Point of Care Analysis of Hematology in the Operating Theater - a Prospective Observational Study of Accuracy and Feasibility.

BACKGROUND: Major surgery entails the risk of severe hemorrhage, and an optimized substitution with red blood cell (RBC) and platelet (PLT) transfusions necessitate rapid test results for RBCs/hemoglobin (HGB)/hematocrit (HCT), and PLTs. The HemoScreen (PixCell Medical, Yokneam Ilit, Israel) is an automated point-of-care hematology analyzer employing image analysis and single-use cuvettes. This study aimed to investigate the correspondence between the HemoScreen and standard laboratory testing (SLT) using the Sysmex XN-9000 in patients undergoing major surgery and to evaluate the feasibility in the operating theater. METHODS: A total of 145 blood samples from 91 adult patients were sampled during abdominal and orthopedic surgery and analyzed on both cell counters. Coefficient of variation (CV) was calculated, Passing-Bablok regression analysis was performed, and Bland-Altman plots were constructed. User experience was assessed through a questionnaire. RESULTS: The HemoScreen showed imprecision with a CV below 5%. Passing-Bablok regression showed positive proportional and negative constant errors for HGB and HCT, a positive proportional error for PLTs, but no dif-ference for RBCs. Bias in the Bland-Altman plots with limits of agreement: RBCs 0.09 x 1012/L (+/- 0.20 x 1012/L), HGB 1.1 g/L (+/- 8.4 g/L), HCT 0.4 % (+/- 2.6%), and PLTs 28.8 x 109/L (+/- 33 x 109/L). The analyzer was scored easy to use with shorter turnaround times compared to SLT. CONCLUSIONS: The HemoScreen is feasible and provides rapid test results with acceptable accuracy for the evaluated application but the two methods cannot be regarded as interchangeable based on the results in this study.

Extracellular membrane vesicles from Limosilactobacillus reuteri strengthen the intestinal epithelial integrity, modulate cytokine responses and antagonize activation of TRPV1.

Bacterial extracellular membrane vesicles (MV) are potent mediators of microbe-host signals, and they are not only important in host-pathogen interactions but also for the interactions between mutualistic bacteria and their hosts. Studies of MV derived from probiotics could enhance the understanding of these universal signal entities, and here we have studied MV derived from Limosilactobacillus reuteri DSM 17938 and BG-R46. The production of MV increased with cultivation time and after oxygen stress. Mass spectrometry-based proteomics analyses revealed that the MV carried a large number of bacterial cell surface proteins, several predicted to be involved in host-bacteria interactions. A 5'-nucleotidase, which catalyze the conversion of AMP into the signal molecule adenosine, was one of these and analysis of enzymatic activity showed that L. reuteri BG-R46 derived MV exhibited the highest activity. We also detected the TLR2 activator lipoteichoic acid on the MV. In models for host interactions, we first observed that L. reuteri MV were internalized by Caco-2/HT29-MTX epithelial cells, and in a dose-dependent manner decreased the leakage caused by enterotoxigenic Escherichia coli by up to 65%. Furthermore, the MV upregulated IL-1ß and IL-6 from peripheral blood mononuclear cells (PBMC), but also dampened IFN-γ and TNF-α responses in PBMC challenged with Staphylococcus aureus. Finally, we showed that MV from the L. reuteri strains have an antagonistic effect on the pain receptor transient receptor potential vanilloid 1 in a model with primary dorsal root ganglion cells from rats. In summary, we have shown that these mobile nanometer scale MV reproduce several biological effects of L. reuteri cells and that the production parameters and selection of strain have an impact on the activity of the MV. This could potentially provide key information for development of innovative and more efficient probiotic products.

Fostering Change Through Occupation-Based Intervention: An International Joint Group Concept Mapping Study.

