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In the present school-based study, a convenience sample of 477 students in grades 6-9 and second year in high school from a city and a smaller town recorded daily occurrence and intensity of headaches in a standard paper diary during a 3-week period. Total headache activity (headache sum), number of headache days, intensity level and duration for weekly headaches were estimated. Approximately 85% of the adolescents had experienced headache of any intensity level during the 3-week recording period. On the average, they reported 2.5 headache days per week and a mean intensity level for headache episodes of 1.7. Our estimates for headache of any intensity level (1-5) occurring at least once a week was surprisingly high (73.8%). For the highest intensity level across the whole 3-week period, almost identical proportions of mild and moderate headaches were reported by students (22.3-22.5%), while about twice as many (40.7%) had experienced severe headaches. Girls consistently reported more headaches than boys, in particular of the moderate and severe intensity types. Students in the city also reported more frequent and intense headaches than those in the town. Peak headache activity was observed at noon and in the afternoon and in the days from the middle of the week until weekend. The use of prospective recordings in diaries will further advance our knowledge on the prevalence and characteristics of recurrent headaches among children and adolescents in community samples. [ABSTRACT FROM AUTHOR]

Background: The impact of hearing impairment is typically studied in terms of its effects on speech perception, yet this fails to account for the interactive nature of communication. Recently, there has been a move towards studying the effects of age‐related hearing impairment on interaction, often using referential communication tasks; however, little is known about how interaction in these tasks compares to everyday communication. Aims: To investigate utterances and requests for clarification used in one‐to‐one conversations between older adults with hearing impairment and younger adults without hearing impairment, and between two younger adults without hearing impairment. Methods & Procedures: A total of 42 participants were recruited to the study and split into 21 pairs, 10 with two younger adults without hearing impairment and 11 with one younger adult without hearing impairment and one older participant with age‐related hearing impairment (hard of hearing). Results from three tasks—spontaneous conversation and two trials of a referential communication task—were compared. A total of 5 min of interaction in each of the three tasks was transcribed, and the frequency of requests for clarification, mean length of utterance and total utterances were calculated for individual participants and pairs. Outcomes & Results: When engaging in spontaneous conversation, participants made fewer requests for clarification than in the referential communication, regardless of hearing status/age (p ≤ 0.012). Participants who were hard of hearing made significantly more requests for clarification than their partners without hearing impairment in only the second trial of the referential communication task (U = 25, p = 0.019). Mean length of utterance was longer in spontaneous conversation than in the referential communication task in the pairs without hearing impairment (p ≤ 0.021), but not in the pairs including a person who was hard of hearing. However, participants who were hard of hearing used significantly longer utterances than their partners without hearing impairment in the spontaneous conversation (U = 8, p < 0.001) but not in the referential communication tasks. Conclusions & Implications: The findings suggest that patterns of interaction observed in referential communication tasks differ to those observed in spontaneous conversation. The results also suggest that fatigue may be an important consideration when planning studies of interaction that use multiple conditions of a communication task, particularly when participants are older or hard of hearing. WHAT THIS PAPER ADDS: What is already known on this subject: Age‐related hearing impairment is known to affect communication; however, the majority of studies have focused on its impact on speech perception in controlled conditions. This indicates little about the impact on everyday, interactive, communication. What this study adds to the existing knowledge: We investigated utterance length and requests for clarification in one‐to‐one conversations between pairs consisting of one older adult who is hard of hearing and one younger adult without hearing impairment, or two younger adults without hearing impairment. Results from three tasks (two trials of a referential communication task and spontaneous conversation) were compared. The findings demonstrated a significant effect of task type on requests for clarification in both groups. Furthermore, in spontaneous conversation, older adults who were hard of hearing used significantly longer utterances than their partners without hearing impairment. This pattern was not observed in the referential communication task. What are the potential or actual clinical implications of this work?: These findings have important implications for generalizing results from controlled communication tasks to more everyday conversation. Specifically, they suggest that the previously observed strategy of monopolizing conversation, possibly as an attempt to control it, may be more frequently used by older adults who are hard of hearing in natural conversation than in a more contrived communication task. [ABSTRACT FROM AUTHOR]

