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  • 1.
    Alimoradi, Z.
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Bahrami, N.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Khodaparast, S.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Griffiths, M. D.
    Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Mediating role of psychological distress and domestic violence in the association of fear of COVID-19 with marital satisfaction and sexual quality of life among women of reproductive age: An Iranian cross-sectional study2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 2Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aimed to determine the mediating role of psychological distress and domestic violence in the association of fear of COVID-19 with marital satisfaction and sexual quality of life (QoL) among Iranian women of reproductive age. METHODS: A cross-sectional study comprising 324 married women was conducted. Online convenience sampling was used to collect data. SPSS PROCESS macro was used for the mediation analysis. The direct and indirect effects of the fear of COVID-19 on sexual QoL and marital satisfaction were estimated comprising a 95% CI using 5000 bootstrap samples. Pairwise comparisons between the mediators were calculated by Hayes' macros. RESULTS: A positive/negative or suspected history of COVID-19 infection had marginally significant relationship with marital satisfaction (p=0.049). The total effect of fear of COVID-19 on sexual QoL was significant (b=-1.31, SE=0.20, p<0.001). Fear of COVID-19 had no significant direct effect on sexual QoL (b=-0.22, SE=0.19, p=0.24) but it had an indirect effect on sexual QoL via mediation of psychological distress (b=-0.34, SE=0.09, 95% CI: -0.53 to -0.19) and domestic violence (b=-0.75, SE=0.18, 95% CI: -1.12 to -0.40). The total effect of fear of COVID-19 on marital satisfaction was significant (b=-1.91, SE=0.32, p<0.001). Fear of COVID-19 had no significant direct effect (b=0.20, SE=0.25, p=0.42) on marital satisfaction but it had an indirect effect on marital satisfaction via mediation of psychological distress (b=-0.59, SE=0.13, 95% CI: -0.86 to -0.36) and domestic violence (b=-1.51, SE=0.29, 95% CI: -2.08 to -0.92). CONCLUSION: The fear of COVID-19 during the pandemic indirectly decreased women's marital satisfaction and sexual QoL via increased psychological distress and domestic violence. Consequently, in critical situations such as the COVID-19 pandemic, improving couples' psychological health and reducing domestic violence are likely to improve women's sexual QoL and marital satisfaction.

  • 2.
    Alimoradi, Zainab
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Abdi, Fatemeh
    School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran.
    Gozal, David
    Department of Child Health and Child Health Research Institute, University of Missouri, Columbia, Missouri, USA.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science.
    Estimation of sleep problems among pregnant women during COVID-19 pandemic: a systematic review and meta-analysis2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e056044Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the sleep problems among pregnant women during the COVID-19 pandemic.

    ELIGIBILITY CRITERIA: English, peer-reviewed, observational studies published between December 2019 and July 2021 which assessed and reported sleep problem prevalence using a valid and reliable measure were included.

    INFORMATION SOURCES: Scopus, Medline/PubMed Central, ProQuest, ISI Web of Knowledge and Embase.

    RISK OF BIAS ASSESSMENT TOOL: The Newcastle-Ottawa Scale checklist.

    SYNTHESIS OF RESULTS: Prevalence of sleep problems was synthesised using STATA software V.14 using a random effects model. To assess moderator analysis, meta-regression was carried out. Funnel plot and Egger's test were used to assess publication bias. Meta-trim was used to correct probable publication bias. The jackknife method was used for sensitivity analysis.

    INCLUDED STUDIES: A total of seven cross-sectional studies with 2808 participants from four countries were included.

    SYNTHESIS OF RESULTS: The pooled estimated prevalence of sleep problems was 56% (95% CI 23% to 88%, I2=99.81%, Tau2=0.19). Due to the probability of publication bias, the fill-and-trim method was used to correct the estimated pooled measure, which imputed four studies. The corrected results based on this method showed that pooled prevalence of sleep problems was 13% (95% CI 0% to 45%; p<0.001). Based on meta-regression, age was the only significant predictor of prevalence of sleep problems among pregnant women.

    LIMITATIONS OF EVIDENCE: All studies were cross-sectional absence of assessment of sleep problems prior to COVID-19, and the outcomes of the pregnancies among those with and without sleep problems in a consistent manner are among the limitation of the current review.

    INTERPRETATION: Pregnant women have experienced significant declines in sleep quality when faced with the COVID-19 pandemic. The short-term and long-term implications of such alterations in sleep on gestational and offspring outcomes are unclear and warrant further studies.

    PROSPERO REGISTRATION NUMBER: CRD42020181644.

