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Objectives: A cost-efficient approach for assessing working postures could be to build statistical models for predicting results of direct measurements from cheaper data, and apply these models to samples in which only the latter data are available. The present study aimed to build and assess the performance of statistical models predicting inclinometer-assessed trunk and arm posture among paper mill workers. Separate models were built using administrative data, workers' ratings of their exposure, and observations of the work from video recordings as predictors. Methods: Trunk and upper arm postures were measured using inclinometry on 28 paper mill workers during three work shifts each. Simultaneously, the workers were video filmed, and their postures were assessed by observation of the videos afterwards. Workers' ratings of exposure, and administrative data on staff and production during the shifts were also collected. Linear mixed models were fitted for predicting inclinometer-assessed exposure variables (median trunk and upper arm angle, proportion of time with neutral trunk and upper arm posture, and frequency of periods in neutral trunk and upper arm inclination) from administrative data, workers' ratings, and observations, respectively. Performance was evaluated in terms of Akaike information criterion, proportion of variance explained (R²), and standard error (SE) of the model estimate. For models performing well, validity was assessed by bootstrap resampling. Results: Models based on administrative data performed poorly (R² ≤ 15%) and would not be useful for assessing posture in this population. Models using workers' ratings of exposure performed slightly better (8% < R² ≤ 27% for trunk posture; 14% < R² ≤ 36% for arm posture). The best model was obtained when using observational data for predicting frequency of periods with neutral arm inclination. It explained 56% of the variance in the postural exposure, and its SE was 5.6. Bootstrap validation of this model showed similar expected performance in other samples (5th-95th percentile: R² = 45-63%; SE = 5.1-6.2). Conclusions: Observational data had a better ability to predict inclinometer-assessed upper arm exposures than workers' ratings or administrative data. However, observational measurements are typically more expensive to obtain. The results encourage analyses of the cost-efficiency of modeling based on administrative data, workers' ratings, and observation, compared to the performance and cost of measuring exposure directly. [ABSTRACT FROM AUTHOR]

In the present school-based study, a convenience sample of 477 students in grades 6-9 and second year in high school from a city and a smaller town recorded daily occurrence and intensity of headaches in a standard paper diary during a 3-week period. Total headache activity (headache sum), number of headache days, intensity level and duration for weekly headaches were estimated. Approximately 85% of the adolescents had experienced headache of any intensity level during the 3-week recording period. On the average, they reported 2.5 headache days per week and a mean intensity level for headache episodes of 1.7. Our estimates for headache of any intensity level (1-5) occurring at least once a week was surprisingly high (73.8%). For the highest intensity level across the whole 3-week period, almost identical proportions of mild and moderate headaches were reported by students (22.3-22.5%), while about twice as many (40.7%) had experienced severe headaches. Girls consistently reported more headaches than boys, in particular of the moderate and severe intensity types. Students in the city also reported more frequent and intense headaches than those in the town. Peak headache activity was observed at noon and in the afternoon and in the days from the middle of the week until weekend. The use of prospective recordings in diaries will further advance our knowledge on the prevalence and characteristics of recurrent headaches among children and adolescents in community samples. [ABSTRACT FROM AUTHOR]

Efficient teamwork is crucial to provide optimal health care. This paper focuses on teamwork between Anaesthesiologists (ANES), Certified Registered Nurse Anaesthetists' (CRNA) and Critical Care Registered Nurses (CCRN) working in challenging environments such as the intensive care unit (ICU) and the operating room (OR). Conflicts are common between physicians and nurses, negatively impacting teamwork. Social hierarchies based on professional status and power inequalities between nurses and physicians plays a vital role in influencing teamwork. Foucault was a famous thinker especially known for his reasoning regarding power/knowledge. A Foucauldian perspective was therefore incorporated into this paper and the overall aim was to explore CCRN/CRNA perception of knowledge/power in teamwork with ANES. Methods A mixed-method approach was applied in this study. Data was collected using a web-based questionnaire containing both closed-end and open-ended questions. A total of 289 CCRNs and CRNAs completed the questionnaire. Data analysis was then conducted through five stages as outlined by Onwuebugzie and Teddlie; analysing quantitative data in SPSS 27.0 and qualitative data with a directed content analysis, finally merging data together in ATLAS.ti v.23. Results The result reveals a dissonance between quantitative and qualitative data; quantitative data indicates a well-functioning interdisciplinary teamwork between CCRN/CRNA and ANES - qualitative data highlights that there are several barriers and inequalities between the two groups. Medicine was perceived as superior to nursing, which was reinforced by both social and organisational structures at the ICU and OR. Conclusion Unconscious rules underlying current power structures in the ICU and OR works in favour of the ANES and biomedical paradigm, supporting medical knowledge. To achieve a more equal power distribution between CCRN/CRNAs and ANES, the structural hierarchies between nursing and medicine needs to be addressed. A more equal power balance between the two disciplines can improve teamwork and thereby reduce patient mortality and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aims: In this paper, we investigated which socioeconomic and demographic groups first adopted digital primary care video consultations when they became accessible to the entire population in Sweden. Methods: We analysed data on all patients (378,000) who had a consultation with the largest provider of digital healthcare in Sweden – Kry – in the first years of national availability of the service, 2016–2018. We studied their income, education, demographics, and diagnosis backgrounds using matched registry data. Moreover, to compare users and non-users of digital primary care, we used data on all physical primary care users in one Swedish region: Skåne. Results: We found that this digital primary care was first used by young and higher-income adults, but not far from half of adult users had incomes below the national median. Digital care patients were more educated than the general population, reflecting that urban inhabitants were more likely than rural inhabitants to be users. First-generation immigrants were less represented among digital care users than in the population. However, second-generation immigrants with two foreign parents were slightly over-represented. The prevalence of some chronic diseases in pre-digital secondary (specialist and hospital) healthcare data among digital care users was similar to the population adjusted for age. Studying all physical primary care users in Skåne region, young digital care users had more primary care diagnoses and previous in-person primary care appointments than non-users, while the pattern was reversed for older users. Conclusions: When digital primary care became nationally available, younger, urban and more educated patients were the first to adopt the new technology. Regarding medical history, young users of digital care had a higher previous disease burden than young non-users, suggesting that these digital services were first adopted by young people with high primary care needs. [ABSTRACT FROM AUTHOR]

