Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.

Setting Two primary care centres in southern Sweden.

Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.

Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.

Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available.

Aims: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.

Methods and results: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay.

Conclusion: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

Aims 

Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context.

Methods and results

In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team’s reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52).

Conclusion

Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

Introduction: When a family member has been critically ill and cared for at an intensive care unit the individual family member as well as the family system are affected and in need of support. The aim of this study was to compare and contrast the responses from 2 different types of follow-up interventions for families of critically ill persons, focusing on individual hopes, health-related quality of life, family functioning and ability to cope with challenges.

Method: Adult family members from 3 hospitals attended 1 of 2 interventions 2 months after intensive care. The family health conversation included the family. The support group conversation included just family members and not the patient who had experienced intensive care. Data were collected via self-reported questionnaires and follow-up interviews with family members. Quantitative and qualitative data were first analyzed separately, and the results were then integrated through mixed methods analysis.

Results: A total of 38 family members took part in the interventions. Family members in the 2 intervention groups talked about how they had more hope for the future, and about how talking within the family and the group had helped them justify their feelings, which empowered them in the transition toward a healthier quality of life. Comparisons of the interventions show a higher significance of family function and hope in the family health conversation.

Discussion: The article illustrates a disparity between how family members function and the needs they have for follow-up. We discuss what kind of follow-up these persons need.

BackgroundA growing body of evidence suggests that exposure to nature is beneficial for human health. However, the observed health effect of nature may be mediated by physical activity and that humans are physically active at a higher intensity outdoors compared to when they are physical active indoors.ObjectiveThis study examines the variation of heart rate and power output for a fixed rating of perceived exertion in a group of healthy older adults in three different environments representing three levels of exposure to nature.MethodsTo this randomized, 3-by-3 crossover design study, healthy older adults (≥65 years) were recruited from local gyms. All participants participated in three experimental conditions; indoors, simulated outdoors and outdoor environments, in a randomized order. The participants exercised for 20 minutes at an intensity equivalent to a rating of 11–13 on the Borg scale for perceived exertion (RPE). Measurements of heart rate, power output (Watt) and ratings of perceived exertion were taken at minutes 1 to 6 and at minute 20. To examine the effect of the environment on heart rate and power, linear mixed models were used.ResultsIn all, 48 participants (56% females) were included in the analysis. No significant main effects on the outcomes were observed for power output (p = 0.073, η2 = 0.04) or heart rate (p = 0.067, η2 = 0.04)ConclusionNo significant effect on the outcomes was observed. However, borderline significant outcomes for power output or heart rate outdoors in nature, along with previous studies in the field, indicates that such an effect cannot be completely ruled out, but any effect is likely to be small. Future research examining health benefits of the independent exposure to nature are encouraged to adjust for the dose of physical activity.

The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives' actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

The practice of using video conferencing systems for health care provider-patient meetings is becoming increasingly more important. Here, we reviewed literature on the subject, with the aim to provide a set of factors and perspective on what has been noted as important for the success/failure of the use of video in consultation meetings. Mostly, previous studies have focused on the outcomes, how well video works for the patient-care professional meeting, when it comes to affecting expected outcomes of the consultation. However, we focus on the contextual factors that have been noted in research on the topic and aim to gather these from a wide range of studies on video used in a home environment. We discuss the results of the study in the broader context of the implementation situation of video consultations systems, providing factors, barriers, and perspectives as well as a general context to use or non-use of the systems. Hence, we provide knowledge that can be taken into account by the designers and developers of such systems.

Ehealth solutions are in great need in the community of elderly in general, as patients or home carers, however a design approach that delivers this is illusive. In this research we present the experiences from a set of design processes targeting elderly’s needs of support or home care, based on a co-design approach. The purpose is to present guiding principles for how to work with elderly in a co-design process, to be used as basis for future set up of co-design processes.

The Internet of Things (IoT) plays a vital role in today’s medicine (Islam et al, 2015). In 2020, 40% of IoT-related technologies will be assigned to the health domain, which makes up around a 117 $ billion in the global market (Bauer, Patel & Veira, 2016). Adding to this the demographic changes will further set a significant challenge in Europe (Steinführer & Haase, 2007). Innovative techniques for supporting health systems and independent life for the aging population is therefore essential, not at least in relation to fall prevention and technology for promoting a good life throughout the lifespan. Further, participation from patients is a goal for healthcare worldwide (Lundgren, Sunesson & Tunved, 2014). For example according to the Health and Medical care act in Sweden (1982:763) it is described that the goal for health care “is good health and care on equal terms for the entire population”. In line with this challenge of integrated care the patient itself will be the most important resource for promotion of health, why Co Design is needed as a method for innovation in healthcare sector. It is important for the users ‘experiences and insights to contribution in improvements but not at least because it has been shown that increased involvement with the user in care reduces the number of hospital visits (Simpsons, 2007).

ICT projects, development and/or research driven, are sources of new innovative eHealth solutions. However, the rate of continued use is low and gaining sustainable benefits in daily operations is difficult (Warth et al.). This research looks at the barriers for the organizational implementation based on research driven projects. 

Three eHealth projects have been analyzed for aspects on the phenomenon, to gain a deeper understanding of the problem. Results are based on discussions between project participants, (professionals, decision makers, patients), and analysis of the project set ups and purposes. 

ResultsFactors that could be seen as important for lack of continued use includes: pure research setup of projects, lack of financial resources in the post projects time , lack of organizational competences for adoption of solutions, no organizational champion or CEO support, lack of fit to organizational processes or scheduling, professional resistance to change, among others. 

DiscussionProject set ups and working methods of the project might hamper the possibilities of effective knowledge transfer and organizational adoption. Experiences from mentioned projects show that a 360-degree co-design approach, which includes major stakeholder (for example, professionals, patients, researchers, patients, decisions makers) should be included. There is a need to prepare for knowledge transfer processes in post project phases, including competence development strategies for professionals and organizational change plans. 

Conclusions A holistic understanding of conditions and challenges is needed for paving the way for health organization to reap benefits from research projects. 

Lessons learned Projects need to include processes for engaging the stakeholders through 360 co-design, knowledge transfer plans and competence development strategies. 