To evaluate the reliability, internal consistency, and construct validity of the Swedish versions of PROMIS-29 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) instruments in patients with systemic sclerosis (SSc). In a cross-sectional study, consecutive SSc patients completed a paper-based survey. Internal consistency was assessed using Cronbach's alpha. Test–retest reliability was tested employing weighted Kappa (Kw) and intra-class correlation coefficient (ICC). Construct validity was evaluated by hypotheses testing using RAND-36, MRC Dyspnea score, Scleroderma Health Assessment Questionnaire (SHAQ) and clinical measurements. Forty-nine patients (86% female; 73% limited cutaneous SSc) completed the survey. The mean disease duration was 11 years and mean SHAQ was 0.5. Internal consistency and test–retest reliability were good with the exception of PROMIS-29 anxiety. PROMIS-29, FACIT-Dyspnea, and Functional limitation showed strong correlations to corresponding RAND-36 domains (|rs|=0.67 to −0.85). Relevant PROMIS-29 domains, FACIT-Dyspnea and Functional limitation correlated strongly to SHAQ and VAS overall disease severity (|rs|=0.60 to −0.75). Ceiling effects (>15%) were found in six PROMIS-29 domains and in both FACIT-Dyspnea and Functional limitations. Four (4/5) hypotheses were confirmed. PROMIS-29 and FACIT-Dyspnea meet the requirements for reliability and have adequate construct validity in Swedish patients with SSc. PROMIS-29v2 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) Index are patient outcome measures that gain increasing interest for the evaluation of patient with rheumatologic diseases. PROMIS-29v2 and FACIT-Dyspnea Index meet the requirements for reliability and have adequate construct validity compared to legacy measures in Swedish patients with systemic sclerosis. Translation and validation of PROMs is important for studies of rare diseases in multi-center collaborations. [ABSTRACT FROM AUTHOR]

Background: Intelligibility can be defined as the speakers' ability to convey a message to the listener and it is considered the key functional measure of speech. The Intelligibility in Context Scale (ICS) is a parent rating scale used to assess intelligibility in children. Aims: To describe normative and validation data on the ICS in Swedish and to investigate how these are related to age, gender and multilingualism. Methods & Procedures: Two studies were included. Study 1 included ICS forms from 319 Swedish‐speaking children (3:2–9:2 years:months). Study 2 included video recordings and ICS forms from 14 children with speech sound disorder (SSD) and two with typical speech. The video recordings were transcribed in the validation process, resulting in intelligibility reference scores to which ICS scores were correlated. Outcomes & Results: Study 1: The mean value of the ICS for the 319 children was 4.73. There were no differences in ICS score related to age or gender. The children in the multilingual group were significantly older than the monolingual group and had significantly lower ICS scores than the group of monolinguals. Study 2: There was a moderate correlation between the ICS score and the transcription‐based intelligibility score, with the two children with typical speech excluded; however, this correlation was not significant. Conclusions & Implications: We contribute mean scores and percentiles on the ICS for Swedish‐speaking children. The finding that the ICS does not provide valid measures of intelligibility for the included children with SSD suggests that the instrument measures a different construct. What this paper adds: What is already known on the subject: The ICS has been translated to numerous languages and validated against articulation measures in several previous studies. The validity of the Swedish version has been investigated against intelligibility based on transcription of single words. What this paper adds to existing knowledge: The study provides normative values of the Swedish version of the ICS for children aged 3–9 years. This is the first study to use a gold standard measure of intelligibility in continuous speech to validate the ICS. The results show a somewhat dubious validity regarding ICS for the group of children with SSD included in the study. What are the potential or actual clinical implications of this work?: The ICS's suitability as a measure of intelligibility is questionable; however, it might be of use for speech and language pathologists to give an overview of the parents' view of their child's ability to communicate, in order to make a decision on possible further assessment and intervention. The normative values of the Swedish version of the ICS could be of use in this decision process. [ABSTRACT FROM AUTHOR]