This article traces the origin, sustenance and implications of a persistent rumour that is responsible for low measles mumps and rubella (MMR) vaccination uptake in the Somali diaspora in a number of countries across the globe. The rumour stipulates that the MMR vaccine – the silent shot – causes autism spectrum disorder (ASD). Although the association between MMR and ASD is non-causal, and various public health initiatives have promoted health information campaigns, the rumour continues to circulate in the Somali diaspora in many countries, including Sweden. This paper shows that there are valid reasons for this. The findings from this paper draw on a systematic scoping review and qualitative interview data from Sweden. The results show that the Somali community experiences higher than average rates of ASD compared to the general population. Moreover, ASD does not exist in the Somali language or their home country, is considered a Western disease that only affects Somali children in the diaspora, and is a highly stigmatised disease. Also, the Somali diaspora has had negative experiences with ASD diagnosis and care. The rumour has been sustained by the absence of an answer to their ASD fear and through active diaspora networks on social media. The network that surrounds the rumour has arguably further helped to create an epistemic community for a community whose concerns have been silenced. [ABSTRACT FROM AUTHOR]

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

The objectives of the study were: 1) Describe the thematic structure and evolution of the field of physical therapy; 2) identify the main research producers (i.e. countries and institutions); and 3) compare their research output and citation impact. Papers related to physical therapy indexed in Web of Science (2000–2018) were identified to delineate the field, using keywords, journals, and citation networks. VOSviewer software, advanced bibliometric text mining, and visualization techniques were used to evaluate the thematic structure. We collected data about the country and institutional affiliation of all the authors and calculated production and citation impact indicators. 85,697 papers were analyzed. Eleven thematic clusters were identified: 1) "health care and education"; 2) "biomechanics"; 3) "psychosocial, chronic pain and quality of life outcomes"; 4) "evidence-based physical therapy research methods"; 5) "traumatology and orthopedics"; 6) "neurological rehabilitation"; 7) "psychometrics and cross-cultural adaptation"; 8) "gait-balance analysis and Parkinson's disease"; 9) "exercise"; 10) "respiratory physical therapy"; and 11) "back pain." The United States, the United Kingdom, and Australia were the most productive countries. Netherlands, Norway, and Sweden had the highest citation impact. Our bibliometric visualization approach makes it possible to comprehensively study the thematic structure of physical therapy. The ranking of producers has evolved and now includes China and Brazil. High research production does not imply a high citation impact. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Medical libraries in Sweden are digitised to a large extent, technically advanced and developing rapidly. This paper investigates technological trends among Swedish medical libraries in the near and distant future and their application within different areas of library activities. The authors also present a roadmap to increase technological developments within medical libraries in Sweden. Current technological trends include digital collaboration tools, mobile technologies and visualisation. Artificial intelligence, big data and smart technologies are upcoming trends. Technologies are applied within all areas of library activities, but preconditions for academic and hospital libraries differ. To remain a relevant provider of information services, libraries must be able to monitor, test and adopt new technologies. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In an aging society with increasing old age life expectancy, it has become increasingly important to monitor the health development in the population. This paper combines information on mortality and disability and explores educational inequalities in disability-free life expectancy in the aging population in Sweden, and to what extent these inequalities have increased or decreased over time. Methods: A random sample of the Swedish population aged 77 years and above (n =2895) provided information about disability in the population in the years 2002, 2004, 2011 and 2014. The prevalence of disability was assessed by five items of personal activities of daily living and incorporated in period life tables for the corresponding years, using the Sullivan method. The analyses were stratified by sex and educational attainment. Estimates at ages 77 and 85 years are presented. Results: Disability-free life expectancy at age 77 years increased more than total life expectancy for all except men with lower education. Women with higher education had a 2.7-year increase and women with lower education a 1.6-year increase. The corresponding numbers for men were 2.0 and 0.8 years. The educational gap in disability-free life expectancy increased by 1.2 years at age 77 years for both men and women. Conclusions: While most of the increase in life expectancy was years free from disability, men with lower education had an increase of years with disability. The educational differences prevailed and increased over the period as the gains in disability-free life expectancy were smaller among those with lower education. [ABSTRACT FROM AUTHOR]

