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BackgroundIndividuals with severe mental illness experience more victimization and discrimination than other persons in the community. Effective rehabilitation and recovery-oriented care interventions aimed at addressing this issue are lacking. We therefore developed a victimization-informed intervention (accompanied by a training module for professionals) called the Victoria intervention. The purpose of the present study was to understand the trial effects by examining the implementation process and the factors that influenced it.Materials and methodsA process evaluation was conducted using a mixed-methods design. During the professionals’ intervision sessions, we used observations to understand the learning processes (n = 25). Subsequently, we studied the use of the intervention in practice through structured questionnaires (n = 215) and semi-structured interviews (n = 34) with clients and professionals. We used descriptive and inferential statistics for the quantitative data and the framework method for the analyses of the qualitative data.ResultsThe observations showed that the trainings were well received. The professionals shared the urgency of paying attention to victimization and discrimination and its harmful effects on participation. They also found the intervention steps to be logical and the intervention protocol easy to use. Nevertheless, they mentioned in the interviews that they had experienced difficulties initiating a conversation about victimization, and if they started one, they did not always follow the steps of the intervention as intended. Few clients said that victimization was placed on the agenda, though those who had discussed victimization with their caregivers expressed their appreciation in the interviews; they felt acknowledged and supported.DiscussionThe findings indicate that the intervention was considered helpful in raising awareness and the acknowledgment of victimization. However, professionals remain reluctant to talk about the subject, and the results show they need more practical training in this regard. This process evaluation has an important added value in that it helps us to understand the results of the effect evaluation of the intervention. The findings will facilitate the development and implementation of interventions that address clients’ victimization experiences in community mental healthcare settings and subsequently enable their participation in society.

Et voksende antal ældre mænd bor alene. Der refereres ofte til dem som en risikogruppe i sundhedssystemerne. Formålet med denne artikel er. at etablere en oversigt over disse mænds helbredsstatus og brug af sundhedsvæsnet. Til det formål trækker vi på tre kilder: En online survey med sundhedsprofessionelle, data fra et national selvrapporteringsstudie og registerbaserede data om brug af sundhedsvæsnet. Resultaterne viser, at ældre mænd, der bor alene, generelt har en lavere sundhedsscore end ældre mænd, der er samboende, og at der blandt mænd, der bor alene er en association imellem lav udannelse og lavere helbredsscore, men også en større brug af gratis sundhedsydelser. Sundhedsprofessionelle, der udfører forebyggende hjemmebesøg betragter mændenes sociale behov som det mest udtalte problem i forhold til mændenes velbefindende og efterspørger nye former for tilbud, som er skræddersyet til mændene. I artiklen diskuterer vi forskellene imellem ældre mænd, der bor i landområder med ældre mænd, der bor i byområder og imellem dem, deer er single, fraskilt eller enkemænd. Vi konkluderer, at de sociale og sundhedsmæssige omsorgssystemer bør skelne imellem undergrupper af ældre mænd, der bor alene, når der udvikles ny service og at gratis service såsom almen praktiserende læger og hjemmehjælp bør betragtes som drivkraft i forhold til at udbedre ulighed i sundhed. A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.

With the trend towards inclusive education, today there are many different school settings in which students with an intellectual disability (ID) or social, emotional and behavioural difficulties (SEBD) are educated. According to the Social Comparison Theory of Festinger, educational contexts influence the self-concept development of these students. This systematic review aims to provide an overview of literature over the last 20 years focusing on the self-concept of students with ID or SEBD in different school settings, in relation to typically developing peers and the relationship between self-concept and various variables. The results of the 15 articles identified for this review mainly indicate neutral self-concept scores. Studies focus primarily on students with ID and on the social and academic dimensions of self-concept. Students in special education tend to score slightly more positive than students in other school settings and students with ID or SEBD report a more negative self-concept than typically developing peers. Most variables included in the studies show no correlation with self-concept. Findings also revealed difficulties in the feasibility of comparison between studies due to statistical shortcomings and lack of clarification in the identified articles. Future directions for self-concept research are discussed comprehensively.

An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5–7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5–7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (>20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5–7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P < .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.

Objective: To describe different domains of participation such as productive, leisure and social activities and describe sociodemographic and spinal cord injury (SCI)-related characteristics that are associated with participation in these domains in a large sample of community-dwelling individuals with SCI in Switzerland.Design: Cross-sectional population-based survey within the Swiss Spinal Cord Injury Cohort Study. Participation in major life domains was measured by the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation). Univariable unconditional analysis and unbiased recursive partitioning were used to identify the predominant associations of sociodemographic and SCI-related characteristics with multiple dimensions of participation.Setting: Community.Participants: Swiss residents aged 16 years or older and living with traumatic or nontraumatic SCI (N=1549).Interventions: Not applicable.Main Outcome Measure: The USER-Participation, a 32-item self-report questionnaire with 3 scales (Frequency, Restrictions, and Satisfaction) to assess key domains of participation (productive, leisure, social).Results: Frequency (median 34.5 out of 100) in productive, outdoor leisure, and social activities was reduced with distinctive perceived restrictions in work and education, sports, and partner relationships. Domestic leisure activities (65.4%) and maintaining social relationships (76.1%) were those activities most often performed and with least perceived restrictions. Participants were generally satisfied with their current daily life activities. Lower scores across all participation scales were associated with more severe SCI, higher age, being female, not having a partner, and lower level of education.Conclusions: This study provides a thorough analysis of participation in major life domains of individuals with SCI in Switzerland. Different risk groups for reduced levels in participation in productive, leisure, and social activities were identified. This population-based evidence is instrumental to the better targeting of rehabilitation and policy interventions that aim to improve community participation. (C) 2019 by the American Congress of Rehabilitation Medicine