Limitations The research is exploratory and based on analysis of past and ongoing eHealth projects. 

Suggestions for future researchBetter understanding for how to integrating competence development and organizational change as a part of eHealth project are needed. An investigation on digital competence among patients and healthcare personnel is planned, with the purpose of defining competence development strategies and requirements for IT-enabled cooperation and co-production.

IT solutions for rehab are seen as an opportunity to provide effective support for patients’ recovery process in their in-home environment, based on instructions from health care professionals. However, what factors in the context affect the usefulness of such systems lie beyond the training process as such. In this research, we followed a co-design process, where the design of a support packaged for home rehab is based on standard products. Through group interviews with teams of home rehab staff, a broader view of the subject was sought. Group discussions involving the initial demonstration and testing of technology provided a wide spectrum of factors that the staff considered important for success, related to issues on both the organizational and the patient levels. These findings were analyzed for success factors in an attempt to reach an understanding of the rehab process context which will have an effect on the usefulness of the support system. As a result, a checklist of aspects on the process that need to be taken into account in the design of a rehab support system is presented and discussed. The results could be used both in the design of solutions and in the selection and implementation of support systems regarding how to improve the actual use of the systems.

Bakgrunn: Tidlig skriftspråkutvikling har vist sammenheng med senere lese- og skriveferdigheter i skolen. I barnehagen er det behov for en didaktikk der lek er kjernen, og hvor alle barn får mulighet til å kommunisere, utforske og leke med skrift. For å få til dette har det betydning hvordan et innhold som skrift representeres og behandles i barnehagen. Hensikten med denne studien er å bidra med kunnskap om hvordan nordiske barnehagelærere tilrettelegger for skriftspråklæring i nordiske barnehager. Følgende forskningsspørsmålet er sentralt: Hvilken oppfatning, praksis og erfaringer beskriver barnehagelærere at de har med høytlesing og skriving?

Metode: 76 barnehagelærer i Sverige og 92 barnehagelærer i Norge besvarte et spørreskjema med åpne og lukket spørsmål om høytlesing og skriving. Resultatene ble analysert med frekvensanalyse i SPSS og med kvalitativ innholdsanalyse av åpne spørsmål.

Resultater: Preliminære funn viser at det er mindre skriving på småbarnsavdeling og stor variasjon i tekstmiljøet knytt til skriving for eldre barn. Høytlesing er en sentral del av barnehagens virksomhet, men det er stor variasjon i vilkårene for høytlesning, hva som leses, hvorfor og hvor ofte det leses.

Implikasjoner for praksis: Studien kan styrke barnehagelærers didaktikk innenfor språk og kommunikasjon gjennom å løfte frem eksempel på hvordan barnehagelærer legger til rette for høytlesing og skriving. Barnehagelærer trenger kunnskap om høytlesing som en didaktikk hvor skriftspråket er i sentrum og hvordan man tilrettelegger for skriving om funksjon, og ikke først og fremst som form, for de yngste barna.

Preschool teachers’ read-aloud and writing practices were investigated using a questionnaire about how activities were planned and organized, and what their purpose was. The results indicate that early literacy practices were not planned systematically. Most of the preschool teachers (77%) reported having storybook read-alouds at least three times per week. A large minority (45.5%) reported never or seldom using writing activities, and rarely in play. The main aims of read-alouds were to promote learning and development, create a sense of community, and regulate group activities. The main aims of writing practices were to learn about letters, understand the function of print, and arouse interest in writing. We discuss the implications of these findings in relation to a need for a didactic approach, where play is the core of early literacy practices.

BACKGROUND: Over the past decade, the importance of person-centered care has led to increased interest in patient-reported outcome measures (PROMs). In cardiovascular care, selecting an appropriate PROM for clinical use or research is challenging because multimorbidity is often common in patients. The aim was therefore to provide an overview of heart-disease specific PROMs and to compare the content of those outcomes using a bio-psycho-social framework of health.

METHODS: A scoping review of heart disease-specific PROMs, including arrhythmia/atrial fibrillation, congenital heart disease, heart failure, ischemic heart disease, and valve diseases was conducted in PubMed (January 2018). All items contained in the disease-specific PROMs were mapped to WHO's International Classification of Functioning, Disability and Health (ICF) according to standardized linking rules.

RESULTS: A total of 34 PROMs (heart diseases in general n = 5; cardiac arrhythmia n = 6; heart failure n = 14; ischemic heart disease n = 9) and 147 ICF categories were identified. ICF categories covered Body functions (n = 61), Activities & Participation (n = 69), and Environmental factors (n = 17). Most items were about experienced problems of Body functions and less often about patients' daily activities, and most PROMs were specifically developed for heart failure and no PROM were identified for valve disease or congenital heart disease.

CONCLUSIONS: Our results motivate and provide information to develop comprehensive PROMs that consider activity and participation by patients with various types of heart disease.

The objective of the present study was to assess historical emissions of Pb to air around a number of glassworks sites in southeastern Sweden, and the possible implications for human exposure. To do so, a four-step method was applied. First, emissions of Pb to air around 10 glassworks were modelled for the 20th century. Second, an assessment of the resulting exposure was made for a number of scenarios. Third, the number of people potentially exposed at different times was estimated, and fourth, measurements of “current” Pb concentrations in PM10 material from four sites were conducted in 2019. The results show that the highest emissions, and exposures, occurred from 1970 to1980. It coincides with the time period when the highest number of people resided in the villages. At this time, the average Pb concentration in air around the six largest factories was about 2.4 μg Pb/m3, i.e. 16 times the present US national ambient air quality standard (NAAQS) of 0.15 μg Pb/m3. By year 2000 the modelled average concentration had dropped to 0.05 μg Pb/m3, a level that is normal for urban regions today. The PM10 measurements from 2019 indicate a further decline, now with a mean value of about 0.02 μg Pb/m3. Over the entire study period, inhalation hazard quotients (HQs) exceeded the dietary HQ by many orders of magnitude, indicating that inhalation has been the most prevalent exposure pathway in the past. At present, both pathways are judged to be associated with low exposures. Even if only roughly approximated, a picture of the historical exposure can increase our understanding of the connection between exposure and disease, and can be valuable when risks are to be communicated to residents near contaminated areas.