To evaluate the reliability, internal consistency, and construct validity of the Swedish versions of PROMIS-29 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) instruments in patients with systemic sclerosis (SSc). In a cross-sectional study, consecutive SSc patients completed a paper-based survey. Internal consistency was assessed using Cronbach's alpha. Test–retest reliability was tested employing weighted Kappa (Kw) and intra-class correlation coefficient (ICC). Construct validity was evaluated by hypotheses testing using RAND-36, MRC Dyspnea score, Scleroderma Health Assessment Questionnaire (SHAQ) and clinical measurements. Forty-nine patients (86% female; 73% limited cutaneous SSc) completed the survey. The mean disease duration was 11 years and mean SHAQ was 0.5. Internal consistency and test–retest reliability were good with the exception of PROMIS-29 anxiety. PROMIS-29, FACIT-Dyspnea, and Functional limitation showed strong correlations to corresponding RAND-36 domains (|rs|=0.67 to −0.85). Relevant PROMIS-29 domains, FACIT-Dyspnea and Functional limitation correlated strongly to SHAQ and VAS overall disease severity (|rs|=0.60 to −0.75). Ceiling effects (>15%) were found in six PROMIS-29 domains and in both FACIT-Dyspnea and Functional limitations. Four (4/5) hypotheses were confirmed. PROMIS-29 and FACIT-Dyspnea meet the requirements for reliability and have adequate construct validity in Swedish patients with SSc. PROMIS-29v2 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) Index are patient outcome measures that gain increasing interest for the evaluation of patient with rheumatologic diseases. PROMIS-29v2 and FACIT-Dyspnea Index meet the requirements for reliability and have adequate construct validity compared to legacy measures in Swedish patients with systemic sclerosis. Translation and validation of PROMs is important for studies of rare diseases in multi-center collaborations. [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]

Purpose: Assessment of complex clinical skills and abilities is a challenge in mental health education. In the present study, an objective structured clinical examination (OSCE) was adapted to psychology and implemented in a Master in Psychology program. The purpose of the present study was to examine aspects of validity of this OSCE. Design/methodology/approach: A total of 55 students enrolled in the Master in the Psychology program at Umeå University, Sweden, participated in two OSCE occasions. In addition to OSCE data, questionnaires were administered immediately after the OSCE to students (n = 18) and examiners (n = 13) to examine their perceptions of the OSCE. Findings: The results provided support for different aspects of validity. The level of internal consistency was close to acceptable, and there was a good correspondence between global ratings and checklist scores for many stations. However, adding an additional category to the global rating scale and reviewing some of the station checklists might improve the assessment further. The present cut-score of the OSCE was comparable to a cut-score set by the borderline regression model. In general, students and examiners perceived the OSCE as a high-quality examination, although examiners raised some issues that could improve the OSCE further. Originality/value: In conclusion, OSCE is a promising assessment in psychology, both from a psychometric perspective and from a test-taker and examiner perspective. The present study is an important contribution to the field as there are only a few examples where OSCE has been used in clinical psychology, and to the best of the authors' knowledge, this paper is the first to evaluate the validity of such an assessment. [ABSTRACT FROM AUTHOR]

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

Background: Preoperative skin preparation is performed differently by different operating room nurses. Aim: To deepen the understanding of skin preparation within an orthopaedic surgical setting from the operating room nurse perspective and to explore their experiences. Methods: A qualitative exploratory design was used. Four focus group interviews were conducted during 2016–2017, at four hospitals in Sweden, using procedures developed by Krueger and Casey. A total of 19 operating room nurses were recruited through purposive sampling. Results: Statements were categorized into four categories of experiences: (1) Knowing, which related to learning and sources of knowledge; (2) Doing, which related to skin preparation and activities based on tradition and evidence; (3) The Team, which related to the assignment of responsibility and collaboration with patients and other professions; and (4) The Setting, which related to factors around the patient and included feelings of time pressure and access to supplies. Conclusions: Theory and practice differ, and some skin preparation used are based on tradition rather than on evidence or recommendations. Elements both within the team in the operating room and within the organization influence the result. Operating room nurses' duty to perform safe skin preparation must be respected in the team. SUMMARY STATEMENT: What is already known about this topic? Skin preparation before surgery is performed differently at different clinics and by different operating room nurses.The procedures used deviate from manufacturers' recommendations and available guidelines.Several skin preparation methods are based on traditional routines that lack scientific support. What this paper adds? Skin preparation is mostly taught and learned in a traditional manner, and a knowledge/practice gap exists.The organization, the team, the patient and the availability of supplies influence the performance and results of skin preparation.A rising demand for keeping up with productivity made operating room nurses concerned for patient safety. The implications of this paper: To provide safe care, skin preparation needs to be based on evidence.To ensure patient safety, management and head nurses must address the insufficiency of resources, the most prominent of which is insufficient time for the assessment and performance of careful skin preparation to prevent surgical site infections. [ABSTRACT FROM AUTHOR]

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin‐to‐skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research. Although the evidence for positive outcomes through skin‐to‐skin contact are robust, there is a dearth of research specifically focused on clinical practice. The methodology considers the four available data sets that used Widström's 9 stages, which consists of studies from Japan, Sweden, Italy and the United States, examining the parameters of each stage across settings from around the world. This research provides an expanded understanding of the timing of the newborn's progression through Widström's 9 observable stages. We found that newborns in all four data sets began with a birth cry and continued through the remaining stages of relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping during the first hours after birth and consolidated the data into a Sign of the Stages chart to assist in further research. The evidence supports making a safe space and time for this important newborn behaviour. Clinical practices should encourage and protect this sensitive period. [ABSTRACT FROM AUTHOR]

