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Background: Clinical scales for upper extremity motor function may not capture improvement among higher functioning people with stroke. Objective: To describe upper extremity kinematics in people with stroke who score within the upper 10% of the Fugl-Meyer Assessment (FMA-UE) and explore the ceiling effects of the FMA-UE. Design: A cross-sectional study design was used. Participants: People with stroke were included from the Stroke Arm Longitudinal Study at University of Gothenburg together with 30 healthy controls. The first analysis included participants who achieved FMA-UE score > 60 within the first year of stroke (assessed at 3 days, 2 weeks, 4 weeks, 3 months, or 12 months post stroke). The second analysis included participants with submaximal FMA-UE (60–65 points, n = 24) or maximal FMA-UE score (66 points, n = 21) at 3 months post stroke. Measurements: The kinematic analysis of a standardized drinking task included movement time, velocity and strategy, joint angles of the elbow, and shoulder and trunk displacement. Results: The high FMA-UE stroke group showed deficits in seven of eight kinematic variables. The submaximal FMA-UE stroke group was slower, had lower tangential and angular peak velocity, and used more trunk displacement than the controls. In addition, the maximal FMA-UE stroke group showed larger trunk displacement and arm abduction during drinking and lower peak angular velocity of the elbow. Conclusions: Participants with near or fully recovered sensorimotor function after stroke still show deficits in movement kinematics; however, the FMA-UE may not be able to detect these impairments. [ABSTRACT FROM AUTHOR]

Introduction: Stress week was included during training of Special Forces (SF) Operators in Sweden to test their ability and limits for handling stress in different unknown situations and environments at a military training facility in Sweden. The aim of the study was to examine the effects of stress and workload experienced in various tasks during firefighting and military medicine simulation training., Methods: This pilot study was performed during the second day of stress week. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) is a validated, subjective, and multidimensional assessment tool for rating perceived workload with six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. These subscales were used as an indicator of stress experienced. The different tasks were assessed by the SF Operators by rating the NASA-TLX subscales for each task, which were then analyzed and compared using ANOVA., Results: There was a significant difference between the two simulation exercises assessed by the participants and instructors, and both groups considered firefighting to be more demanding than medical. The participants perceived the mental and physical demands as more demanding in the firefighting exercises, as well as for the level of frustration and effort. However, no differences regarding performance or temporal demands between the simulation exercises were found., Conclusion: The principle "train as you fight" implies difficult and demanding situations. When exposing Swedish SF Operators to challenging situations, assessment of perceived stress and performance are possible., (2022.)

Background: The time delay from alerted ambulance to arrival at the stroke unit is crucial for patients suffering a suspected stroke. This is a recognized problem why additional explorative knowledge regarding actions taken are needed., Aim: To explore actions taken by nurses that affect lead times in the care pathway from the alerted ambulance to the stroke unit, for low-priority patients suffering a suspected stroke., Method: The design of the study was explorative and descriptive and used a qualitative approach based on Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care pathway at an university hospital in western Sweden were interviewed about their actions that affected the lead time., Results: Actions undertaken affected lead time in the stroke care pathway for low-priority patients related to "promoting the care chain process" and "taking control of the situation"., Conclusions: The staff within all parts of the care pathway affected the lead time, individually as well as via interaction between departments. This calls for the need of further collaboration and consensus concerning how to facilitate a smooth care pathway., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The time elapsing from the alarm being raised to arrival at the stroke unit is crucial for patients suffering a conceivable stroke. More knowledge is needed about critical incidents-both favourable and unfavourable-affecting the lead time in the care chain., Aim: To explore favourable and unfavourable critical incidents (CIs), affecting lead times in the care chain from the alerted ambulance to the stroke unit, as experienced by nurses, for low-priority patients suffering a conceivable acute stroke., Method: The study had an explorative descriptive design using a qualitative approach of Flanagan's Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care chain at a hospital in western Sweden were interviewed about their experiences regarding CIs influencing the lead time for low-priority patients., Results: There were 363 CIs identified related to human interactions and organizational structures. The types of CIs varied depending on where in the care chain they were experienced. Both favourable and unfavourable factors had an impact on the length of the lead time from alerted ambulance to stroke unit for lowpriority patients. Furthermore, CIs occurring both early and later in the care chain affected the whole process., Conclusions: There is a need for greater understanding within each interrelated department in the care chain about how CIs at one part of the care chain have an impact on another., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes., Method: Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2., Results: Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist., Conclusions: This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs., Trial Registration: This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.

Background: Health care workers (HCWs) are at high risk of occupational injuries and approximately 10-15% of patients are affected by an adverse event during their hospital stay. There is scarce scientific literature about how HCWs manage these risks in practice and what support they need. This knowledge is needed to improve safety for patients and HCWs. This study explores HCWs' experiences of workplace incidents that led to injury or posed a risk of patient and worker injury, with focus on HCWs' emotions and actions., Methods: This study employed a qualitative design using the critical incident technique. Semi-structured individual interviews were held with 34 HCWs from three regions in Sweden. Data were analysed using inductive category development., Results: Altogether 71 workplace incidents were reported. The analysis of two dimensions - the emotions HCWs feel and the actions team members and managers take when a workplace incident occurs - yielded two categories each: Anxiety during the incident, Persistent distress after the incident, Team interplay for safety actions and Support and ratification from managers and colleagues. Health care workers risked their own safety and health to provide patient safety. Teamwork and trustful relationships were critical for patient and worker safety. Support and validation from colleagues and managers were important for closure; unsatisfactory manager response and insufficient opportunities to debrief the incident could lead to persistent negative emotions. Participants described insecurity and fear, sadness over being injured at work, and shame and self-regret when the patient or themselves were injured. When the workplace had not taken the expected action, they felt anger and resignation, often turning into long-term distress., Conclusions: Work situations leading to injury or risk of patient and worker injury are emotionally distressing for HCWs. Team interplay may facilitate safe and dynamic practices and help HCWs overcome negative emotions. Organizational support is imperative for individual closure. For safety in health care, employers need to develop strategies for active management of risks, avoiding injuries and providing support after an injury.

