No abstract

Thirty-six long term care residents with dementia and agitation were selected for participation in this eight week study. During the eight week period, the participants received two different four week therapeutic recreation interventions in a clinical crossover design. These interventions included a sensorimotor program and a traditional activity program. The effects of these two programs were evaluated in terms of the effect on strength, flexibility, overall functioning, and agitation. The analysis showed that there was a significant improvement of grip strength, flexibility, and a reduction in agitation during the sensorimotor segment of the treatment. The results of this study indicate a new direction for therapeutic recreation specialists working with older adults with dementia and agitation.

No abstract

Brasile (1990) has proposed a “new perspective” on efforts in the United States to integrate persons without disabilities in activities currently limited exclusively to those with disabilities (i.e., wheelchair sports). It is contended herein that Brasile’s rationale for “reverse integration” is based upon faulty logic; moreover, it violates fundamental concepts that form the foundation of the wheelchair sports movement in the U.S. Not only would it reduce competitive opportunities for persons with disabilities, but reverse integration reflects an outdated perspective that wheelchair sports is primarily a form of rehabilitation rather than sports competition. Finally, the fundamental issue in this debate is identified: who will ultimately decide who is or is not eligible for participation in wheelchair sports in the U.S.? In 1987 the players (i.e., team delegates) within the National Wheelchair Basketball Association voted overwhelmingly against the inclusion of players without disabilities. The athletes themselves should continue to have control of wheelchair sports.

Background Noncommunicable diseases (NCDs) are the leading cause of global mortality, and their risk factors largely manifest at the community level. In collaboration with public health, primary care is well placed to assess and address the local social determinants of NCDs (SDONCDs). Post-Astana, many countries are reorienting their primary care systems to incorporate these traditional public health functions, but there is little evidence to guide reform. We aimed to collate examples of primary care organisations that already engage in this activity. Methods Following Cochrane guidance, PubMed, MEDLINE, Embase & HMIC were searched from inception to 28/7/2019, along with hand-searching of references for any study designs that examined international primary care organisation(s) that addressed local SDONCDs. Independent dual review was used for screening, data extraction, and quality assessment - for which we used ROBINS-i. Results Searches identified 666 studies of which 17 studies from Canada, South Africa, UK, and USA were included. All used descriptive study designs. Individual-level surveys and interviews were the most common SDONCD data collection methods reported. Fewer studies collated population-level data held by external agencies. Actions ranged from individual-level interventions to novel representation of primary care organisations on system-level policy and planning committees. Several enablers and barriers to collecting and mobilising social determinant data within well- and under-resourced primary care settings were identified. Conclusions Several models of integrated public health and primary care already exist that fulfil the Astana mandate of developing place-based preventive services, tailored to local needs. Public health input at this granular level is required to support primary care services as they extend their scope of practice, and to assist with monitoring and evaluation of new initiatives to mitigate unmet health and social needs. Key messages Primary care organisations are increasingly being encouraged to assess and address local social determinants of noncommunicable diseases but there is weak evidence to guide reform. The different approaches described in our review can help policymakers tasked with integrating public health functions into primary care.