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Background: At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7–8 years, but later development remains unstudied. Aims: To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non‐adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. Methods & Procedures: In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow‐ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC‐Sum) for single words and rated on a three‐point scale (VPC‐Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in‐depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s‐errors. Information on secondary palatal surgery and number of visits to an SLP was collected. Outcomes & Results: VPF differed significantly between the groups at both ages when assessed with VPC‐Sum, but not with VPC‐Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s‐errors at age 5 years, and CSCs and s‐errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. Conclusions & Implications: CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre‐school years. WHAT THIS PAPER ADDS: What is already known on this subject: At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7–8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft‐related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge: This longitudinal study provides additional knowledge based on longer follow‐ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft‐related articulation errors. What are the potential or actual clinical implications of this work?: Speech and language therapy should target both cleft‐related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre‐school years, not least for adopted children. [ABSTRACT FROM AUTHOR]

Background: The risks of developmental language disorder (DLD) for both educational progress and socio‐emotional development are well documented, but little is known about how children and young people with DLD experience and describe their language and communication. The need to complement experimental and quantitative studies with qualitative perspectives of the lived experience of individuals with DLD for speech and language therapists (SLT) practice has recently been foregrounded. Aims: To understand further the experiences of young people with DLD focusing on language and communication in a school context, and thereby contribute to the improvement of the communicative situation in school for this group. The study is guided by the following research question: How do young people diagnosed with DLD describe their experiences of language and communication in school? Methods & Procedures: The study is based on data generated from qualitative semi‐structured interviews with 23 participants diagnosed with DLD (age 13–19 years old) living in Sweden. All participants attended mainstream schools. To enable data to be collected during COVID‐19 restrictions, all interviews were conducted using Zoom. Reflexive thematic analysis was used to analyse the data. Outcomes & Results: Four main themes related to experiences of language and communication in school were constructed from the interviews: (1) feelings of inadequacy and comparisons with others; (2) feelings of being misjudged and misunderstood; (3) the importance of feeling safe and comfortable; and (4) the significance of the social and communicative context. The results bear witness of difficult and challenging aspects related to language and communication in school, including educational, social and emotional dimensions. An important outcome of this study is how young people diagnosed with DLD describe their language and communication functioning to be dependent on both individual characteristics and abilities, as well as situational, contextual and social factors. Conclusions & Implications: The results from this study show that young people with DLD can have persisting problems related to language and communication in school, including educational, social and emotional dimensions. SLT services may therefore be needed throughout the school years to ensure that students with DLD receive adequate support. In addition, support that goes beyond language abilities and targets social, contextual and emotional aspects should be considered. WHAT THIS PAPER ADDS: What is already known on this subject: Children and young people have unique knowledge about their language and communication which is instrumental for designing interventions and support strategies. Qualitative analyses of interview data have been able to identify both risk factors and protective strategies in relation to the well‐being of individuals with DLD. Despite this, children and young people with DLD are rarely heard in research or clinical discussions. What this paper adds to existing knowledge: In this study we listen to the voices of young people with DLD as they describe their experiences of language and communication in school. The participants describe a condition that makes them struggle to keep up with peers and puts them at risk of being misjudged by teachers, but also give examples of situations where negative consequences are hardly felt. What are the potential or actual clinical implications of this work?: DLD is a complex and dynamic disorder where contextual and social factors interact with individual abilities in creating the end result. The results of the study indicate that DLD can cause persisting problems related to language and communication in school, with impact on educational, social and emotional dimensions. To counteract these effects, SLT services may be needed throughout the school years, and support that goes beyond language abilities must be considered. [ABSTRACT FROM AUTHOR]

Background: Partnership research practices involving various stakeholder groups are gaining ground. Yet, the research community is still exploring how to effectively coproduce research together. This study describes (a) key programme developments in the creation of a 6‐year partnership research programme in Sweden, and (b) explores the hopes, expectations, and experiences of patient innovators (i.e., individuals with lived experience as patients or caregivers who drive health innovations) and researchers involved in the programme during the first years. Methods: We conducted a prospective longitudinal qualitative study spanning the first 2 years of the programme. Data consisted of meeting protocols and interviews with 14 researchers and 6 patient innovators; 39 interviews were carried out in three evenly‐spaced rounds. We identified significant events and discussion themes in the meeting protocols and analyzed the interviews using thematic analysis, applying a cross‐sectional recurrent approach to track changes over time. Findings: Meeting protocols revealed how several partnership practices (e.g., programme management team, task forces, role description document) were cocreated, supporting the sharing of power and responsibilities among programme members. Based on the analysis of interviews, we created three themes: (1) paving the path to a better tomorrow, reflecting programme members' high expectations; (2) going on a road trip together, reflecting experiences of finding new roles and learning how to cocreate; (3) finding the tempo: from talking to doing, reflecting experiences of managing challenges and becoming productive as a team. Conclusions: Our findings suggest that sharing, respecting, and acknowledging each other's experiences and concerns helps build mutual trust and shape partnership practices. High expectations beyond research productivity suggest that we need to consider outcomes at different levels, from the individual to society, when evaluating the impact of partnership research. Patient or Public Contribution: The research team included members with formal experiences as researchers and members with lived experiences of being a patient or informal caregiver. One patient innovator coauthored this paper and contributed to all aspects of the research, including the design of the study; production of data (as interviewee); interpretation of findings; and drafting the manuscript. [ABSTRACT FROM AUTHOR]

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

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

Background: Because of the shift towards earlier diagnosis of dementia and/or Alzheimer's disease (AD), increasing numbers of individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are seen in memory clinics. Yet, evidence indicates that there is room for improvement when it comes to tailoring of the diagnostic work‐up to the needs of individual patients. To optimize the quality of care, we explored patients' perspectives regarding the diagnostic work‐up at a specialized memory clinic. Methods: This interview study was conducted at Karolinska University Hospital (Sweden). The comprehensive diagnostic work‐up for dementia at the memory clinic in Solna is conducted within 1 week. A sample of 15 patients (8 female; mean age = 61 years [range 50–72]; 11 SCD, 1 MCI and 3 AD dementia) was purposively selected for a series of three semistructured interviews, focussing on (1) needs and expectations (during the week of diagnostic testing), (2) experiences (within 2 weeks after test‐result disclosure) and (3) reflections and evaluation (3 months after disclosure). Transcribed audio‐recorded data were analyzed using thematic content analysis (using MaxQDA software). Results: Three key themes were identified: (1) the expectations and motivations of individuals for visiting the memory clinic strongly impacted their experience; (2) the diagnostic work‐up impacted individuals psychosocially and (3) the diagnostic work‐up provided an opportunity to motivate individuals to adopt a healthier lifestyle. Conclusion: Our findings underscore the importance of enquiring about the expectations and needs of individuals referred to a specialized memory clinic, allowing for expectation management and personalization of provided information/advice, and potentially informing the selection of patients in need of a comprehensive diagnostic work‐up. Structural guidance might be needed to support those with SCD and MCI to help them cope with uncertainty, potentially resolve their issues, and/or stimulate brain health. Patient or Public Contribution: We gathered the perspectives of 15 individuals who had been referred to the memory clinic at three different time points through semistructured interviews, and these interviews were the primary data source. [ABSTRACT FROM AUTHOR]