  • 3.
    Amofah, H. A.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Instenes, I.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Fridlund, B.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Haaverstad, R.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Kuiper, K.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Ranhoff, A. H.
    Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekvål, T. M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Octogenarian patients' sleep and delirium experiences in hospital and four years after aortic valve replacement: A qualitative interview study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 1, article id e039959Article in journal (Refereed)
    Abstract [en]

    Objectives

    Sleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients' long-Term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.

    Design

    An explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.

    Setting

    Patients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.

    Participants

    Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.

    Results

    For the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; Hours in bed represented emotional chaos. Whereas three subthemes described the patients' experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep, the struggle between sleep and activity and elements influencing sleep. Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.

    Conclusions

    For octogenarian patients, sleep disturbances and delirium are long-Term burdens and need a greater attention in order to improve patient care. 

  • 4.
    Arnold, Samuel R. C.
    et al.
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Foley, Kitty-Rose
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Hwang, Ye In (Jane)
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Richdale, Amanda L.
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Uljarevic, Mirko
    Stanford Autism Center, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University.
    Lawson, Lauren P.
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Cai, Ru Ying
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Falkmer, Marita
    Jönköping University, School of Education and Communication, HLK, CHILD. Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Lennox, Nick
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Urbanowicz, Anna
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Trollor, Julian N.
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Cohort profile: The Australian Longitudinal Study of Adults with Autism2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 12, article id e030798Article in journal (Refereed)
    Abstract [en]

    PURPOSE: There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study. ​

    PARTICIPANTS: The Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics). ​

    FINDINGS TO DATE: An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area.

    ​FUTURE PLANS: A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

  • 5.
    Clarke, David
    et al.
    Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford, United Kingdom.
    Jones, Fiona
    Faculty of Health Social Care and Education, St George's University of London, London, United Kingdom.
    Harris, Ruth
    Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings?: A rapid evidence synthesis2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 7, article id e014650Article in journal (Refereed)
    Abstract [en]

    Background

    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings.

    Aims

    To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings.

    Design

    Rapid evidence synthesis.

    Data sources

    Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues.

    Study selection

    Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting.

    Findings

    712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made.

    Conclusions

    Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered. 

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  • 6.
    Eide, Leslie S. P.
    et al.
    Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Nordrehaug, Jan Erik
    Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
    Norekval, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway .
    Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: A prospective cohort study2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 10, article id e012683Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission.

    Design: Prospective cohort study of patients undergoing elective SAVR or TAVI.

    Setting: Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway.

    Participants: Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. Primary and secondary outcome measures: The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries.

    Results: Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (nondelirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. Conclusions: Delirium in octogenarians after aortic valve therapy might be a serious risk factor for postoperative morbidity and mortality. Cardiovascular disorders and injuries were associated with first-time readmissions in these patients.

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  • 7.
    Fröding, Elin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Region Jönköpings län, Jönköping, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Futurum, Region Jönköpings län, Jönköping, Sweden.
    Westrin, Åsa
    Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Ros, Axel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Region Jönköpings län, Jönköping, Sweden.
    Suicide as an incident of severe patient harm: A retrospective cohort study of investigations after suicide in Swedish healthcare in a 13-year perspective2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 3, article id e044068Article in journal (Refereed)
    Abstract [en]

    Objectives

    To explore how mandatory reporting to the supervisory authority of suicides among recipients of healthcare services has influenced associated investigations conducted by the healthcare services, the lessons obtained and whether any suicide-prevention-related improvements in terms of patient safety had followed.

    Design and settings

    Retrospective study of reports from Swedish primary and secondary healthcare to the supervisory authority after suicide.

    Participants

    Cohort 1: the cases reported to the supervisory authority in 2006, from the time the reporting of suicides became mandatory, to 2007 (n=279). Cohort 2: the cases reported in 2015, a period of well-established reporting (n=436). Cohort 3: the cases reported from September 2017, which was the time the law regarding reporting was removed, to November 2019 (n=316).

    Primary and secondary outcome measures

    Demographic data and received treatment in the months preceding suicide were registered. Reported deficiencies in healthcare and actions were categorised by using a coding scheme, analysed per individual and aggregated per cohort. Separate notes were made when a deficiency or action was related to a healthcare-service routine.

    Results

    The investigations largely adopted a microsystem perspective, focusing on final patient contact, throughout the overall study period. Updating existing or developing new routines as well as educational actions were increasingly proposed over time, while sharing conclusions across departments rarely was recommended.

    Conclusions

    The mandatory reporting of suicides as potential cases of patient harm was shown to be restricted to information transfer between healthcare providers and the supervisory authority, rather than fostering participative improvement of patient safety for suicidal patients.

    The similarity in outcomes across the cohorts, regardless of changes in legislation, suggests that the investigations were adapted to suit the structure of the authority’s reports rather than the specific incident type, and that no new service improvements or lessons are being identified.