Background: This study aimed to investigate whether white matter lesions (WML), β-amyloid-, and tau pathologies are independently associated with mobility, dual tasking, and dynamic balance performance in older nondemented individuals., Methods: We included 299 older people (mean, SD, age: 71.8, 5.6 years) from the Swedish BioFINDER study, whereof 175 were cognitively unimpaired and 124 had mild cognitive impairment (MCI). In multivariable regression analyses, dependent variables included mobility (Timed Up & Go [TUG]), dual tasking (TUG with a simultaneous subtraction task, that is, TUG-Cog, as well as dual task cost), and balance (Figure-of-eight). The analyses were controlled for age, sex, education, diagnosis (ie, MCI), and comorbidity (stroke, diabetes, and ischemic heart disease). Independent variables included WML volume, and measures of β-amyloid (abnormal cerebrospinal fluid [CSF] Aβ42/40 ratio) and tau pathology (CSF phosphorylated tau [p-tau])., Results: Multivariable regression analyses showed that an increased WML volume was independently associated with decreased mobility, that is, TUG (standardized β = 0.247; p < .001). Tau pathology was independently associated with dual tasking both when using the raw data of TUG-Cog (β = 0.224; p = .003) and the dual-task cost (β= -0.246; p = .001). Amyloid pathology was associated with decreased balance, that is, Figure-of-eight (β = 0.172; p = .028). The independent effects of WML and tau pathology were mainly observed in those with MCI, which was not the case for the effects of amyloid pathology on balance., Conclusions: Common brain pathologies have different effects where WML are independently associated with mobility, tau pathology has the strongest effect on dual tasking, and amyloid pathology seems to be independently associated with balance. Although these novel findings need to be confirmed in longitudinal studies, they suggest that different brain pathologies have different effects on mobility, balance, and dual-tasking in older nondemented individuals., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.)

BACKGROUND: Ischemic hypoxia induced by suprathreshold G-force loading can adversely affect vision, cognition, and lead to loss of consciousness (LOC). The purpose of this study was to determine whether reductions in cerebral oxygenation, caused by subthreshold G-forces (up to 4 G z and of limited durations that do not lead to LOC), would affect visual perception and working memory performance. METHODS: Sixteen subjects performed visual perception and working memory tasks both before and during G z exposures (1, 2.2, 3, 4 with leg pressurization, 4 with leg and abdomen pressurization) within a human-use centrifuge. RESULTS: As measured using near-infrared spectroscopy, blood oxygenation over medial prefrontal cortex was similar in the 1 and 2.2 G z conditions, but was reduced to a similar extent in the 3 and 4 G z conditions. In parallel, visual perception accuracy was reduced in the 3 and 4 G z conditions, with no difference between the 3 and 4 G z conditions. No change in reaction time was seen. Conversely, neither accuracy nor reaction time changes were observed for the visual working memory task. DISCUSSION: These results indicate that although visual working memory is not affected, the ability to visually discriminate between stimuli is reduced at G-forces as low as 3 and 4 G z . This may have important ramifications for pilots who are routinely subjected to such forces. Croft RJ, Klegrd R, Tribukait A, Taylor NAS, Eiken O. Effects of acceleration-induced reductions in retinal and cerebral oxygenation on human performance. Aerosp Med Hum Perform. 2021; 92(2):7582.

Background: Healthcare managers, in comparison with other healthcare professionals, have an increased likelihood of experiencing technostress at work. Since knowledge about the causes and severity of technostress and about the strategies healthcare managers use to handle it is limited, the aim of this study was to describe their experience of technostress and the actions they employ to address it., Methods: An explorative design based on the critical incident technique was used. In total, 20 healthcare managers (10 women, 10 men) from four hospitals in two county councils in Sweden were purposively selected according to professional background, hierarchical management position, control span, time in the management position, and sex. Semi-structured interviews with regard to critical incidents and actions taken to handle technostress were conducted., Results: Healthcare managers' experiences of technostress (n = 279) were categorised related to three main areas. These involved 'negative aspects of digital communication' (e.g. high workload, invasion of private life, and negative feelings related to digital communication), 'poor user experience of ICT systems (such as illogicality of the ICT system, time-consuming ICT system, or malfunctioning ICT system) and 'needs to improve organisational resources' (e.g. needs associated with digital literacy, user influence and distribution of work and ICT systems). Actions taken to handle technostress (n=196) were described relating to three main areas involving 'culture, norms and social support' (such as good email culture, and co-worker support), 'individual resources' (e.g. individual strategies and competence) and 'organisational resources' (such as IT-related assistance and support)., Conclusions: Healthcare managers described negative aspects of digital communication, poor user experience of ICT systems, and lack of organisational resources as potential technostress creators. These problems were handled by taking action related to culture, norms and social support, and individual as well as organisational resources. All these features, along with consideration of healthcare managers' job demands and resources in general, should be incorporated into actions monitored by healthcare organisations to improve or maintain a sustainable digitalised environment for healthcare managers., Trial Registration: Regional Ethics Board in Linköping #2017/597-31. Registered 20 March 2018. URL not available.

Objective: The objective of this study was to test the predictions of the routine-failure trade-off (or lumberjack) model in a full-scope simulator study with expert operators performing realistic control tasks., Background: A meta-study of degree of automation (DOA) studies concluded that DOA predicts task performance under both routine and automation failure conditions, workload, and situation awareness. Empirical support for this conclusion appears to be weak for complex work situations., Method: A full-scope nuclear power plant simulator experiment was conducted in which licensed operating crews completed realistic procedure execution tasks. Dependent measures selected from the lumberjack model were collected and analyzed for systematic effects., Results: Situation awareness increased with increasing DOA, which contradicts the lumberjack model. Anticipated workload and failure task performance effects were not observed., Conclusion: The experimental results add further evidence challenging the applicability of the lumberjack model to complex work situations., Application: Practitioners should use caution when extending the predictions of the lumberjack model based on data from simple work situations to complex work situations. Researchers should invest more resources in testing the predictive power of the lumberjack model in complex work situations.