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

Through adoption, the state actively contributes to creating families. It therefore also assumes the role of guarantor of the child's best interests in the adoption process, which entails assessing the suitability of presumptive adoptive parents. In the present paper, we use the concluding sections of assessment reports on applicants for intercountry adoption in Sweden to answer the following question: what must be said about an individual or a couple in order for her/them to be seen as a suitable adoptive parent? We thus assume that report conclusions serve to display parent suitability to their audiences. The assessment aligns with Swedish national adoption guidelines, and the study shows how the assessment handbook comes to serve as a catalogue of arguments that not only define good parenthood but also outline a way of life that is suitable for parenthood. The analysis illustrates how valid arguments for granting consent to adopt refer to three layers of suitability. They include not only the applicants' insights into and knowledge about adoption in particular and children in general but also their conventional and orderly life, i.e. a life free from distractions that could hinder a wholehearted focus on children and family life. [ABSTRACT FROM AUTHOR]

At a policy level, governments increasingly stress the importance of children's rights and their ability to participate in decision‐making in child welfare services. An example of this is that the Swedish inspectorate targeting children in residential care is required to consult children and to take account of their opinions. This paper details a study exploring the influence that the inspectorate grants children and particularly how children's views influence the inspection process. The study draws on interviews and observations of inspectors as well as an analysis of a representative sample (n = 147) of documentation from inspections performed during 2012. The result indicates different inspectorial rationales, which in turn influence the importance children's opinions are assigned in the inspection process. Moreover, the findings demonstrate difficulties in giving children's views substantial impact on the inspection process. This can be attributed to the fact that most of the regulatory quality criteria used by the authority diverge from the aspects of care that children attach most importance to. The study adds empirical findings to how the participation of children is realized during inspection. [ABSTRACT FROM AUTHOR]

Background In 2007, a literature review was undertaken of palliative care research from Sweden during the 1970s-2006, paving the way for a follow-up study to explore the recent developments. The aim was to systematically examine palliative care research from Sweden between 2007 and 2012, with special attention to methods, designs and research foci. Methods A literature review was undertaken. The databases Academic search elite, Age line, Ahmed, Cinahl, PsychInfo, PubMed, Scopus, Soc abstracts, Web of science and Libris were reviewed for Swedish palliative care research studies published from 2007 to 2012, applying the search criteria 'palliative care OR palliative medicine OR end-of-life care OR terminal care OR hospice care OR dying OR death'. Results A total of 263 papers met the inclusion criteria, indicating an increased volume of research compared to the 133 articles identified in the previous review. Common study foci were symptom assessment and management, experiences of illness and care planning. Targeting non-cancer-specific populations and utilisation of population-based register studies were identified as new features. There was continued domination of cross-sectional, qualitative and mono-disciplinary studies, not including ethnic minority groups, nonverbally communicable people or children <18 years of age. Conclusions The trend is that Swedish palliative care research has expanded in volume from 2007 to 2012 compared to during the 1970s to 2006, with increasing participation of non-cancer-specific populations. A domination of qualitative approaches and small, cross-sectional studies with few interventions is still characteristic. Still more strategies are needed to expand the knowledge development of palliative care to respond to demographical, epidemiological, therapeutic and healthcare structure changes. [ABSTRACT FROM AUTHOR]

Background and objective: End‐stage renal disease (ESRD) affects a multitude of aspects in the patient's daily life, often entailing their own involvement in various aspects of the treatment. Although patient participation is a core health‐care value, what the concept signifies is not yet fully known. The purpose of this paper is to conceptualize patient participation in dialysis care, depicting patients' and health‐care professionals' perspectives. Design: This explorative study employed qualitative interviews and content analysis. Setting and participants: Seven focus group discussions engaging 42 key informants were performed, including patients, staff and managers with experience of dialysis care. Results: In dialysis care, patient participation connotes a sharing of information and knowledge, the learning of and planning of care, including partaking in shared decisions with regards to treatment and management, and being involved in the management of one's own health‐care treatment and/or self‐care activities. Although these attributes were illustrated by all stakeholders, their significance varied: patients suggested that their preferences regarding primary aspects of participation vary, while staff considered patients' performance of dialysis to be the ultimate form of participation. Further, while patients considered multiple ways to execute participation, staff suggested that aspects such as sharing information were a route to, rather than actual, involvement. Conclusions: Without a common understanding to denote the idea of patient participation, staff and patients are exposed to a potential deficit in terms of facilitating patient participation in everyday encounters of dialysis treatment. Further studies and means to serve a mutual understanding are needed. [ABSTRACT FROM AUTHOR]

Background: Xerostomia can pose significant problems for many elderly people. Objectives: To investigate longitudinal changes in prevalence, persistence, progression, remission and incidence of xerostomia from age 75 to 85 years. Methods: All 75‐year‐olds (born 1932) from two Swedish counties, Sweden were mailed a questionnaire in 2007 (N = 5195), and again in 2017 when they were aged 85 (N = 3323). The total response rates at ages 75 and 85 years were 71.9% and 60.8%, respectively. A 'panel', those who participated in both surveys, comprised 1701 individuals (response rate 51.2%). Results: At age 85, there was almost a doubling of self‐reported 'yes often' xerostomia compared with age 75 (from 6.2% to 11.3%) and was almost twice as common in women than men (p <.001). When combining 'yes often'/'yes sometimes', xerostomia increased from 33.4% to 49.0%, and was more so among women (p <.001). Xerostomia was commoner at night than daytime, with 23.4% reporting 'yes often' night‐time xerostomia at 85 compared with 18.5% at 75, and was also higher in women (p <.001). Progression rates for daytime and night‐time xerostomia were 34.2% and 38.1%, for persistence 67.4% and 68.6%, and for remission 24.4% and 16.5%. Average yearly incidence was higher in women than men for both daytime (3.6% vs. 3.2%) and night‐time (3.9% vs. 3.7%). Regression analyses predicted protective factors for developing xerostomia reported at age 75 as good general and oral health, absence of medications/intraoral symptom/s, good chewing function and social interaction. Conclusions: Xerostomia increases markedly from age 75 to 85 years. [ABSTRACT FROM AUTHOR]

Background and Aim: Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use. Methods: A survey was distributed to first‐line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically. Results: 73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program. Conclusion: This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence. [ABSTRACT FROM AUTHOR]

Background and Aims: The prevalence of cannabis use based on self‐reports is likely to be underestimated in population surveys, especially in contexts where its use is a criminal offence. Indirect survey methods ask sensitive questions ensuring that answers cannot be identified with an individual respondent, therefore potentially resulting in more reliable estimates. We aimed to measure whether the indirect survey method 'randomized response technique' (RRT) increased response rate and/or increased disclosure of cannabis use among young adults compared with a traditional survey. Design: We conducted two parallel nation‐wide surveys during the spring and the summer of 2021. The first survey was a traditional questionnaire‐based one (focusing on substance use and gambling). The second survey applied an indirect survey method known as 'the cross‐wise model' to questions related to cannabis use. The two surveys employed identical procedures (e.g. invitations, reminders and wording of the questions) Setting and Participants: The participants were young adults (aged 18–29 years) living in Sweden. The traditional survey had 1200 respondents (56.9% women) and the indirect survey had 2951 respondents (53.6% women). Measurements In both surveys, cannabis use was assessed according to three time‐frames: life‐time use; use during the past year; and use during the past 30 days. Findings The estimated prevalence of cannabis use was two‐ to threefold higher on all measures when estimated using the indirect survey method compared with the traditional survey: use during life‐time (43.2 versus 27.3%); during the past year (19.2 versus 10.4%); and during the past 30 days (13.2 versus 3.7%). The discrepancy was larger among males and individuals with an education shorter than 10 years, who were unemployed, and who were born in non‐European countries. Conclusions: Indirect survey methods may provide more accurate estimates than traditional surveys on prevalence of self‐reported cannabis use. [ABSTRACT FROM AUTHOR]