  • 8.
    Hvitfeldt-Forsberg, Helena
    et al.
    Medical Management Centre, Karolinska Institutet.
    Mazzocato, Pamela
    Medical Management Centre, Karolinska Institutet.
    Glaser, Daniel
    Medical Management Centre, Karolinska Institutet.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Unbeck, Maria
    Danderyds sjukhus.
    Staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in quality improvement: A focus group discussion study at two hospital settings in Sweden2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 5, article id e013869Article in journal (Refereed)
    Abstract [en]

    Objective: To explore healthcare staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in improvement efforts.

    Design: Two focus group discussions were performed.

    Settings: Two settings were included: a rheumatology department and an orthopaedic section both situated in Sweden.

    Participants: Healthcare staff and managers (n=13) from the two settings.

    Interventions: Two workshops were performed, one at each setting. Workshops were initiated by a short introduction to simulation modelling. Results from the respective simulation model were then presented and discussed in the following focus group discussion.

    Results: Categories from the content analysis are presented according to the following research questions: how and when simulation modelling can assist healthcare improvement? Regarding how, the participants mentioned that simulation modelling could act as a tool for support and a way to visualise problems, potential solutions and their effects. Regarding when, simulation modelling could be used both locally and by management, as well as a pedagogical tool to develop and test innovative ideas and to involve everyone in improvement work.

    Conclusions: Its potential as an information and communication tool and as an instrument for pedagogic work with healthcare improvement render a broader application and value of simulation modelling than previously reported.

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  • 9.
    Johnsen, Anna M.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Association between occupational physical activity and myocardial infarction: a prospective cohort study2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 10, article id e012692Article in journal (Refereed)
    Abstract [en]

    Objective Recommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results from previous studies on occupational physical activity and the association with myocardial infarction have been inconsistent. The aim of this study was to investigate if occupational physical activity is associated with the risk of myocardial infarction.

    Design Prospective cohort study.

    Participants Data from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used, comprising 9961 employees (6849 men, 3112 women, mean age 42.7 years) having no history of myocardial infarction. The participants were categorised into 3 groups according to their level of occupational physical activity.

    Outcome Data regarding incident myocardial infarction were obtained from the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazard regression was used for estimation of HRs for different levels of occupational physical activity in relation to the risk of myocardial infarction.

    Results During a mean follow-up of 13.1 years, 249 cases of incident myocardial infarction were identified. In analyses adjusted for age, sex and socioeconomic status, participants standing and walking more than 50% of their working day had an HR of 1.13 (95% CI 0.83 to 1.54), compared with participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI 0.59 to 1.24). Further adjustment did not alter the results. Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI 0.17 to 0.84), compared with younger persons who sat most of their working day.

    Conclusions No significant association between occupational physical activity and the risk of myocardial infarction was observed in the total group of employees in this study. Based on the results from this study, occupational physical activity in general does not seem to be enough for reducing the risk of myocardial infarction.

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  • 10.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ockander, Marlene
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Käll, Jacob
    Djursdala samhällsförening, Djursdala, Sweden, Sweden.
    McGrath, Jane
    We Coproduce, London, UK.
    Donetto, Sara
    Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 7, article id e029723Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Cocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.

    METHODS AND ANALYSIS:

    Nine ongoing coproduction projects form the core of an interactive research programme ('Samskapa') during a 6-year period (2019-2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.

    ETHICS AND DISSEMINATION:

    All necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops-facilitated in collaboration with participating case studies and citizens-both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations. 

  • 11.
    Lim, E. L. P.
    et al.
    Jönköping University, School of Health and Welfare.
    Khee, G. Y.
    Department of Pharmacy, Singapore General Hospital, Singapore.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Dept. for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Thumboo, J.
    SingHealth Office of Regional Health, Singapore Health Services, Singapore.
    Allgurin, Monika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Social Work. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 12, article id e059794Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore. DESIGN: An organisational case study using a realist evaluation approach drawing on Greenhalgh et al (2004)'s Diffusion of Innovations in Service Organisations to guide data collection and analysis. Data collection included interviews with seven individuals and three focus groups (including stakeholders from the macrosystem, mesosystem and microsystem levels) about their experiences of EN in Singapore, and field notes from participant observations of EN activities. SETTING: SingHealth, a healthcare cluster serving a population of 1.37 million residents in Eastern Singapore. PARTICIPANTS: Policy makers (n=4), EN programme implementers (n=3), practitioners (n=6) and service users (n=7) participated in individual interviews or focus group discussions. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome data from healthcare institutions (n=13) and community agencies (n=59) were included in document analysis. RESULTS: Singapore's ageing population and need to transition from a hospital-based model to a more sustainable community-based model provided an opportunity for change. The personalised nature and logic of the EN model resonated with leaders and led to collective adoption. Embedded cultural influences such as the need for order and hierarchical structures were both barriers to, and facilitators of, change. Coproduction between service users and practitioners in making care improvements deepened the relationships and commitments that held the network together. CONCLUSIONS: The enabling role of leaders (macrosystem level), the bridging role of practitioners (mesosystem level) and the unifying role of service users (microsystem level) all contributed to EN's success in Singapore. Understanding these roles helps us understand how staff at various levels can contribute to the adoption and adaptation of EN and similar complex innovations systemwide.

