Is there any job for me? Qualitative exploration of support needs among young Swedish adults with psychosis envisioning productive activities.

BACKGROUND: Unemployment is high not only among people with mental illness, but also among young adults in general. The combination of having a severe mental illness and being young entails a particularly problematic situation for young people with psychosis. This study aimed to understand how this group envision their future possibilities for entering the labour market or engaging in other productive activities. OBJECTIVE: To explore how young adults with psychosis perceive their possibilities, wishes and support needs for gaining employment or engaging in other productive activities. METHODS: A descriptive design with qualitative individual in-depth interviews was used. Eighteen young adults with psychosis, aged 18-30 years, were interviewed. Data was analysed with qualitative content analysis. RESULTS: Four categories based on the experiences of the participants as being vital for having work or other productive activities were generated: "Wishing for a role in the community", "Being my own coach", "Needing personal support" and "Having a supportive workplace". Each of them included sub-categories. CONCLUSION: The young adults with psychosis were a long way from having paid work, but they desired to have a worker role in the community. They are a heterogeneous group, which entails that it is important that professionals and employers have a person-centered and holistic approach, listening to the individuals themselves.

Experiences of meaning in garden therapy in outpatient psychiatric care in Sweden. A narrative study.

BACKGROUND: Support has been found for using garden therapy as form of intervention for clients with common mental disorders, but no consensus has been found for what contributes to perceived meaningfulness of garden therapy. AIMS: To investigate whether participants perceived garden therapy as meaningful, and if so, what contributed to the meaningfulness. MATERIAL AND METHODS: Narrative individual interviews were conducted twice with six participants who participated in garden therapy and once with two participants. Data was analysed using narrative methodology. RESULTS: Perceived meanings in garden therapy were associated to the participants' individual needs and prerequisites: to land, just be, relax, go back to basics, understand, verbalise, enhance energy, and socialise. The group leaders had an important role to create safety and trust, and to adapt the activities and use of the environment. The activities, the garden environment and social group contributed to perceived meaning in garden therapy. CONCLUSIONS: Garden therapy offered the participants possibilities to meet their different needs and thereby perceived meaning. To achieve this, the group leaders need to adapt the gardening individually to each participant. SIGNIFICANCE: Various components were perceived as meaningful. The group leaders therefore have to adapt the garden therapy to each participant's needs.

Treatment of depression and/or anxiety - outcomes of a randomised controlled trial of the tree theme method® versus regular occupational therapy.

BACKGROUND: Depression and anxiety disorders are a major concern in western countries, and because these often have a negative affect on everyday life interventions based on activities in everyday life are needed. The Tree Theme Method® (TTM) is a client-centred occupational therapy intervention designed to increase the ability to cope with, and to enhance satisfaction with, everyday life, both at home and at work. The aim of this study was to compare the short term outcomes of the TTM intervention with regular occupational therapy treatment for people with depression and/or anxiety disorders. METHODS: This randomised controlled trial included patients from three counties in Sweden. Men and women with depression and/or anxiety disorders, ages 18 to 65, were randomised to either TTM or regular occupational therapy. Assessment data were collected at baseline and the follow-up directly after completing the intervention. Non-parametric and parametric statistical methods were used. RESULTS: The questionnaires were answered by 118 patients at baseline and by 107 patients after completing the intervention. No significant differences in short term outcomes were found between the groups. Both groups showed positive significant outcomes regarding almost all aspects of activities in everyday life, psychological symptoms, and health-related and intervention-related aspects. CONCLUSIONS: Despite the lack of differences between the groups, the positive outcomes regarding activities in everyday life, psychological symptoms, and health-related aspects after completing the intervention indicates the need for further research on the long-term perspective of TTM compared to regular occupational therapy. TRIAL REGISTRATION: Clinical Trials.gov: NCT01980381 ; registered November 2013.

Sustainable enhancement in clients who perceive the Tree Theme Method(®) as a positive intervention in psychosocial occupational therapy.

