Increased concern was raised globally at the outbreak of COVID-19 that victims of domestic violence would be even more at risk when isolated with a violent partner and out of reach of support due to restrictions. Swedish staff in violence against women services prepared for increased calls for help. Instead, a worrying silence arose in a time and place of high uncertainty. This article analyzes the narratology of risk, when staff members in violence against women services, reflect upon their accounts, responses, and experiences, during the pandemic. The analysis is based on three themes, accounting for expected increased influx, making sense of silence and accounting for mobilization. The findings are discussed by applying the relational theory of risk.

Aim/Introduction: An 18F-FDG-PET/CT examination requires the patient to follow instructions before and during the examination procedure to ensure a high image quality. There is thus a need to develop ways to ensure that patients absorb the information given in connection with the examination. Aim To develop communication support for information sharing related to an18F-FDG-PET/CT examination. Materials and Methods: The study has a qualitative design adapting a multiphase structure. A prototype of the communication support consisting of illustrations and text related to an 18F-FDG-PET/CT examination was developed. Interviews were conducted with patients scheduled for an 18F-FDG-PET/CT examination for the frst time and questionnaires were collected from health care professionalswith experience of 18F-FDG-PET/CT. The communication support was revised until consensus about the material. Results: The results are based on interviews with patients (n=10) and questionnaires collected from health care professionals (n=9).The overall theme revealed that information in conjunction with the 18F-FDG-PET/CT examination is a balancing act betweentext and illustrations. The analysis showed two categories;“illustrations as a complement” and “easy to understand lay-out”. Conclusion: The participants strengthened the development of the communication-support by bringing in valuable viewpoints from various perspectives. The results support a person-centered approach, where the information in conjunction with an 18F-FDGPET/CT examination can be adapted to each patient’s needs as a balancing act between text and illustrations.

Our aim was to develop communication support material for information sharing related to an ¹⁸F-FDG PET/CT examination.

Methods: The study had a qualitative design adapting a multiphase structure. A prototype of communication support material consisting of illustrations and text related to an ¹⁸F-FDG PET/CT examination was developed. Interviews were conducted with patients scheduled for an ¹⁸F-FDG PET/CT examination for the first time, and questionnaires were collected from health care professionals with experience in ¹⁸F-FDG PET/CT. The communication support material was revised until consensus was reached about it.

Results: The results are based on interviews with patients (n = 10) and questionnaires collected from health care professionals (n = 9). The overall theme revealed that patient information about an ¹⁸F-FDG PET/CT examination is a balancing act between text and illustrations. The analysis showed 2 categories: "illustrations as a complement" and "easy-to-understand layout."

Conclusion: The participants strengthened the development of the communication support material by bringing in valuable viewpoints from various perspectives. The results support a person-centered approach in which information about an ¹⁸F-FDG PET/CT examination can be adapted to each patient's needs as a balancing act between text and illustrations.

This study investigates radiographers' views on implementing dose-reduction measures, with a focus on verifying patient identity and pregnancy status, practising gonad shielding in men and using compression. An electronic questionnaire was distributed to radiographers working in general radiography and/or computed tomography. The questionnaire was based on factors from a framework for analysing risk and safety in clinical medicine. Ordered logistic regressions were used to analyse associations among factors and use of dose-reduction measures. In total, 466 questionnaires were distributed and 170 radiographers (36%) completed them. Clear instructions and routines, support from colleagues, knowledge and experience, a strong safety culture, managerial support and access to proper equipment influence the likelihood of using dose-reduction measures. The strongest associations were found between support from colleagues and verifying pregnancy status (OR = 5.65, P = 0.026), safety culture and use of gonad shielding (OR = 2.36, P = 0.042), and having enough time and use of compression (OR = 2.11, P = 0.003). A strong safety culture and a supportive work environment appears to be essential for the use of dose-reduction measures, and education, training and stress management can improve utilisation of dose-reduction measures.

Purpose: To evaluate the long-term effects of an Arts on Prescription (AoP) programme on sense of coherence (SOC) in Sweden.

Design: A controlled intervention study with a quasi-experimental prospective design, including questionnaires at baseline, with follow-ups at 6 and 12 months. Participants were on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain, recruited from primary care in six regions. The intervention group also included participants from open psychiatric care. The study sample comprised 586 participants (335 in the intervention group and 251 in the control group).

Results: Both groups showed a significantly stronger SOC at follow-up, with a medium effect size for the intervention group and a small effect size for the control group. No statistically significant difference in SOC change over time was observed between the groups. Participants from open psychiatric care in the intervention group showed a significant improvement in SOC compared to those from primary care. Concerns about finances had a significant main effect on SOC for the entire study population.

Originality: Unlike most AoP studies, this controlled study with a relatively large sample provides insights into the long-term effects of AoP on SOC, with results reported using p-values and effect sizes.

Aging in a Welfare State is a course with the aim of student exchange of knowledge about the Swedish and US healthcare systems. The campus week’s main purpose is to stimulate students’ reflection on their own country’s healthcare system. The week is initiated with a day of perspectives of and study visits on Growing up in Sweden to introduce US students to Sweden’s welfare system. However, most of the week focuses on Aging in a Western Country, Old Age Care and Perspectives of Aging. Prior to the campus week students have prepared for discussions involving a case study of the US system and a paper with reflections on current and future challenges within old age care. Discussions and comparisons of Sweden’s universal high-state regime and US mixed system for older people are a valued feature of campus week. Along with lectures, discussions and study visits related to the welfare system, leisure activities are offered in the form of excursions to Swedish sights. Planning for the campus week requires high coordination. Some of the challenges associated with coordinating campus week involve recruiting Swedish students, getting students from different countries and campuses to interact, logistics of traveling, scheduling lectures and site visits. This presentation contributes challenges and success factors for internationalization in education. Campus week is a valued feature of the course and opens opportunities for students to gain theoretical knowledge at the same time as they have the opportunity for increased understanding through real life experiences of the study visits.

