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Aims: The aim of the study was to estimate the effect of household relative poverty on the risk of diabetic ketoacidosis at diagnosis of children with type 1 diabetes using an international standard measurement of relative poverty. Methods: A national population‐based retrospective study was conducted. The Swedish National Diabetes Register (NDR) was linked with data from Sweden's public statistical agency (Statistics Sweden). Children who were diagnosed with new‐onset type 1 diabetes in the period of 2014–2019 were common identifiers. The definition of diabetic ketoacidosis was venous pH <7.30 or a serum bicarbonate level <18 mmol/L. The exposure variable was defined according to the standard definition of the persistent at‐risk‐of‐poverty rate used by the statistical office of the European Union (Eurostat) and several other European public statistical agencies. Univariate and multi‐variable analyses were used to calculate the effect of relative poverty on the risk of diabetic ketoacidosis. Results: Children from households with relative poverty had a 41% higher risk of diabetic ketoacidosis (1.41, CI 1.12–1.77, p = 0.004) and more than double the risk of severe diabetic ketoacidosis (pH <7.10) (RR 2.10, CI 1.35–3.25, p = 0.001), as compared to children from households without relative poverty. Conclusions: Relative poverty significantly increases the risk of diabetic ketoacidosis at onset of type 1 diabetes in children, even in a high‐income country with publicly reimbursed health care. [ABSTRACT FROM AUTHOR]

Objectives: Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non‐suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio‐demographic variables and patient‐reported outcome measures (PROMs). Methods: The study included people living with HIV (PLWH) aged ≥18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011–2018 were collected. Associations between variables and HIV RNA ≥50 copies/mL were investigated in uni‐ and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size. Results: The study included 38% (n = 2981) women. Women were more likely to have HIV RNA ≥50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10–1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non‐suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non‐suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79–3.17) and men (RR 1.84, 95% CI: 1.40–2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10–2.02). Conclusions: This observational study found a 20% higher relative risk of viral non‐suppression in women than in men and the difference was associated with socio‐demographic factors. The associations between PROMs and viral non‐suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non‐suppression. [ABSTRACT FROM AUTHOR]

Aim: To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group‐based self‐management education with a digital website. Design: A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self‐experience of COPD as a special competence, were involved as research partners at the design of this study. Methods: Eleven individual and two group interviews with five participants in each group were conducted. Results: Group‐based self‐management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self‐reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in‐depth reflection that support learning over time. [ABSTRACT FROM AUTHOR]

Background: There is a lack of a methodological standard to process accelerometer data to measures of physical activity, which impairs data quality and comparability. This study investigated the effect of different combinations of settings of multiple processing components, on the measure of physical activity and the association with measures of cardiometabolic health in an unselected population of middle‐aged individuals. Methods: Free‐living hip accelerometer data, aerobic fitness, body mass index, HDL:total cholesterol ratio, blood glucose, and systolic blood pressure were achieved from 4391 participants 50–64 years old included in The Swedish CArdioPulmonary bioImage Study (SCAPIS) baseline measurement (cross‐sectional). Lab data were also included for calibration of accelerometers to provide comparable measure of physical activity intensity and time spent in different intensity categories, as well as to enhance understanding. The accelerometer data processing components were hardware recalibration, frequency filtering, number of accelerometer axes, epoch length, wear time criterium, time composition (min/24 h vs. % of wear time). Partial least regression and ordinary least regression were used for the association analyses. Results: The setting of frequency filter had the strongest effect on the physical activity intensity measure and time distribution in different intensity categories followed by epoch length and number of accelerometer axes. Wear time criterium and recalibration of accelerometer data were less important. The setting of frequency filter and epoch length also showed consistent important effect on the associations with the different measures of cardiometabolic health, while the effect of recalibration, number of accelerometer axes, wear time criterium and expression of time composition was less consistent and less important. There was a large range in explained variance of the measures of cardiometabolic health depending on the combination of processing settings, for example, 12.1%–20.8% for aerobic fitness and 5.8%–14.0% for body mass index. Conclusions: There was a large variation in the physical activity intensity measure and the association with different measures of cardiometabolic health depending on the combination of settings of accelerometer data processing components. The results provide a fundament for a standard to process hip accelerometer data to assess the physical activity in middle‐aged populations. [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]

Aim: To describe demographic, physical and psychological characteristics associated with insomnia in patients with cardiovascular disease (CVD) participating in nurse‐led Internet‐based cognitive behavioural therapy for insomnia (I‐CBTI), and their motives and expectations regarding participation in I‐CBTI. Design: A mixed method design was applied, including primary care patients with angina pectoris, myocardial infarction, heart failure, atrial fibrillation and atrial flutter or arrhythmia in southern Sweden. Methods: Data on demographics, insomnia severity and physical and psychological characteristics were collected through self‐rated validated questionnaires (n = 126). Motives and expectations were collected through interviews (n = 19) and analysed using the 'personas' model. Results: Physical symptoms and psychological characteristics were associated with insomnia. Three personas were identified: the pragmatist (a curious and optimistic persona), the philosopher (a problem‐solving persona) and the philanthropist (an altruistic persona). Expectations were positive among the three personas, but comorbid conditions reduced the perceived ability to make necessary behavioural changes. [ABSTRACT FROM AUTHOR]

Background: The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area. Aims: To explore the associations between clinical dietitians' self‐reported documentation of patients' goals and outcomes and demographic factors, self‐reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace. Methods: Data from a cross‐sectional study based on a previously tested web‐based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e‐mail lists, e‐newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi‐square test. Associations between dependent‐ and independent variables were measured through logistic regression analysis. Results: Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes. Conclusion: Findings highlight strong associations between the implementation of the NCP 4th step terminology and the documentation of goals and outcomes. Strategies to support dietitians in using standardized terminology and the development of tools for comprehensive documentation of evaluation of goals and outcome are required. [ABSTRACT FROM AUTHOR]

