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1 Neuropsychological Outcome After Cardiac Arrest: Results from a Sub-study of the Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest (TTM2) Trial
- Erik Blennow Nordström, Susanna Vestberg, Lars Evald, Marco Mion, Magnus Segerström, Susann Ullen, John Bro-Jeppesen, Hans Friberg, Katarina Heimburg, Anders M. Grejs, Thomas R. Keeble, Hans Kirkegaard, Hanna Ljung, Sofia Rose, Matthew P. Wise, Christian Rylander, Johan Unden, Niklas Nielsen, Tobias Cronberg, Gisela Lilja
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 789-790
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- Article
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Objective:
To describe cognitive impairment in out-of-hospital cardiac arrest (OHCA) survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.
Participants and Methods:This was a prospective case control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. We administered an extensive neuropsychological assessment at approximately 7 months post-cardiac event, including a neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. Z-scores of individual tests were converted to neuropsychological composite scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions). Between-group differences on the neuropsychological composite scores were investigated with linear regression. Associations between anxiety, depression, fatigue, insomnia, hypertension, diabetes, and the neuropsychological composite scores among OHCA survivors were calculated with Spearman’s rho.
Results:Of 184 eligible OHCA survivors, 108 were included (mean age = 62, 88% male), with 92 MI controls enrolled (mean age = 64, 89% male). Amongst OHCA survivors, 29% performed z <-1 indicating at least borderline-mild impairment in >2 cognitive domains, and 14% performed z <-2 exhibiting major impairment in >1 cognitive domain. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = -0.37, 95% confidence intervals [-0.61, -0.12]), verbal (MD = -0.34 [-0.62, -0.07]), and visual/constructive functions (MD = -0.26 [-0.47, -0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, processing speed (MD = -0.41 [-0.74, -0.09]) and executive functions (MD = -0.69 [-1.13, -0.24]) were also worse following OHCA. Depressive symptoms were associated with worse executive functions (rs = -0.37, p <0.001) and worse processing speed (rs = -0.27, p = 0.01) post-OHCA. Anxiety symptoms (rs = -0.21, p = 0.01) and general fatigue (rs = -0.24, p = 0.01) were associated with worse executive functions. Diabetes was associated with worse processing speed (rs = -0.20, p = 0.03), visual/constructive (rs = -0.29, p <0.001) and executive functions (rs = -0.25, p = 0.02), while hypertension and insomnia were not significantly associated with neuropsychological test performance.
Conclusions:Cognitive impairment is generally mild following OHCA, but most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed worse than MI controls. We suggest that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.
8 - The Silent Expansion of Welfare to Work Policies: how Policies are Enhanced Through the Use of Categorizations, Evidence-Based Knowledge and Self-Governance
- Edited by Anja Eleveld, VU University Amsterdam, Thomas Kampen, Josien Arts
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- Book:
- Welfare to Work in Contemporary European Welfare States
- Published by:
- Bristol University Press
- Published online:
- 10 March 2021
- Print publication:
- 29 January 2020, pp 163-188
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Summary
Introduction
Previous chapters of the book have explored and problematized the justificatory narratives surrounding and paving the way for welfare to work (WTW) programmes. Instead of investigating how such policies are being justified, this chapter digs into some of the ways in which recent WTW programmes in Denmark have avoided facing the imperative of public justification. It analyses how the scope of some WTW policies have been radically extended in quite subtle ways, without having to be publicly scrutinized and justified. Put differently, this chapter analyses politics that does not present itself as politics.
The research endeavour in the chapter is inspired by a recent proliferation of what has been termed ‘management and governance studies’ (Brodkin, 2012; Brodkin and Marston, 2013). Such studies analyse how organizational changes in the management and governance of street-level organizations affect policies (for example, Bjørnholt and Larsen, 2014). For instance, Soss and colleagues (2011) documented in their study of Florida Work Regions how a New Public Management reform, officially aiming at creating a more efficient and better working system through the use of performance measures, in practice led to a marked increase in the use of sanctions – particularly towards the most vulnerable clients. Likewise, Brodkin (2011) questioned the apparent success of a managerial welfare reform in Chicago that linked outcome measurement to fiscal incentives for the frontline workers, through an ethnographic investigation of the ways in which the employees actually produced these performances. This chapter broadens this research agenda in two ways. Firstly, by arguing that there are many different ways apart from governance and management reforms in which WTW policies are being expanded through other means than traditional policy reforms. The growing sophistication of the available data and methods for designing, measuring and implementing new policies also marks new avenues, beyond traditional policy or governance reforms, for expanding and promoting policies through technical and seemingly objective measures. Secondly, the goal is to show how piecemeal and technical adjustments to policies are not only affecting the policies enacted by frontline workers of the welfare state, but also have wider consequences for how WTW policies are justified.