Background. Little is known about associations between low physical activity (PA) and its correlates and outcomes in solid organ transplant recipients. This systematic review with meta-analysis examined correlates and outcomes associated with low PA (ie, not meeting individual study's definition of being physically active) following solid organ transplantation. Methods. We searched PubMed, CINAHL, PsycINFO, and EMBASE from inception to February 2016 to identify peer-reviewed data-based articles. Articles published in English, German, Spanish, French, Italian, Portuguese, or Dutch that examined correlates or outcomes associated with low PA in adult single, solid organ transplant recipients were included. Studies' quality was assessed using a 14-item checklist. Pooled odds ratios and 95% confidence intervals were computed for correlates and outcomes examined in >= 5 studies. Results. Of 7401 publications screened, 34 studies met inclusion criteria and were included in the overall synthesis with 15 included in the meta-analysis. Most focused on renal transplantation (n = 18, 53%) and used cross-sectional designs (n = 26, 77%). Of 30 correlates examined, [condition-related (n = 11), social/economic-related (n = 9), patient-related (n = 4), healthcare system-related (n = 3), and treatment-related (n = 3)], only 4 were examined >= 5 times and included in meta-analyses. None were significantly related to low PA. Of 19 outcomes assessed, only physical health-related quality of life was examined >= 5 times. Low PA was significantly associated with low physical health-related quality of life (odds ratio = 0.172, 95% confidence interval = 0.08-0.37). Conclusions. We found few studies examining most correlates and outcomes related to low PA despite growing evidence that improving PA might be an effective intervention in improving posttransplant outcomes.

(1) Background: The COVID-19 pandemic forced people from all around the globe to strongly modify their daily routines, putting a significant strain on the social aspects of daily lives. While the first wave of the pandemic was a very challenging time in all countries, it is still uncertain whether various lockdown intensities and infection rates differed regarding their psychosocial impact. This work therefore aimed to investigate (i) the psychosocial effects of home confinement in two European countries that underwent different lockdown intensities: Italy and the Netherlands and (ii) the role of communication technology in relation to feelings of loneliness. (2) Methods: A cross-sectional online survey inquiring about different psychosocial variables and the use of and satisfaction towards communication technology was circulated among the general public during the first wave of the COVID-19 pandemic. In total, 629 participants (66% female, 68% from the Netherlands) answered each question twice, referring to “before” and “during” the pandemic. (3) Results: We found significant negative effects of COVID-19 home confinement on depressive feelings (p &lt, 0.001, %∆ = +54%), loneliness (p &lt, 0.001, %∆ = +37.3%), life satisfaction (p &lt, 0.001, %∆ = −19.8%) and mental wellbeing (p &lt, 0.001, %∆ = −10.6%) which were accompanied with a significantly increased need for psychosocial support (p &lt, 0.001, %∆ = +17.3%). However, the magnitude of psychosocial impact did not significantly differ between residents undergoing a more intense (Italy) versus a less intense (Netherlands) lockdown, although the decrease in social participation was found to be significantly different for both countries (z = −7.714, p &lt, 0.001). Furthermore, our findings demonstrate that the increase in loneliness was associated with the adoption of new digital communication tools (r = 0.21, p &lt, 0.001), and significantly higher for individuals who started to adopt at least one new digital communication tool during confinement than for those who did not (z = −4.252, p &lt, 0.001). (4) Conclusions: This study highlights that, although COVID-19 home confinement significantly impacted psychosocial wellbeing during the first wave of the pandemic, this impact did not differ based on lockdown intensity. Recognizing the increasing adoption of digital communication technology in an attempt to reduce lockdown loneliness, future studies should investigate what is needed from the technology to achieve this effect.

