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The aim of this article is to present a communication skills training curriculum for nursing students, based upon phenomenology. Research shows that nurses have difficulty prioritizing dialogue with patients, due to lack of time, organizational and cultural factors. Like other health care professionals, nurses may also have difficulties communicating with patients due to personal fears and shortcomings. The communication training curriculum based upon phenomenology aims at systematically training students to stay focused upon patients' and relatives' narratives, allowing them to reflect upon and better understand their current situation. This approach to communication is applicable in any clinical situation where it important to provide space for the patients' experiences. The philosophical principles guiding the training are presented here as well as the practical steps in the program. Finally, the approach is compared to other common communication methods used in nursing (motivational interviewing, caring conversations, empathy training). The authors hope that the article will highlight the nurses' role as dialogue partner as well as emphasize the importance of communication skills training in nursing education. This approach can be refined, tested and modified in future research and may serve as an inspirational model for creating a generic communicative competence for nurses. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. • The need for generic communication skills for nurses. • Communication training program for nurses based on phenomenology. • Theoretical and practical model for nurses' communication in clinical encounters. [ABSTRACT FROM AUTHOR]

BACKGROUND: The first vaccine against human papillomavirus (HPV)-related disease is now available. Although it has been designed and tested mainly to protect against cervical lesions, it is also expected to be effective against other anogenital cancers. Associations between HPV and vaginal, vulvar, and anal cancers are well established, but the full extent in terms of age and time since diagnosis of these associations is not well known. METHODS: We established a cohort of all women in Sweden who were aged 18-50 years at some timepoint from 1968 to 2004. Using national registration numbers, we linked this cohort to nationwide population, migration, cancer, and death registers. The incidence rate ratios (IRRs) of vaginal, vulvar, anal, and rectal cancer in women with a history of a cervical intraepithelial neoplasm (CIN), grade 3, compared with women with no such history were estimated by use of multivariate Poisson regression. FINDINGS: Women with a history of grade 3 CIN had increased risks of cancer of the vagina (6.74 [95% CI 5.24-8.56]), vulva (2.22 [1.79-2.73]), and anus (IRR 4.68 [3.87-5.62]). No excess risk was found for rectal cancer. For all four anatomical sites, the IRRs varied substantially with the amount of time that had elapsed since the date of first diagnosis of grade 3 CIN. Analyses stratified by attained age during follow-up showed that the risk of cancer conferred by a history of diagnosis of grade 3 CIN was highly age dependent. The observed increased risks were not explained by smoking or socioeconomic status. INTERPRETATION: This study confirms the known association between history of CIN, presumed HPV infection, and increased risk of cancers of the vagina, vulva, and anus by use of large and complete databases, but also shows that this risk varies both by the time from initial diagnosis of grade 3 CIN and by the age of the individual. Further studies are needed to clarify the type of HPV associated with this increase in risk to determine the clinical applicability of the new HPV vaccines. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to examine the association between previous pregnancy losses and subsequent risk of preterm delivery. STUDY DESIGN: A population-based Swedish study including information on all births and women's hospital admissions for pregnancy loss (n = 601,883) in Sweden between 1987 and 2000 was performed. The risk of preterm delivery after a previous pregnancy loss was estimated using logistic regression models. The risk of preterm premature ruptures of the membranes (PROM), preterm labor, and other reasons for preterm delivery was also assessed. RESULTS: Previous spontaneous abortions and missed abortions were associated with increased risks of preterm delivery, and the risks increased with severity of preterm delivery. Previous pregnancy loss increased the risk of preterm PROM and preterm labor foremost in deliveries before 32 weeks, but was not associated with other reasons of very preterm delivery. CONCLUSION: Our results support the hypothesis that pregnancy loss and early preterm delivery may share etiologic causes. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To assess awareness and knowledge of human papillomavirus (HPV) in the adult Swedish population. Methods: A cross-sectional study among young adults aged 18–30 years and the parents of children aged 12–15 years was conducted in 2007 to collect information on awareness and knowledge of HPV. Correlates of HPV knowledge were investigated. Results: Awareness of cervical cancer and condyloma were high but awareness of HPV was low. Many participants were uncertain or did not know about the causal relation between HPV and condyloma, and cancers other than cervical cancer. Among parents, gender, age, country of origin, and education were the most important correlates of HPV knowledge. Among young adults, these factors were gender, income, and education. Conclusions: HPV education campaigns should particularly target young men and those with low education. Educational messages should clarify the risk of HPV, and the causal relationship between HPV and condyloma, and other cancers. [Copyright &y& Elsevier]