Background: Oral cancer is a severe and potentially fatal disease usually starting in the squamous epithelium lining the oral cavity. Together with oropharyngeal carcinoma, it is the fifth to sixth most common malignancy worldwide. To limit the increase in the global oral cancer incidence over the past two decades, the World Health Assembly adopted a resolution urging member states to integrate preventive measures such as engagement and training of dental personnel in screening, early diagnosis, and treatment into their national cancer control programs. Aim: The aim of this study was to investigate if dental hygienists (DHs) and dentists (Ds) in general dental practice care can be entrusted to perform brush sampling of oral potentially malignant disorders (OPMDs), and to evaluate their level of comfort in performing brush biopsies. Methods: Participants were five DHs and five Ds who received one day of theoretical and clinical training in oral pathology to identify OPMDs (leukoplakia [LP], erythroplakia [EP], and oral lichen planus [OLP]), and perform brush sampling for PAP cytology and high‐risk human papillomavirus (hrHPV) analysis. Results: Out of 222 collected samples, 215 were adequate for morphological assessment and hrHPV analysis. All the participants agreed that sample collection can be incorporated in DHs and Ds routine clinical duties, and most of them reported that sample collection and processing was easy/quite easy. Conclusion: Dentists and DHs are capable of collecting satisfactory material for cytology and hrHPV analysis. All the participating DHs and Ds were of the opinion that brush sampling could be handled routinely by DHs and Ds in GDP. [ABSTRACT FROM AUTHOR]

The purpose was to investigate the association between disability, and psychosomatic problems among adolescents at compulsory regular school also taking into account parental and student achievement expectations and student self‐efficacy. We analysed cross‐sectional questionnaire data collected in 2010, from 2004 Swedish adolescents. The results showed that the degree of psychosomatic problems and self‐efficacy varied with regard to whether the adolescent reported having a disability or not. The distribution of parents' and adolescents' own achievement expectations did not differ significantly with regard to having a disability. Neither achievement expectations nor self‐efficacy did moderate the association between disability and psychosomatic problems. [ABSTRACT FROM AUTHOR]

Rationale: Undergraduate nursing students' learning opportunities to practice caring behaviours to assure compassionate and competent nursing practice with standardised patients are few. Earlier studies primarily focused on practicing communication skills in relation to mental health or developing psychomotor skills while caring for a patient with a specific diagnosis. Aim: The study aim was to describe undergraduate nursing students' experiences of practicing caring behaviours with a standardised patient. Method: A sample of forty‐eight undergraduate nursing students in semester four at a school of nursing in southern Sweden, enrolled in a full‐time, 5‐week, on‐campus elective caring behaviour course, were at the first and last week individually video‐recorded during two caring behaviour simulations encountering a standardised patient. After observing each of their video‐recordings, students completed written reflections focusing on their own compassionate and competent verbal and nonverbal caring behaviour. In total, 96 individual written reflections were analysed using qualitative content analysis to describe the experience. Results: One main theme emerged: The challenge of being mindfully present in patient encounters. Four themes further described the experience: A challenging but realistic learning experience, learning the impact of nonverbal behaviour, recognising the complexity of verbal behaviour, and learning to be with the patient instead of only doing for the patient. Conclusion: When caring is intertwined with visible and realistic nursing practice in simulations using standardised patients it facilitates undergraduate nursing students learning compassionate and competent caring behaviour. The learning experience opened the students' eyes to the impact of practicing caring, recognising that being with is not the same as doing for the patient, and thus, how challenging it is to be mindfully present in patient encounters. Designing caring behaviour simulations with standardised patients is a feasible and efficacious educational learning didactic to facilitate students' learning caring behaviour and enhancing patients' experiences. [ABSTRACT FROM AUTHOR]

Background: The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge‐Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. Methods: The educational intervention for nursing home professionals consisted of five 2‐h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow‐up) the intervention. Descriptive and inferential statistics were calculated. Results: The positive effects at follow‐up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. Conclusions: This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow‐up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change. [ABSTRACT FROM AUTHOR]

Introduction: Persons with dementia experience time‐related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the instruments KaTid®‐Senior measuring time processing ability, and Time‐S© Senior and Time‐Proxy© measuring daily time management for persons with dementia. Methods: Persons with dementia (n = 53) and their significant others (n = 49) participated in the study. Rasch analyses were used to evaluate the instruments' rating scale functioning; internal scale validity; person‐response validity; unidimensionality; person‐separation reliability; and internal consistency. Versions excluding items with poor fit to the Rasch model were also evaluated. Results: Overall, the Rasch analyses showed acceptable psychometric properties. All instruments met the criteria for unidimensionality and the reliability was good. More challenging items should be added in KaTid‐Senior for better targeting of persons with mild dementia. Person‐response validity issues in Time‐S Senior need to be addressed. Conclusion: The instruments can validly and reliably be used to assess time processing ability and daily time management in persons with dementia in clinical research and healthcare settings. In turn, this can contribute to the development of methods to compensate for impaired time processing ability and daily time management. The assessments can also increase the possibility of early detection of impaired time processing ability and daily time management, thereby facilitating adequate timing of interventions and enhanced occupational performance. [ABSTRACT FROM AUTHOR]

Background: Promoting healthy work environment as a manager in nursing homes is important to safeguard staff health and well‐being as well as care quality when facing increasing demands. The impact of leadership on staff work environment needs further exploration. Objectives: To describe longitudinal changes in nursing home leadership, direct care staff characteristics, job strain and social support. Methods: This study has a repeated cross‐sectional design, a five‐year follow‐up study. Nursing home staff in 181 corresponding units (n = 1253 in 2014 and n = 1176 in 2019) completed surveys about leadership, staff job strain and social support in a five‐year follow‐up study. Descriptive and regression analyses were conducted. Results: A higher degree of leadership defined by coaching and providing direct feedback to care staff, handling conflicts in a constructive way and having control of the clinical work, was significantly associated with a lower degree of job strain and a higher degree of social support among staff, with stronger associations at follow‐up. The proportion of enrolled nurses increased significantly at follow‐up. Conclusions: Leadership is increasingly important for staff work environment, especially in times of increased workload and decreasing collegiality and deteriorating work atmosphere at work. Implications for Practice: Stakeholder and policy makers in nursing home care may reflect on how managers' leadership is prioritised in these environments because such leadership is associated with staff job strain and social support. Managers striving to improve the work situation of staff may consider their own role and allow flexibility in how and when the work can be performed. [ABSTRACT FROM AUTHOR]