Background Persons with dementia tend to be vulnerable to mobility challenges and hence face a greater risk of fall and subsequent fractures, morbidity, and mortality. Motion-based technologies (MBTs), also called sensor-based technologies or virtual reality, have the potential for assisting physical exercise and training as a part of a disease management and rehabilitation program, but little is known about its' use for people with dementia. Objective The purpose of this pilot study was to investigate the feasibility and efficacy of MBT physical training at home for people with dementia. Methods A 3-phase pilot study: (1) baseline start-up, (2) 15 weeks of group training at a local care center twice a week, and (3) 12 weeks of group training reduced to once a week, supplemented with individual MBT training twice a week at home. A total of 26 people with dementia from a municipality in Southern Denmark were eligible and agreed to participate in this study. Three withdrew from the study, leaving 23 participants for the final analysis. Feasibility was measured by the percentage of participants who trained with MBT at home, and their completion rate of total scheduled MBT sessions. Efficacy was evaluated by physical function, measured by Sit-to-Stand (STS), Timed-Up-and-Go (TUG), 6-minute Walk Test (6MW), and 10-meter Dual-task Walking Test (10MDW); cognitive function was measured by Mini-Mental State Examination (MMSE) and Neuropsychiatric Inventory-Questionnaire (NPI-Q); and European Quality of Life 5 dimensions questionnaire (EQOL5) was used for measuring quality of life. Descriptive statistics were applied accordingly. Wilcoxon signed-rank and rank-sum tests were applied to explore significant differences within and between the groups. Results As much as 12 of 23 participants (52%) used the supplemental MBT training at home. Among them, 6 (50%) completed 75% or more scheduled sessions, 3 completed 25% or less, and 3 completed between 25% and 75% of scheduled sessions. For physical and cognitive function tests, supplementing with MBT training at home showed a tendency of overall stabilization of scores among the group of participants who actively trained with MBT; especially, the 10MDW test even showed a significant improvement from 9.2 to 7.1 seconds (P=.03). We found no positive effect on EQOL5 tests. Conclusions More than half of the study population with dementia used MBT training at home, and among them, half had an overall high adherence to the home training activity. Physical function tended to remain stable or even improved among high-adherence MBT individuals. We conclude that MBT training at home may be feasible for some individuals with dementia. Further research is warranted.

Background Existing research shows that adults with an autism spectrum disorder (ASD) are more vulnerable to develop overt psychosis. However, studies investigating (subclinical) psychotic experiences (PE) in ASD are scarce, and it is unknown if PE are accompanied with more distress in adults with ASD compared to the general population. This study examined lifetime PE and accompanying distress, momentary PE levels, and the impact of daily life stress and negative affect (NA) on momentary PE in males and females with ASD compared to controls. Methods In 50 adults with ASD (males N= 26, females N= 24) and 51 adults without ASD (males N= 26, females N= 25), the Community Assessment of Psychic Experiences (CAPE) was used to analyze group differences in frequency and distress of lifetime subclinical positive, negative, and depressive symptoms. The Experience Sampling Method (ESM) was used to measure momentary PE, NA, and stress (activity-related, event-related, and social stress) for 10 days. Multilevel analyses were conducted to test whether stress and NA were associated with momentary PE and whether these associations were modified by group or sex. Results Adults with ASD reported more lifetime CAPE negative and depressive symptoms, but similar levels of PE, than controls. Higher levels of accompanying distress were found in participants with ASD for each subscale. With respect to ESM momentary PE, higher levels were reported by adults with ASD and a stronger association between event-related stress and momentary PE was found compared to controls. This was not the case for NA, activity-related, and social stress. Overall, no significant differences between male and female outcomes were found. Conclusion Adults with ASD are more prone to encounter lifetime subclinical negative and depressive symptoms and accompanying distress compared to adults without ASD. Similar levels of lifetime PE in both groups were still accompanied with more distress in the ASD group. Furthermore, higher levels of ESM momentary PE were found in participants with ASD. Additionally, event-related stress may act as a risk factor for PE in both females and males with ASD, with a stronger risk-increasing effect than in their control counterparts.

In the Dutch policy discourse it is increasingly thought that active citizenship will positively affect satisfaction with the living environment. This article challenges this assumption by examining whether and how volunteering in village life and individual perceptions of liveability are interrelated. Through a series of hierarchical regressions, we found that having the opportunity to volunteer in village life is not a significant predictor of perceived liveability. Moreover, by classifying rural inhabitants as non-participants, nominal participants and active participants in volunteering in village life, we determined that active residents evaluate liveability less positively than the other two groups. Accordingly, determinants other than volunteering and active citizenship are better able to predict perceived liveability, although the specific variables differ for each group of rural inhabitants. This suggests that governments overestimate both the willingness of rural residents to volunteer and the benefits of becoming active in village life.

Objectives: To report changes in productivity and social participation - alongside clinical and patient-reported outcomes (PROs) - in patients with rheumatoid arthritis (RA) receiving certolizumab pegol (CZP) during routine clinical practice in Belgium. Methods: This was a prospective, non-interventional study, in which patients were prescribed CZP at their physicians' discretion and followed during routine clinical visits. The primary outcomes were household productivity and social participation at the last visit (~52 weeks), measured through responses to the Work Productivity Survey. Secondary outcomes included workplace productivity and achievement of DAS28(ESR) clinical response, low disease activity and remission at the last visit. Baseline demographics and adverse events (AEs) were recorded for all patients who received ≥1 dose CZP. Results: A total of 141 patients were enrolled in the study, of whom 119 (84.4%) formed the full analysis set (received ≥1 dose CZP and had ≥1 post-baseline measurement for ≥1 primary outcome). At Visit 1 (baseline), patients reported an average of 11.0 paid work days, 16.8 household work days and 5.5 days of social participation affected by their disease over the previous month. Rapid improvements in household productivity and social participation were evident from Visit 2 (2-8 weeks). By the final visit, mean improvements were observed for all aspects of productivity, participation and clinical/PROs. A total of 24 AEs were reported. Conclusion: CZP has a positive impact on productivity and social participation in patients with RA in the Belgian daily practice setting, with safety and efficacy profiles that mirror those observed in the trial setting. ispartof: ACTA CLINICA BELGICA vol:74 issue:5 pages:342-350 ispartof: location:England status: published