Background: Violence towards staff working in psychiatric inpatient care is a serious problem. The aim of the present study was to explore staff perspectives of serious violent incidents involving psychiatric inpatients through the following research questions: Which factors contributed to violent incidents, according to staff? How do staff describe their actions and experiences during and after violent incidents?, Methods: We collected data via a questionnaire with open-ended questions, and captured 283 incidents reported by 181 staff members from 10 inpatient psychiatric wards in four different regions. We used the Critical Incident Technique to analyse the material. Our structural analysis started by structuring extracts from the critical incidents into descriptions, which were grouped into three chronological units of analyses: before the incident, during the incident and after the incident. Thereafter, we categorised all descriptions into subcategories, categories and main areas., Results: Staff members often attributed aggression and violence to internal patient factors rather than situational/relational or organisational factors. The descriptions of violent acts included verbal threats, serious assault and death threats. In addition to coercive measures and removal of patients from the ward, staff often dealt with these incidents using other active measures rather than passive defence or de-escalation. The main effects of violent incidents on staff were psychological and emotional. After violent incidents, staff had to continue caring for patients, and colleagues provided support. Support from managers was reported more rarely and staff expressed some dissatisfaction with the management., Conclusions: As a primary prevention effort, it is important to raise awareness that external factors (organisational, situational and relational) are important causes of violence and may be easier to modify than internal patient factors. A secondary prevention approach could be to improve staff competence in the use of de-escalation techniques. An important tertiary prevention measure would be for management to follow up with staff regularly after violent incidents and to increase psychological support in such situations.

Background: Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur., Objectives: The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients., Methods: As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n = 15) and physicians (n = 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches., Results: Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards., Conclusions: To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards., (Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: In hospitals, potentially harmful near misses occur daily exposing patients to adverse events and safety risks. The same applies to ambulance care, but it is unclear what the risks are and why near misses arise., Aim: To explore registered nurses' experiences and behaviours associated with near misses where patient safety in the ambulance service was jeopardized., Methods: Based on critical incident technique, a retrospective and descriptive design with individual qualitative interviews was used. Ten men and five women from the Swedish ambulance service participated., Results: Seventy-three critical incidents of near misses constituted four main areas: Drug management; Human-technology interactions; Assessment and care and Patient protection actions. Incidents were found in drug management with incorrect drug mixing and dosage. In human-technology interactions, near misses were found in handling of electrocardiography, mechanical chest compression devices and other equipment. Misjudgement and delayed treatment were found in patient assessments and care measures while patient protection actions failed in transport safety, hygiene and local area knowledge., Conclusions: Experiencing near misses led to stress, guilt and shame. The typical behaviour in response to near misses was to immediately correct the action. Occasionally, however, the near miss was not discovered until later without causing any harm., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the Airways-Breathing-Circulation-Disability-Exposure (ABCDE) checklist and the Team Emergency Assessment Measure (TEAM) for inter-rater reliability, as well as the application of Situation Awareness Global Assessment Technique (SAGAT) for feasibility and internal consistency., Design: Methodological approach., Setting: Data collection during team training using full-scale simulation at a university clinical training centre. The video-recorded scenarios were rated independently by four raters., Participants: 55 medical students aged 22-40 years in their fourth year of medical studies, during the clerkship in anaesthesiology and critical care medicine, formed 23 different teams. All students answered the SAGAT questionnaires, and of these students, 24 answered the follow-up postsimulation questionnaire (PSQ). TEAM and ABCDE were scored by four professionals., Measures: The ABCDE and TEAM were tested for inter-rater reliability. The feasibility of SAGAT was tested using PSQ. SAGAT was tested for internal consistency both at an individual level (SAGAT) and a team level (Team Situation Awareness Global Assessment Technique (TSAGAT))., Results: The intraclass correlation was 0.54/0.83 (single/average measurements) for TEAM and 0.55/0.83 for ABCDE. According to the PSQ, the items in SAGAT were rated as relevant to the scenario by 96% of the participants. Cronbach's alpha for SAGAT/TSAGAT for the two scenarios was 0.80/0.83 vs 0.62/0.76, and normed χ² was 1.72 vs 1.62., Conclusion: Task performance, team performance and SA could be purposefully measured, and the reliability of the measurements was good., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Transitioning into a new professional role is challenging. Unfortunately, little is currently known about how to reduce experiences of stress among new professionals. The socialization processes role clarity, task mastery, and social acceptance are assumed to reduce experiences of stress as they mediate new professionals' acquisition of knowledge, skills, attitudes, and behaviors. However, little prospective data is available on the actual effect of the processes on stress., Objectives: To prospectively investigate how the socialization processes relate to experiences of stress among new nurses during the first three months of professional working life. Specifically, to investigate development over time, as well as how episodes of increased or decreased levels of the socialization processes relate to concurrent levels of stress. The general purpose of this investigation was to examine the suitability of the socialization processes as targets of an intervention seeking to reduce stress among new professionals., Design: An intensive longitudinal study with weekly data collections over three months., Participants: 264 newly graduated Swedish nurses who started their first job during the period of the study., Methods: The participants were followed prospectively during 14 consecutive weeks after their professional entry. Data on stress (Stress and Energy Questionnaire), role clarity (General Questionnaire for Psychological and Social Factors at Work), task mastery, and social acceptance (Needs Satisfaction and Frustration Scale) were collected weekly using digital surveys (mean response rate 82.7%). Data was analyzed using a multilevel model for intensive longitudinal data., Results: For the typical nurse, stress decreased by 0.13 units per month, role clarity and task mastery increased by 0.08 and 0.05 units, and social acceptance decreased by 0.08 units. In addition, the slopes of 95 percent of the new nurses varied within 1.18 (stress), 0.72 (role clarity), 0.44 (task mastery), and 0.86 (social acceptance) units of the typical nurse. Most importantly, when the new nurses experienced higher levels of task mastery, role clarity, and social acceptance, they experienced lower levels of stress (within-person parameter estimates: task mastery -0.40, p = .001; role clarity -0.34, p = .001; and social acceptance -0.33, p = .001)., Conclusions: Supporting the development of the socialization processes could be one theoretically based strategy to reduce levels of stress among new nurses. As stress among new professionals is not unique to the nursing profession, and the processes are considered important mediators of new professionals' adaptation in general, the results from this study should likely be generalizable to other professions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Symptoms of burnout among new professionals is a well-recognized problem but there is a lack of prevention programs. Effective interventions are based on an understanding of the processes that contribute to the development of a problem and suggest how it may be addressed., Objective: Using the framework of organizational socialization, the objective of this study was to investigate if development of the socialization processes role clarity, social acceptance, and task mastery affects development of symptoms of burnout among new professionals and may specifically be targeted in transition-to-practice programs to prevent symptoms of burnout from occurring. We conducted this investigation by examining the relations between role clarity, social acceptance, task mastery, and symptoms of burnout the first year after professional entry, as well as the relations between changes in the socialization processes and changes in symptoms of burnout during the first three years following professional entry in a sample of new nurses., Method: Relationships between the socialization processes and symptoms of burnout were modeled using a linear latent growth model and data from a nationally representative sample of 1210 new registered nurses., Results: Role clarity, social acceptance, and task mastery were related to symptoms of burnout cross-sectionally and longitudinally. Task mastery was the most important explanatory variable., Conclusions: The results suggest that an intervention designed to support the development of the socialization processes may be effective in preventing symptoms of burnout among new nurses. Interventions targeting role clarity, social acceptance, and task mastery during the first professional year may be expected to have effects during the following years as well, extending the value and importance of such interventions.