Aims: Preclinical and human studies suggest that a social partner's genotype may be associated with addiction‐related outcomes. This study measured whether spousal genetic makeup is associated with risk of developing drug use disorder (DUD) during marriage and whether the risk associated with a spouse's genotype could be disentangled from potentially confounding rearing environmental effects. Design: Univariable and multivariable logistic regression analyses. Setting: Sweden. Participants: Men and women born between 1960 and 1990 and in opposite‐sex first marriages before age 35 (n = 294 748 couples). Measurements Outcome was DUD diagnosis (inclusive of opioids, sedatives/hypnotics/anxiolytics, cocaine, cannabis, amphetamine and other psychostimulants, hallucinogens, other drugs of abuse and combinations thereof) obtained from legal, medical and pharmacy registries. The focal predictor was family genetic risk scores for DUD (FGRS‐DUD), which were inferred from diagnoses in first‐ through fifth‐degree relatives and weighted by degree of genetic sharing. FGRS‐DUD were calculated separately for each partner in a couple. Findings Marriage to a spouse with a high FGRS‐DUD was associated with increased risk of developing DUD during marriage, ORmales = 1.68 (95% CI = 1.50, 1.88) and ORfemales = 1.35 (1.16, 1.56), above and beyond the risk associated with one's own FGRS‐DUD. The risk associated with a spouse's FGRS‐DUD remained statistically significant after covarying for parental education. As indicated by a series of null interaction effects, there was no evidence that the risk associated with a spouse's FGRS‐DUD differed depending on whether the spouse was DUD‐affected, probands' probable contact with in‐laws and whether the spouse was raised by his/her biological parents or in another home. Conclusions: There is relatively robust evidence that a person's risk for developing drug use disorder is associated with the genetic makeup of the person's spouse. [ABSTRACT FROM AUTHOR]

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

Purpose: This study aimed to investigate how rifle carriage and skiing speed during biathlon roller skiing affect range of motion (ROM) in joint angles and equipment (skis and poles), the vertical distance between shoulders and treadmill (vertdist), as well as possible sex differences associated with rifle carriage. Methods: Fourteen biathletes (6 women, 8 men) roller‐skied on a treadmill at submaximal and simulated race speeds, with (WR) and without (NR) a rifle, using gears 3 and 2. Kinematical data for the whole body, poles, roller‐skis, rifle, and treadmill were monitored using a 3D motion capture system. Movements determined as flexion/extension (x), abduction/adduction (y), and/or internal/external rotation (z) were analyzed for the hip, shoulder, thorax, knee, ankle, elbow, poles, and roller skis. ROM (the difference between maximal and minimal angles) in joints and equipment, and vertdist were analyzed over six skiing cycles during each condition (WR and NR) and speed. Results: The maximal vertdist was lower for WR compared with NR (gear 3: 1.53 ± 0.06 vs 1.54 ± 0.06 m; gear 2: 1.49 ± 0.06 vs 1.51 ± 0.06 m; both p < 0.001). ROM in the upper body was altered when roller skiing WR (movements decreased in thorax and shoulder (x) and increased in elbow (only gear 3) (x), thorax (only gear 2), and shoulder (y) and (z); all p < 0.05) and increased with speed, without differences between sexes (p > 0.05). Conclusion: Since rifle carriage and speed appear to affect the kinematics of roller skiing, coaches, and biathletes are advised to perform skiing technique training under competition‐like conditions (i.e., at race speeds while carrying the rifle). [ABSTRACT FROM AUTHOR]

Background: Intensive care is one of the most resource‐intensive forms of care because seriously ill patients are cared for in units with high staffing levels. Studies show that the number of registered nurses (RNs) per patient and nurse education level affects patient outcome. However, there is a lack of studies that consider how nurses/patient ratio with an advanced educational level of specialized nurses in intensive care, affect the intensive care performed in different patient populations. Aim: To investigate if differences in patient characteristics and nurse–patient ratio have an impact on the quality of care. Study Design: This is a retrospective observational study with a review of all patients >15 years receiving care at two general intensive care units with different nurse/patient ratio (unit A, 1:1 nurse/patient ratio and unit B, 0.5:1 nurse/patient ratio). Results: There was no significant difference in the initial severity of illness between the units. However, younger patients, male patients and patients requiring surgery entailed a higher workload and a longer intensive care unit (ICU) stay despite a 1:1 critical care nurse/patient ratio. A small difference, but not significant, with more unplanned re‐intubations occurred at unit A compared with unit B. Conclusion: The differences in the nurse/patient ratio did not reflect a difference in the severity of illness among admitted patients but might be explained by patient characteristics with different needs. Relevance to Clinical Practice: Health care managers should consider not only the number of nurses but also their educational level, specific competencies and skills mix and nursing‐sensitive measures to provide high‐quality ICU care in settings with different patient characteristics. Nursing‐sensitive patient outcomes should be considered in relation to nurse/patient ratio, as important to measure to ensure a high quality of patient care in the ICU. [ABSTRACT FROM AUTHOR]

Objectives: Pressure ulcers cause suffering, prolong care periods, and increase mortality. The aim was to describe and analyze the documentation of pressure ulcers and focused on the medical records from an internal medicine ward in a university hospital in western Sweden. Methods: A quantitative, retrospective review of medical records was conducted for all care events (n = 1,458) with descriptive statistics. Results: Documentation of the pressure ulcers in care plans was 2.1% (n = 31) compared to 6.7 % (n = 46) within final notes written by registered nurses (RN), a lower result compared to PPM (n = 3/14, 21.4%). Risk assessments were carried out in 68 (4.7%) care events, and 31 care plans included pressure ulcers. Moreover, 198 cases of tissue damage were documented, 43 (21.7%) defined as pressure ulcers, the other 147 (74.2%) lacked definition. Conclusions: Differences (2.1%–21.4%) highlight improvements; knowledge and communication of pressure ulcers ensure reliable documentation in medical records. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To identify factors affecting early childhood sleep, and investigate the relationship between sleep and overweight/obesity in childhood. Study Design: Data were collected using parental‐completed questionnaires from N = 10.840 one‐year‐old children in the prospective ABIS‐study (All Babies in Southeast Sweden), followed up until 8 years of age. Chi‐squared test and Pearson Correlation were used to assess the relationship between covariates affecting the children's sleep. Subsequently, longitudinal mixed model analyses were used to predict the effect of different sleep dimensions (bedtime, sleep duration, sleep quality, and the number of awakenings) on BMI Z‐scores. Results: Children to parents born in Sweden, parents with higher education, non‐single parents, non‐smoking mothers during pregnancy, and children with fewer siblings, were more likely to have appropriate sleep habits at 1 year age. A greater number of awakenings and nocturnal feeds, and particularly later bedtime (β = −0.544, p < 0.0001) were linked to shorter sleep duration. Sleep duration early in life was negatively associated with BMI Z‐scores (adjusted effect estimate [95% CI]: β = −0.09, [(−0.15) – (−0.03)], p = 0.005) later. In addition, higher birth weight, small size for gestational age, unhealthy food habits, children of mothers who smoked during pregnancy, and higher parental BMI resulted in higher BMI Z‐scores. Conclusion: The child's BMI Z‐score increases by 0.09 units with every hour shorter sleep duration, indicating that short sleep duration might increase the risk of overweight and obesity in children. Parental educational interventions advising appropriate sleeping patterns should be considered when implementing strategies to combat the development of childhood obesity. [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]