BACKGROUND: Kidney transplantation confers substantial survival and quality of life benefits for many patients with end-stage kidney disease compared with dialysis, but complications and side effects of immunosuppression can impair participation in daily life activities. Life participation is a critically important patient-reported outcome for kidney transplant recipients but is infrequently and inconsistently measured in trials. We convened a consensus workshop on establishing an outcome measure for life participation for use in all trials in kidney transplantation. METHODS: Twenty-five (43%) kidney transplant recipients/caregivers and 33 (57%) health professionals from 8 countries participated in 6 facilitated breakout group discussions. Transcripts were analyzed thematically. RESULTS: Four themes were identified. Returning to normality conveyed the patients' goals to fulfill their roles (ie, in their family, work, and community) and reestablish a normal lifestyle after transplant. Recognizing the diverse meaning and activities of "life" explicitly acknowledged life participation as a subjective concept that could refer to different activities (eg, employment, recreation, family duties) for each individual patient. Capturing vulnerability and fluctuations posttransplant (eg, due to complications and side-effects) distinguished between experiences in the first year posttransplant and the long-term impact of transplantation. Having a scientifically rigorous, feasible, and meaningful measure was expected to enable consistent and frequent assessment of life participation in trials in kidney transplantation. CONCLUSIONS: A feasible and validated core outcome measure for life participation is needed so that this critically important patient-reported outcome can be consistently and meaningfully assessed in trials in kidney transplantation to inform decision making and care of recipients. ispartof: TRANSPLANTATION vol:103 issue:6 pages:1199-1205 ispartof: location:United States status: published

BACKGROUND: Little is known about associations between low physical activity (PA) and its correlates and outcomes in solid organ transplant recipients. This systematic review with meta-analysis examined correlates and outcomes associated with low PA (ie, not meeting individual study's definition of being physically active) following solid organ transplantation. METHODS: We searched PubMed, CINAHL, PsycINFO, and EMBASE from inception to February 2016 to identify peer-reviewed data-based articles. Articles published in English, German, Spanish, French, Italian, Portuguese, or Dutch that examined correlates or outcomes associated with low PA in adult single, solid organ transplant recipients were included. Studies' quality was assessed using a 14-item checklist. Pooled odds ratios and 95% confidence intervals were computed for correlates and outcomes examined in ≥5 studies. RESULTS: Of 7401 publications screened, 34 studies met inclusion criteria and were included in the overall synthesis with 15 included in the meta-analysis. Most focused on renal transplantation (n = 18, 53%) and used cross-sectional designs (n = 26, 77%). Of 30 correlates examined, [condition-related (n = 11), social/economic-related (n = 9), patient-related (n = 4), healthcare system-related (n = 3), and treatment-related (n = 3)], only 4 were examined ≥5 times and included in meta-analyses. None were significantly related to low PA. Of 19 outcomes assessed, only physical health-related quality of life was examined ≥5 times. Low PA was significantly associated with low physical health-related quality of life (odds ratio = 0.172, 95% confidence interval = 0.08-0.37). CONCLUSIONS: We found few studies examining most correlates and outcomes related to low PA despite growing evidence that improving PA might be an effective intervention in improving posttransplant outcomes. ispartof: TRANSPLANTATION vol:103 issue:4 pages:679-688 ispartof: location:United States status: published

For many patients with end-stage kidney disease, transplantation improves survival and quality of life compared with dialysis. However, complications and side effects in kidney transplant recipients can limit their ability to participate in activities of daily living including work, study, and recreational activities. The aim of this study was to identify the characteristics, content, and psychometric properties of the outcome measures used to assess life participation in kidney transplant recipients. We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to July 2018 for all studies that reported life participation in kidney transplant recipients. Two authors identified instruments measuring life participation and reviewed for characteristics. In total, 230 studies were included: 19 (8%) randomized trials, 17 (7%) nonrandomized trials, and 194 (85%) observational studies. Across these studies, we identified 29 different measures that were used to assess life participation. Twelve (41%) measures specifically assessed aspects of life participation (eg, disability assessment, daily activities of living), while 17 (59%) assessed other constructs (eg, quality of life) that included questions on life participation. Validation data to support the use of these measures in kidney transplant recipients were available for only 7 measures. A wide range of measures have been used to assess life participation in kidney transplant recipients, but validation data supporting the use of these measures in this population are sparse. A content relevant and validated measure to improve the consistency and accuracy of measuring life participation in research may inform strategies for transplant recipients to be better able to engage in their life activities. ispartof: AMERICAN JOURNAL OF TRANSPLANTATION vol:19 issue:8 pages:2306-2317 ispartof: location:United States status: published