Purpose: To present a survival analysis of 133 consecutively placed moderately rough implants, all with a total follow-up of 20 years. Materials and Methods: A total of 133 implants of the same brand placed in 46 patients at the same county clinic in Sweden were followed up prospectively over 20 years and analyzed for survival and bone height, the latter evaluated in periapical radiographs. Results: A total of 7 implants failed, 4 of which were in the same patient. Implant failure was associated with a combination of smoking and bruxism in 5 of the 7 failed cases. A 20-year survival rate of 94.7% was observed. Average marginal bone loss (MBL) at 20 years of follow-up was 0.543 ± 1.193 mm, with 9 implants having more than 2 mm of MBL. A total of 20 patients with 25 implants dropped out of the study; however, if death of the patient is excluded as a dropout reason, only 3 implants in 3 patients were unaccounted for. Conclusions: Good clinical results in the 95% survival range were observed with moderately rough implants over a 20-year follow-up period. [ABSTRACT FROM AUTHOR]

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

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Technology is widely used in school to assist students with visual impairments. Drawing with traditional methods is still difficult for those users. In this paper, we present and discuss an evaluation of a haptic and sound interactive drawing program (HIPP). OBJECTIVE: The aim of the study was to identify what aspects of the technological aid support the drawing skill development in children with visual impairment. METHODS: Interviews, observations and video recordings of use situations were used for data gathering. Our analysis is based on cultural-historical activity theory, and examines the mediation between the child and the object of their activity, their drawings, as well as the roles of teachers, classmates, assistants, and family. RESULTS: The haptic and audio drawing program supports the steps (doodling, interpretation, planning, and more intentional drawing) observed in visually-acquired drawing, although possible improvements have also been identified. Observations of the drawing program in use showed that its mix of dynamic multimodal interaction and a stable drawing feedback, enable visually impaired students and sighted teachers to jointly access a shared representation. CONCLUSIONS: Successful long-term use, together with the presented results of our analysis show how multimodal dynamic and stable interaction can successfully support drawing activities. [ABSTRACT FROM AUTHOR]

Objectives: In this paper, we explore and compare types and longitudinal trends of hospital adverse events in Norway and Sweden in the years 2013–2018 with special reference to AEs that contributed to death. Design: Acute care hospitals in both countries performed medical record reviews on randomly selected medical records from all eligible admissions. Analysis: Comparison between Norway and Sweden of linear trends from 2013–2018, and percentage rates of admissions with at least one AE according to types and severities. Setting: Norway and Sweden have similar socio-economic and demographic characteristics, which constitutes a relevant context for cooperation, comparison and mutual learning. This setting has promoted the use of GTT to monitor national rates of AEs in hospital care in the two countries. Participants: 53 367 medical records in Norway and 88 637 medical records in Sweden were reviewed. Results: 13.2% of hospital admissions in Norway and 13.1% in Sweden were associated with an AE of all severities (E-I). 0.23% of hospital admissions in Norway and 0.26% in Sweden were associated with an AE that contributed to death (I). The differences between the two countries were not statistically significant. Conclusions: There were no significant differences in overall rates (E-I) of AEs in Norway and Sweden, nor in rates of AEs that contributed to death (I). There was no significant change in AEs or fatal AEs in either country over the six-year time period. [ABSTRACT FROM AUTHOR]

Aims: The paper aims to contribute to our understanding of the policy process in health promotion by addressing the following questions: What are the characteristics of the policy process in health promotion? How do policy entrepreneurs influence project implementation? Methods: This is a qualitative study with an explorative case study design that uses three different data sources: qualitative interviews, written documents and observations. Results: The paper examines several factors (determinants) that influence the policy process and that, to a lesser extent, are addressed by current models in health policy research. Legitimacy, financial capacity, available structure and political timing are all important determinants that influence the policy process. Policy entrepreneurs, with established networks and knowledge of the environment and its procedures, create legitimacy and provide opportunities for action; however, indistinct organizational boundaries among roles and poorly defined individual responsibilities create policy process uncertainty. As a result, there are lengthy discussions and few decisions, both of which delay the progress of a project. Conclusions: This paper’s theoretical contribution is its analysis of the relationship of policy-making to linear models, via a discussion of policy entrepreneurs, and their importance in the policy process. The paper concludes that we need to consider the influence of policy entrepreneurs, whom build legitimacy and seize action opportunities by coupling the three streams in the policy process, as they help bring projects to fruition. Furthermore, the study points to the importance of policy entrepreneurs throughout the policy process. The paper has practical implications for practitioners whom work with the implementation of community policies. [ABSTRACT FROM AUTHOR]

(1) Background: Overweight and obesity in children have increased worldwide and tend to persist into adolescence and adulthood. The Child Health Service (CHS) has an important role in providing health-promotive interventions, and such interventions are required to be documented in a child's health record. The aim of the study was to investigate Child Health Care (CHC) nurses' documentation of weight-related, health-promotive interventions in the Child Health Care Record (CHCR) regarding lifestyle habits in connection to the four-year visit. (2) Methods: A record review of 485 CHCRs using a review template was accomplished. Of the included CHS units, four used electronic records and two used paper records. Chi-square tests and Spearman's rank-order correlations were used to analyse data. (3) Results: The results showed that CHC nurses document interventions regarding lifestyle habits to a low extent, although children with overweight/obesity seemed to undergo more interventions. There was also a difference between electronic and paper records. (4) Conclusions: The consequences of not documenting the interventions in the CHCR make it difficult to follow up and demonstrate the quality of the CHC nurse's work. There is a need for more research to gain a deeper understanding of the reasons that the work of CHC nurses is not visible in children's health records. [ABSTRACT FROM AUTHOR]