Throughout Europe the most damaging consequences of the coronavirus have fallen disproportionately on older people who live in care homes. This study involves the analysis of secondary data sources relating to deaths, and related harms, in European care homes from seven countries between March and December 2020. The findings are reviewed using the framework of the European Convention on Human Rights to identify examples of human rights violations - namely the right to life, liberty and security, respect for private and family life, and prohibition of torture, and general prohibition of discrimination. A significant contributing factor to the scale and nature of deaths and harms is the abject disregard of older people's human rights. Based on the findings, the authors, a group of social work academics, call for an urgent re-examination of the role of social work in relationship to care homes and the importance of re-engaging with human rights issues for care home residents.

Background The study addresses knowledge gaps in research regarding influences of routine health care delivery of physical activity on prescription (PAP). The aim was to investigate if patient and health care characteristics are associated with increased physical activity 1 year after prescription among patients offered counselor support in addition to health care professionals' prescription. The study was conducted in primary and secondary care in a Swedish health care region. Methods All PAP recipients during 1 year were invited (N = 1503) to participate in this observational prospective study. Data were collected from medical records and questionnaires (baseline and follow-up). Descriptive statistics and multiple logistic regression analysis were used. The outcome variable was increased physical activity after 1 year. Study variables were patient and health care characteristics. Results Three hundred and fifty-five patients with complete follow-up data were included. The mean age was 62 years (SD = 14; range, 18-90) and 68% were females. Almost half (47%) had increased physical activity 1 year after PAP. Multiple logistic regression analysis showed that increased physical activity at follow-up was positively associated with lower baseline activity, counselor use, and positive perception of support. Counselor users with low baseline activity had higher odds ratio for increased physical activity at follow-up than non-users (OR = 7.2, 95% CI = 2.2-23.5 vs. OR = 3.2, 95% CI = 1.4-7.5). Positive perception of support was associated with increased physical activity among counselor users but not among non-users. Conclusions An increase in physical activity after PAP was related to low baseline activity, positive perception of support, and use of counselor support after PAP. Qualified counseling support linked to PAP seems to be important for achieving increased physical activity among patients with lower baseline activity.

The effectiveness of counsellor support in addition to physical activity on prescription (PAP) from health care professionals has rarely been evaluated. This observational follow-up study investigated differences in physical activity levels and health-related quality of life (HRQoL) one year after PAP regarding patients' use of counsellor support in addition to PAP in routine care. The study was conducted in a Swedish health care region in which all patients receiving PAP from health care professionals were offered counsellor support. Data were collected from medical records and questionnaires (baseline and follow-up). Of the 400 study participants, 37% used counsellor support. The group of counsellor users attained a higher level of physical activity one year after receiving PAP compared to the group of non-users (p< 0.001). The level of physical activity was measured by a validated index (score 3-19) calculated from weekly everyday activity and exercise training. Comparison of the change in scores between baseline and follow-up showed a significant difference between the two groups, (p< 0.001). The median difference in the PAP + C group was 2.0 (interquartile range, 7.0) and 0.0. among non-users (interquartile range, 4.0). Significant differences in HRQoL were due to positive improvements among counsellor users, with the main improvement in general health. The conclusion is that patients using counsellor support after receiving PAP from health care professionals had higher physical activity and better HRQoL one year after compared with patients who did not use this support.

Aims To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors. Design A cross-sectional design. Methods Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis. Results Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude. Conclusion This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly. Impact Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child-centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.

Inom svensk social barnavård är privata konsulter, som handlägger barnavårdsutredningar en relativt ny företeelse. Artikelns syfte är att kartlägga och fördjupa kunskapen om omfattningen av privata konsulter som handlägger och genomför barnavårdsutredningar samt att beskriva kommuners/stadsdelars incitament för att anlita privata konsulter eller avsluta uppdrag. Det empiriska materialet är, utifrån ett strategiskt urval, hämtat från tre län/22 kommuner och en storstadsregion/10 stadsdelar i Sverige. Insamlingen av det empiriska materialet genomfördes genom strukturerade telefonintervjuer med en hög grad av standardiserade frågor. Resultatet visar att antalet barnavårdsutredningar ökade markant från år 2013 till år 2017. I de studerade kommunerna/stadsdelarna medförde det en högre arbetsbelastning, en sämre arbetsmiljö och svårigheter att rekrytera erfarna socialsekreterare. De flesta kommunerna/stadsdelarna löste situationen genom att anlita privata konsulter. Det medförde en marknadsorientering av genomförandet av barnavårdsutredningar och en ny arena för privata konsulter skapades. I de studerade kommunerna/stadsdelarna är erfarenheten generellt negativ av att anlita konsulter såväl när det gäller kvaliteten på barnavårdsutredningarna som arbetsmiljön på arbetsplatsen. Det var även en dyr lösning. Efterfrågan på konsulter som kunde utföra barnavårdsutredningar var stor och de kunde därför diktera villkoren. Kommunernas och stadsdelarnas erfarenheter stärktes med tiden, vilket gjorde att de blev mer tydliga i kontrakten gällande krav på konsultens kompetens och erfarenhet samt uppdragets omfattning, innehåll och kvalitet. Det innebar en viss maktförskjutning från konsultföretagen till de anlitande kommunerna/stadsdelarna. Det är inte helt klart vilken utveckling vi kan förutsäga, mer än att konstatera att de privata aktörerna är etablerade i den svenska sociala barnavården. Vi kan även se tendensen till att de privata konsulterna har inneburit vissa positiva förändringar för de kommunalt anställda socionomerna när det gäller höjning av lönenivåer och förbättrade arbetsvillkor. Förändringar som kanske inte hade varit möjliga eller tagit längre tid utan marknadsorienteringen.