Background

Interventional radiology (IR) has evolved into a well-established medical discipline known for its minimally invasive procedures. Establishing a culture of safety in IR settings is crucial to improve patient safety and quality of care. This study describes and compares attitudes about patient safety among professionals working with IR in Sweden. In addition, this study evaluates whether the WHO Safety Checklist for IR is routinely used for radiological interventions.

Methods

This cross-sectional survey uses an electronic questionnaire to collect data from 25 IR units. The attitudes of IR team members (radiographers, physicians, nurses, and assistant nurses) were assessed using the Swedish Safety Attitudes Questionnaire (SAQ), which was adapted for this context.

Results

The two highest factor scores/percentages of positive responses from the IR team were found for job satisfaction (90/94%) and teamwork climate (85/92%), and stress recognition had the lowest values (54/25%). The attitudes were relatively consistent, with few significant differences between the professions (Factor scores: P = 0.039 for job satisfaction, and P = 0.050 for working conditions. Percentage of positive responses: P = 0.027 for perceptions of management). The radiographers tended to have slightly lower values compared to the other professions among these factors (P < 0.05). The WHO safety checklist for IR was not being used on a regular basis, but the respondents recognized its importance for patient safety.

Conclusions

This study shows high factor scores for the different safety climate factors, with job satisfaction having the highest values. Areas that need improvement are perceptions of management and stress recognition. Attitudes were consistent across professions in the IR team, but radiographers had slightly lower values in some aspects.

Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk–benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.

BACKGROUND: In 2020 the Swedish Government started a gradual raising of the retirement age, but employers have been silent on the issue. Little is known about whether and how they reflect on what it will mean for their organization, or whether they already have, or are going to, make arrangements in order to facilitate and motivate older workers to stay longer.

OBJECTIVE: The aim of this study was to explore and describe managers' experiences of older workers and age management in connection with the increase of the retirement age in Sweden.

METHODS: Data was collected through semi-structured interviews with fourteen managers from a broad set of organizations in the public and private sectors, and from the Middle and East of Sweden. The transcribed material was analysed in line with qualitative content analysis.

RESULTS: The analysis ended up in seven main categories with associated sub-categories: Older Workers, Retirement Ages, Transition Initiatives, Competence Transfer, Competence Development, Increased Retirement Ages, Knowledge Gaps.

CONCLUSION: Our findings reveal that there is an ambivalence in addressing the issue of age among the interviewed managers, what we have interpreted and labelled as "silent age discrimination", and it was shown that they do not have elaborated strategies for age management.

Occupational balance (OB) is a subjective feeling that encompass of having the right amount of occupations and the right variation between occupations in life (Wagman et al., 2012). The purpose of the study is to translate the Occupational Balance Questionnaire (OBQ11) (Håkansson et al., 2020) into Chinese version (OBQ11-C) and to examine the psychometric properties for people with depression in Taiwan.

Introduction:The demand for percutaneous coronary intervention (PCI) has been steadily increasing along with the number of patients with coronary heart disease (CHD) in China. However, there is a lack of studies investigating health-related quality of life (HRQoL), self-efficacy, and depression among Chinese patients undergoing their first PCI. The aim of this study was to explore the association between depression, self-efficacy, and HRQoL among Chinese patients with CHD undergoing their first PCI.Methods:In this cross-sectional study, 212 Chinese patients with CHD who underwent their first PCI were recruited through convenience sampling from October 2019 to March 2020. HRQoL, self-efficacy, and depression were assessed using the Seattle Angina Questionnaire, Cardiac Self-Efficacy Scale, and Short-Form Cardiac Depression Scale, respectively, along with the collection of patients' sociodemographic and clinical information.Results:Among the 212 participants, the average age was 59.82 years, and 145 (68.4%) were male. The average scores for self-efficacy, depression, and HRQoL were 33.49 (+/- 10.28), 16.14 (+/- 6.12), and 328.33 (+/- 62.55), respectively. Among the 212 patients who underwent PCI, 134 (63.21%) were found to have depression symptoms according to the cutoff score of 14. A higher body mass index, a diagnosis of acute coronary syndrome, fewer years of CHD diagnosis, the absence of symptoms of depression and greater self-efficacy were significantly positively associated with HRQoL. In total, these variables explained 37.2% of the variance in HRQoL.Conclusion:This study revealed that the HRQoL of patients in this group needs to receive more attention. A comprehensive secondary prevention intervention for CHD patients undergoing their first PCI should emphasize mitigating depression and positively influencing their self-efficacy.

Cortisol dysregulation, neuroinflammation, and cerebrovascular dysfunction are biological processes that have been separately shown to be affected in Alzheimer’s disease (AD). Here, we aimed to identify biomarker signatures reflecting these pathways in 108 memory clinic patients with subjective cognitive decline (SCD, N = 40), mild cognitive impairment (MCI, N = 39), and AD (N = 29). Participants were from the well-characterized Cortisol and Stress in Alzheimer’s Disease (Co-STAR) cohort, recruited at Karolinska University Hospital. Salivary diurnal cortisol measures and 41 CSF proteins were analyzed. Principal component analysis was applied to identify combined biosignatures related to AD pathology, synaptic loss, and neuropsychological assessments, in linear regressions adjusted for confounders, such as age, sex, education and diagnosis. We found increased CSF levels of C-reactive protein (CRP), interferon γ-inducible protein (IP-10), thymus and activation-regulated chemokine (TARC), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) in MCI patients. Further, markers of cortisol dysregulation (flattened salivary cortisol awakening response and flattened cortisol slope) correlated with increased levels of placental growth factor (PlGF), IP-10, and chitinase 3-like 1 (YKL-40) in the total cohort. A biosignature composed of cortisol awakening response, cortisol slope, and CSF IL-6 was downregulated in AD patients. Moreover, biomarker signatures reflecting overlapping pathophysiological processes of neuroinflammation and vascular injury were associated with AD pathology, synaptic loss, and worsened processing speed. Our findings suggest an early dysregulation of immune and cerebrovascular processes during the MCI stage and provide insights into the interrelationship of chronic stress and neuroinflammation in AD. 

