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Objective: To compare changes in the perceived impact of stroke on everyday life over time in a rehabilitation sample that received a client-centred activities of daily living (CADL) intervention or usual ADL (UADL) intervention. Design: Longitudinal follow-up of a randomized controlled trial. Methods: A total of 145 persons with stroke were assigned into CADL or UADL. Groups were assessed using the Stroke Impact Scale (SIS) at 3 months, 12 months and 5 years post-intervention. Changes in SIS domain scores over time were compared within and between groups. Results: Changes in the impact of stroke over time were not related to which intervention the groups received. There were no significant differences in the SIS domains or stroke recovery between groups at the 3-month, 12-month and 5-year follow-ups. Despite an increased impact of stroke over time in some domains in both groups, both groups perceived a decreased impact of stroke in the Participation domain at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. Conclusion: These findings stress the importance of access to follow-up rehabilitation interventions 1-year post-stroke to enable participation in daily activities. Such follow-up and enablement would support the use of self-management strategies in the performance of persons’ valued activities, which might be difficult to perform, due to, for example, impact on hand function or mobility. The results of this study emphasize the importance of prioritizing participation in activities that are meaningful from a personal perspective. Lay abstract In this study, perceived impact of stroke on everyday life over time was compared among 145 persons with stroke who received the client-centred or usual activities of daily living intervention. They were followed up at 3, 12 months and 5-years post-stroke. No differences were found in the impact of stroke over time between groups. Despite increased impact of stroke (indicating more problems) over time in some areas, the groups perceived decreased impact of stroke (less problems) in their participation at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. Findings stress the importance of access to follow-up rehabilitation interventions one-year post-stroke to enable participation in daily activities, and to support the use of self-management strategies to facilitate participation in valued and meaningful activities that might be difficult due to person’s functional limitations.

The archaeology of rank is in many respects the basis for the study of social organisation in ancient societies. Here burial data are considered as closely related to the social position in life. Rank-indicating features marking social position can then be correlated with biological features such as sex, age, kinship, pathological traits, and dietary data, which are possible to study with scientific methods. This study concerns seven boatgraves at Tuna, Alsike parish, Uppland, Sweden, dating to the Vendel and Viking Periods. Molecular sex identifications, stable carbon and nitrogen isotope analyses, and trace element analysis were performed on human bones to gain information on the social structure of the population. No dietary hierarchy, and thus no gender differences, could be detected. However, since we now only have studied the upper stratum of the society, next study should concern the rest of the population. This is already underway since we believe this approach is fruitful for the study of archaeological rank and its implications.

INTRODUCTION: Stroke is a major cause of morbidity and mortality globally. The aim of this study was to examine the stroke survivors’ knowledge of the risk factors for stroke, stroke warning signs and post stroke care seeking behaviour and signs of stroke in rural southwestern Uganda. MATERIALS AND METHODS: A mixed methods cross-sectional study was conducted from October 2018 to February 2019, with 25 stroke survivors in a general population cohort. Questionnaire were administered with 25 people and in-depth interviews conducted with 10 people. Descriptive statistics and thematic content analysis were applied to the quantitative and qualitative data, respectively. RESULTS: Participants described stroke as: a persistent numbness of a particular body part; a condition due to witchcraft; a sexually transmitted infection (‘obulwadde bw’obukaba’); a disease parents get when a daughter engages in pre-marital sex in their home (‘obuko’). The participants reported that their awareness of their own hypertension and diabetes increased post-stroke. Participants also reported that their smoking prevalence decreased in the post-stroke period. Participants reported experiencing persistent headaches and numbness but did not associate them with stroke. Participants responding to the questionnaire described post-stroke care as biomedical (19/25), traditional (13/25) and for rehabilitation (10/25). The participants also described delays in seeking medical care because either they did not know what to do, or they thought the stroke was a self-limiting brief episode or that they required alternative treatment to biomedical care. CONCLUSION: Misconceptions around the causes of stroke, and poor care seeking behaviour suggests a need for health education to improve community knowledge about risk factors and warning signs of stroke to help reduce incidence and improve post stroke treatment outcomes.

