Jörgen Lundälv

Occupations and means of living in adults with cerebral palsy or meningomyelocele during two decades in Sweden

The aim of this study was to focus on education, work and means of living during two decades in two groups of people with cerebral palsy (CP) or meningomyelocele (MMC) within the framework of social policies. Two groups of patients at an adult habilitation unit were interviewed by telephone – Group A (n=55) in 1983 and again in 1997 (n=42), and Group B (n=30) in 1997. All but one subject in Group B had attended upper secondary school (1997), compared with 61% in Group A (1983). In 1983, a majority of Group A worked or studied. In 1997, most of them still worked or studied, compared with only two thirds of the 1997 Group B, but both the A and B groups worked part-time significantly more often in 1997 compared with Group A in 1983. Of those who worked, about one third of Group A and more than half of Group B had wage subsidies from the state in both 1983 and 1997. The majority of Group A thought that over the period from 1983–97 the labour market had generally become harder, which had affected people with disabilities in general in a negative way. Almost all in Group A in 1983 and Group B in 1997 were content with their work tasks and work environment, but one third of Group A had problems within these areas in 1997. Significantly more people had disability pensions, of varying amounts, in 1997 (A and B groups) than in Group A 1983. In conclusion, it seems as if social policies have managed to integrate these people into the regular educational systems and support them financially, but have failed to stimulate the labour market to offer them work, especially regular and permanent work without wage subsides.

Awareness and the arguments for and against the International Classification of Functioning, Disability and Health among representatives of disability organisations.

Disability organisations have not been engaged in the debate about the International Classification of Functioning, Disability and Health (ICF) in Sweden. We wanted to know representatives’ attitudes about the ICF. The aim of the study was to elucidate the arguments for and against the ICF among representatives of disability organisations. The study consisted of eighteen representatives (from six disability organisations) that answered electronic questionnaires. The questionnaires involved ten open questions about the arguments for and against the ICF. The answers of the questionnaires have been categorized according to qualitative content analysis. Our results indicated four themes: awareness, arguments for and against, influence and the future. More than half of the representatives had very limited awareness of the ICF. There was an explicit criticism of individual classification but more positive comments about classification on an aggregated level. The most important issue for representatives was influencing social policy in society, not learning and spreading information about the ICF.

Self-Assessed Physical, Cognitive, and Emotional Impact of Stroke at 1 Month: The Importance of Stroke Severity and Participation

OBJECTIVES The aims of this study were to describe the self-assessed physical, emotional, and cognitive impact of stroke and to investigate associations with participation and stroke severity in early stage (1 month) poststroke. METHODS Participants (n = 104, mean age = 68) with reduced upper extremity function assessed at day 3 were included from a Swedish stroke unit. Participants were evaluated with The National Institutes of Health Stroke Scale at arrival, median 7.9 (0-24). The cohort was assessed for their perceived impact of stroke with the Stroke Impact Scale at 1 month poststroke. RESULTS The perceptions of emotional health, communication skills, and ability to remember were perceived as quite good, with a mean score of 83-86. However, nearly 60% reported limitations in participation. This group also evaluated their physical function to be significantly lower compared to participants who did not report limitations in participation. CONCLUSIONS One month poststroke, a lower score on self-assessed physical function was associated with both a perceived restriction in participation and a more severe stroke. The association of physical function and perceived participation at 1 month poststroke needs to be taken into account when planning the early rehabilitation.

The ICF: International Classification of Functioning, Disability and Health (ICF) – A Swiss army knife? Accessibility and disability in a Scandinavian disability magazine (SDM) – A quantitative content analysis

BACKGROUND The study describes the extent to which the concept of accessibility and accessibility issues has been reported in a national Scandinavian disability magazine. In this study particular attention is paid to how the compatibility between the various domains of the international classification - International Classification of Functioning, Disability and Health (ICF) - has been covered in the magazine over a decade. Furthermore, other types of descriptions that the magazine has made of accessibility for people with physical disabilities are considered. METHODS The study is based on a quantitative content analysis of a total of 326 articles from the Swedish disability magazine (SDM); 450 text pages published during the years 2000-2009. The magazines coverage has been comprehensive. RESULTS AND CONCLUSIONS More than half of the studied texts were news items about various accessibility issues. Every third article can be characterised as a news article or feature article. The most frequently reported of the ICF domains consist of two perspectives: environmental accessibility and civil rights. Public opinion articles in the form of letters to editors and editorials focused on accessibility have a low frequency. Likewise, research reports are few. The study has included a review of illustrations and photographs. The illustrations are generally of high quality, reinforcing the disability message of the article.