BACKGROUND/AIM: The Tree Theme Method(®) is an intervention based on creative activities and occupational storytelling. The Tree Theme Method(®) implies that the clients draw and paint trees symbolising various periods in their life. The pictures are then used as a starting point to tell their life story to enhance their wellbeing and management of their everyday life. This study aimed to evaluate if changes observed among clients regarding their wellbeing and everyday occupations, between baseline and the end of their term of the Tree Theme Method(®) therapy, persisted three years after the completion of the intervention. METHODS: This study had a quantitative design. Thirty-one former clients were recruited to a follow-up three years after completing the intervention. Self-rating questionnaires were used regarding psychological symptoms, self-mastery, sense of coherence, activity level, occupational performance and satisfaction with occupational performance. Non-parametric methods were used for the data analysis. RESULTS: The findings revealed positive significant changes regarding sense of coherence and occupational performance and satisfaction with occupational performance, measured between the end of the intervention and at the time of the three-year follow-up. Furthermore, the respondents' ratings regarding psychological symptoms, self-mastery, activity level and the extent of satisfaction with performed occupations were found to be stable. CONCLUSIONS: The Tree Theme Method(®) appeared to function well as an intervention in psychosocial occupational therapy, where the aim was that a client would enhance their wellbeing and management of their everyday life. However, there is need for further evaluation to assess the effects of the Tree Theme Method(®) intervention.

Increased energy intake in hip fracture patients affects nutritional biochemical markers.

BACKGROUND AND AIMS: We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications. MATERIAL AND METHODS: Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection. RESULTS: The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term post-operative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission. CONCLUSION: The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.

Client perceptions of the Tree Theme Method™: a structured intervention based on storytelling and creative activities.

The Tree Theme Method (TTM) is an intervention based on sessions involving creative activities and life storytelling/story-making, in which the client paints trees representing various periods of his/her life. The aim of this study was to investigate clients' experiences of participating in a TTM intervention and their perceptions of the therapeutic relationship. Thematic interviews were undertaken. Twenty clients attending general outpatient mental healthcare units were recruited after having participated in the intervention. A qualitative content analysis resulted in six categories: "From feeling a pressure to perform to becoming focused and expressive", "Expressing oneself and one's life situation led to awakening of memories and feelings", "New perspectives of self-image, everyday life and relations to others", "Story-making led to shaping and reconstructing one's life story", "Interaction was of importance when reconstructing one's life story" and, finally, "The attitude of the occupational therapist was of importance for the development of the therapeutic relationship". There seemed to be a close association between the intervention and the therapeutic relationship in starting a process of opening up new perspectives on everyday life, but there is a need for further studies including therapists' experience of using the TTM and their perception of the client­therapist relationship.

The Tree Theme Method as an intervention in psychosocial occupational therapy: client acceptability and outcomes.

BACKGROUND/AIM: The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention. METHODS: Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention. RESULTS: A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists' ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction. CONCLUSIONS: The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance.

Molecular properties of the Goodpasture epitope.

Goodpasture disease fulfils all criteria for a classical autoimmune disease, where autoantibodies targeted against the non-collagenous domain of the alpha3-chain of collagen IV initiates an inflammatory destruction of the basement membrane in kidney glomeruli and lung alveoli. This leads to a rapidly progressive glomerulonephritis and severe pulmonary hemorrhage. Previous studies have indicated a limited epitope for the toxic antibodies in the N-terminal part of the non-collagenous domain. The epitope has been partially characterized by recreating the epitope in the non-reactive alpha1-chain by exchanging nine residues to the corresponding ones of alpha3. In this study we have investigated to what extent each of these amino acids contribute to the antibody binding in different patient sera. The results show that seven of the nine substitutions are enough to get an epitope that is recognized equally well as the native alpha3-chain by all sera from 20 clinically verified Goodpasture patients. Furthermore, the patient sera reactivity against the different recombinant chains used in the study are very similar, with some minor exceptions, strongly supporting a highly defined and restricted epitope. We are convinced that the restriction of the epitope is of significant importance for the understanding of the etiology of the disease. Thereby also making every step on the way to characterization of the epitope a crucial step on the way to specific therapy for the disease.