  • 12.
    Nordin, Annika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
    Masterson, Daniel
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Health Sciences, University West, Trollhattan, Sweden.
    Measurement and outcomes of co-production in health and social care: A systematic review of empirical studies2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 9, article id e073808Article, review/survey (Refereed)
    Abstract [en]

    Background: Co-production is promoted as an effective way of improving the quality of health and social care but the diversity of measures used in individual studies makes their outcomes difficult to interpret.

    Objective: The objective is to explore how empirical studies in health and social care have described the outcomes of co-production projects and how those outcomes were measured.

    Design and methods: A scoping review forms the basis for this systematic review. Search terms for the concepts (co-produc∗ OR coproduc∗ OR co-design∗ OR codesign∗) and contexts (health OR 'public service∗ OR "public sector") were used in: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled trials (Wiley), MEDLINE (EBSCOHost), PsycINFO (ProQuest), PubMed (legacy) and Scopus (Elsevier). There was no date limit. Papers describing the process, original data and outcomes of co-production were included. Protocols, reviews and theoretical, conceptual and psychometric papers were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The Mixed Methods Appraisal Tool underpinned the quality of included papers.

    Results: 43 empirical studies were included. They were conducted in 12 countries, with the UK representing >50% of all papers. No paper was excluded due to the Mixed Methods Quality Appraisal screening and 60% of included papers were mixed methods studies. The extensive use of self-developed study-specific measures hampered comparisons and cumulative knowledge-building. Overall, the studies reported positive outcomes. Co-production was reported to be positively experienced and provided important learning.

    Conclusions: The lack of common approaches to measuring co-production is more problematic than the plurality of measurements itself. Co-production should be measured from three perspectives: outputs of co-production processes, the experiences of participating in co-production processes and outcomes of co-production. Both self-developed study-specific measures and established measures should be used. The maturity of this research field would benefit from the development and use of reporting guidelines.

  • 13.
    Oliver, Brant J.
    et al.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    Batalden, Paul B.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    DiMilia, Peter Rocco
    Dartmouth Hitchcock Med Ctr, Community & Family Med, Lebanon, NH 03766 USA..
    Forcino, Rachel C.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    Foster, Tina C.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    Nelson, Eugene C.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jonkoping Acad Sch Hlth & Social Welf, Jonkoping, Sweden..
    COproduction VALUE creation in healthcare service (CO-VALUE): an international multicentre protocol to describe the application of a model of value creation for use in systems of coproduced healthcare services and to evaluate the initial feasibility, utility and acceptability of associated system-level value creation assessment approaches2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 10, article id e037578Article in journal (Refereed)
    Abstract [en]

    Introduction Coproduction introduces a fundamental shift in how healthcare service is conceptualised. The mechanistic idea of healthcare being a 'product' generated by the healthcare system and delivered to patients is replaced by that of a service co-created by the healthcare system and the users of healthcare services. Fjeldstadet aloffer an approach for conceptualising value creation in complex service contexts that we believe is applicable to coproduction of healthcare service. We have adapted Fjeldstad's value creation model based on a detailed case study of a renal haemodialysis service in Jonkoping, Sweden, which demonstrates coproduction characteristics and key elements of Fjeldstad's model. Methods and analysis We propose a five-part coproduction value creation model for healthcare service: (1) value chain, characterised by a standardised set of processes that serve a commonly occurring need; (2) value shop, which offers a customised response for unique cases; (3) afacilitated value network, which involves groups of individuals struggling with similar challenges; (4)interconnectionbetween shop, chain and network elements and (5)leadership. We will seek to articulate and assess the value creation model through the work of a community of practice comprised of a diverse international workgroup with representation from executive, financial and clinical leaders as well as other key stakeholders from multiple health systems. We then will conduct pilot studies of a qualitative self-assessment process in participating health systems, and ultimately develop and test quantitative measures for assessing coproduction value creation. Ethics and dissemination This study has been approved by the Dartmouth-Hitchcock Health Institutional Review Board (D-HH IRB) as a minimal risk research study. Findings and scholarship will be disseminated broadly through continuous engagement with health system stakeholders, national and international academic presentations and publications and an internet-based electronic platform for publicly accessible study information.