In this paper, we explore the performance of past-tense inflection of non-verbs (NVI) in children with developmental language disorder (DLD) and in typically developing controls, to investigate its accuracy as a clinical marker for Swedish-speaking children with DLD. Further, we investigate the relationship between NVI, nonword-repetition, and family history. The sample consists of 36 children with DLD (mean age 9;5 years) and 60 controls (mean age 9;2 years). The DLD group performed significantly lower than the controls on the NVI task, with a large effect size of the difference (d = 1.52). Analysis of the clinical accuracy of NVI resulted in 80.6% sensitivity and 76.6% specificity. NVI was significantly and moderately associated with nonword-repetition in the controls, but not in the DLD group. A positive family history, 80.6% in the DLD group and 6.9% in the controls, was associated with lower performance on NVI. When controlling for group (DLD and controls), a non-significant association between family history and performance on the NVI task was found. NVI is a potential clinical marker of DLD in Swedish school-aged children, but the current NVI task does not reach the level of being acceptable. Further development of the NVI task is warranted to improve its accuracy. [ABSTRACT FROM AUTHOR]

The Coronavirus Pandemic (COVID-19) has a significant impact on countries around the world and many states have introduced restrictions to transport. This includes keeping essential transport moving, for example to transport medical supplies and other essential goods. Many countries have closed their borders and imposed curfews in sharp reductions in transport demand also on regional and continental level. Public transport but also shared mobility services are vectors for distribution of the virus, on the other hand, they are severely impacted by travel bans and individual concerns in order to avoid public gatherings leading to reduced travel and transport demand. Different countries have dealt with these challenging circumstances in different ways - and, in some cases, the directives vary from city to city. Cities in developing countries and emerging economies face bigger challenges than ever before. At the beginning of the Coronavirus Pandemic (COVID-19) google maps started to collect detailed statistics on the movement of people using location data from mobile devices. The paper analyzes the data obtained and shows the results for various areas of movement such as shops, recreation areas, parks, public transport and other. A comparison was made of the collected data in the Republic of Croatia, which had a solid measures, Italian Republic which had many affected during the pandemic and Kingdom of Sweden which had very mild measures during a pandemic. Therefore, a study was made on how measures affected the mobility of people in individual countries with different measures. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate patients' satisfaction with care, 2 years after the introduction of person‐centred handover (PCH) in an oncological inpatient setting, and to describe patients' perceptions of individualised care. Background: To obtain higher levels of patient satisfaction, bedside nursing handovers have been evaluated with positive results. One such model is PCH, which blends aspects of person‐centred care with the bedside report and provides the opportunity for nursing staff and patients to perform the handover together. Design: A survey‐based design was used with one data collection period. Patient satisfaction scores were compared with baseline data from a previous study that has been conducted in the same wards. Method: Patient satisfaction was measured with the EORTC IN‐PATSAT32 questionnaire, and individualised care was assessed with the Individualized Care Scale. A total of 120 adult patients with cancer were invited to participate from August 2017–March 2018. Of these, 90 chose to participate. The STROBE checklist for cross‐sectional studies was used when preparing the paper. Results: Compared to the previous study, statistically significant improvements in patient satisfaction were observed in the subscales "Exchange of information between caregivers" and "Nurses' information provision" postimplementation of PCH. Regarding patients' perceptions of individualised care, the highest scores were in the ICS‐A subscale "Clinical situation" and ICS‐B "Decisional control," while "Personal life situation" scored the lowest overall. Conclusions: Person‐centred handover seems to have sustainable positive effects on important outcomes regarding patient satisfaction. A novel finding is the positive impact on nurses' information provision, indicating that PCH can facilitate effective information exchange between patients and nurses. Relevance to clinical practice: Person‐centred handover seems to improve patients' satisfaction with nurses' provision and exchange of information. Nurses and managers should carefully consider the implementation process of PCH and evaluate its long‐term effects. PCH can be recommended in the oncology inpatient setting. [ABSTRACT FROM AUTHOR]

The article presents a college thesis which investigated the determinants of the outcomes of lumbar spinal stenosis surgery and is based on several papers previously published by F. G. Sigmundsson, B. Jönsson and B.Strömqvist, including papers which appeared in a 2013 issue of "Acta Orthopaedica", a 2012 issue of "Acta Orthopaedica" and a 2014 issue of "Spine".

