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Fanny Alexandra Jakobsen,1 Kjersti Vik,1 Borgunn Ytterhus21Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, NorwayBackground: A shift in the work-divide among generations and an ageing population have altered the balance of care and support between families and welfare states. Although state policy has increasingly acknowledged that older adults ageing in place receive support from family members, how adult children perceive their collaboration with their parents and health care professionals in reablement services remains unclear. The aim of this study is to identify how adult children perceive the collaboration between older parents, family members, and health care professionals in reablement services.Methods: This study has a qualitative research design with a constructivist grounded theory approach. In total, 15 adult children – 6 sons, 8 daughters, and a daughter-in-law, aged 47–64 years – whose parents had received reablement services, participated in in-depth interviews.Results: Our findings clarify how children and their older parents’ reablement services can collaborate to support how the adult children manage and maintain both their own and their parents’ everyday lives. The core category derived from our data analysis was the art of maintaining everyday life, with four subcategories indicating the different dimensions of that process: doing what is best for one’s parents, negotiating the dilemmas of everyday life, managing parents’ reablement, and ensuring the flow of everyday life.Conclusion: To promote collaboration among older adults, their children, and health care professionals in reablement, health care professionals need to proactively involve older adults’ family members in the reablement processes, particularly because older adults and their children do not always express all of their care-related needs to reablement services.Keywords: rehabilitation, informal care, primary care, social need, grounded theory, next of kin

This manuscript suggests a methodology to recognize the most vulnerable welding procedure specifications (WPSs) that contribute to the majority of defective welds annually. Based on the identified WPSs, it also suggests a methodology to recognize the most critical imperfection groups and the related imperfection sub-groups as specified in NS-EN ISO 6520-1. [ABSTRACT FROM AUTHOR]

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Aims: This study examines experiences from the implementation of EPDS as a routine screening for postnatal depression in a health centre seen from health visitors' perspective. Methods: A qualitative approach was chosen to shed light on this issue. Six experienced health visitors and one midwife participated in a focus group interview sharing their experiences and expectations. Results: The analysis indicate that the EPDS screening turned out to be a useful tool for the health visitors to adress mental health issues in health promotion and preventive work with mothers and newborns. The EPDS screening shifted the focus in the consultation from the child solely to also encompass the mother and the relation between them. A precondition for this was that the implementation process was gradual and on the health visitors own terms, likewise that there was a follow-up chain including supervision given to the health visitors, in order to provide help for the mothers who need more help than the health centre can offer. Conclusions: Our study shows that acceptability for routine screening with EPDS amongst health visitors is possible to achieve. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of the present study was to explore and describe how older adults who received home-based rehabilitation perceived the staff during a period of 6 months when they received rehabilitation. Specifically, the study focused on how the participants collaborated with and made use of the services from the staff. Method. In this case-oriented study, three older adults were interviewed continuously during the 6-month period they received home-based rehabilitation. The interviews were analysed continuously using a grounded theory approach. Results. Five different modes of perceiving the staff were identified among the participants: as small talk persons, as discussions partners, as instructors and advisors, as teachers and as persons who carry out tasks efficiently. The three conditions that most came to influence the way the participants perceived collaborated with the staff were as follows: 'experience and encounters with the staff', 'expectations for the future daily life', and 'the participants' needs and tasks related to their disability'. Conclusions. To achieve collaboration and user involvement, the staffs have to encounter each client differently in accordance with the various tasks that must be carried out during rehabilitation. Our findings indicate that this is particularly important for older adults during home-based rehabilitation, since older adults often have changing needs because of comorbidity. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify how older adults perceive environmental factors to have an influence on their participation after receiving home-based rehabilitation services. The respondents were older adults of more than 65 years of age who had received home-based rehabilitation. The questionnaire Measurement of the Quality of the Environment (MQE) was used to gather the data. The results showed that, in this population of older adults, many environmental factors were perceived as do not apply or to lack influence. Factors that were perceived as facilitators for the respondent's participation came under the categories social network, social and healthcare services and commercial services, and physical environments such as the presence of technical aids within the respondents' homes. Few environmental factors were identified as barriers to participation. [ABSTRACT FROM AUTHOR]

