Elisabet Åkesson

Background. Numerous risk factors for stroke are modifiable and are associated with lifestyle and daily habits. An occupational perspective in prevention, which emphasizes habits and routines, can facilitate sustainable and healthy lifestyle changes. Additionally, lifestyle changes generally take place within a social context, making family involvement indispensable. Purpose. This study aims to explore family support from the perspective of persons with risk for stroke (PWRS) who participated in an occupation-based stroke prevention program, and their family members. Method. Explorative qualitative design using interviews was conducted with 10 PWRS who participated in the Make My Day intervention and 10 family members of intervention participants, including both married and nonmarried partners and adult children. Data were analyzed using an inductive semantic approach and reflexive thematic analysis. Findings. Family support depends on the nature of relationships, the family's willingness to accept support, and expectations. Three themes were generated through the analysis: (a) shared perspectives on lifestyle influence support, (b) balancing support and individual responsibility, and (c) generating tensions from different views on health and lifestyle habits. Conclusion. Family support encourages lifestyle changes by sharing activities, offering encouragement, and providing positive reinforcement. Nonetheless, difficulties can occur in maintaining a balance between supporting family members and respecting their personal responsibility, particularly when family members have varying levels of understanding regarding health.

Background. Studying the implementation of occupation-based stroke prevention interventions in primary healthcare is necessary and will provide insights of interventions’ feasibility in clinical practice. Purpose. To explore the implementation of the Make My Day (MMD) stroke prevention intervention in Swedish primary healthcare with health professionals (HPs) and among persons at risk for stroke. Method. The Medical Research Councils process evaluation framework domains, implementation, mechanisms of impact and context, guided investigation of the implementation. Data were collected through logbooks, fieldnotes, and interviews. Descriptive statistics were used to analyze process data while thematic analysis was applied to explore experiences of and interactions with the MMD intervention and contextual influences. Results. There was a high belief in using engaging occupations to facilitate lifestyle habit change among HP's and persons at risk for stroke. The HP's complementary competencies, sharing experiences within groups and digital self-monitoring was valued. Time constraints and age differences in groups impacted MMD delivery. Reaching a representative sample, and different Swedish primary healthcare settings was challenging. Conclusion. The occupation-based framework and intervention implementation was feasible yet sustainability in Swedish primary healthcare requires securing HP staff and time to deliver prevention like MMD, and reaching hard-to-reach groups in the study population.

Lifestyle habits significantly impact health, including stroke risk, and structured approaches in primary healthcare are needed to address risk factors and promote healthy lifestyles. Make My Day, a multifactorial activity-focussed and lifestyle-based stroke prevention programme, was developed to address the rising challenges of increasingly unhealthy lifestyle habits and stroke risk factors. This study evaluated the effect of the Make My Day intervention to reduce stroke risk at 12 months in primary healthcare. In this single-blinded randomised controlled trial, 122 individuals at risk for stroke were randomised to intervention group (n = 63) or control group (n = 59). Inferential statistics and a longitudinal mixed-effect logistic regression model were used to analyse the primary outcome. Inferential statistics were applied to analyse secondary outcomes, that is, goal achievement. At 12 months, the odds for high stroke risk (adjusted OR (CI) = 0.390 (0.156; 0.971), P = .043), was found significantly lower in the intervention group, compared to the control group. Both groups showed significant improvements in several stroke risk factors and goal fulfilment at 12 months. The Make My Day intervention trial indicates a reduction in stroke risk, and the potential of individual goals and engaging everyday activities to support lifestyle change. Make My Day can be a valuable means to address stroke prevention within primary healthcare. The study is registered at ClinicalTrials.gov, Identifier: NCT05279508. Protocol ID: KI2020-00175.

Background: To support recovery after stroke, rehabilitative actions and innovations are needed in resource-limited health care and geographically distant regions. Objective: The first objective was to explore the feasibility of performing home-based training using the novel DISKO-tool including both telerehabilitation and serious gaming customized to target dynamic balance poststroke. The second objective was to assess the outcome using the Balance Evaluation Systems Test as the primary outcome. Methods: This randomized controlled pilot trial, included ambulatory patients ≥18 years of age with physical impairments 3–6 months poststroke. During primary care rehabilitation, patients were randomized to conventional and 6 weeks of DISKO-tool training in the home ( n = 10) or conventional training only ( n = 11). Feasibility was assessed with process, resource, management, and scientific perspectives using questionnaires, logbooks, DISKO-tool data and clinical assessments. Results: The study design was feasible including safety, resource capacity, a retention rate of 87%, high compliance to the protocol (mean 30 training days), and highly rated experience of the tool (median 10 of 10) despite some technical issues. The recruitment rate was low. The DISKO-group presented improved balance, especially in anticipatory postural adjustment compared to the conventional group ( p < 0.001; effect size 2.195; 95% CI 1.015–3.336). Conclusions: Applying the DISKO-tool in home-based stroke rehabilitation was feasible and the piloted methodology suited for a larger RCT, as long as a wider inclusion time window poststroke is applied to enhance the recruitment rate. Rapid development and a limited lifespan of off-the-shelf hardware products warrant continuous technical development.