The main aim of the Swedish physical activity and fitness cohort study ( SPAF-1958) was to describe physical fitness, physical activity, health, and lifestyle across part of the lifespan, and to assess the influences on these factors from the environment, personal factors, and genetics. There is inevitable dropout from longitudinal studies, and it may be systematic. The aim of this first paper of the second follow-up of SPAF-1958 was to provide a dropout analysis to consider to what extent the participants, at 52 years of age, remain a representative sample of the original adolescent study population. Additional aims were to provide an overview of the study protocol and the ongoing study population. Ongoing study participants in SPAF born in 1958 were, at the second follow-up at the age of 52, still representative of the study cohort in terms of sex, adolescent geographical area, upper secondary school program, adolescent body composition, muscular strength, and muscular endurance. However, a higher physical activity and, among women, a higher aerobic capacity in adolescence decreased the risk for dropout. It is important when interpreting results from longitudinal studies to adjust for the systematic dropout that could bias the conclusions drawn from the results. [ABSTRACT FROM AUTHOR]

Aim To evaluate the psychometric properties of a questionnaire addressing psychosocial consequences of false-positive mammographic screening. Background The Consequences of Screening - Breast Cancer and Lung Cancer questionnaires target psychosocial consequences of false-positive cancer screening. The Consequences of Screening - Breast Cancer questionnaire and ten items not considered lung cancer specific from the Lung Cancer questionnaire have been adapted for use in mammographic screening in Sweden, but remain psychometrically untested. Design Instrument development paper with psychometric cross-sectional and test-retest design. Methods Twelve scales of a Swedish questionnaire version were tested by the Rasch model and traditional psychometric methods. Women with false-positive (Group I, n = 640) and negative (Group II, n = 802) screening mammography responded to the study questionnaire and the Nottingham Health Profile during 2009-2011. Results Iterative analyses resulted in nine scales demonstrating Rasch model fit, but all scales exhibited poor targeting with relatively large floor effects. Corrected item-total correlations exceeded the recommended criterion. Score differences between Groups I and II and correlations with Nottingham Health Profile sections followed an expected pattern. Cronbach's α and test-retest reliability was acceptable for group-level assessments for ten and seven scales, respectively. Conclusions Five scales (Sense of dejection, Anxiety, Behavioural, Sleep and Existential values) of the Swedish questionnaire version demonstrated the best psychometric properties. Other scales should be used more cautiously. Although filling an important gap, causes of concern were identified across scales. The questionnaire should therefore be considered for group-level assessments rather than for measurement of individual degrees of psychosocial consequences. [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]

Purpose. To study if partnership modifies the effect of gastrointestinal symptoms on quality of life after radiation therapy for prostate cancer. Material and methods. Using a study-specific questionnaire we conducted a cross-sectional follow-up of the occurrence gastrointestinal symptoms and quality of life after radiation therapy for prostate cancer. We obtained information from 874 prostate cancer survivors treated with radiation therapy at the Sahlgrenska University Hospital, Sweden between 1994 and 2006. In this paper we describe how partnership status affects the association between gastrointestinal symptoms and quality of life. Results. We found that unpartnered men with gastrointestinal symptoms reported a lower quality of life than unpartnered men without such symptoms. Unpartnered men with symptoms had an excess risk of low quality of life compared with unpartnered men without symptoms for those experiencing altered composition of stools, prevalence ratio 3.8 (95% CI 1.1-13.1), leakage, 3.6 (1.3-10.1), sensory bowel symptoms, 4.5 (1.6-12.8), and for urgency, 4.2 (1.2-15.1). We also found that unpartnered men with symptoms had an excess risk of low quality of life compared with partnered men with symptoms for those experiencing altered composition of stools, prevalence ratio 2.9 (95% CI 1.4-5.8), leakage 2.8 (1.2-6.4), sensory bowel symptoms 3.4 (1.5-7.4), urgency 2.6 (1.2-5.8), and for any gastrointestinal symptom 2.5 (1.3-4.9). Conclusion. Unpartnered men may represent a group that is specifically vulnerable to the distressful effects of gastrointestinal symptoms after radiation therapy for prostate cancer. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration - development of team climate and communication and more opportunity for both manager coordination and self-regulation. [ABSTRACT FROM AUTHOR]