Hemodialysis is a life-saving method for patients with acute and chronic kidney failure. This treatment requires sufficiently large and safe vascular access. Ensuring optimal vascular access is therefore a prerequisite and an integral part of the care of these patients. In addition to commonly known vascular approaches such as non-tunnelized or tunneled hemodialysis catheters and AV fistulas, less well-known methods are also available, such as a translumbar or directly surgically inserted hemodialysis catheter into the right atrium. However, these alternative approaches are the only, life-saving alternative for some patients. The ambition of this review article is to offer a comprehensive view of the available options for vascular access, the algorithm for its selection and solutions to the most common complications in clinical practice.

Background: Reablement services are intended to make a difference in the daily lives of older adults. Outcomes are often described in terms of independence, improving quality of life, improving ADL functioning, or reducing services. However, little is known if the older adults or next-of-kin experience these outcomes when talking about participating in reablement services., Aim: This study aims to explore how older adults, next-of-kin, and professionals narrate the reablement recipients' possible outcomes as gains and changes in everyday life during and after the reablement period., Materials and Methods: This meta-synthesis included 13 studies. Data were analyzed with a meta-ethnographic approach, searching for overarching metaphors, in three stages., Results: The metaphor 'the jigsaw puzzle of activities for mastering daily life again' illustrates that re-assembling everyday life after reablement is not a straightforward process of gains and changes but includes several daily activities that must be organized and fit together. To obtain a deeper understanding of the participants' gains, and changes after reablement, we use the theoretical framework of 'doing, being, becoming, and belonging'., Conclusion: The findings indicate the complexity of reablement services as well as the need for a holistic approach., Significance: Outcome measures should be meaningful for reablement recipients.

Background: Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. CLI is associated with high rates of morbidity and mortality with high risk of limb amputation. In the absence of appropriate autologous grafts, unsuitability of prosthetic bypasses, and endovascular methods, fresh cold-stored venous allografts is an option. Endovascular interventional methods are essential methods for maintaining primary and secondary patency., Methods: A single-centre retrospective analysis of 82 surgical revascularizations using allogeneic vascular grafts and rescue endovascular techniques restoring and maintaining the patency of these allogeneic revascularizations in the period between July 2005 and July 2021., Results: We have performed 82 allogeneic revascularizations in 75 patients (52 reconstructions in men/63.4%/, 30 reconstructions in women/36.6%/). The median age of patients was 68 years (49 min, 87 max). We subsequently had to intervene a total of 26 bypasses. We intervened in 30 acute occluded allogeneic bypass grafts and 9 failing stenotic bypass grafts. We performed 52 angiographies. The success rate of rescue endovascular procedures in primary allogeneic reconstruction with distal anastomosis to the popliteal artery is statistically significant (P < 0.02) compared to procedures with distal anastomosis to the tibial and pedal bed. The cumulative patency (primary at time) of allogeneic reconstructions in our group was 89% after 1 month, 51.9% after 12 months, 24.2% after 3 years, 9.8% after 5 years. Limb salvage was 72.6% in 1 year, 53% in 3 years, 36.5% in 5 years, respectively., Conclusions: Cold-stored venous allografts may be used for performing below-the-knee revascularization for CLI with acceptable results, despite the poor long-term patency. Rescue endovascular techniques are an essential method for restoring or maintaining the patency of these reconstructions. These techniques have a high success rate and no other alternative., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Studies from Western countries state that video interaction guidance programmes can support caregiver sensitivity in infant-caregiver dyads., Objectives: The aim of this study was to investigate if Marte Meo, which is such a programme, could contribute to increasing emotional and social support towards motherless infants at an institution for motherless infants in rural Africa., Method: Three caregivers participated in five Marte Meo Counselling sessions. The first guidance naïve film and the last film were analysed qualitatively and quantitatively and organised according to two supportive categories: 1) caregiver responds to infants' initiative, 2) caregiver takes initiative to supportive interaction, and two non-supportive: 3) caregiver behaves in an intrusive manner and 4) caregiver does not respond to the infants' initiative., Results: After receiving Marte Meo Counselling, all three caregivers showed impressive augmentation of awareness and sensitivity in their care towards the infants' emotional and social needs., Conclusion: We found indications that professional caregivers of institutionalised infants in an African country can profit on Marte Meo Counselling, showing positive effects on augmenting caregivers' sensitivity towards the infants, and thereby meet the infants' need of emotional and social support.