  • 14.
    Olsen, Birgitta
    et al.
    Jönköping University, School of Health Science. Univ Orebro, Sch Hlth & Med Sci, Orebro, Sweden.
    Månsson, Fredrik
    Lund Univ, Dept Clin Sci, Infect Dis Res Unit, Malmo, Sweden.
    Camara, Cidia
    Natl Publ Hlth Lab LNSP, Bissau, Guinea Bissau.
    Monteiro, Mario
    Natl Publ Hlth Lab LNSP, Bissau, Guinea Bissau.
    Biai, Ansu
    Natl Publ Hlth Lab LNSP, Bissau, Guinea Bissau.
    Alves, Alfredo
    Simao Mendes Natl Hosp, Dept Obstet & Gynaecol, Bissau, Guinea Bissau.
    Andersson, Sören
    Örebro Univ Hosp, WHO Collaborating Ctr Gonorrhoea & Other STIs, Natl Reference Lab Pathogen Neisseria, Dept Lab Med, Örebro, Sweden.
    Norrgren, Hans
    Lund Univ, Dept Clin Sci, Div Infect Med, Lund, Sweden.
    Unemo, Magnus
    Örebro Univ Hosp, WHO Collaborating Ctr Gonorrhoea & Other STIs, Natl Reference Lab Pathogen Neisseria, Dept Lab Med, Örebro, Sweden.
    Phenotypic and genetic characterisation of bacterial sexually transmitted infections in Bissau, Guinea-Bissau, West Africa: a prospective cohort study2012In: BMJ Open, E-ISSN 2044-6055, Vol. 2, no 2, p. e000636-Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge regarding characteristics and transmission of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium and antibiotic resistance in N gonorrhoeae in Guinea-Bissau, West Africa, is entirely lacking. Objectives: To characterise N gonorrhoeae, C trachomatis and M genitalium samples from Guinea-Bissau and to define bacterial populations, possible transmission chains and for N gonorrhoeae spread of antibiotic-resistant isolates. Design: Prospective cohort study. Setting: Two sexual health and family planning clinics, Bissau, Guinea-Bissau. Participants: Positive samples from 711 women and 27 men. Material and methods: Positive samples for N gonorrhoeae (n=31), C trachomatis (n=60) and M genitalium (n=30) were examined. The gonococcal isolates were characterised with antibiograms, serovar determination and N gonorrhoeae multiantigen sequence typing (NG-MAST). The C trachomatis ompA gene and the M genitalium mgpB gene were sequenced, and phylogenetic analyses were performed. Results: For N gonorrhoeae, the levels of resistance (intermediate susceptibility) to ciprofloxacin, erythromycin, rifampicin, ampicillin, tetracycline, penicillin G and cefuroxime were 10% (0%), 6% (10%), 13% (10%), 68% (0%), 74% (0%), 68% (16%) and 0% (84%), respectively. All isolates were susceptible to cefixime, ceftriaxone, spectinomycin and azithromycin, and the minimum inhibitory concentrations of kanamycin (range: 8-32 mg/l) and gentamicin (range: 0.75-6 mg/I) were low (no resistance breakpoints exist for these antimicrobials). 19 NC-MAST sequence types (STs) (84% novel STs) were identified. Phylogenetic analysis of the C trachomatis ompA gene revealed genovar G as most prevalent (37%), followed by genovar D (19%). 23 mgpB STs were found among the M genitalium isolates, and 67% of isolates had unique STs. Conclusions: The diversity among the sexually transmitted infection (STI) pathogens may be associated with suboptimal diagnostics, contact tracing, case reporting and epidemiological surveillance. In Guinea-Bissau, additional STI studies are vital to estimate the STI burden and form the basis for a national sexual health strategy for prevention, diagnosis and surveillance of STIs.

