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Abstract: The object of this study is to determine how people interpret measurement data; which factors influence their interpretation and which do not. This study forms part of an investigation series undertaken at the paper pulp company Södra Cell in Sweden (N =1200 employees), the investigated parameter being “paper pulp quality”. The findings presented in the study are the outcomes of a questionnaire that was repeated four times (n 1 =54, n 2 =53, n 3 =43, n 4 =38), an interview (n i =32) and regular group discussions that included 10 people (n d =10) and that took place once a month over a three-year period. In order to quantify the quality of the product – paper pulp – different measurements must be combined. This study reveals that different employees prefer different parameters for the quantification of paper pulp quality. This study furthermore shows that there is a correlation between the employees’ choice of parameters and their belonging to a particular pulp mill within the company. We also found that external factors, e.g. the opinion of authorities, affected which parameters were favoured when product quality was determined. Furthermore, the data analysis indicates that there is a correlation between the job-position of employees and the way they interpret measurement data related to product quality. Controllers and operators make similar judgments, with the exception of chemists whose opinions appear to deviate. However, the greatest variation found in the study is related to the individual person – independently of education or physical or psychological condition. The study finally proposes a number of preventive measures to improve the uniformity and reliability of measurements conducted at a process company, the most important of which is improved education of all employees who are in a position to influence product quality. [Copyright &y& Elsevier]

Objectives: Bullying and aggression among children and young people are key public mental health priorities. In this study, we evaluated the cost-effectiveness of a complex school-based intervention to address these outcomes within a large-cluster randomized trial (Inclusive).Methods: Forty state secondary schools were randomly allocated (1:1) to receive the intervention or continue with current practice as controls. Data were collected using paper questionnaires completed in classrooms including measures of their health-related quality of life using the Childhood Utility Index and police and National Health Service resource use. Further detailed data were collected on the cost of delivering the intervention. We calculated incremental cost-effectiveness ratios following the intention-to-treat principle using multilevel linear regression models that allowed for clustering of pupils at the school level.Results: Overall, we found that the intervention was highly cost-effective, with cost-per quality-adjusted life year thresholds of £13 284 and £1875 at 2 years and 3 years, respectively. Analysis of uncertainty in the result at 2 years revealed a 65% chance of being cost-effective, but after 3 years there was a 90% chance that it was cost-effective.Conclusion: This study provides strong evidence collected prospectively from a randomized study that this school-based intervention is highly cost-effective. Education- and health-sector policy makers should consider investment in scaling up this intervention. [ABSTRACT FROM AUTHOR]

Highlights • The main reason for not applying to the programme is the cost. • Some offenders are afraid to be regarded as alcoholics if they install an interlock. • Finding an interlock service centre is easier than finding an appropriate doctor. • Programme participants improve their health more than non-participants. Abstract A permanent alcohol interlock programme was introduced in Sweden in 2012. The programme is voluntary and allows drink driving offenders to keep their driving licenses if they install alcohol interlocks in their vehicles. The duration of the programme is one or two years, depending on the severity of the drink driving offence. This study aims to improve our knowledge of drink drivers' views of the programme, among both participants and those who chose not to participate. These views were collected through paper questionnaires mailed to the drink drivers' residences. Of 1550 questionnaires mailed to participants and 1492 to non-participants, 689 and 408 were completed, for response rates of 45% among participants and 28% among non-participants (excluding returns because of incorrect addresses or because the respondent was deceased). For participants who were employed or had their own business (n = 513), the main reasons for choosing the alcohol interlock were the need to operate a vehicle at work (69.6%, 95% CI: 65.6–73.6%) and to get to/from work (69.4%, 95% CI: 65.4–73.4%). For those not working (n = 153), the main reasons for participating were that the driving license was required to have a social life and meaningful leisure time (79.7%, 95% CI: 73.3–86.2%) and for shopping (65.4%, 95% CI: 57.7–73.0%). For non-participants, the main reasons for not applying were programme costs (64.4%, 95% CI: 59.5–69.3%), being afraid of being considered alcoholics (37.1%, 95% CI: 32.2–42.1%), and doing well without a license (26.5%, 95% CI: 22.0–31.0%). The results also indicate improved health after the drink driving offence. The largest improvement was found in participants in the two-year programme, in which the proportion of respondents who felt good or very good increased by 39.4% (95% CI: 34.2–44.5%) compared to before the drink driving offence. [ABSTRACT FROM AUTHOR]

