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Purpose: National surveys of speech-language pathologists' (SLP) practices play an important role in professional development, and previous research show that many challenges faced by the profession are similar across the globe. This study aims to describe Swedish SLP assessment practices, examine factors that may affect this practice, and discuss the results in the light of international studies. Methods: Data from 584 SLPs were collected through an online questionnaire with multiple choice and open-ended questions. A mixed-method design was deployed where a deductive qualitative analysis of free-text responses complemented quantitative data. Results: In line with previous results from English-speaking countries, both standardized discrete skill tests and contextualized assessments were used by the respondents but fewer used language sample analysis and dynamic assessment procedures, despite international recommendations. There were few differences based on experience, work setting, proportion of multilingual assessments and socio-economic status of the health catchment area. Main challenges reported were lack of time and difficulty prioritizing, and assessment and/or diagnosis of multilingual/L2 children, which is similar to challenges faced by SLPs in other countries. Swedish SLPs also reported lack of national clinical guidelines as a main challenge. Factors contributing to better assessments included experience, and the combination of many sources of information, including professional and interprofessional discussions. Conclusions: The accumulated evidence from this and previous studies show that to address challenges and build on strengths, changes on a systemic level are needed. This includes more time and resources for continuing education and implementation of recommended assessment methods, as well as professional and interprofessional collaborations. [ABSTRACT FROM AUTHOR]

Purpose: For clients to understand social insurance decisions and processes, information from authorities needs to be comprehensible, and clients need sufficient individual abilities. These dimensions are captured by the concept social insurance literacy, which has been operationalized into a measure, the Social Insurance Literacy Questionnaire (SILQ). The aim of this study was to describe the development of the SILQ and evaluate its psychometric properties using Rasch measurement theory. Methods: The development of the SILQ included a Delphi study and cognitive interviews. A preliminary version, divided on four scales corresponding to the domains of the concept (obtaining information, understanding information, acting on information, and system comprehensibility) was psychometrically evaluated according to Rasch measurement theory, in a survey to a stratified random sample of people on sick leave (n = 1151) sent out in the fall of 2020. Results: Overall, the items in the final version of the SILQ demonstrated good fit to the Rasch model, and the response scale worked as intended. Unidimensionality was supported for all scales, but minor problems with local dependency was detected for three items. The person separation was 0.80 for the Obtain scale, 0.82 for the Understand scale, 0.68 for the Act scale, and 0.81 for the System scale. Corresponding ordinal alpha values were 0.91, 0.91, 0.86, and 0.91, respectively. Conclusion: This study is a first step toward exploring literacy in the social insurance field. The SILQ covers individual abilities and systems' comprehensibility, and the results show that it has acceptable psychometric properties. [ABSTRACT FROM AUTHOR]

Aims To compare patient-reported outcomes (PROs) in patients newly (<6 months) diagnosed with atrial fibrillation (AF) with those who have had a longer diagnosis (≥6 months) and to investigate whether or not these outcomes change over a 6-month period. Methods and results In this longitudinal survey study, 129 patients with AF completed the Revised Illness Perception Questionnaire, the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia, and the Hospital Anxiety and Depression Scale at baseline and after 6 months. At baseline, patients newly diagnosed with AF (n = 53), compared with patients with a previous diagnosis (n = 76), reported AF as more temporary (P = 0.003) and had a higher belief in personal and treatment control (P = 0.004 and P = 0.041, respectively). At a 6-month follow-up, patients newly diagnosed reported a lower symptom burden (P = 0.004), better health-related quality of life (HRQoL); (P = 0.015), and a higher personal control (P < 0.001) than patients previously diagnosed. Over time, in patients newly diagnosed, symptom burden and the anxiety symptom score decreased (P = 0.001 and P = 0.014, respectively) and HRQoL improved (P = 0.002). Conclusion Patients newly diagnosed with AF reported more positive PROs both at baseline and at a 6-month follow-up than patients with a previous diagnosis of AF. Therefore, it is important to quickly capture patients newly diagnosed to support their belief in their own abilities. Such support may, alongside medical treatments, help patients manage the disease, which may lead to reduced symptom burden and better HRQoL over time. [ABSTRACT FROM AUTHOR]

Objective: In previous studies, venous ulcers (VUs) have been found to occur more often in patients with lower socioeconomic status. The aim of this study was to explore if socioeconomic factors influence the delay of referral to a vascular service or the time to healing after superficial venous intervention. Method: In this prospective study, patients answered a questionnaire about the duration and recurrence of their VU, comorbidities, body mass index (BMI), smoking, alcohol, social and physical activities, ambulatory status, education, marital status, housing, perceived economic status and dependence on home care. Postoperative complications, VU healing and recurrence were noted one year after superficial venous intervention. Results: A total of 63 patients were included in this study (30 females and 33 males), with a mean age of 71.2 years (range: 37–92 years). Duration of the present VU in patients was: <3 months in 48%; 3–6 months in 27%; 6–12 months in 11%; and >12 months in 14%. Risk factors for delayed referral were recurrent VU (odds ratio (OR): 4.92; p=0.021); walking impairment (OR: 5.43; p=0.009) and dependence on home care (OR: 4.89: p=0.039) in a univariable analysis. The latter was the only significant finding in a multivariable analysis with socioeconomic risk factor (OR: 4.89; p=0.035). In 85% of patients, their VU healed without recurrence during one year follow-up. Healing took longer if the patients: were of older age (p=0.033); had a normal BMI (independent samples t-test, p=0.028); had a recurrent VU (OR: 5.00; p=0.049); or walking impairment (Fishers exact test, OR: 9.14; p=0.008), but no significant socioeconomic risk factors were found. Conclusion: In this study, socioeconomic factors were not important risk factors for delayed referral of VU patients to a vascular service or prolonged healing time after superficial venous intervention. Declaration of interest: This work was supported by the Scandinavian Research Foundation for Varicose Veins and other Venous Diseases (SFÅV) and by ALF funding from Region Örebro County. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Aims: To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self‐reported oral health with registered nurse assessments. Design: A descriptive and comparative study, with a consecutive selection. Methods: A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. Results: Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self‐assessment did. Conclusion: There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. Implications for the Profession and Patient Care: Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self‐assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. Impact: There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. Patient Contribution: Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment. Reporting Method: This study was carried out according to the STROBE checklist. [ABSTRACT FROM AUTHOR]

Purpose: Investigate the association between choline and betaine intake and all-cause mortality in a large Swedish cohort. Methods: Women (52,246) and men (50,485) attending the Västerbotten Intervention Programme 1990–2016 were included. Cox proportional hazard regression models adjusted for energy intake, age, BMI, smoking, education, and physical activity were used to estimate mortality risk according to betaine, total choline, phosphatidylcholine, glycerophosphocholine, phosphocholine, sphingomyelin, and free choline intakes [continuous (per 50 mg increase) and in quintiles]. Results: During a median follow-up of 16 years, 3088 and 4214 deaths were registered in women and men, respectively. Total choline intake was not associated with all-cause mortality in women (HR 1.01; 95% CI 0.97, 1.06; P = 0.61) or men (HR 1.01; 95% CI 0.98, 1.04; P = 0.54). Betaine intake was associated with decreased risk of all-cause mortality in women (HR 0.95; 95% CI 0.91, 0.98; P < 0.01) but not in men. Intake of free choline was negatively associated with risk of all-cause mortality in women (HR 0.98; 95% CI 0.96, 1.00; P = 0.01). No other associations were found between intake of the different choline compounds and all-cause mortality. In women aged ≥ 55 years, phosphatidylcholine intake was positively associated with all-cause mortality. In men with higher folate intake, total choline intake was positively associated with all-cause mortality. Conclusion: Overall, our results do not support that intake of total choline is associated with all-cause mortality. However, some associations were modified by age and with higher folate intake dependent on sex. Higher intake of betaine was associated with lower risk of all-cause mortality in women. [ABSTRACT FROM AUTHOR]