  • 15.
    Pleym, Karin
    et al.
    Western Norway Univ Appl Sci, Dept Hlth & Caring Sci, Bergen, Vestlandet, Norway.;Vestre Viken Hosp Trust, Dept Med, Drammen, Norway..
    Iversen, Marjolein Memelink
    Western Norway Univ Appl Sci, Dept Hlth & Caring Sci, Bergen, Vestlandet, Norway..
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Linkoping Univ Hosp, Dept Clin Neurophysiol, Linkoping, Sweden..
    Experiences and actions related to living with type 1 diabetes during the COVID-19 pandemic in Norway: a qualitative study conducted during July to December 20202022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e056027Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to describe the experiences of adults with type 1 diabetes (T1DM) during the COVID-19 pandemic in Norway, and what actions they took to cope with the situation. Design An inductive, descriptive design applying the critical incident technique was used to collect qualitative data between July 2020 and December 2020. Setting A strategic selection was made from diabetes specialist outpatient clinics at three different hospitals in eastern Norway. The hospitals, two community hospitals and one university hospital, were situated in both rural and urban areas. Participants Inclusion criteria were people with T1DM aged 18-65 years. Exclusion criteria were pregnancy, people with chronic pulmonary disorders, people with active cancer diseases and people diagnosed with a myocardial infarction or stroke during the previous 6 months. Semistructured individual interviews with 19 people with T1DM were conducted. Results Experiences were categorised into two main areas: 'increased psychosocial burden of T1DM during the COVID-19 pandemic' and 'changed conditions for T1DM treatment during the COVID-19 pandemic'. Uncertainty distress and social consequences from infection control measures contributed to the burden of T1DM. Disrupted T1DM follow-up and altered daily routines created challenges. However, having increased time to focus on T1DM self-management during lockdown represented an improvement. Actions to handle the situation were categorised into two main areas: 'actions to handle psychosocial strain related to T1DM and COVID-19' and 'actions to handle changed conditions for T1DM treatment during the COVID-19 pandemic'. Conclusions Patients experienced an increased psychosocial burden of T1DM and difficulties from a disrupted daily life affecting T1DM self-management routines. Uncertainty-reducing behaviours and actions to adapt to the situation provided a general sense of coping despite these difficulties. Tailored information and follow-up by telephone or video call was emphasised to reduce uncertainly distress and support adequate diabetes T1DM self-management.

  • 16.
    Robert, Glenn
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale, Faculty of Nursing and Midwifery, King's College, London, London, United Kingdom.
    Philippou, J.
    Leamy, M.
    Reynolds, E.
    Ross, S.
    Bennett, L.
    Taylor, C.
    Shuldham, C.
    Maben, J.
    Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-20152017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 1, article id e014326Article in journal (Refereed)
    Abstract [en]

    Objectives: Schwartz Center Rounds ('Rounds') are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so.

    Setting: Public healthcare organisations in England.

    Participants: Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations.

    Results: The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors-a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being-initially led to Rounds being seen as 'an idea whose time had come'. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of 'mimetic pressure'.

    Conclusions: The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England.

  • 17.
    Roos af Hjelmsäter, Elin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Höglandssjukhuset, Region Jönköping, Eksjö, Sweden.
    Ros, Axel
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Ryhov, Region Jönköping, Jönköping, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Futurum, Landstinget i Jönköpings län, Jönköping, Sweden.
    Westrin, Åsa
    Faculty of Medicine, Department of Clinical Sciences, Division of Psychiatry, Lund University, Lund, Sweden.
    Deficiencies in healthcare prior to suicide and actions to deal with them: A retrospective study of investigations after suicide in Swedish healthcare2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 12, article id e032290Article in journal (Refereed)
    Abstract [en]

    Objectives

    The overall aim of this study was to aggregate the conclusions of all investigations conducted after suicides reported to the supervisory authority in Sweden in 2015, and to identify deficiencies in healthcare found in these investigations; the actions proposed to deal with the deficiencies; the level of the organisational hierarchy (micro-meso-macro) in which the deficiencies and actions were situated; and outcomes of the supervisory authority's decisions.

    Design and setting

    This is a retrospective study of all reports from Swedish primary and secondary healthcare after suicide to the regulatory authority in Sweden in 2015.

    Results

    In 55% (n=240) of cases, healthcare providers reported healthcare deficiencies that contributed to suicide; these deficiencies were primarily in 'suicide risk assessment' and 'treatment'. Actions aimed at preventing new suicides were proposed in 80% of cases (n=347). By far, the most frequent actions were 'education and competence', present in 52% of cases (n=227) and did not much correspond with identified deficiencies. Sixty-five per cent of the deficiencies and actions were at microlevel, while the remainders were at mesolevel. In 65% (n=284) of cases, the supervisory authority approved the investigation without further requirements.

    Conclusions

    The most common identified deficiencies were related to care in the immediate interface between patient and staff. Actions proposed to prevent new suicides were centred on single educational interventions without distinctive sustainable effects in the organisations and usually did not correspond with the identified deficiencies. Future research should examine if application of a framework based on knowledge of the suicide process, suicide prevention strategies and patient safety would enable more sophisticated investigations that could facilitate progress on suicide prevention. 

  • 18.
    Ropke, Alice
    et al.
    Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Lund, Karina
    Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.
    Thrane, Camilla
    Health Promotion and Rehabilitation, Municipality of Herlev, Herlev, Denmark.
    Juhl, Carsten
    Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Morville, Anne-Le
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Developing an individualised cross-sectoral programme based on activities of daily living to support rehabilitation of older adults with hip fracture: A qualitative study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 6, article id e044539Article in journal (Refereed)
    Abstract [en]

    Objectives: To develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently.