The aim of this study was to describe and compare family members' experiences of approach in encounters with healthcare professionals and possible feelings of alienation in the professional care within four care contexts: the care of older people, psychiatric care, palliative care and diabetes care. The design was an explorative cross‐sectional survey study. Data were collected in Sweden using the Family Involvement and Alienation Questionnaire‐Revised (FIAQ‐R). It measures family members' experiences of the healthcare professionals' approach and the family members' feeling of alienation from the provision of professional care. A total of 1047 questionnaires were distributed to family members using convenient sampling method, of which 294 were included. Data were analysed using rank‐based, non‐parametric statistical methods. The results indicated that most respondents experienced a positive actual approach from the healthcare professionals. Many participants rated the importance of approach at a higher level than their actual experience. Participants in the context of diabetes care reported a more negative actual approach from the healthcare professionals than did participants in the other contexts and considered the healthcare professionals' approach towards them as being less important. The results for the entire group indicated that the participants felt a low level of alienation from the professional care. Participants in the context of the care of older people reported significantly lower level of feeling of being alienated than did participants in the contexts of psychiatric care and diabetes care. The differences between participants in diabetes care and other care contexts can possibly be explained by a more fully implemented self‐care approach among the patients in diabetes care than in the other care contexts. Even though the results are quite positive, it is still important that nurses consider a family‐centred approach to better adapt to the needs of both the family members and the patients. [ABSTRACT FROM AUTHOR]

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

Aims: To test the hypothesis that exposure to parental substance use disorder is associated with an increased risk of being not in education, employment or training (NEET) in male and female offspring during young adulthood. Design, setting and participants: A register‐based, national cohort study of 797 376 individuals born between 1984 and 1990, residing in Sweden at age 17 years. Participants were followed from age 17 years to maximum age 32 years and assessed annually for being NEET. Measurements The exposure variable was binary, defined as any diagnosis of substance use disorder (alcohol and/or drug use disorder) in one or both parents, measured between offspring's birth and age 17 years. Cox regression analysis was used to obtain hazard ratios (HRs) for being NEET, assessed annually as a binary variable using income and employment data. Findings We found that 4.4% of individuals were exposed to parental substance use disorder. When adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis, HRs for being NEET were HR = 1.13 (95% CI 1.09–1.16) for males, and HR = 1.15 (95% CI 1.12–1.19) for females. When stratified by age, adjusted HRs for experiencing the first episode of NEET peaked at age 17–19 years, HR = 1.37 (95% CI 1.25–1.50) for males, and HR = 1.31 (95% CI 1.18–1.44) for females. Conclusions: In Sweden, exposure to parental substance use disorder before age 17 years is associated with increased risk of being not in education, employment or training during early adulthood. The risks were highest at age 17–19 years for both males and females, decreasing with greater age. [ABSTRACT FROM AUTHOR]

With ongoing climate change, analysis of trends in maximum annual daily river flow is of interest. Flow magnitude and timing during the year were investigated in this study. Observations from 11 unregulated rivers in northern Sweden were analysed, using extreme‐value distributions with time‐dependent parameters. The Mann–Kendall test was used to investigate possible trends. The extreme‐value statistics revealed no significant trends for the stations considered, but the Mann–Kendall test showed a significant upward trend for some stations. For timing of maximum flow (day of the year), the Mann–Kendall test revealed significant downward trends for two stations (with the longest records). This implies that the day of the maximum flow is occurring earlier in the year in northern Sweden. [ABSTRACT FROM AUTHOR]

Background: Cancer care trajectories are often complex, with potent multimodality treatments and multiple interactions with health care providers. Communication and coordination are challenging and the patients' responsibilities to take on more active roles in their own care are increasing. Objective: This study aimed to investigate associations between patient activation level and participation in cancer care, sociodemographic characteristics, clinical data, health‐related quality of life (HRQoL) and helpfulness of received information. Methods: In this cross‐sectional population‐based study, patients completed questionnaires on patient activation, perceived participation, HRQoL, helpfulness of received information and sociodemographic characteristics. Responses to the patient activation measures (PAMs) were classified into four levels (higher levels indicating more activation). Data on age, sex and cancer diagnosis were collected from the Swedish Cancer Register. Results: Data from 682 patients were analysed. On comparing patients at PAM levels 1 and 4, the latter reported significantly higher possibilities to influence care decisions (46.6% vs. 20.8%) and to ask questions regarding treatment and care (93.4% vs. 68.4%). Patients at PAM level 4 reported wanting to influence decision‐making to a higher extent, compared with patients at other PAM levels, and reported clinically significantly higher HRQoL. No significant differences were found regarding sociodemographic characteristics. Conclusion: We found strong associations between perceived patient participation and activation levels, with limited possibility for participation among those with lower activation levels. Patient or Public Contribution: Discussions with patient representatives have raised the importance of participation. The preliminary findings were presented and discussed in a workshop with representatives from 21 cancer patient advocacy groups. [ABSTRACT FROM AUTHOR]

Rationale: To maintain patients' dignity and well-being and alleviate suffering, it is essential that healthcare providers engage in caring behaviours. Yet, every year patient boards receive an increasing number of complaints from patients and significant others regarding healthcare providers' non-caring behaviours. Defining and measuring both verbal and nonverbal caring and non-caring behaviour in healthcare delivery is vital to address such complaints. However, no studies were found that incorporated a comprehensive theory of caring to code encounters between healthcare providers and patients. Aim: The aim was to develop and test a Caring Behavior Coding Scheme based on Swanson's Theory of Caring. Method: An instrument development process was used for behavioural coding including observational data from thirty-eight video recordings collected in an undergraduate nursing course at a Swedish University. The observational data involved interactions between undergraduate nursing students and a standardised patient. Result: The Caring Behavior Coding Scheme (the CBCS), contains seventeen verbal and eight nonverbal behavioural codes, categorised as caring and non-caring in accordance with Swanson's Theory of Caring. Content and face validity were assessed. Timed-event sequential continuous coding was performed in INTERACT software. The coder achieved excellent agreement with the developed gold standard (k = 0.87) and excellent mean inter-rater reliability (k = 0.82). All domains in Swanson's Theory of Caring were observed and coded in the interaction. Discussion/Conclusion: The CBCS is a theory-based instrument that contributes to research on healthcare providers' behavioural encounters. It uses verbal and nonverbal caring and non-caring behavioural codes to assess the alignment of both the theory and practice of caring. The CBCS can contribute to both development and measurement of interventions focused on improving healthcare providers' caring behaviour with the intended outcome of patient well-being. [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]

