Mellem arbejde og "off-day" — tvetydighedens muligheder i sociale virksomheder

In a time where ‘work’ seems to be on everyone’s lips, the consequences of not having a job may be severe. Concurrently the economic recession has amplified processes of exclusion in the labor market, particularly among the most vulnerable citizens. Social enterprises, in particular work integration social enterprises (WISEs), have been proposed as possible solutions to this problem. Through two ethnographic fieldworks in such WISEs this article seeks to investigate how participants narrate and experience work in this specific type of en- terprise. In both cases, work was simultaneously talked about as being ‘real’ work conduct- ed in a ‘real’ enterprise where one had to ‘make an effort’ and referred to as ‘not be- ing real’ work and the WISE being a place where one could have an ‘off-day’ and re- lax if needed. Zooming in on everyday life in the two WISEs revealed a dilemma filled and contested landscape. The WISEs in question seemed to reproduce the ration- alities of today’s work society while at the same time challenge and expand these very same rationalities. Thus the article suggests that WISEs, conceptualized as being on the margin of the conventional labor market, produce new practices of work and new understandings as to what work may encompass. In reality however, these expanding practices proved to be fleeting especially when the economy is tightening. The article therefore concludes that these practices themselves exist under constant pressure from the very same recession that they seek to alleviate the consequences of.Den økonomiske krise kalder på et øget fokus på arbejdsintegration af udsatte borgere-et fokus, der bla. adresseres af de sociale virksomheder. I denne artikel undersøger vi arbejde i to sådanne sociale virksomheder: Hvordan det praktiseres og forstås blandt deltagerne. I grænselandet mellem forretning og socialt projekt opstår nogle særlige muligheder for deltagelse og for at overskride dikotomien mellem at være indenfor og udenfor arbejdsmarkedet, men samtidig er organisationerne pressede af selvsamme krise, som de forsøger at afbøde konsekvenserne af

Mellem arbejde og 'off-day':tvetydighedens muligheder i sociale virksomheder

In a time where ‘work’ seems to be on everyone’s lips, the consequences of not having a job may be severe. Concurrently the economic recession has amplified processes of exclusion in the labor market, particularly among the most vulnerable citizens. Social enterprises, in particular work integration social enterprises (WISEs), have been proposed as possible solutions to this problem. Through two ethnographic fieldworks in such WISEs this article seeks to investigate how participants narrate and experience work in this specific type of en- terprise. In both cases, work was simultaneously talked about as being ‘real’ work conduct- ed in a ‘real’ enterprise where one had to ‘make an effort’ and referred to as ‘not be- ing real’ work and the WISE being a place where one could have an ‘off-day’ and re- lax if needed. Zooming in on everyday life in the two WISEs revealed a dilemma filled and contested landscape. The WISEs in question seemed to reproduce the ration- alities of today’s work society while at the same time challenge and expand these very same rationalities. Thus the article suggests that WISEs, conceptualized as being on the margin of the conventional labor market, produce new practices of work and new understandings as to what work may encompass. In reality however, these expanding practices proved to be fleeting especially when the economy is tightening. The article therefore concludes that these practices themselves exist under constant pressure from the very same recession that they seek to alleviate the consequences of.Den økonomiske krise kalder på et øget fokus på arbejdsintegration af udsatte borgere-et fokus, der bla. adresseres af de sociale virksomheder. I denne artikel undersøger vi arbejde i to sådanne sociale virksomheder: Hvordan det praktiseres og forstås blandt deltagerne. I grænselandet mellem forretning og socialt projekt opstår nogle særlige muligheder for deltagelse og for at overskride dikotomien mellem at være indenfor og udenfor arbejdsmarkedet, men samtidig er organisationerne pressede af selvsamme krise, som de forsøger at afbøde konsekvenserne af