Shortage and turnover of registered nurses are worldwide challenges, and work motivation is one factor in retaining staff in the healthcare sector. The aim of this study was to explore registered nurses' motivation expressed in daily communication, using the basic needs in self‐determination theory as a framework. A secondary analysis of ethnographic data, collected through participant observations, informal interviews during observations, and individual interviews, was used. A total sample of all registered nurses employed at a hospital unit in Sweden (n = 10) participated. The data were analyzed thematically through the lens of the basic needs in self‐determination theory: autonomy, competence, and relatedness. Self‐regulation of learning, the possibilities to discuss work‐related challenges with colleagues, and having registered nurses lead dialogues with physicians were factors connected to autonomy. Having a registered nurse and physician solve problems together was a factor connected to competence. A sense of belonging and security in a permissive climate between registered nurses was connected to relatedness. This paper has implications for increased awareness of the three basic motivational needs, which could be used in the development of attractive workplaces. [ABSTRACT FROM AUTHOR]

According to the Swedish Social Services Act, all health personnel are required to report children whom they suspect are subject to maltreatment. This paper describes the organizational and professional conditions in four Swedish children's hospitals regarding the reporting process. Specifically, the study focused on knowledge of risk to children, legal frameworks and the perceptions of organizational support and explored the differences between the hospitals and professional groups. The method used was a quantitative questionnaire, and 295 personnel responded. Hospitals differed in the level of organizational support offered to staff. Importantly, the professional groups showed different levels of knowledge and awareness about structures supporting their reporting obligations, with nurses and nurse assistants showing a lower level of awareness than physicians and hospital social workers. The paper argues that all professional groups need to have equal access to education, with the opportunity to become more involved in the assessment and reporting process and to strengthen multidisciplinary structures. Further, this would reduce risk, dispel the perception that work with children is ‘dirty work’ and counter strategies of avoidance among some professionals. [ABSTRACT FROM AUTHOR]

Purpose – Mobility is an important aspect of well-being, activity and participation. Retiring from paid work is a transition in later life when people need to adjust to a new daily structure and fill the day with activities other than work. Life-course transitions influence demands for mobility and choice of travel mode as people adapt to new circumstances and learning processes. The purpose of this paper is to explore how mobility strategies develop during the first years of retirement. Design/methodology/approach – A qualitative analysis based on initial interviews with a total of 27 retired people during their first year of retirement and again, about three years later. Findings – Important changes during the first years of retirement included illness or a decline in physical health. Mobility had become a means of achieving certain goals after an illness, such as learning to walk, being able to drive or enjoying the time that was left. While some enjoyed not having commitments, others experienced difficulties in filling the day. The results indicate four dimensions of mobility: means of carrying out activities which are needed and desired; resources for creating activities; a leisure activity in itself; and subordinate to staying at home. Originality/value – Gives a deeper understanding of the mobility challenges people ultimately face in later life, and how these are managed, which is important for transport planning and public health policy aimed at improving mobility, activity participation and well-being in later life. [ABSTRACT FROM AUTHOR]

Introduction: An increasing population and a shortage of identified potential organ donors are causing the waiting list for organ transplants to grow continuously. Donation after circulatory death (DCD) is a method aimed at meeting the demand for transplantable organs. However, it presents new challenges in nursing care, and there is a lack of studies investigating nurses' attitudes and knowledge of DCD. Objective: The objective of this study was to determine and describe intensive care nurses' (ICNs') knowledge, attitudes, and views on DCD before a national implementation in Sweden. Method: This study utilized a cross-sectional mixed-method design. A convenience sampling method was employed, targeting ICNs working in four intensive care units in Sweden. A study-specific tool comprising fixed and free-text questions was developed. Fifty-one ICNs participated. Data were analyzed descriptively, and correlation analysis was performed using Spearman's correlation. Free-text answers were qualitatively assessed and analyzed. An integrated analysis was conducted to synthesize the quantitative and qualitative findings. Results: Fifty-three percent reported limited knowledge about DCD. Nurses with previous education on DCD had significantly higher knowledge (r =.380, p =.006), were more engaged with the public debate on organ donation (r =.423, p =.002), and considered the ethical aspects of DCD more thoroughly (r =.386, p =.022). The qualitative analysis identified four key categories: The importance of the team, the need for ethical discussions, increased knowledge of DCD, and unanswered questions and unmet needs. The integrated analysis underscored the need for targeted education, clear guidelines, and ongoing ethical discussions to prepare ICU nurses for DCD. Conclusion: Nurses educated in organ donor care had better knowledge and a more positive attitude toward DCD implementation. The study also highlights the importance of interprofessional teamwork in DCD implementation. The findings suggest that education on DCD could improve the identification and implementation of DCD donors, addressing the global shortage of transplantable organs. [ABSTRACT FROM AUTHOR]

Background: Evidence concerning health care use related to virtual visits is conflicting. More research has been called for regarding the effectiveness of text-based virtual visits (eVisits). Therefore, we investigated patient characteristics, diagnoses, and subsequent health care contacts after eVisits to primary care. Methods: We conducted a register-based cohort study of eVisits to an all-virtual public primary care unit in Sweden and subsequent health care contacts within 14 days. Data for 2021 were acquired from the regional health care databases. Diagnoses were sorted into relevant diagnostic groups, such as skin diagnoses and respiratory tract diagnoses. Multiple logistic regression was performed with subsequent health care contact as the outcome variable and diagnostic group for the eVisit as the predictor variable. Analyses were adjusted for age, sex, and socioeconomic index. Results: There were 5817 eVisits to a nurse and 4267 eVisits to a general practitioner (N = 10 084). Most patients were 20 to 39 years of age (41.8%). Skin diagnoses were most frequent (47.3%), followed by respiratory tract diagnoses (19.9%). Approximately one-fourth (25.8%) of the patients who completed an eVisit with a nurse or a general practitioner had a subsequent face-to-face visit within 14 days, mostly in primary care. Subsequent contacts were more frequent after an eVisit to a nurse than to a general practitioner. After an eVisit to a general practitioner, patients with infections (especially respiratory tract but also urinary tract) and unspecified diagnoses (especially skin-related) were more likely to require further health care contact compared to a group with various other diagnoses. Conclusions: eVisits to an all-virtual primary care unit may be appropriate for uncomplicated medical complaints. Nonetheless, the effectiveness of eVisits in terms of substitution of physical visits, and resource utilization in relation to the more complex care needs of a primary care population, should be further studied. [ABSTRACT FROM AUTHOR]