Background: NHs have been severely exposed during the COVID‐19 pandemic. Little is known about how staff who provide practical daily care of older residents experienced work during the pandemic. The aim of this study was to understand how nursing assistants (NAs) experienced their work at nursing homes (NHs) for older people during the first wave of the COVID‐19 pandemic. Methods: We conducted a qualitative study of focus group discussions with in total 20 participants from four NHs in Stockholm, Sweden. Discussions were held in November 2020. Transcripts were analyzed using inductive thematic analysis. Results: We identified three major themes: 1) We felt abandoned, scared and disrespected, 2) We made sure we made it through, and 3) We can do good work with appropriate resources. NAs felt disregarded as they were often left alone without adequate support from managers, registered nurses and the municipalities. NAs felt distressed and guilty and developed their own strategies to cope and manage their work. Conclusion and Implication for Practice: During the first wave of the COVID‐19 pandemic NAs felt abandoned and burdened due to lack of leadership. Organizational improvements are required to protect the wellbeing of NAs and to ensure sustainability of patient safety. NAs are crucial in the care for vulnerable older people and their experiences should constitute a keystone for development of future policy and practice in NHs. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is one of the most common types of cancer in men and could occur without symptoms. Screening has been debated but remains controversial and, in most countries, organized population‐based screening does not exist. The aim of this study was to describe men's experiences of receiving a prostate cancer diagnosis after opportunistic screening. Methods: This study is a secondary analysis from interviews with 17 men (aged 56–80 years) who had undergone curative treatment for prostate cancer. Data were collected in an urban region of Sweden through interviews conducted face to face or by telephone. An inductive content analysis was used with Consolidated criteria for Reporting Qualitative research as a reporting checklist. Results: Two main categories were identified. Screening is a lifesaver enclosed by ethical dilemmas reflects how men considered screening as a lifesaving test. Testing was surrounded by injustice and an eagerness to encourage other men to undergo screening. Facing challenges during diagnosis reflects the men's experiences of being in an unknown field yet expected to engage in decision‐making concerning appropriate treatment. Receiving the diagnosis rendered mixed emotions about having a cancer disease, that the treatment could cause lifelong symptom distress and the men described being hesitant to talk about their diagnosis. Conclusions: The findings highlight men's opinions about screening and that the lack of routine screening represents injustice. The men considered this as an ethical question of lifesaving justice, while stakeholders may argue that screening could lead to unnecessary suffering and overtreatment. Men do not always talk openly about their diagnosis, linked to the fact that it concerns intimate areas. It is important to balance the information in relation to shared decision‐making regarding treatment. Health care professionals have an ethical responsibility to support and coach the patient in their decision. Patient or Public Contribution: This study was based on interviews with men who had experienced a diagnosis of prostate cancer. [ABSTRACT FROM AUTHOR]

Objective: The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision‐making ability is impaired. Self‐determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients' self‐determination in cases where patients have impaired decision‐making ability, and who are in urgent need of care. Materials and methods: An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2–4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five‐point Likert scale together with free‐text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale. Results: Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2–4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus. Conclusions: The findings highlight the complexity of ACs' attitudes towards older patients' self‐determination. The respect of older patients' self‐determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self‐determination and shared decision‐making. AS have to provide continued ethical training, for example to increase the use of simulation‐based training or moral case deliberations in order to strengthen the ACs' moral abilities within their professional practice. Implications for practice: Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation‐based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs' abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team. [ABSTRACT FROM AUTHOR]

Background: Pain is common and often more complex to assess among nursing homes residents with cognitive impairments. Thus, more research is needed of different pain assessment methods in elderly care and how these assessments outcomes are related to quality of life, as there mostly should be a negative relationship. There is a risk that pain are under diagnosed among persons with cognitive impairment. Aim: The aim was to describe and compare pain prevalence among nursing home residents (1) using different pain assessment methods (2) in relation to cognitive status and to (3) examine associations between pain and quality of life or well-being. Methods: A cross-sectional correlational design was used, participants were 213 nursing home residents and data were collected through interviews using standardised protocols. Instrument used were Katz index of ADL, Mini-Mental-State-Examination, Quality of Life in Late-Stage Dementia scale, WHO-5 well-being index, Numeric Rating Scale and Doloplus-2 scale. Results: The results showed high pain prevalence, but no significant difference based on cognitive level. Pain classifi- cation at the individual level varied somewhat when different instruments are used. The results indicated that use of a single-item proxy-measure for pain tends to show higher pain prevalence and was not statistically significant related to quality of life. The relationship with quality of life was statistically significant when self-rated pain instruments or multi-component observation were used. Conclusions: The study shows that it is difficult to estimate pain in residents living at nursing homes and that it continues to be a challenge to solve. Self-rated pain should be used primarily to assess pain, and a multi-component observation scale for pain should be used when residents are cognitively impaired. Both self-rated pain and multicomponent observation also support the well-known link between pain and quality of life. Single-item proxy assessments should only be used in exceptional cases. [ABSTRACT FROM AUTHOR]

Background: Recovery from life-threatening illness may be experienced as more demanding and lasts longer than patients first expect. Many patients experience recovery after life-threatening illness, as filled with complex problems. These problems are primarily physical and psychological, although also social, and adversely affect daily life as well as perceived quality of life. Patients experience uncertainty about living with the legacy of a life-threatening illness and how it negatively limits their daily lives and experienced health. Aim: The purpose is to illuminate experiences of the meaning of recovery from life-threatening disease. Ethical approval: Approval for the study was obtained through a Regional Research Ethics Committee. Methods: This study was conducted as a qualitative narrative study. This means that written stories of human recovery beyond suffering from life-threatening disease were collected and analysed with a phenomenological hermeneutic method. Results: The findings reveal two major areas -- intrapersonal meanings and relational meanings. Four themes were found in these areas, each of which was divided into subthemes as follows: obstacles, for example disappointment of life, alienation of self and opportunities/resources: for example balance, own knowledge, hope and gratitude; relational obstacles, for example a lack of care, stigmatisation and economic stress; and relational resources such as informal care and professional care. Study limitations: The informants were predominantly women that may be explained by the fact that females seem to be more often engaged in social media and willing to participate in these kinds of studies. Another limitation is that we only reached out to Swedish speaking Facebook groups when recruiting our informants. Conclusions: In the narratives of their recovery process, surprisingly few focused on professional health care as a resource. Experiences from the study may be used to further develop care, especially to support patient self-care regarding intrapersonal and relational resources that promote patient recovery beyond suffering from life-threatening disease. [ABSTRACT FROM AUTHOR]

People with mental ill health attend general emergency care more often than others for physical and psychiatric care needs. Staff in general emergency care report they lack knowledge and strategies to meet with and care for people with mental ill health. This study aimed to describe how people with mental ill health experience encounters with staff in general emergency care. We conducted individual semi‐structured interviews with 11 people with mental ill health about their experiences in general emergency care and subjected the interview data to qualitative content analysis. Our results show the importance to people with mental ill health of being acknowledged as capable persons, and how this relates to their experiences of being recognized, ignored, or dismissed by staff in general emergency care. Even small, ordinary aspects of staff/patient interactions can have major impacts on a person's recovery and well‐being. The study is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines. [ABSTRACT FROM AUTHOR]