Background. Persons living with dementia face a reduction of their life space outside home and disengagement from participation, linked to places visited. Purpose. This study explored stability and change in perceived participation in places visited outside home and its relationship with occupational gaps among older adults. Method. Older adults living with (n = 35) or without (n = 35) dementia were interviewed using the Participation in ACTivities and Places OUTside Home (ACT-OUT) questionnaire and the Occupational Gaps Questionnaire (OGQ). Data analysis used descriptive and inferential statistics. Findings. The group of people living with dementia reported significantly fewer places (p < .001) visited than the comparison group and having abandoned more places visited (p < .001) than the comparison group. The number of occupational gaps was significantly different between groups (p < .001). Implications. Participation outside home is not influenced in a uniform and straightforward way for persons living with dementia; the shrinking world effect appears differently in relation to types of places. Contexte de recherche.Les personnes vivant avec une démence font face à une réduction de l'espace extérieur et se désengagent de la participation sociale, et des lieux visités à l'extérieur.Objectif de la recherche.Cette étude vise à explorer la stabilité et les changements dans les lieux visités à l'extérieur du domicile et leurs relations avec les écarts occupationnels auprès de personnes âgées.Méthodologie.Des personnes âgées vivant avec (n=35) ou sans démence (n=35) ont été interviewées avec les questionnaires “Participation in ACTivities and Places OUTside Home (ACT-OUT) et “Occupational Gaps Questionnaire”. L'analyse des données a été menée à l'aide de statistiques des criptives et inférentielles.Résultats.Le groupe de personnes âgées vivant avec une démence rapporte visiter significativement moins (p < .001) de lieux que le groupe de comparaison et abandonne également plus de lieux (p < .001). Le nombre d'écarts occupationnels était aussi significativement différent entre les deux groupes (p < .001).Implications.La participation à l'extérieur du domicile n'est pas influencée de manière uniforme et directe pour les personnes vivant avec une démence; l'effet de diminution du monde extérieur se produit de manière différenciée selon les types de lieux visités.

Bakgrund: Vårdmöten med patienter med språkbarriärer blir allt vanligare för distriktssköterskan inom kommunal hälso- och sjukvård. Hen har ett ansvar att arbeta personcentrerat och sträva efter jämlik vård, men detta försvåras på grund avspråkbarriärer. Syfte: Var att beskriva distriktssköterskans erfarenheter av att främja personcentrerad vård för patienter i kommunal hälso- och sjukvård när språkbarriärer föreligger. Metod: Studien är kvalitativ, datainsamling har skett via semistrukturerade intervjuer med åtta distriktssköterskor inom kommunal hälso- och sjukvård. Insamlad data har analyserats med kvalitativ innehållsanalys med induktiv ansats. Resultat: Sammanfattades i sex underkategorier och två huvudkategorier;Distriktssköterskans egna strategier och förhållningssätt för att främja personcentrerad vård. Språkligt stöd och organisatoriska förutsättningar krävs för att möjliggöra personcentrerad vård. En god vårdrelation var en förutsättning för att vården skulle bli personcentrerad. Distriktssköterskorna försökte främja personcentrerad vård och en vårdrelation genom egna förhållningsätt och kulturell medvetenhet samt språkligt stöd, från informella och formella tolkar. Slutsats: Kommunikationen och den enskilda distriktssköterskans kulturella medvetenhet, hade en stor betydelse för skapandet av en vårdrelation, som främjar personcentrerad vård. Att kunna kommunicera var viktigt och behovet av formellatolkar som språkligt stöd lyfts av distriktssköterskorna. Dock begränsade organisatoriska förutsättningar möjligheten, att använda formella tolkar i tillräcklig utsträckning. Background: Care meetings with patients with language barriers are becoming more common for the district nurse in municipal health care. The district nurseshave a responsibility to work person-centered and strive for equal care, but this becomes more difficult due to language barriers. Aim: To describe the district nurses' experiences of promoting person-centered care for patients in municipal health care, when language barriers occur. Method: The study has used a qualitative approach. Data collection has taken placeby semi-structured interviews, with eight district nurses in municipal health care. Collected data has been analysed with qualitative content analysis with an inductive approach. Results: Summarised in six subcategories' and two main categories; The district nurse's own strategies and approaches to promote person-centered care. Language support and organisational conditions are required to enable person-centered care. A good care relationship was essential for the care to become person-centered. District nurses tried to promote person-centered care and the establishment of a care relationship, through their own attitudes and cultural awareness, as well as linguistic support from informal and formal interpreters. Conclusion: The communication and the cultural awareness of the individual district nurse was of great importance, for establishing a care relationship that promotes person-centered care. Being able to communicate was important and the need for a formal interpreter as language support was pointed out by the district nurses. However, organisational conditions limited the possibility of using formal interpreters to a sufficient extent.