Background: Lower respiratory tract infections (LRTIs) have an immediate significant impact on morbidity and mortality among older adults. However, the impact following the infectious period of LRTI remains understudied. We aimed to assess the short- to long-term impact of LRTIs on hospitalization, mortality, and healthcare utilization in older adults. Methods: Data from the Swedish National Study of Aging and Care in Kungsholmen (SNAC-K) was analyzed, with data from 2001 to 2019 for mortality and 2001–2016 for healthcare utilization. LRTI-exposed participants were identified and matched with LRTI-nonexposed based on sociodemographics, lifestyle factors, and functional and clinical characteristics. Statistical models evaluated post-LRTI hospitalization risk, days of inpatient hospital admissions, healthcare visits, and mortality. Results: 567 LRTIs-exposed participants during the study period and were matched with 1.701 unexposed individuals. LRTI-exposed individuals exhibited increased risk of hospitalization at 1-year (HR 2.14, CI 1.74, 2.63), 3-years (HR 1.74, CI 1.46, 2.07), and 5-years (HR 1.59, CI 1.33, 1.89). They also experienced longer post-LRTI hospital stays (IRR 1.40, CI 1.18, 1.66), more healthcare visits (IRR 1.47, CI 1.26, 1.71), specialist-care visits (IRR 1.46, CI 1.24, 1.73), and hospital admissions (IRR 1.57, CI 1.34, 1.83) compared to nonexposed participants over 16-years of potential follow-up. Additionally, the 19-year risk of mortality was higher among LRTI-exposed participants (HR 1.45, CI 1.24, 1.70). Men exhibited stronger associations with these risks compared to women. Conclusions: LRTIs pose both short- and long-term risks for older adults, including increased risks of mortality, hospitalization, and healthcare visits that transpire beyond the acute infection period, although these effects diminish over time. Men exhibit higher risks across these outcomes compared to women. Given the potential preventability of LRTIs, further public health measures to mitigate infection risk are warranted. [ABSTRACT FROM AUTHOR]

Background: Sickness absence has been linked to short and long, as well as poor, sleep in a few studies. Such studies have started from a baseline measurement and followed up on subsequent sickness absence. In the present study, however, we focused on the change in biennial reports of sickness absence and sleep measures (using work-related variables as possible modifiers). We also searched for an interaction between predictors and gender since women report more sleep problems. Methods: A total of 5377 individuals (random sample from the Swedish working population) participated across five biennial points of measurement. Data were analyzed using mixed-model logistic regression. Results: The multivariable analysis of variation across the five time points showed that the significant sleep-related predictors of sickness absence (at least one occurrence during the preceding year) were sleep duration during days off (OR = 1.16, 95% Cl = 1.08;1.24) and sleep problems (OR = 1.42, 95% CI = 1.33;1.51). These also remained significant after the addition of psychosocial work factors. Sensitivity analyses indicated that a 9 h sleep duration during days off may represent a critical level in terms of increased sickness absence and that late rising contributed to the association between sickness absence and long sleep duration during days off. Women reported a higher sickness absence than men (OR = 2.16, 95% CI = 1.74;2.68) and had a higher probability of sickness absence for long sleep during days off and during the workweek than men. Conclusions: It was concluded that increases in sleep problems and sleep duration during days off are longitudinally associated with changes in sickness absence and that women have a closer link between the two. This suggests that treatment for sleep problems may reduce the risk of sickness absence. [ABSTRACT FROM AUTHOR]

Objectives: Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide. Design: A nationwide retrospective explorative study investigating medical records. Setting: Primary care in Sweden. Participants: Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death. Results: The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020). Conclusion: A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms. Strengths and limitations of this study: The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group. [ABSTRACT FROM AUTHOR]

Background: As the use of patient-reported outcome measures (PROMs) is increasing in orthopaedic research, there is also a growing need for a standardized interpretation of these scores, such as the Patient Acceptable Symptom State (PASS), defined as the value beyond which patients consider themselves well. The Achilles tendon Total Rupture Score (ATRS) is the only PROM specific for Achilles tendon ruptures. Purpose: To establish the PASS for the ATRS in a Swedish population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients treated for an acute Achilles tendon rupture at a single institution in Sweden (injured between July 1, 2018, and December 31, 2020) were asked to participate in this study. The patients completed a questionnaire consisting of the ATRS and an anchor question: "How satisfied are you with the result of your treatment?" Receiver operating characteristic curve analysis was performed to calculate the PASS threshold for a positive response to the anchor question. Results: Of 516 eligible patients, 316 (61%) were included. The time from injury to completion of the questionnaire ranged from 12 to 27 months. The PASS threshold for the ATRS was found to be 75. The median ATRS of all patients was 80; 66% of patients reached an ATRS ≥75. Overall, 79% of patients were satisfied with the results of their treatment. Conclusion: The estimated PASS for the ATRS was 75 in the general Swedish population at 12 to 27 months after an acute Achilles tendon rupture. [ABSTRACT FROM AUTHOR]