Purpose: This study focuses on 7- to 9-year-old children attending primary school in Swedish areas of low socioeconomic status, where most children's school language is their second language. The aim was to better understand what factors influence these children's narrative listening comprehension both in an ideal listening condition (in quiet) and for the primary school classroom, a typical listening condition (with multitalker babble noise). Method: A total of 86 typically developing 7- to 9-year-olds performed a narrative listening comprehension test (Lyssna, Förstå och Minnas [LFM]; English translation: Listen, Comprehend, and Remember) in two listening conditions: quiet and multitalker babble noise. They also performed the crosslinguistic nonword repetition test and a digit span backwards (DSB) test. A predictive statistical model including these factors, the children's degree of school language exposure, parental education level, and age was derived. Results: Listening condition had the strongest predictive value for LFM performance, followed by school language exposure and nonword repetition accuracy. Parental education level was also a significant predictor. There was a significant three-way interaction effect between listening condition, age, and DSB performance. Conclusions: Multitalker babble noise has a negative effect on children's narrative listening comprehension. The effect of multitalker babble noise could be explained by age differences in the ability to allocate working memory capacity during the narrative listening comprehension task, suggesting that younger children may be more vulnerable for missing information when listening in background noise than their older peers. Supplemental Material: https://doi.org/10.23641/asha.25209248 [ABSTRACT FROM AUTHOR]

BACKGROUND: Gender differences in attitudes towards depression gives reason to believe that sociocultural gender norms play a role in other areas. OBJECTIVE: The aim was to test (i) if the likelihood to think that sick leave with depression symptoms is not reasonable varies between women and men, and (ii) if the likelihood to think sick leave is not reasonable varies depending on the gender of the individual with depression symptoms. METHODS: A study population of 3147 participants responded to a web-survey with a written case briefly describing a man or woman with symptoms of depression. Respondents were asked if they thought it is reasonable that the person was sick listed for two weeks. Logistic regression was used to analyse the data. RESULTS: After controlling for age, education, self-rated health, and respondent's own experience of sickness absence the adjusted OR was 1.45 (95% CI 1.25–1.67) for men being less likely to think sick-leave was reasonable. Gender difference decreased when adjusting for negative attitudes towards depression (adjusted OR 1.24, 95% CI 1.06–1.44). No difference was found between how women and men thought about sick leave in relation to the gender of the case described in the vignette. CONCLUSION: Men were more likely to think that sick leave was not reasonable with decreased OR after adjustment for negative attitudes towards depression. Gender norms might be part of the explanation for differences but are challenging to test. This study contributes to a bourgeoning research field on gendered attitudes and sick leave, in terms of theoretical reasoning and methodological choice. [ABSTRACT FROM AUTHOR]

Objectives To determine the effect of antimalarial agents (AMA) and different doses and pharmaceutical forms of belimumab on preventing renal flares in patients with SLE treated for extra-renal disease. Methods We pooled data from the BLISS-52, BLISS-76, BLISS-SC and BLISS-Northeast Asia trials of belimumab (n  = 3225), that included patients with active SLE yet no severe ongoing nephritis. Participants were allocated to receive intravenous belimumab 1 mg/kg, intravenous belimumab 10 mg/kg, subcutaneous belimumab 200 mg, or placebo in addition to standard therapy. We estimated hazards of renal flare development throughout the study follow-up (52–76 weeks) using Cox regression analysis. Results In total, 192 patients developed a renal flare after a median of 197 days. Compared with placebo, the risk of renal flares was lower among patients receiving intravenous belimumab 10 mg/kg (HR: 0.62; 95% CI: 0.41, 0.92; P  = 0.018) and intravenous belimumab 1 mg/kg (HR: 0.42; 95% CI: 0.22, 0.79; P  = 0.007), while no significant association was found for subcutaneous belimumab 200 mg. AMA use yielded a lower hazard of renal flares (HR: 0.66; 95% CI: 0.55, 0.78; P  < 0.001). The protection conferred was enhanced when belimumab and AMA were co-administered; the lowest flare rate was observed for the combination intravenous belimumab 1 mg/kg and AMA (18.5 cases per 1000 person-years). Conclusions The protection conferred from belimumab against renal flare development in patients treated for extra-renal SLE appears enhanced when belimumab was administered along with AMA. The prominent effect of low-dose belimumab warrants investigation of the efficacy of intermediate belimumab doses. Clinical trial identification BLISS-52: NCT00424476; BLISS-76: NCT00410384; BLISS-SC: NCT01484496; BLISS-NEA: NCT01345253. [ABSTRACT FROM AUTHOR]

Background: Impaired quadriceps muscle strength after anterior cruciate ligament reconstruction (ACLR) is associated with worse clinical outcomes and a risk of reinjuries. Yet, we know little about quadriceps muscle strength in patients reconstructed with a quadriceps tendon (QT) graft, which is increasing in popularity worldwide. Purpose: To describe and compare isokinetic quadriceps strength in patients undergoing ACLR with a QT, hamstring tendon (HT), or bone–patellar tendon–bone (BPTB) autograft. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We included patients with QT grafts (n = 104) and matched them to patients with HT (n = 104) and BPTB (n = 104) grafts based on age, sex, and associated meniscal surgery. Data were collected through clinical strength testing at a mean of 7 ± 1 months postoperatively. Isokinetic strength was measured at 90 deg/s, and quadriceps strength was expressed as the limb symmetry index (LSI) for peak torque, total work, torque at 30° of knee flexion, and time to peak torque. Results: Patients with QT grafts had the most impaired isokinetic quadriceps strength, with the LSI ranging between 67.5% and 75.1%, followed by those with BPTB grafts (74.4%-81.5%) and HT grafts (84.0%-89.0%). Patients with QT grafts had a significantly lower LSI for all variables compared with patients with HT grafts (mean difference: peak torque: −17.4% [95% CI, −21.7 to −13.2], P <.001; total work: −15.9% [95% CI, −20.6 to −11.1], P <.001; torque at 30° of knee flexion: −8.8% [95% CI, −14.7 to −2.9], P =.001; time to peak torque: −17.7% [95% CI, −25.8 to −9.6], P <.001). Compared with patients with BPTB grafts, patients with QT grafts had a significantly lower LSI for all variables (mean difference: peak torque: −6.9% [95% CI, −11.2 to −2.7], P <.001; total work: −7.7% [95% CI, −12.4 to −2.9], P <.001; torque at 30° of knee flexion: −6.3% [95% CI, −12.2 to −0.5], P =.03; time to peak torque: −8.8% [95% CI, −16.9 to −0.7], P =.03). None of the graft groups reached a mean LSI of >90% for peak torque (QT: 67.5% [95% CI, 64.8-70.1]; HT: 84.9% [95% CI, 82.4-87.4]; BPTB: 74.4% [95% CI, 72.0-76.9]). Conclusion: At 7 months after ACLR, patients with QT grafts had significantly worse isokinetic quadriceps strength than patients with HT and BPTB grafts. None of the 3 graft groups reached a mean LSI of >90% in quadriceps strength. [ABSTRACT FROM AUTHOR]

There is growing evidence of the positive effects of constraint-induced movement therapy (CIMT) for infants at high risk of unilateral cerebral palsy (UCP) when provided by parents with in-person coaching/supervision from occupational therapists during home visits. The aim of this study is to investigate whether Baby-mCIMT (modifiedCIMT) can be as effective if parents are coached/supervised remotely. In this case-control study, we recruited 20 infants and re-used 18 controls, 4–8-month-old infants in both groups at high risk of UCP. The same protocol regarding inclusion criteria, data collection, and training volume was used in both groups. The training was conducted for two 6-week periods, separated by a 6-week break, consisting of daily 30 min sessions conducted by parents, supported by therapist coaching once a week. The primary outcome was measured using the Hand Assessment for Infants (HAI). There was no difference in the change of HAI units (p = 0.803) or that of the affected-hand raw score (p = 0.942) between the two groups. The remote coaching method was well received by parents. In conclusion, this demonstrates that remote coaching/supervision is as effective as the in-person approach, requiring less time and effort for both families and healthcare providers. [ABSTRACT FROM AUTHOR]