Background. Involving people with acquired brain injury in service development has the potential to improve service and give experience-based knowledge legitimacy. The objective of this study was to explore experiences of sharing experience-based knowledge of living with acquired brain injury with others, with a particular focus on the conditions for sharing and learning, and the legitimacy of experience-based knowledge. Materials and Methods. Using a single case study design, the processes in two groups that were part of a Swedish supportive network for people with acquired brain injury were explored. One group consisted mainly of people with acquired brain injury who authored a blog and the other group consisted of healthcare staff who produced educational material with the involvement of a person with own experience of acquired brain injury. The data consisted of forty-one collective blogs, fifteen semistructured individual interviews, and ten observations from meetings. The data were analysed by utilizing the community of practice framework and the concepts of legitimate peripheral participation and epistemic injustice. Results. The findings showed that both groups developed learning processes with a focus on everyday rehabilitation as a joint enterprise. Mutual engagement developed from doing activities together and legitimacy in the groups came from engagement in these activities. In the education group, the ambition to involve people with own experience of acquired brain injury was never realized in practice. Hence, experience-based knowledge of living with acquired brain injury never got legitimacy in the group. Conclusions. We conclude that integrating experience-based knowledge from people with own experience of acquired brain injury demands careful and deliberate planning with specific consideration to existing power asymmetries between healthcare professionals and people with own experience. Mitigating epistemic injustice and gaining legitimacy for such knowledge require that people with experience of living with acquired brain injury are recognized as knowledge producers.

Introduction The individual, societal and economic benefits of stroke prevention are high. Even though most risk factors can be reduced by changes to lifestyle habits, maintaining new and healthy activity patterns has been shown to be challenging. The aim of the study is to evaluate the impact of an interdisciplinary team-based, mHealth-supported prevention intervention on persons at risk for stroke. The intervention is mediated by engaging everyday activities that promote health. An additional aim is to describe a process evaluation that serves to increase knowledge about how the programme leads to potential change by studying the implementation process and mechanisms of impact. Methods and analysis The study will be a randomised controlled trial including 104 persons at risk for stroke. Persons at risk of stroke (n=52) will be randomised to an mHealth-supported stroke prevention programme. Controls will have ordinary primary healthcare (PHC) services. The 10-week programme will be conducted at PHC clinics, combining group meetings and online resources to support self-management of lifestyle change using engaging everyday activities as a mediator. Primary outcomes are stroke risk, lifestyle habits and participation in health-promoting activities. Assessments will be performed at baseline and at follow-up (11 weeks and 12 months). The effects of the programme will be analysed using inferential statistics. Implementation will be analysed using qualitative and quantitative methods. Ethics and dissemination The study has been approved by the Swedish Ethical Review Authority. Study results will be disseminated in peer-reviewed journals and at regional and international conferences targeting mixed audiences. Trial registration number NCT05279508.

Among individuals who have recovered from COVID-19 around the world, there is a substantial number who would need support in finding their way back to meaningful and productive work. The aims of this paper are to demonstrate the multitude of factors that shape return to work (RTW) practices across and within several countries, and argue for the need to explore RTW from an international perspective during an on-going pandemic, focusing on working age adults who have recovered from COVID-19. Conditions for RTW differ across countries. Occupational therapy has a central role in medical rehabilitation after injury and illness (including COVID-19), but the occupational therapy community has, to the best of our knowledge, yet to raise awareness and advance evidence regarding its role in post-COVID RTW processes. A robust evidence-based knowledge on RTW that can be utilised by occupational therapists during the present and future pandemics is needed.

Scaffolds of recombinant spider silk protein (spidroin) and hyaluronic acid (HA) hydrogel hold promise in combination with cell therapy for spinal cord injury. However, little is known concerning the human immune response to these biomaterials and grafted human neural stem/progenitor cells (hNPCs). Here, we analyzed short- and long-term in vitro activation of immune cells in human peripheral blood mononuclear cells (hPBMCs) cultured with/without recombinant spidroins, HA hydrogels, and/or allogeneic hNPCs to assess potential host–donor interactions. Viability, proliferation and phenotype of hPBMCs were analyzed using NucleoCounter and flow cytometry. hPBMC viability was confirmed after exposure to the different biomaterials. Short-term (15 h) co-cultures of hPBMCs with spidroins, but not with HA hydrogel, resulted in a significant increase in the proportion of activated CD69⁺ CD4⁺ T cells, CD8⁺ T cells, B cells and NK cells, which likely was caused by residual endotoxins from the Escherichia coli expression system. The observed spidroin-induced hPBMC activation was not altered by hNPCs. It is resource-effective to evaluate human compatibility of novel biomaterials early in development of the production process to, when necessary, make alterations to minimize rejection risk. Here, we present a method to evaluate biomaterials and hPBMC compatibility in conjunction with allogeneic human cells.

It is important to understand how healthy lifestyle habits can be developed as they are essential in cardiovascular disease (CVD) prevention. There is limited knowledge regarding whether, and how, ...

Fertility preservation for male childhood cancer survivors not yet capable of producing mature spermatozoa, relies on experimental approaches such as testicular explant culture. Although the first steps in somatic maturation can be observed in human testicular explant cultures, germ cell depletion is a common obstacle. Hence, understanding the spermatogonial stem cell (SSC) niche environment and in particular, specific components such as the seminiferous basement membrane (BM) will allow progression of testicular explant cultures. Here, we revealed that the seminiferous BM is established from 6 weeks post conception with the expression of laminin alpha 1 (LAMA 1) and type IV collagen, which persist as key components throughout development. With prepubertal testicular explant culture we found that seminiferous LAMA 1 expression is disrupted and depleted with culture time correlating with germ cell loss. These findings highlight the importance of LAMA 1 for the human SSC niche and its sensitivity to culture conditions.