Unlabelled: The Bimanual Fine Motor Function (BFMF) is currently the principal classification of hand function recorded by the Surveillance of Cerebral Palsy in Europe (SCPE) register. The BFMF is used in a number of epidemiological studies, but has not yet been validated., Aims: To examine aspects of construct and content validity of the BFMF., Methods and Results: Construct validity of the BFMF was assessed by comparison with the Manual Ability Classification System (MACS) using register-based data from 539 children born 1999-2003 (304 boys; 4-12 years). The high correlation with the MACS (Spearman's rho = 0.89, CI: 0.86-0.91, p<.001) supports construct validity of the BFMF. The content of the BFMF was appraised through literature review, and by using the ICF-CY as a framework to compare the BFMF and MACS. The items hold, grasp and manipulate were found to be relevant to describe increasingly advanced fine motor abilities in children with CP, but the description of the BFMF does not state whether it is a classification of fine motor capacity or performance., Conclusion: Our results suggest that the BFMF may provide complementary information to the MACS regarding fine motor function and actual use of the hands, particularly if used as a classification of fine motor capacity.

Objective: To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy, fear of falling, gait and balance performance, and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects., Design: Randomized controlled trial, including three groups: two intervention groups (Training, or Training+Physical activity) and one Control group, with a 12-week follow-up., Setting: Stockholm County, Sweden., Participants: Ninety-six older adults, aged 66-87, with verified osteoporosis., Interventions: A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks, and physical activity for 30 minutes, three times/week., Main Measures: Fall-related self-efficacy (Falls Efficacy Scale-International), fear of falling (single-item question - 'In general, are you afraid of falling?'), gait speed with and without a cognitive dual-task at preferred pace and fast walking (GAITRite®), balance performance tests (one-leg stance, and modified figure of eight), and physical function (Late-Life Function and Disability Instrument)., Results: Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls (p ≤ 0.034, 4 points) and improved their balance performance. Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task (p=0.003), at fast walking speed (p=0.008), and for advanced lower extremity physical function (p=0.034)., Conclusions: This balance training program, including dual- and multi-task, improves fall-related self-efficacy, gait speed, balance performance, and physical function in older adults with osteoporosis., (© The Author(s) 2014.)

Objectives: To evaluate the influence of perceived stress and musculoskeletal ache/pain, separately and in combination, at baseline, on self-rated work ability and work performance at two-year follow-up., Methods: Survey data were collected with a 2-year interval. Health care workers participating at both waves were included. Inclusion criteria were good self-reported work ability and unchanged self-rated work performance at baseline, resulting in 770 participants; 617 women and 153 men. Musculoskeletal pain was assessed using the question "How often do you experience pain in joints and muscles, including the neck and low back?", perceived stress with a modified version of a single item from the QPS-Nordic questionnaire, work performance by the question "Have your work performance changed during the preceding 12 months?" and work ability by a single item from the work ability index. Associations between baseline data and the two outcomes at follow-up were analysed by means of the log binomial model and expressed as risk ratios (RR) with 95% confidence intervals (CI)., Results: A combination of frequent musculoskeletal pain and perceived stress constituted the highest risk for reporting decreased work performance (RR 1.7; CI 1.28-2.32) and reduced work ability (RR 1.7; CI 1.27-2.30) at follow-up. Separately, frequent pain, but not stress, was clearly associated with both outcomes., Conclusion: The results imply that proactive workplace interventions in order to maintain high work performance and good work ability should include measures to promote musculoskeletal well-being for the employees and measures, both individual and organizational, to minimize the risk of persistent stress reactions.

Objective: The aim of this study was to analyze the association between frequent headache and self-reported mental and physical work ability in a general population sample in Sweden., Methods: The study was conducted in western Sweden in 2008. Frequent headache was analyzed in relation to mental and physical work ability. Covariates included demographics and socioeconomic variables, work-related variables, and a symptom index. Self-reported and register-based sickness absence data were also analyzed., Results: Sixteen per cent of those who answered the question about headache (n = 2590) had frequent headache (at least once a week). Regression analyses showed that frequent headache sufferers were twice more likely to have poor mental and physical work ability than those having infrequent headache., Conclusions: Frequent headache was associated with poor mental and physical work ability but not with sickness absence.

Background: The aim of this study was to explore if a course consisting of lectures combined with simulator training in coronary angiography (CA) could accelerate the early learning curve when performing CA on patients.Knowledge in performing CA is included in the curriculum for the general cardiologist. The method, according to American College of Cardiology and European Society of Cardiology guidelines, for this training is not well defined but simulator training is proposed to be an option. However, the transfer effect from a CA simulator to performance in real world cath lab is not validated., Methods: Fifty-four residents without practical skills in CA completed the course and 12 continued to training in invasive cardiology. These residents were tracked in the Swedish Coronary Angiography and Angioplasty Registry and compared to a control group of 46 novel operators for evaluation of performance metrics. A total of 4472 CAs were analyzed., Results: Course participants demonstrated no consistent acceleration in the early learning curve in real world cath lab. They had longer fluoroscopy time compared to controls (median 360 seconds (IQR 245-557) vs. 289 seconds (IQR 179-468), p < 0.001). Safety measures also indicated more complications appearing at the ward, in particular when using the femoral approach (6.25% vs. 2.53%, p < 0.001)., Conclusions: Since the results of this retrospective non-randomized study were negative, the role of a structured course including simulator training for skills acquisition in CA is still uncertain. Randomized transfer studies are warranted to justify further use of simulators for training in CA.