Further consolidation and clarity regarding occupation as a means to foster change in interventions are needed. The study aimed to utilize the knowledge of occupational scholars to systematically determine what is required to use occupation as means to foster change within occupation-based interventions and to generate a conceptual model from those results. Group Concept Mapping involved the following: preparation, generation of ideas, structuring of statements, data analysis, interpretation of maps, and development of conceptual model. Fifty-two international occupational scholars brainstormed 125 ideas. A cluster rating map with nine clusters posed the foundation for a conceptual model with seven themes, namely, artful use of occupation, evidence-based use of occupation, collaboration to promote occupation, coordinating intervention fit, client factors, sociocultural context, and structural influences. The conceptual model, capturing dimensions and dynamics required for using occupation to foster change, may guide future research into occupation-based interventions.

Obesity treatment: a role for occupational therapists?

BACKGROUND: Half of the Danish population is overweight or obese. Obesity can negatively impact health and daily life. The Danish National Board of Health´s guidelines for weight loss programmes to the Danish municipalities, recommends multidisciplinary teams, including occupational therapy, and interventions targeting diet, exercise, psychosocial coping, and everyday life. AIM: To describe the structure and content of obesity programmes offered by the 98 municipalities in Denmark, including details such as the health professionals, programme recipients, dose, structure, content, and the role of occupational therapists. METHOD: A quantitative content analysis was conducted on 234 published Danish municipal weight loss programmes. Programme descriptions were identified through internet searches using both sundhed.dk and Google.com. RESULTS: Various health professionals conducted the programmes, and five involved occupational therapists. Programmes targeted children, adolescent and adults. Dose, structure and content were heterogeneous. CONCLUSION: The majority of the programmes were neither evidence-based, nor did they follow recommendations from Danish National Board of Health. Few programmes addressed the role of habits or social participation. Occupational therapists appear to be under-utilized as providers of the programmes. SIGNIFICANCE: Occupational therapists have a role to play in weight loss programmes, because of their training in activity analysis and their consideration of people, environments, and occupations. These components are included in the recommendations about psychosocial aspects and everyday life from the Danish National Board of Health.

Genome sequence of segmented filamentous bacteria present in the human intestine.

Segmented filamentous bacteria (SFB) are unique immune modulatory bacteria colonizing the small intestine of a variety of animals in a host-specific manner. SFB exhibit filamentous growth and attach to the host's intestinal epithelium, offering a physical route of interaction. SFB affect functions of the host immune system, among them IgA production and T-cell maturation. Until now, no human-specific SFB genome has been reported. Here, we report the metagenomic reconstruction of an SFB genome from a human ileostomy sample. Phylogenomic analysis clusters the genome with SFB genomes from mouse, rat and turkey, but the genome is genetically distinct, displaying 65-71% average amino acid identity to the others. By screening human faecal metagenomic datasets, we identified individuals carrying sequences identical to the new SFB genome. We thus conclude that a unique SFB variant exists in humans and foresee a renewed interest in the elucidation of SFB functionality in this environment.

Lessons learned about occupation-focused and occupation-based interventions: A synthesis using group concept mapping methodology.

Introduction: Occupational therapy (OT) is based on the core assumption that humans are active beings through engagement in occupations. Within OT, occupation is typically used as primary means and/or ends i.e. occupation-focused and/or occupation-based interventions are employed. Studies evaluating such interventions are limited.Objectives: To synthesize experiences about occupation-focused and/or occupation-based interventions. Hence, to identify, organize and prioritize experiences with employing occupation as a core element in OT intervention studies.Methods: Participants were OT PhD students and researchers involved in studies concerning occupation-focused and/or occupation-based interventions. Group Concept Mapping was applied.Results: Based on 133 ideas, a conceptual model emerged encompassing two overall dimensions concerning 'developing interventions' and 'planning intervention studies', respectively. Moreover, ten themes related to one or both dimensions were defined and 94 ideas across clusters had high importance ratings.Conclusion: Synthesis of participants' experiences indicates that 'doing' as agent of change is a core element of OT interventions. Moreover, a multi-level perspective is needed to reach sustainable changes in doing. Group- and peer-support can work as amplifier for change, and flexibility is important during intervention. Such complex interventions need special design and mixed methods in the development, and evaluation of outcome needs to address occupation.