It is well known that individuals with experience of child welfare interventions – here conceptualised as placement in out‐of‐home care (OHC) – tend to have substantially poorer educational outcomes compared to their peers. Numerous explanatory factors have been proposed but few have been informed by mainstream sociological research into educational stratification. Through the lens of primary (ability‐driven explanations) and secondary (choice‐based explanations, conditional on educational performance) effects on social background differentials in educational attainment, longitudinal data from more than 14 000 Swedes (of which around 9% have been placed in OHC) were used to estimate the relative importance of these two basic explanatory processes. Results from decomposition analyses suggest that the secondary effect is the key driver in creating differentials in midlife educational attainment among individuals of different social origins. Such impacts were found to be even stronger in the OHC population. Interventions aimed at improving educational performance in children with experience of OHC may not sufficiently reduce educational inequalities across the life course if choice‐based explanations are not addressed. Key Practitioner Messages: Individuals with a history of child welfare intervention are educationally disadvantaged.Causes of educational inequality can be decomposed into primary (ability‐driven explanations) and secondary (choice‐based explanations, conditional on educational achievement) effects.Secondary effects are particularly strong in child welfare populations.Former child welfare clients will continue to be educationally disadvantaged if secondary effects are not addressed.'Causes of educational inequality can be decomposed into primary (ability‐driven explanations) and secondary (choice‐based explanations, conditional on educational achievement) effects' [ABSTRACT FROM AUTHOR]

Background: At least 50% of all ambulance assignments are deemed nonurgent, while 47–96% are initiated by someone other than the patient. Previous research has highlighted the importance of being taken seriously. However, additional knowledge of how significant others experience the situation when a patient is assessed as nonurgent is needed. Objective: The aim of this study was to explore the person‐centred climate in the Ambulance Service from the perspective of significant others by means of the Person‐centred Climate Questionnaire – Family version (PCQ‐F), to psychometrically investigate the construct validity of additional items intended to measure perceptions of being taken seriously and to explore possible relationships between the person‐centred climate and these additional items. Methods: A retrospective, explorative, cross‐sectional survey design was employed. In total, 241 questionnaires were distributed. Descriptive and comparative statistics and a factor analysis of eight items possibly constructing person‐centredness are presented. Results: The 100 respondents experienced the climate as very person‐centred. Relationships were found between the items that might constitute person‐centredness and the PCQ‐F. The PCQ‐F can explain perceived person‐centredness through the additional items that may constitute person‐centredness in the Ambulance Service context. Conclusion: Significant others consider eight aspects of being taken seriously as the core of person‐centredness in nonurgent Ambulance Service assignments. There is a relationship between the psychosocial climate and the additional items that might constitute person‐centredness. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Although many pregnant women experience fear, worry, or anxiety relating to the upcoming birth, little is known regarding the psychological mechanisms contributing to these experiences. In this study, we wanted to take a first step in trying to identify mechanisms of potential interest. The objective of this cross‐sectional study was thus to investigate pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance as potential mechanisms predicting fear of birth among pregnant women. Methods: A sample of 499 pregnant women, recruited in antenatal health care settings in 2 Swedish regions, completed the Fear of Birth Scale, along with measurements of the mechanisms of interest. Linear and logistic hierarchical regression analyses were used to investigate the extent to which pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance predicted fear of birth, both as a continuous and a dichotomous measure. Results: Logistic regression analysis showed high levels of pain catastrophizing and intolerance of uncertainty to be the best predictors of fear of birth, OR 3.49 (95% CI 2.17‐5.61) and OR 3.25 (95% CI 2.00‐5.27), respectively. Positive beliefs about worry and cognitive avoidance were both correlated with fear of birth as a continuous measure, but did not contribute to the logistic regression model. Conclusions: Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth. [ABSTRACT FROM AUTHOR]

Felt stigma is an internalized sense of shame about having an unwanted condition, along with fear of discrimination. The Stigma‐related Social Problems (SSP) scale was constructed to measure the impact of health‐related stigma on psychosocial functioning in people with different diseases and disorders. The performance of the SSP scale was tested in 3,422 subjects from the general population (Mid‐Swed Health Survey) and in subgroups according to gender, age, occupation, and education. The homogeneity and construct validity of the Distress and Avoidance scales were confirmed by exploratory factor analysis and the two factors were accurately reproduced across gender and age subgroups. The internal consistency reliability was high for both the Distress and Avoidance scales. Reliability coefficients were above the 0.90 standard for the Distress scale in all subgroups and for the Avoidance scale in most subgroups. The SSP scale is an instrument with sound psychometric properties that can be used to identify psychosocial disturbances. [ABSTRACT FROM AUTHOR]