    Design: Qualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles.

    Settings: University Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities.

    Participants: One research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists).

    Results: Three generic categories were identified: (1) 'Challenge older adults with goal-oriented ADL tasks', (2) 'Implement strategies to enhance independent and safe performance of ADL tasks', and (3) 'Communicate the important information to the target group and across sectors'. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call.

    Conclusions: Engaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme.

    Trial registration number: This article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID: NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID: NCT04207788; Pre-results. 

  • 19.
    Ros, Eva
    et al.
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
    Ros, Axel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
    Austin, Elizabeth E.
    Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
    De Geer, Lina
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden.
    Lane, Paul
    Townsville Hospital and Health Service, Townsville, Queensland, Australia.
    Johnson, Andrew
    Townsville Hospital and Health Service, Townsville, Queensland, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
    Clay-Williams, Robyn
    Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
    Sustainment of a patient flow intervention in an intensive care unit in a regional hospital in Australia: a mixed-method, 5-year follow-up study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 6, article id e047394Article in journal (Refereed)
    Abstract [en]

    Objective

    In 2014, an escalation plan and morning handover meetings were implemented in an intensive care unit (ICU) to reduce access block for post-operative care. In this study, the improvement intervention is revisited 5 years on with the objective to see if the changes are sustained and to understand factors contributing to sustainability.

    Design

    A mixed-method approach was used, with quantitative analysis of ICU administrative data and qualitative analysis of interviews with hospital management and ICU staff.

    Setting

    ICU with mixed surgical and non-surgical cases in a regional hospital in Australia.

    Participants

    Interview participants: ICU nurses (four), ICU doctors (four) and hospital management (four).

    Main outcome measures

    Monthly number of elective surgeries were cancelled due to unavailability of ICU beds. Staff perceptions of the interventions and factors contributed to sustainability.

    Results

    After a decline in elective surgeries being cancelled in the first year after the intervention, there was an increase in cancellations in the following years (χ 2 =16.38, p=0.003). Lack of knowledge about the intervention and competitive interests in the management of patient flow were believed to be obstacles for sustained effects of the original intervention. So were communication deficiencies that were reported within the ICU and between ICU and other departments. There are discrepancies between how nurses and doctors use the escalation plan and regard the availability of ICU beds.

    Conclusion

    Improvement interventions in healthcare that appear initially to be successful are not necessarily sustained over time, as was the case in this study. In healthcare, there is no such thing as a 'fix and forget' solution for interventions. Management commitment to support communication within and between microsystems, and to support healthcare staff understanding of the underlying reasons for intervention, are important implications for change and change management across healthcare systems.

  • 20.
    Suutari, Anne-Marie
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine and Geriatrics, the Highland Hospital (Höglandssjukhuset), Region Jönköpings län, Eksjö, Sweden.
    Nordin, Annika
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Health Services Department, Stockholm County Council, Stockholm, Sweden.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Faculty of Health Studies, VID Specialized University, Oslo, Akershus, Norway.
    Using stakeholders' experiences to redesign health services for persons living with heart failure: a case study protocol in a Swedish cardiac care setting [Protocol]2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 3, article id e058469Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Clinical guidelines promote recognising persons with heart failure (referred to as PWHF) as coproducers of their own care. Coproduction of healthcare-involving PWHF, families and professionals in care processes-aims to promote the best possible health. Still, it is unclear how to coproduce heart failure (HF) care. This study explores whether and how Experience-Based Co-Design (EBCD) involving PWHF, family members and professionals can be undertaken online, in a Swedish cardiac care setting, to codesign improved experiences of HF care.

    METHODS AND ANALYSIS: In EBCD, stakeholders' experiences are solicited to redesign healthcare services. First, we will undertake a thematic analysis of field notes from consultations and filmed/audio-recorded interviews with PWHF (n=10-12). This analysis will identify 'touchpoints' (emotionally positive/negative events that shape overall service experiences), edited into a 'trigger film'. Next, a thematic analysis of family members' (n=10-12) and professionals' (n=10-12) interviews will identify key themes mirroring their experiences. Separate feedback events with each stakeholder group will confirm identified touchpoints and key themes and identify areas for HF care improvement. At a joint event, prompted by the 'trigger film', stakeholders will agree on one area for HF care improvement. A team including PWHF, family members and professionals, led by an improvement adviser, will then plan, design, implement and evaluate an improvement activity addressing the identified problem area. A deductive thematic analysis of field notes, project documentation and stakeholder focus group interviews, underpinned by MUSIQ, will identify how organisational conditions influence the process. Quantitative measurements, describing the results of the improvement activity, will be integrated with qualitative data to strengthen the case. To reduce resource intensity, we will use online tools during the process.