Lactobacillus reuteri strains protect epithelial barrier integrity of IPEC-J2 monolayers from the detrimental effect of enterotoxigenic Escherichia coli.

Lactobacillus reuteri is an inhabitant of the gastrointestinal (GI) tract of mammals and birds and several strains of this species are known to be effective probiotics. The mechanisms by which L. reuteri confers its health-promoting effects are far from being fully understood, but protection of the mucosal barrier is thought to be important. Leaky gut is a state of abnormal intestinal permeability with implications for the pathophysiology of various gastrointestinal disorders. Enterotoxigenic Escherichia coli (ETEC) can invade the intestinal mucosa and induce changes in barrier function by producing enterotoxin or by direct invasion of the intestinal epithelium. Our hypothesis was that L. reuteri can protect the mucosal barrier, and the goal of the study was to challenge this hypothesis by monitoring the protective effect of L. reuteri strains on epithelial dysfunction caused by ETEC. Using an infection model based on the porcine intestinal cell line IPEC-J2, it was demonstrated that pretreatment of the cells with human-derived L. reuteri strains (ATCC PTA 6475, DSM 17938 and 1563F) and a rat strain (R2LC) reduced the detrimental effect of ETEC in a dose-dependent manner, as monitored by permeability of FITC-dextran and transepithelial electrical resistance (TEER). Moreover, the results revealed that ETEC upregulated proinflammatory cytokines IL-6 and TNFα and decreased expression of the shorter isoform of ZO-1 (187 kDa) and E-cadherin. In contrast, pretreatment with L. reuteri DSM 17938 and 1563F downregulated expression of IL-6 and TNFα, and led to an increase in production of the longer isoform of ZO-1 (195 kDa) and maintained E-cadherin expression. Interestingly, expression of ZO-1 (187 kDa) was preserved only when the infected cells were pretreated with strain 1563F. These findings demonstrate that L. reuteri strains exert a protective effect against ETEC-induced mucosal integrity disruption.

Evaluation of growth, metabolism and production of potentially bioactive components during fermentation of barley with Lactobacillus reuteri.

Eighteen bacterial isolates from millet, buckwheat and rye flour were identified as Lactobacillus reuteri. Genomic fingerprinting (rep-PCR) revealed that they represented five strains and phylogenetic analyses using multi locus sequence analysis (MLSA) showed that all clustered with strains of rodent origin. Two strains (SU12-3 and SU18-3) from different phylogenetic clades were used in fermentations of six varieties of barley, both untreated and heat-treated (with inactivated indigenous enzymes) flour. They were compared with two probiotic strains of human origin (DSM 17938 and ATCC PTA 6475), one previously isolated sourdough strain (LTH 5531) and one strain of Lactobacillus plantarum (36E). Analyses of growth (CFU) and metabolism (1H-NMR) revealed differences at species level, with L. plantarum showing a higher capacity to assimilate nutrients without help of the cereal enzymes. Similarities were observed between L. reuteri strains isolated from sourdough, while the greatest differences between L. reuteri strains were observed between strains 6475 and 17938. Multivariate analysis of the metabolic profiles revealed clear clustering according to flour treatment, species of bacteria and barley variety and to some extent also bacterial strain. Possible bioactive compounds such as γ-aminobutyric acid (GABA), 1,3- propanediol (sign of reuterin production) and histamine were identified and quantified.

In Vivo and In Vitro Detection of Luminescent and Fluorescent Lactobacillus reuteri and Application of Red Fluorescent mCherry for Assessing Plasmid Persistence.

