Experiences and reflections on living with a personal assistance service: a qualitative study of people with neuromuscular disease or spinal cord injury.

PURPOSE: To investigate how people with neuromuscular disease or spinal cord injury experience living with a personal assistance service. MATERIALS AND METHODS: Qualitative study using the Interpretive Description methodology with Aaron Antonovsky's theory of sense of coherence as a theoretical framework. The method was semi-structured individual interviews (n = 3) and focus group interviews (n = 5). In all, 19 adults with neuromuscular disease (n = 13) or spinal cord injury (n = 6) participated. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS: Three themes were identified to understand living with personal assistance and how this affected everyday life: 1) Making meaning of a personal assistance service, 2) Managing a personal assistance service, and 3) Living with a personal shadow. Our findings provide an understanding of living with assistance and how it, among other things, is influenced by the legislation and the local authorities' administration of the service. Participants explained this by an experience of a sense of coherence. CONCLUSION: For people with NMD and SCI, there are complex nuances associated with living with a personal assistance service. The findings illustrate that despite personal challenges of managing assistance services, it can meaningfully contribute to one's life by enhancing one's sense of coherence.

Policy initiatives are important to help people living with neuromuscular disease (NMD) or spinal cord injury (SCI) access flexible personal assistance services, which can enable them to lead independent lives with enhanced meaningfulness.Professionals of people with NMD and SCI should provide knowledge and counseling on how to manage their personal assistance service, which includes taking into account practical, physical, and psychosocial considerations.To ensure optimizing the design and delivery of personal assistance services for the NMD and SCI populations, it is critical that policymakers are made aware of both the positive and challenging aspects of personal assistance services, and should consider engaging persons with lived experience when developing (or re-evaluating) them.

[Fourth generation oral contraceptives are associated with a higher risk of venous thromboembolism compared to second generation]. / Fjerdegenerations-p-piller medfører større risiko for venøs tromboemboli end andengenerations-p-piller.

It has been widely discussed whether fourth generation oral contraceptives (OC) are associated with a higher risk of venous thromboembolism (VTE) compared to second generation. Lack of randomized controlled trials, methodological problems and inconsistent criteria for the VTE event has led to conflicting results. Three newly published studies utilising improved methodology show that fourth generation OC are associated with an increased risk of VTE compared to second generation OC. This knowledge has led to a change in recommendation of the first drug of choice, which is now second generation OC.