Objective: This scoping review aimed to explore available literature on the knowledge, attitudes, and practices of healthcare professionals on providing care to the lesbian, gay, bisexual, or transgender (LGBT) community as well as the experiences and perspectives of the LGBT community on their healthcare.

Material and Methods: The following electronic databases were searched in December 2020: MEDLINE/PubMed, CINAHL, Web of Science, ProQuest, SCOPUS, and Embase for English-language publications; from 2010 to 2020.

Results: This review included 59 studies that were selected from 5,318 studies. This review revealed that there was an increase in publications regarding this topic across the world. This review identified four themes: (I) the current healthcare landscape for the LGBT community, (II) facilitators of and (III) barriers to healthcare access and utilization among the LGBT community, and (IV) varied facets of healthcare of relevance for LGBT healthcare users – communication, space, education and training, research, and policies.

Conclusion: This review serves as a valuable compass for future researchers seeking areas for deeper exploration and understanding. Nevertheless, the limitations of the study underscore the significance of exercising caution when interpreting its findings concerning challenges within LGBT healthcare.

Simulation-based learning is important in social work education. Most common is human-based simulations. In recent years, computer-based simulations have emerged as alternative. A question is if computer-based simulations differ from human-based, are similar abilities, that is, competence, trained when the simulation is computer-based?

Purpose: Survey the international experiences of using computer-based simulations in social work education.

Method: A five step scoping review. Databases focused on educational issues and social work was searched (Eric, Sociological Abstracts, Web of Science, Scopus). Sixteen publications were included.

Results: Five different didactic categories of computer-based simulations were identified. The most common use of computer-based simulations is to practice student's procedural competence, and in lesser extent to enhance students’ meta-competence. Feedback and reflection are central for computer-based simulation, as for human-based simulations.

Conclusion: The study shows a didactic field under development and that computer-based simulations provide opportunities to train self-reflection and critical thinking in social work education.

Background

It has been suggested that the university environment, to improve students’ health status and educational outcomes, should be based on a health promoting approach. More knowledge is needed about health promoting resources and lifestyle factors that may be of value for students in higher education and their future work-life balance. The aim of this study was to explore health-promoting resources, general health and wellbeing, and health promoting lifestyle factors among fourth and final semester students in higher education in healthcare and social work.

Methods

This longitudinal study is based on self-reported data collected through a web-based questionnaire that included questions about general health, wellbeing, and healthy lifestyle factors and made use of instruments: the Sense of Coherence (SOC) scale, the Salutogenic Health Indicator Scale (SHIS), and five questions from the General Nordic Questionnaire (QPS Nordic). The questionnaire was distributed among students enrolled in seven different healthcare and social work programmes at six universities in Sweden. Data was collected when students were in their fourth (2019/2020) and final (2020/2021) semesters analysed with multiple linear and logistic regressions.

Results

The survey included responses from students during the fourth (n = 498) and the final (n = 343) semester of higher education programmes in health and social work. Total SOC scores decreased between the fourth semester and the final semester. The prevalence of the health promoting lifestyle factor of physical exercise decreased between the fourth and final semesters. Students in their final semester reported valuing group work more highly than did students in their fourth semester. Despite this, students in both the fourth and the final semester reported high SOC, low levels of good general health and perceived wellbeing, and sleeping problems.

Conclusions

Students’ report of good general health were associated with wellbeing, high-intensity physical training, and no sleeping problems A high SOC level was associated with good general health, perceived wellbeing, and no sleeping problems. A higher SHIS level was also associated with wellbeing and no sleeping problems. Therefore, we suggest further research focusing on how to prepare students in healthcare and social work during higher education for a future work-life in balance targeting effects on sleep quality.

The aim of this paper is to describe a user-centred development process for an equipment vest for police officers on active duty. Development and evaluation of the vest were conducted through a multidisciplinary collaboration between the police organisation and external researchers with expertise in ergonomics and biomechanics. The development process was initiated with a user needs analysis, followed by pilot testing of the initial vest prototype. In the extensive usability test, 95 police officers participated. Interviews, focus group discussions, and pressure measurements were conducted to assess the vest’s functionality, impact on physical load, safety aspects, and signal value. Throughout the process, several important aspects were identified. Researchers delivered results iteratively to the designers and project manager. The results from the user evaluation guided further development, resulting in an equipment vest tailored to the needs and requirements of Swedish police officers on active duty.

Many older patients receive health care from several different healthcare organizations, which may lead uncertainty about the responsibility for their healthcare needs. Integrated care has been argued to aid the healthcare system by addressing the challenge of the complex care needs of older patients with multiple health problems. Previous research has stated that integrated care models often have been developed with a focus on a single diagnosis, which risks overlooking the extensive and complex care needs of older patients. Prior research has also expressed the need to deepen knowledge about how integrated care models influence health care professionals, patients and their next of kin. Moreover, it is important to understand how the COVID-19 pandemic affected integrated care models which may expand knowledge about integrated home health care in crisis situations.

The overall aim is to study expectations, perceptions and experiences of integrated home health care through the perspective of registered nurses, physicians, patients and their next of kin.

Inductive qualitative designs where data was collected through interviews and field notes in the setting of the mobile integrated care model with a home health care physician (MICM) with registered nurses, physicians and patients and next of kin. Analysis was conducted using qualitative content analysis, phenomenography, and thematic analysis.