Lactobacillus reuteri is a symbiont that inhabits the gastrointestinal (GI) tract of mammals, and several strains are used as probiotics. After introduction of probiotic strains in a complex ecosystem like the GI tract, keeping track of them is a challenge. The main objectives of this study were to introduce reporter proteins that would enable in vivo and in vitro detection of L. reuteri and increase knowledge about its interactions with the host. We describe for the first time cloning of codon-optimized reporter genes encoding click beetle red luciferase (CBRluc) and red fluorescent protein mCherry in L. reuteri strains ATCC PTA 6475 and R2LC. The plasmid persistence of mCherry-expressing lactobacilli was evaluated by both flow cytometry (FCM) and conventional plate count (PC), and the plasmid loss rates measured by FCM were lower overall than those determined by PC. Neutralization of pH and longer induction duration significantly improved the mCherry signal. The persistency, dose-dependent signal intensity and localization of the recombinant bacteria in the GI tract of mice were studied with an in vivo imaging system (IVIS), which allowed us to detect fluorescence from 6475-CBRluc-mCherry given at a dose of 1×1010 CFU and luminescence signals at doses ranging from 1×105 to 1×1010 CFU. Both 6475-CBRluc-mCherry and R2LC-CBRluc were localized in the colon 1 and 2 h after ingestion, but the majority of the latter were still found in the stomach, possibly reflecting niche specificity for R2LC. Finally, an in vitro experiment showed that mCherry-producing R2LC adhered efficiently to the intra cellular junctions of cultured IPEC-J2 cells. In conclusion, the two reporter genes CBRluc and mCherry were shown to be suitable markers for biophotonic imaging (BPI) of L. reuteri and may provide useful tools for future studies of in vivo and in vitro interactions between the bacteria and the host.

Effects of Lactobacillus johnsonii and Lactobacillus reuteri on gut barrier function and heat shock proteins in intestinal porcine epithelial cells.

Heat shock proteins (HSPs) are a set of highly conserved proteins that can serve as intestinal gate keepers in gut homeostasis. Here, effects of a probiotic, Lactobacillus rhamnosus GG (LGG), and two novel porcine isolates, Lactobacillus johnsonii strain P47-HY and Lactobacillus reuteri strain P43-HUV, on cytoprotective HSP expression and gut barrier function, were investigated in a porcine IPEC-J2 intestinal epithelial cell line model. The IPEC-J2 cells polarized on a permeable filter exhibited villus-like cell phenotype with development of apical microvilli. Western blot analysis detected HSP expression in IPEC-J2 and revealed that L. johnsonii and L. reuteri strains were able to significantly induce HSP27, despite high basal expression in IPEC-J2, whereas LGG did not. For HSP72, only the supernatant of L. reuteri induced the expression, which was comparable to the heat shock treatment, which indicated that HSP72 expression was more stimulus specific. The protective effect of lactobacilli was further studied in IPEC-J2 under an enterotoxigenic Escherichia coli (ETEC) challenge. ETEC caused intestinal barrier destruction, as reflected by loss of cell-cell contact, reduced IPEC-J2 cell viability and transepithelial electrical resistance, and disruption of tight junction protein zonula occludens-1. In contrast, the L. reuteri treatment substantially counteracted these detrimental effects and preserved the barrier function. L. johnsonii and LGG also achieved barrier protection, partly by directly inhibiting ETEC attachment. Together, the results indicate that specific strains of Lactobacillus can enhance gut barrier function through cytoprotective HSP induction and fortify the cell protection against ETEC challenge through tight junction protein modulation and direct interaction with pathogens.

Does a Falls Prevention Program Impact Perceived Participation in Everyday Occupations? A Pilot Randomized Controlled Trial.

This study aimed to evaluate the effectiveness of a multi-disciplinary, client-centered, fall prevention program on the experiences of participation and autonomy in everyday occupations among community-dwelling older adults. In total, 131 older adults (65+) were included and randomly allocated into two groups. Intention-to-treat analysis was used. Results of this pilot study showed that the program had a limited effect on the subjective experiences of participation and autonomy in everyday occupations among the participants. However, a trend of increased perceived participation and a decrease in the experience of perceived problems with participation among the participants in the intervention group was shown. Perceived participation and autonomy seem to be subjective experiences, and they seem to vary depending on the individual. To properly understand the impact of fall prevention interventions on participation and autonomy, measurements that capture both subjective and objective experiences are essential to use.

