Effects of work-directed interventions on return-to-work in people on sick-leave for to common mental disorders-a systematic review.

PURPOSE: To evaluate the body of evidence of the effects of work-directed interventions on return-to-work for people on sick leave due to common mental disorders (i.e., mild to moderate depression, anxiety, adjustment disorders and reactions to severe stress). METHODS: The systematic review was conducted in accordance with an a priori developed and registered protocol (Prospero CRD42021235586). The certainty of evidence was assessed by two independent reviewers using the Grading of Recommendations, Assessment, Development and Evaluations. RESULTS: We reviewed 14,794 records published between 2015 and 2021. Of these, eight RCTs published in eleven articles were included in the analysis. POPULATION: Working age adults (18 to 64 years), on sick leave due to mild to moderate depression, anxiety, adjustment disorders or reactions to severe stress. INTERVENTION: Work-directed interventions. COMPARATOR: No comparator, Standard care, or other measures. OUTCOME: return to work, number of days on sick leave, income. Overall, the effects of work-focused CBT and work-focused team-based support on RTW resulted in increased or faster return-to-work compared with standard care or no intervention (low certainty of evidence). The effects of Individual Placement and Support showed no difference in RTW compared with standard care (very low certainty of evidence). CONCLUSION: Interventions involving the workplace could increase the probability of RTW. Areas in need of improvement in the included studies, for example methodological issues, are discussed. Further, suggestions are made for improving methodological rigor when conducting large scale trials.

Experiences of living with fetal alcohol spectrum disorders: a systematic review and synthesis of qualitative data.

AIM: To identify and assess available evidence from qualitative studies exploring experiences of individuals living with fetal alcohol spectrum disorders (FASD) or those living with a child with FASD, as well as experiences of interventions aimed at supporting individuals with FASD and their families. METHOD: A systematic literature search was conducted in six electronic databases: PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Scopus. Included studies were analysed using manifest content analysis. Methodological limitations and confidence in the evidence were assessed using a modified version of the Critical Appraisal Skills Programme and the Grading of Recommendations, Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach respectively. RESULTS: Findings from 18 studies show that individuals with FASD experience a variation of disabilities, ranging from somatic problems, high pain tolerance, destructive behaviour, hyperactivity, and aggressiveness, to social problems with friendship, school attendance, and maintenance of steady employment. Most studies reported parents' experiences with FASD; parenting was viewed as a lifelong engagement and that the whole family is isolated and burdened because of FASD. People with FASD feel that their difficulties affect their daily life in a limiting way and make them feel different from others. INTERPRETATION: From the perspective of primarily parents, individuals with FASD and their parents face many different difficulties, for which they need societal support. WHAT THIS PAPER ADDS: Individuals with fetal alcohol spectrum disorders (FASD) feel their difficulties make them different from others. Parents think of their parenting as a lifelong engagement. There is a shortage of studies investigating experiences of children with FASD. There is a shortage of studies investigating experiences of interventions given to individuals with FASD.

Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD. METHODS: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists. RESULTS: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. CONCLUSIONS: The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

Fall prevention by nursing assistants among community-living elderly people. A randomised controlled trial.

Falls among elderly are a major public health issue in Sweden. The aim was to determine whether nursing assistants can prevent falls by supervising community-living elderly individuals with a history of falling in performing individually designed home exercise programmes. A randomised controlled trial was performed in Sweden, in eight municipalities in the county of Örebro, during 2007-2009. Community-living persons 65 years or older having experienced at least one fall during the last 12 months were included. The intervention group consisted of 76 participants, and there were 72 in the control group. The interventions were free of charge and were shared between a physiotherapist and a nursing assistant. The former designed a programme aiming to improve balance, leg strength and walking ability. The nursing assistant supervised the performance of activities during eight home visits during a 5-month intervention period. The measures and instruments used were health-related quality of life (SF-36), activity of daily living (ADL-staircase), balance, (Falls Efficacy Scale, and Berg Balance Scale), walking ability (Timed Up and Go and the 3-metre walking test), leg strength, (chair stand test). All participants were asked to keep a structured calendar of their physical exercise, walks and occurrence of falls during their 12-month study period. Hospital healthcare consumption data were collected. Although the 5-month intervention did not significantly decrease the risk for days with falls, RR 1.10 (95% CI 0.58, 2.07), p = 0.77, significant changes in favour of the intervention group were noted for balance (p = 0.03), ADL (p = 0.035), bodily pain (p = 0.003) and reported health transition over time (p = 0.008) as well as less hospital care due to fractures (p = 0.025). Additional studies with more participants are needed to establish whether or not falls can be significantly prevented with this model which is workable in home-based fall prevention.

Experiences of relocation in dementia care from the perspective of six care workers.

BACKGROUND: Relocation of persons with dementia might be considered when quality of care cannot be sustained due to increasing needs. Relocation has been studied from the aspects of mortality and morbidity. AIM. To explore the thoughts and experiences of care workers when relocating a person with dementia within municipal sheltered housing. METHOD: This qualitative study was conducted in Sweden and based on interviews with six care workers involved in the relocation of two persons with dementia. Latent content analysis was applied. RESULTS: The findings of one narrative are summarised in the theme 'Walking the tightrope: trying to balance conflicting needs'. In the other narrative the theme 'Balancing closeness and distance' emerged. Eight sub-themes were identified illustrating the relocation time-line. CONCLUSION: Relocation from the care workers' perspective is a complex process with conflicting values and practical issues that hinder the provision of good care and security. IMPLICATIONS FOR PRACTICE: Supporting next of kin in the relocation decision-making process presupposes time for reflection in dialogue with staff. The risk of moral distress should be observed and support for care workers could be provided in the form of supervision, ethical consultations and local guidelines.