Purpose: The aim was to explore experiences of capacity to work in persons working while depressed and anxious in order to identify the essence of the phenomenon capacity to work., Method: Four focus groups were conducted with 17 participants employed within the regular job market. Illness experiences ranged from symptoms to clinical diagnoses. A phenomenological approach was employed., Results: The phenomenon of capacity to work was distinguished by nine constituents related to task, time, context and social interactions. The phenomenon encompassed a lost familiarity with one's ordinary work performance, the use of a working facade and adoption of new time-consuming work practices. Feelings of exposure in interpersonal encounters, disruption of work place order, lost "refueling" and a trade-off of between work capacity and leisure-time activities was also identified. The reduced capacity was pointed out as invisible, this invisibility was considered troublesome., Conclusions: A complex and comprehensive concept emerged, not earlier described in work capacity studies. Rehabilitation processes would benefit from deeper knowledge of the individual's capacity to work in order to make efficient adjustments at work. Results can have particular relevance both in clinical and occupational health practice, as well as in the workplaces, in supporting re-entering workers after sickness absence. Implications for Rehabilitation The reduced capacity to work due to depression and anxiety is not always understandable or observable for others, therefore, the rehabilitation process would benefit from increased knowledge and understanding of the difficulties afflicted individuals experience at work. Identifying tasks that contribute to "refueling" at work might enhance the success of the rehabilitation. Rehabilitation programs could be tailored to better address the inabilities that impact on the capacity to work when depressed and anxious.

Objective: An increasing number of adults with ADHD face problems with everyday activities, and occupational therapists play an important role regarding interventions for this particular group. However, there is a knowledge gap within occupational therapy regarding how adults with ADHD experience engagement in everyday activities. The aim of this study was to understand the experiences of engagement in, and describe how adults with ADHD performed everyday activities., Methods: Twelve people with ADHD between the ages of 21 and 38 were interviewed using a semi-structured interview guide. Data were analysed based on a qualitative content analysis., Results: The results showed how engagement in and performance of everyday activities depended on inspiration, facilitating support, and feelings of togetherness with other people., Conclusions: These results show how adults with ADHD can find strategies to become more independent in their performance of everyday activities. Furthermore, this study suggests how occupational therapists can increase opportunities for adults with ADHD to engage in different activities, make choices, and find meaning in everyday activities.

Aim: The Redesigning Daily Occupations programme (ReDO) is a Swedish work rehabilitation programme for women on sick leave due to stress-related disorders. The aim of the study was to investigate the participants' perceptions of taking part in the work rehabilitation programme., Methods: Seven of the 38 women who completed ReDO were interviewed during and after the programme. The interviews were analysed by manifest and latent content analysis., Results: The informants were satisfied with the content of the programme and the support they received in the programme and when returning to work. The women thought they had become more aware of what they did during a day and how they performed their daily activities, which helped them to change their ways of performing them. The result highlighted different parts of their rehabilitation process which constituted four sub-themes: "Perceptions of the ReDO", "The intrinsic process", "Person-related changes", and "Perceptions of returning to work", and formed the core theme "Critical parts of the rehabilitation process"., Conclusions: The findings may not be generalized to other settings and future research should further investigate work rehabilitation for the target group.

Swedish dentistry has been exposed to frequent rationalisation initiatives during the last half century. Previous research has shown that rationalisation often results in increased risk of developing work-related musculoskeletal disorders, thus reducing sustainability in the production system. In this prospective study, we assessed mechanical exposures among Swedish dentists in relation to specific rationalisations of clinical dental work during a six-year period. Body postures and movements of 12 dentists were assessed by inclinometry synchronised to video recordings of their work. No rationalisation effects could be shown in terms of a reduction in non-value-adding work ('waste'), and at job level, no major differences in mechanical exposure could be shown between baseline and follow-up., Conclusion: The present rationalisation measures in dentistry do not seem to result in rationalisation at job level, but may potentially be more successful at the overall dental system level., Practitioner Summary: In contrast to many previous investigations of the mechanical exposure implications of rationalisation, the present rationalisation measures did not increase the level of risk for dentists. It is highlighted that all occupations involved in the production system should be investigated to assess production system sustainability.

Objectives: The aim of this study was to assess learning curves for coronary angiography using registry data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)., Background: ACC and ESC guidelines for cardiologists in training recommend 200-300 coronary angiographies as primary operator. Whether this is safe or sufficient to reach an adequate proficiency level is not known. The development of learning curves and factors that can determine progress is not yet clearly stated., Methods: We extracted data from SCAAR 2005-2009 and identified 20 novel and 21 expert operators in coronary angiography during this observation period. Metrics possibly influenced by proficiency level were compared between the two groups. Learning curves were then identified with the expert's performance as reference defined as interquartile range (IQR)., Results: Data from a total of 24,000 coronary angiographies were examined. Beginners used similar volumes of contrast but had longer fluoroscopy time compared with experts. Fluoroscopy time appeared to be a metric that demonstrated a clear learning curve and beginners reached experts IQR in 50 % (median) of the procedures after ∼140 coronary angiographies. The risk of complications was independently associated with fluoroscopy time., Conclusions: Fluoroscopy time seems to be the best metric to determine coronary angiography performance level and might therefore be a good proficiency measure during training. On the basis of our results we recommend the trainee to perform at least 150 coronary angiographies during supervision before proceeding with unsupervised procedures. It is not clear if the suggested number of procedures will result in decreased number of complications but the data suggests that fluoroscopy time might be a surrogate marker for complications., (Copyright © 2011 Wiley Periodicals, Inc.)

Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians., Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis., Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses' and doctors' offices were the most common locations for multitasking in the emergency department., Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

The aim of this study was to ascertain experiences and perceptions among physiotherapists (PTs) in Sweden regarding the concept of work ability as well as their perspectives of their professional role in work ability assessments. We conducted an in-depth interview study with four male and twelve female physiotherapists working in the field of occupational health care, orthopaedics, primary health care or rehabilitation. Qualitative content analysis was applied to the data. Work ability was perceived as the ability to perform work tasks as requested. Having the potential to adjust at work and to allocate resources, having an attachment to the workplace and time factors were vital. The physiotherapists were striving for a well-defined role within a multiprofessional team, where work ability assessments were performed in a real work environment. The PTs experienced contradictory roles in relation to the patient but believed they could contribute with valuable material for assessments; this professional help was not always requested. It was noted that there was a need for experience and further education to enable PTs to further engage in work ability assessments. It is important to improve collaboration and to further discuss the work ability concept from the viewpoints of different professionals.

Objective: To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges., Method: Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day., Results: Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work., Conclusion: To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.

Many video-based techniques for assessing postures at work have been developed. Choosing the most appropriate technique should be based on an evaluation of different alternatives in terms of their ability to produce posture information at low input costs, i.e. their cost efficiency. This study compared four video-based techniques for assessing upper arm postures, using cost and error data from an investigation on hairdressers. Labour costs associated with the posture assessments from the video recordings were the dominant factor in the cost efficiency comparison. Thus, a work sampling technique associated with relatively large errors appeared, in general, to be the most cost-efficient because it was labour-saving. Measurement bias and other costs than labour cost for posture assessment influenced the ranking and economic evaluation of techniques, as did the applied measurement strategy, i.e. the numbers of video recordings and repeated assessments of them., Practitioner Summary: The cost efficiency of four video-based techniques for assessing upper arm postures was compared. Work sampling techniques were in general more cost efficient than continuous observations since they were labour-saving. Whilst a labour cost dominated the comparison, 'hidden costs', bias and measurement strategy also influenced this dominance.

Purpose: To investigate the relationship between the level of autonomy and the quality of performance of everyday activities in a population-based cohort of children with spina bifida and to study the agreement between the children's and the parents' ratings of autonomy., Methods: 50 dyads of children (aged 6-14) with spina bifida and their parents rated the children's level of autonomy with an adapted, Swedish version of the Autonomy Scale from the Arc's Self-Determination Scale. Each child's quality of performance of everyday activities was assessed with the Assessment of Motor and Process Skills (AMPS)., Results: The autonomy levels of the children with spina bifida were rated to be lowest in daily routines and highest in leisure activities. Binary logistic regression analyses revealed that age, motor skills and process skills were all significantly related to the autonomy level, but that process skills appeared to predominate in this respect. Concerning the perception of the autonomy level, little agreement was found between each child and his/her parent., Conclusions: It is important to understand and support the development of process skills as expressed in task performance in children with spina bifida and to pay attention to both the parent's and the child's opinion when setting goals and plans for interventions.

Objective: The Job Demand Control model presents combinations of working conditions that may facilitate learning, the active learning hypothesis, or have detrimental effects on health, the strain hypothesis. To test the active learning hypothesis, this study analysed the effects of job demands and job control on general problem-solving strategies., Participants: A population-based sample of 4,636 individuals (55% women, 45% men) with the same job characteristics measured at two times with a three year time lag was used., Methods: Main effects of demands, skill discretion, task authority and control, and the combined effects of demands and control were analysed in logistic regressions, on four outcomes representing general problem-solving strategies., Results: Those reporting high on skill discretion, task authority and control, as well as those reporting high demand/high control and low demand/high control job characteristics were more likely to state using problem solving strategies., Conclusions: Results suggest that working conditions including high levels of control may affect how individuals cope with problems and that workplace characteristics may affect behaviour in the non-work domain.

Objective: A high work involvement is considered central in the burnout process. Yet, research investigating how high work involvement and psychosocial stressors relate to burnout is scarce. High involvement in terms of performance-based self-esteem (PBSE) refers to individuals' strivings to validate self-worth by achievements, a disposition linked to poor health. The aim of the present study was to examine longitudinally PBSE in relation to burnout while also taking into account work- and private life stressors., Participants: The sample consisted of 2121 working women and men., Methods: Main- and mediation effects were investigated using hierarchical regression analysis., Results: The results showed performance-based self-esteem mediated partially between the stressors and burnout. Performance-based self-esteem was the strongest predictor of burnout over time, followed by private life stressors. Women experienced more work stress than did men. Men had stronger associations between work stressors and burnout, while women had stronger associations between performance-based self-esteem and burnout., Conclusions: Individual characteristics along with both private life and work stressors are important predictors of burnout. Factors associated with burnout differ somewhat between women and men.

Purpose: To evaluate the relative and absolute test-re-test reliability of a new step-execution test, "Step-Ex", for clinical use in elderly with and without balance problems., Method: Test-re-test design to assess intrarater reliability. Thirty-four healthy community-dwelling elderly (65-87 years), 16 with balance problems, were tested twice two weeks apart. Step-Ex consists of two portable force platforms that register vertical ground reaction forces connected to a computer for easy detection of temporal events and phases (reaction-, preparation-, stepping- and step execution phase). Standing with one foot on each platform, the subjects were given a tactile stimulus on the heel to initiate rapid steps forward., Results: Test-re-test agreement was good to very good: ICC(2)(.6) 0.83-0.87 (without balance problems) and 0.71-0.83 (with balance problems) with no apparent systematic differences between the tests. The SEM, i.e. the smallest detectable change that may indicate a real clinical improvement for a group of individuals was small, 4.6-8.6%. The smallest real difference, representing the smallest change that reveals clinical improvement for a single individual, was 13-24%., Conclusion: Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of balance training in elderly people with and without balance deficits., Implications for Rehabilitation: • Balance deficits are common in the elderly population. • To evaluate the effects of treatment or changes over time it is of great importance to have reliable instruments. • Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of treatment or changes over time in elderly people with and without balance deficits.