The emphasis on person-centered care in the MICM was evident in the perceptions of the healthcare professionals about the patients and their next of kin, whom they viewed as persons, not simply recipients of health care. Differences were found in the health care provided in the MICM and in comparison, to other healthcare organizations which did not align with the person-centered care ethics. However, providing health care to patients in their own home benefited the provision of person-centered care – the value base of the MICM. The MICM was created with the goal of implementing individually tailored and coherent health care with increased continuity. The healthcare professionals viewed individual medical healthcare plans as co-created with each patient, and yet no patient could recall participating in this co-creation. The coherency of the MICM was regarded as having been improved by teamwork between the registered nurse and the home healthcare physician. Collaborations with other healthcare professionals rarely occurred and should be improved in the future. Participants reported varying experiences of continuity in the MICM, which influenced the possibility of building relationships. Providing continuity with a home healthcare physician for patients is therefore preferable. The work described in this thesis was conducted during the COVID-19 pandemic. The thesis provides unique insights into an integrated care model during a crisis situation, which the healthcare system may face in similar or different ways in the future. The MICM was upheld as the best way to work in home health care, especially as patients and their next of kin regarded the model as making their daily lives easier.

OBJECTIVES: To examine life-course models by investigating the roles of childhood and adult socioeconomic position (SEP) in longitudinal changes in a functional aging index.

METHOD: Up to eight waves of testing, covering 25 years, were available from the Swedish Adoption/Twin Study of Aging: N = 654, intake age = 50-82. A two-slope latent growth curve model was applied to the data, and the impact of including childhood and adult SEP as covariates of the intercept (at age 70) and slopes (before and after age 70) was tested.

RESULTS: Both childhood and adult SEP contributed to the best-fitting model. Childhood SEP was significantly associated with intercept and Slope 1 (before age 70) of the latent growth curve model (p < .05). Association of adult SEP with Slope 2 (after age 70) trended toward significance (p < .10). There was a significant interaction effect of childhood and adult SEP on the intercept (p < .05). As a result, intercept at age 70 was highest and change after age 70 was fastest for those whose SEP decreased from childhood to adulthood.

CONCLUSIONS: Both childhood and adult SEP impact change in functional abilities with age, supporting both critical period and social mobility models. The social environment is modifiable by policies at local, national, and international levels, and these policies need to recognize that early social disadvantage can have long-lasting health impacts.

Type 1 diabetes (T1D) and celiac disease (CeD) are common autoimmune diseases in children where the pathophysiology is not fully characterized. The autoimmune process involves a complex scenario of both inflammatory and regulatory features. Galectin-1 (GAL-1) has a wide range of biological activities e.g., interaction with immune cells. We examined the relationship between GAL-1 and soluble immune markers and T cell subsets in a cohort of children with T1D and/or CeD relative to healthy children. Galectin-1, together with several soluble immune markers (e g interleukins (IL)), tumor necrosis factor (TNF), acute phase proteins and matrix metalloproteinases (MMP) were measured in sera from children with T1D and/or CeD by fluorochrome (Luminex) technique using children without these diseases as a reference. Subgroups of T cells, including T regulatory (Treg) cells, were analyzed by flow cytometry. Association between GAL-1, pro-inflammatory markers and Treg cells differed depending on which illness combination was present. In children with both T1D and CeD, GAL-1 correlated positively with pro-inflammatory markers (IL-1β, -6 and TNF-α). Composite scores increased the strength of correlation between GAL-1 and pro-inflammatory markers, Th1-associated interferon (IFN)-γ, and T1D-associated visfatin. Contrary, in children diagnosed with exclusively T1D, GAL-1 was positively correlated to CD25hi and CD25hiCD101+ Treg cells. For children with only CeD, no association between GAL-1 and other immune markers was observed. In conclusion, the association observed between GAL-1, soluble immune markers and Treg cells may indicate a role for GAL-1 in the pathophysiology of T1D and, to some extent, also in CeD.

Health care in Sweden is heavily subsidized and costs for the user are small, both for physical consultation and telemedicine, and for public and private health care. It has been argued that telemedicine consultations will increase care consumption, lead to higher costs, and create inequalities. As older people often are less skilled in digital technology, increased digitalization of care might increase inequalities. Telehealth is mainly conducted by private companies. This study is based on all private telemedicine consultations in two regions in southern Sweden 2020-2022, with approx. 656,000 inhabitants. 106,000 persons had 343,000 telemedicine consultations, 3.2 consultations p/p. The number of consultations differed neglectable between age groups, for women median was 2.0 for the age groups (< 65/65-79/80+), and for men it was 1.0. The proportion of people WITH telemedicine consultations differed heavily between the age group as well as months. Total number of telemedicine consultations per month varied 4-8.5 thousand among women, and 2-4 thousand among men. The months with most consultations were March-June 2021. Proportion of telehealth consultations was low in the age group 65-79, and even lower among 80+. The proportion of consultations by people 65-79 years increased steadily and reached its peak July-September 2021 with >20%. After that, it increased rapidly down to < 3% among women and < 4% among men. The pattern was similar among people 80+ with peaks at approx. 2% among women and close to 2% among men. The conclusion is that there is still a huge age difference in the use of telehealth consultations.

Introduction

Practice of ankle-foot orthoses (AFO) provision for ambulatory children with cerebral palsy is underreported and the literature is not consistent on choice of AFO-design. This study describes clinical practice of AFO provision for children with cerebral palsy and evaluates how clinical practice aligns with existing recommendations.

Methods

An online, cross-sectional survey was conducted, inviting all Norwegian orthotists working with children with cerebral palsy. Orthotic practice was investigated using a self-reported survey design.