The paper goes on to discuss the prevalence of issues in pre-trial detention practices in both Sweden and Ukraine, as noted by international and national organizations. Sweden has witnessed a growing trend in pre-trial detention statistics, while Ukraine, despite a decreasing trend in remand, faces a substantial number of cases brought against it at the European Court of Human Rights (ECHR) pertaining to pre-trial detention. The historical context reveals that these two countries have responded differently to criticism and challenges, reflecting variations in their legal systems and corresponding regulations on pre-trial detention. Nonetheless, both nations have pursued reforms with a shared objective: to improve the pre-trial detention system. Given these divergent experiences, statistical data, and overall context, it is evident that a comparative analysis of pre-trial detention policies in Sweden and Ukraine is warranted. Such a comparison can offer valuable insights into the existing problems in both countries and suggest pertinent solutions, taking into consideration their distinctive experiences and circumstances. [ABSTRACT FROM AUTHOR]

BACKGROUND: Quality of life (QOL), sense of coherence (SOC) and occupational balance (OB) have been found to increase after rehabilitation among people living with depression and anxiety. However, these aspects have not been investigated over time in participants with different paid work situations, such as being on sick leave or not. OBJECTIVE: To describe and compare the self-rated QOL, SOC and OB after participation in occupational therapy in three groups of people with depression and anxiety disorders based on their work situation during the study period: continuous sick leave, return to work and continuous work. METHODS: Forty-seven women and seven men, 19–60 years old with depression and anxiety were followed over time. They completed questionnaires on QOL, SOC and OB on four occasions. Data were analyzed with non-parametric statistics. RESULTS: No statistically significant differences between the groups were identified. All groups improved in at least one of the studied areas over time: the sick leave group in OB; the return-to-work group in QOL and OB; and the Work group in QOL and SOC. CONCLUSION: The results indicate variations in QOL, SOC and OB between people with different work situations over time after occupational therapy. Studies with larger samples are, however, warranted. [ABSTRACT FROM AUTHOR]

Background: The number of people with common mental disorders (CMDs), especially stress-related disorders, has increased in several countries, including Sweden, during the past decade. Patients seeking care for long-term stress report severe symptoms. Although person-centred care (PCC) has shown several benefits, studies evaluating the effects of a PCC eHealth intervention on patients with CMDs are scarce. Objective: The aim of this study was to compare levels of self-reported symptoms of burnout between a control group receiving treatment as usual (TAU) and an intervention group receiving TAU with the addition of a person-centred eHealth intervention, in patients on sick leave for CMDs. Methods: This study reports analysis of a secondary outcome measure from a randomized controlled trial. Patients (n = 209) on sick leave for CMDs were recruited from nine primary health care centres and allocated to either a control group (n = 107) or an intervention group (n = 102). The intervention consisted of phone support and an interactive digital platform built on PCC principles. Self-reported symptoms of burnout were assessed using the Shirom-Melamed Burnout Questionnaire (SMBQ) at baseline and at 3 and 6 months. Results: Our findings showed changes in SMBQ scores over time in both the control and the intervention group. There was no significant difference in SMBQ scores between the groups; however, a difference in change over time between the groups was observed. The SMBQ scores decreased significantly more in the intervention group than in the controls between 0 and 3 months and between 0 and 6 months. No differences in change between the two groups were seen between the 3- and 6-month follow-ups. Conclusion: This person-centred eHealth intervention for patients on sick leave for CMDs showed a slight initial effect in reducing symptoms of burnout. Taking into account that both groups reported comparable SMBQ scores throughout the study period, the overall effect may be considered limited. Trial registration: : The trial was registered in ClinicalTrials.gov (Identifier NCT03404583). Date of registration: 19/01/2018. https://clinicaltrials.gov/ct2/show/NCT03404583. [ABSTRACT FROM AUTHOR]

Background Maintaining neutral spinal alignment is considered important when performing the barbell back squat exercise. Since male and female lifters may differ in injury location it is important to examine whether they differ in spinal alignment during the back squat. Objectives The study aimed to quantify the spinal alignment in the upper and lower lumbar spine during the barbell back squat exercise in male and female lifters. Secondary aims were to compare alignment during the back squat to standing habitual lumbar spine alignment and determine whether male and female lifters differ in these aspects. Study Design Observational, Cross-sectional. Methods Competitive power- and weightlifters were recruited and performed three repetitions of the barbell back squat exercise using a load equivalent to 70% of their one-repetition maximum. Spinal alignment and range of motion were measured using inertial measurement units placed on the thoracic, lumbar and sacral spine. Data was presented descriptively and comparisons between men and women as well as spinal alignment in four different positions were done with a factorial repeated measures analysis of variance. Results Twenty-three (14 males, 9 females) were included. During execution of the squat, spinal alignment adjustments in the lumbar spine were made in all three planes of movement, compared to the start position, in both male and female lifters. Compared to their standing habitual posture, all lifters adjusted their upper lumbar spine to a less lordotic position when in the start position of the back squat (standing upright with the barbell on their back). Only male lifters assumed a less lordotic alignment in their lower lumbar spine in the start position compared their habitual posture. Conclusions Adjustments of spinal alignment, predominantly in the sagittal plane, are made during execution of the back squat in both male and female lifters. Further, lifters adopt a less lordotic alignment with a heavy barbell on their upper back, more so in male than female lifters. In conclusion, it seems that spinal alignment changes noticeably during the barbell back squat. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore physicians' use of drug information in professional work, with special focus on those working in primary care, and also in relation to personal characteristics of physicians. Methods: A web-based questionnaire was distributed by e-mail to physicians in five regions in Sweden. The questions concerned drug-related queries at issue when searching for information, sources used, and factors of importance for the choice of source, as well as responder characteristics. Results: A total of 3254 (85%) out of 3814 responding physicians stated that they searched for drug information every week. For physicians working in primary health care, the corresponding number was 585 (96%). The most common drug-related issues searched for by 76% of physicians every week concerned pharmacotherapeutic aspects (e.g., dosing), followed by adverse drug reactions (63%). For 3349 (88%) physicians, credibility was the most important factor for the choice of sources of drug information, followed by easy access online (n = 3127, 82%). Further analyses among physicians in primary care showed that some personal characteristics, like seniority, sex, and country of education, as well as research experience, were associated with usage and preferences of drug information sources. Conclusions: This study confirms that physicians often use drug information sources in professional work, in particular those who work in primary health care. Credibility and easy access are key factors for usage. Among physicians in primary care, personal factors influenced the choice of drug information sources. [ABSTRACT FROM AUTHOR]

The research-oriented objective of this study was to document the effectiveness of online support for hearing aid (HA) users compared with traditional support. This study is a randomised controlled trial with parallel group design. The research-oriented objectives were evaluated using the Hearing Handicap Inventory for the Elderly (HHIE) and the Communication Strategies Scale (CSS) at baseline and immediately postintervention. Selected clients at five different clinics were randomised to an intervention group (n = 78) that took part in online hearing support and a control group (n = 58) that received standard care. The analyses (intention-to-treat) showed statistically significant improvements in the HHIE-total and Emotional subscale scores for the intervention group compared with the control group. The intervention group also showed significantly greater improvement in the CSS-total and Verbal and Nonverbal subscale scores. A subgroup analysis was performed including two groups: HA use <1 year and HA use >1 year. A statistically significant improvement was found for the HA users >1 year compared with HA use <1 year. It is effective to clinically include online hearing support for HA users when addressing self-perceived hearing difficulties and to sharpen communication strategy skills. [ABSTRACT FROM AUTHOR]