Sled dogs were an integral part of Labrador Inuit life from the initial expansion and settlement of northeastern Canada to the present day. Tasked with pulling sleds and assisting people with other subsistence activities in the winter, dogs required regular provisioning with protein and fat. In this paper, we conduct stable carbon and nitrogen isotope ratio analysis of the skeletal remains of dogs (n=35) and wild fauna (n=68) from sites located on the north and south coasts of Labrador to characterize dog provisioning between the 15th to early 19th centuries. In addition, we analyse bone (n=20) and dentine (n=4) collagen from dogs from Double Mer Point, a communal house site in Hamilton Inlet to investigate how dog diets intersected with Inuit subsistence and trade activities at a local level. We find that dog diets were largely composed of marine mammal protein, but that dogs on the north coast consumed more caribou and fish relative to dogs from the central and south coast sites. The diets of dogs from Double Mer Point were the most heterogenous of any site, suggesting long-distance movement of people and/or animals along the coast. ArchSci2020

Background: This case study explores changes in work potential and work performance for ten people who worked before their stroke while participating in the ReWork-Stroke programme. It describes measures performed by the occupational therapists to enhance work potential and work performance and the participants&rsquo, level of work re-entry nine months after the start of their work trial. Methods: Ten people who had experienced a mild or moderate stroke participated. Changes were assessed using the Worker Role Interview and the Assessment of Work Performance. Logbooks relating to work potential and work performance were analysed using content analysis. Results: The participants&rsquo, work potential was in general supportive to returning to work at baseline and remained so at the three-month follow-up. Most changes occurred in the environmental factors regarding the participants&rsquo, belief that adaptations at the workplace would make re-entry possible. Changes concerning work performance were predominately in a positive direction. Seven of the participants returned to paid work. Conclusion: The ReWork-Stroke programme seems promising for promoting changes in work potential, work performance, and return to paid work. However, further studies are needed to evaluate changes in work potential and work performance and the programme&rsquo, s effectiveness for increasing work re-entry for people who have had stroke.

A strong cultural connection exists between reindeer and modern Sámi identityand economy. Reindeer domestication is, however, a rather late event, andthere are many Sámi who live off resources other than reindeer herding. Theuse of stable isotope analysis on historic reindeer from different geographicareas can contribute to analysing both the processes involved in reindeer domesticationand different environmental utilization by the Sámi. In this study,reindeer bones from six different sites in northern Sweden, ranging in datefrom the 11th to the 20th century, were analysed for stable isotopes to studyhow reindeer have been utilized in various historic contexts – settlements,offering sites and a marketplace. The stable isotope analysis demonstrateddifferent practices in utilization of reindeer, such as foddering. Foddering issuggested to have caused the elevated δ15N values found in reindeer at theoffering sites Vindelgransele and Unna Saiva, as well as at the settlementVivallen. The analysis further indicates that the offering sites were used bysingle Sámi groups. An important outcome of our study is that the biologyof reindeer in Sápmi was culturally influenced by the Sámi even before thereindeer was domesticated. Finansiär:Stiftelsen Konung Gustaf VI Adolfs fond för svensk kultur

PURPOSE: This study aimed at culturally adapting the Occupational Gaps Questionnaire and to describe gaps which may exist during participation in everyday occupations i.e. the discrepancy between what a person wants to do and what he or she actually does in everyday life, in a reference sample from an English-speaking population in Uganda and furthermore to explore differences in occupational gaps between the Ugandan and Swedish reference samples. METHOD: A cross-sectional design was used and data were collected using the Occupational Gaps Questionnaire in four different districts in Uganda (n = 252). The Swedish representative sample included 771 people. RESULTS: Occupational gaps were reported by 91% of the participants (mean=5.8; SD=3.9) in Uganda. The number of gaps per person was higher than in the Swedish sample. The most common gaps in the Ugandan sample were reported as Working (42%), Studying (37%) and Hobbies (35%) in comparison to Cleaning (29%), Sports (23%) Hobbies as well as Travelling for pleasure (20%) in the Swedish sample. Younger participants perceived significantly more gaps than older participants in both samples. CONCLUSIONS: The majority of the participants perceived gaps, indicating that occupational gaps are perceived to a greater extent in Uganda.