Results

From all eligible orthotists, 54% responded, revealing that AFO provision involves patients, physicians, and physiotherapists at different stages. Patient preference directly influenced the ultimate AFO-design. Shank vertical angle was evaluated by 79%. For children with crouch gait and those with short gastrocnemius, a majority preferred a combination of rigid and articulated/flexible AFO-designs. Instrumented gait analysis was conducted by 51% at AFO delivery stage.

Conclusions

The findings show that AFO provision in Norway is collaborative, involving clinical team members and consideration of patient preferences. A discrepancy between clinical practice and existing recommendations for children with crouch gait and those with short gastrocnemius is observed.

Introduction: health-promotion approaches to address stress-related exhaustion disorders, reduce personal suffering, improve coping and participation in everyday life are needed in primary care. The aim of this study was to investigate self-reported health and well-being before and after an intervention focusing on well-being with photo-supported conversations (BeWellTM).

Material and methods: Eighty-one patients (69 women), 20–67 years old, with exhaustion disorders were recruited at swedish primary health care centres (PHCC) to a controlled clinical study. The intervention group (n = 40) were offered BeWell™ by therapists in addition to care as usual. Controls (n = 41) received only care as usual. The primary outcome, self-rated symptoms of exhaustion (Karolinska exhaustion disorder scale, KeDs), and secondary outcomes, anxiety and depression, sense of coherence, quality of life, occupational balance, and work ability, were assessed by validated questionnaires. Non-parametric statistical analyses were used to compare data collected directly after the treatment period with baseline measures.

Results: Demographics and self-rated baseline measures of health and well-being were comparable between the groups, apart from sick leave being more common in the intervention group. Participants in the intervention group reduced their level of exhaustion more than the control group (median difference on KEDS −9.0 vs −4.0, p = .035). However, the size of the KEDS reduction was related to baseline KEDS and, not independently associated with group assignment. Both groups improved regarding secondary outcome measures.

Conclusion: stress-related symptoms decreased considerably over the treatment period for both groups. The potential benefit of the BeWell™, which was intended to facilitate recovery, needs to be further evaluated.

The “third mission” in academia refers to work that makes research accessible and relevant to policymakers, stakeholders, and the public. This article explores the third mission from a gender and feminist perspective, analysing blog posts to illustrate gender disparities in Swedish academia. The analysis identifies gender differences in blog post frequency, topics, and styles. Women tend to write about general and popular themes with an emotionally charged and inclusive approach. In contrast, men focus more on research-related topics with an ostensibly neutral and assertive style. This difference reflects traditional gendered communication patterns, where women often adopt a relational style, and men take a factual approach. These gendered norms can potentially affect research focus and career progression. The implications suggest that these patterns reinforce societal gender norms, perpetuating disparities and limiting women’s voices in academic and research settings.

PURPOSE: This paper is a personal reflection on the persistence of self-destructive thoughts and ideations in individuals with a history of self-destructiveness.

BACKGROUND: Personal narratives are essential for understanding mental health and illness, particularly for those with a history of self-destructive behaviour. I, a researcher with lived experience of mental illness and self-destructiveness, highlight the importance of presenting them in their raw and unmediated form.

METHODS: This paper is a first-person narrative where I use my own personal experiences to illustrate and analyse the persistence of self-destructive thoughts.

Studier visar att fattigdom påverkar människors livskvalitet och möjligheter till full delaktighet i samhället, och kan ge upphov till ohälsa och skamkänslor. Fattigdom är ett komplext fenomen som kan definieras på olika sätt beroende på tid och plats. Resultat i denna studie baseras på data och definitioner av fattigdom från Statistiska Centralbyrån (SCB). Två definitioner används som utgår ifrån att fattigdom är brist på resurser som leder till att man inte når en allmänt accepterad levnadsstandard. Relativ fattigdom som innebär att hushåll har inkomster lägre än 60 % av medianinkomsten och absolut fattigdom som innebär att inkomsten inte täcker nödvändiga levnadskostnader. I fokus för rapporten är att undersöka barnfattigdom, fattigdom bland ensamstående med och utan barn, fattigdom bland unga vuxna, samt fattigdom bland äldre.

Sammantager visar rapporten att fattigdom utifrån de valda definitionerna i Jönköpings län varierar mellan olika grupper och kommuner. Bland barn i länet lever i genomsnitt 19,5% i relativ fattigdom, vilket är något högre än riksgenomsnittet på 18,3%. När det gäller låg inkomststandard, är den lägsta andelen 1,8%, och den högsta nivån 10,6%. Rapporten visar också att barn med utländsk bakgrund löper en betydligt högre risk för fattigdom.

För ensamstående föräldrar finns också stora variationer mellan kommuner, där kvinnor med barn löper högre risk för fattigdom än ensamstående män. Yngre ensamstående kvinnor utan barn har högre risk att leva i fattigdom i några kommuner. Rapporten visar vidare att unga vuxna (20–29 år) med utländsk bakgrund har en betydligt högre risk för låg inkomststandard än de med svensk bakgrund i alla kommuner.

När det gäller äldre (65–79 år) visar resultatet att ensamstående kvinnor har högre nivåer av fattigdom jämfört med män, men risken är betydligt lägre för sammanboende äldre.

Rapporten visar också att generellt sett har sammanboende äldre lägre risk för fattigdom, och skillnaderna mellan könen är tydliga men mindre framträdande jämfört med ensamstående med hemmaboende barn i åldersgrupperna 20–29 år och 30–49 år.

