To live as mentally disabled in the risk society.

The contemporary society is to some extent characterized by longitudinal changes, towards individualization, uncertainty, and risk. Numerous risks and dangers in modern society have been mastered, while others have emerged, often created by human actions. The individual's freedom of choice has increased, but also the responsibility for the choices made. In this society, the risk society, there is a greater need for formative and situation-related knowledge to manage risks. The aims of this paper are to discuss the concept of risk society in the light of everyday experiences made by people with mental disabilities, how challenges can be mastered and positive possibilities can be utilized. Data collection was made through a multistage focus group, and the data were analysed by qualitative content analysis. The results show that characteristics of the risk society are identified by people with mental disabilities. Change and uncertainty, obstacles created by societal institutions, lack of trust, and the need of adapted working conditions are frequently experienced, impersonal relations and feelings of loneliness as well. However, these conditions can be partly counteracted by belonging to an alternative fellowship, which might lead to quality of life-related personal improvements.

People with mental disabilities negotiating life in the risk society: a theoretical approach.

Risk assessment and risk management owing to the potential threat from people with serious mental disorders living in the local community have been given much attention in psychiatric and mental healthcare research. Research connected to risks associated with living in the community for people with mental disabilities has also been published. This paper focuses on the situation of people with mental health problems and disabilities from a quite different perspective. In the light of the societal change towards what has been named the 'risk society', the consequences for vulnerable groups, especially people with mental disabilities, are discussed. Furthermore, the purpose is to shed light on how structural factors, like the process of individualization and 'de-population' of societal institutions, are affecting the living conditions for people with mental disabilities - positively as well as negatively. The importance of trust in the risk society is highlighted, but also the important role that the local community might play in relation to people with mental disabilities. Finally, some potentialities and new roles that this development towards a risk society and increased individualization paradoxically can open up for people with mental disabilities are outlined.

Socio-economic gradient in food selection and diet quality among 70-year olds.

OBJECTIVE: The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes. DESIGN: Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg. PARTICIPANTS: A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden. METHODS: One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI). RESULTS: Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men. CONCLUSIONS: Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

Relationship between MNA and SF-36 in a free-living elderly population aged 70 to 75.

BACKGROUND: Within a larger study of social network and nutrition, we investigated measurements of nutritional status and health related quality of life. OBJECTIVE: To relate a well-established questionnaire of nutritional status (MNA) to a likewise well-established questionnaire of health related quality of life (SF-36) in community dwelling, free-living and, healthy 70-75 years old persons. DESIGN: Before an interview, the MNA and SF-36 questionnaires were filled in by 128 participants from a sample of 262 subjects. RESULTS: The MNA worked well as a measurement in this sample. Many MNA aspects correlated with the SF-36 scales. The correlations between MNA total score and the eight SF-36 scales varied from .27 to .62. DISCUSSION: This correlation was partly due to the fact that MNA has questions of health but also to the fact that there is an empirical relation between nutrition and health. CONCLUSION: The MNA measurement is applicable to a healthy, free-living elderly population and parts of the MNA can be interpreted as measurements of health related quality of life. Low values of SF-36 could also be used as predictors of risk of malnutrition, although further studies are required to confirm this result.

Cross-cultural analysis of longevity among Swedish and American elders: the role of social networks in the Gothenburg and Missouri longitudinal studies compared.

This paper reports the results of a cross-national comparison of the 'H70' longitudinal study of elders in Gothenburg, Sweden, with the 'Rural Missouri Elders' longitudinal study in Missouri, USA. Analysis of the combined data sets focused on the question of how longevity was affected by culturally divergent forms of social network participation. The H70 study was a representative, systematic 3/10 sample of 70-year-old (in 1971) men and women living in Gothenburg. Follow-up data was gathered when the respondents were 75, 79, 81, 82, 83, 85, 88, 90 and 95 years of age. Face-to-face interviews and physical medical examinations were the major source of data. The Missouri study involved a representative cluster proportional-to-size sample of all rural Missourians 65 years of age and older. Face-to-face interviews were conducted in 1966, 1974 and 1987. Logistic regression and cross-tabular analyses revealed that social networks were important predictors of longevity for both samples. However, marital status and participation in formal organizations predicted longevity for the Americans, whereas contact with children emerged as the predictor variable for the Swedes. Specific functions of the different network patterns in the two countries are discussed.

The Johanneberg study--a sociomedical survey in an urban elderly population. I. General presentation of the study including an analysis of non-response and identification of risk groups.

This study is the Swedish part of a world-wide transcultural and interdisciplinary study in elderly populations which addresses food habits, health and life-style. The aim of this paper is to present the general design including an analysis of non-response, and to identify risk-groups for intervention programmes. The study comprised 217 noninstitutionalized males (n = 73) and females (n = 144), aged 70 and over (mean age 78 years) in a small urban area. Home visits and clinical examinations with standard methods were used. The participation rate was 76%. Significant differences between non-respondents and respondents could be seen, which may be important when planning health promotion. On the basis of experiences during the examinations, a risk-group was identified for prospective and intervention study purposes, based on a multiple variable model and a clinical model.

On the use of the WHO handicap classification in a population study of 73- and 76-year-old men and women.

The WHO ICIDH classification of handicap was used in a population sample studied at 73 (n = 504) and 76 (n = 649) years of age. In the sample, there was either no handicap at all or the degree of handicap was generally low. In most handicap categories, however, the grades increased from 73 to 76 years. The self-rated activity level and the handicap category Occupation showed only low correlation. Good agreement was found between the handicap category Physical independence and assessments of Personal and Instrumental ADL and there was also a correlation between Mobility and maximal walking speed. Correlations were found between the handicap categories and the dimensions in the Nottingham Health Profile (NHP), but r-values were generally rather low. The highest correlation was that with the dimension of Physical mobility. The difference between self-assessed health aspects of quality of life and observer ratings using given norms is stressed.

Liver transplantation in a boy with acute porphyria due to aminolaevulinate dehydratase deficiency.

The clinical and biochemical outcome of a liver transplantation in a seven-year-old boy with acute porphyria due to aminolaevulinate dehydratase deficiency is described. Before transplantation standard liver function tests were normal and the rationale for transplantation was that the new liver would reduce the metabolic disturbance and thus avert the porphyric symptoms. During the year after the transplantation, the functioning of the new liver has been excellent. Basal excretion of porphyrin and porphyrin precursors has remained unchanged but, with the new liver transplant the patient has been able to withstand several porphyrinogenic challenges without increasing the excretion. Episodes of neurological and respiratory crises may have been due to persistent porphyric vulnerability. Alternatively, two early attacks may have been caused by neurotoxic effects of cyclosporin in combination with the existing damage to nervous tissue.

Medical-social intervention in a 70-year-old Swedish population. A general presentation of methodological experience.

The possibilities of improving physical, mental and social functioning or retarding the development of handicap and reducing the need for medical and social services were investigated in an interdisciplinary intervention study in a representative population sample of 1206 70-year-olds. The assessments concerned cognitive function and mental health, earlier and current social interaction and living conditions, state of health including dental status, muscular strength and performance, pulmonary and cardiovascular function, bone mineral content, ADL and dietary habits. The intervention (response rate 76.8%) concerned social, psychological, environmental and medical aspects in 400 and medical aspects only in 406 probands. 400 register controls were sampled for comparison. The intervention period was 2 years, and a follow-up study will be performed at the age of 75. The interventions were guided by the life-style and the activity hypotheses within the resource perspective to promote everyday activities. The study allows comparisons with two previous 70-year-old cohorts investigated with similar methods in Gothenburg.