Background: Parents are a central focus in clinical infant mental health interventions because of the key importance of the caregiver-infant relationship, especially when dyads are burdened by psychosocial and parental mental health problems. However, knowledge is scarce about the lived experience of vulnerable parents who undergo video-based guidance. Aim: The study explores how parents in an infant-psychiatric outpatient clinic who struggled to mentalize and remain emotionally connected to their infant experienced helpful and challenging elements in video guidance. Method: We analyzed the interviews of a strategic sample of 12 parents after undergoing Marte Meo video guidance, using a team-based, reflexive thematic analysis (TA). Results: We identified four main themes: (a) Handling initial feelings of fear and loss of control; (b) Filming as a disturbing or agentic experience; (c) Feeling validated or devalued in the therapeutic relationship; and (d) Bringing insights from video guidance into everyday life. Therapeutic and existential factors became apparent in the main themes of adjustment to the guidance, experiences with filming, the therapeutic relationship and integration of new experiences. Conclusion: The parents' sense of agency, dignity, and shame may be important for their ability to integrate new ideas about themselves. Implications: Video guidance for vulnerable parents in specialized clinical treatment should address relational challenges, parental mental health, and issues of recognition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Simhan, Vik, Veseth and Hjeltnes.)

Background: The Edinburgh Postnatal Depression Scale has been practiced as a routine screening for postnatal depression at a municipal health care centre for more than ten years., Objectives: The aim of this study was to examine how health visitors and midwives perceive and practice this routine screening., Study Design: We chose an exploratory qualitative approach, with analysis of data from focus group interviews., Methods: Ten health visitors and two midwives participated in two focus group interviews by sharing their thoughts and reflections. The analysis was performed in collaboration with all authors according to thematic network analysis., Findings: The Edinburgh Postnatal Depression Scale is well accepted as a screening tool. In addition to giving health visitors and midwives information about mothers who need special attention concerning mental health challenges, the Edinburgh Postnatal Depression Scale is a tool for talking about problems related to early motherhood. A trusting relationship is a prerequisite for these conversations. The health visitors seldom use the word 'depression' in contact with the individual mother. They sometimes lose opportunities to identify mothers in need of help because of a tight time schedule and social and cultural factors. Collaboration on a daily basis with colleagues and family therapists, and monthly guidance from mental health professionals are necessary to secure professional quality and confidence., Conclusion: The Edinburgh Postnatal Depression Scale is a useful screening tool, but there are social and cultural challenges, and the available time during screening consultations is often too short. Collaboration with and guidance from other professionals are necessary., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest, (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Interventions that promote infant mental health face challenges when applied for parents who struggle with psychosocial and psychological burdens. Video-based guidance using the Marte Meo method is used in specialized clinical settings with high-risk families to improve parent-child interaction, parental sensitivity and mentalizing. However, knowledge about the lifeworlds of these parents and their experiences of the therapeutic process during video guidance is limited., Aim: This qualitative study explores how parents in an infant mental health outpatient clinic who had difficulties mentalizing and maintaining an emotional connection with their infants experienced the change process during Marte Meo video guidance., Methods: We identified a strategic sample of parents with difficulties mentalizing and maintaining an emotional connection with their infants through the Parent Development Interview. Twelve parents received video guidance and were afterwards interviewed in-depth. The research interviews were qualitatively analysed via a team-based reflexive thematic analysis., Result: We identified four themes: a) feeling inadequate or disconnected as a parent; b) discovering the infant as a relating and intentional person; c) becoming more agentic and interconnected; and d) still feeling challenged by personal mental health issues., Conclusion: Parents described positive changes in their interactions, in mentalizing their infants, the relationship and themselves as parents, in their experiences of self-efficacy and on a representational level. They also described increased confidence and improved coping despite ongoing personal mental health challenges. The findings suggest that video guidance using the Marte Meo method can be a critical intervention for vulnerable parents but should be coordinated with parents' primary treatments when complex parental mental health issues are involved., (© 2021. The Author(s).)

