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Background Healthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People – eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals. Methods The IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019–05364, Dnr 2020–03550, Dnr 2021–03255). Discussion The findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location. Trial registration ClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

Family members provide the majority of informal care for older adults in Sweden. Nevertheless, by providing a range of assistance, peers often emerge as a central to counter social isolation among older adults. Therefore, there is a need to know more about what informal care provision by older adults to their peers means for different groups of older adults.This study investigated the types of informal care and support that older adults provide to their peers in Sweden, and how these types of care and support are associated with demographic characteristics and social isolation. We also compared older adults who provide informal care and support with those who do not.For this purpose, we used a national online survey named "Involuntary loneliness among senior citizens" answered by 10,044 older adults enrolled in the Swedish Citizen Panel. We adopted a mixed-method design to analyse the survey data, including free-text options (n = 2155) and numerical data. Social isolation was assessed using a score built from the social loneliness items of the UCLA Loneliness Scale.In our population, 21.5% of the older adults were providing informal care and support to their peers. Practical/instrumental help was frequently offered by younger participants (75 years), men and respondents who were less socially isolated. On a general level, the factors that were positively associated with giving informal care and support to peers were older age, being male, retired, married/living in a relationship, living in an urban area/big city and exhibiting greater isolation. Focusing specifically on social support shows that older participants (80) and those experiencing less social isolation (score 24) were more engaged in social activities. CONCLUSION: This paper is unique in exploring the informal peer-caregiver's perceptions of isolation. Data were collected during the COVID-19 pandemic; this highlights the need to recognise informal care and support between older adults and to acknowledge their contributions as an essential component of Swedish civil society, especially during a societal crisis.

An interdisciplinary group of clinical and non-clinical academics in Sweden created a research centre for the study of person-centred care (PCC) in long-term illness: the University of Gothenburg Centre for Person-Centred Care (GPCC). The GPCC steering committee formulated a position paper with three ‘simple routines’ to initiate, implement, and safeguard PCC in daily clinical practice. The EJCN accepted this position paper for publication in 2011. This brief review seeks to present how PCC, as defined in the position paper, has been used in research and published in EJCN during the past 5 years (2016–20). Clinical implications and future research in PCC are also suggested.

The purpose of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). Method A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. Results In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. Conclusion Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.

Aims:The aim of this study is to investigate associations of screen-time and physical activity (PA) with self-efficacy for PA, intrinsic motivation to PA and health-related quality of life (HRQoL) in Colombian schoolchildren from socioeconomically disadvantaged neighborhoods, and to compare these variables among children with normal-weight (NW), overweight (OW) and obesity (OB).Methods:In 678 schoolchildren (age 10–14 years) screen-time (TV, video games, computer) and number of days being physically active ≥ 60 minutes were self-reported. Multi-item scales were used to assess self-efficacy to PA and intrinsic motivation to PA. The KIDSCREEN-27 was used to assess HRQoL.Results:Screen-time was associated with HRQoL in the school/learning environment dimension. Number of days being physically active was associated with self-efficacy for PA, intrinsic motivation for PA and with HRQoL concerning physical well-being, autonomy/parent relation and social support/peers. Group differences were found for days being physically active (OW = 2.8 and OB = 2.7 vs. NW = 3.3) but not for screen-time (NW = 5.0, OW = 4.7 and OB = 5.7 hrs·d-1). OW and OB scored lower on intrinsic motivation to PA than NW (OW = 19.2 and OB = 17.9 versus NW = 20.1). All 3 groups differed in physical well-being scores (NW = 50.3, OW = 48.1, OB = 40.6, P < .001).Conclusions:Schoolchildren with overweight and obesity from socioeconomically disadvantaged neighborhoods need additional motivational support to perform health-enhancing PA to experience higher physical well-being.

