Åke Isacsson

Development of a novel instrument for occupational therapy assessment of the physical environment in the home - A methodologic study on “The Enabler”.

Occupational therapy assessment of the physical environment in the home in relation to the functional capacity of an individual is essential prior to environmental adaptations to reduce handicap. Standardized methods for research and clinical use are in great demand. To introduce and develop a new instrument for occupational therapy assessment, the novel ideogram “The Enabler” was translated into Swedish and revised. It was first tested in practice by occupational therapists in primary health care. After further revisions of “The Enabler” and pre-teaching of raters, each of 30 individuals in their home environments was assessed by two independent raters. Reliability was evaluated using the kappa statistic. After only a few lessons in advance, the raters were able to administer the assessment in practice in a reliable way, agreement between raters was very good to good, k̄ = 0.68–0.87. The Swedish revised version of “The Enabler” is a useful tool for occupational therapy home evaluation and research.

Foreign- and Swedish-born diabetic patients : a population-based study of prevalence, glycaemic control and social position

In this study foreign- and Swedish-born individuals with diabetes mellitus were compared regarding prevalence and characteristics. In a Swedish county 1,568 patients aged 20-64 years were identified, of whom 97.4% were included (143 foreign- and 1,384 Swedish-born) in the study of medical records. There was no difference in prevalence of diabetes (1.4% (95% CI 1.2-1.7%) vs 1.5% (95% CI 1.4-1.6%)) but diagnosis at or after the age of 30 years was more common in foreign-born patients (p<0.001). They were also less often treated with insulin (p<0.001), had shorter duration of diabetes (p<0.001), were more often classified as having a low social position in Sweden (p<0.001) and less often controlled in specialized diabetes care departments (p<0.001, 18% vs 43%). There was a higher occurrence of albuminuria among foreign-born women (p<0.05). No differences were found in glycaemic control, but low social position was related to poor glycaemic control independent of being foreign- or Swedish-born, and it seems to be more important than place of birth.

The experience of everyday occupations and its relation to sense of coherence ‐ a methodological study

Abstract The connection between health and the activation of the body that occurs through occupational engagement in rehabilitation is unquestionable, but what impact on health and well‐being does the experience of occupational performance have in itself? This pilot study was conducted to develop a methodology that captured qualities of experience in the daily occupational repertoire of six heterogeneous cases. The following instruments were used: 1) Experience Sampling Method, 2) Occupational Storytelling, and 3) the Sense of Coherence Scale, encompassing both quantitative and qualitative dimensions of experiences. The first two instruments were found to supplement each other in capturing specific and global experiences of occupations respectively, while the third focused on the individuals sense of coherence in life, connected to a salutogenic understanding of health. The results of the study were the development of 1) individual Experience Quality Profiles (EQPs), based on an eight‐channel flow model,...

Health, health care utilization and living conditions in foreign-born diabetic patients in southern Sweden

Hjelm K, Apelqvist J, Nyberg P, Sundquist J, Isacsson Å (Department of Community Health Sciences Dalby/Lund, University of Lund, Sweden, and Department of Internal Medicine, Lund University Hospital, Sweden). Health, health care utilization and living conditions in foreign‐born diabetic patients in southern Sweden. J Intern Med 1997; 242: 131–41.

Changes in cardiovascular risk factors by combined pharmacological and nonpharmacological strategies: the main results of the CELL Study

Objective. The objectives of the Cost Effectiveness of Lipid Lowering (CELL) study were twofold: (i) to evaluate the effect on overall cardiovascular risk of two types of health care advice (‘usual’ and ‘intensive’) given in primary care, with or without pharmacological medication, with the target being to attain a moderate decrease in cholesterol; (ii) to evaluate the ritual of daily medication on compliance with the health care advice.