Studies have shown that reduced neuromuscular control or strength increases the risk of acute injuries. It is hypothesized that a non-functional movement pattern can predispose for injuries. In the present paper a detailed description of a test battery consisting of nine different tests to screen athletic movement pattern is provided. The aim was to evaluate the inter- and intra-rater reliability of the test battery on a group of male elite soccer players. Twenty-six healthy elite soccer players (17-28 years) were screened. Eighteen participated at a second occasion 7 days later. No significant difference ( P=0.31) was found between test occasion 1 (LS means 18.3, 95% confidence interval 14.9-21.7) and test occasion 2 (18.0, 14.4-21.7) in the mean total score of the test battery. No significant difference in the inter-rater reliability was found between the eight physiotherapists at the two test occasions. The intra-class correlation coefficient was 0.80 and 0.81, respectively. The test battery showed good inter- and intra-rater reliability. The screening battery is easy to use for familiarized professionals and requires minimal equipment. However, further studies are needed to confirm the validity of the test battery in injury prevention, rehabilitation and performance enhancement. [ABSTRACT FROM AUTHOR]

efraimsson e.ö., fossum b., ehrenberg a., larsson k. & klang b. (2011) Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics. Journal of Advanced Nursing 68(4), 767-782. Abstract Aim. This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care. Background. For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking. Method. The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses' smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing. Results. Evocation', 'collaboration', 'autonomy-support' and 'empathy' averaged between 1·31 and 2·23 whereas 'direction' scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by 'closed questions', 'motivational interviewing non-adherent' and 'simple reflections'. 'Motivational interviewing adherent', 'open questions' and 'complex reflections' occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations. Conclusion. In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing. [ABSTRACT FROM AUTHOR]

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]

medin j., windahl j., von arbin m., tham k. & wredling r. (2012) Eating difficulties among patients 3 months after stroke in relation to the acute phase. Journal of Advanced Nursing 68(3), 580-589. Abstract Aim. This paper is a report of a study comparing eating difficulties among patients 3 months after stroke in relation to the acute phase. Background. There is limited knowledge of patients with eating problems early after stroke, hence the progress of eating abilities needs to be further explored. Method. From March 2007 to June 2008 36 stroke patients with 2-7 eating difficulties or problems with reduced alertness or swallowing in the acute phase were included. Eating difficulties were detected using a structured protocol of observation of meals. In addition, stroke severity (National Institute of Health Stroke Scale), functional status (Barthel Index), unilateral neglect (Line Bisection test and Letter Cancellation test), psychological well-being (The Well-being Questionnaire-12), nutritional status (Mini Nutritional Assessment) and oral status (Revised Oral Assessment Guide) were assessed. Results. There were 36 participants (58% female) with a median age of 74·5 years. The proportion of eating difficulties decreased significantly from the acute phase to the 3-month follow-up in 'sitting position', 'managing food on the plate' and 'manipulating food in the mouth' and increased regarding inadequate food consumption. Improvements were shown at 3 months in stroke severity, functional status, nutritional status and neglect. Oral status and psychological well-being remained unchanged. Conclusion. The majority of eating problems persisted 3 months after stroke despite a marked improvement in most of the physical functions. The unchanged psychological well-being and sustained problems with food consumption indicate that factors other than physical function should be taken into account regarding eating difficulties poststroke. [ABSTRACT FROM AUTHOR]

Background: For mothers with diabetes, breastfeeding is a great challenge due to their struggle with potentially unstable blood glucose levels. This paper explores breastfeeding attitudes and impact of breastfeeding on the daily life of mothers with type 1 diabetes compared with non-diabetic mothers.Methods: We performed a prospective cohort study of 108 mothers with type 1 diabetes and a reference group of 104 mothers in the west of Sweden. Data were collected through medical records and structured telephone interviews at 2 and 6 months after childbirth. Results: Women in both the diabetes group and the reference group had high levels of confidence (84% and 93% respectively) in their breastfeeding capacity before childbirth, and 90% assessed breastfeeding as a positive and an important experience during the six months of follow-up. About 80% assessed breastfeeding as influencing daily life 'very much' or 'quite a lot' at 2 months as did 60% at 6 months, with no difference between the groups. In mothers with diabetes, the impact of breastfeeding on the priority of other duties decreased over time, as did feelings of time pressure and negative effects on patterns of sleep. Compared to the reference group, mothers with diabetes at 6 months remained more affected by disruptions in daily life and they felt more worried about their health both at 2 and 6 months after childbirth. For the reference group mothers' sensitivity to unexpected disruptions in daily routines decreased between 2 and 6 months after childbirth, and they expressed a greater need to organize their time than mothers with diabetes. Conclusion: Mothers with diabetes type 1 express more worry for own health and are more sensitive to distruptions. To balance their everyday life and to reduce the risk of stress and ill health they are therefor, compared to other mothers, likely to need additional professional and peer support. [ABSTRACT FROM AUTHOR]