The modelling process of the intervention A description of the process when the intervention was modelled from a Swedish client-centred ADL intervention into the Uganda context. (DOCX 15 kb)

Background According to WHO stroke is a growing societal challenge and the third leading cause of global disease-burden estimated using disability-adjusted life years. Rehabilitation after stroke is an area of mutual interest for health care in many countries. Within the health care sector there is a growing emphasis on ICT services to provide clients with easier access to information, self-evaluation, and self-management. ICT-supported care programs possible to use in clients’ home environments are also recommended when there are long distances to the health care specialists. The aim of this study was to evaluate the technical usability of a SMS-based reminder system as well as user opinions when using such a system to assist clients to remember to perform daily rehabilitation activities, to rate their performance and to allow Occupational therapists (OT’s) to track and follow-up clients’ results over time. Methods Fifteen persons with stroke were invited to participate in the study and volunteered to receive daily SMS-based reminders regarding three activities to perform on a daily basis as well as answer daily SMS-based questions about their success rate during eight weeks. Clients, a number of family members, as well as OTs were interviewed to evaluate their opinions of using the reminder system. Results All clients were positive to the reminder system and felt that it helped them to regain their abilities. Their OTs agreed that the reminder and follow-up system was of benefit in the rehabilitation process. However, some technical and other issues were limiting the use of the system for some clients. The issues were mostly linked to the fact that the SMS system was based on a Swedish phone number, so that all messages needed to be sent internationally. Conclusion In conclusion, it seems that this type of SMS-based reminder systems could be of good use in the rehabilitation process after stroke, even in low income counties where few clients have access to Internet or smart phones, and where access to healthcare services is limited. However, since the results are based on clients’, OTs’ and family members’ expressed beliefs, we suggest that future research objectively investigate the intervention’s beneficial effects on the clients’ physical and cognitive health. Electronic supplementary material The online version of this article (10.1186/s12911-019-0847-3) contains supplementary material, which is available to authorized users.

The Questionnaire to the OTs. (DOCX 14 kb)

The logic model for developing the intervention. The Logic Model for developing the family based mobile phone supported rehabilitation intervention for persons with stroke in Uganda. (DOCX 16 kb)

Guiding principles for implementation of the mobile phone supported F@ceâ ˘. A description of the used guiding principles used by the OTs during the implementation of the intervention. (DOCX 17 kb)

Supplemental material, Supplemental_Material for Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke by Annicka Hedman, Gunilla Eriksson, Lena von Koch and Susanne Guidetti in Clinical Rehabilitation

Sammanfattning. Syftet med uppsatsen, att utforska patienters upplevelser av en IPT för depression i en primärvårdskontex. Med frågeställningen patienters upplevelser och erfarenheter av att ha genomgått IPT för depression.

Strontium isotope analysis of skeletal material as a means to reconstruct prehistoric residential patterns has previously mainly been applied to populations with terrestrial diets. Here we present a model for populations with mixed marine/terrestrial diets, which is based on two-component mixing of strontium isotopes. Applying this model, we can estimate the original strontium isotope value of the terrestrial component of the diet. Accordingly it is possible to identify non-local individuals even if they had a mixed marine/terrestrial diet. The model is applied to tooth enamel samples representing nine individuals recovered from a passage grave in Resmo, on the island of Öland in the Baltic Sea, where at least five non-local individuals, representing at least two different geographical regions of origin, were identified. Non-local individuals were more frequent during the Bronze Age than during previous phases.