Background: Depression is a common disorder in old age and increases with hospitalisation. The aim was to investigate whether improvement in depressive symptoms after hospitalisation is associated with education level, age, gender, living situation, self‐efficacy, activities in daily living and quality of life by (1) examining the prevalence of depressive symptoms at baseline and at 1st and 2nd follow‐up (2) examining different factors' association with depressive symptoms at baseline and (3) examining different factors' association with improvement in depressive symptoms at baseline and at 1st and 2nd follow‐up. Methods: The study consisted of 145 patients, 65 years and older. Data were collected between February 2015 and September 2016 through interviews conducted using structured protocols. The instrument used was Katz index of ADL, Geriatric Depression Scale‐20, Life Satisfaction Questionnaire and the General Self‐Efficacy Scale. The participants were interviewed before discharge from hospital, after 1.5 month and after 3 months. Results: The prevalence of depressive symptoms in older persons was high after hospitalisation. Factors associated with improvement of depressive symptoms after hospitalisation were higher educational level, improvement in activities in daily living and quality of life. Non‐significant results were found for improvement of depressive symptoms and gender, age, living situation or self‐efficacy. Conclusions: Depression is a common health problem in older persons, especially after hospitalisation. It is therefore important that healthcare staff screen older persons for depression during hospitalisation, as this allows identification of those in need and a possibility to help them in an appropriate manner. Persons with lower educational level and depressive symptoms need special attention. [ABSTRACT FROM AUTHOR]

Objectives: The Swedish Dignity Care Intervention (DCI‐SWE) is an intervention for people with palliative care needs to enhance their dignity. The original DCI was developed in Scotland, where it was tested by nurses in municipal care. In this study, the DCI has been tested for the first time in a Swedish home health care context. The aim was to describe experiences of the DCI‐SWE from the perspectives of community nurses (CNs). Methods: This was a feasibility study with a qualitative design. Three focus group interviews and one individual interview were performed with CNs (n = 11). Reflective diaries and field notes were written by the CNs and researchers, respectively. Data were analysed using inductive content analysis. Results: Two main categories and six subcategories were identified. The first main category, 'Practising the palliative approach while responding to palliative care needs', consisted of the subcategories: gives structure while providing palliative care; gives older people opportunities to be confirmed; and responding to existential and sensitive needs. The second main category, 'Aspects influencing the use of the DCI‐SWE' had two subcategories about facilitators and barriers to the use of the DCI‐SWE, and another about how to establish the DCI‐SWE in the context of home health care. Conclusion: The DCI‐SWE offers CNs an overview of older people's concerns while providing palliative care, and gives the older people opportunities to be listened to. Essential prerequisites for using the DCI‐SWE in municipal home health care are that CNs are comfortable holding conversations and are given time and space for these by the organisation. Other aspects facilitating the use of the DCI‐SWE are managers' engagement and support, continuing training for CNs and CNs' opportunities for reflection. [ABSTRACT FROM AUTHOR]

Background: Person‐centred care implies a change in interaction between care professionals and patients where patients are not passive recipients but co‐producers of care. The interactional practices of person‐centred care remain largely unexplored. Objective: This study focuses on the analysis of disagreements, which are described as an important part in the co‐production of knowledge in interaction. Design: A qualitative exploratory study using conversation analysis. Setting and participants: Data were collected from a nurse‐led person‐centred intervention in a hospital outpatient setting. Interactions between adult patients with irritable bowel syndrome (n = 17) and a registered nurse were audio‐recorded. COREQ guidelines were applied. Results: Disagreements were found after demonstration of the nurse's or patients' respective professional or personal knowledge. Disagreements were also evident when deciding on strategies for self‐management. Although negotiations between opposing views of the nurse and patient were seen as important, the patient generally claimed final authority both in knowing how IBS is perceived and in the right to choose self‐management strategies. The nurse generally oriented towards patient authority, but instances of demonstration of nurse authority despite patient resistance were also found. Discussion and conclusions: This study provides information on how co‐production of knowledge and decisions occur in the context of a person‐centred care intervention. Negotiations between nurse and patient views require a flexible approach to communication, adapting interaction to each context while bearing in mind the patients having the final authority. To facilitate co‐production, the patient's role and responsibilities in interaction should be explicitly stated. [ABSTRACT FROM AUTHOR]

Background: Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence‐based clinical decision‐making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. Methods: A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. Results: The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. Conclusions: The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given. [ABSTRACT FROM AUTHOR]

Main problem: Self‐management is essential for patients both before and after kidney transplantation and requires an adequate level of health literacy (HL), that is the ability to comprehend and process health information. Low HL is associated with poor clinical outcome and an increased risk of death. In Europe, HL has been scarcely studied. The aim of this study was to investigate the levels of HL in a Swedish cohort of kidney transplant (KTx) candidates and KTx recipients. Methods: A single centre cross‐sectional cohort study. Participants; n = 50 KTx candidates and n = 49 KTx recipients. HL was measured with the Newest Vital Sign instrument (NVS). Statistical analysis was made using the chi‐square, Mann–Whitney U‐ or t‐test. Results: Study participants; n = 99, 61.6% male, mean age 52 years. Low or possible inadequate HL was seen in 20%. There was no statistical difference in the levels of HL related to sex, educational level, ability to work or between KTx candidates and KTx recipients. Conclusions: In this cohort, one fifth had low or possible inadequate HL measured by the NVS. Screening is needed to identify persons with poor HL. These persons require tailored education and person‐centred care to cope with self‐management. [ABSTRACT FROM AUTHOR]

Aim: To assess the quality of life in frail older persons (65+ years) living in nursing homes and to examine differences between quality of life perceptions among different gender and age groups. Design: Cross‐sectional. Methods: Data were collected during 2015‐2017 based on two questionnaires (WHOQOL‐OLD and WHOQOL‐BREF). Seventy‐eight older persons living in nursing homes in southern Sweden answered the questionnaires in structured interviews. Descriptive and comparative statistics were used to analyse the data. The study was guided by Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines. Results: The frail older persons reported low autonomy related to few opportunities to engage in everyday activities and were unable to do the things they liked to do and not feeling in control of their future. Another important result was that frail older persons seemed to have no or little fear of death and dying. No significant differences between gender or age on quality of life were revealed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Given recent advances in psychometric assessment, there is a need for assessment studies using modern test theory in the field of person‐centred care, mainly due to the dominant use of analytical strategies based on classical test theory. The main objective of the present study was thus to examine whether selected items from commonly used instruments of person‐centred care were able to differentiate between respondents with a reasonably even level of measurement precision across different regions of the construct range using item response theory (IRT). Research Design and Methods: A Swedish sample of care staff in elderly care (N = 1342) completed a survey including a selection of items from three previously validated measures of person‐centred care. Results: All questionnaire items were submitted to IRT analyses to examine the extent to which the items produced information on the underlying construct. The items exhibited different levels of information. However, in general, for those items exhibiting some information, the pattern of information across the trait range was similar for most of them, that is, the items discriminated better in the lower levels of person‐centredness. Discussion and Implications: Item response theory analyses are instrumental in creating shorter measurement instruments that may perform nearly as well as the original longer instruments. Given time and other resource constraints in questionnaire administration, there is a gain in only including the most informative items which efficiently and evenly tap the underlying construct along its entire range and in the context of person‐centred care assessment this study was an initial step towards this goal. Thus, a set of ten items with satisfactory levels of psychometric quality, that is relatively high information levels across a relatively broad range of the underlying construct, is proposed. [ABSTRACT FROM AUTHOR]