The influence of a person's environment and its modifying potential on participation is well recognized for most childhood disabilities, but scarcely studied for adolescents with autism spectrum disorder (ASD). A scoping review was conducted, the aim of which was to map the existing literature about supporting and hindering environments for the participation of adolescents with ASD. Sources of scientific evidence were searched for in four data-bases. Inclusion criteria were the perspectives of adolescents between 12 and 21, families, peers, or significant others; ecologic validity; and a clear connection between environment and participation. The publication dates ranged from 2001 to 2014 and partly up to 2018. The International Classification of Functioning, Disability and Health (ICF) served as the guiding framework for inclusion/exclusion during the selection process. Thematic analysis was performed by five independent reviewers. Results were additionally validated by stake-holders. This scoping review identified 5528 articles, and finally included 31 studies. Two main themes were found: "providing security" indicates how the environment, and specifically the parental, physical, and informational environments, have a securing or intimidating effect. The second theme, "helping to connect", indicates which environments support or hinder social relationships or social activities, and hence participation. An additional third main theme, "tension in participation", relates to ambiguities that seem essential to understand participation or isolation of adolescents with ASD. Results show that participation is a value-laden concept. This research widens the field of dealing with adolescents with ASD, as it directs attention towards the responsibility of the environment regarding participation.

The influence of a person’s environment and its modifying potential on participation is well recognized for most childhood disabilities, but scarcely studied for adolescents with autism spectrum disorder (ASD). A scoping review was conducted, the aim of which was to map the existing literature about supporting and hindering environments for the participation of adolescents with ASD. Sources of scientific evidence were searched for in four databases. Inclusion criteria were the perspectives of adolescents between 12 and 21, families, peers, or significant others; ecologic validity; and a clear connection between environment and participation. The publication dates ranged from 2001 to 2014 and partly up to 2018. The International Classification of Functioning, Disability and Health (ICF) served as the guiding framework for inclusion/exclusion during the selection process. Thematic analysis was performed by five independent reviewers. Results were additionally validated by stake holders. This scoping review identified 5528 articles, and finally included 31 studies. Two main themes were found: “providing security” indicates how the environment, and specifically the parental, physical, and informational environments, have a securing or intimidating effect. The second theme, “helping to connect”, indicates which environments support or hinder social relationships or social activities, and hence participation. An additional third main theme, “tension in participation”, relates to ambiguities that seem essential to under stand participation or isolation of adolescents with ASD. Results show that participation is a value-laden concept. This research widens the field of dealing with adolescents with ASD, as it directs attention towards the responsibility of the environment regarding participation.

Purpose: This study aims to (1) assess differences in participation restrictions between stroke survivors aged under and over 70 years and (2) identify predictors associated with favorable and unfavorable long-term participation in both age groups. Methods: Prospective cohort study in which 326 patients were assessed at stroke onset, two months and one year after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used to measure participation restrictions one year after stroke. Bivariate and multivariate logistic regression analyses were performed including demographic factors, stroke-related factors, emotional functioning and comorbidity as possible predictors. Results: Stroke survivors aged over 70 years perceived more participation restrictions in comparison to stroke survivors aged under 70 years one year after stroke. Independently significant predictors for unfavorable participation outcomes were advancing age, more severe stroke and anxiety symptoms in patients aged over 70 years, and female gender, more severe stroke, impaired cognition and depression symptoms in patients aged under 70 years. Lower age was the only independent predictor associated with favorable participation after one year in stroke survivors aged over 70 years. Conclusions: This study emphasizes the need to pay more attention to participation restrictions in elderly stroke survivors.Implications for rehabilitation More attention in the rehabilitation process should be paid to restrictions in participation of stroke survivors aged older than 70 years, taking into account the different participation needs and predictors of older stroke survivors. Early screening on the presence of anxiety symptoms could potentially prevent long-term restrictions in participation in stroke survivors aged over 70-year old. Stroke survivors experience considerable restrictions in physical activity and mobility after one year, highlighting the need for the development of community-based exercise programs for stroke survivors.

Background: People with recently acquired spinal cord injury (SCI) experience changes in physical, social and psychological aspects of their lives. In the last decades, attention has grown for aspects of self-management and self-efficacy in SCI research. However, we still do not know what the self-management and self-efficacy outcomes of first rehabilitation are and whether utilizing these skills may prevent secondary health conditions (SHCs) and increase participation and psychological adjustment early after SCI.Objective: To describe the course and determinants of self-management and self-efficacy during and after first SCI rehabilitation; and to determine theory-based associations between self-management and self-efficacy with SHCs, participation and psychological adjustment.Methods: Multicenter prospective longitudinal cohort study. All people with a newly acquired SCI admitted to one of the 8 specialized SCI rehabilitation centers in the Netherlands will be considered for inclusion in this study. Main assessments will take place during the first and last week of admission and 3, 6 and 12 months after discharge. The target sample is 250 participants. The primary outcomes are self-management (knowledge and execution of self-care) and self-efficacy (confidence in the ability to manage the consequences of SCI and of self-care). Secondary outcome measures are SHCs, participation and psychological adjustment to SCI.Results: The first results with the complete set of data are expected in June 2019.Conclusions: This protocol describes the SELF-SCI cohort study investigating self-management and self-efficacy of initial inpatient SCI rehabilitation. Second, associations will be investigated with SHCs, participation and psychological adjustment early after onset of SCI, until 1 year after discharge. The results will be used to test theories about motivation to perform health-promoting behaviors and adjustment to SCI.