Background: Reablement is a shift from reactive home care to a more preventive model based on active engagement. In this shift, it is interesting to uncover and understand potential discourses that may exist amongst service providers regarding their views of service recipients., Aim: to explore and describe discourses of the view of service recipients in the context of reablement, from the service providers' perspective., Method: Participants were service providers working in reablement, with the analysis being retrieved from 13 focus groups. A critical discourse analysis was used in order to gain a broader understanding and to capture service providers' views., Findings: Five discourses were constructed. Three discourses indicated the way participants perceived service recipients included in reablement, namely the competent service recipient, the conventional service recipient, and the perfect service recipient. Two discourses categorised recipients related to whether or not they were included in reablement: the suitable service recipient who was excluded and the unsuitable service recipient who was included ., Conclusion: Service providers use a variety of different discourses when they talk about service recipients., Significance: Service providers, including occupational therapists, must be aware of how unconscious discourses can affect those to whom they provide services.

Competing Interests: The authors declare no conflict of interest.

Marte Meo video guidance uses filmed interaction of the actual parent-infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent-infant dyads may illuminate important aspects of the method itself as well as the therapists' role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent-infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent-infant dyads where child protective issues arise, where caregivers' insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists' role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges., (© 2020 The Authors. Infant Mental Health Journal published by Wiley Periodicals, LLC on behalf of Michigan Association for Infant Mental Health.)

A well-known prediction is that the growing elderly population will place a strain on our healthcare systems. At the same time, healthcare is becoming increasingly patient-centered and individualized, with the patient becoming an active participant rather than a mere object of healthcare. The need for change may be met by using a reablement service, utilizing the rehabilitation mindset through home-based services. Rehabilitation and reablement aim to provide opportunities for individuals to participate to a maximum of their potential. This study is part of a larger research project exploring different aspects of reablement in municipalities. It aims to describe how older adults engage in daily activities within the context of reablement and to explore participation in daily activities. A qualitative design was chosen, and the study is explorative in nature due to limited research on participants' experience with reablement. Ten older adults age 70 to 94 years old were recruited and interviewed. The interviews were transcribed verbatim and analyzed using systematic text condensation (STC) strategies. This study provides insights on how older adults experience participation in daily activities and important aspects for performing these activities and living independently as long as possible. Based on the older adults' experiences, three main themes were identified when receiving reablement. First, what to achieve with reablement and feeling a sense of security to participate in daily activities. Second, how to carry out wanted activities using different skills and last, how the social network is important for enabling active living. This calls for healthcare workers to address and facilitate these in reablement. Our findings show the importance of collaborating with the social network and strengthening participation in daily activities to establish and develop existing reablement services., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Trine A. Magne and Kjersti Vik.)

