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Objectives Studies have investigated predictors of participation and showed that fewer depressive symptoms, physical independence, and age could predict the level of participation after stroke. Association between self-assessed functions and perceived levels of participation over time is not yet known. The aim of this study was to investigate perceptions of participation and how this related to background characteristics and self-assessed rehabilitation outcomes, at 1, 6, and 12 months post-stroke. Materials and Methods To capture experienced functioning and participation, a self-assessment questionnaire, the Stroke Impact Scale ( SIS), was used at 1, 6, and 12 months post-stroke. Possible variables with impact on perceived participation were investigated with logistic regression: perceived physical functions, memory and thinking, emotion and communication ( SIS), as well as background characteristics. In addition, directions, distributions, and strength of correlations between each independent variable and the participation domain were analyzed using scatterplots. Results Participation scores were widely distributed during the first year post-stroke. Significant associations were only found between perceived Physical score and participation during the first year post-stroke (1 month, n=92, P<.001; 6 months, n=79, P=.001; 12 months, n =78, P=.002). A moderate-to-high participation score was observed in combination with a high level of perceived emotional health and cognitive skills, at 1, 6, and 12 months. Conclusions The findings indicate that to improve participation during the first year post-stroke, physical functioning as well as emotional and cognitive health can be important areas of concern when forming rehabilitation interventions. [ABSTRACT FROM AUTHOR]

A follow-up study was conducted with 20 patients after the rehabilitation process at six Health Centres at the University Hospital in Umea, Sweden. The study was conducted at the Accident Analysis Group, University Hospital in Umea. None of the patients with physical impairments had self-experiences of injury events in the traffic environment. Sixty percent of the respondents reported feeling safe in the traffic environments. Eighty percent of the respondents were satisfied with the degree of safety and the advantage of roundabouts in traffic environments. The respondents who had personal assistance reported travel anxiety and fear. With respect to dealing with personal assistance and help, risk-taking behaviour and poor knowledge of patients with physical impairment, as a vulnerable road-user group, were important risk factors. [ABSTRACT FROM AUTHOR]

Patients with hearing impairments have no self-reported experiences of feeling insecure in the traffic environment. A follow-up study was conducted with 21 patients after the rehabilitation process at the Hearing Centre and the Accident Analysis Group, University Hospital in Umea, Sweden and 90 per cent of the respondents reported feeling safe in traffic. However, the hearing impaired are more vulnerable than others because they find it difficult to identify in which direction sounds made by cyclists and motorists are actually coming from. In the future, professionals would gain more knowledge about mobility and injury prevention if they tried to detect the coping strategies used by patients with hearing impairments. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma., Design: A qualitative study with a constructivist grounded theory design., Methods: Fifteen in-depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology., Results: The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges., Conclusion: Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process., Impact: As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns., Reporting Method: Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist., Patient or Public Contribution: No patient or public involvement., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective: According to the European Union, fatal road accidents involving Vulnerable Road Users (VRUs) are equal in proportion to fatal car road accidents (46%). VRUs include individuals with mobility challenges such as the elderly and Powered Wheelchair (PWC) users. The aim of this interdisciplinary qualitative study was to identify obstacles and risks for PWC users by exploring their behaviour and experiences in traffic environments., Methods: Videos and in-depth interviews with 13 PWC users aged 20-66 were analysed for this study. The interviews and videos, which include real-life outdoor observations, originate from a qualitative study exploring experiences of PWC use on a daily basis in Sweden. Underlying causal factors to identified risks and obstacles were identified, based on human, vehicle (PWC) and environmental factors in accordance with the Haddon Matrix., Results: The results show significant potential for improvement within all three perspectives of the Haddon Matrix used in the analysis. Participants faced and dealt with various obstacles and risks in order to reach their destination. For example, this includes uneven surfaces, differences in ground levels, steep slopes, as well as interactions with other road users and the influence of weather conditions, resulting in PWC users constantly accommodating and coping with the shortcomings of the vehicle and the environment., Conclusions: There are still major challenges with regard to preventing obstacles and risks in the traffic environment for PWC users. To discern PWC users in traffic accident and injury data bases, a start would be to register type of aid used for persons involved in an accident. Furthermore, to emphasise PWC users' role as VRUs, it may also be advantageous to describe them as drivers rather than users when navigating the traffic environment. Given the limited sample, further research covering more data from a broader perspective would be beneficial. By incorporating emerging knowledge of PWC users' prerequisites and needs, and including them in research and traffic planning, the society will grow safer and more inclusive, and become better prepared for meeting future demands on accessibility from an aging population., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: An increasing number of people with stroke live in their communities, yet the understanding of how their reintegration into society can best be facilitated is incomplete. If needs are not sufficiently met and difficulties overcome, it may result in limited participation and decreased life satisfaction for this group. We aimed to understand life after stroke through the lens of participants' cameras, and hence their views and experiences guided this study., Methods: By the means of photovoice, an action research method, this study was conducted in a collaborative format with six women and five men after stroke. Participants photographed in everyday life for up to four weeks and then met to discuss all images in a focus group setting. Subsequently, participants gave feedback on the method and discussed the upcoming photography exhibition. All photos and the three focus group discussions were analyzed using a thematic analysis with an inductive approach., Results: In the focus group discussions, life after stroke were conceptualized through five main themes: a driving force to participate in society; managing everyday life through inventiveness and persistent training; insufficient healthcare and rehabilitation in the long-term perspective; finding meaningful relationships and activities in daily life. Participants' voices are made clear through selected photos, which aim to present each theme and make results easier to understand., Conclusions: Participants found new ways to approach everyday life situations and had thereby regained a sense of control in life. However, it was evident that psychological processes towards adaptation were hindered by depression and that some individuals felt alone in an ongoing struggle. Additionally, available interventions a long time after stroke were not flexible enough to address all participants' needs., Competing Interests: The authors have declared that no competing interests exist.