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

Background: The older adult population is increasing worldwide, as is the number of older adults who consume alcohol. Although there is a growing body of research on alcohol consumption among older people, few studies focus on changes in at‐risk consumption over time across well‐defined birth cohorts of older adults. Methods: This study used a serial cross‐sectional design in order to compare alcohol consumption patterns among birth cohorts of Swedish 70‐year‐olds (total n = 2,268) examined in 1976 to 1977 (n = 393), 1992 to 1993 (n = 248), 2000 to 2002 (n = 458), and 2014 to 2016 (n = 1,169). Participants took part in a multidisciplinary study on health and aging. Face‐to‐face interviews were conducted by healthcare professionals. Protocols regarding alcohol consumption were similar for all cohorts. The volume of weekly alcohol consumption was estimated during the past month. At‐risk consumption was defined as ≥100 g alcohol/wk corresponding roughly to the National Institute on Alcohol Abuse and Alcoholism definition of heavy consumption. Results: The proportion of at‐risk consumers among men increased from 16.1% in 1976 to 1977 to 29.9% in 2000 to 2002 (p = 0.001) and 45.3% in 2014 to 2016 (p < 0.001). In women, proportions were low in 1976 to 1977 (0.5%) and 1992 to 1993 (2.0%; p = 0.134), but increased to 9.5% in 2000 to 2002 (p < 0.001) and 24.3% in 2014 to 2016 (p < 0.001). The male:female ratio regarding consumption of ≥100 g/wk decreased from 32.2:1 in 1976 to 1977 to 3.1:1 in 2000 to 2002 to 1.9:1 in 2014 to 2016. Spirit consumption decreased dramatically among men during the study period, while women reported very low spirit consumption at all examinations. Wine consumption increased in both sexes between 2000 to 2002 and 2014 to 2016. Beer consumption increased among men between 2000 to 2002 and 2014 to 2016. Conclusions: Recent cohorts of 70‐year‐olds in Sweden report significantly higher levels of alcohol consumption than previous cohorts. There was a dramatic increase in at‐risk consumption among 70‐year‐olds from the 1970s to the mid‐2010s, and this was particularly pronounced among women. This article compares alcohol consumption patterns among four birth cohorts of Swedish 70‐year‐olds born in different decades during the 20th century. The results show that later born cohorts are drinking more alcohol than earlier born cohorts. Also, sex differences in alcohol consumption decreased during the study period (1976–2016). The prevalence of non‐consumers and low consumers decreased among both men and women. Simultaneously, there was an increase in the prevalence of at‐risk consumers among both sexes. [ABSTRACT FROM AUTHOR]

Background: Older people with multi‐morbidity are major users of healthcare and are often discharged from hospital with ongoing care needs. This care is frequently provided by informal caregivers and the time immediately after discharge is challenging for caregivers with new and/or additional tasks, resulting in anxiety and stress. Aim: This study aimed to describe mental health, with particular reference to anxiety and depression and reactions to caregiving, and to investigate any associations between the two, in next of kin of older people with multi‐morbidity after hospitalisation. It also aimed to explore the association between the demographic characteristics of the study group and mental health and reactions to caregiving. Methods: This was a cross‐sectional questionnaire study using the Hospital Anxiety and Depression Scale and the Caregiver Reaction Assessment. The study group consisted of 345 next of kin of older people (65+) with multi‐morbidity discharged home from 13 medical wards in Sweden. Data were analysed using descriptive and analytical statistics. To identify whether reactions to caregiving and next of kin characteristics were associated with anxiety and depression, a univariate logistic regression analysis was performed. Results: More than one quarter of respondents showed severe anxiety and nearly one in 10 had severe depressive symptoms. The frequencies of anxiety and depression increased significantly with increased negative reactions to caregiving and decreased significantly with positive reactions to caregiving. Regarding caregiving reactions, the scores were highest for the positive domain Caregiver esteem, followed by the negative domain Impact on health. Women scored significantly higher than men on Impact on health and spouses scored highest for Impact on schedule and Caregiver esteem. Conclusions: Nurses and other healthcare professionals may need to provide additional support to informal caregivers before and after discharging older people with significant care needs from hospital. This might include person‐centred information, education and training. [ABSTRACT FROM AUTHOR]

Background: People with psychiatric disability have been found to have a poorer quality of life (QOL) compared to the general population, and QOL is an important outcome from psychosocial rehabilitation. Aims: This study aimed at comparing users of two approaches to psychosocial rehabilitation in Sweden, community‐based mental health day centres (DCs) and clubhouses, regarding QOL. A further aim was to investigate predictors of QOL. Methods: People regularly attending DCs (n = 128) or clubhouses (n = 57) completed questionnaires at baseline and a 9‐month follow‐up about socio‐demographics, QOL, self‐esteem, social network, satisfaction with daily occupations, satisfaction with services and the unit's organisation. Results: Quality of life remained stable over time in both groups. QOL at follow‐up was associated with baseline self‐esteem, social network, satisfaction with daily occupations and QOL at baseline. The strongest indicator of a higher QOL at follow‐up was attending a clubhouse programme followed by having scored high on QOL at baseline. Conclusion: Both approaches were suited for supporting their users in maintaining QOL. Visiting clubhouses seems, however, advantageous for QOL in a longer‐term perspective. Although this study contributed some new knowledge, research should further address which circumstances are associated with maintaining stability in QOL. [ABSTRACT FROM AUTHOR]

Objective: To analyse mucosal and major salivary secretion rates, caries and plaque microflora in connection with treatment for cancer in the head and neck region. Methods: Thirty‐three patients were included and the number of teeth, filled surfaces and caries lesions registered. The labial and buccal gland secretion and stimulated whole salivary secretion rates were determined. Supragingival plaque microflora was analysed using cultivation technique. Data were collected pretreatment, during treatment and 6 months, 1 year and 2 years post‐treatment. Results: Two years post‐treatment, 36% had new caries lesions, which had been restored. The labial secretion was comparable with pretreatment, while the buccal secretion was lower (P < .001). The stimulated secretion rate was lower compared with pretreatment (P < .001) and was ≤0.7 mL/minute for 50%. Growth of lactobacilli increased during treatment (P < .001) and remained increased (P < .001), while growth of mutans streptococci was decreased (P < .01) 2 years post‐treatment. Growth of Candida increased over time and was higher 2 years post‐treatment compared with pretreatment (P < .001) while growth of Prevotella was lower (P < .01). Conclusions: Two years post‐treatment, the stimulated salivary secretion rate was substantially decreased, acid‐tolerant lactobacilli and Candida increased, acid‐sensitive microorganisms decreased, and the caries prevalence was low. [ABSTRACT FROM AUTHOR]

Problem: Emergency care in child and adolescent psychiatry often lacks a coherent treatment model. This study reports on the development and implementation of a salutogenic treatment model at the Child & Adolescent Psychiatric Emergency Unit in Malmö, Sweden. Methods: The development and implementation involved all staff categories and was guided by a recognized authority on salutogenesis. Generalized resistance resources (GRR) were identified that could be implemented at the unit to improve patients' sense of coherence. Findings: Eight GRR were developed and implemented at the unit. During the 6‐month period following the implementation, patients (n = 41) and parents reported satisfaction with the treatment, while mental health improved between admission and discharge, and both treatment length and readmission rates were reduced. Conclusion: A salutogenic treatment model involving GRR seems to be a promising approach in child and adolescent psychiatric emergency treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country. METHODS: A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country. RESULTS: Emphasis of recommendations on whole‐grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days. CONCLUSIONS: The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization. [ABSTRACT FROM AUTHOR]