Background: The probability of pregnancy after in vitro fertilisation (IVF) declines with age in parallel with a reduction in the ovarian reserve. However, there is considerable variation in the ovarian reserve in women of advanced reproductive age; so to give such women accurate advice about the prospects of treatment success, factors other than age must be considered. Anti-Müllerian hormone (AMH) has been shown to be a good indicator of ovarian reserve, and its utility is explored in this paper. Aims: To determine the utility of AMH serum levels for prediction of ovarian response to gonadotropin stimulation and outcome in IVF in women of advanced reproductive age. Methods: The material consists of 127 women with a median age of 42 years (range 39-46) having had their first cycle of IVF/intracytoplasmic sperm injection (ICSI) treatment from November 2006 to December 2008. During this period, a total of 772 oocyte retrievals and 715 embryo transfers were performed at the clinic (median age 36.4 years). AMH was analysed with the Beckman Coulter DSL ELISA. Agonist and antagonist protocols were used and monitored by ultrasound and oestradiol; embryo transfer was performed on day 2, 3 or 5 of culture. Results: The lower the AMH, the higher the risk of cycle cancellation, low oocyte yield and treatment failure. Women with a serum AMH above 8.6 pmol/L had a good chance of achieving live birth after IVF/ICSI treatment. Conclusions: Anti-Müllerian hormone is useful for identifying a good prognosis group in women of advanced reproductive age. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 510-516 Oral health-related quality of life in older Swedish people with pain problems Objectives: The aim of the present paper was to explore the oral health-related quality of life in old Swedish people with pain problems, with special reference to demography, socio-economic factors, health, and general health-related quality of life. Method: Individuals ≥80 years (n = 186) who earlier reported pain problems answered two multi-item instruments on oral health-related quality of life (Oral Health Impact Profile, OHIP-14) and general health-related quality of life (Short Form Health Survey, SF-12), respectively. Socio-demographic and health questions were also inquired. Results: Both the oral and general health-related quality of life were rated very low. Two thirds (67.2%) reported at least one of the aspects in the OHIP-14 fairly often, very often or all the time. The mean additive score of the OHIP-14 was 14.6 (SD 10.5). The mean value of the physical component scale (PCS) of SF-12 was 25.9 (SD 6.2) and of the mental component scale (MCS) 44.1 (SD 11.5). The OHIP-14 was consistently and significantly correlated with self-rated general and oral health, chewing ability and MCS. The associations between self-rated general and oral health in relation to the OHIP-14 were independent of possible confounders: OR 3.63 (95% CI 1.58-8.32) and OR 2.68 (95% CI 1.44-4.99), respectively. Conclusion: Old people with pain problems experienced very low oral and general health-related quality of life. Personnel caring for the oldest with pain problems should be aware that oral health problems can contribute to a low quality of life and that oral care should be included in the general care. [ABSTRACT FROM AUTHOR]

suhonen r., papastavrou e., efstathiou g., lemonidou c., kalafati m., da luz m.d.a., idvall e., berg a., acaroglu r., sendir m., kanan n., sousa v.d., katajisto j., välimäki m. & leino-kilpi h. (2011) Nurses' perceptions of individualized care: an international comparison. Journal of Advanced Nursing 67(9), 1895-1907. Abstract Aim. This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. Background. Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. Methods. A descriptive comparative survey was used to sample orthopaedic surgical nurses ( n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. Results. Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. Conclusions. Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area. [ABSTRACT FROM AUTHOR]

This paper examines whether and to what extent three recently implemented family policies in Sweden change incentives regarding employment and choice of childcare for parents of young children, and whether these incentives differ by income level. These policy innovations warrant close examination because they represent a decisive ideological shift from what was a coherent set of policies that created incentives for high levels of female employment and that has been identified as a model of best practice in Europe. Simulating the economic incentive effects of the three new policies for heterosexual couple families with different levels of income, we find that while family policy in Sweden continues to provide the strongest support for a model of gender equality that combines full-time dual earning with public childcare, alternative organizations of family life are now more affordable. Nonetheless, the extent to which the costs of deviation from this model have changed varies by income level. [ABSTRACT FROM PUBLISHER]