Background: Atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion in abnormal cervical cytology among young women in cervical cancer screening is an increasing health burden, and comparative effectiveness studies of different management options for such diagnoses are needed.Objective: The objective of the study was to compare the incidence of invasive cervical cancer, following different management options pursued after an atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion index smear.Study Design: In this nationwide cohort study, we included all women aged 22-50 years and resident in Sweden 1989-2011 and with at least 1 cervical smear registered during the study period (n = 2,466,671). Follow-up of a first atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion cytological diagnosis within 25 months was classified as repeat cytology, colposcopy/biopsy, or without further assessment. Incidence rate ratios and 95% confidence intervals of subsequent cervical cancer within 6.5 years following atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion were estimated using Poisson regression by age group and management strategy.Results: Women managed with repeat cytology within 6 months after atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion cytology had a similar risk of cervical cancer compared with colposcopy/biopsy (incidence rate ratio, 1.1, 95% confidence interval, 0.5-2.5, and incidence rate ratio, 2.0, 95% confidence interval, 0.6-6.5, respectively) among women aged 22-27 years. For women aged 28 years and older, women managed with repeat cytology had a higher risk for cervical cancer than women managed with colposcopy/biopsy.Conclusion: Our findings suggest that women with a first cytological diagnosis of atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion up to age 27 years may indeed be safely followed up with repeat cytology within 6 months. A large amount of colposcopies that are currently performed in this group, therefore, could safely be discontinued. [ABSTRACT FROM AUTHOR]

Objective: We sought to evaluate the management of women with abnormal cytology in terms of subsequent risk of invasive cervical cancer. Study Design: The screening histories of all invasive cervical cancer cases diagnosed in Sweden 1999-2001 and of 5 population-based controls per case were reviewed. In all, 159 patients and 258 control subjects aged < 67 years had an abnormal smear result 0.5-6.5 years prior to cancer diagnosis. The cervical cancer risk was estimated in relation to management by calculating odds ratios. Results: Histologic assessment of low-grade squamous abnormalities strongly reduced the risk compared to repeated cytology (odds ratio, 0.46; 95% confidence interval, 0.24-0.89). Delaying histologic assessment was also associated with a higher risk (odds ratio, 5.65; 95% confidence interval, 1.39-23.05). After high-grade squamous atypia, absence of any cytologic or histologic specimen was a major determinant of cancer risk (odds ratio, 12.52; 95% confidence interval, 1.42-infinitive). Conclusion: For adequate protection against invasive cervical cancer, further assessment with histology must be recommended also for women with low-grade squamous abnormalities. [Copyright &y& Elsevier]

Background Data are scarce on the potential change in suicidal behavior among adolescents and young adults after receiving a cancer diagnosis. Patients and methods We conducted a population-based cohort study including 7 860 629 Swedes at the age of ≥15 during 1987–2009. Among the cohort participants, 12 669 received a first diagnosis of primary cancer between the age of 15 and 30. We measured the relative risks (RRs) of suicidal behavior (defined as completed suicides or suicide attempts) after cancer diagnosis. We also carried out a case-crossover study nested within the cohort to adjust for unmeasured confounders. Results Twenty-two completed suicides (versus 14 expected) and 136 suicide attempts (versus 80 expected) were identified among the cancer patients. The RR of suicidal behavior was 1.6 [95% confidence interval (CI), 1.4–1.9] after a cancer diagnosis, compared with cancer-free individuals. Risk increase was greatest immediately after diagnosis; the RR was 2.5 (95% CI 1.7–3.5) during the first year after diagnosis and was 1.5 (95% CI 1.2–1.8) thereafter. This pattern was similar for completed suicide and suicide attempts. The elevated risks were evident for majority of the main cancer types, except for cancer in thyroid, testis and melanoma. The case-crossover analysis of suicidal behavior during the first year after cancer diagnosis revealed similar results. Conclusions Adolescents and young adults receiving a cancer diagnosis are at substantially increased risk of suicidal behavior, particularly during the first year after diagnosis. Although the absolute excess risk is modest, these findings emphasize the need to support and carefully monitor this vulnerable population. [ABSTRACT FROM PUBLISHER]