PFOS, PFOA, PFNA and PFHxS are the PFAS substances that currently contribute most to human exposure, and in 2020 the European Food Safety Authority (EFSA) presented a draft opinion on a tolerable intake of 8 ng/kg/week for the sum of these four substances (equaling 0.42 mu g/kg if expressed as an annual dose). Diet is usually the dominating exposure pathway, and in particular the intake of PFOS has been shown to be strongly related to the consumption of fish and seafood. Those who eat freshwater fish may be especially at risk since freshwater and its biota typically display higher PFOS concentrations than marine systems. In this study, we estimated the range in PFOS intake among average Swedish "normal" and "high" consumers of freshwater fish. By average we mean persons of average weight who eat average-sized portions. The "normal consumers" were assumed to eat freshwater fish 3 times per year, and the "high consumers" once a week. Under these assumptions, the yearly tolerable intake for "normal" and "high" consumers is reached when the PFOS concentrations in fish equals 59 and 3.4 mu g per kg fish meat. For this study, PFOS concentrations in the muscle tissue of edible-sized perch, pike and pikeperch were retrieved from three different Swedish datasets, covering both rural and urban regions and a total of 78 different inland waters. Mean PFOS concentrations in fish from these sites varied from 0.3 to 750 mu g/kg. From the available data, the annual min-max dietary PFOS intake for male "normal consumers" was found to be in the range 0.0021-5.4 mu g/kg/yr for the evaluated scenarios, with median values of 0.02-0.16 mu g/kg/yr. For male "high consumers", the total intake range was estimated to be 0.04-93 mu g/kg/yr, with median values being 0.27-1.6 mu g/kg/yr. For women, the exposure estimates were slightly lower, about 79% of the exposure in men. Despite highly variable PFOS concentrations in fish from different sites, we conclude that the three most commonly consumed freshwater species in Sweden constitute an important source for the total annual intake even for people who eat this kind of fish only a few times per year. The analyses of PFOA, PFNA and PFHxS showed values which were all below detection limit, and their contribution to the total PFAS intake via freshwater fish consumption is negligible in comparison to PFOS.

A common, yet poorly evaluated, advice to remove contaminants from urban vegetables is to wash the produce before consumption. This study is based on 63 samples of chard, kale, lettuce and parsley that have grown near a heavily traf-ficked road in the third largest city in Sweden, with one portion of each sample being analysed without first being washed, and the other portion being subjected to common household washing. Concentrations of 71 elements were analysed by ICP-SFMS after a sample digestion that dissolves both the plant tissues and all potentially adhering parti-cles. The results show that the washing effect, or the fraction removed upon washing, varies significantly between el-ements: from approximately 0 % for K to 68 % for the n-ary sumation REEs. Considering traditional metal contaminants, the efficiency decreased from Pb (on average 56 % lost) to Co (56 %) > Cr (55 %) > As (45 %) > Sb (35 %) > Ni (33 %) > Cu (13 %) > Zn (7 %) > Cd (7 %), and Ba (5 %). A clear negative correlation between the washing effect and the different elements' bioconcentration factors shows that the elements' accessibility for plant uptake is a key control-ling factor for the degree to which they are removed upon washing. Based on the average washing efficiencies seen in this study, the average daily intake of Pb would increase by 130 % if vegetables are not washed prior to consumption. For the other contaminant metals this increase corresponds to 126 % (Co), 121 % (Cr), 82 % (As), 55 % (Sb), 50 % (Ni), 16 % (Cu), 8 % (Zn), 7 % (Cd) and 5 % (Ba). The advice to wash vegetables is therefore, for many elements, highly motivated for reducing exposure and health risks. For elements which are only slightly reduced when the vegetables are washed, however, advising should rather focus on reducing levels of contamination in the soil itself.

As the use of food supplements increases, voices are being raised questioning the safety of these products. As acontribution to understanding the trace and major elemental composition of food supplements and their potential health risks, this study presents concentrations of 71 elements in 138 supplements, categorised intosynthetic products and three groups of products with natural ingredients. Concentrations were converted intoaverage daily doses (ADDs) and compared to tolerable daily intakes (TDIs). For elements where we found significant ADDs relative to the TDI a comparison was also made to the normal dietary intake. Our main findings arethat: 1) Most elements display highly variable concentrations in food supplements; more so than in normalfoodstuff; 2) For ten of the analysed elements some products rendered ADDs > 50 % of the TDI. Half of theelements were essential (Fe, Mn, Se, Mo, Zn), and as such motivated in food supplements. The other half (As, Pb,Cd, Al, Ni) represent non-essential and highly toxic elements, where the occurrence in food supplements ought tobe viewed as contamination. Although none of these toxic metals were declared on any product’s table ofcontent, several products gave high ADDs - in several cases even exceeding the TDIs; 3) The risk of reaching highADDs for the toxic elements is strongly associated with products that contain marine ingredients (e.g. algae,mussels etc), and to some degree products of terrestrial plant-based origin. The health of consumers wouldbenefit if food regulatory frameworks were updated to better address the risks of food supplements occasionallybeing contaminated with different toxic metals, for example by setting maximum permissible concentrations fora longer list of elements. 

Soil pollution constitutes one of the major threats to public health, where spreading to groundwater is one of several critical aspects. In most internationally adopted frameworks for routine risk assessments of contaminated land, generic models and soil guideline values are cornerstones. In order to protect the groundwater at contaminated sites, a common practice worldwide today is to depart from health risk-based limit concentrations for groundwater, and use generic soil-to-groundwater spreading models to back-calculate corresponding equilibrium levels (concentration limits) in soil, which must not be exceeded at the site. This study presents an extensive survey of how actual soil and groundwater concentrations, compiled for all high-priority contaminated sites in Sweden, relate to the national model for risk management of contaminated sites, with focus on As, Cu, Pb and Zn. Results show that soil metal concentrations, as well as total amounts, constitute a poor basis for assessing groundwater contamination status. The evaluated model was essentially incapable of predicting groundwater contamination (i.e. concentrations above limit values) based on soil data, and erred on the "unsafe side" in a significant number of cases, with modelled correlations not being conservative enough. Further, the risk of groundwater contamination was almost entirely independent of industry type. In essence, since neither soil contaminant loads nor industry type is conclusive, there is a need for a supportive framework for assessing metal spreading to groundwater accounting for site-specific, geochemical conditions.