The Texas Revised Inventory of Grief (TRIG) was developed to measure the intensity of grief after the death of a close person. It consists of two scales: TRIG I (past behaviors) and TRIG II (present feelings). Because of inconsistencies in previous validations, the instrument needs to be further validated, hence the aim of this study was to evaluate the psychometric properties of the TRIG in a sample of bereaved family caregivers in Sweden. The TRIG was translated to Swedish according to standard principles, and 129 bereaved family caregivers completed the questionnaire. Parallel analysis was used to decide the number of factors to extract, followed by confirmatory factor analysis. An ordinal version of Cronbach's alpha was used to evaluate the internal consistency of the scales. Construct validity was tested against the Hospital Anxiety and Depression Scale (HADS). The factor analyses resulted in one factor being retained for both scales. The internal consistency was excellent (α > 0.9) for both scales. Construct validity was supported by strong correlations between TRIG I and TRIG II as well as moderate correlations between the TRIG scales and HADS. In conclusion, the TRIG has sound psychometric qualities and the two scales should be treated as unidimensional measures of grief. Hence, the instrument is suited to be used in the context of palliative care. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Understanding the role of premorbid body mass index (BMI) in the emergence of eating disorders may be key to identifying effective prevention strategies. We explore relations between BMI and eating disorders traits in young twins. Method: The effect of BMI at age 9/12 and 15 on eating disorder traits measured using the Eating Disorders Inventory‐2 (EDI) at ages 15 and 18 was examined using bivariate modelling in a longitudinal population sample of Swedish twins. Results: The correlation between BMI and EDI within individuals was stable across all ages and remained significant after adjusting for later BMI. Bivariate analysis indicated significant positive genetic correlations between BMI ages 9/12 and 15 and subsequent EDI scores. The relationship remained significant for BMI age 9/12 and EDI age 15 in the adjusted model, indicating a longitudinal association. Conclusion: Our results have implications for conceptualizing the interrelation of BMI and eating disorders across childhood and adolescence. [ABSTRACT FROM AUTHOR]

Summary: The clinical examination in diagnostic criteria for temporomandibular disorders (DC/TMD) is a strict procedure and comprises mandatory commands. However, learning and using these mandatory commands in general practice have proven to be difficult and their use of DC/TMD is minimal. To investigate whether reliability on a diagnostic level for DC/TMD diagnoses differs between examiners using the mandatory commands or not. Six examiners were divided into two groups: one using the mandatory commands in DC/TMD for the clinical examination and one who did not use the mandatory commands. A reliability assessment was performed twice, one occasion for each group of examiners. The assessment was performed according to the guidelines from the International Network for Orofacial Pain and Related Disorders Methodology. Each group of examiners thereby examined 16 subjects (11 TMD patients and 5 healthy individuals) each, and the diagnostic agreement (reliability) as compared to diagnoses derived by a reference standard examiner was calculated with Cohen’ s kappa coefficient. The DC/TMD diagnoses myalgia, arthralgia and headache attributed to TMD were included in the reliability assessment. There was no significant difference regarding diagnostic agreement reliability between the examiners using or not using the mandatory DC/TMD commands. This study indicates that not using the mandatory commands in DC/TMD in general practice does not impair the diagnostic reliability regarding the diagnoses myalgia, arthralgia and headache attributed to TMD compared to including the commands. [ABSTRACT FROM AUTHOR]

Abstract: This study explored the development of theory of mind (ToM) in 80 Swedish‐speaking 3‐ to 5‐year‐olds, a previously unstudied language and culture. The ToM scale was translated and tested in a Swedish context. The results show that the ToM abilities improve significantly with age. In addition, a gender difference was observed for the whole sample, girls outperformed boys, but follow‐up analyses revealed that the difference only remained significant for the 4‐year‐olds. No gender differences were observed at 3 and 5 years of age. When conducting a scalability analysis, the overall Wellman and Liu scale showed less than acceptable scalability. However, when removing the last task of the scale (Real–Apparent Emotion), the fit and scalability was good. The reason for this divergent result is discussed in terms of cultural differences, such as parental and pedagogical practices in Sweden, which might especially focus on developing children's socio‐emotional understanding. Highlights: Is the theory of mind (ToM) scale a feasible method to assess preschool‐aged children in a Swedish context? The scale shows significant development from 3 to 5 years of age. To achieve a good scalability, the final task of the scale was removed. The scale measures ToM abilities developing in preschoolers. Cultural differences, such as parental and pedagogical practices, may alter the developmental trajectory of ToM abilities. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of the present study was to validate the Swedish version of the educational needs assessment tool (SwENAT) in undifferentiated spondyloarthritis (USpA) and use it to study the educational needs of patients with USpA. Methods: This was a cross‐sectional study, recruiting a random sample of patients with USpA from a hospital register in Sweden. Educational needs data were collected, together with disease activity and function indices (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Bath Ankylosing Spondylitis Functional Index [BASFI]). Rasch analysis was utilized to evaluate the construct validity, internal consistency and unidimensionality of the SwENAT before studying differences in educational needs between patient subgroups (gender, age and disease severity). Results: Complete responses were obtained from 77 patients (48 women), with a mean age (standard deviation [SD]) of 50 (12) years, a disease duration of 16 (11) years, a BASDAI score of 4.9 (1.9) and a BASFI score of 3.1 (2.3). The SwENAT satisfied the requirements of the Rasch model (χ2 = 11.488; p = 0.119), including strict unidimensionality. Overall, the mean (SD) SwENAT score was 86 (32). Women reported higher needs than men in the domains of pain (mean [SD] 13.1 [6.8] versus 10.1 [6.0]; p = 0.05); movement (mean [SD] 13.0 [5.5] versus 9.9 [5.7]; p = 0.02) and self‐help (mean [SD] 17.0 [5.8] versus 14.1 [5.0]; p = 0.03). Higher disease activity (BASDAI >4) was associated with higher educational needs (mean [SD] 92.6 [31.9] versus 73.7 [29.4]; p = 0.02). Conclusions: These data suggest that the SwENAT is valid in USpA. Women and patients with higher disease activity are more likely to have high levels of educational needs, so special attention and strategies to target patient education are warranted. [ABSTRACT FROM AUTHOR]