Objective: To examine the subjective understanding of participation and integration of persons with spinal cord injuries from 5 European countries and to compare these findings with the International Classification of Functioning, Disability and Health (ICF)'s conceptualization of participation. Methods: Semi-structured interviews with 54 persons with acquired spinal cord injuries and 3 with spina bifida from 5 countries were examined using qualitative content analysis. Results: Integration was most often associated with social acceptance and, furthermore, with ordinary performance, equality and freedom of choice. Participation was most often described as ordinary performance, with less emphasis on social acceptance and equality. However, participation and integration overlapped in people's narratives and were difficult to separate. The perception of participation and integration was largely similar across countries. In contrast to others, however, Finnish interviewees were more likely to associate participation with contributing to society. A variety of life domains was identified, of which recreation and leisure, work life, sports and going out were the most prevalent. Conclusion: While participation domains are well covered by the ICF, as is the notion of ordinary performance, interviewees also referred to a rights (e.g. acceptance) and duties (e.g. contribution) perspective.

In the Dutch policy discourse it is increasingly thought that active citizenship will positively affect satisfaction with the living environment. This article challenges this assumption by examining whether and how volunteering in village life and individual perceptions of liveability are interrelated. Through a series of hierarchical regressions, we found that having the opportunity to volunteer in village life is not a significant predictor of perceived liveability. Moreover, by classifying rural inhabitants as non-participants, nominal participants and active participants in volunteering in village life, we determined that active residents evaluate liveability less positively than the other two groups. Accordingly, determinants other than volunteering and active citizenship are better able to predict perceived liveability, although the specific variables differ for each group of rural inhabitants. This suggests that governments overestimate both the willingness of rural residents to volunteer and the benefits of becoming active in village life.

Study design Multicentre cross-sectional study.Objectives To describe relationships between time since injury (TSI) and participation in individuals with tetraplegia and paraplegia.Setting Community sample from the NetherlandsMethods Individuals (N= 265) aged 28-65 years, living with spinal cord injury (SCI) for >= 10 years, age at injury between 18-35 years and using a wheelchair for everyday mobility in three TSI strata: 10-19, 20-29, and >= 30 years post-injury. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used, which consists of three scales: Frequency (including subscales for Productive, Leisure, and Social activities), Restrictions, and Satisfaction. Linear regression analyses were used to study the effect of TSI on participation, and to adjust for personal and lesion characteristics, for individuals with tetraplegia and paraplegia separately.Results Mean age was 48.4 years, with a mean TSI of 24 years. About 73.6% were male, 40.4% had tetraplegia and 81.9% had a motor complete injury. In individuals with tetraplegia (N= 107), longer TSI was independently associated with lower scores on the Frequency scale (p = 0.025) and the subscale frequency of Leisure activities (p = 0.004). In individuals with paraplegia (N= 158), longer TSI was independently associated with lower scores on the subscale frequency of Productive activities (p = 0.006). TSI was not associated with participation Restrictions and Satisfaction with participation.Conclusions Longer TSI is associated with a reduced frequency of participation in individuals with long-term SCI. Interestingly, this negative association is not accompanied by a similar association in the person's experience of participation.

To understand the difficulties students with disabilities experience in their social participation in general education, this study examined which child, peer, and class variables relate to peer acceptance and friendships. In a cross-sectional study, sociometric data were gathered for students without disabilities (N = 985) and students with disabilities (N = 65), together with personal related variables of students with disabilities, attitudes of peers towards students with disabilities, and classroom information. Using separate social networks for both boys and girls, the findings of the logistic multilevel regression analyses showed different outcomes for peer acceptance of boys and girls with disabilities. The implications of the findings are discussed in the light of possible interventions to improve peer acceptance and friendships of students with disabilities in general primary education.

BACKGROUND: Being highly self-efficacious is a key factor in successful chronic disease self-management. It is unknown whether neuropsychological rehabilitation improves self-efficacy in managing the consequences of brain injury.OBJECTIVE: To investigate whether levels of general and brain injury specific self-efficacy and quality of life (QoL) increased after neuropsychological rehabilitation and whether cognitive performance was associated with self-efficacy.METHODS: We conducted a retrospective clinical cohort study of 62 patients with acquired brain injury and cognitive complaints with measurements before start and after completion of treatment. QoL was measured with the visual analogue scale (EQ VAS) of the EuroQol (EQ-5D); self-efficacy with the TBI Self-efficacy Questionnaire (SEsx) and the General Self-efficacy Scale (GSES). Cognitive performance was measured as a compound score of tests for memory, attention and information processing speed.RESULTS: Self-efficacy for managing brain injury-specific symptoms and QoL increased significantly after neuropsychological rehabilitation. Both general and brain injury-specific self-efficacy were positively associated with QoL after completion of the programme. Cognitive performance was not associated with self-efficacy for managing brain injury-specific symptoms nor with general self-efficacy.CONCLUSIONS: Self-efficacy and QoL improve after treatment. Further research is needed to identify the specific ingredients responsible for improvement of self-efficacy in patients with cognitive complaints.