Background The McGill Quality of Life Questionnaire - Expanded (MQOL-E) and the Quality of Life in Life-Threatening Illness-Family Carer/Caregiver version (QOLLTI-F) are developed for use with patients facing the end of life and their family carers, respectively. They are also developed for possible use as companion instruments. Contemporary measurement validity theory places emphasis on response processes, i.e. what people feel and think when responding to items. Response processes may be affected when measurement instruments are translated and adapted for use in different cultures. The aim of this study was to translate and examine content validity and response processes during completion of MQOL-E and QOLLTI-F version 2 (v2) among Swedish patients with life-threatening illness and their family carers. Methods The study was conducted in two stages (I) translation and adaptation (II) examination of content validity and response processes using cognitive interviews with 15 patients and 9 family carers. Participants were recruited from the hemodialysis unit, heart clinic, lung clinic and specialized palliative care of a Swedish county hospital. Patients had life-threatening illness such as advanced heart failure, advanced chronic obstructive pulmonary disease, end-stage kidney disease or advanced cancer. Patients were outpatients, inpatients or receiving home care. Results Patients and family carers respectively believed that the items of the MQOL-E and QOLLTI-F v2 reflect relevant and important areas of their quality of life. Although some items needed more time for reflection, both instruments were considered easy to understand. Some changes were made to resolve issues of translation. Participants expressed that reflecting on their situation while answering questions was valuable and meaningful to them, and that responding was an opportunity to express feelings. Conclusions The results of response processes pertaining to the Swedish translations of both MQOL-E and QOLLTI-F v2 contribute evidence regarding content validity, linguistic equivalence and cultural appropriateness of the translated instruments. In addition, results show that the instruments may support conversations on matters of importance for quality of life between patients and/or family carers and health care professionals. Further research is needed to study the psychometric properties of Swedish translations.

Background: The intensity of predeath grief is associated with postdeath grief in family caregivers of patients in palliative care. Different factors during caregiving may influence this association.Objective: To examine (1) the intensity of grief in relation to preparedness for caregiving, caregiver burden, and social support, and (2) if these variables moderate associations between predeath and postdeath grief.Methods: This prospective correlational study used unpaired t-test to compare grief in relation to preparedness for caregiving, caregiver burden, and social support. Hierarchical multiple linear regression analysis investigated moderation effects. Family caregivers were recruited from 10 palliative homecare facilities. The Anticipatory Grief Scale, Texas Revised Inventory of Grief, Preparedness for Caregiving Scale, Caregiver Burden Scale, and Multidimensional Scale of Perceived Social Support were used. Ethical approval for the study was granted by the Regional Ethical Review Board in Stockholm, Sweden.Results: In total, 128 family caregivers participated. Those with high caregiver burden scored significantly higher intensity of predeath but not postdeath grief. Caregiver burden and social support moderated the association between intensity of predeath grief and postdeath grief. There was a stronger association between predeath and postdeath grief among caregivers with low caregiver burden or low social support. Preparedness for caregiving had no moderating effect.Discussion: Attention should be directed to caregiver burden and social support during family caregiving, as these variables seem to be significant for the intensity of grief before and after the patient's death. Acknowledging predeath grief during caregiving and recognizing pre- and postdeath grief as parts of the same process are of importance in clinical practice and when designing supportive interventions.

Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.

Rätt till fast läkarkontakt kan absolut vara bra, speciellt för diagnostik, bedömning och medicinsk behandling. Men det räcker inte, skriver forskare och lärare vid Linnéuniversitetet.

Background: Mobility and balance is essential for older adults’ well-being an independence and the ability tomaintain physically active. Early identification of functionalimpairmentmay enable early risk-of-fall assessments and preventivemeasures.  There is a need to find new solutions to assess functional ability in easy, efficient, and accurateways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques.

Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality.

Methods: Fifty-four older adults (+65 years) were recruited through pensioners’ associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included.

Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST.

Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.

There is a call to action for physiotherapists worldwide to contribute to the transition towards 'sustainable health'. In this paper, we build upon the current definition of 'sustainable health' and also on 'sustainable physical activity' to introduce and theoretically substantiate the concept of sustainable human movements, and suggest a definition thereof. Sustainable human movements will be described as a threshold concept with three aligned critical concepts; (i) movement control, including forces as causes of emerging movements, (ii) movement quality, referring to how movements are performed in terms of optimisation, and (iii) physical literacy, including motivation, confidence and physical competence. A deep understanding of these concepts, combined with a collaboration and learning approach applied together with the patient, is proposed to enable a sustainable human movement approach to permeate physiotherapy theory and practice. To facilitate this, a generic and easily accessible tool has recently been developed. It combines support for structured observational movement analysis and pedagogical support for creating a mutual and extended understanding of a patient's lived experience. This encourages the patient to become actively involved and take responsibility for promoting his/her 'sustainable health'. The aims of this paper are to a) suggest a theoretical framework for and definition of the concept sustainable human movements, and b) introduce a clinical tool that ultimately aims at promoting sustainable movements and health.

BACKGROUND: Hospice care is a perceived need in the Iranian health system. AIM: This qualitative study is explaining the stakeholders' perception of what is required to develop a hospice care system for patients living with cancer in Iran.

METHODS: A total of 21 participants (specialists, policymakers, healthcare providers, cancer patients and family caregivers) were selected through purposeful sampling and interviewed in-depth in 2020. Interviews were analysed through directed content analysis.

FINDINGS: A total of 1054 codes, 7 categories and 21 subcategories were extracted. The requirements include the need to provide: multiple settings and diverse services; participatory decision making; integration into the health system; specialised human resources; an organised system of accountability; the preparation of the existing health system; and wider capacity-building in existing Iranian society.

CONCLUSION: It is essential that Iranian services create a participatory comprehensive care plan, utilise expert manpower, integrate hospice care into the existing health system and organise a system of accountability. Policymakers should focus on the preparation of the health system and capacity building in society.