Objective: To enhance the understanding of long-term participation in working-aged people 7-8 years after stroke., Methods: This study had a qualitative design, using a thematic analysis methodology. Eleven individuals took part in an in depth interview 7-8 years after a first time stroke. They had received care at the Sahlgrenska University Hospital in Gothenburg, and were recruited as a heterogenic sample with respect to age, gender, stroke severity and subtype., Results: From the participants' experiences four themes emerged: "Returning to work after stroke"; "Working life 7-8 years after stroke"; "Social life 7-8 years after stroke"; and "A state of reorientation in life". Quotes about experienced participation in everyday life were summarized and presented as "Participation after stroke narratives". Participants chose to emphasize on work- and social life when describing situations of successful participation. Being included in the wider community and having a sense of purpose, when interacting with others, were factors that these narratives had in common. Participants had gradually become accustomed to a somewhat altered life situation. Some consequences after stroke were still considered frustrating in social or work situations. However, the importance of these issues had reduced and were no longer problematized., Conclusions: Participants felt content with their everyday life in general, which was a principal and positive result of this study. Reaching a stage of acceptance seemed to be a complex and continuous struggle, and an individual approach in long-term rehabilitation would be valuable to support this personal process. More knowledge about what factors that facilitate participation in people of working-age many years after stroke is needed, so that more people can reach a state of positive identity and participation., Competing Interests: The authors have declared that no competing interests exist.

Objective: Powered mobility devices (PMDs) are commonly used as aids for older people and people with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in traffic safety contexts. However, the problem of accidents involving PMD drivers has been reported in many countries where these vehicles have become increasingly popular. The aim of this study is to extract and analyze national PMD-related accident and injury data reported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will provide valuable insight into the risks and obstacles that PMD drivers are exposed to in the traffic environment and may contribute to improving the mobility of this group in the long term. Methods: The current study is based on data from 743 accidents and 998 persons. An analysis was performed on a subset of data ( N  = 301) in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single ( N  = 427) or collision ( N  = 315). Results: The results show that there was a 3-fold increase in the number of PMD-related accidents reported to STRADA during the period 2007-2016. With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominated by males. Single accidents were more common than collisions ( N  = 427 and N  = 316, respectively) and the level of injury sustained in each type of accident is on par. The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), due to either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many of the single accidents was a difference in ground level (34%, typically a curb). Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly at junctions or intersections (70%). Abbreviated Injury Scale (AIS) 3+ injuries were dominated by hip and head injuries in both single accidents and collision events. Conclusions: The present study shows that further research on PMD accidents is required, with regard to both single accidents and collision events. To ensure that appropriate decisions are made, future work should follow up on injury trends and further improve the quality of PDM-related accident data. Improved vehicle stability and design, increased usage of safety equipment, proper training programs, effective maintenance services, and development of a supporting infrastructure would contribute to increased safety for PMD drivers.