Experimental infections with Actinobacillus pleuropneumoniae in pigs--I. Comparison of five different parenteral antibiotic treatments.

SPF pigs aged 10 weeks were infected intranasally with Actinobacillus pleuropneumoniae serotype 2. After the onset of clinical symptoms of respiratory disease, which occurred 20 h post-infection, parenteral treatment with ceftiofur, danofloxacin, enrofloxacin, penicillin or tiamulin was initiated (n = 8 per group). Untreated groups, of which one was infected, served as controls. The uninfected control group did not show any signs of disease, while the infected control group was severely affected by the infection and also expressed a decreased weight gain following the challenge. Based on clinical signs, the magnitude of pathological lesions in the respiratory tract found at necropsy performed 17 days post-infection and the number of reisolates of A. pleuropneumoniae made at necropsy, treatments with the quinolones (danofloxacin and enrofloxacin) and the cephalosporine (ceftiofur) were superior to those with penicillin and tiamulin. The latter groups also developed antibodies to A. pleuropneumoniae to a larger extent. Some of the pigs treated with ceftiofur and danofloxacin developed antibodies to A. pleuropneumoniae, and the microbe was reisolated from approximately 50% of these animals. In contrast, pigs treated with enrofloxacin did not develop antibodies to A. pleuropneumoniae, and the challenge strain was not found at necropsy. The performance with respect to daily weight gain and feed conversion corresponded well with the clinical signs developed and the findings made at necropsy. The decreased growth recorded during the acute phase of the disease was, to a large extent, caused by a reduced feed intake.

Experimental infections with Actinobacillus pleuropneumoniae in pigs--II. Comparison of antibiotics for oral strategic treatment.

The present study was aimed at scrutinizing the efficacy of oral antimicrobial treatments at experimental challenge using a strain of Actinobacillus pleuropneumoniae serotype 2 known to cause severe disease. SPF pigs aged 10 weeks were infected intranasally and the antimicrobial treatments were initiated 5 h prior to that exposure. Several antimicrobial drugs, as well as the length of the treatment period, were elucidated. The outcome of the challenge was monitored by registration of clinical symptoms, weight gains and the development of serum antibodies to A. pleuropneumoniae. At necropsy, the magnitude of pathological lesions in the respiratory tract and the rate of reisolation of the infective strain were recorded. Animals that became diseased displayed a decreased growth rate caused, to a large extent, by a reduced feed intake. The performance with respect to daily weight gain and feed conversion corresponded well with the clinical signs developed and serologic reactions, as well as with the findings made at necropsy. The results obtained among pigs treated with enrofloxacin, but also with florfenicol or chlortetracycline, were superior to those of pigs treated with penicillin, tiamulin or tilmicosin. A positive effect was obtained using a strategic in-feed medication against infection with A. pleuropneumoniae. Provided that the drug used is effective against the target microbe, initiating treatment prior to infection appeared to be more important than the length of the treatment. It should, however, be remembered that A. pleuropneumoniae was reisolated from all but one medicated group following an experimental challenge given after initiating the medication. Consequently medical treatment as described did not eradicate the microbe.

Cultural and biochemical criteria for the identification of haemophilus spp from swine.

Twenty-two Haemophilus cultures of types prevalent in swine and of different geographic origins were subjected to biochemical and cultural examinations. Three subgroups were identified: One was unrease-positive, produced porphyrin from delta-aminolevulinic acid, and grew on infusion mediums supplemented only with V factor; the 2nd was unrease-negative, porphyrin-positive, and grew only on serum-enriched mediums with added V factor; and the 3rd was unrease-negative, porphyrin-negative, and grew only on serum-enriched mediums with added V and X factors. The groups generally corresponded to Haemophilus parahaemolyticus, Haemophilus parasuis, and Haemophilus suis, respectively. By means of the unrease and porphyrin tests, it was possible to assign, presumptively, porcine haemophilus cultures to 1 of the 3 species. Other tests, such as beta-galactosidase, hemolysis, and fermentation of carbohydrates were of secondary value in differentiating between these species.