Objective: To explore the relationship between managers' leadership and their health, by investigating what psychosocial conditions in the workplace managers experience as being important to their health, and how their health influences their leadership., Participants and Methods: Semi-structured interviews with forty-two managers at different managerial levels in a large Swedish industrial production company., Results: Most managers felt their health was good, but many perceived their work as stressful. They said it was important to their health that they did a good job and achieved results as expected, that conditions in the workplace enabled this achievement, and that their performance was acknowledged. In comparison to the other managerial levels, the first-line managers' work and health were especially dependent on such enabling conditions. The results also showed that the managers' health influenced their leadership, the quality of their work and the quality of their relationship with subordinates., Conclusion: Managers' leadership, health and their work conditions are reciprocally related to each other. A productive and healthy workplace is facilitated by focusing on managers' conditions for leadership, their health and their work conditions.

The present study investigates the dental work in terms of time distribution and mechanical exposure in value-adding work (VAW) and non-VAW. Further rationalisation of dental work would typically involve an increase in the proportion of VAW. Information on mechanical exposure within the classes of VAW and non-VAW may be used to predict possible implications of rationalisation. Sixteen dentists were investigated. Using a data logger, postures and movements were continuously recorded for each subject during the 4 h of work, which included the 45 min of video recording. Time distribution and mechanical exposure for the six different work activities identified were evaluated from the video recordings, using a loss analysis technique. VAW, which comprised 54% of the total working time, generally implied significantly more constrained mechanical exposures as compared with non-VAW. The results suggest that future rationalisation of dental work, involving a reduction of non-VAW, may increase the risk of developing musculoskeletal disorders. Statement of Relevance: The present study illustrates the potential effects of rationalisation on biomechanical exposures for dentists. The results highlight the significance of integrating ergonomic issues into the rationalisation process in dentistry in addition to ordinary workstation and tool design improvements performed by ergonomists.

Objective: To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology (OBGYN)., Study Design: This was a prospective cohort study carried out at two community hospitals in Sweden. Thirteen consultants in obstetrics and gynecology were included. They had previously independently performed 10-100 advanced laparoscopies. Participants were tested for visuospatial ability by the Mental Rotations Test version A (MRT-A). After a familiarization session and standardized instruction, all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies. Performance in the simulator was measured by Total Time, Score and Ovarian Diathermy Damage. Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance. The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability., Results: Visuospatial ability correlated with Total Time (r=-0.62; p=0.03) and Score (r=0.57; p=0.05) in the medium level of the virtual tubal occlusion. In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time (r=-0.64; p=0.02), Ovarian Diathermy Damage (r=-0.65; p=0.02) and with overall Score (r=0.64; p=0.02)., Conclusions: Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator. Testing visuospatial ability might be helpful when designing individual training programs., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

What Is Known and Objective: Biologically based therapies (BBTs) such as herbal medicines represent the most commonly used type of complementary and alternative medicine by cancer patients. There is a paucity of data regarding individuals' motives for starting and continuing use of BBTs in cancer. Our objective is to explore lay perspectives on use of BBTs in cancer. Our hope is that the data generated will support pharmacists and other professionals in improving their communication about BBTs with patients., Methods: Interviews with 12 individuals with cancer who used BBTs were analyzed with interpretive description and framework analysis, to build on previous literature and gain new knowledge of clinical relevance., Results: The findings suggest that users are motivated to continue to use BBTs when they experience these as both effective and harmless. Perceived effects of BBTs include a wide range of responses such as improved physical and psychological well-being, and cancer-related benefits. These experiences go beyond the legal health and medical claims for these products. The findings indicate that users' views of side-effects, ascribed to BBT use, are situation-dependent with the potential to either facilitate or hinder continued BBT use., What Is New and Conclusion: Our results indicate the importance of acknowledging users' own views of BBTs to improve patient-provider communication. This should aid the design of more effective BBT surveillance systems and hence increase patient safety and satisfaction., (© 2010 Blackwell Publishing Ltd.)

Background: Sickness absence is a common ''prescription'' in health care in many Western countries. Despite the significance of sick-listing for the life situation of patients, physicians have limited training in how to handle sickness-certification cases and the research about sickness-certification practices is scarce., Aim: Gain knowledge on physicians' learning regarding management of sickness certification of patients in formal, informal, and non-formal learning situations, respectively, and possible changes in this from 2004 to 2008., Methods: Data from two comprehensive questionnaires to physicians in Sweden about their sickness-certification practice in 2004 (n = 7665) and 2008 (n = 36,898); response rates: 71% and 61%, respectively. Answers from all the physicians ≤64 years old and who had sickness certification tasks (n = 4019 and n = 14,210) were analysed., Outcome Measures: ratings of importance of different types of learning situations for their sickness-certification competence., Results: Few physicians stated that formal learning situations had contributed to a large or fairly large extent to their competence in sickness certification, e.g. undergraduate studies had done that for 17%, internship for 37%, and resident training for 46%, respectively. Contacts with colleagues had been helpful for 65%. One-third was helped by training arranged by social insurance offices. There was a significant increase between 2004 and 2008 in all items related to formal and non-formal learning situations, while there were no changes regarding informal learning situations., Conclusions: This study of all physicians in Sweden shows that physicians primarily attain competence in sickness certification in their daily clinical practice; through contacts with colleagues and patients.

Background: New strategies for selection and training of physicians are emerging. Previous studies have demonstrated a correlation between visual-spatial ability and visual working memory with surgical simulator performance. The aim of this study was to perform a detailed analysis on how these abilities are associated with metrics in simulator performance with different task content. The hypothesis is that the importance of visual-spatial ability and visual working memory varies with different task contents., Methods: Twenty-five medical students participated in the study that involved testing visual-spatial ability using the MRT-A test and visual working memory using the RoboMemo computer program. Subjects were also trained and tested for performance in three different surgical simulators. The scores from the psychometric tests and the performance metrics were then correlated using multivariate analysis., Results: MRT-A score correlated significantly with the performance metrics Efficiency of screening (p = 0.006) and Total time (p = 0.01) in the GI Mentor II task and Total score (p = 0.02) in the MIST-VR simulator task. In the Uro Mentor task, both the MRT-A score and the visual working memory 3-D cube test score as presented in the RoboMemo program (p = 0.02) correlated with Total score (p = 0.004)., Conclusions: In this study we have shown that some differences exist regarding the impact of visual abilities and task content on simulator performance. When designing future cognitive training programs and testing regimes, one might have to consider that the design must be adjusted in accordance with the specific surgical task to be trained in mind.