Letting go of an old habit: group leaders' experiences of a client-centred multidisciplinary falls-prevention programme.

OBJECTIVE: It has been suggested that the prevention of disability and falls should be conducted from a client-centred approach, especially when it includes how individuals learn new strategies in everyday life. In addition, programmes for the prevention of falls need to be multi-professional and multidisciplinary in order to be effective. In preventive work with clients, using the approach of client-centredness, the therapists work together with the clients to enable them to achieve occupational goals. There are few studies in fall prevention that have explored group leaders' experiences, i.e., studies that focus on the experiences of group leaders when working from a client-centred approach. METHODS: This study aims to explore, by the use of focus-group interviews, the therapists' experiences of being group leaders in a fall-prevention programme that applied the ideas and approaches described above. RESULTS: The analysis revealed that a change in the role of being a group leader had taken place during the intervention process. Three primary categories pertaining to this process were identified: (i) the group leaders moved between the role of expert and the role of facilitator; the group climate (ii) facilitated the translation of expert knowledge to applied knowledge; and (iii) increased awareness as a prerequisite for change.

Role of Lactobacillus reuteri cell and mucus-binding protein A (CmbA) in adhesion to intestinal epithelial cells and mucus in vitro.

Lactobacillus reuteri, a symbiotic inhabitant of the gastrointestinal tract in humans and animals, is marketed as a probiotic. The ability to adhere to intestinal epithelial cells and mucus is an interesting property with regard to probiotic features such as colonization of the gastrointestinal tract and interaction with the host. Here, we present a study performed to elucidate the role of sortase (SrtA), four putative sortase-dependent proteins (SDPs), and one C-terminal membrane-anchored cell surface protein of Lactobacillus reuteri ATCC PTA 6475 in adhesion to Caco-2 cells and mucus in vitro. This included mutagenesis of the genes encoding these proteins and complementation of mutants. A null mutation in hmpref0536_10255 encoding srtA resulted in significantly reduced adhesion to Caco-2 cells and mucus, indicating involvement of SDPs in adhesion. Evaluation of the bacterial adhesion revealed that of the five putative surface protein mutants tested, only a null mutation in the hmpref0536_10633 gene, encoding a putative SDP with an LPxTG motif, resulted in a significant loss of adhesion to both Caco-2 cells and mucus. Complementation with the functional gene on a plasmid restored adhesion to Caco-2 cells. However, complete restoration of adhesion to mucus was not achieved. Overexpression of hmpref0536_10633 in strain ATCC PTA 6475 resulted in an increased adhesion to Caco-2 cells and mucus compared with the WT strain. We conclude from these results that, among the putative surface proteins tested, the protein encoded by hmpref0536_10633 plays a critical role in binding of Lactobacillus reuteri ATCC PTA 6475 to Caco-2 cells and mucus. Based on this, we propose that this LPxTG motif containing protein should be referred to as cell and mucus binding protein A (CmbA).

"I am not living my life": lived experience of participation in everyday occupations after stroke in Tehran.

OBJECTIVE: To describe and understand the lived experience and to identify what characterizes the phenomenon of participation in everyday occupations after stroke, in Tehran, Iran. METHODS: Eight individuals with stroke, who had previously been admitted to a neurological hospital ward in Tehran, were interviewed in-depth on one occasion. Data were collected and analysed using the Empirical, Phenomenological, Psychological method. RESULTS: The findings identified 3 main characteristics of the phenomenon of participation in everyday occupations as being: (i) I cannot do activities as before; (ii) I am not the same person - discovery of a different self; (iii) I am not living my life. CONCLUSION: Enabling participation after stroke within a client-centred paradigm in this socio-cultural context requires consideration of the essential meaning of this concept as characterized by the dynamic process between the characteristics of "doing", "identity", and "living life". The study highlights how the provision of efficient rehabilitation services in this Eastern context requires attention to both "doing" and to "identity" in rehabilitation interventions, in order to enable individuals to adapt to their new lives after stroke and to "live their lives".