Aim. This paper is a report of a study conducted to describe primary healthcare personnel's knowledge of multidrug-resistant and preventive hygiene measures. Background. The group of patients at risk for multi-drug resistant bacteria is largely cared for in primary care. Knowledge of multidrug-resistant and hygiene preventive measures among primary healthcare personnel is therefore essential. Method. A descriptive and comparative questionnaire survey among primary healthcare personnel was performed in 2008. In total, five urban and rural primary healthcare centres situated in one county in central Sweden were included. Convenient sampling was used and 10 physicians, 38 district nurses and 10 nursing assistants participated. Knowledge/medical facts concerning multidrug-resistant and hygiene preventive measures were investigated and data were analysed using a quantitative approach. Results. Knowledge/medical facts concerning several aspects of multidrug-resistant bacteria, particularly Extended-Spectrum-Beta-Lactamase producing bacteria, were deficient as was knowledge of different aspects of hygiene preventive measures. Physicians showed significantly better results than district nurses and nursing assistants did. Awareness of proper hand-washing as an effective preventive method and use of aprons in nursing care was high among all participants. Staff who knew they had cared for these patients had significantly better results than the others did. Conclusion. Our findings suggest that evidence-based education of multidrug-resistant and hygiene preventive measures, in primary health with subsequent follow-ups should become a prioritized clinician and management concern. Research is needed that focus implementation of evidence-based educations, staff attitudes and responsibilities related to the work with patients at risk of multidrug-resistant bacteria. [ABSTRACT FROM AUTHOR]

Background. From March 1994 to March 1998, breast cancer patients (an estimated relapse risk with 70% or more within five years with standard therapy) were randomised to treatment with tailored fluorouracil, epirubicin, and cyclophosphamide (FEC) therapy or FEC followed by marrow-supported high dose therapy in the Scandinavian Breast Group 9401 study. The aim of the present paper was to investigate differences in toxicity and eight health-related quality of life (HRQoL) variables (physical functioning, role functioning, emotional functioning, social functioning, cognitive functioning, fatigue, nausea-vomiting, and global quality of life) between women in the six dose steps used in the tailored and granulocyte colony stimulating factor supported FEC-arm at the assessment point 16 weeks after random assignment to treatment. Methods. The European Organization and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30 were mailed to the patients. Results. A total of 157 (87%) in the tailored FEC-group responded to the questionnaire within the time frame 16 weeks after inclusion in the study. Overall, toxicity was low, reaching grade 1--2 also in the higher dose steps. There were no overall differences between the dose steps on any of the tested HRQoL variables. Patients at dose step 4 scored statistically significantly higher on physical functioning than patients at dose step 1 (p == 0.022) and compared to those at dose step 2 (p == 0.014). Patients at dose steps −−2 and −−1 (combined to one group) reported statistically significantly higher mean scores on cognitive functioning than patients at dose step 1 (p == 0.022). Conclusion. Patients who received higher doses, based on the tailored dosing strategy, did not seem to have worse HRQoL than those who had lower doses. [ABSTRACT FROM AUTHOR]

This paper investigates students' initial encounters with the seminar as a working form in higher education. The main interest was to explore how the communication pattern, the aim of the seminar and meaning were negotiated. The results originate from an ethnographic field study where we followed a group of students in a Masters program in Social Science during their first five weeks. Data were analyzed from a socio-cultural perspective and the concepts of participation and reification. We found that there was an implicit negotiation of the communication pattern, what to discuss and the function of the seminar. In these processes, the students and teacher participated in the negotiation of meaning. Different objects were created through a reification process, around which the negotiation of meaning took place. [ABSTRACT FROM AUTHOR]

The paper gives an overview of the functioning of the official statistical system in Sweden with particular emphasis on coordination tools. The Swedish statistical system was decentralised in 1994. Today Statistics Sweden is responsible for about 40 percent of the number of products but for slightly more than 80 percent of the production of official statistics. The approach Statistics Sweden has chosen in its coordinating function is to encourage "soft" coordination. This means encouraging discussions and trying to reach consensus before decisions rather than issuing regulations. So far, this approach to coordination of Swedish official statistics has been successful. The cooperation between the authorities responsible for official statistics and the transparency and efficiency of the system has improved. However, there are still many problems to solve and many possibilities for improvement. [ABSTRACT FROM AUTHOR]

