Factors related to successful job reintegration of people with a lower limb amputation

Objective: To study demographically, amputation-, and employment-related factors that show a relationship to successful job reintegration of patients after lower limb amputation. Design: Cross-sectional study. Setting: University hospital. Patients: Subjects had an acquired unilateral major amputation of the lower limb at least 2 years before, were aged 18 to 60 years (mean, 46yr), and were living in the Netherlands. All 322 patients were working at the time of amputation and were recruited from orthopedic workshops. Intervention: Questionnaires sent to subjects to self-report (1) demographic and amputation information and (2) job characteristics and readjustment postamputation. Questionnaire sent to rehabilitation specialists to assess physical work load. Main Outcome Measures: Demographically related (age, gender); amputation-related (comorbidity; reason and level; problems with stump, pain, prosthesis use and problems, mobility, rehabilitation); and employment-related (education, physical workload) information about the success of job reintegration. Results: Job reintegration was successful in 79% and unsuccessful in 21% of the amputees. Age at the time of amputation, wearing comfort of the prosthesis, and education level were significant indicators of successful job reintegration. Subjects with physically demanding jobs who changed type of job before and after the amputation more often successfully returned to work than subjects who tried to stay at the same type of job. Conclusions: Older patients with a low education level and problems with the wearing comfort of the prosthesis are a population at risk who require special attention during the rehabilitation process in order to return to work. Lowering the physical workload by changing to another type of work enhances the chance of successful reintegration

Participation and satisfaction after spinal cord injury: results of a vocational and leisure outcome study

Study design: Survey. Objectives: Insight in (1) the changes in participation in vocational and leisure activities and (2) satisfaction with the current participation level of people with spinal cord injuries (SCIs) after reintegration in society. Design: Descriptive analysis of data from a questionnaire. Setting: Rehabilitation centre with special department for patients with SCIs, Groningen, The Netherlands. Subjects: A total of 57 patients with traumatic SCI living in the community, who were admitted to the rehabilitation centre two to 12 years before the current assessment. Main outcome measures: Changes in participation in activities; current life satisfaction; support and unmet needs. Results: Participation expressed in terms of hours spent on vocational and leisure activities changed to a great extent after the SCI. This was mainly determined by a large reduction of hours spent on paid work. While 60% of the respondents successfully reintegrated in work, many changes took place in the type and extent of the job. Loss of work was partially compensated with domestic and leisure activities. Sports activities were reduced substantially. The change in participation level and compensation for the lost working hours was not significantly associated with the level of SCI-specific health problems and disabilities. As was found in other studies, most respondents were satisfied with their lives. Determinants of a negative life satisfaction several years following SCI were not easily indicated. Reduced quality of life was particularly related to an unsatisfactory work and leisure situation. Conclusions: Most people with SCI in this study group were able to resume work and were satisfied with their work and leisure situation

K2 eller K3 – vilket regelverk bör ett företag välja?