Sustaining international partnerships: the European Master of Science Programme in Occupational Therapy, a case study.

International partnerships are a mechanism for supporting the academic development of occupational therapy and promoting cultural competence. This case study describes the factors that have helped to sustain a post-qualifying programme implemented by five higher education institutions in Denmark, the Netherlands, Sweden, Switzerland and the UK since 1999. Data collection methods were documentary analysis and the reflections of a purposive sample of six key informants. Cohort and outcome data, from 193 students from 31 countries who enrolled between 1999 and 2011, are reported. Each cohort comprises students from an average of eight countries to optimize inter-cultural dialogue. Four factors support sustainability. These are 1) supportive professional European networks; 2) timeliness and alignment with European higher education policy; 3) partnership structures and processes that emphasize joint decision making and accountability; and 4) the stimulus and satisfaction associated with internationalization. The main limitations are considering the OT-EuroMaster as an intrinsic case study and using opportunistic data collection that undermines the rigor and transferability of the findings. Future opportunities include doctoral networks, transnational research and sharing our curricula design with other Regions to spread the collaborative, capacity building endeavours more widely.

Effects of hand-training in persons with myotonic dystrophy type 1--a randomised controlled cross-over pilot study.

PURPOSE: To investigate the effects of a hand-training programme on grip, pinch and wrist force, manual dexterity and activities of daily living, in adults with myotonic dystrophy type 1 (DM1). METHOD: In this randomised controlled trial with a crossover design, 35 adults with DM1 were, after stratification for grip force, assigned by lot to two groups. Group A started with 12 weeks of hand training, while group B had no intervention. After a wash-out period of 12 weeks, where none received training, the order was reversed. The Grippit® was used as primary outcome measure and the hand-held Microfet2™ myometer, the Purdue Pegboard, the Canadian Occupational Performance Measure (COPM) and the Assessment of Motor and Process Skills (AMPS) were secondary outcome measures. Assessments were performed before and after training and control periods, i.e. four times altogether. RESULTS: Ten persons dropped out and 13 had acceptable adherence. Intention-to-treat analyses revealed significant intervention effects for isometric wrist flexor force (p = 0.048), and for COPM performance (p = 0.047) and satisfaction (p = 0.027). On an individual level, improvements were in general showed after a training period. CONCLUSION: The hand-training programme had positive effects on wrist flexor force and self-perception of occupational performance, and of satisfaction with performance. No evident detrimental effects were shown. IMPLICATIONS FOR REHABILITATION: Myotonic dystrophy type 1 (DM1) is a slowly progressive neuromuscular disease characterised by myotonia and muscle weakness and wasting. People with DM1 are often concerned about their ability to carry out ADL and to participate in, e.g. work, sports and hobbies when they gradually become weaker. This pilot study showed that a hand-training programme improved wrist flexor force and self-perception and satisfaction of occupational performance. Resistance training of hand muscles with a silicon-based putty can be a therapy option for people with DM1 in clinical practise.

Segmented filamentous bacteria in human ileostomy samples after high-fiber intake.

Segmented filamentous bacteria (SFB) are inhabitants of the small intestine of various animals, where they can be detected microscopically due to their specific morphology and intimate association with the intestinal epithelium. SFB colonize the distal part of the small intestine in a host-specific manner and affects important functions of the immune system, such as the induction of secretory IgA production and regulation of T-cell maturation. Considering the influences SFB have on immune functions, they could be regarded as a key species in host-microbial interactions of the gastrointestinal tract. Although these influences might be executed by other microorganisms, a human-adapted variant of SFB is not unlikely. In this study, ileostomy samples from 10 human subjects were screened with PCR, using primers derived from sequences of SFB from rat and mouse. PCR products were obtained from samples taken from one individual at two time points. Sequencing revealed the presence of a 16S rRNA gene with high similarity (98%) to the corresponding genes from SFB of mouse and rat origin, thus indicating the presence of a human variant of SFB. The findings presented in this study will hopefully encourage research to elucidate whether this intriguing organism is a persistent member of the normal human microbiota.