To estimate daily catchment precipitation from point observations there is a need to understand the spatial pattern, particularly in mountainous regions. One of the most important processes occurring there is orographic enhancement, which is affected by, among other things, wind speed and wind direction. The objective of this paper was to investigate whether the relationship between precipitation, airflow and topography could be described by statistical relationships using data easily available in an operational environment. The purpose was to establish a statistical model to describe basic patterns of precipitation distribution. This model, if successful, can be used to account for the topographical influence in precipitation interpolation schemes. A statistical analysis was carried out to define the most relevant variables, and, based on that analysis, a regression model was established through stepwise regression. Some 15 years of precipitation data from 370 stations in Sweden were used for the analysis. The geostrophic wind, computed from pressure observations, was assumed to represent the airflow at the relevant altitude. Precipitation data for each station were divided into 48 classes representing different wind directions and wind speeds. Among the variables selected, the single most important one was found to be the location of a station with respect to a mountain range. On the upwind side, precipitation increased with increasing wind speed. On the leeward side there was less variation in precipitation, and wind speed did not affect the precipitation amounts to the same degree. For ascending air, slope multiplied by wind speed was another important factor. The effect of slope was enhanced close to the coast, and reduced for mountain valleys with upwind barriers. The stepwise procedure led to a regression model that also included the meridional and zonal wind components. Their inclusion might indicate the importance of air mass characteristics not explicitly accounted for. Copyright © 2003 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

The concept of motility, mobility capital, has been put forward to understand mobility from a more holistic perspective through incorporating subjective and objective as well as material and non-material aspects in the examination of individuals' mobility potentials. In this paper, building on a survey study in the two municipalities of Malmö and Gothenburg in Sweden, I developed a quantitative operationalization of motility in relation to cycling and employed GIS-based and statistical analyses to identify a set of appropriate indicators to measure the three dimensions of cycling motility namely access, competence, and appropriation. The analyses reveal three operational dimensions underlying the process of appropriating cycling to carry out daily trips. More specifically, individuals' perceptions of the functional and social suitability of cycling and its compatibility with their principles and values seem to be significant for the appropriation of a bike as a daily travel mode. Altogether, the findings support that the quantitative operationalization of cycling motility can deepen our understanding of the factors shaping individuals' cycling potentials and practices, hence offering valuable insights into the development of successful cycling interventions that create material and nonmaterial infrastructure, competences, and positive representations necessary for the appropriation of cycling. [ABSTRACT FROM AUTHOR]

Abstract. This paper describes the Swedish Register System and the linkage between the different registers. It contains a few examples of register statistics where the links have been utilised and gives an overview of methodological problems. To meet our users' needs we must continue to improve the system, must achieve better linkage, greater consistency and better documentation. We must also develop a common methodology for the statistical work behind a system of statistical registers. [ABSTRACT FROM AUTHOR]

Researchers subject to time and budget constraints may conduct small nested case–control studies with individually matched controls to help optimize statistical power. In this paper, we show how precision can be improved considerably by combining data from a small nested case–control study with data from a larger nested case–control study of a different outcome in the same or overlapping cohort. Our approach is based on the inverse probability weighting concept, in which the log-likelihood contribution of each individual observation is weighted by the inverse of its probability of inclusion in either study. We illustrate our approach using simulated data and an application where we combine data sets from 2 nested case–control studies to investigate risk factors for anorexia nervosa in a cohort of young women in Sweden. [ABSTRACT FROM AUTHOR]

Background: When new elements are included in the medical curriculum and the total time frame remains unchanged, established disciplines have to shorten their courses. This might bring about frustration among the teachers and students concerned, which in turn might affect how other courses are perceived. Findings: Two course evaluations, one before and one after a major change in the curriculum were compared. Comments were also analysed. We found that the students' and teachers' frustration influenced the students' evaluations of a new course in the philosophy of medicine and accordingly brought about an unintended message effect referred to as a framing effect. Conclusions: The results of this observational study indicate that a negative framing effect might influence course-evaluations. We suggest that this study might be used as a point of departure for further empirical studies about negative framing effects. [ABSTRACT FROM AUTHOR]