The Dawn of a New, New International Economic Order

OBJECTIVES: To determine whether being overweight or obese is associated with significant health outcomes in an 85-year-old population. less thanbrgreater than less thanbrgreater thanDESIGN: A cross-sectional population-based study. less thanbrgreater than less thanbrgreater thanSETTING: Linkoping, Sweden. less thanbrgreater than less thanbrgreater thanPARTICIPANTS: Three hundred thirty-eight people born in 1922 were identified using the local authoritys register. less thanbrgreater than less thanbrgreater thanMEASUREMENTS: Data related to sociodemographic characteristics, health-related quality of life (HRQoL), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double-checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. less thanbrgreater than less thanbrgreater thanRESULTS: Overweight (body mass index (BMI) 25.0-29.9 kg/m(2)) and obese (BMI andgt;= 30.0 kg/m(2)) participants perceived more difficulty performing instrumental activities of daily living (IADLs) and had more comorbidity than their normal-weight counterparts (BMI 18.5-24.9 kg/m(2)), but their overall HRQoL and health service costs did not differ from those of normal-weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.1-4) and cleaning (OR = 2.2, 95% CI = 1.2-4.2) than their normal-weight counterparts. Although obesity was also associated with multimorbidity (OR = 3, 95% CI = 1.2-8), the health service cost of each case of multimorbidity (n = 251) was highest in normalweight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1-8.1). less thanbrgreater than less thanbrgreater thanCONCLUSION: For 85-year-olds, being obese, as opposed to overweight, is associated with self-reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well-being similar to that of those with normal weight.Funding Agencies|Health Research Council of the South-East of Sweden||County of Ostergotland||Janne Elgqvist Family Foundation||</p

Teaching Legal Ethics: Exploring the Continuum

Spaeth et al assert that the only reason to teach legal ethics, or professional responsibility, is to try to make the legal profession more worthy of its stated ideals. The University of Pennsylvania Law School Center on Professionalism\u27s efforts to achieve this are discussed

Client participation in the rehabilitation process

This thesis evaluates the rehabilitation process with respect to client participation. The Swedish version of a client-centred structure, the Canadian Occupational Performance Measure (COPM), is evaluated from the perspectives of the clients, the occupational therapists and the members of a rehabilitation team. Data have been collected through diaries, the COPM, assessments of ability to perform activities of daily living, mobility, self-assessments of pain and health, interviews with clients, interviews with staff, and focus groups interviews. The results show that a structured method is needed in order to improve clients’ active participation in goal formulation. The Swedish version of the COPM has high responsiveness to change over time. The use of the COPM improved client participation in the goal-formulation process, according to the results from a study with experiment and control groups. The clients perceived that treatment goals were identified, they were able to recall the goals and felt that they were active participants. They also perceived they had a higher ability to manage after the rehabilitation period was completed compared to clients in the control group. The clinical utility of the Swedish version of the COPM was confirmed in focus-group interviews with occupational therapists. The occupational therapists perceived the COPM as helpful in the goal-setting process and planning of treatment interventions. Even though problems are identified, they are directly related to, and formulated as, goals. Clients receive feedback on improvement over time. The COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role. Therapists need knowledge about the theoretical foundation of the instrument and have to develop a personal interview technique. When the COPM is used in a team setting, it provides the team with broader information on what is purposeful occupation to the client. The focus is on occupational performance rather than function. According to team members the use of the COPM as a team tool increased client participation, was a good outcome measure, resulted in distinct goals, and focused on goals that were meaningful to the client. Implementation of a client-centred approach is facilitated when a structured method is used, but this is not enough. Involvement and motivation from all team members are required, as well as support during the introduction and implementation period. Support from management, knowledge about the underlying theory, time for discussions and reflections as well as opportunities to develop a personal interview technique are pointed out as important factors for a successful implementation.On the day of the defence date the status on article V was Submitted.</p

Decisions on driving after brain injury/disease: Feasibility and construct validity of a new simulator assessment tool

Introduction Driving is a complex activity involving a high level of cognitive abilities and thus might be affected after a brain injury/disease. The aim of this research was to evaluate the feasibility and construct validity of a driving simulator tool as a complement to existing driving assessments of patients with cognitive dysfunctions after a brain injury/disease. Method A descriptive and prospective research design was achieved. For construct validation, decisions were based on results from the Useful Field of View, Nordic Stroke Driver Screening Assessment, Trail Making Test and, when necessary for the decision, an on-road observation. Results from the simulator tool were not included in the clinical decision process. Results A total of 129 patients from four different rehabilitation services were included. The results showed a significant difference in test results between those who were considered medically fit versus unfit to drive. A factor analysis revealed four components, all including attention in combination with processing speed, visuospatial function, simultaneous capacity and executive function; these are all represented in the simulator tool. A correlation analysis showed that simulator subtest 3 (response/divergent response to stimuli) had the strongest correlation with most of the other tests included. Conclusions The simulator was found to be feasible and valid and found to include components other than those measured in the other tests.Funding Agencies|County Council of Ostergotland, Sweden [LIO-582071, SC-2017-00091-26]; Medical Research Council of Southeast Sweden [FORSS -605951, 654091, 755541, 850271]</p