Aims: To study the prevalence of somatic and mental health comorbidity and the use of opioid medication among patients on long-term sick-leave due to chronic musculoskeletal pain (CMP); to compare an orthopaedic-based assessment of ability to work with a team assessment; to investigate the relationship between intensity of pain and psychosocial characteristics in this group. Methods: A cross-sectional study was carried out with 174 consecutive patients on sick-leave for a mean of 21 months. All were referred from the Social Insurance Office for orthopaedic evaluation and assessment of the ability to work. Of them, only 83/174 patients were referred by the Office for psychiatric evaluation. Results: Neck pain was the main cause of disability. Patients with neck pain often suffered pain in more than two sites, and greater intensity of pain. Thirty-four percent of all participants had been prescribed opioid medication before consultation. Degrees of disability, unemployment, low degree of education and to be an immigrant were related to intensity of pain. Unrecognized psychiatric disorders changed the main cause of inability to work in 69% of patients who underwent both orthopaedic and psychiatric evaluation. Conclusions: An evaluation based on biopsychosocial function is valuable in reaching an accurate assessment of the patient’s diagnosis, and ability to work in CMP. Ability to work and degree of sick-leave in patients on long-term sick-leave is determined to a large extent by undiagnosed mental health comorbidities, and not solely somatic complaints.

Globally, childhood obesity has increased over the last decades and is a serious public health challenge. Physical activity (PA) plays an important role in weight management; however children do not meet the recommend levels of PA. A growing number of theories address PA and motivation to engage in PA as a complex interaction between individual preferences, experiences and physical and social environments. In this study we …

Obesity in children affects physical-and mental health and can develop anxiety, depression, as well as other disorders. The objective was to evaluate the Health-Related Quality of Live (HRQOL) in schoolchildren, according to the nutritional status, and to compare our results with those of the European Union. A cross-sectional study was conducted with 679 schoolchildren, 10-14 years, in a public school of Medellin. The KIDSCREEN -27 questionnaire was used to asses HRQOL. Women, especially with obesity, had a less favorable perception of their physical activity, health, mood and family life, while men perceived less social support from friends; they were mocked by their peers and also felt harassed. Our results are consistent with those found in the European study. The Health-Related Quality of Live in schoolchildren is not homogenous, is affected by age, sex and by the cultural constraints about the construction of the body image. Key words: Bullying, obesity, schoolchildren, overweight, quality of life, social acceptance Health Psychology, Quality of Life La obesidad afecta la salud física y mental de niños/niñas. Se evaluó la calidad de vida relacionada con la salud (CVRS) en escolares, de acuerdo al estado nutricional y se compararon los resultados con los de la Unión Europea. Se realizó un estudio transversal con 679 escolares, 10 a 14 años, de una escuela pública de Medellín, Colombia. Se empleó el KIDSCREEN-27 para medir CVRS. Las mujeres, especialmente con obesidad, tuvieron una percepción menos favorable de la actividad física, salud, estado de ánimo y vida familiar, mientras que los hombres perciben más desfavorablemente el apoyo de amigos y la aceptación social, sintiéndose objeto de burla e intimidación. Los resultados son consistentes con los encontrados en el estudio europeo. La percepción de CVRS de los escolares no es homogénea, está afectada por la edad, el sexo y los condicionantes culturales alrededor de la construcción de la imagen corporal. Palabras claves autores Aceptación social, acoso escolar, calidad de vida, obesidad escolar, sobrepeso, Palabras claves descriptores Calidad de Vida, Psicología de la Salud

BACKGROUND & OBJECTIVES: This study aimed to assess levels of physical activity (PA) and sedentary behaviours among Danish and Colombian adolescents, and to compare relevant environmental and psychosocial factors associated with physical inactivity (PI) between both student groups. Further, we aimed to compare PI between Danish students born in Denmark and those with immigrant background living in Denmark, but born in another country.METHODS: The comparative study was performed with 1.374 Danish adolescents (among them 152 born outside the country) who participated in the Danish Youth Cohort and 452 Colombian students who completed the ISCOLE questionnaire, both from the most disadvantaged socioeconomic strata.RESULTS: The prevalence of physical inactivity (PI) was much higher among Colombian students (74.6%) compared with Danish (25.2%) and with students with a non-Danish background living in Denmark (21.1%). Both groups of Danish adolescents participated more often in organized sports, spent more time on sports after school, were more likely to actively commute to school compared to Colombians and spent less time on screen viewing than Colombians did. In both Columbian and Danish students, low time spent on sports after school, and poorer self-perceived health, were associated with PI. Sedentary behaviours (time in front of screen) were also positively associated with PI.CONCLUSION: Most Colombian adolescents were not meeting the recommendation of accumulating at least 60 minutes per day of moderate-to-vigorous intensity PA for positive health outcomes as most Danish adolescents did independently of their ethnic background. We assume that the physical and social environment in the neighbourhoods where adolescents live may explain the differences in levels of PA between the countries.