Objectives: Dental hygienists (DHs) have an important role in the treatment of patients with periodontitis. The objective of the current qualitative interview study was to gain understanding about personal and organizational factors that influence best‐evidenced DH practice in the treatment of periodontitis. Methods: Data were obtained by interviewing Swedish DHs, who had been engaged in a preceding clinical field study on evidence‐based periodontal therapy. Qualitative content analysis was used for analysis. Data sampling was terminated after 18 interviews, when deemed that sufficient amount of information had been gained. Results: In the analysis of the interview data, a main theme was identified as "I know what to do, but I do as I usually do; DHs' ambivalence between theory and practice in the treatment of patients with periodontitis." The results elucidated that the DHs were well aware of "what to do" in order to offer their patients adequate periodontal care, but this knowledge was not congruent with how they usually worked. Established routines and culture at the clinic, DHs' predetermined beliefs about lack of motivation and ability to cooperate among patients, lack of time and reflection, economic demands in care and lack of interest and support by co‐working dentists were barriers to best‐evidenced DH practice in periodontal care. Conclusions: The results elucidate the complexity of best‐evidenced DH practice in the treatment of periodontal patients and indicate needs for quality improvement of the periodontal care provided in general dental practice, by actions taken on both individual/professional and organizational levels. [ABSTRACT FROM AUTHOR]

BACKGROUND: The presence of health problems in a child is known to be negatively associated with later academic achievement, but less is known about the educational outcomes for siblings of children in poor health. The study investigated how having a sibling with health problems affects a healthy sibling's academic achievement. METHODS: We utilized medical and social microdata from Swedish administrative population registers. Our sample consisted of N = 115,106 individuals (51.3% boys) born in 1990 in Sweden. We compared children with ill siblings to children whose siblings did not have poor health. Siblings' hospital admissions and the academic achievements of the healthy sibling during their final year of compulsory education (at the age of 15‐16) were analyzed using linear and logistic regression in relation to individual health‐ and family‐related confounders. RESULTS: Sibling hospitalization was significantly associated with lower overall grade points (β = −10.73, p <.001) and an increased odds ratio (OR) of ineligibility for upper secondary education (OR = 1.42, 95% confidence interval = 1.31‐1.52, p <.001). CONCLUSIONS: School and health personnel should also consider the needs of healthy siblings during their work with children in poor health, because they too can be disadvantaged. [ABSTRACT FROM AUTHOR]

Background: Oral health is important for well‐being and overall health. Older peoples′ oral health is well described in the residential care context, but remains understudied in short‐term care. Objective: The aim of this study was to describe oral health, daily oral care and related factors among older people in short‐term care and to compare self‐perceived oral health with professional assessment. Materials and methods: This cross‐sectional study included 391 older people in 36 short‐term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples' perceptions of their own oral health were measured with a global question on self‐perceived oral health. Self‐care ability was assessed with Katz Index of Activities of Daily Living (Katz‐ADL). Results: Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self‐care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self‐perceived oral health. Conclusion: Professionals' assessments of oral health differed considerably from the older peoples′ own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self‐care (ADL). This study indicates that in order to improve older peoples′ oral health and oral care we need to provide person‐centred oral care and to develop a close collaboration between nursing and dental staff. [ABSTRACT FROM AUTHOR]

Children who have parents with any kind of illness may become young carers who take a responsibility not expected of children for household tasks, or personal or emotional care for parents and siblings. So far, little is known about children in Sweden who are at risk of becoming young carers. The aim of this article is therefore to explore the extent and impact of children's caring activities as reported in a pilot study by a sample of children in Sweden. A number of international questionnaires measuring the amount of caring activities, impact of caring, quality of life, and psychological well‐being were translated and combined into a survey. The pilot survey was completed by 30 children 10–18 years of age. Also, when completing the survey, the children were interviewed concerning their experiences of caregiving. The participants report on a group level emotional symptoms such as fear and nervousness above the clinical cut‐off value. They also rate a lower level of caring compared with findings from the United Kingdom, but they report a higher degree of negative impact of caring than young carers in the United Kingdom. [ABSTRACT FROM AUTHOR]

Abstract: Background: Respiratory muscle impairment following cervical spinal cord injury (CSCI) may lead to reduced voice function, although the individual variation is large. Voice problems in this population may not always receive attention since individuals with CSCI face other, more acute and life‐threatening issues that need/receive attention. Currently there is no consensus on the tasks suitable to identify the specific voice impairments and functional voice changes experienced by individuals with CSCI. Aims: To examine which voice/speech tasks identify the specific voice and communication changes associated with CSCI, habitual and maximum speech performance of a group with CSCI was compared with that of a healthy control group (CG), and the findings were related to respiratory function and to self‐reported voice problems. Methods & Procedures: Respiratory, aerodynamic, acoustic and self‐reported voice data from 19 individuals (nine women and 10 men, aged 23–59 years, heights = 153–192 cm) with CSCI (levels C3–C7) were compared with data from a CG consisting of 19 carefully matched non‐injured people (nine women and 10 men, aged 19–59 years, heights = 152–187 cm). Outcomes & Results: Despite considerable variability of performance, highly significant differences between the group with CSCI and the CG were found in maximum phonation time, maximum duration of breath phrases, maximum sound pressure level and maximum voice area in voice‐range profiles (all p = .000). Subglottal pressure was lower and phonatory stability was reduced in some of the individuals with CSCI, but differences between the groups were not statistically significant. Six of 19 had voice handicap index (VHI) scores above 20 (the cut‐off for voice disorder). Individuals with a vital capacity below 50% of the expected for an equivalent reference individual performed significantly worse than participants with more normal vital capacity. Completeness and level of injury seemed to impact vocal function in some individuals. Conclusions & Implications: A combination of maximum performance speech tasks, respiratory tasks and self‐reported information on voice problems help to identify individuals with reduced voice function following CSCI. Early identification of individuals with voice changes post‐CSCI, and introducing appropriate rehabilitation strategies, may help to minimize development of maladaptive voice behaviours such as vocal strain, which can lead to further impairments and limitations to communication participation. [ABSTRACT FROM AUTHOR]

Background: What already is known is that as many as 50% of all Swedish Ambulance Care Service assignments are considered as non‐emergency. Therefore, due to medical protocols and triage system, patients are refused conveyance to the Accident and Emergency Department by the Ambulance Care Service. Aim: The aim of this study was to psychometrically explore the construct validity of a possible dimension of person‐centredness, developed from a previous published qualitative study in a nonemergency ambulance care context. A second aim was to explore patients’ experiences of the person‐centred climate and to explore possible relationship between it and person‐centredness. Design/Methods: A retrospective, explorative, cross‐sectional survey design with a convenience sample was employed. A total of 111 questionnaires were analysed using descriptive and comparative statistics. An explanatory factor analysis was also conducted. Findings: A one‐factor solution for the specific items possibly constructing person‐centredness was found. The responses to the Person‐centred Climate Questionnaire‐Patient version (PCQ‐P) revealed that the climate was received as highly person‐centred. Relationships were found between the specific items possibly constructing person‐centredness and PCQ‐P. Conclusion: A highly valid construct of person‐centredness exists within nonurgent Ambulance Care Service assignments comprising eight aspects of being taken seriously. The climate in which nonemergency ambulance care is provided has great potential to facilitate person‐centredness by means of taking patients seriously. The psychosocial aspects of PCQ‐P and person‐centredness are somewhat related to each other. [ABSTRACT FROM AUTHOR]