Rationale and aim: Little is known about persistent pain after lung transplantation. Therefore, the aim was to present a multidimensional assessment of self‐reported pain 1‐5 years after lung transplantation and its relationship with fatigue and transplant‐specific well‐being. Methods: This nationwide, cross‐sectional cohort study is part of the self‐management after thoracic transplantation study. A total of 117 lung recipients, all White, who were due for their annual follow‐up at one (n = 35), two (n = 28), three (n = 23), four (n = 20) and 5 years (n = 11) after lung transplantation were included. We used three instruments; the Pain‐O‐Meter (POM), which provides information about pain intensity, sensation, location and duration, the MFI‐19 fatigue instrument and the Organ Transplant Symptom and Well‐being Instrument (OTSWI). Permission to carry out this study was granted by the Regional Ethical Review Board in southern Sweden (D‐nr 2014‐124). Results: The prevalence of pain was 51% after 1 year, 68% after 2 years, 69.5% after 3 years, 75% after 4 years and 54.5% after 5 years. Women experienced more pain than men. Lung recipients with pain reported lower well‐being and higher symptom distress but were not more fatigued than those without pain. Study limitations: The limitations of this study are due to the cross‐sectional design. The recruitment of patients during the study period was probably affected by the different conditions regarding staffing at the outpatient lung transplant clinic in the two thoracic transplant centres in Sweden. The slightly different approach to the care of these patients in the pre, peri and postoperative setting contributes to the heterogeneity of the study population. Conclusion: Chronic bodily pain up to 5 years after lung transplantation reduces perceived well‐being. Lung recipients with pain report higher symptom distress than those without pain. [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]

Background: There is a lack of knowledge about oral care among older people living in short-term care (STC) units and how the quality of oral care provided by nursing staff is perceived by the older people. Aim: To (i) describe person-related conditions among older people in STC, (ii) describe and compare perceptions of the quality of oral care (including perceptions of care received and the subjective importance of such care), within and between older people who have the ability to perform oral self-care and those who are dependent on help with oral care and (iii) examine the relationship between person-related conditions and the quality of oral care. Methods: A cross-sectional study was conducted with 391 older people in STC units in Sweden based on self-reported questionnaire and clinical assessments. Results: The older people were assessed as having normal oral health (2%), moderate oral health problems (78%) or severe oral health problems (20%). When comparing older people's perceptions of quality of oral care in terms of perceived reality and subjective importance, significant differences appeared within and between groups. Psychological well-being had a significant relationship with perception of the quality of oral care (both perceived reality and subjective importance), and gender and oral health status had a significant relationship with subjective importance. Conclusions: Older people's perceptions of areas for improvement regarding quality of oral care is a new and important knowledge for nursing staff in STC units. Older people want personalised information regarding oral health and oral care. Registered Nurses who take the responsibility in nursing care for older people's oral health may avoid unnecessary suffering by older people caused by oral health problems. Implications for practice: Older people's perspective is an important component for quality work and might lead to improvements in the quality of oral care in STC. [ABSTRACT FROM AUTHOR]

Abstract: Background: Myotonic dystrophy type 1 (DM1) is a slowly progressive multi‐systemic disease with an autosomal‐dominant inheritance caused by a mutation on chromosome 19 (19q13.3). Aims: To explore speech characteristics in a group of individuals with the congenital and childhood‐onset forms of DM1 in terms of intelligibility, speech‐sound production, nasality and compensatory articulation. A further aim was to analyse whether speech characteristics were correlated to subforms of DM1 and if speech outcome could be related to muscle strength. Methods & Procedures: Fifty native Swedish speakers (7–29 years old) with the congenital and childhood‐onset forms of DM1 and 13 healthy controls participated in the study. The intelligibility of spontaneous speech, speech‐sound production — single‐word and sentence repetition — including percentage consonants correct (PCC) and compensatory articulation, were evaluated by speech–language pathologists from video recordings. A nasometer and lip‐force meter were used for objective evaluations of nasality and orofacial strength. Outcomes & Results: In severe (n = 9) and mild congenital DM1 (n = 13), all participants had impaired intelligibility to some degree, while this applied to 79% of those with childhood DM1 (n = 28). PCC for bilabials were 53.9% in severe congenital DM1, 57.4% in mild congenital DM1 and 85.3% in childhood DM1; the corresponding results for dentals were 69.3%, 59.2% and 87.3%. Bilabials were most often compensated for with interdental or labiodental articulation. Dentals were substituted with interdental articulation. Velars were seldom affected. The mean nasalance score was high in the study group compared with controls and with normative data and the majority had weak lips. Maximum lip force, as well as the mean nasalance score, correlated significantly with the intelligibility score. Conclusions & Implications: The deviant production of bilabial consonants, interdental articulation and hypernasal speech are characteristic features of dysarthria in congenital and childhood DM1. Dysarthria is more frequent and more severe in congenital DM1 compared with childhood DM1. Most individuals with congenital DM1 and childhood‐onset DM1 will need speech therapy from a young age. For some children with incomprehensible speech or severe neurodevelopmental disorders, alternative and augmentative ways of communication will be part of the treatment. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Swedish Program for health surveillance of preschool children includes screening of language and communication abilities. One important language screening is carried out at age 4 years as part of a general screening conducted by health nurses at child health centres. The instruments presently in use for this screening mainly focus on expressive phonology. This may result in both over‐referral of children with phonological difficulties and under‐referral of children with language disorders (LDs), involving difficulties with vocabulary, grammar and/or language comprehension. Previous research has proposed non‐word repetition as a clinical marker for LD. It has also been found that higher predictive power is achieved when non‐word repetition is combined with the assessment of lexical/semantic skills. Taking these findings into account, the construction of a language screening instrument may yield more adequate referrals to speech–language therapists (SLTs). Aims: To construct a new standardized language screening instrument for 4‐year‐olds and to test its properties. Methods & Procedures: An instrument was developed and revised after piloting. A population of 352 children was screened at the regular 4‐year check‐up by 11 health nurses. The final sample consisted of 328 children aged 46–53 months (23% multilingual). Children performing below a preliminary cut‐off were referred to an SLT (n = 52). Five SLTs carried out an assessment on average within 5 weeks using a gold standard language test battery. Children who screened negatively were followed up with a parent questionnaire at age 5;6. Outcomes & Results: Thirty‐one true‐positives and 11 false‐positives were identified after SLT assessment. A further six children were identified as false‐negatives (two through referral to an SLT and four through parent questionnaire at age 5;6). A receiver‐operating characteristics curve with a C statistic of .94 was calculated. Based on optimal cut‐off, the sensitivity of the screening instrument was found to be .84, and specificity was .96. Multilingual children performed similar to monolingual children; boys performed significantly lower than girls; and children with a family history of language‐related problems performed lower than those without. Interrater reliability was high, as was Cronbach's alpha. Conclusions & Implications: The screening instrument seems sufficiently valid for its purpose to identify children who need further assessment by an SLT. A follow‐up study including SLT assessment for all children to check for false‐negatives would be interesting in future, as would studies comparing results from the 4‐year screening with those from earlier screens. [ABSTRACT FROM AUTHOR]