Aims: To explore Registered Nurses' motives to undergo specialist training and to choose a particular speciality. Design: A descriptive qualitative interview study. Methods: Semi‐structured interviews were conducted during 2021 with 20 Swedish specialist nurse students from different specialisation areas. Qualitative content analysis was used. The COREQ checklist was used to report the study. Results: Specialist nurse students' motivations for further training were divided into three main categories with two sub‐categories each. The main categories were 'toward new challenges and conditions in work life', 'contributions to the development and higher competencies in health care' and 'personal work and life experiences as ground for choice'. Conclusion: Our study demonstrates the importance of motivating factors in the career choices of Specialist nurse students, such as personal challenges, desirable working conditions, career growth opportunities and personal experiences in the career choices. Creating a supportive work environment that helps to prioritise work‐life balance and offers the development of new skills might help retain nurses. No Patient or Public Contribution: No patient or public contribution was used. However, if more nurses would choose to undergo specialist training, especially in areas facing significant shortages, it would most likely lead to improved health‐related outcomes for patients or populations. [ABSTRACT FROM AUTHOR]

The article presents a college thesis which investigated the determinants of the outcomes of lumbar spinal stenosis surgery and is based on several papers previously published by F. G. Sigmundsson, B. Jönsson and B.Strömqvist, including papers which appeared in a 2013 issue of "Acta Orthopaedica", a 2012 issue of "Acta Orthopaedica" and a 2014 issue of "Spine".

Purpose -- The purpose of this paper is twofold: first, to explore to what extent teachers eat together with pupils during school lunches and their attitudes toward using these lunches to reach the educational goals stated in the Swedish compulsory school curriculum; and second, to study to what degree teachers see themselves and school meal personnel as role models during school lunches. Design/methodology/approach -- A questionnaire was completed by 3,629 teachers in Swedish schools. Findings -- In total, 90 percent of the teachers ate lunch together with the pupils one or more days per week. The majority reported that meals were fully (54 percent), or partially (40 percent) subsidized when they were eating with pupils. In total, 72 percent thought that school lunches should be considered part of the school's educational activities while 28 percent thought that it should be a time to get a break from educational activities. Most teachers thought that school lunches could be useful for learning about the issues of food waste and healthy eating while there were more diverse views on using lunches for learning about fundamental values. A majority of the teachers considered themselves to be role models in the school meal situation. Practical implications -- The authors suggest that the educational component of the school meal per se should be regulated in the Educational Act together with guidelines from the Swedish National Agency for Education. Originality/value -- This study is unique since it covers a previously little studied area; teachers' attitudes toward using the school lunch situation for educational purposes. [ABSTRACT FROM AUTHOR]

Objective: To translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) from English to Swedish and to evaluate psychometric properties of the questionnaire. Methods: A cross-sectional study design, where the translation followed a process including initial translation, synthesis, backward translation, expert committee, and pretest. Content validity was assessed using Content validity index (CVI). Psychometric assessments included floor-ceiling effects and internal consistency. Results: Language and cultural congruence were achieved, and content validity index scores were high (0.923-1). The psychometric evaluations provided acceptable outcomes concerning internal consistency, with Cronbach's alpha scores for the total scale (0.902), the activities subscale (0.861) and the self-management subscale (0.818) respectively. Ceiling effects were evident, but no floor effects. Conclusion: This study found the Swedish version of the SSEQ promising as a tool for assessment of self-efficacy in a Swedish stroke care setting, although further psychometric assessments are recommended in future studies. [ABSTRACT FROM AUTHOR]

Background: Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time. Aim: The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. Research design: The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version. Participants and research context: 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch's ANOVA, Games–Howell post-hoc test and Pearson's correlation analysis were done. Ethical considerations: The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration. Results: The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress. Conclusion: The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context. [ABSTRACT FROM AUTHOR]

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

Introduction: Early recognition of pain in children is crucial, and their self-report is the primary source of information. However, communication about pain in healthcare settings can be challenging. For non-verbal communication regarding different symptoms, children prefer digital tools. The electronic Faces Thermometer Scale (eFTS) utilizes a universal design with colors, face emojis, and numbers on an 11-point scale (0-10) for pain assessment. The aim of this study was to establish content validity of the eFTS for pain assessments in children. Methods: A mixed methods design was used. The study took place at a university hospital in eastern Sweden, involving 102 children aged 8-17 years who visited outpatient clinics. Participants were presented with 17 pictures representing varying pain levels and asked to assess hypothetical pain using the eFTS. A think-aloud approach was employed, prompting children to verbalize their thoughts about assessments and the eFTS. Quantitative data were analyzed using descriptive and comparative statistics, together with a qualitative approach for analysis of think-aloud conversations. Results: A total of 1,734 assessments of hypothetical pain using the eFTS were conducted. The eFTS differentiated between no pain (level 0-1) and pain (level 2-10). However, no clear agreement was found in the differentiation between hypothetical pain intensity levels (level 2-10). The analysis revealed that children utilized the entire scale, ranging from no pain to high pain, incorporating numbers, colors, and face emojis in their assessments. Discussion: The variability in assessments was influenced by prior experiences, which had an impact on the statistical outcome in our study. However, employing the think-aloud method enhances our understanding of how children utilize the scale and perceive its design, including the incorporation of emotion-laden anchors. Children express a preference for using the eFTS to assess their pain during hospital visits. [ABSTRACT FROM AUTHOR]

Background: Insufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers. Methods: Seven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Results: The PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging. Conclusions: PAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community. [ABSTRACT FROM AUTHOR]