Organization of Health Care Teams and the Population's Contacts with Primary Care

The aim of the study to examine a six-year development of the panorama of contacts and diagnoses at Södra Sandby Health Centre, where care teams had been introduced, and then to compare this development with that of the rest of the Dalby primary care district, where there were no care teams. In Södra Sandby the number of contacts with general practitioners (GPs) increased between 1984 and 1989 by 8% more than expected from the increase in staff, while the number of contacts with district care (district nurses and assistant nurse) increased by 62% more than expected. The corresponding figures for Dalby were 1% and 34%, respectively. The total proportion of the population visiting GPs in Södra Sandby during 1989 was 54%, and in Dalby 58%. The corresponding figure for district care in Södra Sandby was 40%. The proportion of contacts for which no appointment was made in advance decreased in Södra Sandby from 45% in 1984 to 22% in 1989. The corresponding figures for Dalby were 61% and 64%. This study did not find any verification for the fear that the organization of care teams would lead to a reduction in the number of contacts, e.g. on account of the frequency of meetings and conferences. The nurses seemed to retain their independent role, with the population contacting them in their surgeries or the nurses visiting them at home.

Use of primary health care in Spili Crete and in Dalby Sweden.

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC). In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%) but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%). There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.

HIV/AIDS : Information and knowledge : a comparative study of Kenyan and Swedish teenagers

Knowledge of hiv/aids, exposure to hiv/aids information and appreciation of given information was studied, by a questionnaire, among 326 Kenyan and 146 Swedish teenage school students in 1994. The aim of the study was to examine differences and similarities in knowledge in the two populations and to examine which sources of information about hiv and aids the respondents had been exposed to and which were most appreciated. The overall knowledge about hiv/aids was high but in specific items the knowledge and awareness of different risk behaviours for contracting hiv/aids differed for the Kenyan and Swedish teenagers. The dissemination of hard factual information about hiv/aids has thus been successful in reaching out although not in stopping the spread of hiv/aids. This calls for new strategies in disease prevention and health promotion. Those strategies should focus much more on lifestyle changes. The health care system, the school and the existing strong civil and voluntary information structures have an important role to play in that work.

Differences in the diagnose panorama in primary health care in Dalby, Sweden and Spili, Crete

We have compared the use of primary health care and the diagnoses at visits to doctors in the Spili Health Centre (SHC) in Crete and the Dalby Health Centre (DHC) in Sweden. In DHC more patients per 1000 population visited the doctors than in SHC. This was so regardless of age-group and sex, in fact more or less regardless of diagnosis. Other differences between the populations were: The diagnosis acute otitis media was more frequent in the Dalby children than in the Spili ones. The opposite was true of “head injuries” which were more frequent in the Spili boys. Visits to doctors for bronchitis was more frequent in the Spili men, maybe because of the extensive smoking habits of Cretan men. Visits for diseases of the musculoskeletal system were more frequent in DHC than in SHC. A hypothesis worth testing is that this was influenced by differences in the health insurance and sick benefit systems. Angina pectoris was fairly frequent in both areas but cardiosclerosis (including healed myocardial infarction) was more common in DHC than in SHC. Use of primary health care may be influenced by the need for health care in the population, the accessibility of the health care facilities, the costs for the patients, the quality of care as perceived by the patients and by other sociocultural factors. Comparative studies, even though fairly uncommon today, may be of use in generating hypotheses about the impact of different factors on the use of health care.

Interrater Reliability and Construct Validity—An Investigation of the IDA Assessment

To support planning in habilitation/rehabilitation interventions with the mentally retarded, the IDA (Irena Daily Activity Model—the working model for day activities centre) assessment was developed as a method for a general occupational functioning assessment. This study was designed to examine the reliability and construct validity of the IDA assessment, which were evaluated in terms of interrater reliability and convergent validity. The IDA was applied in two random samples consisting of 6 patients each: 5 men and 7 women, a total of 12 attendees at two different day activity centres for people with developmental disabilities and mental retardation. Interrater reliability was measured by comparing the IDA measurements obtained by 6 raters at each unit (n = 12), who rated each subject independently on the IDA scale. Kappa as value of agreement was calculated and gave a value of k = 0.71 in the assessment of the performance areas of mobility-sensory motor components. This corresponds to a good agreement....