Objective: The main objective of this study was to investigate different psychometric properties of the Swedish version of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) in patients with chronic musculoskeletal pain in an orthopedic setting. Methods: A total of 449 participants took part in the study, including 288 patients with chronic musculoskeletal pain and 161 participants in a reference group. Internal consistency, convergent validity, and measurement invariance of the constructs of DAPOS were investigated across sex and diagnostic groups. The Beck Depression Inventory and the Spielberger Anxiety Inventory were used for measures of convergent validity. Multigroup confirmatory factor analysis was performed to test measurement invariance of the theoretical constructs of DAPOS. Results: Internal consistency was good for all 3 constructs, and correlations concerned with convergent validity were found to be acceptable to good. With regard to cross-validation, the 3 constructs of DAPOS were strictly measurement invariant with respect to sex. Across diagnostic groups, the constructs of anxiety and positive outlook were almost strictly measurement invariant, although there were some restrictions of measurement invariance for the construct of depression. Discussion: To be able to rely on an instrument with as few items as DAPOS, the cross-validation of its constructs for sex and diagnostic groups is a valuable information, particularly when investigated in patients with musculoskeletal pain. Based on these results, we recommend that DAPOS could replace longer and more time-consuming screening tests in clinical settings.

Patricia Olaya-Contreras1, Torgny Persson2, Jorma Styf11Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at The University of Gothenburg, Sweden; 2The Lundby Hospital, Gothenburg, SwedenBackground: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients.Methods and patients: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient’s diagnoses and capacity to work. The mean age was 45 (23–61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard.Results: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression.Conclusion: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.Keywords: agreement, disability, underlying diagnoses

Background and purpose Methods for identification of patients with illness behavior in orthopedic settings are still being debated. The purpose of this study was to test the association between illness behavior, depressed mood, pain intensity, self-rated disability, and clinical status in patients with chronic musculoskeletal pain (CMP). Methods We examined 174 consecutive sick-listed patients (90 women). Musculoskeletal function was estimated by range of motion, muscle strength, and motor and sensory function. The degree of illness behavior was measured by Waddell signs (WS). Results WS were observed in 47/174 (27%) of the patients, 16% of whom manifested excessive illness behaviour. In general, more patients with WS were depressed (OR = 4.4; 95% CI: 1.8–11) and experienced greater pain (OR = 2.9; CI: 1.1–7.7). No abnormal physical function could be observed in two-thirds of the patients. Other predictive factors for manifesting WS at the clinical examinations were longer sick leave and previous full sick leave (p < 0.05). Interpretation Excessive illness behavior is related to psychological distress in patients with CMP and long-term disability. Thus, some patients may also require psychological assessment. Looking for WS during consultation is useful for targeting other factors that may be important in the diagnostic process.

Low back pain (LBP) is described as highly recurrent and frequently persistent public health worldwide. The “stay active” concept has been regarded as the most appropriate treatment recommendation for patients with acute LBP. The objective of this study was to evaluate the influence of distress on disability, physical activity and pain intensity in subjects with severe acute LBP. Methods A Randomised Control Trial (RCT) was conducted, 99 employed subjects (mean age 45 years, 20–63), 61% white- and 39% blue-collar workers with acute LBP were examined within 48 h after the onset of pain. All patients were initially assessed using the Depression Anxiety and Positive Outlook Scale (DAPOS) and the Tampa Scale of Kinesiophobia (TSK) questionnaires. Thereafter, the patients documented the following in a diary over a 7-day period: pain intensity, disability rating index (DRI) and step count (pedometer). Linear Mixed Models (LMM) for repeated measures were employed for the statistical analyses. All results were adjusted for age, gender, treatment, number of days and for the interaction term (treatment *DAPOS-D). Results Prospectively, DRI and pain intensity responses were differentially mediated by the treatment, in interaction with the scores of DAPOS (p 38) had a lower step count over time (p Conclusion Depressed mood and fear of movement affect the outcomes of disability, the level of physical activity and the pain intensity in patients with acute LBP.