Background: Reablement services aim at improving participation in everyday activities at home and in the local community for older adults, focusing on the older adults' resources and goal for participation. Reablement services have been implemented in a number of municipalities in Scandinavia. To our knowledge, there are a few studies focusing on home care service providers experience working within the frame of reablement., Aim: To provide knowledge regarding how home care service providers working with reablement in the home care setting describe their experiences., Methods: The study had a qualitative design and included five focus group discussions with 25 healthcare professionals working in community health care in two municipalities. The data were analysed using a grounded theory approach., Result: The analysis illustrated how the participants experienced both engagement and challenges working with reablement. This was identified by the two categories: creating sustainable change and negotiating the line between helping and enabling. The first described how increased focus on enabling participation among the service recipients created sustainable changes for the older adults and was considered a positive change for both the recipients and the health professionals. The latter showed how the participants found working with reablement as a process of negotiation. This was what the health professionals found most challenging with reablement., Conclusion: Working within the frame of reablement offered the service providers, a framework for being more flexible in meeting the fluctuating needs of the older adults. This was done by increasingly utilise ones' clinical skills and changing from providing passive care to working on increasing the older persons' participation in everyday activities. Working with reablement also created challenges. This was related to the health professionals perceived expectations of what some of the older adults expected home care to be and caused ambivalence., Implications for Practice: Nurses and healthcare workers should focus on older adults' resources and goals in order to give services that enhance participation in daily activities., (© 2019 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Aim: To describe health professionals' perspectives of next of kin in the context of reablement. Methods: A total of 49 health professionals from different organizational levels participated. Their ages, genders, experiences, and professions varied. A total of 10 focus group discussions were held in two municipalities. The data analysis was conducted using a constructivist grounded theory approach. Results: The core category was identified as negotiating between themselves. Two categories captured the different dimensions of the core category: facing a dilemma with next of kin in reablement and ambiguous motives for collaborating with next of kin. Conclusion: In collaboration with next of kin, it is important for health professionals to be aware of and manage the possible differences in expectations and opinions concerning reablement. Health professionals need to acknowledge that next of kin can be a source of support for older adults. They also need to take into consideration that next of kin may need support, information, and education associated with their roles as next of kin to older adults. Implications for rehabilitation Health professionals need to be aware of how they collaborate with next of kin and what they expect of them. There is a need for health professionals to find a routine in how next of kin can become partners in reablement without compromising the older adult's autonomy. This study contributes to further awareness of the different roles of health professionals and next of kin regarding expectations of reablement. Health professionals may benefit from providing a more family-centred approach by taking into account that next of kin can be a resource in reablement. In addition, they need to take into consideration that next of kin also have their own needs and must be respected.

Background: Early parent- child relations play an important role in children's development. Therapeutic intervention towards infants and toddlers at high-risk intends to prevent mental health problems. In this work, the parent-child-dyad is crucial. The video interaction guidance method, Marte Meo, is one among different methods used in attachment-based treatment in an outpatient infant mental health clinic. Parental sensitivity towards infants and toddlers needs is considered significant in developing secure attachment. Secure attachment is further considered decisive for mental health and the extent to which children are at risk of developing mental health problems. Different treatment methods aim at strengthening parents' sensitivity. This study's purpose was to gain further understanding about parent's experiences with Marte Meo - therapy and highlight the importance for parental sensitivity., Methods: This is a cross-sectional phenomenological hermeneutical study. Four biological parents of three infants and toddlers aged 0-20 months who received Marte Meo- therapy in a clinical context were selected. Data was collected using semi structured interviews., Results: This article presents the study's key-finding; we suggest that sensitivity increases. The key components of this are: watching edited video interaction in a therapeutic context, emotional activation, mutuality, self-esteem / self-confidence and reflective function. These are further elaborated and discussed., Conclusion: The findings indicate that Marte Meo contributes to facilitate development-supportive interaction, strengthen parental sensitivity, emotional availability, reflective functioning and coping - experience.

Background: Active ageing reflects the message from World Health Organisation about addressing the challenge faced by the rapidly ageing population. Knowledge about barriers and facilitators to an active lifestyle must be given more attention. In addition, men seem to participate less in cultural activities and less in fall-prevention groups than women do. When mostly women work with the elderly in primary care, one might question whether the activities offered to older men meet their activity preferences. The aim of this study is to provide new knowledge about challenges and motivators encountered by retired men in maintaining physical activity when ageing., Methods: Nine retired men, aged between 66 and 83, wrote a Time Geographic Diary for 7 days each. Two focus group discussions with the men were held. A Systemic Text Condensation was used to analyse the data., Results: The analyses identified three categories to describe challenges in being physical active: differences between men and women; meaningful physical activity; and environmental - especially socio-cultural - constraints. Motivating conditions were seen as: new activities to get younger friends, and more information about how to cope., Conclusions: To achieve the aim of active ageing, service providers as well as local authorities need to have a better understanding of the challenges retired men encounter when ageing. This study highlights vital aspects of the challenges faced by retired men in maintaining their physical activity level.