In Sweden, a practice has developed where the social services have started to hire private consultants in child protection investigations. This article analyses and compares the handling of child protection investigations carried out by private consultants and municipally employed social workers with regard to the reasons for the reports, the investigations, the assessments, and the decisions taken about interventions. The concepts funnel and filtering and children's participation are used in the analysis. The study has a mixed-methods design, where qualitative and quantitative data and analysis are combined and integrated. Data consists of 120 case files regarding the social service's handling of investigations as well as interviews with managers of social service departments. Findings: The results show several differences in the handling of child protection investigations carried out by social workers and private consultants in the municipalities studied. The private consultants worked to a greater extent with investigations that were initiated due to concerns about violence. Investigations conducted by consultants contained less information and specifically concerning children's perspective. These children also received interventions to a lesser extent than children assessed by the municipal social workers. Application: The study indicates that from a child's perspective, it matters whether a municipally employed social worker or a private consultant performs an investigation. Consultants generally work temporarily in a workplace, and it may therefore be more difficult to establish a trusting relationship with the children, which can be a barrier to children's participation and the implementation of a child's perspective.

The aim of this article is to investigate how children's care responsibility is recognised in records of personal assistance carried out by the Swedish Social Insurance Agency (SSIA). The article consists of document analysis, examining how caring activities are made visible in the records, and professionals' views and actions regarding responsibilities placed on children. Data consist of 100 cases randomly selected from the SSIA register amongst applicants with children, focusing on parents' descriptions of their needs, the public officials' assessments, and statements from professionals. Recurring themes related to young carers were developed.

In Sweden, personal assistance is one form of support for persons with certain functional impairment. The aim of personal assistance is to give compensatory support to individuals so that they can enjoy the right to live a life like anyone else. This article explores what kind of support parents who have functional impairments and apply for personal assistance may need when they have underage children. The article is focused on the following: What support needs in parenting are expressed in personal assistance applications and by whom? How are the expressed needs in parenting met by the intervention personal assistance, i.e. how do the decisions correspond with the expressed needs? The article is based on qualitative and quantitative document-analyses of 100 randomly selected applications for the right to personal assistance submitted to the Swedish Social Insurance Agency by applicants who were parents with children 0–17 years of age, during the years 2014–2017. The central concepts resulting from the analyses of the empirical material were support and care. The results show that in many cases the children were invisible in the material studied. In several investigations, there was no information at all about the applicant’s children. Many applications for assistance were refused. Few parents received assistance in their parenting role. In the documents, we found the following themes in statements about needs for support related to the role as a parent: practical support, care and supervision, support with communication, emotional support and safety, and support to be involved in the children’s lives.

BACKGROUND: Measuring physical activity and sedentary behavior accurately remains a challenge. When describing the uncertainty of mean values or when making group comparisons, minimising Standard Error of the Mean (SEM) is important. The sample size and the number of repeated observations within each subject influence the size of the SEM. In this study we have investigated how different combinations of sample sizes and repeated observations influence the magnitude of the SEM.

METHODS: A convenience sample were asked to wear an accelerometer for 28 consecutive days. Based on the within and between subject variances the SEM for the different combinations of sample sizes and number of monitored days was calculated.

RESULTS: Fifty subjects (67% women, mean ± SD age 41 ± 19 years) were included. The analyses showed, independent of which intensity level of physical activity or how measurement protocol was designed, that the largest reductions in SEM was seen as the sample size were increased. The same magnitude in reductions to SEM was not seen for increasing the number of repeated measurement days within each subject.

CONCLUSION: The most effective way of reducing the SEM is to have a large sample size rather than a long observation period within each individual. Even though the importance of reducing the SEM to increase the power of detecting differences between groups is well-known it is seldom considered when developing appropriate protocols for accelerometer based research. Therefore the results presented herein serves to highlight this fact and have the potential to stimulate debate and challenge current best practice recommendations of accelerometer based physical activity research.

Earlier studies have implied a change in dietary habits of the Swedish population towards a low carbohydrate, high fat diet. Questions have been raised about the development in recent years and potential health effects. We have investigated the dietary intake of Swedish female students enrolled in a university nutrition course between 2002 and 2017. The students carried out self-reporting of all food and drink intake over one weekday and one weekend day. Intake of macronutrients (E%) and micronutrients were calculated for the whole period while statistical analysis was performed for changes between 2009 and 2017 (729 women). Results showed significant changes in carbohydrate intake (from 47.0 to 41.4 E%) and fat intake (from 31.7 to 37.5 E%). Carbohydrate intake was significantly lower than the Nordic Nutrition Recommendations (45-60 E%). However, daily fiber intake remains high (3.0 g/MJ) in a national context, and intake of vitamin D and folate appears to increase during the period. The results suggest that the observed national transition from carbohydrate to fat intake persists, and that it might be especially evident among individuals interested in food and nutrition. Considering the fiber and micronutrient intake, the change is not necessarily unfavorable for this particular group.

Background This study is part of the Swedish initiative for the establishment of standardized, modern patient-reported measures for national use in Swedish healthcare. The goal was to translate and culturally adapt eight pediatric Patient-Reported Outcomes Measurement Information System (PROMIS(R)) item banks (anger, anxiety, depressive symptoms, family relationships, fatigue, pain interference, peer relationships and physical activity) into Swedish. Methods Authorization to translate all currently available pediatric PROMIS item banks (autumn, 2016) into Swedish was obtained from the PROMIS Health Organization. The translation followed the Functional Assessment of Chronic Illness Therapy translation recommendations with one major modification, which was the use of a bilingual multi-professional review workshop. The following steps were applied: translation, reconciliation, a two-day multi professional reviewer workshop, back translation, and cognitive debriefing with eleven children (8-17 years) before final review. The bilingual multi-professional review workshop provided a simultaneous, in-depth assessment from different professionals. The group consisted of questionnaire design experts, researchers experienced in using patient-reported measures in healthcare, linguists, and pediatric healthcare professionals. Results All item banks had translation issues that needed to be resolved. Twenty-four items (20.7%) needed resolution at the final review stage after cognitive debriefing. The issues with translations included 1. Lack of matching definitions with items across languages (6 items); 2. Problems related to language, vocabulary, and cultural differences (6 items); and 3. Difficulties in adaptation to age-appropriate language (12 items). Conclusions The translated and adapted versions of the eight Swedish pediatric PROMIS item banks are linguistically acceptable. The next stage will be cross-cultural validation studies in Sweden. Despite the fact that there are cultural differences between Sweden and the United States, our translation processes have successfully managed to address all issues. Expert review groups from already-established networks and processes regarding pediatric healthcare throughout the country will facilitate the future implementation of pediatric PROMIS item banks in Sweden.