KAMEDO Report No. 77 Sinking of the MS Sleipner, 26 November 1999

The catamaran HS Sleipner struck a rock and sunk in bad weather and heavy seas on 26 November 1999. Rescue efforts were provided by helicopters and other ships. A total of 68 victims were rescued alive and 16 died, mostly by drowning. Problems were encountered with evacuation, life jackets, and life rafts. Most of those rescued alive suffered from hypothermia. Response times for rescue helicopters should be improved. Emphasis should be placed on correct manifest lists of passengers and crew. Special emphasis must be placed on media relations and cross-boundary issues. Exercises should focus on cooperation and coordination.

Activation, medicalisation and inter-organisational cooperation in health insurance – implications for frontline social work in Sweden

ABSTRACT This paper focuses on tensions between activation principles and medicalisation in the Swedish sickness insurance and its implications for frontline caseworkers in Social Security Agencies and Public Employment Services. The right to sickness cash benefits has become stricter and more conditioned upon the person’s work ability and employability. The paper describes recent policy changes towards activation and stricter entitlement criteria for sickness benefits policy and explores the consequences of such new activation policies in terms of changed work modes for caseworkers dealing with long-term sick people’s return-to-work process. It is concluded that on the one hand frontline work contains a significant portion of discretion and professional assessment of work abilities, and on the other hand rule-bound administrative work. Furthermore, frontline workers need to apply organisational professionalism as inter-organisational cooperation is required in order to support long-term sick people to return-to-work. Medicalisation of ill-health, manifested in the right to sickness benefits has not been substantially circumscribed by new activation policies in the sickness insurance.

The impact of physical function on participation in the first year post-stroke.

Studies have investigated predictors of participation and showed that fewer depressive symptoms, physical independence, and age could predict the level of participation after stroke. Association between self‐assessed functions and perceived levels of participation over time is not yet known. The aim of this study was to investigate perceptions of participation and how this related to background characteristics and self‐assessed rehabilitation outcomes, at 1, 6, and 12 months post‐stroke.

Teaching Note—Popular Science Writing in a Social Work Program: From an Idea to a Student Anthology

ABSTRACT The purpose of this article is to describe how students, as part of their education, published course papers in an anthology. Over a period of 2.5 years, we followed students in an undergraduate social work program. The course, which focused on long-term illnesses and the functional barriers people with disabilities face in society, ended with a graded seminar in which students presented written manuscripts based on the course content. The papers were later compiled into a student anthology. The publishing process involved several participants, including teachers, a book publisher, and a disability organization. This article describes experiences based on the perspectives of the students, the disability organization, the publisher, and the editor. It ends with advice and recommendations for those who want to use this method.

Injury events sustained in residential environments: age and physical disability as explanatory factors for differences in injury patterns in Sweden

ABSTRACT The aim is to analyze how age and physical (dis)ability jointly condition the probability of different types of injuries in residential settings, in order to identify injury countermeasures. There is a need to identify risk factors associated with injuries involving disabled people in their homes. The data include 62,674 records of unintentional injuries in the residential settings from Injury Database 2001–2015. Injuries were twice as likely to occur in residential settings, compared to other environments. Individuals with dis-abilities were more likely to be injured in their residences through falls, compared to non disabled individuals. Contusion was a more common injury type in the disabled group, while open wounds were more common in the non disabled group. Age was the most important factor for predicting fractures and the risk for fractures increased by age, while risk factors related to physical disability did not appear to play a role. The evidence is clear that people with disabilities, and older people without disabilities, would benefit from safety interventions in their home to reduce harm from falls after they have occurred. In keeping with principles to support autonomy, it is recommended that a range of passive measures be implemented to reduce injury risks.

Injury events in residential areas - risk groups and etiological factors for falling, cutting and poisoning.

Background Injury events in homes constitute a major social problem. Falling, cutting and poisoning make up 85 per cent of all injury events in residential areas. This study is based on a unique data set that includes several million cases of falling, cutting and poisoning in Sweden during the period 1990-2013 which lead to either to death, hospitalisation or to a visit to a health care provider, and a control group randomly selected from the population. Three riskgroups are given special attention in the analysis: (1) old people, (2) children, (3) persons with disabilities and or long term illnesses. Methods Multilevel regression analysis and geographical information systems, GIS. Results The results show the probability for each riskgroup to be exposed to each type of injury event, and how this probability varies with place (GIS), previous exposure, type of household, socioeconomic status and type of housing. Conclusions The project is ongoing. Our cross-sectorial group has demonstrated the importance of injury epidemiology as a guiding principle in architectural design, particularly for high-risk groups.