Objectives: The aims of this study were to describe the self-assessed physical, emotional, and cognitive impact of stroke and to investigate associations with participation and stroke severity in early stage (1 month) poststroke., Methods: Participants (n = 104, mean age = 68) with reduced upper extremity function assessed at day 3 were included from a Swedish stroke unit. Participants were evaluated with The National Institutes of Health Stroke Scale at arrival, median 7.9 (0-24). The cohort was assessed for their perceived impact of stroke with the Stroke Impact Scale at 1 month poststroke., Results: The perceptions of emotional health, communication skills, and ability to remember were perceived as quite good, with a mean score of 83-86. However, nearly 60% reported limitations in participation. This group also evaluated their physical function to be significantly lower compared to participants who did not report limitations in participation., Conclusions: One month poststroke, a lower score on self-assessed physical function was associated with both a perceived restriction in participation and a more severe stroke. The association of physical function and perceived participation at 1 month poststroke needs to be taken into account when planning the early rehabilitation., (Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Disability organisations have not been engaged in the debate about the International Classification of Functioning, Disability and Health (ICF) in Sweden. We wanted to know representatives' attitudes about the ICF. The aim of the study was to elucidate the arguments for and against the ICF among representatives of disability organisations. The study consisted of eighteen representatives (from six disability organisations) that answered electronic questionnaires. The questionnaires involved ten open questions about the arguments for and against the ICF. The answers of the questionnaires have been categorized according to qualitative content analysis. Our results indicated four themes: awareness, arguments for and against, influence and the future. More than half of the representatives had very limited awareness of the ICF. There was an explicit criticism of individual classification but more positive comments about classification on an aggregated level. The most important issue for representatives was influencing social policy in society, not learning and spreading information about the ICF.

Background: The study describes the extent to which the concept of accessibility and accessibility issues has been reported in a national Scandinavian disability magazine. In this study particular attention is paid to how the compatibility between the various domains of the international classification - International Classification of Functioning, Disability and Health (ICF) - has been covered in the magazine over a decade. Furthermore, other types of descriptions that the magazine has made of accessibility for people with physical disabilities are considered., Methods: The study is based on a quantitative content analysis of a total of 326 articles from the Swedish disability magazine (SDM); 450 text pages published during the years 2000-2009. The magazine's coverage has been comprehensive., Results and Conclusions: More than half of the studied texts were news items about various accessibility issues. Every third article can be characterised as a news article or feature article. The most frequently reported of the ICF domains consist of two perspectives: environmental accessibility and civil rights. Public opinion articles in the form of letters to editors and editorials focused on accessibility have a low frequency. Likewise, research reports are few. The study has included a review of illustrations and photographs. The illustrations are generally of high quality, reinforcing the disability message of the article., (Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.)

A fire developed in a facility being used as a discotheque that resulted in death for 63 young people. The rescue operations, ambulance responses, medical care provided at the scene, hospital operations, and psychosocial responses are described. Bodies blocked the exit and many survivors had to evacuate by leaping from windows. A total of 16 ambulances were used. Survivors and people not directly involved in the incident created disturbances and some even attacked responders. Many of those who escaped early suffered mild inhalation injuries and those who escaped later, sustained more severe inhalation injuries. High levels of both carbon-monoxide and cyanide were detected at autopsy. A total of 213 persons were transported to hospitals, 85 by ambulance. Most who died at the scene had severe burn injuries, were unconscious, or suffered from fire-gas injuries. A total of 150 victims were admitted to a hospital, of which 74 (49.3%) required intensive care. Only one of the four hospitals actuated a disaster alert. Psychosocial support was complicated due the multicultural characteristics of those involved. Support to the survivors and relatives of the victims was provided by representatives of various religious organization, non-profit organizations, and by the government of Gothenburg. Many recommendations are provided to better prepare for future events.