Introduction: Lymphoedema may cause complex problems that can strongly influence patients' health‐related quality of life (HRQoL). The main purpose of this study was to investigate the impact of lymphoedema on HRQoL in patients with varying forms of lymphoedema. Methods: The Lymphoedema Quality of Life Inventory (LyQLI), measuring three domains, physical, psychosocial and practical, and the Short Form 36 Health Survey Questionnaire (SF‐36), measuring eight health domains, were sent to 200 lymphoedema patients. Out of those who answered both questionnaires, 88 patients had lymphoedema secondary to cancer treatment and they additionally received the Functional Assessment of Cancer Therapy Scale‐General (FACT‐G). The relation between continuous variables and the three domains were analysed by Spearman's correlation coefficients, and Kruskal–Wallis test was used to analyse categorical variables. Results: Altogether 129 patients completed the LyQLI and SF‐36 and 79 of them also completed FACT‐G. Twenty per cent had a high mean score (≥2.0) in at least one domain of the LyQLI, thus having a low HRQoL. Lower HRQoL was found in the practical domain of LyQLI in patients with lower limb lymphoedema compared to patient with lymphoedema in upper limb or head/neck (p = 0.002) and in patients working part‐time compared to patients working full‐time (p = 0.005). The impact on HRQoL tended to decrease with age, with a significant correlation in the psychosocial domain (rs = 0.194, p = 0.028). Compared with the general Swedish population, patients with lymphoedema scored significantly lower in general health (p = 0.006), vitality (p = 0.002) and social functioning (p = 0.025) assessed by the SF‐36. From a cancer‐specific view, HRQoL was similar to other Swedish studies using the FACT‐G. Conclusions: This study indicates that about 20% of the patients with lymphoedema had major impact on their HRQoL. More effort and research is needed to identify, understand and support groups of patients with severe lymphoedema‐related problems. [ABSTRACT FROM AUTHOR]

The major aim of the present study was to explore what people with psychiatric disabilities, living in two different types of housing, consider to be the best and the worst in their housing situation. A secondary aim was to explore to what extent additional questions to a questionnaire with a free‐response format can provide complementary information to the previous knowledge in the field. The content analysis revealed that the physical attributes were of great significance for the residents in ordinary housing, while both psychosocial aspects and physical attributes were important for those living in supported housing. When providing good housing solutions for people with psychiatric disabilities, attention needs to be given to these aspects by politicians, policymakers as well as by nursing staff. [ABSTRACT FROM AUTHOR]

Abstract: This study addresses the relationship between children's participation and the protection and provision offered to them by social services in Sweden. It applies a theoretical framework for analysing child welfare that is anchored in the United Nations Convention on the Rights of the Child. How child participation may affect child protection and provision is examined empirically using case documentation from 2 municipalities. The main finding is that when children are not given voice or opportunity to influence the framing of what “the problem” is, the design of protection and care tends to be poorly matched to the actual problems documented in the child investigation and vice versa; when children can influence framing, this is associated with well‐matched protection and care. This suggests that traditional child welfare ethos, to the effect that protection should be of such overriding concern that children even should be protected from participation, is misguided. The study further illustrates the intrinsic problems with the family orientation of Swedish social services and its reliance on partnership with parents, which makes it difficult to live up to the Convention on the Rights of the Child. Incorporating child participation into existing service models can transform Swedish social services to an augmented child‐focused system that by ensuring participation also promotes protection and provision. [ABSTRACT FROM AUTHOR]

Aim: The aim was to explore the outcome, on a local level, of steering, organisation and practices of elderly care foodservice by Swedish municipalities, and changes relative to national actions. Methods: A survey using a web‐based questionnaire about elderly care foodservice targeting all Swedish municipalities (n = 290) was conducted in 2006 and 2013/2014. The questionnaire included the topics: organisation of foodservice, its practice in elderly care and steering devices such as guidelines and policies. Based on the share of a rural population, municipalities were divided into groups: rural (≥50%), urban (<50%) and city (≤20%). Results: The response rate from municipalities was 80% in 2006 and 56% in 2013/2014; 45% participated in both surveys. The results showed increased use of local food policies (P = 0.03) and meal choice (P < 0.001), while access to clinical/community dietitians declined (P = 0.01) between the surveys. In home‐help services, daily delivered cook‐serve meals declined (P < 0.001) and chilled meals delivered three times a week increased (P = 0.002) between the surveys. City municipalities used private foodservice organisations the most (P < 0.001), and reported reduced use of cook‐serve systems in favour of chilled. In rural municipalities, the use of public providers (98%) and a cook‐serve system (94%) were firmly established. Urban municipalities were placed between the other groups. Conclusions: National actions such as soft governance and benchmarking appear largely to determine local level outcomes. However, conditions for adapting these measures vary between municipality groups. While efficiency enhancing trends were prominent, questions remain whether national actions should be expanded beyond performance to also examine their consequences. [ABSTRACT FROM AUTHOR]

The aim of this study was to further investigate the psychometric properties (with focus on construct validity and scale function) of the Swedish version of the Person-centred Care Assessment Tool (P- CAT) in a sample consisting of staff working in elderly care units (N = 142). The aim was also to further develop and psychometrically test a modified, noncontext-specific version of the instrument ( mP- CAT) in a sample consisting of staff working in primary health care or within home care for older people (N = 182). Principal component analysis with varimax rotation initially suggested a three-factor solution for the P- CAT, explaining 55.96% of variance. Item 13 solely represented one factor wherefore this solution was rejected. A final 2-factor solution, without item 13, had a cumulative explained variance of 50.03%. All communalities were satisfactory (>0.3), and alpha values for both first factor (items 1-6, 11) and second factor (items 7-10, 12) were found to be acceptable. Principal component analysis with varimax rotation suggested a final 2-factor solution for the mP- CAT explaining 46.15% of the total variance with communalities ranging from 0.263 to 0.712. Cronbach's α for both factors was found to be acceptable (>0.7). This study suggests a 2-factor structure for the P- CAT and an exclusion of item 13. The results indicated that the modified noncontext-specific version, mP- CAT, seems to be a valid measure. Further psychometric testing of the mP- CAT is however needed in order to establish the instrument's validity and reliability in various contexts. [ABSTRACT FROM AUTHOR]