PURPOSE. The purpose of this study is to illuminate how persons with acquired brain injury (ABI) and their significant others experienced individualised occupation-based interventions using commonly available everyday technology (ET) to compensate for perceived difficulties with performance of tasks in daily life. METHOD. Qualitative research interviews were conducted with 10 persons with ABI and with one of their significant others. The data were analysed according to qualitative content analysis. RESULTS. The persons with ABI experienced that they mastered their lives in a better way by the compensatory use of ET. They became capable of doing tasks independently and experienced themselves as being a new person. During the intervention process, persons with ABI became aware of the compensatory potential of familiar ET, and they were supported to use effective compensatory strategies and incorporate them into their habits. Their significant others felt a relief in daily life, and their mood was positively affected as they experienced reduced responsibility and need of control. CONCLUSIONS. This qualitative study has shown that persons with ABI, as well as their significant others, experienced a multitude of benefits from occupation-based interventions using commonly available ET to compensate for their difficulties in the performance of tasks in daily life and that the goals achieved affected their overall contentment with life.

Most work in horse stables is performed manually in much the same way as a century ago. It is the least mechanized sector dealing with large animals. People working with horses are exposed to several types of risk for developing musculoskeletal problems, but the work tasks and workload have not been investigated in detail. The aim of this study was to estimate the postural load of the work tasks performed around horses to find those that were harmful and required measures to be taken to reduce physical strain. Altogether, 20 subjects (stable attendants and riding instructors) were video recorded while carrying out their work in the stable, and preparing and conducting riding lessons. The work was analyzed with the Ovako Working posture Analysis System (OWAS) to determine the postural load and to categorize the potential harmfulness of the work postures. Three work tasks involved about 50% of the work positions in the three OWAS categories (AC2 to AC4) where measures for improvement are needed: "mucking out" (50%), "bedding preparation" (48%), and "sweeping" (48%). These work tasks involved over 60% work postures where the back was bent, twisted, or both bent and twisted. Therefore, it is important to find preventive measures to reduce the workload, which could include improved tools, equipment, and work technique.

Based on data from 156 typically developing 10-12-year-olds from Sweden, reading comprehension skills were studied in three subgroups: those classified with specific poor word decoding skills (n = 10), those with specific poor language comprehension (n = 12), and those with mixed difficulties in word decoding and language comprehension (n = 11). The mixed poor group achieved significantly lower scores than both specific groups in reading comprehension, and was the only group displaying poor reading comprehension test results relative to the performance of the full sample. Results are indicative of the necessity of a combined effect of poor word decoding and language in reading comprehension difficulties for this group. Implications and limitations are discussed.

Objectives: To describe upper arm postures and movements among female hairdressers, including the variability between hairdressers, between days within hairdresser, and between tasks, as a basis for understanding the characteristics of exposures in the job, considering possible sources of variation and recovery, and discussing appropriate exposure assessment strategies., Methods: Data on upper arm postures were collected using inclinometers during four working days the same week from 28 female hairdressers working in 13 salons. Twenty of the hairdressers noted customer on and off times in a diary, to allow separate analyses of customer tasks (CT) and auxiliary non-customer tasks (AT), including breaks. For a number of posture and movement variables, mean values and variance components between subjects (BS) and within subjects between days (BD) were estimated using restricted maximum likelihood algorithms in one-way random effect models., Results: For the 20 hairdressers with diaries, CT accounted for 279 min (58%) (SD(BS) = 39 min and SD(BD) = 85 min) of the working day and AT and breaks for 207 min (42%) (SD(BS) = 46 min and SD(BD) = 88 min). The hairdressers worked with the right arm elevated >60 degrees for 6.8% of the whole job (SD(BS) = 2.8% and SD(BD) = 2.0%). On average, the hairdressers worked with the right arm elevated >60 degrees for 9.0% of the time during CT, compared to 3.7% during AT, resulting in a contrast between tasks of 0.35., Conclusions: Hairdressers may be at risk for developing musculoskeletal disorders in the neck and shoulders due to a considerable occurrence of highly elevated arms, especially during CT. On the other hand, we do not find reasons to classify hairdressing as a job with too little variation. Posture variability between days within hairdressers was in the same order of magnitude as that between hairdressers, suggesting that 'typical' workdays do not exist. The exposure contrast between CT and AT for variables describing elevated arm postures indicates that for these variables a simple task-based approach for estimating job exposure could be successful.

Objectives: Inter-hospital patient transports are required around the clock. During these transports it is the responsibility of the accompanying nurse specialists to ensure their patient's safety, while at the same time providing optimal nursing care in an unusual and often stressful situation. The aim of this study was to explore and describe the nurse specialists' cause of worries and concerns (WaC) and how they manage these., Design: An explorative and qualitative design based on the critical incident technique was used., Data Collection: Interviews were conducted with 30 nurse specialists within the fields of anaesthetic, intensive and pre-hospital care in the south of Sweden., Results: WaC felt by the nurse specialists were based on being unable to influence their work situation, or carry out their tasks as expected. Their responses to these unusual situations were resolved by using internal (acquired knowledge and experience) and external resources (consulting colleagues having different competences)., Conclusion: A safe working environment improves the possibility to deliver a satisfactory work performance. Shared experiences and communication between colleagues should be encouraged; teamwork should be enhanced by the implementation of local and national training courses, and unambiguous work guidelines should be given., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to evaluate the quality of the performance of everyday activities in children with spina bifida., Methods: Fifty children with spina bifida (of 65 children in a geographic cohort), aged 6 to 14 years, were evaluated with Assessment of Motor and Process Skills., Results: Compared with age-normative values, 60% of the children with spina bifida were found to have motor ability measures below 2 SD and 48% process ability measures below 2 SD. Most of the children with spina bifida had difficulties performing well-known everyday activities in an effortless, efficient and independent way, relating to both motor and process skills. The motor skills hardest to accomplish involved motor planning and the process skills hardest to accomplish were adaptation of performance and initiations of new steps, thus actually getting the task done., Conclusion: To reach autonomy in life, children with spina bifida may need particular guidance to learn not only how to do things but also how to get things done.