Connecting rehabilitation and everyday life--the lived experiences among women with stress-related ill health.

PURPOSE: The aim was to describe and understand how connecting rehabilitation experiences and everyday life was characterised in the lived experiences during the rehabilitation in women with stress-related ill health. METHOD: Five women were interviewed on three occasions during a rehabilitation programme and once 3 months later. Data were analysed using the Empirical, Phenomenological and Psychological method. RESULTS: The participants experienced connections between their rehabilitation and their previous, present and future everyday life influencing both rehabilitation and everyday life in a back-and-forth process. These connections were experienced in mind or in doing, mostly targeting the private arena in everyday life. Connecting rehabilitation experiences to their working situations was more challenging and feelings of frustration and being left alone were experienced. CONCLUSIONS: Although the participants described constructive connections between rehabilitation experiences and the private arena in everyday life, they mostly failed to experience connections that facilitated a positive return to work. Recommended support in the return to work process in rehabilitation comprises the provision of practical work-related activities during rehabilitation; being supportive in a constructive dialogue between the participant and the workplace, and continuing this support in follow-ups after the actual rehabilitation period. IMPLICATIONS FOR REHABILITATION: Rehabilitation for persons with stress-related ill health needs to focus on the private arena as well as the work situation in everyday life. Creative activities may enable experiences that inspire connections in mind and connections targeting the private arena in everyday life. The work situation needs to be thoroughly discussed during rehabilitation for enabling the participants to experience a support in the return to work process. Rehabilitation including practical work-related activities, support in a constructive dialogue between the participant and the manager at the workplace, and continued support in follow-ups targeting the workplace might be beneficial for successfully return to work.

Changing everyday activities of couples in late life: converging and keeping up.

The influence of mutual spousal interrelations in domains such as health and wellbeing has been demonstrated, but little is known about the domain of everyday activities of couples in late life. In the present explorative study, we considered all of the activities participating couples talked about to be their everyday activities. Its aim was to understand, over time, changes in everyday activities as experienced by late-life community-dwelling couples. In a two-year period, 41 individual and joint interviews were conducted with 8 couples, who were purposefully selected from the Longitudinal Aging Study Amsterdam. Analyses involved the construction of couple narratives and constant comparisons within and across couples. Changing everyday activities in late-life couples was interpreted to be a two-way process of (1) converging, and (2) keeping up, which occurred in three fluid phases. Converging was a slow inward movement with a shift towards diminished everyday activities performed in a smaller world. Keeping up was an outward movement in order to resist the converging process by using everyday activities as a means to keep fit, physically and mentally, and to connect with the wider social world. In the first phase, couples maintained their unique linked activity pattern. In the second phase, spouses resisted converging by keeping up. In the third phase, spouses co-performed everyday activities closely together. The findings support the need to develop couple-oriented interventions that aim to enhance the couples' functioning in the domain of everyday activities.

A comparison of perceived occupational gaps between people with stress-related ill health or musculoskeletal pain and a reference group.

AIM: To describe and compare how occupational gaps were reported in everyday occupations in a rehabilitation group of people with musculoskeletal pain or stress-related ill health and in a reference group from the Swedish population. METHOD: Seventy-two persons with musculoskeletal pain or stress-related ill health and 261 people from the Swedish population were included. The Occupational Gaps Questionnaire, measuring to what extent individuals perceive a discrepancy between what they want to do and what they actually do, was completed by the participants. Descriptive statistics were used to analyse the data. RESULTS: Occupational gaps were reported more often in the rehabilitation group. Leisure activities were the gaps reported most often. The occupational repertoire seemed to decrease over time as the number of activities was decreasing, particularly leisure and work-related activities. Instrumental ADL were more desirable as the length of sick leave extended. CONCLUSIONS: Being on sick leave appears to start a process towards occupational deprivation where the areas that remain in the occupational repertoire become more important. Our study highlights the need to emphasize the whole occupational repertoire in rehabilitation and to facilitate engagement in valued activities to create a sound base for the process of returning to work.