Objective: To examine the metric properties of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) in persons with spinal cord injury in Switzerland from a classical and item response theory perspective.Design: Cross-sectional survey.Subjects: Persons with spinal cord injury living in the Swiss community (n = 1,549).Methods: Score distributions and internal consistency were evaluated using Classical Test Theory. The Restrictions and Satisfaction scales were subjected to Rasch analysis. Anchored analyses were performed to account appropriately for items with structural missing.Results: Internal consistency was good for the Restrictions (alpha = 0.90) and Satisfaction scales (alpha = 0.90), but not for the Frequency scale (alpha = 0.65). Rasch analyses showed acceptable model fit for the Restrictions and Satisfaction scales after collapsing response categories of some items and merging some items into testlets. Differential item functioning was small. Anchoring allowed inclusion of the item work/education in the Restrictions scale and work/education and/or partner relationship in the Satisfaction scale.Conclusion: The Restrictions and Satisfaction scales of the USER-Participation showed satisfactory metric properties. The Frequency scale showed fewer optimal properties, but nonetheless provides important additional information regarding participation. Conversion tables were performed to transform USER-Participation raw scores into a 0-100 interval scale using Rasch-based ability estimates for use in epidemiological studies.

While there is an increased interest in describing attitudes of teachers, parents and peers towards students with special educational needs in regular education, there is a lack of knowledge about various variables relating to the attitudes of these three groups. The aims of this study are: (1) to examine which variables relate to the attitudes of teachers (N = 44), parents (N = 508) and peers (N = 1113) towards students with Attention Deficit/Hyperactivity Disorder, Autistic Spectrum Syndrome or a cognitive disability in regular primary education and (2) to examine whether teachers and parents' attitudes affect the attitudes of peers. An attitude survey was used to assess attitudes and data were analysed by means of multilevel analyses. The variables found in this study relating to attitudes can be used as a foundation to develop interventions to change attitudes.

Purpose. To assess the degree of participation of the visually impaired elderly and to make a comparison with population-based reference data.Method. This cross-sectional study included visually impaired elderly persons (>= 55 years; n = 173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions.Results. Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%).Conclusions. Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.

Objectives: To assess changes in participation in society (frequency, restrictions, satisfaction) during and after cardiac rehabilitation (CR) and to assess associations between participation and heath-related quality of life (HRQOL). Design: Prospective cohort study. Setting: Outpatient CR center. Participants: Patients with coronary artery disease (N=121; mean age, 57y; 96 men [79%]). Interventions: Multidisciplinary CR. Main Outcome Measures: Participation in society was assessed with the Utrecht Scale for Evaluation of Rehabilitation-Participation and HRQOL with the MacNew Heart Disease health-related quality of life questionnaire. All measurements were performed pre-CR, post-CR, and 1 year after the start of CR. Results: Frequency of participation did not change during and after CR. The proportion of patients experiencing restrictions in participation decreased from 69% pre-CR to 40% post-CR (P

To understand the difficulties students with disabilities experience in their social participation in general education, this study examined which child, peer, and class variables relate to peer acceptance and friendships. In a cross-sectional study, sociometric data were gathered for students without disabilities (N = 985) and students with disabilities (N = 65), together with personal related variables of students with disabilities, attitudes of peers towards students with disabilities, and classroom information. Using separate social networks for both boys and girls, the findings of the logistic multilevel regression analyses showed different outcomes for peer acceptance of boys and girls with disabilities. The implications of the findings are discussed in the light of possible interventions to improve peer acceptance and friendships of students with disabilities in general primary education.

In this study we examine the effectiveness of an intervention program to influence attitudes of elementary school students towards peers with intellectual, physical and severe physical and intellectual disabilities. A quasi-experimental longitudinal study was designed with an experimental group and a control group, both comprising two rural schools. An intervention program was developed for kindergarten (n(experimental) = 22, n(control) = 31) and elementary school students without disabilities (n(experimental) = 91, n(control) = 127) (age range 4-12 years old). This intervention consisted of a 3 weeks education project comprising six lessons about disabilities. The Acceptance Scale for Kindergarten-revised and the Attitude Survey to Inclusive Education were used to measure attitudes at three moments: prior to the start of the intervention, after the intervention and 1 year later. The outcomes of the multilevel analysis showed positive, immediate effects on attitudes of kindergarten students, but limited effects on elementary school students' attitudes.