Rationale: More research is needed to uncover the effectiveness of combined strength and foam‐rolling interventions to prevent running‐related injuries. Objectives: To evaluate effectiveness of an 18‐week general strength and foam‐rolling intervention on the incidence of running‐related injuries. Method: This is an 18‐week observational comparative study. A total of 433 recreational runners participated (n = 203 female). The intervention group (n = 228) performed general strength and foam‐rolling exercises twice weekly for 18 weeks, the control group (n = 205) maintained their regular training habits. Running volume and running‐related pain were reported weekly. Secondary analyses were performed on the subgroups of the intervention group based on compliance; low compliance (n = 100), intermediate compliance (n = 63), and high compliance (n = 65). Cumulative incidence proportions were calculated and time‐to‐event statistics were performed to compare survival times between groups. Univariate cox proportional hazards ratio was calculated to estimate the risk of running‐related injuries at 18 weeks. Results: A total of 100 running‐related injuries were sustained. The cumulative incidence proportion for the control and intervention groups was 27.1% (95% CI: 21.4–33.9) and 23.0% (95% CI: 17.8–29.4), respectively. No statistically significant difference was found between the overall intervention group and control group (log‐rank p = 0.31). A significant difference existed between the high‐compliance subgroup and the control group (log‐rank p = 0.00). Highly compliant runners were 85% less likely (hazard rate ratio = 0.15; 95% CI: 0.05–0.46) to sustain an injury during the study compared with controls. Conclusion: Recreational runners highly compliant with the intervention were 85% less likely and took on average 57 days longer to sustain a running‐related injury when compared with controls, with a cumulative incidence proportion of 4.6% after 18 weeks. [ABSTRACT FROM AUTHOR]

Objectives Emerging evidence demonstrates that aPS-PT associate with thrombotic events. Genetic predisposition, including HLA-DRB1 alleles, is known to contribute to the occurrence of conventional aPL [anti-β2glycoprotein-I (anti-β2GPI) and aCL]. We investigated associations between aPS-PT and HLA-DRB1 * alleles and thrombosis in SLE. Conventional aPL were included for comparison. Methods We included 341 consecutive SLE patients, with information on general cardiovascular risk factors, including blood lipids, LA and thrombotic events. aPS/PT, anti-β2GPI and aCL of IgA/G/M isotypes and LA were quantified. Results aPS/PT antibodies associated positively with HLA-DRB1 *13 [odds ratio (OR) 2.7, P  = 0.002], whereas anti-β2GPI and aCL antibodies associated primarily with HLA-DRB1*04 (OR 2.5, P  = 0.0005). These associations remained after adjustment for age, gender and other HLA-DRB1 * alleles. HLA-DRB1*13 , but not DRB1*04 , remained as an independent risk factor for thrombosis and APS after adjustment for aPL and cardiovascular risk factors. The association between DRB1*13 and thrombosis was mediated by aPS-PT positivity. HLA-DRB1*03 , on the other hand, associated negatively with thrombotic events as well as all aPL using both uni- and multivariate analyses. HLA-DRB1*03 had a thrombo-protective effect in aPL-positive patients. Additionally, HLA-DRB1*03 was associated with a favourable lipid profile regarding high-density lipoprotein and triglycerides. Conclusions HLA-DRB1*13 confers risk for both aPS-PT and thrombotic events in lupus. The association between HLA-DRB1*13 and thrombosis is largely, but not totally, mediated through aPS-PT. HLA-DRB1*03 was negatively associated with aPL and positively with favourable lipid levels. Thus, HLA-DRB1*03 seems to identify a subgroup of SLE patients with reduced vascular risk. [ABSTRACT FROM AUTHOR]

Background: Chronic exertional compartment syndrome (CECS) causes exercise-induced leg pain. The diagnosis is confirmed by intramuscular pressure (IMP) measurements. Fasciotomy has been demonstrated to be a successful treatment for CECS; however, few studies have examined postoperative IMP and long-term outcomes. Purpose: To evaluate long-term outcomes and postoperative IMP in patients surgically treated for anterior CECS, and to identify possible preoperative or postoperative factors associated with overall satisfaction with treatment at follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive series of 209 patients who underwent fasciotomy of the anterior compartment for CECS between 2009 and 2019 and had at least 1 year of follow-up were approached for inclusion. A total of 144 patients (69%), with a follow-up time of 1 to 11.5 years, were ultimately included. All patients underwent preoperative and postoperative 1-minute postexercise IMP measurements of the anterior compartment and completed a questionnaire covering pain and activity parameters at both time points. The follow-up questionnaire included an additional question on overall satisfaction with treatment, and surgical details were collected from the patient's medical records. Results: The median IMP was significantly lower at follow-up than at baseline (17 mm Hg [range, 5-91 mm Hg] vs 49 mm Hg [range, 25-130 mm Hg]; P <.001). The overall satisfaction rate was 77%, and 83% reported a decreased pain level. The group of patients who were satisfied with the treatment included more men and had a higher ΔIMP and a lower revision rate (P <.05). Among the 16 patients (11%) who had undergone revision fasciotomies before follow-up, the satisfaction rate was 56%, and 64% reported a decrease in pain level. Conclusion: Fasciotomy significantly reduced 1-minute postexercise IMP in patients with CECS and resulted in satisfaction and decreased pain in more than three-quarters of the patients at long-term follow-up. The male sex and a significant decrease in IMP were both positively associated with treatment satisfaction. Patients who underwent revision surgery before the follow-up had lower satisfaction rates and less pain reduction than the overall group. [ABSTRACT FROM AUTHOR]

Assessment of cognitive function and its consequences for activities of daily living is an important part of a dementia evaluation. To describe patients' functional impairment accurately, a feasible instrument is needed. The Cognitive Impairment in Daily Life (CID) is an instrument developed with that purpose. To describe and compare self- and proxy-reported difficulties in everyday life in patients undergoing a dementia investigation, measured by CID. A secondary aim was to compare the results between those who were diagnosed with dementia versus those without dementia. Self- and proxy-reported data using CID in 77 cases in dementia investigations. Of those, 32 were diagnosed with dementia and were compared to those without dementia (n = 45). Descriptive statistics. When comparing self-reported and proxy-reported activity problems, most activities differed significantly. Proxies reported more difficulties than patients did. When comparing no dementia and dementia groups, significant differences were shown regarding initiative, planning and performance but not for memory and attention estimated by the patient themselves. Proxies differed significantly from patients in all tasks. Overall, proxies reported that patients had more difficulties than patients reported themselves. The CID seems to be usable in dementia investigations and the results highlight the importance of involving both patients and relatives. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Background and aim: Physical activity levels in older people often decrease and may mean impaired physical functioning leading to an increased fall risk. The aim of this study was to investigate self-reported change in physical activity dose and deterioration in balance performance, gait speed, and self-rated health (SRH) in older women between two time points in a follow-up study. Methods: A cohort of community-living women, aged 69–79 years (n = 351) were evaluated by questionnaire and clinical tests on balance, gait speed, and SRH at baseline. One hundred and eighty-six women were followed-up by these tests 8.5 years after inclusion. The non-parametric Wilcoxon signed-rank test and Mann–Whitney U test were used for the analysis. Results: The greatest changes were seen in one-leg standing time (OLST) with eyes closed (− 60%) and eyes open (− 42%). The population was divided into high exercise (HE, n = 49) and low exercise (LE, n = 51) groups. At baseline the HE group had an OLST of 19 s with eyes open and 3 s with eyes closed. In the LE group, these values were 7.3 s and 2 s. At follow-up, differences between HE and LE concerning tandem walk forwards (steps) (HE = 8.5; LE = 2.5) and backwards (HE = 11; LE = 3.5) emerged. The HE group estimated SRH (VAS-scale) 30 mm higher at baseline and 17 mm higher at follow-up than the LE group. Conclusion: Greater physical activity seems to be an important predictor for maintaining physical function and SRH in older women. [ABSTRACT FROM AUTHOR]