Heart rhythm at the time of death documented by an implantable loop recorder

The aims of this study were to describe arrhythmias documented with an implantable loop recorder (ILR) in post-acute myocardial infarction (AMI) patients with left ventricular dysfunction at the time of death and to establish the correlation to mode of death. Post-mortem ILR device interrogations were analysed from patients dying in the CARISMA study. Mode of death was classified by a modified CAST classification. Twenty-six patients died with an implanted ILR. Of these, 16 had an electrocardiogram recorded at the time of death. Ventricular tachycardia (VT)/ventricular fibrillation (VF) was terminal rhythm in eight patients and bradyarrhythmias were observed in another eight patients. Of the deaths with peri-mortem recordings, seven were classified as sudden cardiac death (SCD). In six of these, VF was documented at the time of death. Six monitored deaths were classified as non-SCD (NSCD) of which only two had recordings of VT/VF, whereas four had bradyarrhythmias. All peri-mortem recordings in non-cardiac death (NCD) were bradyarrhythmia. Long-term monitoring in a population of post-AMI patients with left ventricular ejection fraction <40% showed that VT/VF and bradyarrhythmia each accounted for half of the recorded events at the time of death. The ILR confirmed that ventricular tachyarrhythmias are associated primarily with SCD, whereas bradyarrhythmias and electromechanical dissociation seems dominant in NSCD and NCD. The study was registered at ClinicalTrials.gov: NCT0014511

Risk markers of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction: a CARISMA substudy

Aims High-degree atrioventricular block (HAVB) after acute myocardial infarction (AMI) is associated with increased risk of mortality. Risk markers and predictors of HAVB occurring after AMI are largely unknown. The aim of this study was to assess the predictive value of risk markers derived from a series of non-invasive and invasive tests for the development of HAVB documented by an implantable loop recorder (ILR) in late convalescent phases of an AMI. Methods and results The study included 292 patients with AMI and subsequent left ventricular dysfunction without prior HAVB or implanted pacemaker. An ILR was implanted for continuous arrhythmia surveillance. Risk stratification testing was performed at inclusion and 6 weeks after AMI. The tests included echocardiography, electrocardiogram (ECG), 24 h Holter monitoring, and an invasive electrophysiological study. High-degree atrioventricular block was documented in 28 (10%) patients during a median follow-up of 2.0 (0.4-2.0) years. Heart rate variability (HRV) measures and non-sustained ventricular tachycardia occurring at the week 6 Holter monitoring were highly predictive of HAVB. Power law slope <-1.5 ms(2)/Hz was the most powerful HRV parameter (HR = 6.02 [2.08-17.41], P <0.001). Conclusion Late HAVB development in post-AMI patients with left ventricular dysfunction can be predicted by risk stratification tests. Measures of HRV reflecting autonomic dysfunction revealed the highest predictive capabilitie

Heart rate variability density analysis (Dyx) for identification of appropriate implantable cardioverter defibrillator recipients among elderly patients with acute myocardial infarction and left ventricular systolic dysfunction

Aims Dyx is a new heart rate variability (HRV) density analysis specifically designed to identify patients at high risk for malignant ventricular arrhythmias. The aim of this study was to test if Dyx can improve risk stratification for malignant ventricular tachyarrhythmias and to test if the previously identified cut-off can be reproduced. Methods and Results This study included 248 patients from the CARISMA study with ejection fraction 70 years and QRS > 120 ms), Dyx <= 1.96 significantly added predictive value (P = 0.0066). Conclusions Dyx was a better predictor of ventricular tachyarrhythmias than the traditional measures of HRV and heart rate turbulence, particularly in the elderly. Dyx might be a useful tool for better selection of ICD candidates in the elderly population, since a normal Dyx in this group was associated with a very low risk for malignant ventricular arrhythmia

Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study

There is a lack of knowledge about malnutrition and risk of malnutrition upon admission and after discharge in older medical patients. This study aimed to describe prevalence, risk factors, and screening tools for malnutrition in older medical patients. In a prospective observational study, malnutrition was evaluated in 128 older medical patients (≥65 years) using the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) and the Eating Validation Scheme (EVS). The European Society of Clinical Nutrition (ESPEN) diagnostic criteria from 2015 were applied for diagnosis. Agreement between the screening tools was evaluated by kappa statistics. Risk factors for malnutrition included polypharmacy, dysphagia, depression, low functional capacity, eating-related problems and lowered cognitive function. Malnutrition or risk of malnutrition were prevalent at baseline (59–98%) and follow-up (30–88%). The baseline, follow-up and transitional agreements ranged from slight to moderate. NRS-2002 and MNA-SF yielded the highest agreement (kappa: 0.31 (95% Confidence Interval (CI) 0.18–0.44) to 0.57 (95%CI 0.42–0.72)). Prevalence of risk factors ranged from 17–68%. Applying ESPEN 2015 diagnostic criteria, 15% had malnutrition at baseline and 13% at follow-up. In conclusion, malnutrition, risk of malnutrition and risk factors hereof are prevalent in older medical patients. MNA-SF and NRS-2002 showed the highest agreement at baseline, follow-up, and transitionally