    ETHICS AND DISSEMINATION: The Swedish Ethical Review Authority approved the study in May 2021. The results will be disseminated through seminars, conference presentations and publications.

  • 21.
    Vislapuu, Maarja
    et al.
    Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
    Igland, Jannicke
    Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
    Vorderstrasse, Allison
    Rory Meyers College of Nursing, New York University, New York City, New York, USA.
    Iversen, Marjolein M.
    Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway.
    Psychometric properties of the Norwegian version of the short form of The Problem Areas in Diabetes scale (PAID-5): a validation study2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 2, article id e022903Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the psychometric properties of the short form of The Problem Areas in Diabetes scale (PAID-5) in Norwegian adult patients with type 1 or type 2 diabetes.

    DESIGN: Cross-sectional survey design.

    METHODS: Participants (n=143) were included from three Western-Norway endocrinology outpatient clinics. Demographic and clinical data were collected in addition to questionnaires concerning diabetes-related distress, fear of hypoglycaemia, symptoms of depression, emotional well-being and perception of general health. Psychometric evaluation of the PAID-5 included confirming its postulated one-factor structure using confirmatory factor analysis (CFA) and assessing convergent validity, discriminant validity, internal consistency and test-retest reliability. The retest questionnaire was sent out 35±15 days after the initial assessment to those who agreed (n=117).

    RESULTS: The CFA for the PAID-5 scale showed excellent one-factor structure, and there was high internal consistency (α=0.89) and good test-retest reliability (Intraclass Correlation Coefficient, ICC=0.81). The PAID-5 correlated positively with fear of hypoglycaemia (r=0.598) and depression (r=0.380) and negatively with emotional well-being (r=-0.363) and perception of general health (r=-0.420), thus satisfying convergent validity. Patients who had experienced episodes of serious hypoglycaemia in the past 6 months had a significantly higher PAID-5 mean score (7.5, SD=4.95) than those who had not had these episodes (5.0, SD=4.2 (p=0.043)).

    CONCLUSION: The Norwegian PAID-5 was shown to be a reliable and valid short questionnaire for assessing diabetes-related distress among people with type 1 or type 2 diabetes. However, its ability to discriminate between groups needs to be tested further in larger samples. The PAID-5 scale can be a particularly valuable screening instrument in outpatient clinics, as its brevity makes it easy to use as a tool in patient-provider encounters. This short questionnaire is useful in the national diabetes registry or population cohort studies as it enables increased knowledge regarding the prevalence of diabetes-related distress.

  • 22.
    Wilkens, Jens
    et al.
    Department of Clinical Sciences, Malmö, Lunds University Faculty of Medicine, Lund, Sweden.
    Thulesius, Hans
    Department of Clinical Sciences, Malmö, Lunds University Faculty of Medicine, Lund, Sweden; and Department of Medicine and Optometry, Linnaeus University Faculty of Health Social Work and Behavioural Sciences, Kalmar, Sweden.
    Arvidsson, Eva
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Research and Development unit for Primary Care, Futurum Academy of Health and Care, Jönköping, Sweden; and Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden.
    Lindgren, Anna
    Centre for Mathematical Sciences, Lund University Faculty of Engineering, Lund, Sweden.
    Ekman, Bjorn
    Department of Clinical Sciences, Malmö, Lunds University Faculty of Medicine, Lund, Sweden.
    Study protocol: effects, costs and distributional impact of digital primary care for infectious diseases-an observational, registry-based study in Sweden2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 8, article id e038618Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The ability to provide primary care with the help of a digital platform raises both opportunities and risks. While access to primary care improves, overuse of services and medication may occur. The use of digital care technologies is likely to continue to increase and evidence of its effects, costs and distributional impacts is needed to support policy-making. Since 2016, the number of digital primary care consultations for a range of conditions has increased rapidly in Sweden. This research project aims to investigate health system effects of this development. The overall research question is to what extent such care is a cost-effective and equitable alternative to traditional, in-office primary care in the context of a publicly funded health system with universal access. Three specific areas of investigation are identified: clinical effect; cost and distributional impact. This protocol describes the investigative approach of the project in terms of aims, design, materials, methods and expected results.

    METHODS AND ANALYSIS: The research project adopts a retrospective study design and aims to apply statistical analyses of patient-level register data on key variables from seven regions of Sweden over the years 2017-2018. In addition to data on three common infectious conditions (upper respiratory tract infection; lower urinary tract infection; and skin and soft-tissue infection), information on other healthcare use, socioeconomic status and demography will be collected.

    ETHICS AND DISSEMINATION: This registry-based study has received ethical approval by the Swedish Ethical Review Authority. Use of data will follow the Swedish legislation and practice with regards to consent. The results will be disseminated both to the research community, healthcare decision makers and to the general public.

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