Aims:

To describe burden and health-related quality of life amongst caregivers of out-of-hospital cardiac arrest survivors and explore the potential association with cognitive function of the survivors. Caregivers of patients with ST-elevation myocardial infarction were used as controls.

Methods:

Data were collected from the cognitive substudy of the Targeted Temperature Management-trial. Caregiver burden was assessed with the 22-item Zarit Burden Interview, with scores <20 considered as no burden. Health-related quality of life was assessed with the SF-36v2 (R), with T scores 47-53 representing the norm. Cardiac arrest survivors were categorized based on the results from cognitive assessments as having "no cognitive impairment" or "cognitive impairment".

Results:

Follow-up 6 months post event was performed for caregivers of 272 cardiac arrest survivors and 108 matched myocardial infarction controls, included at an intended ratio of 2:1. In general, caregivers of cardiac arrest survivors and controls reported similar caregiver burden. The overall scores for quality of life were within normative levels and similar for caregivers of cardiac arrest survivors and control patients. Compared to those with no cognitive impairment, caregivers of cognitively impaired cardiac arrest survivors (n = 126) reported higher levels of burden (median 18 versus 8, p < 0.001) and worse quality of life in five of eight domains, particularly "Role-Emotional" (mean 45.7 versus 49.5, p = 0.002).

Conclusions: In general, caregivers of cardiac arrest survivors and myocardial infarction controls reported similar levels of burden and quality of life. Cognitive outcome and functional dependency of the cardiac arrest survivor impact burden and quality of life of the caregiver.

Negative attitudes towards aging are common in society. However, few studies haveinvestigated how older adults perceive this phenomenon. This study investigated (a) how olderadults in Sweden perceive general attitudes towards the older population and whether negativeperceptions are associated with low life satisfaction, self-compassion, and health-related qualityof life (HRQL), and (b) whether perceived attitudes predict life satisfaction when controlling forHRQL, self-compassion, and age. The sample comprised 698 randomly selected participants, aged66–102 years, from the Blekinge part of the Swedish National Study on Ageing and Care. The resultsshowed that 25.7% of the participants held negative attitudes towards older adults and reportedlower life satisfaction and HRQL. Self-compassion was related to higher life satisfaction, perceivedpositive attitudes, and better mental HRQL. Overall, perceived attitudes, HRQL, self-compassion,and age predicted 44% of the participants’ life satisfaction. Understanding the factors that influenceolder adults’ life satisfaction is crucial, as health-related losses might reduce the opportunity fora successful life. Our study makes an important contribution to the field, showing that perceivedattitudes explained 1.2% of the variance of life satisfaction, whereas mental and physical HRQLaccounted for 18% of life satisfaction.

Objectives: Self-compassion is a psychological construct associated with self-acceptance and coping with the aging process. The Self-Compassion Scale (SCS), in both long and short forms, is the most widely used measure of self-compassion. Studies on the psychometric properties of the short form (SCS-SF) are scarce. The aim of this study was to translate into Swedish and test the psychometric properties of the SCS-SF. Another aim was to investigate whether self-compassion differs by age and gender in older adults.

Method: We tested the Swedish SCS-SF in a sample of 594 randomly selected older adults, aged 66 to 102 years, for internal consistency, construct validity, and factor structure.

Results: The results showed the SCS-SF had acceptable internal consistency in the total sample (Cronbach’s alpha = 0.68) and somewhat higher (Cronbach’s alpha = 0.76) in the youngest old (age 66 years). The six-factor structure found in the original study was not observed in confirmatory factor analyses in our older sample. Exploratory factor analyses showed that a two-factor solution, formed by the positive and negative components had the best fit; however, only the negative component had good internal consistency.

Conclusion: Overall, the SCS-SF seemed to have insufficient reliability in this sample of older adults and further studies are needed to see whether new instruments are needed for this population. Self-compassion was generally higher in men than women, but did not differ by age in this sample of older adults.

Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research hasshown that compassion interventions for healthcare professionals can decrease work-related stress through theintroduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations.Internet-based stress management interventions have hitherto shown promising results in reducing stress.However, further research is needed to examine the effectiveness of internet-based compassion interventions forhealthcare professionals.Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effectsof an internet-based compassion course for healthcare professionals on work-related stress and stress ofconscience.Method: Healthcare professionals will be offered an internet-based stress management course of five modulesacross a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled inone of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n =120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stressmanagement course (n = 36). We hypothesise that the internet-based compassion course would reduce theparticipants’ stress of conscience to a greater degree compared to the other two groups. The secondary hypothesisis that the compassion course would increase the participants’ professional quality of life (i.e., higher jobsatisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion courseis expected to reduce the participants’ work-related stress and sick leave rates to the same degree (non-inferiority)as the cognitive behavioural stress management course and to a higher degree when compared to thewaitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondaryoutcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related StressCopenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will beperformed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimatingequation for repeated measurements to examine whether changes over time differ between the groups andwhether the improvements persist over time.Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and addto the existing knowledge of internet-based interventions for stress management in healthcare professionals.

Studien ingår i ett större praktiknära forskningsprojekt inom ramen för en nationell försöksverksamhet på uppdrag av den svenska regeringen. Försöksverksamheten ska utveckla och pröva hållbara samverkansmodeller mellan akademi och skola vad gäller forskning, skolverksamhet och lärarutbildning. Syfte med föreliggande studie är att undersöka möjligheterna att utforma en gemensam digital plattform som en informationslänk mellan lärosätet och skolor med lärarstudenter. Plattformen avser att stärka samarbetet ytterligare mellan lärosäte och de aktuella skolorna, genom att förenkla viss kommunikation som sker mellan aktörerna och sprida/dela praktiknära forskning. Plattformen syftar till att skapa 2 möjligheter att följa praktiknära forskningsprojekt utifrån skilda aktörers perspektiv. Resultatet visar att det krävs uthållighet och förståelse för varandras kulturer, både mellan fält och akademi men även mellan olika funktioner i samma verksamhet, för att nå ett samarbete som upplevs meningsfullt och hållbart över tid. Här framträder det delade objektet som betydelsefullt, det vill säga the boundery object som skrivs fram av Collins, Evans och Gorman (2007). En gemensam digital plattform torde kunna fungera som ett delat, sammanlänkande objekt i linje med Collins m.fl. (2007) resonemang och därmed bidra till olika former av samverkan mellan olika aktörer. Rätt utformad och administrerad skulle en digital plattform kunna erbjuda ett gemensamt ägandeskap av samverkansprocessen för alla parter oavsett tolkning av the boundery object. En digital arena kan förstås som the boundery object, i det vi skulle vilja kalla för det tredje rummet (Olsson & Brunner Cederlund, 2020).