Abstract: Background: Low‐grade glioma (LGG) is a type of brain tumour often situated in or near areas involved in language, sensory or motor functions. Depending on localization and tumour characteristics, language or cognitive impairments due to tumour growth and/or surgical resection are obvious risks. One task that may be at risk is writing, both because it requires intact language and memory function and because it is a very complex and cognitively demanding task. The most commonly reported language deficit in LGG patients is oral lexical‐retrieval difficulties, and poor lexical retrieval would be expected to affect writing fluency. Aims: To explore whether writing fluency is affected in LGG patients before and after surgery and whether it is related to performance on tasks of oral lexical retrieval. Methods & Procedures: Twenty consecutive patients with presumed LGG wrote a narrative and performed a copy task before undergoing surgery and at 3‐month follow‐up using keystroke‐logging software. The same tasks were performed by a reference group (N = 31). The patients were also tested using the Boston Naming Test (BNT) and word‐fluency tests before and after surgery. Writing fluency was compared between the patients and the reference group, and between the patients before and after surgery. Relationships between performance on tests of oral lexical retrieval and writing fluency were investigated both before and after surgery. Outcome & Results: Different aspects of writing fluency were affected in the LGG patients both before and after surgery. However, when controlling for the effect of typing speed, the LGG group differed significantly from the reference group only in the proportion of pauses within words. After surgery, a significant decline was seen in production rate and typing speed in the narrative task, and a significant increase was seen in pauses before words. Strong positive relationships were found between oral lexical retrieval and writing fluency both before and after surgery. Conclusions & Implications: Although aspects of writing fluency were affected both before and after surgery, the results indicate that typing speed is an important factor behind the pre‐surgery differences. However, the decline in overall productivity and the increase in pauses before words after surgery could be related to a lexical deficit. This is supported by the finding that oral lexical‐retrieval scores were strongly correlated with writing fluency. However, further exploration is needed to identify the language and cognitive abilities affecting writing processes in LGG patients. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate (ii) whether inclusion of a single motivational interviewing (MI) session, as an adjunct to periodontal therapy, might be beneficial for preventing relapse in oral hygiene behaviours among patients treated for chronic periodontitis and (ii) whether individual and clinical characteristics can be of predictive value for retention of sufficient oral hygiene behaviours. Material & methods: This 3‐year follow‐up of a previously reported randomized controlled trial (RCT) study of 6‐month duration included 26 patients. Patients in the test group had received one MI session by a clinical psychologist before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non‐surgical periodontal therapy. Efficacy variables assessed for evaluation of the standard of self‐performed periodontal infection control were marginal bleeding index (MBI; primary efficacy variable) and plaque score (PI). Results: The patterns of change in MBI and PI scores were similar for test and control groups over the observation period. At 3 years, both groups showed a desirable mean full‐mouth MBI of 15%, a figure that was comparable to that at the short‐term evaluation after active periodontal treatment. The post‐treatment MBI was the only variable identified as a predictor of retained adequate oral hygiene behaviours. Conclusion: A single MI session as an adjunct to conventional periodontal therapy could not be proven to be of long‐term beneficial additive effect with regard to prevention of relapse in oral hygiene behaviour. Desirable standard of self‐performed infection control after active periodontal treatment predicted the retention of sufficient oral hygiene behaviour over time. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate attitudes to dental care, and to assess possible associations with socio‐economic and clinical variables over a period of ten years, and to investigate the association between OHRQoL assessed by oral impact on daily performance (OIDP), and socio‐economic, dental care habits, smoking and oral status. Materials and methods: Cross‐sectional studies performed in the county of Dalarna, Sweden, in 2003, 2008 and 2013. Random samples of 1,107‐1,115 dentate individuals, aged 30‐85 years, who answered a questionnaire and who were radiographically and clinically examined were included. Results: The importance of preventive treatment, regular recalls and meeting the same caregiver as on previous visits became less important. In individuals with alveolar bone loss, meeting the same caregiver as on previous visits was important (P<.05). In individuals with manifest caries, information on treatment cost was important, while prevention became less important (P<.05). OIDP was reported by 31% of the individuals in the study, and frequent impact was reported by 10%. Individuals with manifest caries lesions, less than 20 remaining teeth, and temporomandibular disorders (TMD) reported OIDP to a significantly higher degree, compared to orally healthy individuals. Conclusion: Attitudes important in maintaining and improving good oral health, such as preventive care and regular recalls to dentistry, became less important during this period of 10 years. Oral impact was found to be associated with irregular dental visits and limited economy for dental care, individuals with less than 20 remaining teeth, TMD and manifest caries. [ABSTRACT FROM AUTHOR]

Burnout is a construct that has garnered considerable attention in sport psychology within recent years. Several hypothesized models regarding how the three dimensions (exhaustion, devaluation, and reduced sense of accomplishment) temporally relate to each other have been advanced. One proposal outlined by Maslach and Leiter suggests that exhaustion predicts devaluation which predicts reduced sense of accomplishment. However, there is no consensus among researchers as it has been argued that exhaustion predicts devaluation and reduced accomplishment separately. The aim of this study was to test multiple alternative hypotheses regarding the relationships of the burnout dimensions in athletes. Two samples of Swedish youth elite athletes with differing time spans between measurements were used. Specifically, one sample involved time‐intensive measures collected every week over an eight‐week period, and the other sample included four measurement points across an 18‐month period. Results showed that none of the previously proposed models outlining the temporal relations of burnout dimensions were supported. Statistical analysis of the models including the cross‐lagged predictions of dimensions did not have any statistically significant impact except when exhaustion negatively predicted devaluation between time 1 (month 0) and time 2 (month 6) in the 18‐month sample; this relation faded in the following time points. Further, issues regarding the stability of devaluation and reduced sense of accomplishment emerged as their autocorrelation were very weak in the time‐intensive sample. These findings raise a number of points for further theoretical and practical discussions about the athlete burnout construct. [ABSTRACT FROM AUTHOR]