Bakgrund: Fysisk aktivitet på Recept, FaR, är en metod där fysisk aktivitet ordineras på motsvarande sätt som ett läkemedel. Övervikt och fetma ökar hos befolkningen och ungefär en tredjedel är inte tillräckligt fysiskt aktiva, vilket leder till ökade hälsoproblem. Syfte: Undersöka effekten av Fysisk aktivitet på Recept i kombination med att ha träffat en receptmottagare, med avseende på självskattad hälsa, fysisk aktivitet, stillasittande och motivation. Metod: Empirisk studie med material från hälsoenkäter utfördes, vilka 143 deltagare (18-81år) besvarade vid start och efter tre månader. Resultat: Hälften av deltagarna hade ökat sin fysiska aktivitet efter tre månader. Totalt minskade 28 % av hela gruppen sitt stillasittande, det självskattade allmänna hälsotillståndet förbättrades och motivation till ökad fysisk aktivitet var stor. Deltagarna minskade också sitt midjemått och BMI under studietiden. Slutsats: Att ha fått FaR i kombination med att ha träffat en receptmottagare visade sig efter tre månader ha haft effekt på deltagarnas levnadsvanor. Fortsatta studier av materialet hade varit intressant att göra, till exempel att undersöka om förändringarna kvarstår och om ytterligare förbättringar kan ses efter sex och tolv månader. Nyckelord: Fysisk aktivitet, stillasittande, motivation, hälsa

Kvinnans kropp förändras i samband med graviditet och barnafödande. Detta kan leda till sexuell ohälsa första tiden som nybliven mamma. Det är viktigt att barnmorskor kan identifiera och våga diskutera de problemen som kan finnas för att kunna hjälpa kvinnan. Syftet med studien var att belysa faktorer som kan påverka kvinnors upplevelse av sitt sexualliv efter genomgången vaginal förlossning. Metoden är en litteraturstudie som har utförts med en kvalitativ ansats. Artiklarna hade både kvalitativa och kvantitativa ansatser vilket gav studien både djup och bredd. I resultatet framkom att kvinnor funderade över hur deras sexuella samliv påverkades efter vaginal förlossning. De kroppsliga förändringar kvinnan genomgick hade betydelse för hennes upplevelse av sitt sexualliv. Det sexuella samlivet påverkades i negativ riktning av trötthet. Smärta vid samlag hade oftast lagt sig efter tre till sex månader, medan nedsatt lust kunde hålla i sig upp till ett och ett halvt år. Dessa faktorer ledde till att frekvensen samlag minskade. Detta kunde bli ansträngande för den parrelationen kvinnorna levde i då behovet av sexuellt umgänge ofta var ojämnt mellan kvinna och man. Resultatet visade att barnmorskor endast berörde ämnet sexualitet genom att ge kvinnan recept på preventivmedel. Barnmorskor bör aktivt fråga kvinnan om besvär med sexuallivet för att underlätta rollen som nybliven mamma, kvinna och älskarinna.

Stone Age research on Northern Europe frequently makes gross generalizations about the Mesolithic and Neolithic, although we still lack much basic knowledge on how the people lived. The transition from the Mesolithic to the Neolithic in Europe has been described as a radical shift from an economy dominated by marine resources to one solely dependent on farming. Both the occurrence and the geographical extent of such a drastic shift can be questioned, however. It is therefore important to start out at a more detailed level of evidence in order to present the overall picture, and to account for the variability even in such regional or chronological overviews. Fifteen Stone Age sites were included in this study, ranging chronologically from the Early Mesolithic to the Middle or Late Neolithic, c. 8300–2500 BC, and stretching geographically from the westernmost coast of Sweden to the easternmost part of Latvia within the confines of latitudes 55–59° N. The most prominent sites in terms of the number of human and faunal samples analysed are Zvejnieki, Västerbjers and Skateholm I–II. Human and faunal skeletal remains were subjected to stable carbon and nitrogen isotope analysis to study diet and ecology at the sites. Stable isotope analyses of human remains provide quantitative information on the relative importance of various food sources, an important addition to the qualitative data supplied by certain artefacts and structures or by faunal or botanical remains. A vast number of new radiocarbon dates were also obtained. In conclusion, a rich diversity in Stone Age dietary practice in the Baltic Region was demonstrated. Evidence ranging from the Early Mesolithic to the Late Neolithic show that neither chronology nor location alone can account for this variety, but that there are inevitably cultural factors as well. Food habits are culturally governed, and therefore we cannot automatically assume that people at similar sites will have the same diet. Stable isotope studies are very important here, since they tell us what people actually consumed, not only what was available, or what one single meal contained. We should not be deceived in inferring diet from ritually deposited remains, since things that were mentally important were not always important in daily life. Thus, although a ritual and symbolic norm may emphasize certain food categories, these may in fact contribute very little to the diet. By the progress of analysis of intra-individual variation, new data on life history changes have been produced, revealing mobility patterns, breastfeeding behaviour and certain dietary transitions. The inclusion of faunal data has proved invaluable for understanding the stable isotope ecology of a site, and thereby improve the precision of the interpretations of human stable isotope data. The special case of dogs, though, demonstrates that these animals are not useful for inferring human diet, since, due to the number of roles they possess in human society, dogs could deviate significantly from humans in their diet, and in several cases have been proved to do so. When evaluating radiocarbon data derived from human and animal remains from the Pitted-Ware site of Västerbjers on Gotland, the importance of establishing the stable isotope ecology of the site before making deductions on reservoir effects was further demonstrated. The main aim of this thesis has been to demonstrate the variation and diversity in human practices, challenging the view of a “monolithic” Stone Age. By looking at individuals and not only at populations, the whole range of human behaviour has been accounted for, also revealing discrepancies between norm and practice, which are frequently visible both in the archaeological record and in present-day human behaviour.