Background: The values and attitudes of healthcare professionals influence their handling of ‘do-not-attempt- resuscitation’ (DNAR) orders. The aim of this study was a) to describe attitudes, perceptions and practices among Swedish physicians and nurses towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and b) to investigate if the physicians and nurses were familiar with the national ethical guidelines for cardiopulmonary resuscitation.

Methods: This was a retrospective observational study based on a questionnaire and was conducted at 19 wards in two regional hospitals and one county hospital.

Results: 210 physicians and 312 nurses (n = 522) responded to the questionnaire. Every third (35%) professional had read the guidelines with a lower proportion of physicians (29%) compared to nurses (38%). Around 40% of patients had the opportunity or ability to participate in the DNAR discussion. The DNAR decision was discussed with 38% of patients and the prognosis with 46%. Of the patients who were considered to have the ability to participate in the dis- cussion, 79% did so. The majority (81%) of physicians and nurses believed that patients should always be asked about their preferences before a DNAR decision was made.

Conclusions: Swedish healthcare professionals take a patient’s autonomy into account regarding DNAR decisions. Nevertheless, as 50% of patients were considered unable to participate in the DNAR discussion, questions remain about the timing of patient participation and whether more discussions could have been conducted earlier. Given the uncertainty about timing, the majority of patients deemed competent participated in DNAR discussions.

Målet har varit att göra ett effektivt, integrerande och interaktivt dialogstöd (https://sadima.lnu.se/). Stödet är avsett att användas i mödravårdssam­tal mellan kvinnor med begränsade kunskaper i svenska och svensktalande barnmorskor och är ett komplement till tolk. Samtalsstödet finns på arabiska, engelska, svenska och är fritt tillgängligt på internet.  Vi vill uppnå förbättrad och effek­­tiviserad kommu­ni­ka­tion mellan barnmorskor och kvinnor. Samtalsstödet ska leda till ökad patientsäkerhet med färre komplika­tioner och minskad sjuklighet och dödlighet bland kvinnorna och deras barn, och därigenom öka vårdkvaliteten och effektivisera bru­ket av sam­hälleliga resurser. Avsikten är att sprida och nyttiggöra sam­talsstödet till ansvariga i Sveriges Kom­muner och Regioner (SKR) och samordnings­barn­morskor i Sverige. Stödet består av en del där information kan inhämtas och en del där information kan ges om gravidi­tet, förloss­ning och preventiv­medel. Genom webbsidan ska mödra­hälso­­­vården göras mer jämlik och kom­munikativ, med ökad patientsäkerhet och egenmakt för kvinnor i mödravården.

Vi har analyserat material med språkliga, normkritiska och vård­vetenskapliga metoder. I projektet har appen Sadima utvecklats i två versioner, en första testversion och sedan en andra version som ut­for­mats som en webbsida. För ut­veck­lan­det av den första versionen av appen fick vi medel av Vinnova (2016–2019). Vi arbetade med barnmorskor och skapade en testapp som sedan revide­ra­des och förbättrades suc­ces­sivt genom forskning om kvinnornas och barnmorskornas er­faren­het av att använda samtalsstödet. Det befintliga stödets innehåll är patientsäkrat av läkare och barnmorskor i Region Kalmar. 

Vi har mätt funktiona­liteten i samtalsstödet genom iterativa tester, en­käter och fokusgrupper med barnmorskor och arabisktalande kvinnor, där stödets information har pro­ble­ma­tiserats; det har gällt etnicitet (språk och kultur), klass (utbildning) och jämlikhet mellan kvinnor. Mät­ningarna har granskats och utvärde­rats av referensgruppen för bedömning av funktiona­liteten hos samtalsstödet. Grup­pen har bedömt att samtalsstödet bidragit till bättre förståelse, ökad patient­säkerhet och effektivare vård. 

Background: The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. Methods: Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. Results: The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. Conclusions: This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients’ engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients. © 2021, The Author(s)

Background: The loss of a close person from sudden cardiac arrest (CA) leaves family members at risk of developing grief reactions such as symp- toms of prolonged grief, anxiety, depression, and posttraumatic stress. The aim was to describe longitudinal variations in grief reactions and its asso- ciation with professional and social support among bereaved family members after a close person’s death from sudden CA.

Methods: This longitudinal multimethod survey included 69 bereaved family members who completed a questionnaire 6 and 12-months after the CA, including the Prolonged Grief Disorder-13, Hospital Anxiety and Depression Scale, PTSD Checklist for DSM-5, and Multidimensional Scale of Perceived Social Support. Qualitative data were collected by open-ended questions. Quantitative data was analyzed using Wilcoxon signed-rank test and linear regression analysis while written comments were analyzed using qualitative content analysis.

Results: The median age was 62 years, 67 % were women, and 38 % had been present during the resuscitation attempts. Using the cut-off scores at the 6- and 12-month assessments respectively, 14 % and 17 % reported symptoms of prolonged grief, 32 % and 26 % symptoms of anxiety, 14 % and 9 % depression, and 4 % and 1 % posttraumatic stress. Professional and social support at the 6-month assessment were significantly associ- ated with symptoms of prolonged grief, anxiety, depression, and/or posttraumatic stress at the 12-month assessments but could not predict any changes in the grief reactions.

Conclusions: Family members’ grief reactions point to the importance of proactive and available support over time to meet family members’ needs.