Background: Sleeping Beauties (SBs) are publications that are scarcely cited in the years immediately following publication but then suddenly become highly cited later. Such publications have unique citation patterns and can reveal important developments in the field in which they appear. Objectives: No holistic analysis of nursing SBs has been done yet. The aim of this study was to identify and analyze the SB phenomenon in the nursing research literature. Method: The corpus for the nursing SB identification was harvested from the Web of Science Core Collection (Thomas Reuters) for the period 1934-2015. Citation histories of 212,239 publications were screened. From those, 3,209 publications with more than 100 citations were selected for analysis. We used our own software and applied the van Raan (2004) and Baumgartner (2010) criteria for SBs-a 5-year sleeping period with at most 10 citations during that time, an average of at least five citations per year after the first 10 years, with at least 100 citations in total. The knowledge context for SBs was determined using citing papers. All citing papers were analyzed with the help of VOSviewer software. Results: Nine publications were identified as SBs (prevalence of 0.004%). The length of sleep duration ranged from 5 to 10 years (M = 6.8, SD = 2.0), depth of sleep ranged from 0.2 to 0.8 citations (M = 0.6, SD = 0.2), and awake intensity ranged from 6.4 to 15.0 citations (M = 11.0, SD = 3.8). The average number of citations to SBs was 229. Most nursing SBs were produced in the United States (n = 8) from top institutions in journals with high-impact factors. Nursing SBs covered topics including resilience, sampling in qualitative research, metasynthesis, postoperative pain in children, dementia rating scales, care of patients with Alzheimer's disease, nursing theory related to fatigue mechanisms in cancer patients, and family participation during resuscitation. Nursing SBs were cited by authors from a large number of institutions and countries; the number of publications citing nursing SBs is growing exponentially and showing increasing and global interest in the research presented in them. Discussion: This study demonstrated that SBs in nursing are similar to other scientific disciplines. Existence of SBs suggests that nursing knowledge accumulation is supported by research and professional processes similar to those that emerged in other academic disciplines. [ABSTRACT FROM AUTHOR]

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

The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors. [ABSTRACT FROM AUTHOR]

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

Aim: To describe intensive care nurses' conceptions of participating during the donation after circulatory death (DCD) process in intensive care units in Sweden. Design: A qualitative design with a phenomenographic approach. Methods: In total, 12 semi‐structured interviews were conducted in April 2022 with intensive care nurses from three hospitals. Data were analysed using a phenomenographic approach. Results: Conceptions of participating during the DCD process varied. Four main themes emerged: DCD as a system; Intensive care nurses' role in the situation; Life to death to life; The essence of DCD. Variations emerged regarding what the informants talked about and how they talked about the what. Variations were based on informants' perspective of their role in relation to the structure and the team, and their conceptions of care for patients and their relatives. Conclusion: The findings illustrated success factors and challenges. Knowledge, experience, distinct structure, and relationship with relatives, among other factors, were described as success factors, while a lack of experience, difficulty in prognosing death, and organisational obstacles emerged as challenges. Furthermore, the findings showed that intensive care nurses play an important role in optimising the outcome of the DCD process. Their work related to DCD was conceived as being meaningful to fulfil more peoples' wishes to donate organs. Impact: People on the waiting list for organ transplantation are dying due to a shortage of organs. The implementation of DCD, as a complement to Donation after Brain Death (DBD), contributed to an increase in the number of organ donors, and intensive care nurses play an important role during the DCD process. Previous research manifests the complexity concerning their role. There is a lack of nursing research regarding intensive care nurses' conceptions of what it means to participate in the DCD process, which emphasises the significance of this study. Reporting Method: This study is reported using consolidated criteria for reporting qualitative research (SRQR). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Functional abdominal pain disorders are common and disabling in children, but treatment options are limited. In a pilot study, we aimed to investigate if a brief group education program for pediatric patients with functional abdominal pain disorders and their parents is feasible and acceptable. Group education in adult irritable bowel syndrome has shown large treatment effects, but it has not been evaluated in children. The gastrointestinal (GI) group education, delivered in the clinic to 23 child–parent dyads, consisted of lectures by a pediatric gastroenterologist, a psychologist, and a dietician. Validated digital questionnaires were filled in by children and parents before and after the intervention. Most participants in the GI group education attended all sessions, and credibility in treatment was deemed high. Children's self-reported knowledge of functional abdominal pain disorders increased, and improvements in gastrointestinal symptoms were reported at the end of this study. Our findings indicate that group education for children and adolescents with functional abdominal pain disorders, and their parents, is acceptable and feasible and may improve symptoms. A brief group education program may be of benefit in the management of pediatric functional abdominal pain disorders in several cases and when the family needs more knowledge than can be provided in primary care. [ABSTRACT FROM AUTHOR]

Background: Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well‐being are often reported in patients on haemodialysis (HD). Aims: We aimed to explore needs, barriers and facilitators—as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well‐being. Methods: This is an observational cross‐sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal—aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well‐being from the perspective of patients, their carers and HCPs. Results: In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private. Conclusions: Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support. [ABSTRACT FROM AUTHOR]

Aim: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts. Design: A mixed methods design with a longitudinal questionnaire survey and focus group interviews. Methods: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November–January 2019/2020 and November–January 2020/2021). A cross‐lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April–October 2021). Qualitative data collection and analysis were inspired by Grounded Theory. Results: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur. Conclusion: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve. Implications for the Profession: By ensuring a shared care ideology, good inter‐professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful. Impact: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]