Subclavian steal-carotid recovery phenomenon appears to be related to the occlusion of the truncus brachiocephalicus and can be a rare cause of neurological deficit. In this syndrome, the right common carotid artery and right subclavian artery are filled with retrograde flow from the ipsilateral vertebral artery. We present a patient with this type of steal syndrome managed by a classical surgical procedure for stent reocclusion in the truncus brachiocephalicus.Key words: steal phenomenon endarterectomy truncus brachiocephalicus.

Introduction: The complexity of the process and outcome of vocational rehabilitation yearns for a multifaceted approach. This article investigates whether importance of participation in major life areas for men and women predicts the outcome of vocational rehabilitation., Methods: This longitudinal study provides measure points at the start of the intervention (T1), at the end of the intervention (T2) and at a follow-up 6-12 months after completing the rehabilitation program (T3). Associations were assessed by nominal logistic regression., Results: The importance of participation in work was positively associated to return to work (RTW), while the importance of participation in leisure activities and importance of participation in family was negatively associated with RTW after the rehabilitation. Gender and number of children also contributed significantly to the regression model., Conclusion: To identify individuals' subjective evaluation of the importance of participation may be of value in explaining return or not RTW and contribute to explain gender differences in outcomes. It may also inform rehabilitation counselors in collaboration with clients and facilitate tailoring interventions to the individual's needs.

Purpose: Guidelines for women with epilepsy (WWE) are advising those on enzyme inducing drugs EIAEDs to take vitamin K the last month of pregnancy. The primary aim of this study was to investigate whether WWE have a higher frequency of large post partum hemorrhage. Secondary we wanted to see if this was more severe in women taking EIAEDs, and also to evaluate whether those receiving prenatal vitamin K supplementation have a less pronounced risk., Methods: All patients (n=109), with the diagnosis of epilepsy giving birth at OUS Rikshospitalet from 2006 to 2011 were selected to be in the epilepsy group. They were compared to controls with regard to the amount of post partum hemorrhage, gestational age for the mother, birth weight and APGAR score in the newborns., Results: No significant difference between the groups regarding post partum hemorrhage, gestational age, birthweight or APGAR score in the newborn was found. Also, comparing the WWE using EIAED who received prenatal vitamin K with those who did not receive vitamin K, no significant difference in post partum hemorrhage could be demonstrated., Conclusion: In this study, WWE was not found to have increased risk of post partum hemmorrhage including those using EIAED with/without vitamin K supplementation., (Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Importance: Most acute kidney injury observed in the hospital is defined by sudden mild or moderate increases in the serum creatinine concentration, which may persist for several days. Such acute kidney injury is associated with lower long-term kidney function. However, it has not been demonstrated that an intervention that reduces the risk of such acute kidney injury better preserves long-term kidney function., Objectives: To characterize the risk of acute kidney injury with an intervention in a randomized clinical trial and to determine if there is a difference between the 2 treatment groups in kidney function 1 year later., Design, Setting, and Participants: The Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularisation Study (CORONARY) enrolled 4752 patients undergoing first isolated coronary artery bypass graft (CABG) surgery at 79 sites in 19 countries. Patients were randomized to receive CABG surgery either with a beating-heart technique (off-pump) or with cardiopulmonary bypass (on-pump). From January 2010 to November 2011, 2932 patients (from 63 sites in 16 countries) from CORONARY were enrolled into a kidney function substudy to record serum creatinine concentrations during the postoperative period and at 1 year. The last 1-year serum creatinine concentration was recorded on January 18, 2013., Main Outcomes and Measures: Acute kidney injury within 30 days of surgery (≥50% increase in serum creatinine concentration from prerandomization concentration) and loss of kidney function at 1 year (≥20% loss in estimated glomerular filtration rate from prerandomization level)., Results: Off-pump (n = 1472) vs on-pump (n = 1460) CABG surgery reduced the risk of acute kidney injury (17.5% vs 20.8%, respectively; relative risk, 0.83 [95% CI, 0.72-0.97], P = .01); however, there was no significant difference between the 2 groups in the loss of kidney function at 1 year (17.1% vs 15.3%, respectively; relative risk, 1.10 [95% CI, 0.95-1.29], P = .23). Results were consistent with multiple alternate continuous and categorical definitions of acute kidney injury or kidney function loss, and in the subgroup with baseline chronic kidney disease., Conclusions and Relevance: Use of off-pump compared with on-pump CABG surgery reduced the risk of postoperative acute kidney injury, without evidence of better preserved kidney function with off-pump CABG surgery at 1 year. In this setting, an intervention that reduced the risk of mild to moderate acute kidney injury did not alter longer-term kidney function., Trial Registration: clinicaltrials.gov Identifier: NCT00463294.