The role of cultural policy within the general political planning of a community can vary both historically and regionally. The aim of this study has been to explore the cultural policy plans, during the 1990's, in the recently formed geographical region of "Västra Götaland". This is a qualitative study, carried out during 1999, and based upon structured interviews with five representatives of the cultural-policy sector in the "Västra Götaland" region. In order to identify connections and tendencies in a more general social context the aims of the five representatives regarding cultural policy have been explored from the perspective of three cultural policy paradigms, namely Dorte Skot-Hansen, Olav R. Spilling and Göran Nylöf. To get a deeper understanding of existing regional politics, the General Regional Development Plan from "Västra Götaland" and two other Swedish regions have been examined from a cultural policy perspective. In addition, the results of the interviews have been compared to the General Regional Development Plans. In the scientific survey of the study, the concepts and terminology of the development plans are discussed and clarified. The study also includes a review of the regional political ideas that existed in Swedish society from the 1950´s to the end of the 1990´s. There is also a historical review of national and regional cultural policy from the 1970´s up to the present day. This study demonstrates that today cultural policy is perceived to have a more important and integrated role in general developmental politics, than in the past. Uppsatsnivå: D

Human burials from the cemetery at the Rounala church, northern Sweden, were radiocarbon (C-14) dated to shed light on the use of the cemetery. Carbon, nitrogen and sulfur stable isotope analysis of bone collagen from 19 distinct individuals indicated that these individuals had a mixed diet consisting of freshwater, marine and terrestrial resources. Dietary modeling using FRUITS was employed to calculate the contributions of the different resources for each individual. These data were then used to calculate individual Delta R values, taking into account freshwater and multiple marine reservoir effects, the latter caused by Baltic and Atlantic marine dietary inputs, respectively. C-14 dating of tissues from modern freshwater fish species demonstrate a lack of a freshwater reservoir effect in the area. Two OxCal models were used to provide endpoint age estimates. The calibrated data suggest that the site's cemetery was most likely in use already from the 14th century, and perhaps until at least the late 18th century.

Supplemental material, sj-docx-1-hol-10.1177_09596836211041728 for Species-specific reservoir effect estimates: A case study of archaeological marine samples from the Bering Strait by Jack PR Dury, Gunilla Eriksson, Arkady Savinetsky, Maria Dobrovolskaya, Kirill Dneprovsky, Alison JT Harris, Johannes van der Plicht, Peter Jordan and Kerstin Lidén in The Holocene

Supplemental material, sj-docx-1-hol-10.1177_09596836211041728 for Species-specific reservoir effect estimates: A case study of archaeological marine samples from the Bering Strait by Jack PR Dury, Gunilla Eriksson, Arkady Savinetsky, Maria Dobrovolskaya, Kirill Dneprovsky, Alison JT Harris, Johannes van der Plicht, Peter Jordan and Kerstin Lidén in The Holocene