Roles of assistive devices for home care staff in Sweden: a qualitative study.

PURPOSE: To explore home care staff experiences in relation to assistive devices and the use of assistive device at work. METHOD: Individual conversational interviews with 14 home care staff were used. Qualitative content analysis was used to analyse the data. RESULTS: A broad meaning attached to the use of assistive devices at work emerged in three themes. In 'staff's role at work in relation to assistive devices', their different roles emerged in relation to knowledge and instruction as well as safeguarding the user. 'Assistive devices as a product and their significance for staff' showed that devices were an integrated part of staff work in the users' home. Devices influenced staff cooperation, feelings and were significant in relation to time and finance. Regarding 'assistive devices and their significance for the user from the staff's perspective', the staff felt that devices were a prerequisite for the user coping with everyday life and they also had an emotional significance. CONCLUSION: Assistive devices play a significant and important role for home care staff. An increased understanding among prescribers and other health care staff about home care staff knowledge about, work with and experience from assistive devices could contribute to a better care and rehabilitation for home care recipients.

Nursing staff's description of a good encounter in nursing homes.

Background. It has been stated that there is too little research on what constitutes good communication and good encounters in nursing homes. Aim and objectives. The aim of the present study was to examine nursing staff members' views on what is important in caring encounters with older people living in nursing homes. Design. A qualitative descriptive study using focus group interviews with staff in a nursing home in Sweden. Method. Focus group interviews, analysed using qualitative content analysis. Results. Three main themes emerged describing nursing staff members' opinions about the content of good encounters: 'Caring encounters from the perspective of equality', 'Caring encounters from the perspective of integrity' and 'Caring encounters from the perspective of promoting security'. Conclusions. The nursing staff had theoretical knowledge of what constitutes a good caring encounter, but they seemed to need more supervision and training to develop their ways of encountering older people as well as to become stronger in their professional role. When performing such training with staff, the methodology of appreciative inquiry could be a powerful tool. Relevance to clinical practice. It is important to help staff become empowered and to help them develop and improve their encounters with older care recipients.

Demanding behaviours and workload in elderly care in Sweden: occurrence at two time points within a decade.

The aim of this study was to investigate the occurrence of demanding behaviours in persons >or=65 years receiving home care or living in sheltered accommodation at two points in time, 1993 and 2002. Another aim was to investigate whether the perceived workload in staff had changed during this period. All persons >or=65 years living at home and utilizing home care services or those who lived in some form of sheltered housing were included and assessed by staff using a three-part questionnaire, in two cross-sectional studies. The study group comprised 1187 and 1017 participants which equals 77% and 99% respectively. Symptoms and degree of behavioural and psychiatric symptoms common in dementia that were assessed with a subscale in The Gottfries-Bråne-Steen Scale, demonstrated an all over increase from 1993 to 2002. Items from The Multi Dimensional Dementia Assessment Scale (MDDAS) measured a decrease in 'daily' occurrences of dementia symptoms but an increase in 'sometimes per week'. A mixed pattern was seen concerning behaviours where increases as well as decreases were found. The behaviours 'constantly seeking attention' and 'shrieking continuously' increased significantly. The number of individuals showing restless, aggressive or shrieking behaviours increased significantly over the decade. Two items from the MDDAS were used to measure the workload. The physical workload increased significantly over the decade whereas the rising tendencies of the psychological workload were not statistically significant. The mean age over the decade had increased from 83 to 86 years, which together with the findings make the recipients of home care and sheltered housing a very vulnerable group. The demanding problems place considerable pressure on staff.

Patterns of and reasons for relocation in dementia care.

Because dementia is a progressive disease, the need for care in municipal shelter accommodations might change over time, raising the crucial question whether to relocate an individual. The aim of the study was to investigate the number of relocations between municipal dementia housing units and to examine the patterns and reasons for relocation, together with the various municipal prerequisites for carrying out relocation. Thirty-three managers of 101 dementia care units in 12 municipalities in Sweden were interviewed, and records of persons who had moved into or out of the dementia care units during the year 2002 were reviewed retrospectively. The results showed that turnover occurred in 35% of the 865 rooms during the year. Of those relocations, 78 (9%) were persons who moved to another accommodation-either into (59), between (13), or out of (6) a dementia care unit. This finding indicates that there are situations in which remaining in place was considered less appropriate than relocating a single individual with dementia to other accommodations with or without dementia specialization. The most common reason for relocation within the municipal shelters was an increased need for care.

Increased physiotherapy in sheltered housing in Sweden: a study of structure and process in elderly care.

The effect of increasing the level of physiotherapy services in elderly care was studied using an intervention and a control unit. The units had 20 and 2 hours of physiotherapy services per week, respectively. Physiotherapy and occupational therapy records were reviewed before and during the project. Physiotherapists also kept extended documentation over an 11-month period. Data analyses employed the chi-square test and content analysis. There was a significant increase in the number of patients receiving physiotherapy and occupational therapy within both units. No significant differences between the units were found for the number of patients receiving physiotherapy. The number of patients receiving occupational therapy differed significantly between units before as well as during the intervention. Primarily care assistants and auxiliary nurses initiated contact with the physiotherapists mainly for patient-orientated errands. Fifty per cent of the instructions given by the physiotherapist at the 20-hour unit related to movement-orientated activities of daily living. At the 2-hour unit, the majority of instructions (52%) were programme-orientated.