Aims : This study aimed to compare the prevalence in different gambling types as well as problem gambling in the Nordic countries, examining gambling, leisure activities, school truancy, parental relations and consumption of alcohol and other substances as covariates for problem gambling. Methods : Cross-country data were provided by the European Survey Project on Alcohol and Other Drugs (ESPAD) 2015. Prevalence of gambling and potential covariates were analysed for Denmark, Finland, Iceland Norway and Sweden (N =13,172 respondents aged 16 years), while analyses regarding problem gambling only included countries that participated in the optional questions on gambling problems (Denmark, Finland and Sweden; N =8108). We tested variables for problem gambling by bivariate logistic regression and multivariate logistic regression. Results : Cross-country differences were found in gambling and problem gambling, as well as differences in covariates for problem gambling. Sweden had the lowest rate of problem gambling. No significant difference was found between Denmark and Finland. Reports of too much gaming, inhalants, slots, betting and online gambling were positively associated with problem gambling, while parental monitoring and parental caring had a negative association. The relevance of the covariates varied across countries. Conclusions : Results indicate that although gambling regulation and its implementation have an important impact on gambling behaviour, we need more research on social, economic and cultural factors and how youth understand and interact with them. Contexts and regulations in other related fields should inform gambling research, policies and interventions. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine nurses' attitudes about the importance of family in nursing care from an international perspective. We used a cross-sectional design. Data were collected online using the Families' Importance in Nursing Care—Nurses' Attitudes (FINC-NA) questionnaire from a convenience sample of 740 registered nurses across health care sectors from Sweden, Ontario, Canada, and Hong Kong, China. Mean levels of attitudes were compared across countries using analysis of variance (ANOVA). Multiple regression was used to identify factors associated with nurses' attitudes and to test for interactions by country. Factors associated with nurse attitudes included country, age, gender, and several practice areas. On average, nurses working in Hong Kong had less positive attitudes compared with Canada and Sweden. The effects of predictors on nurses' attitudes did not vary by country. Knowledge of nurses' attitudes could lead to the development of tailored interventions that facilitate nurse-family partnerships in care. [ABSTRACT FROM AUTHOR]

Although alcohol-intoxicated witnesses to violent crimes are common, research on how alcohol affects witnesses' perception of aggression is sparse. In the present study, it was investigated whether different levels of intoxication altered how severe witnesses perceived aggression displayed by involved parties in an intimate partner violence (IPV) scenario to be. An experimental mixed-groups design 3 (sober vs. moderate vs. high breath alcohol concentration [BAC]) x 2 (immediate vs. one week delayed interview) was used. Socially drinking men and women (n = 137; 67 and 70, respectively) were randomized to an alcohol condition (0.8 g/kg adjusted to 0.75 g/kg for women, divided into two intoxication groups: moderate ≤0.08 and high ≥0.08) or a control condition (juice). They were also randomized into a direct interview condition or a delayed interview condition. In a laboratory setting, they consumed drinks and viewed an IPV scenario on film. During their interview, the participants rated how severe they perceived the involved parties' aggression to be. Inter alia, participants in the high BAC group perceived both parties' physically aggressive behavior as comparatively less severe than the sober and moderately intoxicated witnesses did. The high BAC group also perceived the IPV scenario as less unpleasant than the other two groups, and they maintained this perception over time and repeated interviews. A BAC level of ≥0.08 was required to significantly lower witnesses' perceived severity of physical aggression, possibly caused by alcohol's anxiety-dampening effect as well as its impairing effect on cognitive processing capacity over this level of intoxication. That alcohol intoxication at (or over) such a BAC level makes witnesses perceive physical aggression as less severe and less unpleasant, and also that such an altered perception holds over time and repeated interviews, is important for legal practitioners to be aware of when handling intoxicated witnesses to violence. Therefore, this issue warrants further investigation. [ABSTRACT FROM AUTHOR]

Background First- pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c- 3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed. Objective To assess the economic impact of achieving complete or near complete reperfusion after the first pass. Methods Post hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c--3 was achieved, stratified into two groups: (1) mTICI 2c--3 achieved after the first pass (FPE group) or (2) after multiple passes (non- FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer- reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK). Results Among patients who achieved mTICI 2c--3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90- day modified Rankin Scale score 0--2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non- FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization- related (24-- 33% reduction) and annual care (11--27% reduction) costs across all countries. Conclusions FPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a manual therapy (naprapathy) for common orthopaedic disorders. Methods: An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists (n = 78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected. The treatments lasted from January 2007 to November 2007. Results: N = 75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21.7 (95% CI: 9.1–34.3)), physical function (17.6 (6.7–28.4)), and QoLs (0.823 (95% CI: 0.785–0.862) compared with 0.713 (95% CI: 0.668–0.758)) were statistically significantly in favor of the experimental group (p-values < 0.01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1161 in the control group. Conclusions: Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems. Trial registration: Not applicable, as per information given by ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the relationship between implant patient mortality compared to reference populations. The aim of this study was to report the mortality pattern in patients treated with dental implants up to a 15-year period, and to compare this to mortality in reference populations with regard to age at surgery, sex, and degree of tooth loss.Materials and Methods: Patient cumulative survival rate (CSR) was calculated for a total of 4,231 treated implant patients from a single clinic. Information was based on surgical registers in the clinic and the National Population Register in Sweden. Patients were arranged into age groups of 10 years, and CSR was compared to that of the reference population of comparable age and reported in relation to age at surgery, sex, and type of jaw/dentition.Results: A similar, consistent, general relationship between CSR of different age groups of implant patients and reference populations could be observed for all parameters studied. Completely edentulous patients presented higher mortality than partially edentulous patients (P < .05). Furthermore, implant patients in younger age groups showed mortality similar to or higher than reference populations, while older patient age groups showed increasingly lower mortality than comparable reference populations for edentulous and partially edentulous patients (P < .05).Conclusion: A consistent pattern of mortality in different age groups of patients compared to reference populations was observed, indicating higher patient mortality in younger age groups and lower in older groups. The reported pattern is not assumed to be related to implant treatment per se, but is assumed to reflect the variation in general health of a selected subgroup of treated implant patients compared to the reference population in different age groups. [ABSTRACT FROM AUTHOR]

Background: The lack of classification by educational attainment in death and population exposure data at older ages is an important constraint for studying changes and patterns of mortality disparities by education in Denmark and Sweden. The missing educational distribution of population also restricts analyses aiming at estimating contributions of compositional change to the improvements in national longevity. This study proposes a transparent approach to solve the two methodological issues allowing to obtain robust education-specific mortality estimates and population weights. Methods: Using nonparametric approach, we redistribute the unknown cases and extrapolate the mortality curves of these sub-populations with the help of population-level data on an aggregate level from the Human Mortality Database. Results: We present reconstructed and harmonized education-specific abridged and complete life tables for Sweden and Denmark covering 5-year-long periods from 1991–1995 to 2011–2015. The newly estimated life tables are in good agreement with the national life tables and show plausible age- and education-specific patterns. The observed changes in life expectancy by education suggest about the widening longevity gap between the highest and lowest educated for males and females in both countries. Conclusions: The proposed simple and transparent method can be applied in similar country-specific cases showing large proportions of missing education or other socio-economic characteristics at older ages. [ABSTRACT FROM AUTHOR]