Background Few studies have investigated how people with aphasia (PWA) experience literacy skills. Taking the insider's perspective is a way to increase understanding of the individual experiences of literacy among PWA, which may have clinical implications. Aims To describe how literacy, i.e., reading and writing, is experienced in everyday life by PWA and to gain insight into the part played by literacy skills in their lives. Methods & Procedures A qualitative descriptive research approach was taken. In-depth interviews were conducted with 12 PWA (six women and six men) who had all lived with aphasia for at least 6 months post-stroke. The interviews were analysed using qualitative content analysis. Outcomes & Results One overarching theme emerged from the data: literacy as an ongoing recovery process. Based on this overarching theme, two subthemes were identified: changes in conditions for literacy (experiences of reading and writing initially post-onset compared with experiences at the time of the interview); and facing expectations about literacy (participants' own and other people's expectations of them in terms of literacy). Conclusions & Implications The findings are important at a general level in that they indicate that PWA are able to articulate their individual experiences and thoughts about literacy, i.e., reading and writing. Specifically, PWA in this study experience literacy as playing an essential part in their lives and the findings imply that personal experiences are important in the design of reading and writing interventions in speech and language therapy. [ABSTRACT FROM AUTHOR]

Background In the last decade, a large number of children with cleft lip and palate have been adopted to Sweden. A majority of the children were born in China and they usually arrive in Sweden with an unoperated palate. There is currently a lack of knowledge regarding speech and articulation development in this group of children, who also have to deal with a late first language switch. Aims To study consonant proficiency in 3-year-old internationally adopted children with unilateral cleft lip and palate (UCLP) compared with peers with UCLP born in Sweden. Also to study the type and frequency of consonant errors and to perceptually compare velopharyngeal competence between the groups. Methods & Procedures Thirty-two children born between 2006 and 2010 with UCLP participated in the study-14 adopted from China and 18 children born in Sweden. Both groups were treated by the same cleft palate team. Audio recordings at 3 years of age were perceptually analysed by blinded listeners. Consonant proficiency was measured via per cent consonants correct adjusted for age (PCC-A), per cent correct manners (PCM) and per cent correct places (PCP). The prevalence of audible nasal air leakage and velopharyngeal competence were judged and compared between groups. The type and frequencies of consonant errors related to place and manner of articulation were also analysed. Outcomes & Results The internationally adopted children had significantly fewer correct consonants compared with the Swedish-born children. This was true for PCC-A, PCP and PCM. This group also had significantly higher prevalence of glottal stops/fricatives and deleted target consonants more often. Also the internationally adopted children had a higher prevalence of incompetent velopharyngeal function. The only outcome variable with similar results in the groups was audible nasal air leakage. Conclusions & Implications The present study indicated that there were significant differences regarding consonant proficiency and velopharyngeal competence between internationally adopted children with a UCLP and their Swedish-born peers with UCLP at the age of 3 years. Internationally adopted children with UCLP should be considered an at risk group for a higher prevalence of speech difficulties than non-adoptees. Thus, it is particularly important to follow this group of children over time. Longitudinal studies of speech and language development in internationally adopted children with UCLP are needed. [ABSTRACT FROM AUTHOR]

Sweden and Finland were the first countries to ban corporal punishment 30 years ago. Since then, the prevalence of attitudes supporting the use of corporal punishment and the practice itself have decreased. This study examines the current frequencies of corporal punishment and other humiliating upbringing practices in Finnish and Swedish families. The analysis is based on survey data among 3170 Finnish and 1358 Swedish parents with children from newborn to 12 years of age. Data were analysed using univariate tests (chi-square) and logistic regression. According to the analysis, a larger proportion of Finnish parents, and especially mothers, use humiliating upbringing practices compared to Swedish parents. This difference is not found with regard to corporal punishment. A larger proportion of Finnish parents push their children compared to Swedish parents, while a larger proportion of Swedish parents shake their children. In both countries, corporal punishment is more frequently used by fathers, boys are more often victimised than girls, toddlers are more often exposed to corporal punishment and school-age children are more often subjected to psychologically abusive practices. Corporal punishment and other humiliating upbringing practices are strongly correlated in both countries. The differences found between countries were not explained by socio-demographic factors. Key Practitioner Messages Use of corporal punishment is still quite common among Finnish and Swedish parents., Parents use corporal punishment more often towards children aged two to six years while other humiliating upbringing practices are used more often towards children above age six., The differences between Finland and Sweden in the use of corporal punishment and other humiliating upbringing practices are not explained by traditional socioeconomic characteristics, nor by the parents' own experiences. [ABSTRACT FROM AUTHOR]

Background In recent years, analyses of cleft palate speech based on phonetic transcriptions have become common. However, the results vary considerably among different studies. It cannot be excluded that differences in assessment methodology, including the recording medium, influence the results. Aims To compare phonetic transcriptions from audio and audio/video recordings of cleft palate speech by means of outcomes of per cent correct consonants (PCC) and differences in consonant transcriptions. Methods & Procedures Thirty-two 3-year-olds born with cleft palate were audio and audio/video recorded while performing a single-word test by picture naming. The recordings were transcribed according to the International Phonetic Alphabet. The transcriptions from the audio and the audio/video recordings were analysed with regard to PCC, differences in the use of phonetic consonant symbols and the use of diacritics. Outcomes & Results PCC was higher when the calculation was based on transcriptions from audio recordings than when based on audio/video recordings. No such differences were seen when age-appropriate consonant processes were scored as correct. Consonants were not excluded as often in the transcriptions from audio/video recordings as they were in the transcriptions from audio recordings, and more target consonants were transcribed as dental/alveolar in the transcriptions from audio/video recordings and palatal/velar/uvular in the transcriptions from audio recordings than vice versa. Further, interdental articulation, linguolabial articulation and audible nasal air leakage were more common in the transcriptions from audio/video recordings than in those from audio recordings. All these differences were statistically significant. Conclusions & Implications Phonetic transcription is influenced to some extent by visual cues. However, as long as age-appropriate articulatory and phonological simplification processes are scored as correct when evaluating consonant production in the speech of young children born with cleft palate using phonetic transcription, the recording medium does not seem to affect the results. [ABSTRACT FROM AUTHOR]

Aim and objective In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. Background The ultimate goal of elderly care is to meet the older person's needs and individual preferences ( PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. Design and methods A cross-sectional Swedish sample of elderly care staff ( N = 322) completed an electronic survey including measures of personality (Mini- IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. Results Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. Conclusions Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. Implications for practice Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care. [ABSTRACT FROM AUTHOR]

Objective The aim was to evaluate the effect of a chlorhexidine-containing brush-on gel when used as supplement to oral hygiene instructions and mechanical debridement, on peri-implant mucositis in adults. Materials and methods The study group consisted of 38 adults (48-87 years.) with peri-implant mucositis that were consecutively enrolled in three private clinics after informed consent. The study employed a double-blind controlled design with two parallel arms. After baseline registrations, oral hygiene reinforcement and mechanical debridement, the patients were randomly allocated to either a test group with once daily tooth brushing with an oral care brush-on gel containing 0.2% chlorhexidine digluconate (Cervitec Gel) or a control gel group. The duration of the intervention was 12 weeks. The primary outcome was bleeding on probing ( BOP) and secondary endpoints were local plaque score ( LPS) and pocket probing depth ( PPD). Results The groups were balanced at baseline. The daily use of the chlorhexidine-containing gel resulted in reduced BOP after 4 and 12 weeks compared with the control group ( P < 0.05). The PPD was significantly reduced ( P < 0.05) after 12 weeks compared to baseline in the test group, but not in the control group. No side effects or adverse events were reported. Conclusion The present findings indicated moderate but significant improvements of clinical parameters when mechanical debridement was combined with a self-applied oral care brush-on gel for the management of peri-implant mucositis. [ABSTRACT FROM AUTHOR]