Slutsatsen av rapporten är att fattigdom i Jönköpings län varierar avsevärt mellan olika kommuner, utrikesfödda och ensamstående mödrar med hemmaboende barn utgör grupper med ökad risk för ekonomisk utsatthet. Fattigdom är ett komplext fenomen som påverkar flera aspekter av livet, från utbildning och hälsa till socialt välbefinnande. För att effektivt bekämpa fattigdom behövs omfattande strategier som fokuserar på olika faktorer, såsom utbildning, bostad, och vård. Fortsatt forskning är nödvändig för att undersöka långvarig fattigdom och de faktorer som bidrar till socioekonomiska skillnader i regionen.

This study examines how Swedish social workers across various social work agencies identify and support suicidal clients. Thematic analysis of interviews with seven social workers reveals a reliance on strong client relationships and past experiences with suicidal clients. The social workers consistently assess severity of suicidal intent in clients. Despite variations in roles, social workers generally express comfort in dealing with suicidal clients by using intuition, discretion and professional and organizational logics to support suicidal clients in personalized ways. The exercise of professional discretion and interventions varies based on roles, work conditions, and relationships with suicidal clients. Notably, social workers in addiction recovery outpatient care exhibit a high degree of discretionary power, while youth treatment workers in residential care units prioritize continuity of care, involving psychiatry when needed. Case workers often view psychiatry as responsible for decisions about suicidal clients and routinely refer them to psychiatric care.

INTRODUCTION: The identification of salivary molecules that can be associated to dental caries could provide insights about caries risk and offer valuable information to develop caries prediction models. However, the search for a universal caries biomarker has proven elusive due to the multifactorial nature of this oral disease. We have therefore performed a systematic effort to identify caries-associated metabolites and proteins in saliva samples from adolescents that had a caries experience and those that were caries-free.

METHODS: Quantification of approximately 100 molecules was performed by the use of a wide range of techniques, ranging from NMR metabolomics to ELISA, Luminex or colorimetric assays, as well as clinical features like plaque accumulation and gingival index. In addition, simplified dietary and oral hygiene habits questionnaires were also obtained.

RESULTS: The caries-free group had significantly lower consumption of sweetened beverages and higher toothbrushing frequency. Surprisingly, very few compounds were found to individually provide discriminatory power between Caries-experienced and Caries-Free individuals. The data analysis revealed several potential reasons that could underly this lack of association value with caries, including differences in metabolite concentrations throughout the day, a lack of correlation between metabolite concentrations in plaque and saliva, or sex-related differences, among others. However, when multiple compounds were combined by multivariate analysis and random forest modelling, a combination of 3-5 compounds were found to provide good prediction models for morning (with an AUC accuracy of 0.87) and especially afternoon samples (AUC=0.93).

CONCLUSION: While few salivary biomarker could differentiate between caries-free and caries-experienced adolescents, a combination of markers proved effective, particularcly in afternoon samples. To predict caries risk, these biomarkers should be validated in larger cohorts and longitudinal settings, considering factors such as gender differences, and variations in oral hygiene and diet.

Background and purpose: Despite the presence of both national and regional clinical practical guidelines (CPGs) in Sweden, no previous studies have investigated the quality of CPGs or the level of agreement between national and regional CPGs. This study aimed to examine the quality of national CPGs recommending prosthetics and orthotics (P&O), and; quantify agreement between national and regional CPGs in Sweden.

Materials and Methods: National and regional CPGs were identified in public databases and by surveyed local Nurse Practitioners. Quality of the national guidelines was assessed by using AGREE II. Agreement between recommendations in the national and regional CPGs were quantified on a four-grade rating scale ("similar", "partially similar", "not similar/not present" and "different").

Results: Of 18 national CPGs, three CPGs (CPGs of Diabetes, Musculoskeletal disorders and Stroke) had nine recommendations related to P&O. The Musculoskeletal disorders and Stroke CPGs had quality scores >60% in all domains and the Diabetes CPG had scores >60% in five out of six domains according to AGREE II. Seven regional CPGs for P&O treatment were identified. Three national recommendations (in Diabetes CPG) showed "similar" content for all regions and two national recommendations (in Diabetes CPG) showed "not similar" content for all regions. The remaining four national recommendations (in Diabetes, Musculoskeletal disorders and Stroke CPGs) had varying agreement with regional CPGs.

Interpretation: There is a limited number of national recommendations for treatment within P&O. There was variation in the agreement of P&O-related recommendations in national and regional CPGs, which might lead to unequal care throughout the national healthcare system.

Introduction Restless Legs Syndrome (RLS) is a neurological disorder characterized by an urge to move arms and legs, commonly combined with distress, pain and motor restlessness. It can cause fragmented sleep, daytime symptoms, and decreased quality of life. Pharmacological treatment can suppress symptoms, but not cure. When challenged with illness, people may turn to their inner psychological resources such as self-esteem and mastery. The Pearlin Mastery scale was developed to study stress and coping, is commonly used in people with chronic illnesses, however, not yet validated in people with RLS. Aim The aim was to test reliability and construct validity of the Pearlin Mastery Scale in persons with RLS. Methods A cross-sectional postal survey including the Pearlin Mastery Scale, Restless Legs Syndrome-6 Scale, Pittsburgh Sleep Quality Index and Patient Health Questionnaire was sent out to members (n = 1500) of the national RLS association and 788 (52.5%) agreed to participate. Data were analyzed using classical test theory, Confirmatory factor analysis and Rasch measurement theory analysis. Hypothesis testing for construct validity was done by bivariate correlation analyses. Results Most respondents were women (65%), retired (71%) and had a mean-age of 70.8 years (SD 11.4). The 7-item version of the Pearlin Mastery Scale showed poor fit to the one factor model. After omitting the two positively worded items (i.e., item 4 and 6), the 5-item version was found to be unidimensional, with satisfactory internal consistency. However, all items showed considerable ceiling effects. No measurement variance was seen regarding age-groups or sex. Higher level of mastery was moderately correlated with less depressive symptoms but only weakly correlated to RLS-related sleep problems. Conclusion The 5-item version of the Pearlin Mastery Scale is suggested to be used in persons with RLS due to its acceptable psychometric properties. The instrument could be applied as an outcome measure for behavioral change interventions aiming to support mastery in RLS.