Usability of Norm Values on Results from a Simulator Device and Cognitive Tests in Traffic Medicine

Introduction: Driving is an essential everyday task for most adults, and fitness to continue car-driving after a brain injury/disease is a common issue in rehabilitation settings. There is no consensus on how this assessment should be performed and thus further research and development are of great value. The aim was to study the usability of cut-off values, based on recently developed norm values for a driving simulator device (CyberSiM), as well as cognitive tests, for patients already considered fit-to-drive after a standardized traffic medical investigation. Methods: The study had a retrospective case-control design. Norm results (n = 129) were compared with patient results (n = 126) divided into two age groups (&amp;lt;= 59 years and &amp;gt;= 60 years). Results: from Useful Field of View, Trail Making Test, Nordic Stroke Driver Screening Assessment as well as a simulator device (CyberSiM) were compared. Results: The group of patients considered fit-to-drive after a traffic medicine assessment had worse results on all cognitive tests compared with norms. Results on CyberSiM subtests II and III did not differ from norms. The proportion of patients within suggested cut-off limits (mean +/- 2SD norm) and considered fit to drive (mean +/- 2SD norm) were highest (75-95%) for all three subtests of CyberSiM and for Useful Field of View in both age groups. Conclusion: Availability of norm values in decision on continued driving is of value when interpreting the results of cognitive assessments sensitive to age, but it must be handled with care because many factors are important for individuals ability to drive.Funding: The development of CyberSiM was funded by VINNOVA (2013-04010). The data collection in the present study wasfunded by the Council of Östergötland, Sweden (LIO-582071 and SC-2017-00091-26) and the Medical Research Councilof Southeast Sweden (FORSS-654091; 755541; 605951; 850271).</p

Cognitive prerequisites for fitness to drive : Norm values for the TMT, UFOV and NorSDSA tests

Background: Fitness-to-drive assessment is a growing area for occupational therapists. There are few off-road tests specially developed to assess fitness to drive, and several cognitive tests have no age-specific norms. Aims/objectives: The aim was to identify and describe age-related norm values for the Trail Making Test, Nordic Stroke Driver Screening Assessment and Useful Field of View test, and to study inter-correlation between test results. Materials and methods: The sample included 410 volunteers; 149 men and 261 women, mean age 52 +/- 16.8 years. Commonly used off-road tests were used: TMT A and B, UFOV and NorSDSA. Results: Normative data for the specific subtests and total score for NorSDSA and UFOV are provided and presented in four age groups. Age correlated with the results for most of the subtests. Conclusions: Off-road cognitive test scores are necessary and valuable for occupational therapists in their contribution to the final decision on continued driving. In clinical practice, it can be difficult to interpret cognitive test results when working with driving assessments. Age-based norm values are suggested to be a way to provide clinicians with a benchmark against which scores can be compared

Cognitive impairment and its consequences in everyday life : experiences of people with mild cognitive impairment or mild dementia and their relatives

Background: The aim of this study was to explore experiences of cognitive impairment, its consequences in everyday life and need for support in people with mild cognitive impairment (MCI) or mild dementia and their relatives. Methods: A qualitative approach with an explorative design with interviews was chosen. The participants included five people with MCI and eight people with mild dementia and their relatives. All participants were recruited at a geriatric memory clinic in Sweden. The Grounded Theory method was used. Results: The following categories emerged: noticing cognitive changes; changed activity patterns; coping strategies; uncertainty about own ability and environmental reactions; support in everyday life; support from the healthcare system; consequences in everyday life for relatives; and support for relatives. The main findings were that people with MCI and dementia experienced cognitive changes that could be burdensome and changed activity patterns. Most of them, however, considered themselves capable of coping on their own. The relatives noticed cognitive changes and activity disruptions to a greater extent and tried to be supportive in everyday life. Degree of awareness varied and lack of awareness could lead to many problems in everyday life. Conclusions: Perceived cognitive impairment and its consequences in everyday life were individual and differed among people with MCI or dementia and their relatives. Thus, healthcare professionals must listen to both people with cognitive impairment and their relatives for optimal individual care planning. Support such as education groups and day care could be more tailored towards the early stages of dementia

Cognition, daily living, and health-related quality of life in 85-year-olds in Sweden

This study investigates how cognition influences activities of daily living and health-related quality of life in 85-year-olds in Sweden (n = 373). Data collection included a postal questionnaire comprising demographics and health-related quality of life measured by the EQ-5D. The ability to perform personal activities of daily living (PADL) was assessed during a home visit that included administering the Mini Mental State Examination (MMSE). Cognitive impairment was shown in 108 individuals (29%). The majority were independent with respect to PADL. A larger number of participants with cognitive impairment reported that they needed assistance in instrumental activities of daily living (IADL) compared to the group without cognitive impairment. Impaired cognition was significantly related to problems with IADL. Significant but low correlations were found between cognition and health-related quality of life – higher ratings on perceived quality of life correlated with higher results on the MMSE