Background and Aims: A strong cardiorespiratory fitness is suggested to have beneficial effects on cardiovascular risk; the exact mechanisms underlying the cardioprotective effects of fitness remain uncertain. Our aim was to investigate associations between cardiorespiratory fitness and multiple plasma proteins, in order to obtain insights about physiological pathways associated with the effects of exercise on cardiovascular health. Methods: In the Prospective investigation of Obesity, Energy and Metabolism (POEM) study (n=444 adults aged 50 years, 50% women), cardiorespiratory fitness was measured by a maximal exercise test on bicycle ergometer with gas exchange (VO2peak) normalized for body lean mass (dual-energy X-ray absorptiometry (DXA)). We measured 82 cardiovascular proteins associated with cardiovascular pathology and inflammation in plasma samples with a proximity extension assay. Results: In sex-adjusted linear regression, VO2peak was associated with 18 proteins after Bonferroni correction for multiple testing (p<0.0006). Following additional adjustment for fat mass (DXA), fasting glucose (mmol/L), low-density lipoprotein (LDL, mmol/L), smoking status, waist/hip ratio, blood pressure (mmHg), education level, and lpnr (lab sequence number), higher VO2peak was significantly associated with lower levels of 6 proteins: fatty-acid binding protein-4 (FABP4), interleukin-6 (IL-6), leptin, cystatin-B (CSTB), interleukin-1 receptor antagonist (IL-1RA), and growth differentiation factor 15 (GDF-15), and higher levels of 3 proteins: galanin, kallikrein-6 (KLK6), and heparin-binding EGF-like growth factor (HB-EGF), at nominal p-values (p<0.05). Conclusions: We identified multiple novel associations between cardiorespiratory fitness and plasma proteins involved in several atherosclerotic processes and key cellular mechanisms such as inflammation, energy homeostasis, and protease activity, which shed new light on how exercise asserts its beneficial effects on cardiovascular health. Our findings encourage additional studies in order to understand the underlying causal mechanisms for these associations. [ABSTRACT FROM AUTHOR]

Preoperative testing of physical performance is common for patients undergoing an esophagectomy, but little evidence exists suggesting which measures are most suitable. This study compared outcome measures currently used at participating hospitals (spirometry, cycle ergometer test) against other validated tests – Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP), Timed Up and Go (TUG), 6 Minute Walk Test (6MWT), heel raise test, shoulder abduction test, Timed Stands Test (TST) and handgrip strength. 109 patients were recruited from three university hospitals in Sweden. Participants were tested using a protocol testing respiratory and peripheral muscle strength, lung function, endurance and fitness. There were strong correlations between the cycle ergometer and grip strength (r = 0.619), 6MWT (r = 0.572), MIP (r = 0.619) and MEP (r = 0.529). A strong correlation was also seen between spirometry and grip strength (r = 0.508–0.574). A moderate correlation was found between spirometry, MIP (r = 0.405–0.470) and MEP (r = 0.366–0.452), the cycle ergometer, TUG (r = −0.321) and TST (r = −0.308) and between 6MWT and PEF (r = −0.333). The strong correlations between different measures suggest that in cases where the standard tests are inadvisable or impractical, simple tests like grip strength and 6MWT could be used instead. [ABSTRACT FROM AUTHOR]

Summary: This study sets out to investigate the potential differences between social workers using voice- or silence strategies in their experience of organisational resources, attitudes and health, and whether social workers moving between strategies (voice or silence) over time have a different experience of the same outcomes than those who stay with the same strategy group. The participating social workers (n = 1356) responded to two web-based questionnaires over a one-year period. Findings: The results show that voice strategies are related to the experience of more positive organisational resources, more positive attitudes (greater job satisfaction and organisational commitment, but lower intention to exit) and more positive health (greater recovery, but less emotional exhaustion and stress symptoms) than those using silence strategies. The results also show that moving from silence to voice is related to the experience of increased organisational resources, more positive attitudes and more positive health at T2, while those moving from voice to silence reported the opposite. Applications: The longitudinal approach applied in this study adds empirical evidence of the relationship between voice/silence and work-related attitudes, as well as health and well-being. The close relationship between organisational resources, employee voice behaviour and related individual outcomes regarding attitudes and health imply that Human Resources (HR) management has a lot to gain by developing and securing a voice-friendly and considerate climate in their organisations. [ABSTRACT FROM AUTHOR]

Under the umbrella of 1G to 5G, different technologies have been used to provide mobile communication. Various technologies are being proposed to bring a person in remote area under coverage. However, a statistical analysis on what these users get from already existing technologies has not been carried out. We fill this gap by carrying out such a study using a measurement campaign, where we present a framework for analyzing mobile signal strength experienced at the user end. Measurements are taken throughout the Norrbotten county, the northernmost county in Sweden, using mobile phones recording various parameters at regular intervals. Based on measured signal strength, a coverage map has been made via inverse distance weighting (IDW) interpolation. Based on the coverage map, various analyses are carried out on signal strength over residential areas and roads of Norrbotten. Overall, we lay a framework to analyze and quantify the effect of signal strength on users. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the effects of web-based education in the field of drug utilization on elderly individuals’ knowledge of, concerns about and self-assessed understanding of drug utilization. The 260 included participants were randomized to a control group or an intervention group. To assess drug utilization literacy, we used a questionnaire containing 20 multiple-choice questions on drug utilization and ten statements about drug utilization (to which participants graded their response using a Likert scale: two about common concerns and eight about their self-assessed understanding of drug utilization). The Beliefs about Medicines Questionnaire-General was also used. The intervention group scored higher on the knowledge questions (p < 0.001) and on six of the eight statements about self-assessed understanding of drug utilization at the first check after 2 weeks (p < 0.05). At a second check 6 months later, the difference remained for the knowledge questions, but there was no difference in self-assessed understanding of drug utilization between the groups. There were no differences in the concerns about drug utilization or beliefs about medication at any time. We conclude that a web-based education can improve drug utilization literacy in elderly individuals and might contribute to the safer use of medications. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the psychometric characteristics of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T); reliability (inter‐rater and test–retest) and validity (convergent validity) in a Swedish context. Background: Pressure ulcers are considered as an adverse event and are a problem in healthcare worldwide. The first step in pressure ulcer prevention is to identify patients that are at risk. PURPOSE T is a new pressure ulcer risk assessment instrument that was developed in the UK using "golden standard" instrument method. Design: Observational, descriptive and comparative. Methods: A total of 235 patients and 28 registered nurses were recruited (May 2018–November 2018) from six hospital wards at a university hospital and two community nursing homes in Sweden. Blinded (ward/nursing home nurses and expert nurses) PURPOSE T assessments and follow‐up retests were undertaken. Cross‐tabulation and kappa statistics were used to examine the reliability, and phi correlation was used to test the convergent validity. The study followed the STROBE guideline. Results: The clinical evaluation showed "very good" (kappa) inter‐rater and test–retest reliability for PURPOSE T assessment decision overall. The agreement of "at risk"/"not at risk" for both inter‐rater and test–retest was also high, at least 95.5%. The convergent validity between PURPOSE T and other traditional assessment instruments was moderate. Conclusion: The evaluation of PURPOSE T demonstrated good psychometric characteristics. Further research is needed to evaluate PURPOSE T's usability among registered nurses. Relevance to clinical practice: There is a lack of evidence‐based validated pressure ulcer risk assessment instruments for use in health care. According to our findings, the Swedish version of PURPOSE T could be used in hospitals and nursing homes to identify patients in risk or with pressure ulcers. [ABSTRACT FROM AUTHOR]