IMPORTANCE: Visual-motor integration (VMI) is typically examined in children to promote handwriting, but it may also be relevant for adults' capacity for technology use.

OBJECTIVE: To examine the reliability and validity of speed of completion of the box clicking test, a web-based test of VMI.

DESIGN: Participants in the Understanding America Study completed online surveys on a regular basis, including a very brief (less than 30 s) self-administered box clicking test. For validity testing, we examined whether box clicking speed was associated with constructs relevant to visual-perceptual skills and motor coordination, the skills underlying VMI. Test-retest reliability was examined by computation of intraclass correlation coefficients.

PARTICIPANTS: A total of 11,114 adults. MEASURES: Measures included the completion time for the box clicking task and measures relevant to visual perception (e.g., perceptual speed) and motor coordination (e.g., self-reported functional limitation).

RESULTS: Results suggested that the box clicking test was a VMI task. Slower test performance was associated with lower visual-perceptual speed and a greater likelihood of reporting difficulties with dressing, a motor coordination relevant task. Box clicking tests taken within at least 2 yr of one another had moderate test-retest stability, but future studies are needed to examine test-retest reliabilities over brief (e.g., 2-wk) time intervals.

CONCLUSIONS AND RELEVANCE: The box clicking test may serve both as a tool for research and to clinically observe whether clients have VMI difficulties that interfere with computer, smartphone, or tablet use.

Plain-Language Summary: Use of devices such as smartphones and computers is increasingly becoming integral for daily functioning. Visual-motor integration (VMI) has often been addressed by occupational therapists to support handwriting of children, but it may also be important for technology use by adults. Prior literature supports the relevance of VMI to technology use, and adults with various chronic conditions have been found to have decrements in VMI. We tested the psychometric properties of a brief box clicking test of VMI that could be used to examine VMI underlying technology use among adults. Overall, results suggested that the box clicking test was a VMI task. Just as speed of gait has been used as an index of functional mobility, speed on the box clicking task seemed serviceable as an index of VMI ability. The box clicking test may also be used for clinical observation of whether VMI interferes with technology use.

BACKGROUND: Neuroinflammation is a hallmark of the Alzheimer's disease (AD) pathogenic process. Cortisol dysregulation may increase AD risk and is related to brain atrophy. This cross-sectional study aims to examine interactions of cortisol patterns and neuroinflammation markers in their association with neuroimaging correlates.

METHOD: 134 participants were recruited from the Karolinska University Hospital memory clinic (Stockholm, Sweden). Four visual rating scales were applied to magnetic resonance imaging or computed tomography scans: medial temporal lobe atrophy (MTA), global cortical atrophy (GCA), white matter lesions (WML), and posterior atrophy. Participants provided saliva samples for assessment of diurnal cortisol patterns, and underwent lumbar punctures for cerebrospinal fluid (CSF) sampling. Three cortisol measures were used: the cortisol awakening response, total daily output, and the ratio of awakening to bedtime levels. Nineteen CSF neuroinflammation markers were categorized into five composite scores: proinflammatory cytokines, other cytokines, angiogenesis markers, vascular injury markers, and glial activation markers. Ordinal logistic regressions were conducted to assess associations between cortisol patterns, neuroinflammation scores, and visual rating scales, and interactions between cortisol patterns and neuroinflammation scores in relation to visual rating scales.

RESULT: Higher levels of angiogenesis markers were associated with more severe WML. Some evidence was found for interactions between dysregulated diurnal cortisol patterns and greater neuroinflammation-related biomarkers in relation to more severe GCA and WML. No associations were found between cortisol patterns and visual rating scales.

CONCLUSION: This study suggests an interplay between diurnal cortisol patterns and neuroinflammation in relation to brain structure. While this cross-sectional study does not provide information on causality or temporality, these findings suggest that neuroinflammation may be involved in the relationship between HPA-axis functioning and AD.

An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

AIM: This paper describes the trajectory during 1 year of four patient-reported outcomes (PROs), namely, sleep, depressive symptoms, health-related quality of life (HrQoL), and well-being, in patients with heart failure (HF), their relationship and the patient characteristics associated with changes in these PROs.

METHODS AND RESULTS: Data analyses of PROs from 603 patients (mean age 67 years; 29% female, 60% NYHA II) enrolled in the HF-Wii study. On short term, between baseline and 3 months, 16% of the patients experienced continuing poor sleep, 11% had sustained depressive symptoms, 13% had consistent poor HrQoL, and 13% consistent poor well-being. Across the entire 1-year period only 21% of the patients had good PRO scores at all timepoints (baseline, 3, 6, and 12 months). All others had at least one low score in any of the PROs at some timepoint during the study. Over the 12 months, 17% had consistently poor sleep, 17% had sustained symptoms of depression, 15% consistently rated a poor HrQoL, and 13% poor well-being. Different patient characteristics per PRO were associated with a poor outcomes across the 12 months. Age, education, New York Heart Association, and length of disease were related to two PRO domains and submaximal exercise capacity (6 min test), co-morbidity, and poor physical activity to one.

CONCLUSION: In total, 79% of the patients with HF encountered problems related to sleep, depressive symptoms, HrQoL, and well-being at least once during a 1-year period. This underscores the need for continuous monitoring and follow-up of patients with HF and the need for dynamic adjustments in treatment and care regularly throughout the HF trajectory.

Background: Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare.

Aims: To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare.

Materials and methods: Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis.

Results: The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures.

Conclusion: Existential conversations in group may contribute to a more reflected doing in accordance with one’s own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual’s own preferences.