Abstract: An increased focus on international and national levels of society to meet the transportation needs of older people and people with disabilities is realized through legislation, directives and guidelines on accessibility. This paper examines effects of removing physical barriers according to current Swedish governmental accessibility directives on older peoples’ perceptions of outdoor environments (usability) and on their mobility and perceived safety as pedestrians. This paper also focuses on municipal planners’ views on the implementation of improved accessibility. A before–after study, using both qualitative and quantitative methods, is conducted. The results from the questionnaires show that older peoples’ overall satisfaction with the outdoor environment has increased after implementation; however no differences are found if physical barriers specifically are considered. Older peoples’ mobility is also unchanged; nevertheless, fewer respondents are stating difficulties in walking due to barriers in the outdoor environments as reason to avoid outdoor mobility. Problems do remain after implementation, for example concerning safety/security-related issues and inaccessible entrances and indoor environments. [ABSTRACT FROM AUTHOR]

Abstract: The paper focuses on Swedish homeowners’ need for and perceptions about adopting building envelop energy efficiency measures. The paper is based on a questionnaire survey of 3059 homeowners (response rate of 36%) selected by stratified random sampling during the summer of 2008. The results showed that 70–90% of the respondents had no intention of adopting such a measure over the next 10years. The main reasons for non-adoption were that homeowners were satisfied with the physical condition, thermal performance, and aesthetics of their existing building envelope components. A greater proportion of respondents perceived that improved attic insulation has more advantages than energy efficient windows and improved wall insulation, but windows were more likely to be installed than improved attic insulation. Respondents gave high priority to economic factors in deciding on an energy efficiency measure. Interpersonal sources, construction companies, installers, and energy advisers were important sources of information for homeowners as they planned to adopt building envelope energy efficiency measures. Policy measures to facilitate the rate of adoption of energy efficient building envelope measures are discussed. [Copyright &y& Elsevier]

Background: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.Methods: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.Results: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.Conclusions: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.Clinical Trial Registration: NCT02492191. [ABSTRACT FROM AUTHOR]

Background: The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. Objective: This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. Design: A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. Results: We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work- family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. Conclusion: These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling. [ABSTRACT FROM AUTHOR]

Abstract: Previous research suggests that, despite a desire to introduce environmental concerns into New Product Design, many companies in the northwest of England have not done so. In order to understand more about why companies do or do not take on sustainability methodologies, an entirely new and rigorous approach was taken. This paper therefore presents the results of a questionnaire investigating the up-take of Eco/Sustainable Design in manufacturing companies in Sweden – a country that might be considered more environmentally progressive than the UK – and discusses them alongside the results of an identical questionnaire in the UK. The results are presented in the context of risk and risk aversion/management – in particular the risk associated with taking on board Design for Sustainability as a design method or a company strategy. It is found that there is no clear “winner” in sustainability between UK and Swedish engineering companies; there is encouraging news in both countries, with a desire to practice sustainability, but some that is not so good with the number of companies that actually implement relevant methodologies. It is apparent that there are still hindrances and perceived risks preventing companies taking sustainability fully on board, despite the recognition that sustainability is a “good thing”; the importance of the implementation of sustainability has not yet been fully grasped by industry and by those with the responsibility required to effect any changes. [Copyright &y& Elsevier]