Objective: To develop a patient-level simulation model for predicting lifetime health outcomes of patients with type 1 diabetes and as a tool for economic evaluation of type 1 diabetes treatment based on data from a large, longitudinal cohort.Research Design and Methods: Data for model development were obtained from the Swedish National Diabetes Register. We derived parametric proportional hazards models predicting the absolute risk of diabetes complications and death based on a wide range of clinical variables and history of complications. We used linear regression models to predict risk factor progression. Internal validation was performed, estimates of life expectancies for different age-sex strata were computed, and the impact of key risk factors on life expectancy was assessed.Results: The study population consisted of 27,841 patients with type 1 diabetes with a mean duration of follow-up of 7 years. Internal validation showed good agreement between the predicted and observed cumulative incidence of death and 10 complications. Simulated life expectancy was ∼13 years lower than that of the sex- and age-matched general population, and patients with type 1 diabetes could expect to live with one or more complications for ∼40% of their remaining life. Sensitivity analysis showed the importance of preventing renal dysfunction, hypoglycemia, and hyperglycemia as well as lowering HbA1c in reducing the risk of complications and death.Conclusions: Our model was able to simulate risk factor progression and event histories that closely match the observed outcomes and to project events occurring over patients' lifetimes. The model can serve as a tool to estimate the impact of changing clinical risk factors on health outcomes to inform economic evaluations of interventions in type 1 diabetes. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to examine the caries incidence in adolescents using the Public Dental Service (PDS) during a 5‐year period in relation to their caries experience at baseline and risk classification. Methods: A 5‐year retrospective cohort study based of the dental records from 17 PDS clinics in south‐eastern Sweden was conducted; 159 individuals born in 1997 were included, and their caries risk was classified at 12 and 17 years of age. Caries prevalence and documented risk groups were assessed at baseline and after 5 years. Results: The increment of caries (both initial and manifest caries) was higher, to a statistically significant degree, after 5 years in adolescents who were recorded as caries‐free at baseline compared to individuals with caries at baseline (P <.001). In individuals with caries at baseline, the greatest increment of caries was found at approximal sites (P <.001). At baseline, individuals were classified as low (94%), medium (6%) and high risk (0%). After 5 years, the figures were 74%, 20% and 6%, respectively. Although classified in a low‐caries risk group, 9% had ≥6 decayed or filled surfaces at baseline, and 23% did after 5 years. Approximately 62% of individuals were registered as caries‐free at baseline, and 45% were after 5 years. Conclusions: There was an increase in caries over 5 years, especially among adolescents without caries experience at baseline. The majority of adolescents had the same risk classification after 5 years. Further research with a larger sample size is needed to evaluate risk assessment for caries. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate whether adolescent elite female and male handball players with shoulder muscle weakness, deficits in shoulder rotation range of motion (ROM) or in joint position sense (JPS), or scapular dyskinesis in the preseason had a higher rate of new shoulder injuries compared to players without these characteristics. DESIGN: Prospective cohort study. METHODS: We studied 344 uninjured players (452 player-seasons, 50% female). We measured their shoulder strength in isometric external rotation (1ER), isometric internal rotation (HR), isometric abduction, and eccentric external rotation, as well as their shoulder ROM, JPS, and scapular dyskinesis, during the preseason. Players were monitored weekly regarding match and training hours and shoulder injuries during 1 or 2 seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios related to the first Injury and 95% confidence intervals (CIs). RESULTS: During 2 seasons, the participants reported 48 new shoulder injuries. In female players, the hazard rate ratio was 2.37 (95% Cl: 1.03,5.44) for 1ER weakness and 2.44 (95% Cl: 1.06, 5.51) for HR weakness. The hazard rate ratio was 0,85 (95% Cl: 0.39,1.83) for an lER/IIR ratio of less than 0.75 and 1.53 (95% Cl: 0.36,6.52) for scapular dyskinesis. In male players, the hazard rate ratio was 1,02 (95% Cl: 0.44,2.36) for 1ER weakness, 0.74 (95% Cl: 0.31,1.75) for HR weakness, 2.0 (95% Cl: 0.68, 5.92) for an IER/IIR ratio of less than 0.75, and 3.43 (95% Cl: 1,49,7.92) for scapular dyskinesis. There were no associations between new shoulder injuries and deficits in ROM or JPS. CONCLUSION: In adolescent elite handball, male players with preseason scapular dyskinesis and female players with preseason HR or 1ER shoulder weakness had an increased shoulder injury rate. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate changes in sleep quality, fatigue, mental health, and health-related quality of life (HRQoL) over a two-year period among patients undergoing peritoneal dialysis treatment at home. We further explored the extent to which sleep quality, fatigue, and mental health predicted health-related quality of life outcomes. This prospective study included 55 patients. Sleep parameters changed over two years, independently of treatment. Sleep variables at baseline, to some extent, predicted sleep quality after two years. Daytime sleepiness can be a long-term problem. Findings indicate improvements in nocturnal sleep over a two-year time period, independently of dialysis treatment. In contrast, fatigue remained unchanged over the same time period. Transplantation seems to generally benefit the outcome of HRQoL. Strategies to improve sleep and HRQoL may include systematic risk factor modification and efforts to optimise symptomatic treatment. [ABSTRACT FROM AUTHOR]

Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries. Clinical Relevance: Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses. [ABSTRACT FROM AUTHOR]

It has been previously observed that athletes of certain origin nationality dominate particular sports; however, this phenomenon has been less studied in cross-country (XC) skiing, especially with regards to performance-related aspects, such as pacing. The aim of the present study was to examine the effect of nationality on pacing strategies of XC skiers who finished the "Vasaloppet" from 2004 to 2017. We studied 183,919 finishers (19,465 women and 164,454 men), classified into 15 nationalities, i.e. nationalities with number of finishers larger than 0.25% of the total number of finishers. In women, athletes from Russia (7:47:46 h:min:s) were the fastest and athletes from Denmark (10:01:03 h:min:s) the slowest (p < 0.001, η2 = 0.057). In men, athletes from Russia (6:33:03 h:min:s) were the fastest and athletes from Denmark (9:03:27 h:min:s) the slowest (p < 0.001, η2 = 0.069). In women and men, a small nationality× split interaction on speed was observed (p < 0.001, η2 = 0.016–0.019) with Russians presenting a more even pacing compared to their slower counterparts. It was concluded that fast nationalities present a more even pacing, which should be attributed to the general trend of fast athletes for a more even pacing. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the intelligibility of children’s atypical speech in relation to listeners’ language background. Method: Forty-eight participants listened to and transcribed isolated words repeated by children with speech sound disorders. Participants were divided into, on the one hand, a multilingual group (n = 29) that was further divided into subgroups based on age of acquisition (early, 0–3 years; intermediate, 4–12 years; and late, > 12 years) and, on the other hand, a monolingual comparison group (n = 19). Results: The monolingual listeners obtained higher intelligibility scores than the multilingual listeners; this difference was statistically significant. Participants who acquired Swedish at an older age (> 4 years) were found to have lower scores than other listeners. The later the age of acquisition, the less of the atypical speech was decoded correctly. A further analysis of the transcriptions also revealed a higher level of nonwords among the incorrect transcriptions of the multilinguals than that of the monolinguals who used more real words, whereas both groups were equally prone to using blanks when they did not perceive a word. Conclusions: This indicates a higher risk of communicative problems between late acquirers of Swedish and children with speech sound disorders. Clinical implications, such as involving communication partners in the intervention process, are discussed as well as possible linguistic explanations to the findings. This study could be seen as a starting point in the field of research regarding the relations between the language background of the listener and the ability to perceive atypical speech. [ABSTRACT FROM AUTHOR]

It is important that operating room personnel monitor the correct amount of blood loss during surgery in order to properly replace lost volume. The aim of this study was to investigate the accuracy of operating room personnel in visually estimating blood loss in surgical sponges. We performed an observational study with comparative descriptive design at a university hospital including all members of the surgical team. In total, 163 observations were completed. The participants estimated the amount of blood in surgical sponges in 4 stations with varying amounts of blood and/or numbers of sponges. Data were analyzed using the Wilcoxon signed rank, Kruskal-Wallis, and Mann-Whitney tests. Both overestimations and underestimations occurred. Underestimations dominated and tended to increase with major amounts of blood. Operating room personnel miscalculated the amount of blood by a median value of 30% regardless of profession, years of experience, and self-assessed ability about visual estimation. This study highlights that assessments of patients' conditions can be partially based on methods often demonstrated to be inaccurate. Inaccurate visual estimation of blood loss might endanger patient safety. [ABSTRACT FROM AUTHOR]