Significance: This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

In this article we point out why social workers and treatment staff must have knowledge of how to identify emotions, understand their own emotions and understand the emotions they elicit in others as a prerequisite for successful rehabilitation. In particular, the emotions of shame and pride play a crucial role in the interaction between social workers and clients. There is currently a need for empirically applicable models that facilitate social workers and therapists in institutional care to identify shame and pride in the interaction with clients. Here we provide a model that can be used to analyze the quality of the social bonds between treatment staff and young clients in institutional care. Institutionalized treatment of young people is often based on an asymmetrical power relationship and the transformation of deviant young people's identity into normal ones. This is fraught with risks, as the power imbalance can preserve and reinforce deviant identities. To encourage the emergence of a normalized identity, the client's good qualities must form the basis of treatment. Greater understanding of the emotions evoked in a treatment situation is necessary for successful rehabilitation.

OBJECTIVES: This study determines the effect of an integrated 12-month follow-up support programme on the oral health of patients with head and neck cancer (HNC) who received radiotherapy (RT).

METHODS: Participants were randomly assigned to an intervention group (n = 47) or a control group (n = 45). The intervention group received usual care and an integrated supportive programme, which included face-to-face education and telephone coaching. The control group received usual care. After a clinical dental examination, the prevalence of caries, gingival inflammation and plaque were registered. Oral health impact profile (OHIP)-14 and the WHO Oral Health Questionnaire for Adults were used to evaluate oral health in both groups.

RESULTS: A total of 79 participants completed a 12-month follow-up. The intervention group had lower caries increment between baseline and the 12-month follow-up compared with controls, although this was not statistically significant. After 12 months, the intervention group had statistically significant better outcomes in the plaque index (p = 0.038) and the OHIP-14 (p = 0.002) than the control group. No statistically significant differences were found between the two groups concerning gingival index. However, the intervention group reported an overall better state of teeth (p = 0.034) and gums after 12 months (p = 0.042).

CONCLUSIONS: The integrated supportive programme showed positive effects on improving oral health in patients with HNC regarding plaque control, the state of teeth and gums and oral health-related quality of life during the 12-month follow-up.

Background: Many healthcare professionals collaborate in the clinical care of individuals who have undergone a Transtibial Amputation (TTA), and a good start to their rehabilitation is essential. The Prosthetist plays a long-term role in patient care, while surgeons often have limited follow-up, typically 1-2 weeks post-surgery.

Objective: This paper aims to present the perspective of two Prosthetists on the subject of TTA: why this perspective is needed, the effect of the limb length, the incision techniques used, new alternatives in postoperative treatment, and its impact on early prosthetic fitting, within a Swedish context.

Methodology: To address this aim, each section was discussed individually, summarizing relevant evidence from a professional perspective, using various evidence sources (e.g., peer-reviewed literature, and national patient registries).

Findings: From the authors' view, when using modern postoperative treatment and prosthetic technology, the Sagittal Incision (SF) incision may be beneficial to Posterior Flap (PF) incision in TTA, if the aim is to reduce the time to prosthetic fitting. New postoperative treatment methods are being made more accessible and recognized. This might not be a valid solution in all places, but they contribute to the evidence base used for decision-making following TTAs.

Conclusion: From a Prosthetist perspective, more could be done to improve the pathway from amputation to prosthetic fitting and ensure the best functional outcome for the patient. Traditional methods from the 1950s have been discussed, and other alternatives have been contrasted.

About 3.9 million people live with Young Onset Dementia (YOD) worldwide. As dementia progresses, there may be a need for transition to residential care. It can be challenging for persons with YOD to access age-appropriate services, even though they might have different needs compared to persons with late-onset dementia. This scoping review aimed to present the experiences of people with YOD living in residential care facilities. Peer-reviewed research articles focusing on either the perspective of people with dementia onset before the age of 65 living in residential care or their family members were included. A literature search in MEDLINE, CINAHL, PsycINFO, Scopus, ProQuest, and Web of Science conducted in December 2023 yielded 13 qualitative studies from Europe, North America, and Australasia. Four studies included experiences of persons with YOD, three included experiences of family members, and six had a mix of participant experiences. In total, 90 (Md = 9) persons with dementia and 292 (Md = 17) family members participated. A synthesis of findings indicates that a home-like environment and age-adjusted activities based on the interests of the individual were highly valued. This review provides a first step towards understanding what person-centered care means for people with YOD in residential care. However, even though people with YOD can communicate their experiences and needs, there were few studies focusing on their perspectives. To improve care, further research needs to focus on the voices of individuals with dementia.

BACKGROUND: Health and social care staff play a significant role in detecting and reporting abuse among persons with dementia. However, they are often left to their own judgements which can lead to elder abuse not being detected or acted on. The aim was to explore what healthcare and social care staff consider elder abuse, and their experience of elder abuse perpetrated by family members of persons with dementia.

METHODS: This mixed-method vignette study was conducted in Sweden during the year 2021. In total 39 staff working in dementia care were included. They first answered the Caregiver Scenario Questionnaire and then participated in a group interview.

RESULTS: An inconsistency was revealed regarding whether a management strategy for behavioural difficulties included in the Caregiver Scenario Questionnaire should be considered an abusive act or not. No participants were able to identify all five abusive behaviour management strategies. Participants described witnessing 101 abusive acts including different types of abuse of a person with dementia, with emotional/psychological abuse and neglect being most common.

CONCLUSIONS: Health and social care staff who work close to older persons are able to detect abuse perpetrated by family members. However, inconsistency in defining abusive acts demonstrates the uncertainty in identifying abuse. This may lead to abuse not being identified, but it also creates feelings of inadequacy among staff.

Background

The salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO).

Method

The study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness.

Result

The findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits.

Conclusion

This study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA.

Trial registration

Not applicable.