This paper provides an overview of basic Marte Meo video interaction guidance concepts and describes the therapeutic performance of the method applied in the context of early mother-infant interaction and postnatal depression. Weight is put upon the importance of the therapeutic relationship. Further Marte Meo therapy is understood in the light of Daniel Stern's theory of 'schemas of being with' and accompanied by clinical vignettes from therapy sessions. The empirical basis for the paper is a study of postnatal depression, mother-infant interaction and video guidance, carried out in Southern Norway. The study examined Marte Meo from a phenomenological perspective. Marte Meo was offered to mothers with either postnatal depression or depressive symptoms. In in-depth interviews the participants reported that the Marte Meo method, 'from the outside looking in', increased their reflections about their infants and their own mental states as well as their sensitive interaction with their newborn. Their mothering was improved and they reported feeling less depressed. We argue that Marte Meo methodology can guide new mothers with depressive symptoms, and contribute to the creation of new schemas of being together.

Background: The increasing number of older adults will put pressure on health care services in the community. It is thus critical to ensure that services promote healthy ageing and participation.The aim of the study was to explore service providers' perception and understanding of the conditions for participation among older adults who receive home-based care., Methods: The study design was a grounded theory, with six focus groups representing different parts of home-based care in two different municipalities. The data were analysed by a constant comparative method following the guidelines from grounded theory., Results: The findings showed how four different conditions influenced the opportunity for participation or could give a push towards passivity. Firstly, the timing of applications for services. Secondly, the older adults and their family's expectations about participation. Thirdly, external factors such as adequate housing and assistive devices. Finally, the service delivery per se could constitute a barrier for participation, because the services often focused on passive help and 'standard packages'., Conclusion: The findings show how factors at the system level, the execution of services and characteristics among older adults and their family may contribute to the individual service recipient being on the verge of being passive., (© 2012 Blackwell Publishing Ltd.)

Objective: The objective of this study was to provide knowledge about participation and change in participation among men and women experiencing chronic musculoskeletal pain and undergoing multidisciplinary vocational rehabilitation., Participants: Six women and four men participating in a vocational rehabilitation intervention., Method: Data were collected through semi-structured in-depth interviews. The participants were encouraged to talk about their experiences and thoughts regarding participation in different life areas using previous, present, and future expectations. The analysis performed was constant comparative and inspired by grounded theory., Results: The core category was identified as "goal-oriented participation" which represented participation as intentional and situated. Three categories, "participating as before," "participation constantly changing," and "participating in work on hold," were used, taking into account gender-influenced trajectories and understandings of participation before, during, and after sick leave and rehabilitation., Conclusion: The different trajectories of participation seemed to be gender specific and were connected to broader societal and environmental factors. These combined aspects seemed to affect values, motivation, and understanding of important goals while experiencing chronic pain. Examining goal-oriented participation may add to the understanding of gender differences in the rehabilitation process and thereby have implications for rehabilitation interventions.

Objective: The focus of this study is how skills acquired from everyday life in one's native country can represent a resource in language training and work for immigrants and refugees. The specific aim is to explore what significance activity and participation in activity have on language training., Methods: This qualitative study is based on fieldwork carried out in relation to a group of illiterate immigrants at a centre for adult education. The sample consists of 11 adult immigrants and refugees, male and female, between the ages of 20 and 65. The interviews with all the participants were carried out with the help of an interpreter., Results: The main findings were that the individual immigrant's history of activities received little attention during the language training. There was hardly any mention of previous experience from everyday life and work. By relying on different activities in the language training, the resources and background of the individual immigrant would have become more visible. Familiar activities from one's own culture enable communication when language skills are limited.