Mutilation is a rare and unusual act performed on a victim, especially in cases of homicide. Knowledge on mutilation homicide is scarce as the base rate of this type of homicide is very low. Moreover, previous studies examining this specific criminal behavior have been mainly descriptive, neglecting to look at other factors related to the act of mutilation. Furthermore, depending on the cultural context and country of origin, the infliction of mutilation pre-, per-, or post-homicide translates into different meanings. Therefore, it is important to examine mutilation homicide in the context of non-Western countries. Using crime and forensic examination reports subjected to forensic examination and convicted for a homicide between 1995 and 2011 (N = 1,200) in Korea, the rate of mutilation homicide was estimated. Based on the 65 cases (5.4%) identified, information on the offenses and offenders were described. Moreover, using a series of bivariate analyses, the current study compared cases of mutilation homicides in Korea with other countries. Findings revealed interesting differences and similarities between mutilation homicide cases from Korea and the other countries. For instance, offender–victim relationship, victim's gender, and criminal history were significantly different from the comparison groups. In addition, compared with Korea, mutilation homicide cases were significantly more likely to involve an accomplice in Finland, suggesting the need to carry the body over a long distance. Investigators and researchers need to understand the cultural context in which these acts are committed as the infliction of mutilation may serve different purposes across different countries. [ABSTRACT FROM AUTHOR]

Background: Understanding how nursing students in European countries perceive their future professional role is an important step in creating awareness of the diversity and similarities between countries. Investigating nursing students' perceptions of their future profession could help in the design of education and the retention of nurses. Aim: To compare nursing students' perceptions of the professional nurse's role between Belarus, Lithuania, Poland and Sweden. Method: A cross‐sectional design was implemented. The study used two scales of the Professional Nursing Image Survey, which has questions about 10 skills and abilities and 14 functions and duties of a nurse. Results: A total of 392 final‐year nursing students in four countries participated in the study. Statistically significant differences were found between countries in terms of all 10 skills and abilities and in the distribution of responses concerning functions and duties of a nurse. Conclusions: Nursing students in Belarus, Lithuania, Poland and Sweden perceive differently the role of a nurse in terms of some functions and responsibilities. This may influence the adaptation of nurses who enjoy freedom of movement among the countries. Implications for nursing policy: The knowledge gained in this study could be beneficial in improving nursing education, as it could illuminate the discrepancy between educational goals and students' perceptions of their future professional role. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence, activity limitations and potential risk factors of upper extremity impairments in type 1 diabetes in comparison to controls. Methods: In a cross-sectional population-based study in the southeast of Sweden, patients with type 1 diabetes <35 years at onset, duration ≥20 years, <67 years old and matched controls were invited to answer a questionnaire on upper extremity impairments and activity limitations and to take blood samples. Results: Seven hundred and seventy-three patients (ages 50 ± 10 years, diabetes duration 35 ± 10 years) and 708 controls (ages 54 ± 9 years) were included. Shoulder pain and stiffness, hand paraesthesia and finger impairments were common in patients with a prevalence of 28-48%, which was 2-4-folds higher than in controls. Compared to controls, the patients had more bilateral impairments, often had coexistence of several upper extremity impairments, and in the presence of impairments, reported more pronounced activity limitations. Female gender (1.72 (1.066-2.272), p = 0.014), longer duration (1.046 (1.015-1.077), p = 0.003), higher body mass index (1.08 (1.017-1.147), p = 0.013) and HbA1c (1.029 (1.008-1.05), p = 0.007) were associated with upper extremity impairments. Conclusions: Compared to controls, patients with type 1 diabetes have a high prevalence of upper extremity impairments, often bilateral, which are strongly associated with activity limitations. Recognising these in clinical practise is crucial, and improved preventative, therapeutic and rehabilitative interventions are needed. Implications for rehabilitation: Upper extremity impairments affecting the shoulder, hand and fingers are common in patients with type 1 diabetes, the prevalence being 2-4-fold higher compared to non-diabetic persons. Patients with diabetes type 1 with upper extremity impairments have more pronounced limitations in daily activities compared to controls with similar impairments. Recognising upper extremity impairments and activity limitations are important and improved preventive, therapeutic and rehabilitation methods are needed. [ABSTRACT FROM AUTHOR]

The objective was to investigate the variability in dental caries experience in Swedish children and adolescents, at two different area levels: dental clinics and SAMS (small areas for market statistics), with respect to multiple individual socioeconomic factors (SES). Records of manifest caries using the DMFT indices (decayed, missing, filled teeth, dependent variables) were collected from electronic dental records for 300,988 individuals aged 3-19 years (97.3% coverage) from the Region Västra Götaland, Sweden. SES data were obtained from official registers and covered ethnicity, wealth, parental education, and employment. The SES variables were used as an independent aggregated variable - an in dex - categorized in deciles. Age and gender were independently included in the multilevel models. Two-level logistic regression analyses explored the probability of a dental caries experience and the variability (intracluster correlation) within dental clinic areas and SAMS, respectively. The most deprived (10th decile, SAMS level) 3- to 6-year-old children had an OR of 5.00 (95% CI 4.61-5.43) for dental caries experience (deft), compared with children in the 1st to 5th deciles. For older children and adolescents (≥7 years), the corresponding OR (DFT) was 2.25 (95% CI 2.15-2.35). Small geographical areas explained more of the variance in caries experience compared with the more aggregated level dental clinics. SES was more strongly related to the risk of dental caries experience than age and gender. In conclusion, the associations between SES and dental caries experience in Swedish children and adolescents were strong in the study and strongest in young children at a low level. [ABSTRACT FROM AUTHOR]

Abstract Peer-assessment in nursing education using an OSCE protocol is an increasing educational activity that complements that of teachers. However, little is known about how students' and teachers' assessments correspond. The study aimed to compare OSCE assessments made by student examiners and faculty examiners during examinations of clinical skills in undergraduate nursing education. Four cohorts of third-year nursing students participated between 2014 and 2016. The students underwent a clinical examination of the management of central venous catheters and totally implantable venous access devices. Students who performed the examinations were observed both by a faculty examiner and student examiner. Both observers used the same OSCE protocol for the assessment but independently. The OSCE protocols from both faculty and student examiners were reviewed and compared. Total agreement between the student and faculty examiner was reached in 127 of 135 (94%) paired protocols. The level of agreement was substantial with a kappa value of 0.79 (95% CI 0.65–0.93). The conclusion was that the level of agreement between student and faculty examiners was high when using an OSCE protocol in clinical examinations of two different clinical skill tasks. The structured checklist (OSCE protocol) was easy to use for the student examiners despite the lack of experience or training in advance. Highlights • The level of agreement in the assessments was high despite no introduction to the OSCE protocol for the students. • Nursing student examiners may be used in peer assessment using a structured OSCE protocol. • Using checklists such as an OSCE protocol facilitates giving and receiving peer feedback in nursing education. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyse quality of life (QoL) pretreatment and up to 24 months post radiation therapy (RT) in patients with head and neck (H&N) cancer. Methods: Twenty‐nine patients (19 men and 10 women) with a mean age of 59 ± 8 years were included. The stimulated salivary secretion was measured and the patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ‐C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS) pretreatment and at 6, 12 and 24 months post RT. Results: At all time‐points after RT (6, 12, and 24 months), patients with hyposalivation (stimulated secretion rate ≤0.7 mL/min) reported clinically significant differences (> 10 points) regarding insomnia, swallowing, social eating, dry mouth, and sticky saliva. Statistically significant differences were found for emotional functioning and insomnia at 12 months (P < 0.05 for both) and for sticky saliva at both 12 and 24 months (P < 0.05 and P < 0.01). The number of clinically significant differences increased from 10 at both 6 and 12 months post‐RT to 14 functioning/symptom scales and single items at the 24 months follow‐up. At 24 months post RT, 21% of patients with hyposalivation had HADS scores suggesting anxiety problems compared to 7% for those with stimulated salivary secretion rates >0.7 mL/min. Conclusion: Patients with hyposalivation showed deterioration in health related quality of life (QoL) at 24 months compared with 12 months post RT. Most pronounced were problems with insomnia, swallowing, social eating, dry mouth, and sticky saliva. [ABSTRACT FROM AUTHOR]