Vi har redogjort för K2- och K3-regelverken och i praktiken finns tydliga skillnader. I K2-regelverket finns begränsande förenklingsregler och i K3-regelverket ges möjlighet att göra egna bedömningar och utforma redovisning och årsredovisning efter företagets situation. I slutsatsen utgår vi från ett medelstort företag, vilket vi definierar som ett företag som ligger över gränsvärdet 50/25/50 men under gränsvärdet 50/40/80. Mot ovanstående bakgrund väcks diskussion kring, gällande de i praktiken väsentliga skillnaderna, vilket regelverk som betraktas mest lämpligt för ett medelstort företag. De faktorer som eventuellt blir att ta hänsyn till är företagets bransch, behov av redovisningsprincip och vilken typ av intressentkrets som föreligger. Därtill bör även beaktas hur intressenterna bedömer företaget grundat på val av regelverk samt i vilken grad intressenterna efterfrågar en rättvisande bild av företagets verksamhet. Vilket regelverk som får anses mest lämpligt för ett medelstort företag beror på företagets individuella situation och framtida avsikter. Det går därför egentligen inte att med en jämfö-rande diskussion, ur denna aspekt, hävda att det ena regelverket är mer fördelaktigt än det andra. Vilket regelverk som anses bättre kommer även bero på hur revisionsbyråer framställer det ena regelverket i jämförelse med det andra. Vår slutsats är att K3 i många fall kommer att uppfattas vara det mest fördelaktiga valet för ett medelstort företag. Dels kommer det utgöra huvudregelverk och om företaget i framtiden har avsikter att expandera kommer ett byte till detta regelverk likväl föreligga. Dels har K3 större internationell anknytning vilket även kan vara positivt om företaget är verksamma internationellt eller tror sig bli så i framtiden. Obero-ende av annat, är K3 även mest fördelaktigt för företag med en bred intressentkrets men även kan företag verksamma inom vissa branscher gynnas av dess redovisningsprinciper. K2 är, ur företagens aspekt, att föredra av förenklingsskäl. Följs de standardiserade reglerna betraktas en rättvisande bild av dess finansiella situation avspeglas på lång sikt. Å andra sidan begränsar förenklingsreglerna företagets möjligheter och alternativ vid redovisningen och vissa avstamp från ÅRL:s grundläggande principer följer därav. Trots att vi ovan hävdat att K2 är att föredra ur företagens aspekt är det svårt att i praktiken se några fördelar för ett medelstort företag vid tillämpningen av dess redovisningsprinciper. K3-regelverket, som är betydligt mer komplicerat och omfattande än K2, ger trots allt användaren större möjligheter gällande redovisningen. Ur intressentperspektiv är K3 regelverket med dess mer informativa årsredovisning att föredra. De höga kraven på redovisningen innebär dels att en rättvisande bild av redovisningen ges, dels att årsredovisningen innehåller mer information. Det går dock att argumentera att K2-regelverket är minst lika bra ur intressentperspektiv, den information dess intressenter efterfrågar skulle i praktiken kunna läggas till i noter. Swedbank grundar stora delar av sina beräkningar och analyser av ett företag på siffror och nyckeltal som de själva framställer. Att det finns skillnader mellan de två olika regelverken och den information som framställs verkar inte påverka Swedbank i allt för stor grad. Skatteverket är indifferent till om företagen tillämpar K2 eller K3 då det är deklarationen som står i fokus. Däremot kan Skatteverket ställa sig mer skeptiska till K2-företags deklarationsunderlag på grund av att de justeringar K2-företag måste göra inför deklarationen kan leda till oavsiktliga fel. För externa ägare kan även nyckeltal vara av intresse för att kunna kontrollera ett företags ekonomiska ställning. Det har tidigare konstaterats att samma typ av företag med samma typ av ekonomiska förutsättningar kan uppvisa skilda resultat och avvikande nyckeltal beroende på om det redovisar enligt K2 eller K3. Valet av redovisningsprincip kan alltså få påverk

Health-promotion and disease-prevention for very old persons

The overall aim of this thesis was to evaluate the effects of health-promoting and disease-preventive interventions on health and frailty in very old community-dwelling persons, and to explore the participants’ experiences in relation to these interventions. Studies I and II were evaluations of the three-armed randomised, single-blind and controlled trial Elderly Persons in the Risk Zone, which consisted of the two health-promoting and disease-preventive interventions preventive home visits (PHV) and multi-professional senior group meetings (senior meetings). A total of 459 persons aged 80 years or older and still living at home were included in the study. Participants were independent in ADL and without overt cognitive impairment. They were assessed at baseline and followed up at one and two years after intervention. An intention-to-treat analysis was performed using the outcome variables; morbidity, symptoms, self-rated health, satisfaction with health (study I), frailty measured as tiredness in daily activities and frailty measured with eight frailty indicators (study II). In study III, seventeen participants in the intervention preventive home visits were interviewed in their own homes. The interviews were analysed using a phenomenographic method. In study IV focus group methodology was used to interview a total of 20 participants who had participated in the intervention senior meetings. The interviews were analysed according to the focus group method described by Kreuger. The results of studies I and II showed that both interventions postponed morbidity and delayed deterioration in satisfaction with physical and psychological health for up to two years compared to the control group. Both interventions also showed favourable effects in postponing the progression of frailty measured as tiredness in daily activities for up to one year. The intervention senior meetings had an advantage over preventive home visits since it prevented a decline in general self-rated health for up to one year. However, neither of the interventions was effective in postponing the progression of symptoms or frailty as measured with the sum of frailty indicators. The participants that were defined as frail according to frailty indicators (>3 indicators) increased in all three study arms during the two-year study period. The interviews with the participants involved in the intervention preventive home visits (study III) revealed four categories which explained how they experienced the visit and its consequences for health: the PHV made them visible and proved their human value, it brought a feeling of security and gave the participants an incentive to action. A few of the participants experienced that the PHV was of no value. The focus group interviews with the participants who had received the senior meetings (study IV) revealed that the participants lived in the present. However, the supportive environment together with learning a preventive approach contributed to the participants’ experiencing the senior meetings as a key to action. In conclusion, the studies in this thesis show that it is possible to postpone a decline in health outcomes measured as morbidity, self-rated health, satisfaction with health and frailty measured as tiredness in daily activities in older persons at risk of frailty. Both interventions might have functioned as a trigger to motivate the participants to engage in a health-promoting behaviour. The contributing factors were the holistic information, the fact that participants were strengthened in their role as older persons, that someone cared about their health, and the fact that the interventions focused on personal needs. The senior meetings were the most beneficial intervention, which may be due to the group setting where the participants could learn from each other, gain role models and share their problems. Altogether this could have increased participants’ understanding and ability to use their own resources and may have motivated them to take measures and engage in health-promoting activities