Browsing by Subject "institutionalization"

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  • Laakso, H. M.; Hietanen, M.; Melkas, S.; Sibolt, G.; Curtze, S.; Virta, M.; Ylikoski, R.; Pohjasvaara, T.; Kaste, M.; Erkinjuntti, T.; Jokinen, H. (2019)
    Background and purposeImpairment of executive functions (EFs) is a common cognitive symptom post-stroke and affects independence in daily activities. Previous studies have often relied on brief cognitive tests not fully considering the wide spectrum of EF subdomains. A detailed assessment of EFs was used to examine which of the subdomains and tests have the strongest predictive value on post-stroke functional outcome and institutionalization in long-term follow-up. MethodsA subsample of 62 patients from the Helsinki Stroke Aging Memory Study was evaluated with a battery of seven neuropsychological EF tests 3 months post-stroke and compared to 39 healthy control subjects. Functional impairment was evaluated with the modified Rankin Scale (mRS) and Instrumental Activities of Daily Living (IADL) scale at 3 months, and with the mRS at 15 months post-stroke. Institutionalization was reviewed from the national registers of permanent hospital admissions in up to 21-year follow-up. ResultsThe stroke group performed more poorly than the control group in multiple EF tests. Tests of inhibition, set shifting, initiation, strategy formation and processing speed were associated with the mRS and IADL scale in stroke patients. EF subdomain scores of inhibition, set shifting and processing speed were associated with functional outcome. In addition, inhibition was associated with the risk for earlier institutionalization. ConclusionsExecutive function was strongly associated with post-stroke functional impairment. In follow-up, poor inhibition was related to earlier permanent institutionalization. The results suggest the prognostic value of EF subdomains after stroke.
  • Ochieng, Robert M.; Arts, Bas; Brockhaus, Maria; Visseren-Hamakers, Ingrid J. (2018)
    Reducing emissions from deforestation and forest degradation in developing countries (REDD+) has opened up a new global discussion on forest monitoring and carbon accounting in developing countries. We analyze and compare the extent to which the concept of measurement, reporting, and verification (MRV) for REDD+ has become institutionalized in terms of new policy discourses, actors, resources, and rules in Indonesia, Peru, and Tanzania. To do so, we draw on discursive institutionalism and the policy arrangement approach. A qualitative scale that distinguishes between "shallow" institutionalization on the one end, and "deep" institutionalization on the other, is developed to structure the analysis and comparison. Results show that in all countries MRV has become institutionalized in new or revised aims, scope, and strategies for forest monitoring, and development of new agencies and mobilization of new actors and resources. New legislations to anchor forest monitoring in law and procedures to institutionalize the roles of the various agencies are being developed. Nevertheless, the extent to which MRV has been institutionalized varies across countries, with Indonesia experiencing "deep" institutionalization, Peru "shallow-intermediate" institutionalization, and Tanzania "intermediate-deep" institutionalization. We explore possible reasons for and consequences of differences in extent of institutionalization of MRV across countries.