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Background: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden., Aims: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect., Methods: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024., Results: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this., Conclusions: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.

Objective: Axonal injury (AI) after traumatic brain injury (TBI) is often overlooked as an explanation for cognitive complaints when no damage is detected by computed tomography. The purpose was to assess cognition during the 12 months following a TBI and suspected traumatic axonal injury (TAI)., Methods: The sample included 17 patients younger than 65 years old, however one died. In the acute phase and at 6 and 12 months, cognition, reaction time, psychomotor performance and finger tapping speed were assessed. Working memory and work status were added at 12 months. Acute MRI findings were recorded., Results: After 1 year, all patients still showed cognitive dysfunction. A recovery had been noted at 6 months, but a cognitive decline was indicated for the majority at 12 months. The sick-listed patients had TAI located in the corpus callosum and the brainstem. They were cognitively more impaired and in more areas than the four patients who had returned to work., Conclusion: Cognitive screening can identify the long-term impact of TAI identified by conventional MRI, used as a routine clinical technique. For rehabilitation and for insurance-related matters, these injuries must be taken seriously, as a deterioration over time might occur. Further research is needed.

Purpose: To describe cognitive function, activities of daily living (ADL), housing and return to work after cardiac arrest (CA) and examine the prognostic value of early assessments., Method: Two years after CA 22 persons were assessed with the Barrow Neurological Screen for Higher Cerebral Functions (BNIS) and the Functional Independence Measure (FIM). Data on early assessments of neurological status (The National Institute of Health Stroke Scale, NIHSS), mental status (the Mini Mental State Examination, MMSE) and ADL ability (FIM) were retrieved., Results: Sixty-four per cent were living in their own home, 36% lived in sheltered accommodation and 29% of those of working age had returned to work. Cognitive dysfunction was noted in 95% according to neuropsychological screen. Four persons living in own homes were in need of assistance in social-cognitive ADL. All those in sheltered accommodation needed help in ADL; one was independent in motor functions. This need for assistance was reflected at initial assessments by a higher degree of neurological deficits, cognitive dysfunctions and dependency in ADL activities., Conclusion: The majority had persistent cognitive dysfunctions. Persons in sheltered accommodation were dependent for ADL. Early evaluation is important for understanding and planning for future need for assistance and care, having realistic goals.