, les individus, qui reçoivent des soins de santé, sont de plus en plus diversifiés, tant aux plans culturel linguistique que social. Cette situation amène les ergothérapeutes et les étudiants à travailler davantage auprès de personnes aux ancrages socioculturels variés. Plusieurs auteurs estiment que le rapport à l'Autre, c'est-à-dire celui porteur d'une différence significative, est notamment fonction des caractéristiques psychologiques des professionnels de la santé. Afin d'explorer cet aspect, un questionnaire a été rempli par 158 étudiants de 1" année en ergothérapie de France et de Suisse. Il documente les dimensions psychologiques contribuant à la sensibilité interculturelle. L'analyse des données fournit un profil de ces étudiants. Ces résultats permettent de ressortir des pistes pour améliorer leur encadrement concernant la rencontre avec des personnes aux ancrages culturels divers durant la formation initiale, incluant les stages