Abstract: Background: A randomised study in non-resectable rectal cancer showed that preoperative chemoradiotherapy (CRT) resulted in better local control and disease-specific survival, but not overall survival than radiotherapy alone. The present paper presents long-term (>4years) health-related quality of life (HRQoL) and a comparison between the results and reference values from the Norwegian general population. Material and methods: A total of 207 patients with primarily non-resectable rectal cancer were randomised to preoperative CRT (2Gyx25+5FU/leucovorin) or RT (2Gyx25) before surgery. HRQoL was assessed using EORTC QLQ-C30, completed at baseline and sent to all patients alive in Norway and Sweden (n =105) after a minimum of 4years post treatment. A difference of ⩾5 points on the 0–100 scales was considered clinically significant. Results: Seventy-six (72%) patients answered at follow-up. No statistically significant differences between the CRT and RT groups appeared at follow-up, although clinically significant differences in social functioning, dyspnoea and diarrhoea were found. Over time, a clinically significant reduction in physical functioning was found in both groups. Moreover, reduced social functioning and less diarrhoea in the CRT group and better role functioning and more diarrhoea in the RT group were found. Comparisons between the study group and age and gender matched reference values indicate impaired social functioning and more diarrhoea among the patients. Conclusion: There were no statistically significant differences in HRQoL between the randomisation groups. In general, despite having impaired social functioning and more diarrhoea, patients reported HRQoL comparable with the reference population several years after treatment. [Copyright &y& Elsevier]

Abstract: Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the “social” and the “economic” indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16–84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. [Copyright &y& Elsevier]

Abstract: This paper describes project work undertaken in order to map out and analyze language teachers’ experiences and views of various assessment principles and procedures with a particular focus on those that promote learning and relate to grading. A questionnaire survey in a nationally representative sample of 605 language education teachers in Sweden was conducted. In a second stage, a sub-sample of 20 teachers was then strategically drawn from the total sample for participation in a repertory grid interview study which delved deeper into the issues. Results from the combined analyses of the questionnaire and interview study demonstrate that the most common forms of assessment reported by both lower and upper secondary language teachers are ‘observation of free oral communication’, ‘own tests’, and ‘essay on given topic’. Elicited interview data reveal that command of grammar is ranked as the third most important criterion for assessment. This corresponds to questionnaire data about the tasks teachers use in their own language tests, where translation is common. In addition, non-language factors are reported to carry considerable weight in teachers’ grading of student achievement. [Copyright &y& Elsevier]

Abstract: The number of jobs at recycling centres are increasing, at the same time as there are indications of work environment problems. The aim of this paper was to investigate physical and psychosocial working conditions for employees at recycling centres in Sweden, to describe how they were perceived, to compare differences between subgroups, and further to identify proposals for improvement. Employees at 42 recycling centres (n =122) responded a postal questionnaire. Of these 32 employees from 16 recycling centres were interviewed, as also their employer (n =16). The work at recycling centres was reported to be a meaningful service job comprising many social interactions with users, but also substantial physical strain. There was a high frequency of injuries and minor injuries. Several risks were identified. There is a need for several preventive actions, e.g. better planning when building recycling centres, including better machines and equipment and more training, especially in handling hazardous waste. [Copyright &y& Elsevier]

Green Public Procurement (GPP) has been considered as an important policy instrument in the context of sustainable consumption and production. The state and progress of GPP has earlier been measured by questionnaires and interviews, both methods being based on the assessment by the purchaser, and questionnaires having low response rates. Recently, a new method was developed, analyzing the existence of environmental criteria in the calls for tenders. However, the studies have dealt neither with the progress in GPP, nor the statistical evidence of differences between countries. Our aim was to analyze more thoroughly whether the differences in the proportions of ‘green’ calls for tenders between the three Nordic countries, Denmark, Finland and Sweden, in 2003 and 2005 were real, and whether there had occurred any progress between the years concerned. The paper also presents the ‘GPP-record’ method, which enables more valid measurement of the environmental soundness of public purchasing. The statistical analyses were done using logit models with country, year and product group as the explanatory factors. It proved to be relevant to take into account the variation that occurred from the random existence of product groups in the samples of calls for tender. There were less environmental criteria in the calls for tenders in Finland than in Denmark and Sweden in 2003, but in 2005 no significant difference between Finland and Denmark was observed. Both Finland and Sweden saw progress in this area between 2003 and 2005. [Copyright &y& Elsevier]