Since the official proclamation of the promotion of the health as an objective of public health politics (Ottawa, 1986), the attention centred on the development and promotion of the health resources for the population. Understanding for “health assets” any factor or resource that promotes individuals, communities, and populations capacity to maintain health and welfare. The study is a user-centred design that considers participants as active subject that helps us to understand the reality inside its frame of reference. Research is carried out from the community and with the community in a participatory process in rural communities and with the objective to qualify, fortify and empower to the communities in relation to the concept of health. Tree exploratory focal groups and fourteen in depth interviews were carried out. Results identify how professionals and users defined health concept and describe people practices and feelings related to health assets of their community. To conclude with the design of a plan of action that contributes to the promotion of the health and to the community empowerment. Desde la proclamación oficial de la promoción de la salud como objetivo de las políticas de salud pública (Ottawa, 1986), la atención se fue centrando cada vez más en el desarrollo y potenciación de los recursos de salud para la población. Así, se consideran “activos para la salud” cualquier factor o recurso que potencie la capacidad de los individuos, de las comunidades y poblaciones para mantener la salud y el bienestar. Este trabajo utiliza un diseño participativo centrado en el usuario entendiéndolo como sujeto activo que nos ayuda a comprender la realidad dentro de su marco de referencia. El trabajo se realiza desde la comunidad y con la comunidad en un proceso participativo en comunidades rurales y con el objetivo de capacitar, fortalecer y empoderar a las comunidades en torno al concepto de salud (WHO, 2012). Se realizaron 3 grupos focales exploratorios y 14 entrevistas en profundidad. En los resultados se identifica cómo se define el concepto de salud por parte de los profesionales y de los usuarios y se conocen las prácticas de las personas implicadas y su sentir en relación a los activos de salud de su comunidad. Concluimos con el diseño de un plan de acción que contribuye a la promoción de la salud empoderando a su vez a la comunidad.

Introduction The aim of this study was to examine the health-and work outcomes of renal transplant recipients long-term after transplantation as well as the pattern of work status, work ability and disability benefits during the end-stage renal disease (ESRD) trajectory that precedes transplantation. Methods 34 transplant recipients completed interviews 3, 13 months and >6 years post-transplantation. Health status (SF-36), work ability (WAI), and fatigue (CIS) were assessed by questionnaires, clinical data were derived from medical charts, and data on functional limitations were extracted from the social security system database. The work status trajectory preceding transplantation was examined retrospectively. Results Of the 34 third wave transplant recipients, 29% were severely fatigued. Compared with the general working population, recipients experienced worse general health and less vitality. Non-working recipients had worse renal function and general health, and more limitations in physical functioning compared to working recipients. The WAI score indicated moderate work ability for 60% of the employed recipients. Although 67% were employed (45% parttime), 30% of those working still received some disability benefits. Social insurance physicians found variable levels of functional limitations. The mean work status trajectory showed more sickness absence and less work ability during dialysis, but after transplantation, both work status and work ability generally improved. Conclusions Transplant recipients have a compromised health status which leads to functional limitations and disability. Although work status improved after transplantation, a substantial number of the transplant recipients received disability benefits. The negative health consequences of anti-rejection medications may play an important role in long-term work ability. These results indicate that a 'new' kidney has advantages over dialysis with respect to work, but does not necessarily leads to 'normal' work outcomes.

Desde la proclamación oficial de la promoción de la salud como objetivo de las políticas de salud pública (Ottawa, 1986), la atención se fue centrando cada vez más en el desarrollo y potenciación de los recursos de salud para la población. Así, se consideran “activos para la salud” cualquier factor o recurso que potencie la capacidad de los individuos, de las comunidades y poblaciones para mantener la salud y el bienestar. Este trabajo utiliza un diseño participativo centrado en el usuario entendiéndolo como sujeto activo que nos ayuda a comprender la realidad dentro de su marco de referencia. El trabajo se realiza desde la comunidad y con la comunidad en un proceso participativo en comunidades rurales y con el objetivo de capacitar, fortalecer y empoderar a las comunidades en torno al concepto de salud (WHO, 2012). Se realizaron 3 grupos focales exploratorios y 14 entrevistas en profundidad. En los resultados se identifica cómo se define el concepto de salud por parte de los profesionales y de los usuarios y se conocen las prácticas de las personas implicadas y su sentir en relación a los activos de salud de su comunidad. Concluimos con el diseño de un plan de acción que contribuye a la promoción de la salud empoderando a su vez a la comunidad., Since the official proclamation of the promotion of the health as an objective of public health politics (Ottawa, 1986), the attention centred on the development and promotion of the health resources for the population. Understanding for “health assets” any factor or resource that promotes individuals, communities, and populations capacity to maintain health and welfare. The study is a user-centred design that considers participants as active subject that helps us to understand the reality inside its frame of reference. Research is carried out from the community and with the community in a participatory process in rural communities and with the objective to qualify, fortify and empower to the communities in relation to the concept of health. Tree exploratory focal groups and fourteen in depth interviews were carried out. Results identify how professionals and users defined health concept and describe people practices and feelings related to health assets of their community. To conclude with the design of a plan of action that contributes to the promotion of the health and to the community empowerment.