Older adults wish to stay at home, participate in society and manage on their own as long as possible. Many older adults will, however, eventually become dependent on care and help to maintain their daily living. Thus, to enhance activity and participation also among older adults that receive home-based services, there is a strong need for development of knowledge-based practice regarding participation. The specific aim of this study is to explore how service providers perceive that their working conditions influence on their possibilities to promote participation among older adults, and more specifically, how they perceive the influence of their working conditions. A purposeful sampling strategy was applied, and six focus groups with professionals in two municipalities were conducted. The focus groups comprised four and six participants of varying ages, length of working experience and professions. A total of 30 service providers participated. The data were analysed by a constant comparative method following the guidelines from Grounded Theory. The analysis identified the categories 'encountering needs that cannot be met', 'expectations about participation', 'organisation of services' and 'professional standards' influencing the service delivery. During this analytical process, 'being on the verge' emerged as a core category that describes the service providers' experience of a stressful workday, i.e. when they had the feeling of working against their own professional standards and being pushed to their limits. The findings indicate how the professional standards of service providers on the whole are in line with health policy for in-home services. Policy objectives are, however, not always followed owing to different constraints at the level of service delivery. Along the path from political ideals to the practical execution of services, external circumstances related to the organisation of services are perceived as crucial., (© 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.)

Purpose: The primary aim of the study was to explore how people with a disability experience participation in society. A secondary aim was to contribute to the understanding of the concept of participation in terms of the International Classification of Functioning, Disability and Health (ICF)., Method: Six people with disabilities participated in focus group discussions. The data were analysed following the guidelines for the constant comparative method., Results: Three main categories emerged with regard to the participants' experiences of participation in society. These included: (1) being engaged, (2) being a member of society and (3) interacting as a citizen. Furthermore, a sense of 'climbing up and sliding down the participation ladder' emerged as a core category of participation. This image reflected the dynamic interaction between individual and society; between, on one hand, an individual' attitude, engagement, motivation, interest and capacity, as well as their sense of responsibility vis-a-vis an activity or a social group; and, on the other hand, the opportunities that society and their immediate social worlds offer them., Conclusions: The fact that participants experience social participation as 'climbing up and sliding down the participation ladder' is important as it enables service providers, managers and policy makers to identify which intrapersonal and environmental factors operate together to limit or enhance the social participation of people with disabilities. This also implies that there is a need for a committed relationship in issues concerning participation for all in society, between people with disabilities and urban planners, and service providers. Findings also imply that participation means being autonomous and making decisions about one's own life and that the subjective dimension of participation must be considered in the revision of the ICF model. Another consideration is to separate activity and participation into two dimensions; i.e. to render more visible the fact that participation is related to environmental, as well as to personal, factors.

Purpose: The purpose of this study was to provide knowledge about professional carers' subjective descriptions and understanding of older adults' participation in everyday life, when living in place and depending on home-based service delivery., Method: Thirty professionals from different organisational levels were selected, allowing for differences in ages, gender, length of working experience, and profession or education. Six focus group discussions were held. A grounded theory approach was used to analyse the data., Results: The core category was identified as 'participation in one's own life'. Two categories included the care providers' descriptions and understanding of participation in the life of older adults; 'carrying out tasks in everyday-life' and 'interaction during service delivery'. Participation as carrying out tasks was related to the contexts inside and outside the house. The professional carers' understandings of older adults' participation in interaction during service delivery included three categories; 'Being included and taking part in decision-making', 'socialising during service delivery' and 'collaboration in keeping up or regaining functions'., Conclusions: To promote participation for older adults living in place and in the context of service delivery, the findings suggest that the professional carers must extend their focus on participation as socialising and its significance for older adults. At a system level there is a need to focus on how the professional role in home-based service delivery can be adjusted and developed to promote collaboration about participation in older adults., (© 2011 Informa UK, Ltd.)